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MS.SHASHIKALA JAVALI1st YEAR M.Sc NURSING,PEDIATRIC NURSING2012-2014 BATCH.SARVODAYA COLLEGE OF NURSINGBANGALORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRESS
Ms. SHASHIKALA JAVALI
1ST YEAR MSC NURSINGSARVODAYA COLLEGE OF NURSING.#11/2, MAGADI MAINROAD, AGRAHARA, DASARAHALLI, BANGALORE -560 079.
2. NAME OF THE INSTITUTION Sarvodaya College of Nursing, Bangalore.3. COURSE OF THE STUDY AND
SUBJECT1ST year M.Sc. Nursing.
Pediatric Nursing4. DATE OF ADMISSION OF COURSE 9/07/2012
1
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
5. TITLE OF THE TOPIC “A study to asses the effectiveness of video
assisted teaching program on knowledge
regarding childhood obesity among
students of selected school at Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK6.0 Introduction6.1 Need for the study6.1.1 Statement of the problem6.2 Review of related literature6.3 Objectives of the study6.3.1 Operational definitions6.3.2 Assumptions6.3.3 Hypothesis6.3.4 Sampling Criteria(Inclusion and Exclusion criteria)6.3.5 Delimitations
EnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosed
Enclosed7. MATERIALS AND METHODS
7.1. Sources of data: The data will be collected from the students of selected school.
7.2. Method of data collection: Interview method and self administered questionnaire will be used to collect the data.
7.3 Does the study require any investigations or interventions to be conducted on the patients or other humans or animals? YES
7.4. Has ethical clearance been obtained from your institution? YES
8 LIST OF REFERENCES Enclosed
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1. NAM
E OF THE CANDIDATE AND
ADDRESS
Ms. SHASHIKALA JAVALI
1ST YEAR MSC NURSING
SARVODAYA COLLEGE OF NURSING,
#11/2, MAGADI MAINROAD, AGRAHARA
2
DASARAHALLI, BANGALORE -560 079.
2. NAME OF THE INSTITUTION Sarvodaya College of Nursing, Bangalore.
3. COURSE OF THE STUDY AND
SUBJECT
1st year M.Sc. Nursing.
Pediatric Nursing.
4. DATE OF ADMISSION OF COURSE 9/07/2012
5. TITLE OF THE TOPIC “A study to asses the effectiveness of video
assisted teaching program on knowledge
regarding childhood obesity among students
of selected school at Bangalore.”
6. BRIEF RESUME OF INTENDED WORK
6.0 INTRODUCTION
“Childhood obesity is a huge systemic problem. It's a pandemic to a certain extent.”
-Cathy Nonas
3
Childhood obesity is a serious medical condition that affects children
and adolescents. It occurs when a child is well above the normal weight for his or her age
and height. Childhood obesity is particularly troubling because the extra pounds often
start children on the path to health problems that were once confined to adults, such as
diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to
poor self-esteem and depression. [1]
One of the best strategies to reduce childhood obesity is to improve the
diet and exercise habits of entire family. Treating and preventing childhood obesity helps
protect the health of your child now and in the future. [2]
Obesity is the most common nutritional disorder, particularly
among the affluent, all over the world. Obesity may be described as a condition
characterized by excessive deposition of fat in the body. It usually results from
consumption of food in excess of physiological needs. [3]
Obesity in general is defined as the presence of excess adipose tissue in the
body to such a degree that it may lead to health hazards (Prenticeet al. 2001; Rossner
2002). Obesity is not a single disorder but a heterogeneous group of conditions with
multiple causes. Body weight is determined by an interaction between genetic,
environmental, psychological factors acting through the physiological mediators of
energy intake and expenditure. Even in India, malnutrition has attracted the focus of
health workers, as childhood obesity was rarely observed. But over the past few years,
childhood obesity is increasingly being observed with the changing lifestyle of families
with increased purchasing power, increasing hours of inactivity due to addiction to
4
television, videogames and computer, which have replaced outdoor games and other
social activities (Singh and Sharma 2005).
Globally, an estimated 10 percent of school children aged between 5 to 17 years
are overweight and obese (Childhood Obesity-the Global Picture 2006). The prevalence
of obesity in children has increased over the past few decades and its statistics are
alarming. The prevalence and etiologies behind the childhood obesity may vary
according to an individual lifestyle and their socio-economic status. Most of the reports
with regards to childhood obesity are from studies conducted at metropolitan cities in
India. . [4]
6.1 NEED FOR THE STUDY
The prevalence of child obesity is increasing rapidly worldwide. [5.1] It is
associated with several risk factors for later heart disease and other chronic diseases
5
including hyper lipidaemia, hyper insulinaemia, hypertension, and early atherosclerosis.
[5.2, 5.3] These risk factors may operate through the association between child and adult
obesity, but they may also act independently. [5]
Worldwide, obesity trends are causing serious public health concern and in many
countries threatening the viability of basic health care delivery. It is an independent risk
factor for cardiovascular diseases and significantly increases the risk of morbidity and
mortality. The last two decades have witnessed an increase in health care costs due to
obesity and related issues among children and adolescents. Childhood obesity is a global
phenomenon affecting all socio-economic groups, irrespective of age, sex or ethnicity.
Aetio pathogenesis of childhood obesity is multi-factorial and includes genetic,
neuroendocrine, metabolic, psychological, environmental and socio-cultural factors.
Many co-morbid conditions like metabolic, cardiovascular, psychological, orthopedic,
neurological, hepatic, pulmonary and renal disorders are seen in association with
childhood obesity. The treatment of overweight and obesity in children and adolescents
requires a multidisciplinary, multi-phase approach, which includes dietary management,
physical activity enhancement, restriction of sedentary behavior, pharmacotherapy and
bariatric surgery. [6]
.
Obesity is measured using the Body Mass Index (BMI) for an individual. This is
measured through a calculation relating height to weight and age, and there are agreed
figures for obesity.[7]
6
Obesity rates are generally the highest in communities with high levels of
poverty and low levels of income. Low-income communities are often underserved by
grocery stores and frequently have fewer places that are safe for children to play. A
higher prevalence of obesity seen in the urban areas in developing countries is associated
with the change from rural to urban lifestyle causing decreased levels of physical activity
and an increase intake of energy-dense diet. .[8]
Most children do not get the required amount of physical activity. A lack of
safe places to play outside, community infrastructures that do not support walking and
biking as a means of transportation and the recent reduction and elimination of physical
education in schools has led to increased levels of obesity in children. .
Children living in neighborhoods considered unsafe by their parents are more
likely to be overweight than children who live in what their parents consider to be safe
neighborhoods [9] Moving from a high poverty area to a low poverty area is associated
with a 50 percent increase in the overall availability of outdoor places to play and engage
in physical activity[10] Living in communities without access to fresh foods limits the
ability of parents to provide nutritious meals for their children, and this lack of access
disproportionately affects minority and low-income families. [11]
Many countries in South-East Asia including India are going through an
economic and nutrition transition. [12] The nutrition transition is associated with a change
in dietary habits, decreasing physical activity and rising prevalence of obesity. [13]
Overweight and obesity are major risk factors for a number of chronic diseases, including
diabetes, cardiovascular diseases and cancer. Obesity in children and adolescents is
7
gradually becoming a major public health problem in many developing countries,
including India. [14]
One-half of obese school children become obese adults. However, whether or not
obesity persists into adulthood, obesity in childhood appears to increase the risk of
subsequent morbidity'. [15],[16],[17] Significance of estimating prevalence of childhood
obesity thus cannot be overemphasized. There are a few studies, reporting, prevalence of
childhood and adolescent obesity and overweight from different parts of India (Punjab,
Maharashtra, Delhi and South India) that range from 3% to 29%, and also indicate that
the prevalence is higher in urban than in rural areas. [18]
Many countries in South-East Asia including India are going through an
economic and nutrition transition. [19] The nutrition transition is associated with a change
in dietary habits, decreasing physical activity and rising prevalence of
obesity. [20] Overweight and obesity are major risk factors for a number of chronic
diseases, including diabetes, cardiovascular diseases and cancer. Obesity in children and
adolescents is gradually becoming a major public health problem in many developing
countries, including India. [21] 'One-half of obese school children become obese adults.
However, whether or not obesity persists into adulthood, obesity in childhood appears to
increase the risk of subsequent morbidity'. [22],[23],[24]
Significance of estimating prevalence of childhood obesity thus cannot be
overemphasized. There are a few studies, reporting, prevalence of childhood and
adolescent obesity and overweight from different parts of India (Punjab, Maharashtra,
Delhi and South India) that range from 3% to 29%, and also indicate that the prevalence
is higher in urban than in rural areas.[25]
8
"Karnataka is ranked 9th in female obesity and 14th in male obesity with
17.3% obese women and 12% obese men. Most alarming is increasing cases of childhood
obesity."
Morbid obesity is considered life-threatening. "About 5% of Bangalore's population
is morbidly obese. This reduces life expectancy by 12-15 years and can be a cause of life-
threatening diseases," said Dr Shrikanth. [26]
The present study was conducted to assess the BMI and Body Fat percent among
the affluent adolescent girls (n = 794) (9-18 years) and to determine the prevalence of
overweight and obesity.
All measurements were recorded for two and a half years, at six monthly
intervals. The study design was cross linked longitudinal in nature, thus increasing the
sample size at the end of the study from 794 to an observational figure of 3970. BMI
clubbed with BIA field technique to measure the adiposity (body fat %) were used to
assess the overweight among them.
According to CDC BMI criteria, the prevalence of overweight and obesity in
affluent adolescent school girls was seen in 13.1% and 4.3% respectively. The actual
body fat per cent values for assessing overweight and obesity among the girls was
calculated based on cutoffs of 85th and 95th percentile values respectively. The body fat
% 85th percentile values for assessing overweight among the girls ranged from 20.7 to
34.1 and 95th percentile values from 25.9 to 41.2 for ages 9 to 17.5 years respectively.
Higher velocity of BMI and body fat per cent were also observed during the pubertal
period, between 10-12 years among the girls. Overweight is an emerging health problem
in adolescent girls belonging to affluent families in Bangalore city. [27]
9
In world wide controversy is going on regarding childhood obesity, It is more
prevalence in India. I had been seen many obesity children and wonder about that causes,
that is the reason impressed me to do this research on my statement problem.
According to my intension, children’s are taking more unhealthy foods like junk food,
ice cream etc. Lack of activity, always eating and supportive eating practice.
6.2 REVIEW OF LITERATURE
10
Review of literature is the systematic and critical review of the important
published scholarly literature on particular topic. This helps the investigator to find what
is already known and what problems remain to be solved.
The Review of literature of the present study is organized under the following
headings.
1. Prevalence of Overweight and Obesity in Indian Adolescent School Going Children:
It’s Relationship with Socioeconomic Status and Associated Lifestyle Factors.
2. Study of childhood obesity among school children aged 6 to 12 years in union
territory.
3. Prevalence of Obesity and Its Influencing Factor among Affluent School Children.
4. Prevalence of Childhood Obesity in School Children from Rural and Urban Areas in
Mysore.
5. Breast-feeding and childhood obesity — a systematic review.
1. Prevalence of Overweight and Obesity in Indian Adolescent School Going
Children: It’s Relationship with Socioeconomic Status and Associated Lifestyle
Factors.
Obesity and overweight have become a worldwide epidemic, and there is an
urgent need to examine childhood obesity and overweight across countries using a
standardized international standard. In the present study we have investigated the
prevalence of obesity and overweight and their association with socioeconomic status
(SES) and the risk factors like diet, physical activity like exercise, sports, and sleeping
11
habit in afternoon, eating habits like junk food, chocolate, eating outside at weekend,
family history of diabetes and obesity.
The study was carried out in 5664 school children of 12–18 years of age and
having different SES. The obesity and overweight were considered using an updated
body mass index reference. SES and life style factors were determined using pre-tested
questionnaire.
Age-adjusted prevalence of overweight was found to be 14.3% among
boys and 9.2% among girls whereas the prevalence of obesity was 2.9% in boys and
1.5% in girls. The prevalence of overweight among children was higher in middle SES as
compared to high SES group in both boys and girls whereas the prevalence of obesity
was higher in high SES group as compared to middle SES group. The prevalence of
obesity as well as overweight in low SES group was the lowest as compared to other
group. Eating habit like junk food, chocolate, eating out side at weekend and physical
activity like exercise, sports, sleeping habit in afternoon having remarkable effect on
prevalence on overweight and obesity among middle to high SES group. Family history
of diabetes and obesity were also found to be positively associated.
Our data suggest that the prevalence of overweight and obesity varies remarkably
with different socio economic development levels. [28]
12
2. Study of childhood obesity among school children aged 6 to 12 years in union
territory.
To study the prevalence of obesity and overweight among school children in
Puducherry. To identify any variation as per age, gender, place of residence and type of
school.
Secondary data analysis of a school-based cross sectional study in all the four
regions of Puducherry.
Children between 6 and 12 yrs were sampled using multistage random sampling
with population proportionate to size from 30 clusters. Anthropometric data (BMI) was
analyzed using CDC growth charts. Data was analyzed using SPSS, BMI (CDC)
calculator, CI calculator and OR calculator.
The prevalence of overweight among children was 4.41% and prevalence of
obesity was 2.12%. Mahe region had the highest prevalence of overweight and obesity .
Female children from private schools and urban areas were at greater risk of being
overweight and obese. Childhood obesity is a problem in Puducherry and requires timely
intervention for its control. [29]
13
3. Prevalence of Obesity and Its Influencing Factor among Affluent School Children.
Childhood obesity is a fast emerging problem for which national representative
data is scarce. Effective preventive of adult obesity will require prevention and
management of childhood obesity. To know the prevalence of obesity in two affluent
school children of Davangere city studying between 5th and 10th standard and to
identify the factors influencing childhood obesity. A cross sectional study followed by a
case control study was conducted in two affluent schools of Davangere city – Sri.
Siddaganga and Sri. Taralabalu residential school. A total of 1496, school children
studying between 5th and 10th standard aged between 10 and 15 years were enrolled
and data on family history of obesity, diet, snacking habits and physical activity was
collected. Out of 1496 children 86 were obese. Prevalence of obesity was 5.74 %.
Prevalence of obesity was more in girls (8.82%) than boys (4.42%). Prevalence of
obesity increased, with increase in age in both boys and Girls. Family history of
obesity, snacking of high energy foods and lack of physical activity were the important
influencing factor of obesity Consumption of high fat and high energy (Junk foods)
and snacking in between the meals should be avoided by children. Health education
should be given to parents, teachers and children regarding dietary habit and sedentary
life style. [30]
14
4. Prevalence of Childhood Obesity in School Children from Rural and Urban Areas in
Mysore.
Prevalence studies on obesity in school children has been carried out extensively
worldwide but such explorations are very limited in Indian populations, especially a
comparative account between rural and urban areas. Very few earlier investigations in
India have reported an increased prevalence of childhood obesity ranging from 5.5 % to
17%. This study was designed to know the prevalence of childhood obesity in school
children from rural and urban areas in Mysore population. Data on the prevalence of
obesity in children were collected and analyzed from three and four major schools from
urban and rural areas of Mysore district respectively. The prevalence of childhood
obesity in Mysore is not very high as compared to other reports from different regions of
the country. However, it is an important multifactorial condition which needs immediate
medical attention to stop the march of healthy children towards chronic disorders. [31]
5. Breast-feeding and childhood obesity — a systematic review.
To investigate the relationship between breast-feeding and obesity in childhood,
Systematic review and meta-analysis of published epidemiological studies (cohort, case–
control or cross-sectional studies) comparing early feeding-mode and adjusting for
potential confounding factors. Electronic databases were searched and reference lists of
relevant articles were checked. Calculations of pooled estimates were conducted in fixed-
and random-effects models. Heterogenecity was tested by Q-test. Publication bias was
15
assessed from funnel plots and by a linear regression method. Odds ratio (OR) for obesity
in childhood defined as body mass index (BMI) percentiles. Nine studies with more than
69 000 participants met the inclusion criteria. The meta-analysis showed that breast-
feeding reduced the risk of obesity in childhood significantly. The adjusted odds ratio
was 0.78, 95% CI (0.71, 0.85) in the fixed model. The assumption of homogeneity of
results of the included studies could not be refuted (Q-test for heterogeneity, P>0.3),
stratified analyses showed no differences regarding different study types, age groups,
definition of breast-feeding or obesity and number of confounding factors adjusted for. A
dose-dependent effect of breast-feeding duration on the prevalence of obesity was
reported in four studies. Funnel plot regression gave no indication of publication bias.
Breast-feeding seems to have a small but consistent protective effect against obesity in
children. [32]
6.2.1 STATEMENT OF THE PROBLEM
“A study to asses the effectiveness of video assisted teaching program on
knowledge regarding childhood obesity among students of selected school at
Bangalore.”
16
6.3 OBJECTIVE OF THE STUDY
To asses the pre test and post test knowledge on childhood obesity among
school students.
To determine the effectiveness of video assisted teaching program on
knowledge regarding childhood obesity, among school students.
To find an association between the knowledge scores with the selected
demographic variables
6.3.1 OPERATIONAL DEFINTION
1.Effectiveness: Refers to gain in knowledge as determined by significant difference in
pre test and post test knowledge score on childhood obesity after administering video
assisted teaching program.
2.Video assisted teaching program:, It refers to systematically organized teaching
program which include introduction, definition, causes, symptoms, diagnosis, treatment,
prevention and complications of childhood obesity.
3. Knowledge; It refers the response of the students to the questions stated in
questionnaires, regarding childhood obesity among students of selected school at,
Bangalore.
17
4.Childhood obesity: Childhood obesity is defined as a condition of abnormal or
excessive fat accumulation throughout the body.
5 . Students: The children who are studying in 8th & 9th standard between the age group
of 14 and 15 years. .
6.3.2 ASSUMPTION
1. Students may have limited knowledge regarding childhood obesity.
2. Teaching strategy may be effective in improving the knowledge
6.3.3 HYPOTHESIS
H1 – There is significant improvement in knowledge scores after video assisted
teaching program than before video assisted teaching program.
H2- There is no significant association between knowledge level and selected socio -
demographic variables.
6.3.4 SAMPLING CRITERIA
Inclusion criteria
The students who are:
1. Available at the time of data collection.
2. Willing to participate in the study.
18
3. Knows to read and write English.
Exclusion criteria
The students whose :
1. Parents are health professionals.
6.3.5 DE-LIMITATIONS
1. This study is limited to selected school at Bangalore.
2. This study is limited to four weeks.
7.0 METHODS AND MATERIALS
7.1 SOURCES OF DATA
The data will be collected from the students in selected school at Bangalore.
7.2METHODS OF DATA COLLECTION
Interview method and self administered questionnaire will be used to collect the data.
7.2.1 Research approach:
Evaluative approach.
19
7.2.2 Research Design:
The researcher will use Quasi Experimental (one group pre-test and post test) research
design.
7.2.1 Settings:
Students of selected school at Bangalore.
7.2.2 Population:
The Population of present study consists of 8th & 9th std students of selected school at
Bangalore.
7.2.3 Sample:
The Study will be conducted among students who meet the inclusion criteria.
7.2.4 Sample Size:
The Researcher will select 100 samples for the study.
7.2.5 Sampling Technique:
Simple random sampling technique.
20
7.2.6 Tool for data collection:
The tool will be in the form of self- administered knowledge
questionnaire.
The tool consist of two sections namely section A and B.
Section A consist of information related to socio-demographic
characteristics.
Section B consist of questions related to knowledge on childhood obesity.
7.2.9 Method of data Analyses & Interpretation:
Data will be analyzed in terms of the objectives & hypothesis of the study by both
descriptive & inferential statistics.
1) Demographical variables will be analyzed by Frequency & Percentage.
2) The knowledge of the students will be analyzed by using mean, median &
standard deviation.
3) The effectiveness of video assisted teaching program is analyzed by paired ‘t’test.
4) Association Between knowledge and selected demographic variables will be
analyzed by chi- square test.
7.2.10 Duration of the study:
4 Weeks
21
7.2.11 Research Variables:
Independent Variable: video assisted teaching program on childhood obesity.
Dependent Variables: Knowledge on childhood obesity.
Demographic Variable: Age, Sex, parents Educational status and occupation,
dietary pattern vegetarian / non- vegetarian per week , height,
weight ,residence ,diet pattern breakfast, snacking habits per week, eating outside
at weekend ,pocket money per day / per week, physical activity like
exercise ,sports, physiological problems, psychological problems, family history
of diabetes and obesity ,socio economic status, previous sources of knowledge
Yes/No. If Yes specify.
7.2.12 Projected Outcome:
The study may be beneficial in improving the level of knowledge of students
regarding childhood obesity and to help them to improve their food habits, So as
to have a quality of healthy life style.
7.3 Does the study require any investigation or intervention to be conducted and the
school teachers or other human beings or animals?
-Yes
7.4 Has ethical clearance been obtained from your institution?
22
-Yes ethical clearance report is here with enclosed.
8. LIST OF REFERENCES.
1. Mayo Clinic staff. Childhood obesity. mayoclinic.com. May 4, 2012
http://www.mayoclinic.com/health/childhood-obesity/DS00698
2. Mayo Clinic staff. Childhood obesity. mayoclinic.com. May 4, 2012
http://www.mayoclinic.com/health/childhood-obesity/DS00698
3. EDITORS-DESK. Child obesity: Causes & Cure. asklaila.com.
http://www.asklaila.com/article/Bangalore/Child-obesity-Causes-Cure/148465/
4. Y. S. Saraswathi, Mohsen Najafi , M. R. Gangadhar and Suttur S. Malini.
Prevalence of Childhood Obesity in School Children from Rural and Urban Areas
in Mysore, Karnataka, India; 2011;3(1): 51-55
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cardiovascular risk in children. Ann NY Acad Sci. 1993;699:93–103.
5.3 Mahoney LT, Burns TL, Stanford W. Coronary risk factors measured in
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young adults: the Muscatine study. J Am Coll Cardiol. 1996;27:277–284.
23
6. MIRANDA JANE PALLAN. CHILDHOOD OBESITY AND ITS
PREVENTION IN PRIMARY SCHOOL-AGED CHILDREN: A FOCUS ON
SOUTH ASIAN COMMUNITIES IN THE UK. 2010
http://etheses.bham.ac.uk/1347/1/Pallan11PhD.pdf
7. All-Party Parliamentary Group on Obesity. (2002) Fat kids equals fat profits: are
we exploiting our children’s health?
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939400/
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mass index. Health and Social Work, 34(3), 169-178.
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setting and race, ethnicity, and socioeconomic status. Evidence-Based
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Int J Obes Relat Metab Disord. 1999;23:S2-11
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25
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Natesan, Sandeep Arepally, V Senthilvel. Study of childhood obesity among
school children aged 6 to 12 years in union territory of Puducherry. Indian Journal
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31. Y. S. Saraswathi, Mohsen Najafi , M. R. Gangadhar and Suttur S. Malini
Prevalence of Childhood Obesity in School Children from Rural and Urban Areas
in Mysore, Karnataka, India 3(1): 51-55 (2011)
26
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000-1 1-Abst-PDF/JLS-3-1-051-11-055-Saraswathi-Y-S/JLS-3-1-051-11-055-
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