Search results for: eczema action plan

Authors: M. S. Matlala, I. Ignatious

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Environmental sustainability has taken the center stage in human life all over the world. Energy is the most essential component of our life. The conventional sources of energy are non-renewable and have a detrimental environmental impact. Therefore, there is a need to move from conventional to non-conventional renewable energy sources to satisfy the world’s energy demands. The study aimed at screening for microbial cellulolytic enzymes using a proteomic approach. The objectives were to screen for microbial cellulases with high specific activity and separate the cellulolytic enzymes using a combination of zymography and two-dimensional (2-D) gel electrophoresis followed by tryptic digestion, Matrix-assisted Laser Desorption Ionisation-Time of Flight (MALDI-TOF) and bioinformatics analysis. Fungal and bacterial isolates were cultured in M9 minimal and Mandel media for a period of 168 hours at 60°C and 30°C with cellobiose and Avicel as carbon sources. Microbial cells were separated from supernatants through centrifugation, and the crude enzyme from the cultures was used for the determination of cellulase activity, zymography, SDS-PAGE, and two-dimensional gel electrophoresis. Five isolates, with lytic action on carbon sources studied, were a bacterial strain (BARK) and fungal strains (VCFF1, VCFF14, VCFF17, and VCFF18). Peak cellulase production by the selected isolates was found to be 3.8U/ml, 2.09U/ml, 3.38U/ml, 3.18U/ml, and 1.95U/ml, respectively. Two-dimensional gel protein maps resulted in the separation and quantitative expression of different proteins by the microbial isolates. MALDI-TOF analysis and database search showed that the expressed proteins in this study closely relate to different glycoside hydrolases produced by other microbial species with an acceptable confidence level of 100%.

Keywords: cellulases, energy, two-dimensional gel electrophoresis, matrix-assisted laser desorption ionisation-time of flight, MALDI-TOF MS

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Authors: Rafika Bayu Kusumandari, Istyarini, Ispen Safrel

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Character education will be more meaningful if carried out since early childhood. This is because early childhood education is the foundation of the formation of character. This study intends to find a model of character education in early childhood based on Javanese culture. In keeping with the focus of the study, long-term goals to be achieved through this research is to find once described the development of a model of character education in early childhood Javanese culture based in Semarang are then applied across early childhood education institutions in Semarang City. The specific objective of the study is: Describe the character models and management education in early childhood Java-based culture in Semarang City. The benefits of this research are; Provide an overview of the model and describe the management of character education in early childhood Java-based culture in Semarang City. Referring to the objectives of the research program was designed with a "Research and Development", meaning that a program of research followed by development programs for improvement or refinement. To produce a prototype model of character education in early childhood Java-based culture in the city, taken systematic measures in the form of the action, reflection, evaluation and innovation by applying qualitative research methods, descriptive, development, experimentation, and evaluation. This study aims to gain in-depth description of the model of character education in early childhood Java-based culture in the city of Semarang. The reason for the use of the use of qualitative methods researcher's knowledge, no study results and empirical research specifically about the model of character education in early childhood Java-based culture in the city of Semarang. On the implementation of character education early childhood adapted to the characteristics of each school and the emphasis of each agency arrangements for early childhood education, culture-based Java. Javanese culture should be introduced early in order not to erode the cultural lost outside the entrance as the era of globalization. In addition, Java is promoting a culture of courtesy and manners are very appropriate for the character formation of children of early age.

Keywords: education character, Javanese culture, childhood, character

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Authors: Sara Arafeh, Kovriguine Evguine

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Cytochromes P450 are enzymes that require a supply of electrons to catalyze the synthesis of steroid hormones, fatty acids, and prostaglandin hormone. Cytochrome P450 Oxidoreductase (CYPOR), a membrane bound enzyme, provides these electrons in its open conformation. CYPOR has two cytosolic domains (FAD domain and FMN domain) and an N-terminal in the membrane. In its open conformation, electrons flow from NADPH, FAD, and finally to FMN where cytochrome P450 picks up these electrons. In the closed conformation, cytochrome P450 does not bind to the FMN domain to take the electrons. It was found that when the cytosolic domains are isolated, CYPOR could not bind to cytochrome P450. This suggested that the membrane environment is important for CYPOR function. This project takes the initiative to better understand the dynamics of CYPOR in its full length. Here, we determine the distance between specific sites in the FAD and FMN binding domains in CYPOR by Forster Resonance Energy Transfer (FRET) and Ultrafast TA spectroscopy with and without NADPH. The approach to determine these distances will rely on labeling these sites with red and infrared fluorophores. Mimic membrane attachment is done by inserting CYPOR in lipid nanodiscs. By determining the distances between the donor-acceptor sites in these domains, we can observe the open/closed conformations upon reducing CYPOR in the presence and absence of cytochrome P450. Such study is important to better understand CYPOR mechanism of action in various endosomal membranes including hepatic CYPOR which is vital in plasma cholesterol homeostasis. By investigating the conformational cycles of CYPOR, we can synthesize drugs that would be more efficient in affecting the steroid hormonal levels and metabolism of toxins catalyzed by Cytochrome P450.

Keywords: conformational cycle of CYPOR, cytochrome P450, cytochrome P450 oxidoreductase, FAD domain, FMN domain, FRET, Ultrafast TA Spectroscopy

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Authors: Halonen

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Covid-19 pandemic and the succeeding crises have profoundly shaken the accustomed ways of interaction and thereby challenged the customary engagement patterns among entrepreneurs Consequently, this has led to the experience of lack of collegial interaction for some. Networks and relationships are a crucial factor to strengthening resilience, being especially significant in non-ordinary times. This study aims to shed light on entrepreneurs’ resilience development in and through entrepreneurs’ communal and training space. The context for research is a communal training space in a municipality in Finland of which goal is to help entrepreneurs to experience of peer support and community as part of the "tribe" is strengthened, the entrepreneurs' well-being at work, resilience, ability to change, innovativeness and general life management is strengthened. This communal space is regarded as an example of a physical community of practice (CoP) of entrepreneurs. The research aims to highlight the importance of rediscovering the “new normal” communality as itself but as a key building block of resilience. The initial research questions of the study are: RQ1: What is the role of entrepreneurs’ CoP and communal space in nurturing resilience development among them? RQ2: What positive entrepreneurial outcomes can be achieved through established CoP. The data will be gathered starting from the launch of the communality space in September 2023 onwards. It includes participatory observations of training gatherings, interviews with entrepreneurs and utilizes action research as the method. The author has an active role in participating and facilitating the development. The full paper will be finalized by the fall 2024. The idea of the new normal communality in a CoP among entrepreneurs is to be rediscovered due to its positive impact on entrepreneur’s resilience and business success. The other implications of study can extend to wider entrepreneurial ecosystem and other key stakeholders. Especially emphasizing the potential of communality in CoP for fostering entrepreneurs’ resilience and well-being ensuing business growth, community-driven entrepreneurship development and vitality of the case municipality.

Keywords: resilience, resilience development, communal space, community of practice (CoP)

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Authors: P. Afsharian, S. Mousazadeh, M. Shahhoseini, R. Aflatoonian

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Introduction: Matrix MetalloProteinases (MMPs) degrade extracellular matrix components to provide normal remodeling and contribute to pathological tissue destruction and cell migration in endometriosis. It is accepted that MMPs are resistant to suppression by progesterone in endometriotic tissues. The physiological effects of progesterone are mediated by its two progesterone receptor (PGR) isoforms, namely PGR-A and PGR-B. The capacity of progesterone affect to gene expression is dependent on the PGR-A/PGR-B ratio. The imbalance ratio in endometriotic tissue may be an important mechanism to be resulted in Progesterone resistance and modify progesterone action via differential regulation of specific progesterone response genes and improve endometriosis disease. Material and methods: RNA was extracted from twenty ectopic (endometriotic) and eutopic (endometrial) tissue samples of women undergoing laparoscopy for endometriosis and 20 healthy fertile women at Royan Institute, Tehran, Iran. Analysis of PGR-A, PGR-B, MMP-2 and MMP-9 mRNA expression was performed using Real-time PCR in ectopic and eutopic tissues. Then, Statistical analysis was calculated according to the 2-ΔΔCT equation for all samples. Results: Quantitative RT–PCR analyses of PGR-A and PGR-B mRNA revealed that there were differences in both isoformes of PGRs mRNA expressions between ectopic and control eutopic tissues. We were able to demonstrate low expression levels of PGR-B isoforms in ectopic tissues. Although, PGR-A expression was significantly higher in the same ectopic samples compare to controls.This method permitted us to demonstrate significant overexpression of MMP-2 and MMP-9 in ectopic samples compared to control endometrial tissues, as well. Conclusions: Our data suggest that low expression levels of PGR-B and overexpression of PGR-A can alter PGR-A/PGR-B ratio in endometriotic ectopic tissues. Imbalance ratio of PGRs in endometriotic tissue may be able to consequence MMP-2 and MMP-9 overexpression which can be important in pathogenesis and treatment of disease.

Keywords: endometriosis, matrix metalloproteinases, progesterone receptor -A and -B, PGR-A/PGR-B ratio

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Authors: Monika Sogani, Zainab Syed, Adrian C. Fisher

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Pollution of estrogenic compounds has caught the attention of researchers as the slight increase of estrogens in the water bodies has a significant impact on the aquatic system. They belong to a class of endocrine disrupting compounds (EDCs) and are able to mimic hormones or interfere with the action of endogenous hormones. The microbial electrochemical remediation system (MERS) is employed here for exploiting an electrophototrophic bacterium for evaluating the capacity of biodegradation of ethinylestradiol hormone (EE2) under anaerobic conditions with power generation. MERS using electro-phototrophic bacterium offers a tailored solution of wastewater treatment in a developing country like India which has a huge solar potential. It is a clean energy generating technology as they require only sunlight, water, nutrients, and carbon dioxide to operate. Its main feature that makes it superior over other technologies is that the main fuel for this MERS is sunlight which is indefinitely present. When grown in light with organic compounds, these photosynthetic bacteria generate ATP by cyclic photophosphorylation and use carbon compounds to make cell biomass (photoheterotrophic growth). These cells showed EE2 degradation and were able to generate hydrogen as part of the process of nitrogen fixation. The two designs of MERS were studied, and a maximum of 88.45% decrease in EE2 was seen in a total period of 14 days in the better design. This research provides a better insight into microbial electricity generation and self-sustaining wastewater treatment facilities. Such new models of waste treatment aiming waste to energy generation needs to be followed and implemented for building a resource efficient and sustainable economy.

Keywords: endocrine disrupting compounds, ethinylestradiol, microbial electrochemical remediation systems, wastewater treatment

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Authors: Nasiruddin Khan

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The increased use of caffeinated beverages and energy drink is posing threat to all ages and gender especially, younger adults. There is a lack of scientific evidence in Oman regarding caffeine and energy drink consumption. Our study aims to demonstrate the prevalence, pattern, knowledge and awareness, and side effects of caffeine intake among university students. This cross-sectional study including (N=365) apparently healthy male and female Omani university students aged 18-30 years, was carried out from February 2018-June 2018. A self-administered questionnaire with various sections was used to obtain information. The prevalence of caffeinated beverage consumption was commonly high among participants (97%). The males preferred Nescafe, coffee (both p < 0.001), espresso (p < 0.022), and soda (p < 0.008) while females consumed more tea (p < 0.029). The awareness about negative health impact of caffeine intake was significantly higher in females rather than males (p < 0.002). The overall prevalence of energy drink consumption was 42.1% (n=149), and higher in males (75%, p < 0.001). More males consumed 3-5 and > 5 cans/day while females used 1-2 cans/day. The starting age of energy drink use was higher in females (16-20 years (51.1%)) as compared to males (11-15 years (33.3%)). Females were more aware of caffeine as energy drink ingredient (p < 0.036) than males. The major source of information about enery drink was family and friends (58.3%). Red Bull was the commonly used brand (55.5%) among participants. Common reasons for high energy drink consumption were energy boost (68.4 %), taste (62.9%), reduce fatigue (52.1%), and better performance (47.3%). Females reported breathing problem, and abnormal heart beat (p < 0.004, 0.054, respectively), while more males reported irritability than females (p < 0.052). The prevalence of caffeinated beverage and energy drink consumption is high among participants. The awareness, and knowledge among university student is not satisfactory and needs immediate action to avoid excess use of such consumption.

Keywords: energy drink, caffeinated beverages, awareness, Oman

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Authors: Myoungsoon You, Heejung Son

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Background: In the current study, we investigated the effects of emotions induced by an infectious disease outbreak on the various protective behaviors taken during the crisis and on the perception after the crisis. The investigation was based on two psychological theories of appraisal tendency and action tendency. Methods: A total of 900 participants in South Korea who experienced the 2015 Middle East Respiratory Syndrome outbreak were sampled by a professional survey agency. To assess the influence of the emotions fear and anger, a regression approach was used. The effect of emotions on various protective behaviors and perceptions was observed using a hierarchical regression method. Results: Fear and anger induced by the infectious disease outbreak were both associated with increased protective behaviors during the crisis. However, the differences between the emotions were observed. While protective behaviors with avoidance tendency (adherence to recommendations, self-mitigation), were raised by both fear and anger, protective behaviors with approach tendency (information-seeking) were increased by anger, but not fear. Regarding the effect of emotion on the risk perception after the crisis, only fear was associated with a higher level of risk perception. Conclusions: This study confirmed the role of emotions in crisis protective behaviors and post-crisis perceptions regarding an infectious disease outbreak. These findings could enhance understanding of the public’s protective behaviors during infectious disease outbreaks and afterward risk perception corresponding to emotions. The results also suggested strategies for communicating with the public that takes into account emotions that are prominently induced by crises associated with disease outbreaks.

Keywords: crisis communication, emotion, infectious disease outbreak, protective behavior, risk perception

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Authors: Juyeon Lee, Sungeun You

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Experiential avoidance is one’s tendency to avoid painful internal experience, unwanted adverse thoughts, emotions, and physical sensations. The Multidimensional Experiential Avoidance Questionnaire (MEAQ) is a measure of experiential avoidance, and the original scale consisted of 62 items with six subfactors including behavioral avoidance, distress aversion, procrastination, distraction/suppression, repression/denial, and distress endurance. The purpose of this study was to examine the factor structure of the MEAQ in a Korean sample. Three hundred community adults and university students aged 18 to 35 participated in an online survey assessing experiential avoidance (MEAQ and Acceptance and Action Questionnaire-II; AAQ-II), depression (Patient Health Questionnaire-9; PHQ-9), anxiety (Generalized Anxiety Disoder-7; GAD-7), negative affect (Positive and Negative Affect Scale; PANAS), neuroticism (Big Five Inventory; BFI), and quality of life (Satisfaction with Life Scale; SWLS). Factor analysis with principal axis with direct oblimin rotation was conducted to examine subfactors of the MEAQ. Results indicated that the six-factor structure of the original scale was adequate. Eight items out of 62 items were removed due to insufficient factor loading. These items included 3 items of behavior avoidance (e.g., “When I am hurting, I would do anything to feel better”), 2 items of repression/denial (e.g., “I work hard to keep out upsetting feelings”), and 3 items of distress aversion (e.g., “I prefer to stick to what I am comfortable with, rather than try new activities”). The MEAQ was positively associated with the AAQ-II (r = .47, p < .001), PHQ-9 (r = .37, p < .001), GAD-7 (r = .34, p < .001), PANAS (r = .35, p < .001), and neuroticism (r = .24, p < .001), and negatively correlated with the SWLS (r = -.38, p < .001). Internal consistency was good for the MEAQ total (Cronbach’s α = .90) as well as all six subfactors (Cronbach’s α = .83 to .87). The findings of the study support the multidimensional feature of experiential avoidance and validity of the MEAQ in a sample of Korean adults.

Keywords: avoidance, experiential avoidance, factor structure, MEAQ

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Authors: Tracy Smith-Carrier

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Burgeoning research extols the benefits of innovative experiential learning activities to increase participants’ engagement, enhance their individual learning, and bridge the gap between theory and practice. This presentation discusses findings from a multiple case study on poverty simulation events conducted with two samples: undergraduate students and community participants. After exploring the nascent research on the benefits and limitations of poverty simulation activities, the study explores whether participating in a poverty simulation resulted in changes to participants’ beliefs about the causes and effects of poverty, as well as shifts in their attitudes and actions toward people experiencing poverty. For the purposes of triangulation, quantitative and qualitative data from a variety of sources were analyzed: participant feedback surveys, qualitative responses, and pre, post, and follow-up questionnaires. Findings show statistically significant results (p<.05) from both samples on cumulative scores of the modified Attitudes Toward Poverty Scale, indicating an improvement in participants’ attitudes toward poverty. Although generally positive about their experiences, participating in the simulation did not appear to have prompted participants to take specific actions to reduce poverty. Conclusions drawn from the research study suggest that poverty simulation planners should be wary of adopting scenarios that emphasize, or fail to adequately contextualize, behaviours or responses that might perpetuate individual explanations of poverty. Moreover, organizers must carefully consider how to ensure participants in their audience currently experiencing low-income do not become emotionally distressed, triggered or further marginalized in the process. While overall participants were positive about their experiences in the simulation, the events did not appear to have prompted them to action. Moving beyond the goal of increasing participants’ understandings of poverty, interventions that foster greater engagement in poverty issues over the long-term are necessary.

Keywords: empathy, experiential learning, poverty awareness, poverty simulation

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Authors: A. Kourou, M. Panoutsopoulou

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Nowadays, disaster risk reduction requires innovative ways of working collaboratively, monitoring tools, management methods, risk communication, and knowledge, as key factors for decision-making actors. Experience has shown that the assessment of seismic risk and its effective management is still an important challenge. In Greece, Ionian Islands region is characterized as the most seismic area of the country and one of the most active worldwide. It is well known that in case of a disastrous earthquake the local authorities need to assess the situation in the affected area and coordinate the disaster response. In particular, the main outcomes of 'Telemachus' project are the development of an innovative operational system that hosts the needed data of seismic risk management in the Ionian Islands and the implementation of educational actions for the involved target groups. This project is funded in the Priority Axis 'Environmental Protection and Sustainable Development' of Operational Plan 'Ionian Islands 2014-2020'. EPPO is one of the partners of the project and it is responsible, among others, for the development of proper training material. This paper presents the training material of 'Telemachus' and its usage as a helpful, managerial tool in case of earthquake emergency. This material is addressed to different target groups, such as civil protection staff, people that involved with the tourism industry, educators of disabled people, etc. Very positive aspect of the project is the involvement of end-users that should evaluate the training products; test standards; clarify the personnel’s roles and responsibilities; improve interagency coordination; identify gaps in resources; improve individual performance; and identify opportunities for improvement. It is worth mentioning that even though the abovementioned material developed is useful for the training of specific target groups on emergency management issues within Ionian Islands Region, it could be used throughout Greece and other countries too.

Keywords: education of civil protection staff, Ionian Islands Region of Greece, seismic risk, training material

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Authors: Richard Wolfel, Amy Richmond

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Urban resilience and vulnerability are critical concepts in the modern city due to the increased sociocultural, political, economic, demographic, and environmental stressors that influence current urban dynamics. Urban scholars need help explaining urban resilience and vulnerability. First, cities are dominated by people, which is challenging to model, both from an explanatory and a predictive perspective. Second, urban regions are highly recursive in nature, meaning they not only influence human action, but the structures of cities are constantly changing due to human actions. As a result, explanatory frameworks must continuously evolve as humans influence and are influenced by the urban environment in which they operate. Finally, modern cities have populations, sociocultural characteristics, economic flows, and environmental impacts on order of magnitude well beyond the cities of the past. As a result, the frameworks that seek to explain the various functions of a city that influence urban resilience and vulnerability must address the complex adaptive nature of cities and the interaction of many distinct factors that influence resilience and vulnerability in the city. This project develops a taxonomy and framework for organizing and explaining urban vulnerability. The framework is built on a well-established political development model that includes six critical classes of urban dynamics: political presence, political legitimacy, political participation, identity, production, and allocation. In addition, the framework explores how environmental security and technology influence and are influenced by the six elements of political development. The framework aims to identify key tipping points in society that act as influential agents of urban vulnerability in a region. This will help analysts and scholars predict and explain the influence of both physical and human geographical stressors in a dense urban area.

Keywords: urban resilience, vulnerability, sociocultural stressors, political stressors

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Authors: Jacquelyn Burkell, Jane Bailey

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Artificial intelligence (AI) solutions deployed within the justice system face the critical task of providing acceptable explanations for decisions or actions. These explanations must satisfy the joint criteria of public and professional accountability, taking into account the perspectives and requirements of multiple stakeholders, including judges, lawyers, parties, witnesses, and the general public. This research project analyzes and integrates two existing literature on explanations in order to propose guidelines for explainable AI in the justice system. Specifically, we review three bodies of literature: (i) explanations of the purpose and function of 'explainable AI'; (ii) the relevant case law, judicial commentary and legal literature focused on the form and function of reasons for judicial decisions; and (iii) the literature focused on the psychological and sociological functions of these reasons for judicial decisions from the perspective of the public. Our research suggests that while judicial ‘reasons’ (arguably accurate descriptions of the decision-making process and factors) do serve similar explanatory functions as those identified in the literature on 'explainable AI', they also serve an important ‘justification’ function (post hoc constructions that justify the decision that was reached). Further, members of the public are also looking for both justification and explanation in reasons for judicial decisions, and that the absence of either feature is likely to contribute to diminished public confidence in the legal system. Therefore, artificially automated judicial decision-making systems that simply attempt to document the process of decision-making are unlikely in many cases to be useful to and accepted within the justice system. Instead, these systems should focus on the post-hoc articulation of principles and precedents that support the decision or action, especially in cases where legal subjects’ fundamental rights and liberties are at stake.

Keywords: explainable AI, judicial reasons, public accountability, explanation, justification

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Authors: Igbekoyi Olusola Esther, Olurankinse Felix

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This paper examined the factors that militate against Will writing among entrepreneurs in Ondo State Nigeria and the effect of intestate death on business continuity after the exit of the entrepreneurs. The paper was written with a view to providing information on the reasons why intestate death is common among entrepreneurs in Ondo State and the effects on continuity of business after death of the initial owners. Data were obtained from primary source through the administration of questionnaires to entrepreneurs drawn from 50 registered manufacturing companies. These companies have been in existence for a minimum of 10 years with minimum staff strength of 20 workers each. These companies were selected using the purposive random sampling technique in order to capture firms that meet the requirements of this paper. Data obtained were analyzed using descriptive statistics, chi-square and regression analysis. The findings of the paper revealed that administration of Will, traditional beliefs, Will execution procedures, age and non- admissibility of Wills in court are the major factors that militates against Will writing among entrepreneurs in Ondo State. It was also discovered that chaos and instability in business, reduction in sales and productivity, poor succession planning, polygamous nature of marriages, difficulty in sourcing for funds and gender preference are joint predictors of business continuity in event intestate death which is evident in the result where R2 =.954;(F 6, 26)= 89.644; (P < 0.01). The individual beta co-efficient, t- statistics and significance of each variable revealed that gender preference (.735; 7.031; .000) and poor succession plan (.402; 2.840; .009) have significant positive effect on business continuity; while reduction in sales and productivity (-.059; -.335; .740) and difficulty in sourcing for funds (-.217; -1.367; .188) have negative effect; other variables also have positive relationship but they are not significant. It is therefore concluded that business continuity after the exit of the entrepreneur is highly dependent on the rebuilding of confidence on Wills administration in ondo state Nigeria, proper succession planning and elimination of gender preferences.

Keywords: intestacy, business continuity, entrepreneurs, will, succession planning

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Authors: Gusa Hall, Barrie Keeler, Achal Khanna

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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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Authors: Massy Guillaume

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Introduction: The implementation of creativity in educational policies or curricula raises several issues, including the evaluation of creativity and the means to do so. This doctoral research focuses on the appropriation and transposition of creativity assessment models by future teachers. Our objective is to identify the elements of the models that are most transferable to practice in order to improve their implementation in the students' curriculum while seeking to create a new model for assessing creativity in the school environment. Methods: In order to meet our objective, this preliminary quantitative exploratory study by questionnaire was conducted at two points in the participants' training: at the beginning of the training module and throughout the practical work. The population is composed of 40 people of diverse origins with an average age of 26 (s:8,623) years. In order to be as close as possible to our research objective and to test our questionnaires, we set up a pre-test phase during the spring semester of 2022. Results: The results presented focus on aspects of the OECD Creative Competencies Assessment Model. Overall, 72% of participants support the model's focus on skill levels as appropriate for the school context. More specifically, the data indicate that the separation of production and process in the rubric facilitates observation by the assessor. From the point of view of transposing the grid into teaching practice, the participants emphasised that production is easier to plan and observe in students than in the process. This difference is reinforced by a lack of knowledge about certain concepts such as innovation or risktaking in schools. Finally, the qualitative results indicate that the addition of multiple levels of competencies to the OECD rubric would allow for better implementation in the classroom. Conclusion: The identification by the students of the elements allowing the evaluation of creativity in the school environment generates an innovative approach to the training contents. These first data, from the test phase of our research, demonstrate the difficulty that exists between the implementation of an evaluation model in a training program and its potential transposition by future teachers.

Keywords: creativity, evaluation, schooling, training

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Authors: S. Mogili, J. S. Kuang, N. Zhang

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Knee joints, the beam column connections found at the roof level of a moment resisting frame buildings, are inherently different from conventional interior and exterior beam column connections in the way that forces from adjoining members are transferred into joint and then resisted by the joint. A knee connection has two distinct load resisting mechanisms, each for closing and opening actions acting simultaneously under reversed cyclic loading. In spite of many distinct differences in the behaviour of shear resistance in knee joints, there are no special design provisions in the major design codes available across the world due to lack of in-depth research on the knee connections. To understand the relative importance of opening and closing actions in design, it is imperative to study knee joints under varying shear stresses, especially at higher opening-to-closing shear stress ratios. Three knee joint specimens, under different input shear stresses, were designed to produce a varying ratio of input opening to closing shear stresses. The design was carried out in such a way that the ratio of flexural strength of beams with consideration of axial forces in opening to closing actions are maintained at 0.5, 0.7, and 1.0, thereby resulting in the required variation of opening to closing joint shear stress ratios among the specimens. The behaviour of these specimens was then carefully studied in terms of closing and opening capacities, hysteretic behaviour, and envelope curves to understand the differences in joint performance based on which an attempt to suggest design guidelines for knee joints is made emphasizing the relative importance of opening and closing actions. Specimens with relatively higher opening stresses were observed to be more vulnerable under the action of seismic loading.

Keywords: Knee-joints, large-scale testing, opening and closing shear stresses, seismic performance

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Authors: K. O. Ogbedeh, C. P. Ekwe, G. O. Ihejirika, S. A. Dialoke, O. P. Onyewuchi, C. P. Anyanwu, I. E. Kalu

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As one of the major pests of field crops, termites attack groundnut at all stages of its development, especially during prolonged dry spell. Effect of palm bunch ash and neem(Azardirachta indica A. Juss) leaf powder on termite infestation in groundnut field in Owerri, Nigeria was investigated in this study. The field trial was carried out in 2016 at the Teaching and Research Farm of the Federal University of Technology, Owerri, Nigeria. The experiment was laid out in a 3x3 Factorial fitted into a Randomized Complete Block Design (RCBD) with three replications. The treatments include three rates of palm bunch ash at 0.0 (control), 1.0 and 2.0tons/ha and three rates of neem leaf powder at 0.0(control), 1.0, 2.0 tons/ha respectively. Data were collected on percentage emergence, termite incidence and termite severity. These were subjected to analysis of variance (ANOVA), and means were separated using least significant difference at 5% level of probability. The result shows that there were no significant (P= 0.05) differences in percentage emergence amongst treatment means due to palm bunch ash and neem leaf powder applications. Contrarily, palm bunch ash at 2.0 tons/ha recorded the least termite incidence especially at twelve weeks after planting (12WAP) with a value of 22.20% while control plot maintained highest values at 6WAP (48.70%) and 12WAP (48.30%) respectively. Also palm bunch ash at 2.0tons/ha depressed termite severity more than other treatments especially at 2 and 4 WAP (0.56) respectively. Control plots on the other hand consistently maintained highest termite severity throughout the trial with the highest value at 2 and 12WAP (1.56). Conclusively, palm bunch ash exhibited highest depressive action against termite on groundnut especially at higher application value (2.0tons/ha).

Keywords: groundnut, incidence, neem, palm, severity, termites

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Authors: Shunsuke Aoki, Taku Ri, Tatsuya Yamazaki

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These days, along with the development of e-sports, video games as a competitive sport is attracting attention. But, in many cases, action in the screen does not match the real motion of operation. Inclusiveness of player motion is needed to increase reality and excitement for sports games. Therefore, in this study, the authors propose a method to recognize player motion by using the motion capture technology and develop a virtual basketball game. The virtual basketball game consists of a screen with nine targets, players, depth sensors, and no ball. The players pretend a two-handed basketball shot without a ball aiming at one of the nine targets on the screen. Time-series data of three-dimensional coordinates of player joints are captured by the depth sensor. 20 joints data are measured for each player to estimate the shooting motion in real-time. The trajectory of the thrown virtual ball is calculated based on the time-series data and hitting on the target is judged as success or failure. The virtual basketball game can be played by 2 to 4 players as a competitive game among the players. The developed game was exhibited to the public for evaluation on the authors' university open campus days. 339 visitors participated in the exhibition and enjoyed the virtual basketball game over the two days. A questionnaire survey on the developed game was conducted for the visitors who experienced the game. As a result of the survey, about 97.3% of the players found the game interesting regardless of whether they had experienced actual basketball before or not. In addition, it is found that women are easy to comfort for shooting motion. The virtual game with motion capture technology has the potential to become a universal entertainment between e-sports and actual sports.

Keywords: basketball, motion capture, questionnaire survey, video ga

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Authors: Dina Atmani-Kilani, Farah Yous, Djebbar Atmani

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The etiology of peptic ulcer is closely related to stress, excessive consumption of nonsteroidal anti-inflammatory drugs, or ethanol. Clematis flammula (Ranunculaceae) is a medicinal plant widely used by rural populations to treat inflammatory disorders. This study was designed to assess the gastroprotective potential of C. flammula extracts. Gastric ulcer was induced by stress, indomethacin, HCl / ethanol, and absolute ethanol on NMRI-type mice. The antioxidant potency of the ethanolic extract of Clematis flammula (EECF) was evaluated on catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) activities. Glutathione (GSH) and malonaldehyde (MDA) levels were also quantified. The anti-inflammatory potential was evaluated through the effect of EECF on myeloperoxidase activity (MPO) and vascular permeability. Complementary tests concerning the quantification of mucus levels, gastric motility, inhibition of ATPase H+/K+activity, as well as a histopathological study were also undertaken to explore the mechanism of action of the EECF. The EECF exhibited a significant (p <0.001) and optimal (100 mg/kg) gastroprotective effect by elevating SOD, CAT, and GSH levels, thereby minimizing the production of MDA and lowering the activity of MPO and vascular permeability. EECF also increased the rate of mucus production, decreased gastric motility, and completely suppressed the H+/K+ ATPase activity. Histopathological study confirmed the effectiveness of the extract in the prevention of peptic ulcer. The results obtained in this study demonstrated the gastro-protective effect of EECF via acidic antioxidant, anti-inflammatory, cytoprotective and anti-secretory mechanisms, which may justify its use as a substitute in peptic ulcer treatment.

Keywords: clematis flammula, superoxide dismutase, myeloperoxidase, ATPase, pump

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Authors: Andrea Vasquez, Pedro Maldonado-Alvarado

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In general, 'gluten-free' foods like breadmaking products provide functional or nutraceutical benefits for the consumer's health and increased their demand on the market. In Ecuador, there is an overproduction of superfoods, and the food by-products are undervalued. For the first time, to the author's best knowledge, gluten-free bread mixtures from quinoa and banana flour, cassava starch, lupine flour (LF), or whey protein (WP) with hydroxypropylmethylcellulose (HPMC) and transglutaminase (TG) were evaluated on their functional and sensory properties. Free amino groups and thiols, rheology, and electrophoresis SDS PAGE were performed to analyze the crosslinking of TG at different concentrations with HC or PL proteins. Dough characterization, pasting properties were evaluated, respectively, by a MIXOLAB and a rheometer with a pasting cell. The texture, porosity, and loaf volume were characterized using a texturometer, ImageJ software, and breadmaking ability, respectively. Finally, a breadmaking aptitude and sensorial bread acceptability were performed. A significant decrease in the content of free amino groups (0.16 to 0.11 and 0.46 to 0.36 mM/mg of protein) and free thiol groups (0.37 to 0.21 and 1.79 to 1.32 mM/mg protein) was observed when 1.0% and 0.5% TG were added to LF and WP, respectively. In apparent viscosity analysis, the action of TG on HC proteins changes their viscosity, while the viscosity of LF is not modified by TG. Results of electrophoresis in PL showed bands of higher molecular weight of different fragments of proteins with 1% TG. Formulation with 59.8, 39.9, 160.8, 6.0, 1.0, and 1.5% of, respectively, QF, BF, CS, LF or WP, TG, and HPMC had the best properties in dough parameters, pasting parameters (lower pasting temperature and higher peak viscosity), best crumb structure, lower crumb hardness and higher loaf volume (2.24 and 2.28 mL/g). All the loaves of bread were acceptable in baking aptitude and general acceptability.

Keywords: breadmaking, gluten-free, superfoods, by-products, Ecuador

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Authors: Ju-Chun Chien

Abstract:

The Ottawa Charter for Health Promotion proposed that the role of health services should shift the focus from cure to prevention. Nowadays, besides having physical examinations, people could also conduct genetic tests to provide important information for diagnosing, treating, and/or preventing illnesses. However, because of the incompletion of the Chinese Genetic Database, people in Taiwan were still unfamiliar with genetic testing. The purposes of the present study were to: (1) Figure out people’s attitudes towards genetic testing. (2) Examine factors that influence people’s intention to pursue genetic testing by means of the Health Belief Model (HBM). A pilot study was conducted on 249 Taiwanese in 2017 to test the feasibility of the self-developed instrument. The reliability and construct validity of scores on the self-developed questionnaire revealed that this HBM-based questionnaire with 40 items was a well-developed instrument. A total of 542 participants were recruited and the valid participants were 535 (99%) between the ages of 20 and 86. Descriptive statistics, one-way ANOVA, two-way contingency table analysis, Pearson’s correlation, and stepwise multiple regression analysis were used in this study. The main results were that only 32 participants (6%) had already undergone genetic testing; moreover, their attitude towards genetic testing was more positive than those who did not have the experience. Compared with people who never underwent genetic tests, those who had gone for genetic testing had higher self-efficacy, greater intention to pursue genetic testing, had academic majors in health-related fields, had chronic and genetic diseases, possessed Catastrophic Illness Cards, and all of them had heard about genetic testing. The variables that best predicted people’s intention to pursue genetic testing were cues to action, self-efficacy, and perceived benefits (the three variables all correlated with one another positively at high magnitudes). To sum up, the HBM could be effective in designing and identifying the needs and priorities of the target population to pursue genetic testing.

Keywords: genetic testing, knowledge of GT, people in Taiwan, the health belief model

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Authors: Javier De La Torre Costa, Belen Rubio Ballester, Martina Maier, Paul F. M. J. Verschure

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After a stroke, a great number of patients experience persistent motor impairments such as hemiparesis or weakness in one entire side of the body. As a result, the lack of use of the paretic limb might be one of the main contributors to functional loss after clinical discharge. We aim to reverse this cycle by promoting the use of the paretic limb during activities of daily living (ADLs). To do so, we describe the key components of a system that is composed of a wearable bracelet (i.e., a smartwatch) and a mobile phone, designed to bring a set of neurorehabilitation principles that promote acquisition, retention and generalization of skills to the home of the patient. A fundamental question is whether the loss in motor function derived from learned–non–use may emerge as a consequence of decision–making processes for motor optimization. Our system is based on well-established rehabilitation strategies that aim to reverse this behaviour by increasing the reward associated with action execution as well as implicitly reducing the expected cost associated with the use of the paretic limb, following the notion of the reinforcement–induced movement therapy (RIMT). Here we validate an accelerometer–based measure of arm use, and its capacity to discriminate different activities that require increasing movement of the arm. We also show how the system can act as a personalized assistant by providing specific goals and adjusting them depending on the performance of the patients. The usability and acceptance of the device as a rehabilitation tool is tested using a battery of self–reported and objective measurements obtained from acute/subacute patients and healthy controls. We believe that an extension of these technologies will allow for the deployment of unsupervised rehabilitation paradigms during and beyond the hospitalization time.

Keywords: stroke, wearables, learned non use, hemiparesis, ADLs

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Authors: Sinan Bilgen, Bekir Ozer Ay, Nilay Sezer Uzol

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After decades of conventional shapes, irregular forms with complex geometries are getting more popular for form generation of tall buildings all over the world. This trend has recently brought out diverse building forms such as twisting tall buildings. This study investigates both the aerodynamic and design features of twisting tall buildings through comparative analyses. Since twisting a tall building give rise to additional complexities related with the form and structural system, lateral load effects become of greater importance on these buildings. The aim of this study is to analyze the inherent characteristics of these iconic forms by comparing the wind loads on twisting tall buildings with those on their prismatic twins. Through a case study research, aerodynamic analyses of an existing twisting tall building and its prismatic counterpart were performed and the results have been compared. The prismatic twin of the original building were generated by removing the progressive rotation of its floors with the same plan area and story height. Performance-based measures under investigation have been evaluated in conjunction with the architectural design. Aerodynamic effects have been analyzed by both wind tunnel tests and computational methods. High frequency base balance tests and pressure measurements on 3D models were performed to evaluate wind load effects on a global and local scale. Comparisons of flat and real surface models were conducted to further evaluate the effects of the twisting form without façade texture contribution. Comparisons highlighted that, the twisting form under investigation shows better aerodynamic behavior both for along wind but particularly for across wind direction. Compared to the prismatic counterpart; twisting model is superior on reducing vortex-shedding dynamic response by disorganizing the wind vortices. Consequently, despite the difficulties arisen from inherent complexity of twisted forms, they could still be feasible and viable with their attractive images in the realm of tall buildings.

Keywords: aerodynamic tests, motivation for twisting, tall buildings, twisted forms, wind excitation

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Authors: Mariana Anaya Villafana

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The sudden change of a significant percentage of the Latino community in the United States elections towards a Republican political orientation was reflected during the 2016 presidential election. This moment represented a radical change that is happening inside the Latino community in the United States, the support they have given to Trump's campaign only demonstrates their support for new anti-immigration regulations and conservative values, which are causing a division of ideologies inside the Latino community. One of the main goals of the following research is to understand the whole phenomenon 'Why would people join their own oppressor?' Align themselves with the politics that prevent many of their relatives to come to the United States and made the assimilation process difficult for their parents. It is important to prove that a change in the identity has happened, through the use of power relations and the attachment to the desired object. A group of Hispanics/Latinos have decided to vote for Trump in order to belong to a society that hasn’t been able to fully include them within it, an action that can result on the non-intentional harm of the values and aims of the rest of the Latino/Hispanic community. In order to understand their new political beliefs, it is necessary to use the method of discourse analysis to comprehend those comments and interviews that are published on web sites such as: 'Latinos for Trump' and 'GOP Hispanic Division'. Among the results that the research has shown, the notion of the 'American Dream' can be considered as a determinant object for the construction of a new identity that is rooted in hard work and legality. One that is proud of the Latino heritage but still wants to maintain the boundaries between legality and illegality in relation to the immigrants. This discourse results on a contradiction to most of the cases because they mention that their families came to the U.S. as immigrants; the only difference is that they work hard to obtain legal citizenship.

Keywords: populism, identity, Latino Community, migration

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Authors: Takuro Kida, Yuichi Kida

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We show a base of the new trend of algorithm mathematically that treats a historical reason of continuous discrimination in the world as well as its solution by introducing new concepts of parallel world that includes an invisible set of errors as its companion. With respect to a matrix operator-filter bank that the matrix operator-analysis-filter bank H and the matrix operator-sampling-filter bank S are given, firstly, we introduce the detailed algorithm to derive the optimum matrix operator-synthesis-filter bank Z that minimizes all the worst-case measures of the matrix operator-error-signals E(ω) = F(ω) − Y(ω) between the matrix operator-input-signals F(ω) and the matrix operator-output signals Y(ω) of the matrix operator-filter bank at the same time. Further, feedback is introduced to the above approximation theory and it is indicated that introducing conversations with feedback does not superior automatically to the accumulation of existing knowledge of signal prediction. Secondly, the concept of category in the field of mathematics is applied to the above optimum signal approximation and is indicated that the category-based approximation theory is applied to the set-theoretic consideration of the recognition of humans. Based on this discussion, it is shown naturally why the narrow perception that tends to create isolation shows an apparent advantage in the short term and, often, why such narrow thinking becomes intimate with discriminatory action in a human group. Throughout these considerations, it is presented that, in order to abolish easy and intimate discriminatory behavior, it is important to create a parallel world of conception where we share the set of invisible error signals, including the words and the consciousness of both worlds.

Keywords: signal prediction, pseudo inverse matrix, artificial intelligence, conditional optimization

Procedia PDF Downloads 146

Authors: Kristin Drexler

Abstract:

Climate change has exacerbated food and livelihood insecurity for Mayan milpa farmers in Central America. For centuries, milpa farming has been sustainable for subsistence; however, in the last 50 years, milpas have become less reliable due to accelerating climate change, resource degradation, declining markets, poverty, and other factors. Using interviews with extension leaders and milpa farmers in Belize, this qualitative study examines the capacity for increasing climate-smart agriculture (CSA) aspects of existing traditional milpa practices, specifically no-burn mulching, soil enrichment, and the use of cover plants. Applying community capitals and socio-ecological systems frameworks, this study finds four key capitals were perceived by farmers and agriculture extension leaders as barriers for increasing CSA practices: (1) human-capacity, (2) financial, (3) infrastructure, and (4) governance-justice capitals. The key barriers include a lack of CSA technology and pest management knowledge-sharing (human-capacity), unreliable roads and utility services (infrastructure), the closure of small markets and crop-buying programs in Belize (financial), and constraints on extension services and exacerbating a sense of marginalization in Maya communities (governance-justice). Recommendations are presented for government action to reduce barriers and facilitate an increase in milpa crop productivity, promote food and livelihood security, and enable climate resilience of Mayan milpa communities in Belize.

Keywords: socio-ecological systems, community capitals, climate-smart agriculture, food security, milpa, Belize

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Authors: Shimaa Abdel-Rahman Amin El-Badawy

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Commercial law is the set of legal rules that apply to business and regulates the trade of trade. The meaning of this is that the commercial law regulates certain relations only that arises as a result of carrying out certain businesses. which are business, as it regulates the activity of a specific sect, the sect of merchants, and the commercial law as other branches of the law has characteristics that distinguish it from other laws and various, and various sources from which its basis is derived from It is the objective or material source. the historical source, the official source and the interpretative source, and we are limited to official sources and explanatory sources. so what do you see what these sources are, and what is their degree and strength in taking it in commercial disputes. The first topic / characteristics of commercial law. Commercial law has become necessary for the world of trade and economics, which cannot be dispensed with, given the reasons that have been set as legal rules for commercial field.In fact, it is sufficient to refer to the stability and stability of the environment, and in exchange for the movement and the speed in which the commercial environment is in addition to confidence and credit. the characteristic of speed and the characteristic of trust, and credit are the ones that justify the existence of commercial law.Business is fast, while civil business is slow, stable and stability. The person concludes civil transactions in his life only a little. And before doing any civil action. he must have a period of thinking and scrutiny, and the investigation is the person who wants the husband, he must have a period of thinking and scrutiny. as if the person who wants to acquire a house to live with with his family, he must search and investigate. Discuss the price before the conclusion of a purchase contract. In the commercial field, transactions take place very quickly because the time factor has an important role in concluding deals and achieving profits. This is because the merchant in contracting about a specific deal would cause a loss to the merchant due to the linkage of the commercial law with the fluctuations of the economy and the market. The merchant may also conclude more than one deal in one and short time. And that is due to the absence of commercial law from the formalities and procedures that hinder commercial transactions.

Keywords: law, commercial law, Islamic law, custom and Islamic law

Procedia PDF Downloads 61

Authors: Irna Malganova

Abstract:

The paper assessed the effectiveness of the use of urban functional zoning using the method of M.A. Kramer by the example of Kazan city (Republic of Tatarstan, Russian Federation) using geoinformation technologies. On the basis of the data obtained, the calculations were carried out to obtain data on population density, overcoming geographic determinism, as well as the effectiveness of the formation of urban frameworks. The authors proposed recommendations for the effectiveness of municipal frameworks in the period from 2018 to 2021: economic, social, environmental and social. The study of effective territorial planning in a given period allows to display of the dynamics of planning changes, as well as assessment of changes in the formation of urban frameworks. Based on the incoming data obtained from the master plan of the municipal formation of Kazan, in the period from 2018 to 2021, there was an increase in population by 13841 people or 1.1% of the values of 2018. In addition, the area of Kazan increased by 2419.6 hectares. In the structure of the distribution of areas of functional zones, there was an increase in such zones of the municipality as zones of residential and public purpose. Changes in functional zoning, as well as territories requiring reorganization, are presented using geoinformation technologies in open-source software Quantum Geographic Information System (QGIS 3.32). According to the calculations based on the method of functional zoning efficiency by M.A. Kreimer, the territorial-planning structure of Kazan City is quite effective. However, in the development of spatial planning concepts, it is possible to emphasize the weakened interest of the population in the development of territorial planning documents. Thus, the approach to spatial planning of Kazan differs from foreign methods and approaches based on the joint development of planning directions and development of territories of municipalities between the developers of the planning structure, business representatives and the population. The population plays the role of the target audience on which territorial planning is oriented. It follows that there is a need to satisfy the opinions and demands of the population.

Keywords: spatial development, metamorphosis, Kazan city, spatial planning, efficiency, geographic determinism., GIS, QGIS

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Authors: Mona Nada, Fahmy Fahmy

Abstract:

Background: Pleomorphic dermal sarcoma is a rare form of skin cancer affecting cutaneous layer and, in some cases associated with recurrence and metastasis, very commonly to seen in elderly patient affecting the area of head and neck. Pleomorphic dermal sarcoma rises in ultraviolet light exposed areas. The symptoms and severity of this kind of skin cancer varies according to histological factors. The differentiation of Pleomorphic dermal sarcoma needs extensive immunohistochemistry, as the diagnosis depends mainly on exclusion to rule out other malignancy like poorly differentiated squamous cell carcinoma, melanoma, angiosarcoma and leiomyosarcoma. Objective: assessing the management of Pleomorphic dermal sarcoma in our unit and compared to the updated guidelines. Design: Retrospective study Collection of patient data from medical records at countess of Chester plastic surgery unit of the last 5 years, all histologically confirmed Pleomorphic dermal sarcoma (2017-2023). Data were collected confirmed to be Pleomorphic dermal sarcoma were included in the study. The data collected: clinical description of the lesions at first presentation, operation time, multidisciplinary team discussion, plan, referral as well as second operation and investigation done. With comparison of histological examination, immunohistochemistry staining, the excision and rate of recurrence. Results: data collected N19 from (2017-2023) showed the disease predominantly affecting males and the lesion mainly in head and neck, the diagnosis needed extensive immunohistochemistry to differentiate between other malignancy. recurrence present in numbers of the cases which managed after multidisciplinary team discussion either by excision or radiotherapy. Conclusion: Pleomorphic dermal sarcoma is a rare malignancy which needs more understanding and avoid missing as it is aggressive form of skin cancer, there is a chance of metastasis and recurrence which makes it very important to understand the process of development of the cancer and frequent review of the management guidelines.

Keywords: pleomorphic dermal sarcoma, recurrence, radiotherapy, surgical

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