Search results for: Jason M. Stephen
54 Improving the Quality of Discussion and Documentation of Advance Care Directives in a Community-Based Resident Primary Care Clinic
Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese
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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.Keywords: advance directives, community-based, pocket card, primary care clinic
Procedia PDF Downloads 16453 A Seven Year Single-Centre Study of Dental Implant Survival in Head and Neck Oncology Patients
Authors: Sidra Suleman, Maliha Suleman, Stephen Brindley
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Oral rehabilitation of head and neck cancer patients plays a crucial role in the quality of life for such individuals post-treatment. Placement of dental implants or implant-retained prostheses can help restore oral function and aesthetics, which is often compromised following surgery. Conventional prosthodontic techniques can be insufficient in rehabilitating such patients due to their altered anatomy and reduced oral competence. Hence, there is a strong clinical need for the placement of dental implants. With an increasing incidence of head and neck cancer patients, the demand for such treatment is rising. Aim: The aim of the study was to determine the survival rate of dental implants in head and neck cancer patients placed at the Restorative and Maxillofacial Department, Royal Stoke University Hospital (RSUH), United Kingdom. Methodology: All patients who received dental implants between January 1, 2013 to December 31, 2020 were identified. Patients were excluded based on three criteria: 1) non-head and neck cancer patients, 2) no outpatient follow-up post-implant placement 3) provision of non-dental implants. Scanned paper notes and electronic records were extracted and analyzed. Implant survival was defined as fixtures that had remained in-situ / not required removal. Sample: Overall, 61 individuals were recruited from the 143 patients identified. The mean age was 64.9 years, with a range of 35 – 89 years. The sample included 37 (60.7%) males and 24 (39.3%) females. In total, 211 implants were placed, of which 40 (19.0%) were in the maxilla, 152 (72.0%) in the mandible and 19 (9.0%) in autogenous bone graft sites. Histologically 57 (93.4%) patients had squamous cell carcinoma, with 43 (70.5%) patients having either stage IVA or IVB disease. As part of treatment, 42 (68.9%) patients received radiotherapy, which was carried out post-operatively for 29 (69.0%) cases. Whereas 21 (34.4%) patients underwent chemotherapy, 13 (61.9%) of which were post-operative. The Median follow-up period was 21.9 months with a range from 0.9 – 91.4 months. During the study, 23 (37.7%) patients died and their data was censored beyond the date of death. Results: In total, four patients who had received radiotherapy had one implant failure each. Two mandibular implants failed secondary to osteoradionecrosis, and two maxillary implants did not survive as a result of failure to osseointegrate. The overall implant survival rates were 99.1% at three years and 98.1% at both 5 and 7 years. Conclusions: Although this data shows that implant failure rates are low, it highlights the difficulty in predicting which patients will be affected. Future studies involving larger cohorts are warranted to further analyze factors affecting outcomes.Keywords: oncology, dental implants, survival, restorative
Procedia PDF Downloads 23352 Analysis of Splicing Methods for High Speed Automated Fibre Placement Applications
Authors: Phillip Kearney, Constantina Lekakou, Stephen Belcher, Alessandro Sordon
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The focus in the automotive industry is to reduce human operator and machine interaction, so manufacturing becomes more automated and safer. The aim is to lower part cost and construction time as well as defects in the parts, sometimes occurring due to the physical limitations of human operators. A move to automate the layup of reinforcement material in composites manufacturing has resulted in the use of tapes that are placed in position by a robotic deposition head, also described as Automated Fibre Placement (AFP). The process of AFP is limited with respect to the finite amount of material that can be loaded into the machine at any one time. Joining two batches of tape material together involves a splice to secure the ends of the finishing tape to the starting edge of the new tape. The splicing method of choice for the majority of prepreg applications is a hand stich method, and as the name suggests requires human input to achieve. This investigation explores three methods for automated splicing, namely, adhesive, binding and stitching. The adhesive technique uses an additional adhesive placed on the tape ends to be joined. Binding uses the binding agent that is already impregnated onto the tape through the application of heat. The stitching method is used as a baseline to compare the new splicing methods to the traditional technique currently in use. As the methods will be used within a High Speed Automated Fibre Placement (HSAFP) process, this meant the parameters of the splices have to meet certain specifications: (a) the splice must be able to endure a load of 50 N in tension applied at a rate of 1 mm/s; (b) the splice must be created in less than 6 seconds, dictated by the capacity of the tape accumulator within the system. The samples for experimentation were manufactured with controlled overlaps, alignment and splicing parameters, these were then tested in tension using a tensile testing machine. Initial analysis explored the use of the impregnated binding agent present on the tape, as in the binding splicing technique. It analysed the effect of temperature and overlap on the strength of the splice. It was found that the optimum splicing temperature was at the higher end of the activation range of the binding agent, 100 °C. The optimum overlap was found to be 25 mm; it was found that there was no improvement in bond strength from 25 mm to 30 mm overlap. The final analysis compared the different splicing methods to the baseline of a stitched bond. It was found that the addition of an adhesive was the best splicing method, achieving a maximum load of over 500 N compared to the 26 N load achieved by a stitching splice and 94 N by the binding method.Keywords: analysis, automated fibre placement, high speed, splicing
Procedia PDF Downloads 15551 Application of Neutron Stimulated Gamma Spectroscopy for Soil Elemental Analysis and Mapping
Authors: Aleksandr Kavetskiy, Galina Yakubova, Nikolay Sargsyan, Stephen A. Prior, H. Allen Torbert
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Determining soil elemental content and distribution (mapping) within a field are key features of modern agricultural practice. While traditional chemical analysis is a time consuming and labor-intensive multi-step process (e.g., sample collections, transport to laboratory, physical preparations, and chemical analysis), neutron-gamma soil analysis can be performed in-situ. This analysis is based on the registration of gamma rays issued from nuclei upon interaction with neutrons. Soil elements such as Si, C, Fe, O, Al, K, and H (moisture) can be assessed with this method. Data received from analysis can be directly used for creating soil elemental distribution maps (based on ArcGIS software) suitable for agricultural purposes. The neutron-gamma analysis system developed for field application consisted of an MP320 Neutron Generator (Thermo Fisher Scientific, Inc.), 3 sodium iodide gamma detectors (SCIONIX, Inc.) with a total volume of 7 liters, 'split electronics' (XIA, LLC), a power system, and an operational computer. Paired with GPS, this system can be used in the scanning mode to acquire gamma spectra while traversing a field. Using acquired spectra, soil elemental content can be calculated. These data can be combined with geographical coordinates in a geographical information system (i.e., ArcGIS) to produce elemental distribution maps suitable for agricultural purposes. Special software has been developed that will acquire gamma spectra, process and sort data, calculate soil elemental content, and combine these data with measured geographic coordinates to create soil elemental distribution maps. For example, 5.5 hours was needed to acquire necessary data for creating a carbon distribution map of an 8.5 ha field. This paper will briefly describe the physics behind the neutron gamma analysis method, physical construction the measurement system, and main characteristics and modes of work when conducting field surveys. Soil elemental distribution maps resulting from field surveys will be presented. and discussed. Comparison of these maps with maps created on the bases of chemical analysis and soil moisture measurements determined by soil electrical conductivity was similar. The maps created by neutron-gamma analysis were reproducible, as well. Based on these facts, it can be asserted that neutron stimulated soil gamma spectroscopy paired with GPS system is fully applicable for soil elemental agricultural field mapping.Keywords: ArcGIS mapping, neutron gamma analysis, soil elemental content, soil gamma spectroscopy
Procedia PDF Downloads 13450 The Effect of the Structural Arrangement of Binary Bisamide Organogelators on their Self-Assembly Behavior
Authors: Elmira Ghanbari, Jan Van Esch, Stephen J. Picken, Sahil Aggarwal
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Low-molecular-weight organogelators form gels by self-assembly into the crystalline network which immobilizes the organic solvent. For single bisamide organogelator systems, the effect of the molecular structure on the molecular interaction and their self-assembly behavior has been explored. The spatial arrangement of bisamide molecules in the gel-state is driven by a combination of hydrogen bonding and Van der Waals interactions. The hydrogen-bonding pattern between the amide groups of bisamide molecules is regulated by the number of methylene spacers; the even number of methylene spacers between two amide groups, in even-spaced bisamides, leads to the antiparallel position of amide groups within a molecule. An even-spaced bisamide molecule with antiparallel amide groups can make two pairs of hydrogen bonding with the molecules on the same plane. The odd-spaced bisamide with a parallel directionality of amide groups can form four independent hydrogen bonds with four other bisamide molecules on different planes. The arrangement of bisamide molecules in the crystalline state and the interaction of these molecules depends on the molecular structure, particularly the parity of the spacer length between the amide groups in the bisamide molecule. In this study, the directionality of amide groups has been exploited as a structural characteristic to affect the arrangement of molecules in the crystalline state and produce different binary bisamide gelators with different degrees of crystallinities. Single odd- and even-spaced single bisamides were synthesized and blended to produce binary bisamide organogelators to be characterized in order to understand the effect of the different directionality of amide groups on the molecular interaction in the crystalline state. The pattern of molecular interactions between these blended molecules, mixing or phase separation, has been monitored via differential scanning calorimetry (DSC) and crystallography techniques; X-ray powder diffraction (XRD) and Small-angle X-ray scattering (SAXS). The formation of lamellar structures for odd- and even-spaced bisamide gelators was confirmed by using SAXS and XRD techniques. DSC results have shown that binary bisamide organogelators with different parity of methylene spacers (odd-even binary blends) have a higher tendency for phase separation compared to the binary bisamides with the same parity (odd-odd or even-even binary blends). Phase separation in binary odd-even bisamides was confirmed by the presence of individual (100) reflections of odd and even lamellar structures. The structural characteristic of bisamide organogelators, the parity of spacer length in binary systems, is a promising tool to control the arrangement of molecules and their crystalline structure.Keywords: binary bisamide organogelators, crystalline structure, phase separation, self-assembly behavior
Procedia PDF Downloads 18549 Impacts of Climate Change and Natural Gas Operations on the Hydrology of Northeastern BC, Canada: Quantifying the Water Budget for Coles Lake
Authors: Sina Abadzadesahraei, Stephen Déry, John Rex
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Climate research has repeatedly identified strong associations between anthropogenic emissions of ‘greenhouses gases’ and observed increases of global mean surface air temperature over the past century. Studies have also demonstrated that the degree of warming varies regionally. Canada is not exempt from this situation, and evidence is mounting that climate change is beginning to cause diverse impacts in both environmental and socio-economic spheres of interest. For example, northeastern British Columbia (BC), whose climate is controlled by a combination of maritime, continental and arctic influences, is warming at a greater rate than the remainder of the province. There are indications that these changing conditions are already leading to shifting patterns in the region’s hydrological cycle, and thus its available water resources. Coincident with these changes, northeastern BC is undergoing rapid development for oil and gas extraction: This depends largely on subsurface hydraulic fracturing (‘fracking’), which uses enormous amounts of freshwater. While this industrial activity has made substantial contributions to regional and provincial economies, it is important to ensure that sufficient and sustainable water supplies are available for all those dependent on the resource, including ecological systems. In this turn demands a comprehensive understanding of how water in all its forms interacts with landscapes, the atmosphere, and of the potential impacts of changing climatic conditions on these processes. The aim of this study is therefore to characterize and quantify all components of the water budget in the small watershed of Coles Lake (141.8 km², 100 km north of Fort Nelson, BC), through a combination of field observations and numerical modelling. Baseline information will aid the assessment of the sustainability of current and future plans for freshwater extraction by the oil and gas industry, and will help to maintain the precarious balance between economic and environmental well-being. This project is a perfect example of interdisciplinary research, in that it not only examines the hydrology of the region but also investigates how natural gas operations and growth can affect water resources. Therefore, a fruitful collaboration between academia, government and industry has been established to fulfill the objectives of this research in a meaningful manner. This project aims to provide numerous benefits to BC communities. Further, the outcome and detailed information of this research can be a huge asset to researchers examining the effect of climate change on water resources worldwide.Keywords: northeastern British Columbia, water resources, climate change, oil and gas extraction
Procedia PDF Downloads 26448 Assessing Acceptability and Preference of Printed Posters on COVID-19 Related Stigma: A Post-Test Study Among HIV-Focused Health Workers in Greater Accra Region of Ghana
Authors: Jerry Fiave, Dacosta Aboagye, Stephen Ayisi-Addo, Mabel Kissiwah Asafo, Felix Osei-Sarpong, Ebenezer Kye-Mensah, Renee Opare-Otoo
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Background: Acceptability and preference of social and behaviour change (SBC) materials by target audiences is an important determinant of effective health communication outcomes. In Ghana, however, pre-test and post-test studies on acceptability and preference of specific SBC materials for specific audiences are rare. The aim of this study was therefore to assess the acceptability and preference of printed posters on COVID-19 related stigma as suitable SBC materials for health workers to influence behaviours that promote uptake of HIV-focused services. Methods: A total of 218 health workers who provide HIV-focused services were purposively sampled in 16 polyclinics where the posters were distributed in the Greater Accra region of Ghana. Data was collected in March 2021 using an adapted self-administered questionnaire in Google forms deployed via WhatsApp to participants. The data were imported into SPSS version 27 where chi-square test and regression analyses were performed to establish association as well as strength of association between variables respectively. Results: A total of 142 participants (physicians, nurses, midwives, lab scientists, health promoters, diseases control officers) made up of 85(60%) females and 57(40%) males responded to the questionnaire, giving a response rate of 65.14%. Only 88 (61.97%) of the respondents were exposed to the posters. The majority of those exposed said the posters were informative [82(93.18%)], relevant [85(96.59%)] and attractive [83(94.32%)]. They [82(93.20%)] also rated the material as acceptable with no statistically significant association between category of health worker and acceptability of the posters (X =1.631, df=5, p=0.898). However, participants’ most preferred forms of material on COVID-19 related stigma were social media [38(26.76%)], television [33(23.24%)], SMS [19(13.38%)], and radio [18(12.70%)]. Clinical health workers were 4.88 times more likely to prefer online or electronic versions of SBC materials than nonclinical health workers [AOR= 4.88 (95% CI= 0.31-0.98), p=0.034]. Conclusions: Printed posters on COVID-19 related stigma are acceptable SBC materials in communicating behaviour change messages that target health workers in promoting uptake of HIV-focused services. Posters are however, not among the most preferred materials for health workers. It is therefore recommended that material assessment studies are conducted to inform the development of acceptable and preferred materials for target audiences.Keywords: acceptability, AIDS, HIV, posters, preference, SBC, stigma, social and behaviour change communication
Procedia PDF Downloads 10347 Antimicrobial Activity, Phytochemistry and Toxicity Of Extracts Of Naturally Growing and Cultivated Aloe Turkanensis
Authors: Zachary Muthii Rukenya, James Mbaria, Peter Mbaabu, Kiama Stephen Gitahi, Ronald Onzago
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Aloe turkanensis is one of the widely used medicinal shrub and in Kenya the plant is mainly found in Baringo, Isiolo, Laikipia, Turkana and West Pokot Counties where it is used in ethno-medicine and ethno-veterinary medicine. The Turkana community uses the plant products to manage malaria, wounds, stomach ache, constipation, pain, skin infection, poultry diseases and retained afterbirth in cows. This evaluated the efficacy and safety of the plant obtained from Turkana County, Kenya. Preliminary data on the use of the plant in the county was collected through observation, photographing and interviews. A sample of the whole plant was harvested in Natira sublocation, in ex-Turkana west district in February 2012 after identification by Aloe-working group herbalists who voluntarily provided information on its medicinal uses. Botanical identification was done at Kenya Forest Research Centre in Karura where voucher specimen was deposited. Cold maceration using 70% methanol and distilled water was used for extraction. Bioassays were to determine the effects of the plant extracts on brine shrimp and selected bacterial and fungal cultures. The extracts were tested in-vitro activity against standard cultures of B. cereus (ATCC 11778), S. aureus (ATCC25923), P. aeroginosa (ATCC 27853), E. coli (ATCC 25922) and a human infections clinical isolate of C. albicans. The extracts of Aloe turkanensis inhibited the growth B. cereus (100-200 mg/ml), S. aureus (50-100 mg/ml), P. aeroginosa (200mg/ml), E. coli (400mg/ml) while C. albicans was not affected. The extracts also inhibited the growth of S. aureus and B. cereus with mean diameters of inhibition zones being 19.75±1 mm and 18.5±05 mm reapectively. Phytochemical screening showed the presence of alkaloids, tarpenoids, steroids, quinones, saponins and tannins in the plant extracts. The extract was found to be non-toxic at a concentration of 1000µg/ml with a 100% survival of Brine Shrimp larva. It was concluded that Aloe turkanensis growing the study area has metabolites that inhibit the growth of microorganisms and is however, there is need for further studies to validate the in-vivo bioactivity of the plant and more generate adequate toxicological data.to support conservation, value chain addition of its products and widespread use as a herbal remedy.Keywords: Aloe turkanensis, bioactivity, cultivated, human infections
Procedia PDF Downloads 32146 Evaluation of Invasive Tree Species for Production of Phosphate Bonded Composites
Authors: Stephen Osakue Amiandamhen, Schwaller Andreas, Martina Meincken, Luvuyo Tyhoda
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Invasive alien tree species are currently being cleared in South Africa as a result of the forest and water imbalances. These species grow wildly constituting about 40% of total forest area. They compete with the ecosystem for natural resources and are considered as ecosystem engineers by rapidly changing disturbance regimes. As such, they are harvested for commercial uses but much of it is wasted because of their form and structure. The waste is being sold to local communities as fuel wood. These species can be considered as potential feedstock for the production of phosphate bonded composites. The presence of bark in wood-based composites leads to undesirable properties, and debarking as an option can be cost implicative. This study investigates the potentials of these invasive species processed without debarking on some fundamental properties of wood-based panels. Some invasive alien tree species were collected from EC Biomass, Port Elizabeth, South Africa. They include Acacia mearnsii (Black wattle), A. longifolia (Long-leaved wattle), A. cyclops (Red-eyed wattle), A. saligna (Golden-wreath wattle) and Eucalyptus globulus (Blue gum). The logs were chipped as received. The chips were hammer-milled and screened through a 1 mm sieve. The wood particles were conditioned and the quantity of bark in the wood was determined. The binding matrix was prepared using a reactive magnesia, phosphoric acid and class S fly ash. The materials were mixed and poured into a metallic mould. The composite within the mould was compressed at room temperature at a pressure of 200 KPa. After initial setting which took about 5 minutes, the composite board was demoulded and air-cured for 72 h. The cured product was thereafter conditioned at 20°C and 70% relative humidity for 48 h. Test of physical and strength properties were conducted on the composite boards. The effect of binder formulation and fly ash content on the properties of the boards was studied using fitted response surface technology, according to a central composite experimental design (CCD) at a fixed wood loading of 75% (w/w) of total inorganic contents. The results showed that phosphate/magnesia ratio of 3:1 and fly ash content of 10% was required to obtain a product of good properties and sufficient strength for intended applications. The proposed products can be used for ceilings, partitioning and insulating wall panels.Keywords: invasive alien tree species, phosphate bonded composites, physical properties, strength
Procedia PDF Downloads 29545 Investigation of the IL23R Psoriasis/PsA Susceptibility Locus
Authors: Shraddha Rane, Richard Warren, Stephen Eyre
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L-23 is a pro-inflammatory molecule that signals T cells to release cytokines such as IL-17A and IL-22. Psoriasis is driven by a dysregulated immune response, within which IL-23 is now thought to play a key role. Genome-wide association studies (GWAS) have identified a number of genetic risk loci that support the involvement of IL-23 signalling in psoriasis; in particular a robust susceptibility locus at a gene encoding a subunit of the IL-23 receptor (IL23R) (Stuart et al., 2015; Tsoi et al., 2012). The lead psoriasis-associated SNP rs9988642 is located approximately 500 bp downstream of IL23R but is in tight linkage disequilibrium (LD) with a missense SNP rs11209026 (R381Q) within IL23R (r2 = 0.85). The minor (G) allele of rs11209026 is present in approximately 7% of the population and is protective for psoriasis and several other autoimmune diseases including IBD, ankylosing spondylitis, RA and asthma. The psoriasis-associated missense SNP R381Q causes an arginine to glutamine substitution in a region of the IL23R protein between the transmembrane domain and the putative JAK2 binding site in the cytoplasmic portion. This substitution is expected to affect the receptor’s surface localisation or signalling ability, rather than IL23R expression. Recent studies have also identified a psoriatic arthritis (PsA)-specific signal at IL23R; thought to be independent from the psoriasis association (Bowes et al., 2015; Budu-Aggrey et al., 2016). The lead PsA-associated SNP rs12044149 is intronic to IL23R and is in LD with likely causal SNPs intersecting promoter and enhancer marks in memory CD8+ T cells (Budu-Aggrey et al., 2016). It is therefore likely that the PsA-specific SNPs affect IL23R function via a different mechanism compared with the psoriasis-specific SNPs. It could be hypothesised that the risk allele for PsA located within the IL23R promoter causes an increase IL23R expression, relative to the protective allele. An increased expression of IL23R might then lead to an exaggerated immune response. The independent genetic signals identified for psoriasis and PsA in this locus indicate that different mechanisms underlie these two conditions; although likely both affecting the function of IL23R. It is very important to further characterise these mechanisms in order to better understand how the IL-23 receptor and its downstream signalling is affected in both diseases. This will help to determine how psoriasis and PsA patients might differentially respond to therapies, particularly IL-23 biologics. To investigate this further we have developed an in vitro model using CD4 T cells which express either wild type IL23R and IL12Rβ1 or mutant IL23R (R381Q) and IL12Rβ1. Model expressing different isotypes of IL23R is also underway to investigate the effects on IL23R expression. We propose to further investigate the variants for Ps and PsA and characterise key intracellular processes related to the variants.Keywords: IL23R, psoriasis, psoriatic arthritis, SNP
Procedia PDF Downloads 16844 Can Zirconia Wings of Resin Retained Cantilever Bridges Be Effectively Bonded To Tooth Tissue When Compared With Metal Wings In The Anterior Dentition in vivo? - A Systematic Review.
Authors: Ariyan S. Araghi, Guy C. Jackson, Stephen J. Bonsor
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Materials & Methods: A systematic literature search was undertaken using pre-determined inclusion and exclusion criteria. This review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement. Several databases were used to search for randomised control trials and longitudinal cohort studies, which were published less than thirty years ago. A total of 54 studies met the predefined inclusion criteria. Four studies reviewed the success, survival, and failure characteristics of zirconia framework resin retained bridges, whilst two reviewed non-precious metal resin retained bridges. Results: The analysis of the studies revealed an overall survival rate of 95.9% for zirconia-based restorations compared to 90.7% for non-precious metal frameworks. Non-precious metal resin retained bridges displayed a higher overall failure rate of 11.9% compared to 4.6% for zirconia-based restorations in the analysed papers. The most frequent complications were wing debonding for the non-precious metal wing group, whereas substructure fracture and veneering ceramic fracture were more prevalent for the zirconia arm of the study. Conclusion: Both types of resin retained bridges provide effective medium to long-term survival. Zirconia-based frameworks will provide marginally increased success and survival and greatly improved aesthetics. However, catastrophic failure is more likely with zirconia-based restorations. Non-precious metal is time tested but performs worse than its zirconia counterpart with regards to longevity; it does not exhibit the same framework fractures as zirconia. Cement choice and attention to the adhesive bonding systems used appear to be paramount to restoration longevity with both restoration subtypes. Furthermore, improved longevity can be seen when air particle abrasion is incorporated into the adhesive protocol. Within the limitations of this study, it has been determined that zirconia-based resin retained bridges can be effectively used in anterior cantilever bridges. Clinical Significance: Zirconia-based resin retained bridges have been demonstrating promising results in terms of improved success and survival characteristics, together with improved aesthetics when compared to non-precious metal winged resin retained bridges. Their popularity is increasing in the age of digital dentistry as many restorations are manufactured using such technology. It is essential that clinicians understand the limitations of each material type and principles of adhesion to ensure restoration longevity.Keywords: resin retained bridge, fixed partial denture, zirconia bridge, adhesive bridge
Procedia PDF Downloads 8143 Systematic Review of Digital Interventions to Reduce the Carbon Footprint of Primary Care
Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris
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Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventionsKeywords: carbon footprint, environmental impact, primary care, sustainable healthcare
Procedia PDF Downloads 6242 Evaluation of Prehabilitation Prior to Surgery for an Orthopaedic Pathway
Authors: Stephen McCarthy, Joanne Gray, Esther Carr, Gerard Danjoux, Paul Baker, Rhiannon Hackett
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Background: The Go Well Health (GWH) platform is a web-based programme that allows patients to access personalised care plans and resources, aimed at prehabilitation prior to surgery. The online digital platform delivers essential patient education and support for patients prior to undergoing total hip replacements (THR) and total knee replacements (TKR). This study evaluated the impact of an online digital platform (ODP) in terms of functional health outcomes, health related quality of life and hospital length of stay following surgery. Methods: A retrospective cohort study comparing a cohort of patients who used the online digital platform (ODP) to deliver patient education and support (PES) prior to undergoing THR and TKR surgery relative to a cohort of patients who did not access the ODP and received usual care. Routinely collected Patient Reported Outcome Measures (PROMs) data was obtained on 2,406 patients who underwent a knee replacement (n=1,160) or a hip replacement (n=1,246) between 2018 and 2019 in a single surgical centre in the United Kingdom. The Oxford Hip and Knee Score and the European Quality of Life Five-Dimensional tool (EQ5D-5L) was obtained both pre-and post-surgery (at 6 months) along with hospital LOS. Linear regression was used to compare the estimate the impact of GWH on both health outcomes and negative binomial regressions were used to impact on LOS. All analyses adjusted for age, sex, Charlson Comorbidity Score and either pre-operative Oxford Hip/Knee scores or pre-operative EQ-5D scores. Fractional polynomials were used to represent potential non-linear relationships between the factors included in the regression model. Findings: For patients who underwent a knee replacement, GWH had a statistically significant impact on Oxford Knee Scores and EQ5D-5L utility post-surgery (p=0.039 and p=0.002 respectively). GWH did not have a statistically significant impact on the hospital length of stay. For those patients who underwent a hip replacement, GWH had a statistically significant impact on Oxford Hip Scores and EQ5D-5L utility post (p=0.000 and p=0.009 respectively). GWH also had a statistically significant reduction in the hospital length of stay (p=0.000). Conclusion: Health Outcomes were higher for patients who used the GWH platform and underwent THR and TKR relative to those who received usual care prior to surgery. Patients who underwent a hip replacement and used GWH also had a reduced hospital LOS. These findings are important for health policy and or decision makers as they suggest that prehabilitation via an ODP can maximise health outcomes for patients following surgery whilst potentially making efficiency savings with reductions in LOS.Keywords: digital prehabilitation, online digital platform, orthopaedics, surgery
Procedia PDF Downloads 19041 A Novel Chicken W Chromosome Specific Tandem Repeat
Authors: Alsu F. Saifitdinova, Alexey S. Komissarov, Svetlana A. Galkina, Elena I. Koshel, Maria M. Kulak, Stephen J. O'Brien, Elena R. Gaginskaya
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The mystery of sex determination is one of the most ancient and still not solved until the end so far. In many species, sex determination is genetic and often accompanied by the presence of dimorphic sex chromosomes in the karyotype. Genomic sequencing gave the information about the gene content of sex chromosomes which allowed to reveal their origin from ordinary autosomes and to trace their evolutionary history. Female-specific W chromosome in birds as well as mammalian male-specific Y chromosome is characterized by the degeneration of gene content and the accumulation of repetitive DNA. Tandem repeats complicate the analysis of genomic data. Despite the best efforts chicken W chromosome assembly includes only 1.2 Mb from expected 55 Mb. Supplementing the information on the sex chromosome composition not only helps to complete the assembly of genomes but also moves us in the direction of understanding of the sex-determination systems evolution. A whole-genome survey to the assembly Gallus_gallus WASHUC 2.60 was applied for repeats search in assembled genome and performed search and assembly of high copy number repeats in unassembled reads of SRR867748 short reads datasets. For cytogenetic analysis conventional methods of fluorescent in situ hybridization was used for previously cloned W specific satellites and specifically designed directly labeled synthetic oligonucleotide DNA probe was used for bioinformatically identified repetitive sequence. Hybridization was performed with mitotic chicken chromosomes and manually isolated giant meiotic lampbrush chromosomes from growing oocytes. A novel chicken W specific satellite (GGAAA)n which is not co-localizes with any previously described classes of W specific repeats was identified and mapped with high resolution. In the composition of autosomes this repeat units was found as a part of upstream regions of gonad specific protein coding sequences. These findings may contribute to the understanding of the role of tandem repeats in sex specific differentiation regulation in birds and sex chromosome evolution. This work was supported by the postdoctoral fellowships from St. Petersburg State University (#1.50.1623.2013 and #1.50.1043.2014), the grant for Leading Scientific Schools (#3553.2014.4) and the grant from Russian foundation for basic researches (#15-04-05684). The equipment and software of Research Resource Center “Chromas” and Theodosius Dobzhansky Center for Genome Bioinformatics of Saint Petersburg State University were used.Keywords: birds, lampbrush chromosomes, sex chromosomes, tandem repeats
Procedia PDF Downloads 38940 Ballistic Performance of Magnesia Panels and Modular Wall Systems
Authors: Khin Thandar Soe, Mark Stephen Pulham
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Ballistic building materials play a crucial role in ensuring the safety of the occupants within protective structures. Traditional options like Ordinary Portland Cement (OPC)-based walls, including reinforced concrete walls, precast concrete walls, masonry walls, and concrete blocks, are frequently employed for ballistic protection, but they have several drawbacks such as being thick, heavy, costly, and challenging to construct. On the other hand, glass and composite materials offer lightweight and easier construction alternatives, but they come with a high price tag. There has been no reported test data on magnesium-based ballistic wall panels or modular wall systems so far. This paper presents groundbreaking small arms test data related to the development of the world’s first magnesia cement ballistic wall panels and modular wall system. Non-hydraulic magnesia cement exhibits several superior properties, such as lighter weight, flexibility, acoustics, and fire performance, compared to the traditional Portland Cement. However, magnesia cement is hydrophilic and may degrade in prolonged contact with water. In this research, modified magnesia cement for water resistant and durability from UBIQ Technology is applied. The specimens are made of a modified magnesia cement formula and prepared in the Laboratory of UBIQ Technology Pty Ltd. The specimens vary in thickness, and the tests cover various small arms threats in compliance with standards AS/NZS2343 and UL752 and are performed up to the maximum threat level of Classification R2 (NATO) and UL-Level 8(NATO) by the Accredited Test Centre, BMT (Ballistic and Mechanical Testing, VIC, Australia). In addition, the results of the test conducted on the specimens subjected to the small 12mm diameter steel ball projectile impact generated by a gas gun are also presented and discussed in this paper. Gas gun tests were performed in UNSW@ADFA, Canberra, Australia. The tested results of the magnesia panels and wall systems are compared with one of concrete and other wall panels documented in the literature. The conclusion drawn is that magnesia panels and wall systems exhibit several advantages over traditional OPC-based wall systems, and they include being lighter, thinner, and easier to construct, all while providing equivalent protection against threats. This makes magnesia cement-based materials a compelling choice of application where efficiency and performance are critical to create a protective environment.Keywords: ballistics, small arms, gas gun, projectile, impact, wall panels, modular, magnesia cement
Procedia PDF Downloads 7739 A Disappearing Radiolucency of the Mandible Caused by Inadvertent Trauma Following IMF Screw Placement
Authors: Anna Ghosh, Dominic Shields, Ceri McIntosh, Stephen Crank
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A 29-year-old male was a referral to the maxillofacial unit following a referral from his general dental practitioner via a routine pathway regarding a large periapical lesion on the LR4 with root resorption. The patient was asymptomatic, the LR4 vital and unrestored, and this was an incidental finding at a routine check-up. The patient's past medical history was unremarkable. Examination revealed no extra or intra-oral pathology and non-mobile teeth. No focal neurology was detected. An orthopantogram demonstrated a well-defined unilocular corticated radiolucency associated with the LR4. The root appeared shortened with the radiolucency between the root and a radio-opacity, possibly representing the displacement of the apical tip of the tooth. It was recommended that the referring general practitioner should proceed with orthograde root canal therapy, after which time exploration, enucleation, and retrograde root filling of the LR4 would be carried out by a maxillofacial unit. The patient was reviewed six months later where, due to the COVID-19 pandemic, the patient had been unable to access general dental services for the root canal treatment. He was still entirely asymptomatic. A one-year review was planned in the hope this would allow time for the orthograde root canal therapy to be completed. At this review, the orthograde root canal therapy had still not been completed. Interestingly, a repeat orthopantogram revealed a significant reduction in size with good bony infill and a significant reduction in the size of the lesion. Due to the ongoing delays with primary care dental therapy, the patient was subsequently internally referred to the restorative dentistry department for care. The patient was seen again by oral and maxillo-facial surgery in mid-2022 where he still reports this tooth as asymptomatic with no focal neurology. The patient's history was fully reviewed, and noted that 15 years previously, the patient underwent open reduction and internal fixation of a left angle of mandible fracture. Temporary IMF involving IMF screws and fixation wires were employed to maintain occlusion during plating and subsequently removed post-operatively. It is proposed that the radiolucency was, as a result of the IMF screw placement, penetrating the LR4 root resulting in resorption of the tooth root and development of a radiolucency. This case highlights the importance of careful screw size and physical site location, and placement of IMF screws, as there can be permeant damage to a patient’s dentition.Keywords: facial trauma, inter-maxillary fixation, mandibular radiolucency, oral and maxillo-facial surgery
Procedia PDF Downloads 13638 Newspaper Headlines as Tool for Political Propaganda in Nigeria: Trend Analysis of Implications on Four Presidential Elections
Authors: Muhammed Jamiu Mustapha, Jamiu Folarin, Stephen Obiri Agyei, Rasheed Ademola Adebiyi, Mutiu Iyanda Lasisi
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The role of the media in political discourse cannot be overemphasized as they form an important part of societal development. The media institution is considered the fourth estate of the realm because it serves as a check and balance to the arms of government (Executive, Legislature and Judiciary) especially in a democratic setup, and makes public office holders accountable to the people. They scrutinize the political candidates and conduct a holistic analysis of the achievement of the government in order to make the people’s representative accountable to the electorates. The media in Nigeria play a seminal role in shaping how people vote during elections. Newspaper headlines are catchy phrases that easily capture the attention of the audience and call them (audience) to action. Research conducted on newspaper headlines looks at the linguistic aspect and how the tenses used has a resultant effect on peoples’ attitude and behaviour. Communication scholars have also conducted studies that interrogate whether newspaper headlines influence peoples' voting patterns and decisions. Propaganda and negative stories about political opponents are stapling features in electioneering campaigns. Nigerian newspaper readers have the characteristic of scanning newspaper headlines. And the question is whether politicians effectively have played into this tendency to brand opponents negatively, based on half-truths and inadequate information. This study illustrates major trends in the Nigerian political landscape looking at the past four presidential elections and frames the progress of the research in the extant body of political propaganda research in Africa. The study will use the quantitative content analysis of newspaper headlines from 2007 to 2019 to be able to ascertain whether newspaper headlines had any effect on the election results of the presidential elections during these years. This will be supplemented by Key Informant Interviews of political scientists or experts to draw further inferences from the quantitative data. Drawing on newspaper headlines of selected newspapers in Nigeria that have a political propaganda angle for the presidential elections, the analysis will correspond to and complements extant descriptions of how the field of political propaganda has been developed in Nigeria, providing evidence of four presidential elections that have shaped Nigerian politics. Understanding the development of the behavioural change of the electorates provide useful context for trend analysis in political propaganda communication. The findings will contribute to how newspaper headlines are used partly or wholly to decide the outcome of presidential elections in Nigeria.Keywords: newspaper headlines, political propaganda, presidential elections, trend analysis
Procedia PDF Downloads 23537 Cross Carpeting in Nigerian Politics: Some Legal and Moral Issues Generated
Authors: Agbana Olaseinde Julius, Opadere Olaolu Stephen
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The concept of cross carpeting is as old as politics itself. Basically, it entails an individual leaving a political party/group, to join another. The reasons for which cross carpeting is embarked upon are diverse: ideological differences; ethnic and/or religious differences; access to actual or perceived better political opportunities; liberty of association; rancor; etc. The current democratic dispensation in Nigeria has experienced renewed and rather alarming rate of cross carpeting, for reasons including those enumerated above and others. Right to cross carpet is inherent in a democratic setting as well as the political stakeholder; so does it also comprise of the constitutional right of ‘freedom of association’. However, the current species of cross carpeting in Nigeria requires scrutiny, in view of some potential legal and moral challenges it poses for both the present and the future. Cross carpeting is considered both legal and constitutional, but the current spate raises the question of expediency, particularly in a nascent democracy. It is considered to have a propensity of negatively impacting political stability in a polity with fragile nerves. Importantly too, cross carpeting is considered a potential damage to the psyche of posterity with regards to a warped disposition to promises, honour and integrity. The perceived peculiar dimension of cross carpeting in Nigeria raises questions on the quality of leadership presently obtainable in the country, vis-à-vis greed, self-centeredness, disregard for the concern and interest of avowed followers/fans, entrenchment of distrust, etc. Thus, the study made use of primary and secondary sources of information. The primary sources included the Constitutions of the Federal Republic of Nigeria 1999 (as amended); judicial decisions; and the Electoral Act, 2010 (as Amended). The secondary sources comprised of information from books, journals, newspapers, magazines and Internet documents. Data obtained from these sources were subjected to content analysis. Findings of this study show that though the act of cross carpeting may not be in breach of any Statute or Law, it however, in most cases, breaches the morals of expediency. The morality thereof is far from justifiable, and should be condemned in the interest of the present and posterity. There is a great and urgent need to embark on a re-entrenchment of the culture of political ideology in the Nigerian polity, as obtainable in developed democracies. In conclusion, the need to exercise the right of cross carpeting with caution cannot be overemphasized. Membership of a political group/party should be backed by commitment to well defined ideologies and values. Commitment to them should be regarded akin to that found in the family, which is not easily or flippantly jettisoned.Keywords: cross-carpeting, Nigeria, legal, moral issues, politics
Procedia PDF Downloads 44736 Review on Recent Dynamics and Constraints of Affordable Housing Provision in Nigeria: A Case of Growing Economic Precarity
Authors: Ikenna Stephen Ezennia, Sebnem Onal Hoscara
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Successive governments in Nigeria are faced with the pressing problem of how to house an ever-expanding urban population, usually low-income earners. The question of housing and affordability presents a complex challenge for these governments, as the commodification of housing links it inextricably to markets and capital flows. Therefore, placing it as at the center of the government’s agenda. However, the provision of decent and affordable housing for average Nigerians has remained an illusion, despite copious schemes, policies and programs initiated and carried out by various successive governments. Similarly, this phenomenon has also been observed in many countries of Africa, which is largely a result of economic unpredictability, lack of housing finance and insecurity, among other factors peculiar to a struggling economy. This study reviews recent dynamics and factors challenging the provision and development of affordable housing for the low income urban populace of Nigeria. Thus, the aim of the study is to present a comprehensive approach for understanding recent trends in the provision of affordable housing for Nigerians. The approach is based on a new paradigm of research: transdisciplinarity; a form of inquiry that crosses the boundaries of different disciplines. Therefore, the review takes a retrospective gaze at the various housing development programs/schemes/policies taken by successive governments of Nigeria within the last few decades and exams recent efforts geared towards eradicating the problems of housing delivery. Sources of data included relevant English language articles and the results of literature search of Elsevier Science Direct, ISI Web of Knowledge, Pro Quest Central, Scopus, and Google Scholar. The findings reveal that factors such as; rapid urbanization, inadequate planning and land use control, lack of adequate and favorable finance, high prices of land, high prices of building material, youth/touts harassment of developers, poor urban infrastructure, multiple taxation, and risk share are the major factors posing as a hindrance to adequate housing delivery. The results show that the majority of Nigeria’s affordable housing schemes, programs and policies are in most cases poorly implemented and abandoned without proper coordination. Consequently, the study concludes that the affordable housing delivery strategies in Nigeria are an epitome of lip service politics by successive governments; and the current trend of leaving housing provision to the vagaries of market forces cannot be expected to support affordable housing especially for the low income urban populace.Keywords: affordable housing, housing delivery, national housing policy, urban poor
Procedia PDF Downloads 22035 Development of Intellectual Property Information Services in Zimbabwe’s University Libraries: Assessing the Current Status and Mapping the Future Direction
Authors: Jonathan Munyoro, Takawira Machimbidza, Stephen Mutula
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The study investigates the current status of Intellectual Property (IP) information services in Zimbabwe's university libraries. Specifically, the study assesses the current IP information services offered in Zimbabwe’s university libraries, identifies challenges to the development of comprehensive IP information services in Zimbabwe’s university libraries, and suggests solutions for the development of IP information services in Zimbabwe’s university libraries. The study is born out of a realisation that research on IP information services in university libraries has received little attention, especially in developing country contexts, despite the fact that there are calls for heightened participation of university libraries in IP information services. In Zimbabwe, the launch of the National Intellectual Property Policy and Implementation Strategy 2018-2022 and the introduction of the Education 5.0 concept are set to significantly change the IP landscape in the country. Education 5.0 places more emphasis on innovation and industrialisation (in addition to teaching, community service, and research), and has the potential to shift the focus and level of IP output produced in higher and tertiary education institutions beyond copyrights and more towards commercially exploited patents, utility models, and industrial designs. The growing importance of IP commercialisation in universities creates a need for appropriate IP information services to assist students, academics, researchers, administrators, start-ups, entrepreneurs, and inventors. The critical challenge for university libraries is to reposition themselves and remain relevant in the new trajectory. Designing specialised information services to support increased IP generation and commercialisation appears to be an opportunity for university libraries to stay relevant in the knowledge economy. However, IP information services in Zimbabwe’s universities appear to be incomplete and focused mostly on assisting with research publications and copyright-related activities. Research on the existing status of IP services in university libraries in Zimbabwe is therefore necessary to help identify gaps and provide solutions in order to stimulate the growth of new forms of such services. The study employed a quantitative approach. An online questionnaire was administered to 57 academic librarians from 15 university libraries. Findings show that the current focus of the surveyed institutions is on providing scientific research support services (15); disseminating/sharing university research output (14); and copyright activities (12). More specialised IP information services such as IP education and training, patent information services, IP consulting services, IP online service platforms, and web-based IP information services are largely unavailable in Zimbabwean university libraries. Results reveal that the underlying challenge in the development of IP information services in Zimbabwe's university libraries is insufficient IP knowledge among academic librarians, which is exacerbated by inadequate IP management frameworks in university institutions. The study proposes a framework for the entrenchment of IP information services in Zimbabwe's university libraries.Keywords: academic libraries, information services, intellectual property, IP knowledge, university libraries, Zimbabwe
Procedia PDF Downloads 15634 Structures and Analytical Crucibles in Nigerian Indigenous Art Music
Authors: Albert Oluwole Uzodimma Authority
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Nigeria is a diverse nation with a rich cultural heritage that has produced numerous art musicians and a vast range of art songs. The compositional styles, tonal rhythm, text rhythm, word painting, and text-tone relationship vary extensively from one dialect to another, indicating the need for standardized tools for the structural and analytical deconstruction of Nigerian indigenous art music. The purpose of this research is to examine the structures of Nigerian indigenous art music and outline some crucibles for analyzing it, by investigating how dialectical inflection influences the choice of text tone, scale mode, tonal rhythm, and the general ambiance of Nigerian art music. The research used a structured questionnaire to collect data from 50 musicologists, out of which 41 responded. The study's focus was on the works of two prominent twentieth-century composers, Stephen Olusoji, and Nwamara Alvan-Ikoku, titled "Oyigiyigi" and "O Chineke, Inozikwa omee," respectively. The data collected was presented in percentages using pie charts and tables. The study shows that in Nigerian Indigenous music, several aspects are to be considered for proper analysis, such as linguistic sensitivity, dialectical inflection influences text-tone relationship, text rhythm and tonal rhythm, which help to convey the proper meanings of messages in songs. It also highlights the lack of standardized rubrics for analysis, which necessitated the proposal of robust criteria for analyzing African music, known as Neo-Eclectic-Crucibles. Hinging on eclectic approach, this research makes significant contributions to music scholarship by addressing the need for standardized tools and crucibles for the structural and analytical deconstruction of Nigerian indigenous art music. It provides a template for further studies leading to standardized rubrics for analyzing African music. This research collected data through a structured questionnaire and analyzed it using pie charts and tables to present the findings accurately. The analysis focused on the respondents' perspectives on the research objectives and structural analysis of two indigenous music compositions by Olusoji and Nwamara. This research answers the questions on the structures and analytical crucibles used in Nigerian indigenous art music, how dialectical inflection influences text-tone relationship, scale mode, tonal rhythm, and the general ambiance of Nigerian art music. This paper demonstrates the need for standardized tools and crucibles for the structural and analytical deconstruction of Nigerian indigenous art music. It highlights several aspects that are crucial to analyzing Nigerian indigenous music and proposes the Neo-Eclectic-Crucibles criteria for analyzing African music. The contribution of this research to music scholarship is significant, providing a template for further studies and research in the field.Keywords: art-music, crucibles, dialectical inflections, indigenous, text-tone, tonal rhythm, word-painting
Procedia PDF Downloads 10033 Impact of Emotional Intelligence and Cognitive Intelligence on Radio Presenter's Performance in All India Radio, Kolkata, India
Authors: Soumya Dutta
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This research paper aims at investigating the impact of emotional intelligence and cognitive intelligence on radio presenter’s performance in the All India Radio, Kolkata (India’s public service broadcaster). The ancient concept of productivity is the ratio of what is produced to what is required to produce it. But, father of modern management Peter F. Drucker (1909-2005) defined productivity of knowledge work and knowledge workers in a new form. In the other hand, the concept of Emotional Intelligence (EI) originated back in 1920’s when Thorndike (1920) for the first time proposed the emotional intelligence into three dimensions, i.e., abstract intelligence, mechanical intelligence, and social intelligence. The contribution of Salovey and Mayer (1990) is substantive, as they proposed a model for emotional intelligence by defining EI as part of the social intelligence, which takes measures the ability of an individual to regulate his/her personal and other’s emotions and feeling. Cognitive intelligence illustrates the specialization of general intelligence in the domain of cognition in ways that possess experience and learning about cognitive processes such as memory. The outcomes of past research on emotional intelligence show that emotional intelligence has a positive effect on social- mental factors of human resource; positive effects of emotional intelligence on leaders and followers in terms of performance, results, work, satisfaction; emotional intelligence has a positive and significant relationship with the teachers' job performance. In this paper, we made a conceptual framework based on theories of emotional intelligence proposed by Salovey and Mayer (1989-1990) and a compensatory model of emotional intelligence, cognitive intelligence, and job performance proposed by Stephen Cote and Christopher T. H. Miners (2006). For investigating the impact of emotional intelligence and cognitive intelligence on radio presenter’s performance, sample size consists 59 radio presenters (considering gender, academic qualification, instructional mood, age group, etc.) from All India Radio, Kolkata station. Questionnaires prepared based on cognitive (henceforth called C based and represented by C1, C2,.., C5) as well as emotional intelligence (henceforth called E based and represented by E1, E2,., E20). These were sent to around 59 respondents (Presenters) for getting their responses. Performance score was collected from the report of program executive of All India Radio, Kolkata. The linear regression has been carried out using all the E-based and C-based variables as the predictor variables. The possible problem of autocorrelation has been tested by having the Durbinson-Watson (DW) Statistic. Values of this statistic, almost within the range of 1.80-2.20, indicate the absence of any significant problem of autocorrelation. The possible problem of multicollinearity has been tested by having the Variable Inflation Factor (VIF) value. Values of this statistic, around within 2, indicates the absence of any significant problem of multicollinearity. It is inferred that the performance scores can be statistically regressed linearly on the E-based and C-based scores, which can explain 74.50% of the variations in the performance.Keywords: cognitive intelligence, emotional intelligence, performance, productivity
Procedia PDF Downloads 16332 Anxiety Treatment: Comparing Outcomes by Different Types of Providers
Authors: Melissa K. Hord, Stephen P. Whiteside
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With lifetime prevalence rates ranging from 6% to 15%, anxiety disorders are among the most common childhood mental health diagnoses. Anxiety disorders diagnosed in childhood generally show an unremitting course, lead to additional psychopathology and interfere with social, emotional, and academic development. Effective evidence-based treatments include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI’s). However, if anxious children receive any treatment, it is usually through primary care, typically consists of medication, and very rarely includes evidence-based psychotherapy. Despite the high prevalence of anxiety disorders, there have only been two independent research labs that have investigated long-term results for CBT treatment for all childhood anxiety disorders and two for specific anxiety disorders. Generally, the studies indicate that the majority of youth maintain gains up to 7.4 years after treatment. These studies have not been replicated. In addition, little is known about the additional mental health care received by these patients in the intervening years after anxiety treatment, which seems likely to influence maintenance of gains for anxiety symptoms as well as the development of additional psychopathology during the subsequent years. The original sample consisted of 335 children ages 7 to 17 years (mean 13.09, 53% female) diagnosed with an anxiety disorder in 2010. Medical record review included provider billing records for mental health appointments during the five years after anxiety treatment. The subsample for this study was classified into three groups: 64 children who received CBT in an anxiety disorders clinic, 56 who received treatment from a psychiatrist, and 10 who were seen in a primary care setting. Chi-square analyses resulted in significant differences in mental health care utilization across the five years after treatment. Youth receiving treatment in primary care averaged less than one appointment each year and the appointments continued at the same rate across time. Children treated by a psychiatrist averaged approximately 3 appointments in the first two years and 2 in the subsequent three years. Importantly, youth treated in the anxiety clinic demonstrated a gradual decrease in mental health appointments across time. The nuanced differences will be presented in greater detail. The results of the current study have important implications for developing dissemination materials to help guide parents when they are selecting treatment for their children. By including all mental health appointments, this study recognizes that anxiety is often comorbid with additional diagnoses and that receiving evidence-based treatment may have long-term benefits that are associated with improvements in broader mental health. One important caveat might be that the acuity of mental health influenced the level of care sought by patients included in this study; however, taking this possibility into account, it seems those seeking care in a primary care setting continued to require similar care at the end of the study, indicating little improvement in symptoms was experienced.Keywords: anxiety, children, mental health, outcomes
Procedia PDF Downloads 26731 Effects of Soil Neutron Irradiation in Soil Carbon Neutron Gamma Analysis
Authors: Aleksandr Kavetskiy, Galina Yakubova, Nikolay Sargsyan, Stephen A. Prior, H. Allen Torbert
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The carbon sequestration question of modern times requires the development of an in-situ method of measuring soil carbon over large landmasses. Traditional chemical analytical methods used to evaluate large land areas require extensive soil sampling prior to processing for laboratory analysis; collectively, this is labor-intensive and time-consuming. An alternative method is to apply nuclear physics analysis, primarily in the form of pulsed fast-thermal neutron-gamma soil carbon analysis. This method is based on measuring the gamma-ray response that appears upon neutron irradiation of soil. Specific gamma lines with energies of 4.438 MeV appearing from neutron irradiation can be attributed to soil carbon nuclei. Based on measuring gamma line intensity, assessments of soil carbon concentration can be made. This method can be done directly in the field using a specially developed pulsed fast-thermal neutron-gamma system (PFTNA system). This system conducts in-situ analysis in a scanning mode coupled with GPS, which provides soil carbon concentration and distribution over large fields. The system has radiation shielding to minimize the dose rate (within radiation safety guidelines) for safe operator usage. Questions concerning the effect of neutron irradiation on soil health will be addressed. Information regarding absorbed neutron and gamma dose received by soil and its distribution with depth will be discussed in this study. This information was generated based on Monte-Carlo simulations (MCNP6.2 code) of neutron and gamma propagation in soil. Received data were used for the analysis of possible induced irradiation effects. The physical, chemical and biological effects of neutron soil irradiation were considered. From a physical aspect, we considered neutron (produced by the PFTNA system) induction of new isotopes and estimated the possibility of increasing the post-irradiation gamma background by comparisons to the natural background. An insignificant increase in gamma background appeared immediately after irradiation but returned to original values after several minutes due to the decay of short-lived new isotopes. From a chemical aspect, possible radiolysis of water (presented in soil) was considered. Based on stimulations of radiolysis of water, we concluded that the gamma dose rate used cannot produce gamma rays of notable rates. Possible effects of neutron irradiation (by the PFTNA system) on soil biota were also assessed experimentally. No notable changes were noted at the taxonomic level, nor was functional soil diversity affected. Our assessment suggested that the use of a PFTNA system with a neutron flux of 1e7 n/s for soil carbon analysis does not notably affect soil properties or soil health.Keywords: carbon sequestration, neutron gamma analysis, radiation effect on soil, Monte-Carlo simulation
Procedia PDF Downloads 14330 Using Convolutional Neural Networks to Distinguish Different Sign Language Alphanumerics
Authors: Stephen L. Green, Alexander N. Gorban, Ivan Y. Tyukin
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Within the past decade, using Convolutional Neural Networks (CNN)’s to create Deep Learning systems capable of translating Sign Language into text has been a breakthrough in breaking the communication barrier for deaf-mute people. Conventional research on this subject has been concerned with training the network to recognize the fingerspelling gestures of a given language and produce their corresponding alphanumerics. One of the problems with the current developing technology is that images are scarce, with little variations in the gestures being presented to the recognition program, often skewed towards single skin tones and hand sizes that makes a percentage of the population’s fingerspelling harder to detect. Along with this, current gesture detection programs are only trained on one finger spelling language despite there being one hundred and forty-two known variants so far. All of this presents a limitation for traditional exploitation for the state of current technologies such as CNN’s, due to their large number of required parameters. This work aims to present a technology that aims to resolve this issue by combining a pretrained legacy AI system for a generic object recognition task with a corrector method to uptrain the legacy network. This is a computationally efficient procedure that does not require large volumes of data even when covering a broad range of sign languages such as American Sign Language, British Sign Language and Chinese Sign Language (Pinyin). Implementing recent results on method concentration, namely the stochastic separation theorem, an AI system is supposed as an operate mapping an input present in the set of images u ∈ U to an output that exists in a set of predicted class labels q ∈ Q of the alphanumeric that q represents and the language it comes from. These inputs and outputs, along with the interval variables z ∈ Z represent the system’s current state which implies a mapping that assigns an element x ∈ ℝⁿ to the triple (u, z, q). As all xi are i.i.d vectors drawn from a product mean distribution, over a period of time the AI generates a large set of measurements xi called S that are grouped into two categories: the correct predictions M and the incorrect predictions Y. Once the network has made its predictions, a corrector can then be applied through centering S and Y by subtracting their means. The data is then regularized by applying the Kaiser rule to the resulting eigenmatrix and then whitened before being split into pairwise, positively correlated clusters. Each of these clusters produces a unique hyperplane and if any element x falls outside the region bounded by these lines then it is reported as an error. As a result of this methodology, a self-correcting recognition process is created that can identify fingerspelling from a variety of sign language and successfully identify the corresponding alphanumeric and what language the gesture originates from which no other neural network has been able to replicate.Keywords: convolutional neural networks, deep learning, shallow correctors, sign language
Procedia PDF Downloads 10029 4-Channel CWDM Optical Transceiver Applying Silicon Photonics Ge-Photodiode and MZ-Modulator
Authors: Do-Won Kim, Andy Eu Jin Lim, Raja Muthusamy Kumarasamy, Vishal Vinayak, Jacky Wang Yu-Shun, Jason Liow Tsung Yang, Patrick Lo Guo Qiang
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In this study, we demonstrate 4-channel coarse wavelength division multiplexing (CWDM) optical transceiver based on silicon photonics integrated circuits (PIC) of waveguide Ge-photodiode (Ge-PD) and Mach Zehnder (MZ)-modulator. 4-channel arrayed PICs of Ge-PD and MZ-modulator are verified to operate at 25 Gbps/ch achieving 4x25 Gbps of total data rate. 4 bare dies of single-channel commercial electronics ICs (EICs) of trans-impedance amplifier (TIA) for Ge-PD and driver IC for MZ-modulator are packaged with PIC on printed circuit board (PCB) in a chip-on-board (COB) manner. Each single-channel EIC is electrically connected to the one channel of 4-channel PICs by wire bonds to trace. The PICs have 4-channel multiplexer for MZ-modulator and 4-channel demultiplexer for Ge-PD. The 4-channel multiplexer/demultiplexer have echelle gratings for4 CWDM optic signals of which center wavelengths are 1511, 1531, 1553, and 1573 nm. Its insertion loss is around 4dB with over 15dB of extinction ratio.The dimension of 4-channel Ge-PD is 3.6x1.4x0.3mm, and its responsivity is 1A/W with dark current of less than 20 nA.Its measured 3dB bandwidth is around 20GHz. The dimension of the 4-channel MZ-modulator is 3.6x4.8x0.3mm, and its 3dB bandwidth is around 11Ghz at -2V of reverse biasing voltage. It has 2.4V•cmbyVπVL of 6V for π shift to 4 mm length modulator.5x5um of Inversed tapered mode size converter with less than 2dB of coupling loss is used for the coupling of the lensed fiber which has 5um of mode field diameter.The PCB for COB packaging and signal transmission is designed to have 6 layers in the hybrid layer structure. 0.25 mm-thick Rogers Duroid RT5880 is used as the first core dielectric layer for high-speed performance over 25 Gbps. It has 0.017 mm-thick of copper layers and its dielectric constant is 2.2and dissipation factor is 0.0009 at 10 GHz. The dimension of both single ended and differential microstrip transmission lines are calculated using full-wave electromagnetic (EM) field simulator HFSS which RF industry is using most. It showed 3dB bandwidth at around 15GHz in S-parameter measurement using network analyzer. The wire bond length for transmission line and ground connection from EIC is done to have less than 300 µm to minimize the parasitic effect to the system.Single layered capacitors (SLC) of 100pF and 1000pF are connected as close as possible to the EICs for stabilizing the DC biasing voltage by decoupling. Its signal transmission performance is under measurement at 25Gbps achieving 100Gbps by 4chx25Gbps. This work can be applied for the active optical cable (AOC) and quad small form-factor pluggable (QSFP) for high-speed optical interconnections. Its demands are quite large in data centers targeting 100 Gbps, 400 Gbps, and 1 Tbps. As the demands of high-speed AOC and QSFP for the application to intra/inter data centers increase, this silicon photonics based high-speed 4 channel CWDM scheme can have advantages not only in data throughput but also cost effectiveness since it reduces fiber cost dramatically through WDM.Keywords: active optical cable(AOC), 4-channel coarse wavelength division multiplexing (CWDM), communication system, data center, ge-photodiode, Mach Zehnder (MZ) modulator, optical interconnections, optical transceiver, photonics integrated circuits (PIC), quad small form-factor pluggable (QSFP), silicon photonics
Procedia PDF Downloads 41828 Evaluation of Anti-inflammatory Activities of Extracts Obtained from Capparis Erythrocarpos In-Vivo
Authors: Benedict Ofori, Kwabena Sarpong, Stephen Antwi
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Background: Medicinal plants are utilized all around the world and are becoming increasingly important economically. The WHO notes that ‘inappropriate use of traditional medicines or practices can have negative or dangerous effects and that future research is needed to ascertain the efficacy and safety of such practices and medicinal plants used by traditional medicine systems. The poor around the world have limited access to palliative care or pain relief. Pharmacologists have been focused on developing safe and effective anti-inflammatory drugs. Most of the issues related to their use have been linked to the fact that numerous traditional and herbal treatments are classified in different nations as meals or dietary supplements. As a result, there is no need for evidence of the quality, efficacy, or safety of these herbal formulations before they are marketed. The fact that access to drugs meant for pain relief is limited in low-income countries means advanced studies should be done on home drugs meant for inflammation to close the gap. Methods: The ethanolic extracts of the plant were screened for the presence of 10 phytochemicals. The Pierce BCA Protein Assay Kit was used for the determination of the protein concentration of the egg white. The rats were randomly selected and put in 6 groups. The egg white was sub-plantar injected into the right-hand paws of the rats to induce inflammation. The animals were treated with the three plant extracts obtained from the root bark, stem, and leaves of the plant. The control groups were treated with normal saline, while the standard groups were treated with standard drugs indomethacin and celecoxib. Plethysmometer was used to measure the change in paw volume of the animals over the course of the experiment. Results: The results of the phytochemical screening revealed the presence of reducing sugars and saponins. Alkaloids were present in only R.L.S (1:1:1), and phytosterols were found in R.L(1:1) and R.L.S (1:1:1). The estimated protein concentration was found to be 103.75 mg/ml. The control group had an observable increase in paw volume, which indicated that inflammation was induced during the 5 hours. The increase in paw volume for the control group peaked at the 1st hour and decreased gradually throughout the experiment, with minimal changes in the paw volumes. The 2nd and 3rd groups were treated with 20 mg/kg of indomethacin and celecoxib. The anti-inflammatory activities of indomethacin and celecoxib were calculated to be 21.4% and 4.28%, respectively. The remaining 3 groups were treated with 2 dose levels of 200mg/kg plant extracts. R.L.S, R.L, and S.R.L had anti-inflammatory activities of 22.3%, 8.2%, and 12.07%, respectively. Conclusions: Egg albumin-induced paw model in rats can be used to evaluate the anti-inflammatory activity of herbs that might have potential anti-inflammatory activity. Herbal medications have potential anti-inflammatory activities and can be used to manage various inflammatory conditions if their efficacy and side effects are well studied. The three extracts all possessed anti-inflammatory activity, with R.L.S having the highest anti-inflammatory activity.Keywords: inflammation, capparis erythrocarpos, anti-inflammatory activity, herbal medicine, paw volume, egg albumin
Procedia PDF Downloads 8927 Monitoring Future Climate Changes Pattern over Major Cities in Ghana Using Coupled Modeled Intercomparison Project Phase 5, Support Vector Machine, and Random Forest Modeling
Authors: Stephen Dankwa, Zheng Wenfeng, Xiaolu Li
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Climate change is recently gaining the attention of many countries across the world. Climate change, which is also known as global warming, referring to the increasing in average surface temperature has been a concern to the Environmental Protection Agency of Ghana. Recently, Ghana has become vulnerable to the effect of the climate change as a result of the dependence of the majority of the population on agriculture. The clearing down of trees to grow crops and burning of charcoal in the country has been a contributing factor to the rise in temperature nowadays in the country as a result of releasing of carbon dioxide and greenhouse gases into the air. Recently, petroleum stations across the cities have been on fire due to this climate changes and which have position Ghana in a way not able to withstand this climate event. As a result, the significant of this research paper is to project how the rise in the average surface temperature will be like at the end of the mid-21st century when agriculture and deforestation are allowed to continue for some time in the country. This study uses the Coupled Modeled Intercomparison Project phase 5 (CMIP5) experiment RCP 8.5 model output data to monitor the future climate changes from 2041-2050, at the end of the mid-21st century over the ten (10) major cities (Accra, Bolgatanga, Cape Coast, Koforidua, Kumasi, Sekondi-Takoradi, Sunyani, Ho, Tamale, Wa) in Ghana. In the models, Support Vector Machine and Random forest, where the cities as a function of heat wave metrics (minimum temperature, maximum temperature, mean temperature, heat wave duration and number of heat waves) assisted to provide more than 50% accuracy to predict and monitor the pattern of the surface air temperature. The findings identified were that the near-surface air temperature will rise between 1°C-2°C (degrees Celsius) over the coastal cities (Accra, Cape Coast, Sekondi-Takoradi). The temperature over Kumasi, Ho and Sunyani by the end of 2050 will rise by 1°C. In Koforidua, it will rise between 1°C-2°C. The temperature will rise in Bolgatanga, Tamale and Wa by 0.5°C by 2050. This indicates how the coastal and the southern part of the country are becoming hotter compared with the north, even though the northern part is the hottest. During heat waves from 2041-2050, Bolgatanga, Tamale, and Wa will experience the highest mean daily air temperature between 34°C-36°C. Kumasi, Koforidua, and Sunyani will experience about 34°C. The coastal cities (Accra, Cape Coast, Sekondi-Takoradi) will experience below 32°C. Even though, the coastal cities will experience the lowest mean temperature, they will have the highest number of heat waves about 62. Majority of the heat waves will last between 2 to 10 days with the maximum 30 days. The surface temperature will continue to rise by the end of the mid-21st century (2041-2050) over the major cities in Ghana and so needs to be addressed to the Environmental Protection Agency in Ghana in order to mitigate this problem.Keywords: climate changes, CMIP5, Ghana, heat waves, random forest, SVM
Procedia PDF Downloads 20026 Blending Synchronous with Asynchronous Learning Tools: Students’ Experiences and Preferences for Online Learning Environment in a Resource-Constrained Higher Education Situations in Uganda
Authors: Stephen Kyakulumbye, Vivian Kobusingye
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Generally, World over, COVID-19 has had adverse effects on all sectors but with more debilitating effects on the education sector. After reactive lockdowns, education institutions that could continue teaching and learning had to go a distance mediated by digital technological tools. In Uganda, the Ministry of Education thereby issued COVID-19 Online Distance E-learning (ODeL) emergent guidelines. Despite such guidelines, academic institutions in Uganda and similar developing contexts with academically constrained resource environments were caught off-guard and ill-prepared to transform from face-to-face learning to online distance learning mode. Most academic institutions that migrated spontaneously did so with no deliberate tools, systems, strategies, or software to cause active, meaningful, and engaging learning for students. By experience, most of these academic institutions shifted to Zoom and WhatsApp and instead conducted online teaching in real-time than blended synchronous and asynchronous tools. This paper provides students’ experiences while blending synchronous and asynchronous content-creating and learning tools within a technological resource-constrained environment to navigate in such a challenging Uganda context. These conceptual case-based findings, using experience from Uganda Christian University (UCU), point at the design of learning activities with two certain characteristics, the enhancement of synchronous learning technologies with asynchronous ones to mitigate the challenge of system breakdown, passive learning to active learning, and enhances the types of presence (social, cognitive and facilitatory). The paper, both empirical and experiential in nature, uses online experiences from third-year students in Bachelor of Business Administration student lectured using asynchronous text, audio, and video created with Open Broadcaster Studio software and compressed with Handbrake, all open-source software to mitigate disk space and bandwidth usage challenges. The synchronous online engagements with students were a blend of zoom or BigBlueButton, to ensure that students had an alternative just in case one failed due to excessive real-time traffic. Generally, students report that compared to their previous face-to-face lectures, the pre-recorded lectures via Youtube provided them an opportunity to reflect on content in a self-paced manner, which later on enabled them to engage actively during the live zoom and/or BigBlueButton real-time discussions and presentations. The major recommendation is that lecturers and teachers in a resource-constrained environment with limited digital resources like the internet and digital devices should harness this approach to offer students access to learning content in a self-paced manner and thereby enabling reflective active learning through reflective and high-order thinking.Keywords: synchronous learning, asynchronous learning, active learning, reflective learning, resource-constrained environment
Procedia PDF Downloads 13825 Enabling Participation of Deaf People in the Co-Production of Services: An Example in Service Design, Commissioning and Delivery in a London Borough
Authors: Stephen Bahooshy
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Co-producing services with the people that access them is considered best practice in the United Kingdom, with the Care Act 2014 arguing that people who access services and their carers should be involved in the design, commissioning and delivery of services. Co-production is a way of working with the community, breaking down barriers of access and providing meaningful opportunity for people to engage. Unfortunately, owing to a number of reported factors such as time constraints, practitioner experience and departmental budget restraints, this process is not always followed. In 2019, in a south London borough, d/Deaf people who access services were engaged in the design, commissioning and delivery of an information and advice service that would support their community to access local government services. To do this, sensory impairment social workers and commissioners collaborated to host a series of engagement events with the d/Deaf community. Interpreters were used to enable communication between the commissioners and d/Deaf participants. Initially, the community’s opinions, ideas and requirements were noted. This was then summarized and fed back to the community to ensure accuracy. Subsequently, a service specification was developed which included performance metrics, inclusive of qualitative and quantitative indicators, such as ‘I statements’, whereby participants respond on an adapted Likert scale how much they agree or disagree with a particular statement in relation to their experience of the service. The service specification was reviewed by a smaller group of d/Deaf residents and social workers, to ensure that it met the community’s requirements. The service was then tendered using the local authority’s e-tender process. Bids were evaluated and scored in two parts; part one was by commissioners and social workers and part two was a presentation by prospective providers to an evaluation panel formed of four d/Deaf residents. The internal evaluation panel formed 75% of the overall score, whilst the d/Deaf resident evaluation panel formed 25% of the overall tender score. Co-producing the evaluation panel with social workers and the d/Deaf community meant that commissioners were able to meet the requirements of this community by developing evaluation questions and tools that were easily understood and use by this community. For example, the wording of questions were reviewed and the scoring mechanism consisted of three faces to reflect the d/Deaf residents’ scores instead of traditional numbering. These faces were a happy face, a neutral face and a sad face. By making simple changes to the commissioning and tender evaluation process, d/Deaf people were able to have meaningful involvement in the design and commissioning process for a service that would benefit their community. Co-produced performance metrics means that it is incumbent on the successful provider to continue to engage with people accessing the service and ensure that the feedback is utilized. d/Deaf residents were grateful to have been involved in this process as this was not an opportunity that they had previously been afforded. In recognition of their time, each d/Deaf resident evaluator received a £40 gift voucher, bringing the total cost of this co-production to £160.Keywords: co-production, community engagement, deaf and hearing impaired, service design
Procedia PDF Downloads 271