Abstract: Perfect restoration of fractured distal femur has been a challenging task for the medical practitioners. In the present study, model of a fractured bone has been created using the scan data of the damaged bone. Thereafter, customized implant of Stainless Steel (SS-316L) for this fractured femur bone is modeled using the reverse engineering approach. Clinical set-up is prepared by assembling all the models together. Stress and deformation analysis of this clinical set-up has been performed in order to check the load bearing capacity and intactness of the joint. From this analysis, it has been inferred that the stresses and deformation developed due to the static load of the person is within the permissible limits.
Abstract: Coil reinforced thin-walled (CRTW) tubes are used in medicine to treat problems affecting blood vessels within the body through minimally invasive procedures. The CRTW tube considered in this research makes up part of such a device and is inserted into the patient via their femoral or brachial arteries and manually navigated to the site in need of treatment. This procedure replaces the requirement to perform open surgery but is limited by reduction of blood vessel lumen diameter and increase in tortuosity of blood vessels deep in the brain. In order to maximize the capability of these procedures, CRTW tube devices are being manufactured with decreasing wall thicknesses in order to deliver treatment deeper into the body and to allow passage of other devices through its inner diameter. This introduces significant stresses to the device materials which have resulted in an observed increase in the breaking of the proximal segment of the device into two separate pieces after it has failed by buckling. As there is currently no international standard for measuring the mechanical properties of these CRTW tube devices, it is difficult to accurately analyze this problem. The aim of the current work is to address this discrepancy in the biomedical device industry by developing a measurement system that can be used to quantify the effect of process and design changes on CRTW tube performance, aiding in the development of better performing, next generation devices. Using materials testing frames, micro-computed tomography (micro-CT) imaging, experiment planning, analysis of variance (ANOVA), T-tests and regression analysis, test methods have been developed for assessing the impact of process and design changes on the device. The major findings of this study have been an insight into the suitability of buckle and three-point bend tests for the measurement of the effect of varying processing factors on the device’s performance, and guidelines for interpreting the output data from the test methods. The findings of this study are of significant interest with respect to verifying and validating key process and design changes associated with the device structure and material condition. Test method integrity evaluation is explored throughout.
Abstract: In the present work, reverse engineering (RE) approach has been used to create a 3D model of a fractured femur bone using the computed tomography (CT) scan data. Thereafter, counter fit fixation plates of Titanium alloy (Ti6Al4V) have been designed and analyzed considering physiological static loading conditions. From the analysis, it has been inferred that the stresses and deformation developed are quite low. It implies that these designed customized fixation plates are able to provide stable fixation resulting in improved fracture union.
Abstract: This research aimed to measure the impact of the use of a mobile learning (iTunes U) app for the development of metacognition skills delivered in the enrichment program offered to gifted students at the secondary level in Jeddah. The author targeted a group of students on an experimental scale to evaluate the achievement. The research sample consisted of a group of 38 gifted female students. The scale of evaluation of the metacognition skills used to measure the performance of students in the enrichment program was as follows: Satisfaction scale for the assessment of the technique used and the final product form after completion of the program. Appropriate statistical treatment used includes Paired Samples T-Test Cronbach’s alpha formula and eta squared formula. It was concluded in the results the difference of α≤ 0.05, which means the performance of students in the skills of metacognition in favor of using iTunes U. In light of the conclusion of the experiment, a number of recommendations and suggestions were present; the most important benefit of mobile learning applications is to provide enrichment programs for gifted students in the Kingdom of Saudi Arabia, as well as conducting further research on mobile learning and gifted student teaching.
Abstract: Anthropometry helps in associating the physical properties of an individual with their racial, cultural, and psychological attributes. Numerous research studies have included different skeletal diameters as a variable. However, most of the studies suggest their inclusion describing specific characteristics/traits of the body. However, there seems to be a scarcity of literature related to the effect of any kind of longitudinal physical training on human skeletal diameters. Hence, the present investigation was conducted to study the variability of covariance of selected skeletal diameters of females in a longitudinal physical training programme. The sample for the study was 78 college going students of the University of Delhi, classified equally in three groups, i.e. viz. (a) Progressive load of training or conditioning group coded as PLT; (b) Constant load of training or non-conditioning group coded as CLT; and (c) No-load or control or sedentary group coded as NL. Collectively, mean age of the sample was 19.54±1.79 years. The randomly selected samples were given maximum consideration to maintain their homogeneity. The variables included biacromial diameter, biiliocristal diameter, bitrochantaerion diameter, humeral bicondylar, femoral bicondylar, wrist diameter, ankle diameter, and foot breadth. Multi-group repeated measure design was adopted for the experimentation. Each group was measured four times after completion of each of the three meso-cycles of six-weeks duration. The measurements were taken following the standard landmarks and procedures. Mean, standard deviation, analysis of co-variance and its post-hoc analysis were computed to analyze the data statistically. The study concluded that both the progressive and constant load of physical training bring changes in the selected skeletal diameters of females. It also reflected the increase due to growth also along with training.
Abstract: In India, there is a lack of standard, systematic sizing approach for producing readymade garments. Garments manufacturing companies use their own created size tables by modifying international sizing charts of ready-made garments. The purpose of this study is to tabulate the anthropometric data which cover the variety of figure proportions in both height and girth. 3,000 data have been collected by an anthropometric survey undertaken over females between the ages of 16 to 80 years from the some states of India to produce the sizing system suitable for clothing manufacture and retailing. The data are used for the statistical analysis of body measurements, the formulation of sizing systems and body measurements tables. Factor analysis technique is used to filter the control body dimensions from the large number of variables. Decision tree-based data mining is used to cluster the data. The standard and structured sizing system can facilitate pattern grading and garment production. Moreover, it can exceed buying ratios and upgrade size allocations to retail segments.
Abstract: With the development of the automotive technology and electric vehicle, the contribution of the wind noise on the interior noise becomes the main source of noise. The main transfer path which the exterior excitation is transmitted through is the greenhouse panels and side windows. Simulating the wind noise transmitted into the vehicle accurately in the early development stage can be very challenging. The basic methodologies of this study were based on the Lighthill analogy; the exterior flow field around a passenger car was computed using unsteady Computational Fluid Dynamics (CFD) firstly and then a Finite Element Method (FEM) was used to compute the interior acoustic response. The major findings of this study include: 1) The Sound Pressure Level (SPL) response at driver’s ear locations is mainly induced by the turbulence pressure fluctuation; 2) Peaks were found over the full frequency range. It is found that the methodology used in this study could predict the interior wind noise induced by the exterior aerodynamic excitation in industry.
Abstract: Introduction: Some parameters should be considered to investigate the chronic effects of radiation absorption in radiation workers. Trace elements are parameters which small changes in them can cause significant effects on live systems. The role of trace element concentration in human health is significant. These elements play an important role in the developing and functioning of the immune system, cellular respiration, and oxidation processes. Considering the importance and necessity of this issue and few studies, measurements of concentration changes of these elements due to the absorbed dose are important. Purpose: This study aimed to determine the biological effects of occupational dose absorption on plasma and erythrocyte concentration of Zn and Cu in the radiology staff of Tehran Oil Hospital. Material and methods: In this analytical-comparative study, 72 people have entered. 36 people (18 males and 18 females) were selected as radiology staff in the diagnostic and therapeutic departments of Tehran Oil Hospital. And 36 people (18 males and 18 females) were selected as general section staff in the same hospital as a control group. Radiology and control groups’ age and sex were matched. 10 ml of venous blood was taken from all people. An atomic absorption spectrometer was used to obtain zinc and copper plasma concentrations. Levine test was used to compare these results validity. Results: The mean concentrations of copper and zinc were measured as 0.951 and 0.754 mg/L in the plasma phase and 3.2 and 0.401 mg/L in the RBC phase for the radiology group. Copper and zinc average concentrations, respectively 0.976 and 0.813 mg/L in the plasma phase and 2.906 and 0.476 mg/L in the RBC phase, were measured for the control group. These elements Concentrations in the plasma phase were significantly different from that of the control group, but the concentrations in the red blood cell phase did not show a significant difference compared to the control group. In comparison, a separate comparison between men and women in the experimental and control groups showed a significant difference in the values of the elements mentioned. With a significant increase in samples, a better justification than the available statistical results can be extracted. Conclusions: Within this study results, chronic occupational probabilistic absorption destructive effects (even within the permitted range) on blood trace element concentration have been confirmed.
Abstract: Trapping efficiency of methyl eugenol and three locally made food-based lures were evaluated in three locations for trapping of B. dorsalis on mango homestead trees in Ibadan South west Nigeria. The treatments were methyl eugenol, brewery waste, pineapple juice, orange juice, and control (water). The experiment was laid in a Complete Randomized Block Design (CRBD) and replicated three times in each location. Data collected were subjected to analysis of variance and significant means were separated by Turkey’s test. The results showed that B. dorsalis was recorded in all locations of study. Methyl eugenol significantly (P < 0.05) trapped higher population of B. dorsalis in all the study area. The population density of B. dorsalis was highest during the ripening period of mango in all locations. The percentage trapped flies after 7 weeks were 77.85%-82.38% (methyl eugenol), 7.29%-8.64% (pineapple juice), 5.62-7.62% (brewery waste), 4.41%-5.95% (orange juice), and 0.24-0.47% (control). There were no significance differences (p > 0.05) on the population of B. dorsalis trapped in all locations. Similarly, there were no significant differences (p > 0.05) on the population of flies trapped among the food attractants. However, the three food attractants significantly (p < 0.05) trapped higher flies than control. Methyl eugenol trapped only male flies while brewery waste and other food based attractants trapped both male and female flies. The food baits tested were promising attractants for trapping B. dorsalis on mango homestead tress, hence increased dosage could be considered for monitoring and mass trapping as management strategies against fruit fly infestation.
Abstract: Microbial contamination of ready-to-eat foods and beverages sold by street vendors has become an important public health issue. In developing countries including South Africa, health risks related to such kinds of foods are thought to be common. Thus, this study assessed knowledge, attitude and practices of street food vendors. Street vendors in the city of Mangaung Metro were investigated in order to assess their knowledge, attitudes and handling practices. A semi-structured questionnaire and checklist were used in interviews to determine the status of the vending sites and associa. ted food-handling practices. Data was collected by means of a face-to-face interview. The majority of respondents were black females. Hundred percent (100%) of the participants did not have any food safety training. However, street vendors showed a positive attitude towards food safety. Despite the positive attitude, vendors showed some non-compliance when it comes to handling food. During the survey, it was also observed that the vending stalls lack basic infrastructures like toilets and potable water that is currently a major problem. This study indicates a need for improvements in the environmental conditions at these sites to prevent foodborne diseases. Moreover, based on the results observed food safety and food hygiene training or workshops for street vendors are highly recommended.
Abstract: This paper is going to discuss two issues encountered in using PLAXIS. Both issues were monitored during application of PLAXIS to estimate the excavation-induced displacement. Column Soil Mixing (CSM) was applied to stabilise the excavation. It was understood that the estimated excavation induced deformation at the top of the CSM blocks highly depends on the material type defining pavement material adjacent to the CSM blocks. Cohesive material for pavement will result in the unrealistic connection between pavement and CSM even by defining an interface element. To find the most realistic approach, the interface defined in three different manners (1) no interface elements were applied (2) a non-cohesive soil layer was defined between pavement and CSM block to represent the friction between these materials (3) built-in interface elements in PLAXIS was used to define the boundary between the pavement and the CSM block. The result showed that the option 2 would result in more realistic results. The second issue was in the modelling of the contact line between the CSM block and an inclined layer underneath. The analysis result showed that the excavation-induced deformation highly depends on how the PLAXIS user defines the contact area. It was understood that if the contact area had defined as a point in which CSM block had intersected the layer underneath the estimated lateral displacement of CSM block would be unrealistically lower than the model in which the contact area was defined as a line.
Abstract: Kolkata, the City of Joy, is a greying metropolis not only in respect of its concrete jungle but also because of the largest population of 60-plus residents that it shelters among all other cities in India. Declining birth and death rates and a negative growth of population indicate that the city has reached the last stage of demographic transition. Thus, the obvious consequence has been the ageing of its population. With this background, the present paper attempts to study the demographic and socio-economic status of the elderly population in Kolkata. Analysis and findings have been based on secondary data obtained from Census of India of various years, Sample Registration System Reports and reports by HelpAge India. Findings show that the elderly population is increasing continuously. With respect to gender, the male elderly outnumbers the female elderly population. The percentage of households having one elderly member is more in the city due to the emergence of the nuclear families and erosion of joint family system. With respect to socio-economic status, those elderly who are the heads of the family are lower in percentages than those in the other age groups. Also, male elderly as head of the family are greater in percentage than female elderly. Elderly in the category of currently married records the highest percentage followed by widowed, never married and lastly, separated or divorced. Male elderly outnumber the female elderly as currently married, while female elderly outnumbers the male elderly in the category of widowed. In terms of living status, the percentage of elderly who are living alone is highest in Kolkata and the reason for staying alone as no support from children also happens to be highest in this city. The literacy rate and higher level of education is higher among the male than female elderly. Higher percentages of female elderly have been found to be with disability. Disability in movement and multiple disabilities have been found to be more common among the elderly population in Kolkata. Percentages of male literate pensioners are highest than other categories. Also, in terms of levels of education male elderly who are graduate and above other than technical degree are the highest receivers of pension. Also, in terms of working status, elderly as non-workers are higher in percentages with the population of elderly females outnumbering the males. The old age dependency ratio in the city is increasing continuously and the ratio is higher among females than male. Thus, it can be stated that Kolkata is witnessing continuous and rapid ageing of its population. Increasing dependency ratio is likely to create pressure on the working population, available civic, social and health amenities. This requires intervention in the form of planning, formulation and implementation of laws, policies, programs and measures to safeguard and improve the conditions of the elderly in Kolkata.
Abstract: Viability and competency during competition is the dream of every team sports so as to have a good result. But it seems factors abound which deter the performance of even a good sports team. Different individuals with different state of mind all come together to perform in team sports with different degree of satisfaction. This study investigated the role of satisfaction on performance among Afe Babalola University team sports. Descriptive survey research design was used and the population consists of all male and female athletes in the team sports that participated in the last 2019 Ekiti State Higher Institution games (ESHIGA). Total enumeration technique was used for the three team sports; football (44), basketball (24) and volleyball (24). A total of 92 participants were involved in the research. The instrument used for the study was a modified Athlete Satisfaction Scale (ASS). The questionnaire was divided into two sections. The Cronbach’s Alpha reliability coefficient of 0.71 was obtained. The hypotheses were tested at 0.05 significant levels. The completed questionnaire was collated, coded, and analyzed using descriptive statistics of frequency counts and percentage and inferential statistics of chi-square (X2). Findings of this study revealed that satisfaction significantly influences team sports performance among Athletes of Afe Babalola University. The responsibility of satisfying athlete lies on the coaches, fans, sports administrators as well as organizers of such event, as it is not only financial reward that gives satisfaction. The performance of a team sports is quiet important and its being determined by the degree of satisfaction of each individual that make up the team. All effort must be made to satisfy athlete in order to guarantee optimum performance.
Abstract: Introduction: Students make plans for their career and are keen in exploring options of employment in those carriers. They make their employment choice based on their desires and preferences. This study aims to identify if students of King Saud Bin Abdulaziz for Health Sciences, College of Applied Medical Sciences after obtaining appropriate education prefer to work as clinicians, university faculty, or full-time researchers. There are limited studies in Saudi Arabia exploring the university student’s employment choices and preferences. This study would help employers to build the required job positions and prevent misleading employers from opening undesired positions in the job market. Methodology: The study included 394 students from third and fourth years both male and female among the eighth programs of college of applied medical sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus. A prospective quantitative cross-sectional study was conducted; data were collected by distributing a seven item questionnaire and analyzed using SPSS. Results: Among the participants, 358 (90.9%) of them chose one of the three listed career choices, 263 (66.8%) decided to work as hospital staff after their education, 75 students (19.0%) chose to work as a faculty member in a university after obtaining appropriate degree, 20 students (5.1%) preferred to work as full-time researcher after obtaining appropriate degree, the remaining 36 students (9.1%) had different career goals, such as obtaining a master degree after graduating, to obtain a bachelor of medicine and bachelor in surgery degree, and working in the private sector. The most recurrent reason behind the participants' choice was "career goal", where 276 (70.1%) chose it as a reason. Conclusion: The findings of the study showed that most student’s preferred to work in hospitals as clinicians, followed by choice of working as a faculty in a university, the least choice was to be working as full-time researchers.
Abstract: This study examines the levels of dopamine and serotonin in blood samples of children who stutter compared with normal fluent speakers. Blood specimens from 50 children who stutter (6 females, 44 males) and 50 normal children matched age and gender were collected for the purpose of the current study. The concentrations of dopamine and serotonin were measured using the 1100 series high-performance liquid chromatography coupled with ultraviolet detector instrument (HPLC-UV). It was revealed that dopamine level in the blood samples of stuttering group and fluent group was not significant (P = 0.769), whereas the level of serotonin was significantly higher in the blood samples of stuttering group than the blood samples of fluent normal group (P = 0.015). It is concluded that serotonin blockers could be used in future studies to evaluate its role as a medication for the treatment of stuttering.
Abstract: The paper declares effects of exercise intervention of the research project “Basic research of balance changes in seniors”, granted by the Czech Science Foundation. The objective of the presented study is to define predictors, which influence bio-psycho-social consequences and effects of balance ability in senior 65 years old and above. We focused on the Fall-Efficacy Scale changes evaluation in seniors. Comprehensive hypothesis of the project declares, that motion uncertainty (dyskinesia) can negatively affect the well-being of a senior in bio-psycho-social context. In total, random selection and testing of 100 seniors (30 males, 70 females) from Prague and Central Bohemian region was provided. The sample was divided by stratified random selection into experimental and control groups, who underwent input and output testing. For diagnostics the methods of Medical Anamnesis, Functional anthropological examinations, Tinetti Balance Assessment Tool, SF-36 Health Survey, Anamnestic comparative self-assessment scale were used. Intervention method called "Life in Balance" based on yoga techniques was applied in four-week cycle. Results of multivariate regression were verified by repeated measures ANOVA: subject factor, phase of intervention (between-subject factor), body fluid (within-subject factor) and phase of intervention × body fluid interaction). ANOVA was performed with a repetition involving the factors of subjects, experimental/control group, phase of intervention (independent variable), and x phase interaction followed by Bonferroni multiple comparison assays with a test strength of at least 0.8 on the probability level p < 0.05. In the paper results of the first-year investigation of the three years running project are analysed. Results of balance tests confirmed no significant difference between females and males in pre-test. Significant improvements in balance and walking ability were observed in experimental group in females comparing to males (F = 128.4, p < 0.001). In the females control group, there was no significant change in post- test, while in the female experimental group positive changes in posture and spine flexibility in post-tests were found. It seems that females even in senior age react better to incentives of intervention in balance and spine flexibility. On the base of results analyses, we can declare the significant improvement in social balance markers after intervention in the experimental group (F = 10.5, p < 0.001). In average, seniors are used to take four drugs daily. Number of drugs can contribute to allergy symptoms and balance problems. It can be concluded that static balance and walking ability of seniors according Tinetti Balance scale correlate significantly with psychic and social monitored markers.
Abstract: Introduction: Medical malpractice can be defined as health workers neglecting the expected standard or intentionally not implementing it, doing it wrong and/or incomplete, not being able to implement the accurate practice due to personal or systemic reasons despite desiring to do it correctly and the condition that causes permanent or temporary damage to the patient as a result. If the training periods in which health workers improve their knowledge and skills are passed efficiently, they are expected to have a low rate of error in their professional lives. Aim: Aim of the study is to determine the medical malpractice tendencies of students studying in nursing department. Material and Methods: This descriptive research has been performed with 454 students who study in 3rd and 4th years in the Nursing Department of the Faculty of Health Sciences in a state university in normal and evening education and go out for clinical practice during the 2017-2018 academic year. The sample consisted of 454 students who agreed to participate in the study. Ethics committee approval, the permission of the institution and the verbal consent of the participants were obtained. In collection of data, ‘Personal Information Form’ developed by the researchers and the Malpractice Tendency Scale (SMT) were used. The data were analyzed using SPSS 20 package program. 0.05 was used as the level of significance. Results: The Cronbach’s alpha internal consistency coefficient of the scale was 0.94 and the total mean value of the scale was 211.69 ± 22.14. The mean age of the participants was 22,08 ± 1,852 years; 165 (36,4%) were male and 288 (63,6%) were female. Their mean General Point Average (GPA) was 2.65 ± 0.454 (min 1.03 - max 3.90). Students' average duration of self study per week was 2.89 ± 3.81 (min 0 - max 30) hours. The mean score (80.73) of the 4th year students in the sub-dimension of Drug and Transfusion Applications was significantly higher than the mean score (79.20) of 3rd year students (p < 0.05). The mean score (81.01) of the Drug and Transfusion Applications sub-dimension of those who willingly chose the profession was higher than the mean score (78.88) of those who chose the profession unwillingly. The mean average score (21.48) of Fallings sub-dimension of students who cared for 3 to 4 patients per day was lower than the mean score (22.41) of those who cared for 5 patients and over daily on average (p < 0.05). Conclusion: As a result of this study, it was concluded that malpractice tendency of nursing students was low, and an inverse relationship was found between the duration of education and malpractice tendency.
Abstract: In this paper, the techniques to solve time dependent electromagnetic wave propagation equations based on the Finite Difference Method (FDM) are proposed by comparing the results with Finite Element Method (FEM) in 2D while discussing some special simulation examples. Here, 2D dynamical wave equations for lossy media, even with a constant source, are discussed for establishing symbolic manipulation of wave propagation problems. The main objective of this contribution is to introduce a comparative study of two suitable numerical methods and to show that both methods can be applied effectively and efficiently to all types of wave propagation problems, both linear and nonlinear cases, by using symbolic computation. However, the results show that the FDM is more appropriate for solving the nonlinear cases in the symbolic solution. Furthermore, some specific complex domain examples of the comparison of electromagnetic waves equations are considered. Calculations are performed through Mathematica software by making some useful contribution to the programme and leveraging symbolic evaluations of FEM and FDM.
Abstract: This paper describes the qualification test campaign performed on the Demise Observation Capsule DOC-EQM as part of the Future Launch Preparatory Program FLPP3. The mechanical environment experienced during launch ascent and separation phase was first identified and then replicated in terms of sine, random and shock vibration. The loads identification is derived by selecting the worst possible case. Vibration and shock qualification test performed at CIRA Space Qualification laboratory is herein described. Mechanical fixtures’ design and validation, carried out by means of FEM, is also addressed due to its fundamental role in the vibrational test campaign. The Demise Observation Capsule (DOC) successfully passed the qualification test campaign. Functional test and resonance search have not been point any fault and damages of the capsule.
Abstract: Rapid aging and depopulation could lead to serious problems, including workforce shortages and health expenditure costs. The current and predicted future LTC workforce shortages could be a real threat to Taiwan’s society. By means of comparison of data from 144 nursing aide trainees and 727 general public, the main purpose of the present study was to determine whether there were any notable differences between the two groups toward engaging in LTC services. Moreover, this study focused on recognizing the attributes of the general public who had the willingness to take LTC jobs but continue to ride the fence. A self-developed questionnaire was designed based on Ajzen’s Theory of Planned Behavior model. After conducting exploratory factor analysis (EFA) and reliability analysis, the questionnaire was a reliable and valid instrument for both nursing aide trainees and the general public. The main results were as follows: Firstly, nearly 70% of nursing aide trainees showed interest in LTC jobs. Most of them were middle-aged female (M = 46.85, SD = 9.31), had a high school diploma or lower, had unrelated work experience in healthcare, and were mostly unemployed. The most common reason for attending the LTC training program was to gain skills in a particular field. The second most common reason was to obtain the license. The third and fourth reasons were to be interested in caring for people and to increase income. The three major reasons that might push them to leave LTC jobs were physical exhaustion, payment is bad, and being looked down on. Secondly, the variables that best-predicted nursing aide trainees’ intention to engage in LTC services were having personal willingness, perceived behavior control, with high school diploma or lower, and supported from family and friends. Finally, only 11.80% of the general public reported having interest in LTC jobs (the disapproval rating was 50% for the general public). In comparison to nursing aide trainees who showed interest in LTC settings, 64.8% of the new workforce for LTC among the general public was male and had an associate degree, 54.8% had relevant healthcare experience, 67.1% was currently employed, and they were younger (M = 32.19, SD = 13.19) and unmarried (66.3%). Furthermore, the most commonly reason for the new workforce to engage in LTC jobs were to gain skills in a particular field. The second priority was to be interested in caring for people. The third and fourth most reasons were to give back to society and to increase income, respectively. The top five most commonly reasons for the new workforce to quitting LTC jobs were listed as follows: physical exhaustion, being looked down on, excessive working hours, payment is bad, and excessive job stress.