Search results for: brief cognitive behavior therapy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9784

Search results for: brief cognitive behavior therapy

6394 Influence of AAR-Induced Expansion Level on Confinement Efficiency of CFRP Wrapping Applied to Damaged Circular Concrete Columns

Authors: Thamer Kubat, Riadh Al Mahiadi, Ahmad Shayan

Abstract:

The alkali-aggregate reaction (AAR) in concrete has a negative influence on the mechanical properties and durability of concrete. Confinement by carbon fiber reinforced polymer (CFRP) is an effective method of treatment for some AAR-affected elements. Eighteen reinforced columns affected by different levels of expansion due to AAR were confined using CFRP to evaluate the effect of expansion level on confinement efficiency. Strength and strain capacities (axial and circumferential) were measured using photogrammetry under uniaxial compressive loading to evaluate the efficiency of CFRP wrapping for the rehabilitation of affected columns. In relation to uniaxial compression capacity, the results indicated that the confinement of AAR-affected columns by one layer of CFRP is sufficient to reach and exceed the load capacity of unaffected sound columns. Parallel to the experimental study, finite element (FE) modeling using ATENA software was employed to predict the behavior of CFRP-confined damaged concrete and determine the possibility of using the model in a parametric study by simulating the number of CFRP layers. A comparison of the experimental results with the results of the theoretical models showed that FE modeling could be used for the prediction of the behavior of confined AAR-damaged concrete.

Keywords: ATENA, carbon fiber reinforced polymer (CFRP), confinement efficiency, finite element (FE)

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6393 A Case of Postpartum Pulmonary Edema Induced by Oxytocin

Authors: May Zaw, Amber Latif, William Lim

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Postpartum dyspnea can be due to many causes, such as pulmonary embolism, amniotic fluid embolism, and peripartum cardiomyopathy, but less frequently due to acute pulmonary edema. The incidence of acute pulmonary edema during pregnancy and in the postpartum period has been estimated to be around 0.08%. About half of the cases are attributed to tocolytic therapy. Herein, we present a case of a young woman presenting with acute hypoxia after induction of labor with oxytocin and found to have acute pulmonary edema. This case aims to illustrate and add to a growing body of literature regarding oxytocin-induced acute pulmonary edema and highlights the importance of recognizing the rare complication of oxytocin and necessary interventions to avoid complications. Oxytocin-induced pulmonary edema is a relatively uncommon condition, but physicians should have a high index of suspicion to initiate timely intervention and avoid fetal complications.

Keywords: pulmonary, pregnancy, oxytocin, postpartum

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6392 Excellent Outcome with Early Diagnosis in an Infant with Wiskott-Aldrich Syndrome in a Tertiary Hospital in Oman

Authors: Surekha Tony, Roshan Mevada

Abstract:

Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disease resulting in recurrent infections, eczema, and microthrombocytopenia. In its classical form, significant combined immune deficiency, autoimmune complications, and risk of hematological malignancy necessitate early correction, preferably before 2 years of age, with hematopoietic stem cell transplant (HSCT) or gene therapy. Clinical features and severity are varied, making the diagnosis difficult in milder cases. We report an Omani boy diagnosed in early infancy with WAS based on clinical presentation and confirmed by genetic diagnosis with cure by HSCT from an HLA-identical sibling donor.

Keywords: genetic diagnosis, hematopoietic stem cell transplant, infant, Wiskott-Aldrich syndrome

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6391 Modeling the Effect of Thermal Gradation on Steady-State Creep Behavior of Isotropic Rotating Disc Made of Functionally Graded Material

Authors: Tania Bose, Minto Rattan, Neeraj Chamoli

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In this paper, an attempt has been made to study the effect of thermal gradation on the steady-state creep behavior of rotating isotropic disc made of functionally graded material using threshold stress based Sherby’s creep law. The composite discs made of aluminum matrix reinforced with silicon carbide particulate have been taken for analysis. The stress and strain rate distributions have been calculated for the discs rotating at elevated temperatures having thermal gradation. The material parameters of creep vary radially and have been estimated by regression fit of the available experimental data. Investigations for discs made up of linearly increasing particle content operating under linearly decreasing temperature from inner to outer radii have been done using von Mises’ yield criterion. The results are displayed and compared graphically in designer friendly format for the above said disc profile with the disc made of particle reinforced composite operating under uniform temperature profile. It is observed that radial and tangential stresses show minor variation and the strain rates vary significantly in the presence of thermal gradation as compared to disc having uniform temperature.

Keywords: creep, isotropic, steady-state, thermal gradation

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6390 Effect of Infill Walls on Response of Multi Storey Reinforced Concrete Structure

Authors: Ayman Abd-Elhamed, Sayed Mahmoud

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The present research work investigates the seismic response of reinforced concrete (RC) frame building considering the effect of modeling masonry infill (MI) walls. The seismic behavior of a residential 6-storey RC frame building, considering and ignoring the effect of masonry, is numerically investigated using response spectrum (RS) analysis. The considered herein building is designed as a moment resisting frame (MRF) system following the Egyptian code (EC) requirements. Two developed models in terms of bare frame and infill walls frame are used in the study. Equivalent diagonal strut methodology is used to represent the behavior of infill walls, whilst the well-known software package ETABS is used for implementing all frame models and performing the analysis. The results of the numerical simulations such as base shear, displacements, and internal forces for the bare frame as well as the infill wall frame are presented in a comparative way. The results of the study indicate that the interaction between infill walls and frames significantly change the responses of buildings during earthquakes compared to the results of bare frame building model. Specifically, the seismic analysis of RC bare frame structure leads to underestimation of base shear and consequently damage or even collapse of buildings may occur under strong shaking. On the other hand, considering infill walls significantly decrease the peak floor displacements and drifts in both X and Y-directions.

Keywords: masonry infill, bare frame, response spectrum, seismic response

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6389 Knowledge and Awareness of HIV/AIDS among Male Prisoners in Kuwait

Authors: Saroj Bala Grover, Al Munther Alhasawi, Prem N. Sharma, P. S. N. Menon

Abstract:

Background: Prisoners are considered one of the high-risk populations for the transmission of human immunodeficiency virus (HIV) infection. Targeting this group is one of the strategies to reduce the incidence of acquired immune deficiency syndrome (AIDS) in the community. Subjects and Methods: A cross-sectional study was conducted among male inmates in Kuwait’s prison by administering three sets of questionnaires to assess the level of their knowledge and awareness about the mode of transmission of HIV/AIDS, their risky personal behavior that may lead to HIV infection, and the presence of any negative attitudes and stigmatization towards HIV infected individuals. Results: The study included 123 male inmates, with a mean ± SD age of 30.9 ± 8.4 years. Most participants had good general knowledge (90%) about the mode of transmission of HIV/AIDS, including sharing contaminated syringes, risky personal behaviors such as having unprotected sex and increased number of extramarital relationships (66%), and the avoidance of the regular use of condoms. The younger age group (< 35 years) had more extramarital relationships than those > 35 years (71.4% Vs. 46.4%; p=0.016). There was a perceived attitude of stigmatization among inmates towards HIV-infected persons. Conclusions: This vulnerable group of prisoners, especially young adults, need educational programs to improve knowledge about the transmission of HIV and to correct and change their risky personal behaviors to protect themselves and the community against HIV transmission.

Keywords: HIV/AIDS, Kuwait, prisoners, knowledge, awareness, personal behavior, extramarital relationships, safe sex, discrimination, stigmatization

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6388 Determinants of Customer Value in Online Retail Platforms

Authors: Mikko Hänninen

Abstract:

This paper explores the effect online retail platforms have on customer behavior and retail patronage through an inductive multi-case study. Existing research on retail platforms and ecosystems generally focus on competition between platform members and most papers maintain a managerial perspective with customers seen mainly as merely one stakeholder of the value-exchange relationship. It is proposed that retail platforms change the nature of customer relationships compared to traditional brick-and-mortar or e-commerce retailers. With online retail platforms such as Alibaba, Amazon and Rakuten gaining increasing traction with their platform based business models, the purpose of this paper is to define retail platforms and look at how leading retail platforms are able to create value for their customers, in order to foster meaningful customer’ relationships. An analysis is conducted on the major global retail platforms with a focus specifically on understanding the tools in place for creating customer value in order to show how retail platforms create and maintain customer relationships for fostering customer loyalty. The results describe the opportunities and challenges retailers face when competing against platform based businesses and outline the advantages as well as disadvantages that platforms bring to individual consumers. Based on the inductive case research approach, five theoretical propositions on consumer behavior in online retail platforms are developed that also form the basis of further research with this research making both a practical as well as theoretical contribution to platform research streams.

Keywords: retail, platform, ecosystem, e-commerce, loyalty

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6387 The Effect of Motivation of Chinese Tourists to Visit North Korea on Their Revisit Intention: Focused on the Tourists with the Experience of Visiting North Korea

Authors: Kim Jin-OK, Lee Jin-Eui, Han Seung-Hoon, Kim Nam-Jo

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This study aimed to analyze the effect of the motivation of Chinese tourists to visit North Korea on their decision making process. Chinese tourists account for a considerable portion of foreign tourists in the world, while North Korea is the favorite tourist attraction of Chinese tourists. The motivation to visit North Korea was divided into three factors: the redness, which is the modern cultural heritage of Communism based on the red tourism accounting for the significant portion of domestic tourism, the novelty of the special environment of North Korean society, and the convenience of tour to North Korea in terms of geographical distance and policy of China. Red tourism refers to visiting the places of revolutionary events, monuments, artifacts and the residences of previous communist leaders, and other places related to the past Chinese Communist Party. As a revolutionary tourism, red tourism has recently been taking place in the old communist countries to recall their memories on the revolutionary places in China, as well as in North Korea, Vietnam, Cambodia, Russia, Bulgaria, Cuba, etc. In order to examine the effect of the segmented motivations on the revisit intention of Chinese tourists who have experienced a tour to North Korea, this study employed the model of goal-directed behavior, a model developed by adding a variable of emotion to the theory of planned behavior, which has a strong explanatory power on the decision making process of people in social science. For achieving the aim of the study, the data was collected through the survey in Dandong, China against Chinese tourists who have visited North Korea. The results of this study found that not only the novelty of North Korea, but also the redness, which accounts for the largest proportion in the domestic tourism, are significantly affecting overseas tour of Chinese tourists at this time point where overseas tour of Chinese tourists continue to increase. The results, therefore, suggest that the old communist countries, including those in Asia, need an emotional promotion strategy that stimulates nostalgia by focusing on the redness of the modern cultural heritage of Communism to attract Chinese tourists.

Keywords: model of goal-directed behavior, modern cultural heritage, North Korea, red tourism

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6386 Investigating the Sloshing Characteristics of a Liquid by Using an Image Processing Method

Authors: Ufuk Tosun, Reza Aghazadeh, Mehmet Bülent Özer

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This study puts forward a method to analyze the sloshing characteristics of liquid in a tuned sloshing absorber system by using image processing tools. Tuned sloshing vibration absorbers have recently attracted researchers’ attention as a seismic load damper in constructions due to its practical and logistical convenience. The absorber is liquid which sloshes and applies a force in opposite phase to the motion of structure. Experimentally characterization of the sloshing behavior can be utilized as means of verifying the results of numerical analysis. It can also be used to identify the accuracy of assumptions related to the motion of the liquid. There are extensive theoretical and experimental studies in the literature related to the dynamical and structural behavior of tuned sloshing dampers. In most of these works there are efforts to estimate the sloshing behavior of the liquid such as free surface motion and total force applied by liquid to the wall of container. For these purposes the use of sensors such as load cells and ultrasonic sensors are prevalent in experimental works. Load cells are only capable of measuring the force and requires conducting tests both with and without liquid to obtain pure sloshing force. Ultrasonic level sensors give point-wise measurements and hence they are not applicable to measure the whole free surface motion. Furthermore, in the case of liquid splashing it may give incorrect data. In this work a method for evaluating the sloshing wave height by using camera records and image processing techniques is presented. In this method the motion of the liquid and its container, made of a transparent material, is recorded by a high speed camera which is aligned to the free surface of the liquid. The video captured by the camera is processed frame by frame by using MATLAB Image Processing toolbox. The process starts with cropping the desired region. By recognizing the regions containing liquid and eliminating noise and liquid splashing, the final picture depicting the free surface of liquid is achieved. This picture then is used to obtain the height of the liquid through the length of container. This process is verified by ultrasonic sensors that measured fluid height on the surface of liquid.

Keywords: fluid structure interaction, image processing, sloshing, tuned liquid damper

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6385 Applications of Artificial Intelligence (AI) in Cardiac imaging

Authors: Angelis P. Barlampas

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The purpose of this study is to inform the reader, about the various applications of artificial intelligence (AI), in cardiac imaging. AI grows fast and its role is crucial in medical specialties, which use large amounts of digital data, that are very difficult or even impossible to be managed by human beings and especially doctors.Artificial intelligence (AI) refers to the ability of computers to mimic human cognitive function, performing tasks such as learning, problem-solving, and autonomous decision making based on digital data. Whereas AI describes the concept of using computers to mimic human cognitive tasks, machine learning (ML) describes the category of algorithms that enable most current applications described as AI. Some of the current applications of AI in cardiac imaging are the follows: Ultrasound: Automated segmentation of cardiac chambers across five common views and consequently quantify chamber volumes/mass, ascertain ejection fraction and determine longitudinal strain through speckle tracking. Determine the severity of mitral regurgitation (accuracy > 99% for every degree of severity). Identify myocardial infarction. Distinguish between Athlete’s heart and hypertrophic cardiomyopathy, as well as restrictive cardiomyopathy and constrictive pericarditis. Predict all-cause mortality. CT Reduce radiation doses. Calculate the calcium score. Diagnose coronary artery disease (CAD). Predict all-cause 5-year mortality. Predict major cardiovascular events in patients with suspected CAD. MRI Segment of cardiac structures and infarct tissue. Calculate cardiac mass and function parameters. Distinguish between patients with myocardial infarction and control subjects. It could potentially reduce costs since it would preclude the need for gadolinium-enhanced CMR. Predict 4-year survival in patients with pulmonary hypertension. Nuclear Imaging Classify normal and abnormal myocardium in CAD. Detect locations with abnormal myocardium. Predict cardiac death. ML was comparable to or better than two experienced readers in predicting the need for revascularization. AI emerge as a helpful tool in cardiac imaging and for the doctors who can not manage the overall increasing demand, in examinations such as ultrasound, computed tomography, MRI, or nuclear imaging studies.

Keywords: artificial intelligence, cardiac imaging, ultrasound, MRI, CT, nuclear medicine

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6384 Video-Based System for Support of Robot-Enhanced Gait Rehabilitation of Stroke Patients

Authors: Matjaž Divjak, Simon Zelič, Aleš Holobar

Abstract:

We present a dedicated video-based monitoring system for quantification of patient’s attention to visual feedback during robot assisted gait rehabilitation. Two different approaches for eye gaze and head pose tracking are tested and compared. Several metrics for assessment of patient’s attention are also presented. Experimental results with healthy volunteers demonstrate that unobtrusive video-based gaze tracking during the robot-assisted gait rehabilitation is possible and is sufficiently robust for quantification of patient’s attention and assessment of compliance with the rehabilitation therapy.

Keywords: video-based attention monitoring, gaze estimation, stroke rehabilitation, user compliance

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6383 A Multilevel Approach of Reproductive Preferences and Subsequent Behavior in India

Authors: Anjali Bansal

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Reproductive preferences mainly deal with two questions: when a couple wants children and how many they want. Questions related to these desires are often included in the fertility surveys as they can provide relevant information on the subsequent behavior. The aim of the study is to observe whether respondent’s response to these questions changed over time or not. We also tried to identify socio- economic and demographic factors associated with the stability (or instability) of fertility preferences. For this purpose, we used IHDS1 (2004-05) and follow up survey IHDS2 (2011-12) data and applied bivariate, multivariate and multilevel repeated measure analysis to it to find the consistency between responses. From the analysis, we found that preferences of women changes over the course of time as from the bivariate analysis we have found that 52% of women are not consistent in their desired family size and huge inconsistency are found in desire to continue childbearing. To get a better overlook of these inconsistencies, we have computed Intra Class Correlation (ICC) which tries to explain the consistency between individuals on their fertility responses at two time periods. We also explored that husband’s desire for additional child specifically male offspring contribute to these variations. Our findings lead us to a cessation that in India, individuals fertility preferences changed over a seven-year time period as the Intra Class correlation comes out to be very small which explains the variations among individuals. Concerted efforts should be made, therefore, to educate people, and conduct motivational programs to promote family planning for family welfare.

Keywords: change, consistency, preferences, over time

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6382 Probabilistic Slope Stability Analysis of Excavation Induced Landslides Using Hermite Polynomial Chaos

Authors: Schadrack Mwizerwa

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The characterization and prediction of landslides are crucial for assessing geological hazards and mitigating risks to infrastructure and communities. This research aims to develop a probabilistic framework for analyzing excavation-induced landslides, which is fundamental for assessing geological hazards and mitigating risks to infrastructure and communities. The study uses Hermite polynomial chaos, a non-stationary random process, to analyze the stability of a slope and characterize the failure probability of a real landslide induced by highway construction excavation. The correlation within the data is captured using the Karhunen-Loève (KL) expansion theory, and the finite element method is used to analyze the slope's stability. The research contributes to the field of landslide characterization by employing advanced random field approaches, providing valuable insights into the complex nature of landslide behavior and the effectiveness of advanced probabilistic models for risk assessment and management. The data collected from the Baiyuzui landslide, induced by highway construction, is used as an illustrative example. The findings highlight the importance of considering the probabilistic nature of landslides and provide valuable insights into the complex behavior of such hazards.

Keywords: Hermite polynomial chaos, Karhunen-Loeve, slope stability, probabilistic analysis

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6381 The Physiological Effect of Cold Atmospheric Pressure Plasma on Cancer Cells, Cancer Stem Cells, and Adult Stem Cells

Authors: Jeongyeon Park, Yeo Jun Yoon, Jiyoung Seo, In Seok Moon, Hae Jun Lee, Kiwon Song

Abstract:

Cold Atmospheric Pressure Plasma (CAPP) is defined as a partially ionized gas with electrically charged particles at room temperature and atmospheric pressure. CAPP generates reactive oxygen species (ROS) and reactive nitrogen species (RNS), and has potential as a new apoptosis-promoting cancer therapy. With an annular type dielectric barrier discharge (DBD) CAPP-generating device combined with a helium (He) gas feeding system, we showed that CAPP selectively induced apoptosis in various cancer cells while it promoted proliferation of the adipose tissue-derived stem cell (ASC). The apoptotic effect of CAPP was highly selective toward p53-mutated cancer cells. The intracellular ROS was mainly responsible for apoptotic cell death in CAPP-treated cancer cells. CAPP induced apoptosis even in doxorubicin-resistant cancer cell lines, demonstrating the feasibility of CAPP as a potent cancer therapy. With the same device and exposure conditions to cancer cells, CAPP stimulated proliferation of the ASC, a kind of mesenchymal stem cell that is capable of self-renewing and differentiating into adipocytes, chondrocytes, osteoblasts and neurons. CAPP-treated ASCs expressed the stem cell markers and differentiated into adipocytes as untreated ASCs. The increase of proliferation by CAPP in ASCs was offset by a NO scavenger but was not affected by ROS scavengers, suggesting that NO generated by CAPP is responsible for the activated proliferation in ASCs. Usually, cancer stem cells are reported to be resistant to known cancer therapies. When we applied CAPP of the same device and exposure conditions to cancer cells to liver cancer stem cells (CSCs) that express CD133 and epithelial cell adhesion molecule (EpCAM) cancer stem cell markers, apoptotic cell death was not examined. Apoptotic cell death of liver CSCs was induced by the CAPP generated from a device with an air-based flatten type DBD. An exposure of liver CSCs to CAPP decreased the viability of liver CSCs to a great extent, suggesting plasma be used as a promising anti-cancer treatment. To validate whether CAPP can be a promising anti-cancer treatment or an adjuvant modality to eliminate remnant tumor in cancer surgery of vestibular schwannoma, we applied CAPP to mouse schwannoma cell line SC4 Nf2 ‑/‑ and human schwannoma cell line HEI-193. A CAPP treatment leads to anti-proliferative effect in both cell lines. We are currently studying the molecular mechanisms of differential physiological effect of CAPP; the proliferation of ASCs and apoptosis of various cancer cells and CSCs.

Keywords: cold atmospheric pressure plasma, apoptosis, proliferation, cancer cells, adult stem cells

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6380 Microscopic Simulation of Toll Plaza Safety and Operations

Authors: Bekir O. Bartin, Kaan Ozbay, Sandeep Mudigonda, Hong Yang

Abstract:

The use of microscopic traffic simulation in evaluating the operational and safety conditions at toll plazas is demonstrated. Two toll plazas in New Jersey are selected as case studies and were developed and validated in Paramics traffic simulation software. In order to simulate drivers’ lane selection behavior in Paramics, a utility-based lane selection approach is implemented in Paramics Application Programming Interface (API). For each vehicle approaching the toll plaza, a utility value is assigned to each toll lane by taking into account the factors that are likely to impact drivers’ lane selection behavior, such as approach lane, exit lane and queue lengths. The results demonstrate that similar operational conditions, such as lane-by-lane toll plaza traffic volume can be attained using this approach. In addition, assessment of safety at toll plazas is conducted via a surrogate safety measure. In particular, the crash index (CI), an improved surrogate measure of time-to-collision (TTC), which reflects the severity of a crash is used in the simulation analyses. The results indicate that the spatial and temporal frequency of observed crashes can be simulated using the proposed methodology. Further analyses can be conducted to evaluate and compare various different operational decisions and safety measures using microscopic simulation models.

Keywords: microscopic simulation, toll plaza, surrogate safety, application programming interface

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6379 Safety of Implementation the Gluten - Free Diet in Children with Autism Spectrum Disorder

Authors: J. Jessa

Abstract:

Background: Autism is a pervasive developmental disorder, the incidence of which has significantly increased in recent years. Children with autism have impairments in social skills, communication, and imagination. Children with autism has more common than healthy children feeding problems: food selectivity, problems with gastrointestinal tract: diarrhea, constipations, abdominal pain, reflux and others. Many parents of autistic children report that after implementation of gluten-, casein- and sugar free diet those symptoms disappear and even cognitive functions become better. Some children begin to understand speech and to communicate with parents, regain eye contact, become more calm, sleep better and has better concentration. Probably at the root of this phenomenon lies elimination from the diet peptides construction of which is similar to opiates. Enhanced permeability of gut causes absorption of not fully digested opioid-like peptides from food, like gluten and casein and probably others (proteins from soy and corn) which impact on brain of autistic children. Aim of the study: The aim of the study is to assess the safety of gluten-free diet in children with autism, aged 2,5-7. Methods: Participants of the study (n=70) – children aged 2,5-7 with autism are divided into 3 groups. The first group (research group) are patients whose parents want to implement a gluten-free diet. The second group are patients who have been recommended to eliminate from the diet artificial substances, such as preservatives, artificial colors and flavors, and others (control group 1). The third group (control group 2) are children whose parents did not agree for implementation of the diet. Caregivers of children on the diet are educated about the specifics of the diet and how to avoid malnutrition. At the start of the study we exclude celiac disease. Before the implementation of the diet we performe a blood test for patients (morphology, ferritin, total cholesterol, dry peripheral blood drops to detect some genetic metabolic diseases), plasma aminogram) and urine tests (excretion of ions: Mg, Na, Ca, the profile of organic acids in urine), which assess nutritional status as well as the psychological test assessing the degree of the child's psychological functioning (PEP-R). All of these tests will be repeated after one year from the implementation of the diet. Results: To the present moment we examined 42 children with autism. 12 of children are on gluten- free diet. Our preliminary results are promising. Parents of 9 of them report that, there is a big improvement in child behavior, concentration, less aggression incidents, better eye contact and better verbal skills. Conclusion: Our preliminary results suggest that dietary intervention may positively affect developmental outcome for some children diagnosed with ASD.

Keywords: gluten free diet, autism spectrum disorder, autism, blood test

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6378 Control Strategies for a Robot for Interaction with Children with Autism Spectrum Disorder

Authors: Vinicius Binotte, Guilherme Baldo, Christiane Goulart, Carlos Valadão, Eliete Caldeira, Teodiano Bastos

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Socially assistive robotic has become increasingly active and it is present in therapies of people affected for several neurobehavioral conditions, such as Autism Spectrum Disorder (ASD). In fact, robots have played a significant role for positive interaction with children with ASD, by stimulating their social and cognitive skills. This work introduces a mobile socially-assistive robot, which was built for interaction with children with ASD, using non-linear control techniques for this interaction.

Keywords: socially assistive robotics, mobile robot, autonomous control, autism

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6377 A Systematic Review on the Whole-Body Cryotherapy versus Control Interventions for Recovery of Muscle Function and Perceptions of Muscle Soreness Following Exercise-Induced Muscle Damage in Runners

Authors: Michael Nolte, Iwona Kasior, Kala Flagg, Spiro Karavatas

Abstract:

Background: Cryotherapy has been used as a post-exercise recovery modality for decades. Whole-body cryotherapy (WBC) is an intervention which involves brief exposures to extremely cold air in order to induce therapeutic effects. It is currently being investigated for its effectiveness in treating certain exercise-induced impairments. Purpose: The purpose of this systematic review was to determine whether WBC as a recovery intervention is more, less, or equally as effective as other interventions at reducing perceived levels of muscle soreness and promoting recovery of muscle function after exercise-induced muscle damage (EIMD) from running. Methods: A systematic review of the current literature was performed utilizing the following MeSH terms: cryotherapy, whole-body cryotherapy, exercise-induced muscle damage, muscle soreness, muscle recovery, and running. The databases utilized were PubMed, CINAHL, EBSCO Host, and Google Scholar. Articles were included if they were published within the last ten years, had a CEBM level of evidence of IIb or higher, had a PEDro scale score of 5 or higher, studied runners as primary subjects, and utilized both perceived levels of muscle soreness and recovery of muscle function as dependent variables. Articles were excluded if subjects did not include runners, if the interventions included PBC instead of WBC, and if both muscle performance and perceived muscle soreness were not assessed within the study. Results: Two of the four articles revealed that WBC was significantly more effective than treatment interventions such as far-infrared radiation and passive recovery at reducing perceived levels of muscle soreness and restoring muscle power and endurance following simulated trail runs and high-intensity interval running, respectively. One of the four articles revealed no significant difference between WBC and passive recovery in terms of reducing perceived muscle soreness and restoring muscle power following sprint intervals. One of the four articles revealed that WBC had a harmful effect compared to CWI and passive recovery on both perceived muscle soreness and recovery of muscle strength and power following a marathon. Discussion/Conclusion: Though there was no consensus in terms of WBC’s effectiveness at treating exercise-induced muscle damage following running compared to other interventions, it seems as though WBC may at least have a time-dependent positive effect on muscle soreness and recovery following high-intensity interval runs and endurance running, marathons excluded. More research needs to be conducted in order to determine the most effective way to implement WBC as a recovery method for exercise-induced muscle damage, including the optimal temperature, timing, duration, and frequency of treatment.

Keywords: cryotherapy, physical therapy intervention, physical therapy, whole body cryotherapy

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6376 Numerical Evaluation of Lateral Bearing Capacity of Piles in Cement-Treated Soils

Authors: Reza Ziaie Moayed, Saeideh Mohammadi

Abstract:

Soft soil is used in many of civil engineering projects like coastal, marine and road projects. Because of low shear strength and stiffness of soft soils, large settlement and low bearing capacity will occur under superstructure loads. This will make the civil engineering activities more difficult and costlier. In the case of soft soils, improvement is a suitable method to increase the shear strength and stiffness for engineering purposes. In recent years, the artificial cementation of soil by cement and lime has been extensively used for soft soil improvement. Cement stabilization is a well-established technique for improving soft soils. Artificial cementation increases the shear strength and hardness of the natural soils. On the other hand, in soft soils, the use of piles to transfer loads to the depths of ground is usual. By using cement treated soil around the piles, high bearing capacity and low settlement in piles can be achieved. In the present study, lateral bearing capacity of short piles in cemented soils is investigated by numerical approach. For this purpose, three dimensional (3D) finite difference software, FLAC 3D is used. Cement treated soil has a strain hardening-softening behavior, because of breaking of bonds between cement agent and soil particle. To simulate such behavior, strain hardening-softening soil constitutive model is used for cement treated soft soil. Additionally, conventional elastic-plastic Mohr Coulomb constitutive model and linear elastic model are used for stress-strain behavior of natural soils and pile. To determine the parameters of constitutive models and also for verification of numerical model, the results of available triaxial laboratory tests on and insitu loading of piles in cement treated soft soil are used. Different parameters are considered in parametric study to determine the effective parameters on the bearing of the piles on cemented treated soils. In the present paper, the effect of various length and height of the artificial cemented area, different diameter and length of the pile and the properties of the materials are studied. Also, the effect of choosing a constitutive model for cemented treated soils in the bearing capacity of the pile is investigated.

Keywords: bearing capacity, cement-treated soils, FLAC 3D, pile

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6375 Prediction of Alzheimer's Disease Based on Blood Biomarkers and Machine Learning Algorithms

Authors: Man-Yun Liu, Emily Chia-Yu Su

Abstract:

Alzheimer's disease (AD) is the public health crisis of the 21st century. AD is a degenerative brain disease and the most common cause of dementia, a costly disease on the healthcare system. Unfortunately, the cause of AD is poorly understood, furthermore; the treatments of AD so far can only alleviate symptoms rather cure or stop the progress of the disease. Currently, there are several ways to diagnose AD; medical imaging can be used to distinguish between AD, other dementias, and early onset AD, and cerebrospinal fluid (CSF). Compared with other diagnostic tools, blood (plasma) test has advantages as an approach to population-based disease screening because it is simpler, less invasive also cost effective. In our study, we used blood biomarkers dataset of The Alzheimer’s disease Neuroimaging Initiative (ADNI) which was funded by National Institutes of Health (NIH) to do data analysis and develop a prediction model. We used independent analysis of datasets to identify plasma protein biomarkers predicting early onset AD. Firstly, to compare the basic demographic statistics between the cohorts, we used SAS Enterprise Guide to do data preprocessing and statistical analysis. Secondly, we used logistic regression, neural network, decision tree to validate biomarkers by SAS Enterprise Miner. This study generated data from ADNI, contained 146 blood biomarkers from 566 participants. Participants include cognitive normal (healthy), mild cognitive impairment (MCI), and patient suffered Alzheimer’s disease (AD). Participants’ samples were separated into two groups, healthy and MCI, healthy and AD, respectively. We used the two groups to compare important biomarkers of AD and MCI. In preprocessing, we used a t-test to filter 41/47 features between the two groups (healthy and AD, healthy and MCI) before using machine learning algorithms. Then we have built model with 4 machine learning methods, the best AUC of two groups separately are 0.991/0.709. We want to stress the importance that the simple, less invasive, common blood (plasma) test may also early diagnose AD. As our opinion, the result will provide evidence that blood-based biomarkers might be an alternative diagnostics tool before further examination with CSF and medical imaging. A comprehensive study on the differences in blood-based biomarkers between AD patients and healthy subjects is warranted. Early detection of AD progression will allow physicians the opportunity for early intervention and treatment.

Keywords: Alzheimer's disease, blood-based biomarkers, diagnostics, early detection, machine learning

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6374 Evaluation of Cooperative Hand Movement Capacity in Stroke Patients Using the Cooperative Activity Stroke Assessment

Authors: F. A. Thomas, M. Schrafl-Altermatt, R. Treier, S. Kaufmann

Abstract:

Stroke is the main cause of adult disability. Especially upper limb function is affected in most patients. Recently, cooperative hand movements have been shown to be a promising type of upper limb training in stroke rehabilitation. In these movements, which are frequently found in activities of daily living (e.g. opening a bottle, winding up a blind), the force of one upper limb has to be equally counteracted by the other limb to successfully accomplish a task. The use of standardized and reliable clinical assessments is essential to evaluate the efficacy of therapy and the functional outcome of a patient. Many assessments for upper limb function or impairment are available. However, the evaluation of cooperative hand movement tasks are rarely included in those. Thus, the aim of this study was (i) to develop a novel clinical assessment (CASA - Cooperative Activity Stroke Assessment) for the evaluation of patients’ capacity to perform cooperative hand movements and (ii) to test its inter- and interrater reliability. Furthermore, CASA scores were compared to current gold standard assessments for upper extremity in stroke patients (i.e. Fugl-Meyer Assessment, Box & Blocks Test). The CASA consists of five cooperative activities of daily living including (1) opening a jar, (2) opening a bottle, (3) open and closing of a zip, (4) unscrew a nut and (5) opening a clipbox. Here, the goal is to accomplish the tasks as fast as possible. In addition to the quantitative rating (i.e. time) which is converted to a 7-point scale, also the quality of the movement is rated in a 4-point scale. To test the reliability of CASA, fifteen stroke subjects were tested within a week twice by the same two raters. Intra-and interrater reliability was calculated using the intraclass correlation coefficient (ICC) for total CASA score and single items. Furthermore, Pearson-correlation was used to compare the CASA scores to the scores of Fugl-Meyer upper limb assessment and the box and blocks test, which were assessed in every patient additionally to the CASA. ICC scores of the total CASA score indicated an excellent- and single items established a good to excellent inter- and interrater reliability. Furthermore, the CASA score was significantly correlated to the Fugl-Meyer and Box & Blocks score. The CASA provides a reliable assessment for cooperative hand movements which are crucial for many activities of daily living. Due to its non-costly setup, easy and fast implementation, we suggest it to be well suitable for clinical application. In conclusion, the CASA is a useful tool in assessing the functional status and therapy related recovery in cooperative hand movement capacity in stroke patients.

Keywords: activitites of daily living, clinical assessment, cooperative hand movements, reliability, stroke

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6373 Finite Element Analysis of Steel-Concrete Composite Structures Considering Bond-Slip Effect

Authors: WonHo Lee, Hyo-Gyoung Kwak

Abstract:

A numerical model considering slip behavior of steel-concrete composite structure is introduced. This model is based on a linear bond stress-slip relation along the interface. Single node was considered at the interface of steel and concrete member in finite element analysis, and it improves analytical problems of model that takes double nodes at the interface by adopting spring elements to simulate the partial interaction. The slip behavior is simulated by modifying material properties of steel element contacting concrete according to the derived formulation. Decreased elastic modulus simulates the slip occurrence at the interface and decreased yield strength simulates drop in load capacity of the structure. The model is verified by comparing numerical analysis applying this model with experimental studies. Acknowledgment—This research was supported by a grant(13SCIPA01) from Smart Civil Infrastructure Research Program funded by Ministry of Land, Infrastructure and Transport(MOLIT) of Korea government and Korea Agency for Infrastructure Technology Advancement(KAIA) and financially supported by Korea Ministry of Land, Infrastructure and Transport(MOLIT) as U-City Master and Doctor Course Grant Program.

Keywords: bond-slip, composite structure, partial interaction, steel-concrete structure

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6372 The Influence of Incorporating in the Concrete of Recycled Waste from Shredding Used Tires and Crushed Glass on Their Characteristics and Behavior

Authors: Samiha Ramdani, Abdelhamid Geuttala

Abstract:

There is no doubt that the batteries increasingly used tires create environmental concerns. Algeria generates large amounts of by industrial and household waste, such as used tires and colored glass bottles and dishes, whose valuation in cementitious materials could be an interesting ecological and economical alternative for broadening eliminating cumbersome landfills. This work is a contribution to the promotion of local materials with the use of waste tires and glass bottle in the development of a new cementitious composite having the acceptable compressive strength and a capacity of improved strains. For this purpose, rubber crumb (GC) from shredding used tires were used as partial replacement of quarry sand with 10%, 20%, 40, 60%. In addition, some mixtures also contain glass powder at15% cement replacement by volume. The compressive strength, tensile strength, deformability, the water permeability and penetration Inions chlorides are studied. As results; an acceptable compressive strength was obtained with the substitution rate of 10% and 20% by volume, the deformability of the composite increases with increased replacement rate. The addition of finely ground glass as a partial replacement of cement concrete increases the resistance to penetration of Inions chloride and reduce the water permeability thereof; then increases their durability.

Keywords: crumb rubber, deformability, compressive strength, finely ground glass, durability, behavior law

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6371 Development a Home-Hotel-Hospital-School Community-Based Palliative Care Model for Patients with Cancer in Suratthani, Thailand

Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

Abstract:

Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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6370 Web-Based Alcohol Prevention among Iranian Medical University Students: A Randomized Control Trail

Authors: Farzad Jalilian, Mehdi Mirzaei Alavijeh

Abstract:

Background: E-interventions as a universal approach to prevent a high-risk behavior, such as alcohol drinking. This study was conducted to evaluate web-based alcohol drinking preventative intervention efficiency among medical university students in Iran. Methods: Overall, 150 freshman and sophomore male student’s college students participated in this study as intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to alcohol drinking prevention among college students. Cross-tabulation, t-test, repeated measures, and GEE by using SPSS statistical package, version 21 was used for the statistical analysis. The participants were followed up for 6 months with data collection scheduled at baseline, 3 and 6 months. The primary outcomes are attitude, self-control, and sensation seeking. Furthermore, the secondary outcome is comparing alcohol drinking among the study groups. Results: It was found significant reduce in average response for an attitude towards alcohol drinking and sensation seeking among intervention group (P < 0.05). But after intervention not significant difference between intervention and control group of improve self-control and reduce alcohol drinking (P > 0.05). Conclusion: Our intervention has been accompanied with reducing alcohol use rate. These findings indicate that e-intervention may be effectiveness approach to address the alcohol prevention among college students.

Keywords: e-interventions, alcohol drinking, students, Iran

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6369 Service Quality and Consumer Behavior on Metered Taxi Services

Authors: Nattapong Techarattanased

Abstract:

The purposes of this research are to make comparisons in respect of the behaviors on the use of the services of metered taxi classified by the demographic factor and to study the influence of the recognition on service quality having the effect on usage behaviors of metered taxi services of consumers in Bangkok Metropolitan Areas. The samples used in this research are 400 metered taxi service users in Bangkok Metropolitan Areas and use a questionnaire as the tool for collecting the data. Analysis statistics is mean and multiple regression analysis. Results of the research revealed that the consumers recognize the overall quality of services in each aspect include tangible aspects of the service, responses to customers, assurance on the confidence, understanding and knowing of customers which is rated at the moderate level except the aspect of the assurance on the confidence and trustworthiness which are rated at a high level. For the result of a hypothetical test, it is found that the quality in providing the services on the aspect of the assurance given to the customers has the effect on the usage behaviors of metered taxi services and the aspect of the frequency on the use of the services per month which in this connection. Such variable can forecast at one point nine percent (1.9%). In addition, quality in providing the services and the aspect of the responses to customers have the effect on the behaviors on the use of metered taxi services on the aspect of the expenses on the use of services per month which in this connection, such variable can forecast at two point one percent (2.1%).

Keywords: consumer behavior, metered taxi service, satisfaction, service quality

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6368 Optimizing PharmD Education: Quantifying Curriculum Complexity to Address Student Burnout and Cognitive Overload

Authors: Frank Fan

Abstract:

PharmD (Doctor of Pharmacy) education has confronted an increasing challenge — curricular overload, a phenomenon resulting from the expansion of curricular requirements, as PharmD education strives to produce graduates who are practice-ready. The aftermath of the global pandemic has amplified the need for healthcare professionals, leading to a growing trend of assigning more responsibilities to them to address the global healthcare shortage. For instance, the pharmacist’s role has expanded to include not only compounding and distributing medication but also providing clinical services, including minor ailments management, patient counselling and vaccination. Consequently, PharmD programs have responded by continually expanding their curricula adding more requirements. While these changes aim to enhance the education and training of future professionals, they have also led to unintended consequences, including curricular overload, student burnout, and a potential decrease in program quality. To address the issue and ensure program quality, there is a growing need for evidence-based curriculum reforms. My research seeks to integrate Cognitive Load Theory, emerging machine learning algorithms within artificial intelligence (AI), and statistical approaches to develop a quantitative framework for optimizing curriculum design within the PharmD program at the University of Toronto, the largest PharmD program within Canada, to provide quantification and measurement of issues that currently are only discussed in terms of anecdote rather than data. This research will serve as a guide for curriculum planners, administrators, and educators, aiding in the comprehension of how the pharmacy degree program compares to others within and beyond the field of pharmacy. It will also shed light on opportunities to reduce the curricular load while maintaining its quality and rigor. Given that pharmacists constitute the third-largest healthcare workforce, their education shares similarities and challenges with other health education programs. Therefore, my evidence-based, data-driven curriculum analysis framework holds significant potential for training programs in other healthcare professions, including medicine, nursing, and physiotherapy.

Keywords: curriculum, curriculum analysis, health professions education, reflective writing, machine learning

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6367 Wrist Pain, Technological Device Used, and Perceived Academic Performance Among the College of Computer Studies Students

Authors: Maquiling Jhuvie Jane R., Ojastro Regine B., Peroja Loreille Marie B., Pinili Joy Angela., Salve Genial Gail M., Villavicencio Marielle Irene B., Yap Alther Francis Garth B.

Abstract:

Introduction: This study investigated the impact of prolonged device usage on wrist pain and perceived academic performance among college students in Computer Studies. The research aims to explore the correlation between the frequency of technological device use and the incidence of wrist pain, as well as how this pain affects students' academic performance. The study seeks to provide insights that could inform interventions to promote better musculoskeletal health among students engaged in intensive technology use to further improve their academic performance. Method: The study utilized descriptive-correlational and comparative design, focusing on bona fide students from Silliman University’s College of Computer Studies during the second semester of 2023-2024. Participants were recruited through a survey sent via school email, with responses collected until March 30, 2024. Data was gathered using a password-protected device and Google Forms, ensuring restricted access to raw data. The demographic profile was summarized, and the prevalence of wrist pain and device usage were analyzed using percentages and weighted means. Statistical analyses included Spearman’s rank correlation coefficient to assess the relationship between wrist pain and device usage and an Independent T-test to evaluate differences in academic performance based on wrist pain presence. Alpha was set at 0.05. Results: The study revealed that 40% of College of Computer Studies students experience wrist pain, with 2 out of every 5 students affected. Laptops and desktops were the most frequently used devices for academic work, achieving a weighted mean of 4.511, while mobile phones and tablets received lower means of 4.183 and 1.911, respectively. The average academic performance score among students was 29.7, classified as ‘Good Performance.’ Notably, there was no significant relationship between the frequency of device usage and wrist pain, as indicated by p-values exceeding 0.05. However, a significant difference in perceived academic performance was observed, with students without wrist pain scoring an average of 30.39 compared to 28.72 for those with wrist pain and a p-value of 0.0134 confirming this distinction. Conclusion: The study revealed that about 40% of students in the College of Computer Studies experience wrist pain, but there is no significant link between device usage and pain occurrence. However, students without wrist pain demonstrated better academic performance than those with pain, suggesting that wrist health may impact academic success. These findings imply that physical therapy practices in the Philippines should focus on preventive strategies and ergonomic education to improve student health and performance.

Keywords: wrist pain, frequency of use of technological devices, perceived academic performance, physical therapy

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6366 Barriers for Sustainable Consumption of Antifouling Products in the Baltic Sea

Authors: Bianca Koroschetz, Emma Mäenpää

Abstract:

The purpose of this paper is to study consumer practices and meanings of different antifouling methods in order to identify the main barriers for sustainable consumption of antifouling products in the Baltic Sea. The Baltic Sea is considered to be an important tourism area. More than 3.5 million leisure boaters use the sea for recreational boating. Most leisure boat owners use toxic antifouling paint to keep barnacles from attaching to the hull. Attached barnacles limit maneuverability and add drag which in turn increases fuel costs. Antifouling paint used to combat barnacles causes particular problems, as the use of these products continuously adds to the distribution of biocides in the coastal ecosystem and leads to the death of marine organisms. To keep the Baltic Sea as an attractive tourism area measures need to be undertaken to stop the pollution coming from toxic antifouling paints. The antifouling market contains a wide range of environment-friendly alternative products such as a brush wash for boats, hand scrubbing devices, hull covers and boat lifts. Unfortunately, not a lot of boat owners use these environment-friendly alternatives and instead prefer the use of the traditional toxic copper paints. We ask “Why is the unsustainable consumption of toxic paints still predominant when there is a big range of environment-friendly alternatives available? What are the barriers for sustainable consumption?” Environmental psychology has concentrated on developing models of human behavior, including the main factors that influence pro-environmental behavior. The main focus of these models was directed to the individual’s attitudes, principals, and beliefs. However, social practice theory emphasizes the importance to study practices, as they have a stronger explanatory power than attitude-behavior to explain unsustainable consumer behavior. Thus, the study focuses on describing the material, meaning and competence of antifouling practice in order to understand the social and cultural embeddedness of the practice. Phenomenological interviews were conducted with boat owners using antifouling products such as paints and alternative methods. This data collection was supplemented with participant observations in marinas. Preliminary results indicate that different factors such as costs, traditions, advertising, frequency of use, marinas and application of method impact on the consumption of antifouling products. The findings have shown that marinas have a big influence on the consumption of antifouling goods. Some marinas are very active in supporting the sustainable consumption of antifouling products as for example in Stockholm area several marinas subsidize costs for using environmental friendly alternatives or even forbid toxic paints. Furthermore the study has revealed that environmental friendly methods are very effective and do not have to be more expensive than painting with toxic paints. This study contributes to a broader understanding why the unsustainable consumption of toxic paints is still predominant when a big range of environment-friendly alternatives exist. Answers to this phenomenon will be gained by studying practices instead of attitudes offering a new perspective on environmental issues.

Keywords: antifouling paint, Baltic Sea, boat tourism, sustainable consumption

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6365 Novel EGFR Ectodomain Mutations and Resistance to Anti-EGFR and Radiation Therapy in H&N Cancer

Authors: Markus Bredel, Sindhu Nair, Hoa Q. Trummell, Rajani Rajbhandari, Christopher D. Willey, Lewis Z. Shi, Zhuo Zhang, William J. Placzek, James A. Bonner

Abstract:

Purpose: EGFR-targeted monoclonal antibodies (mAbs) provide clinical benefit in some patients with H&N squamous cell carcinoma (HNSCC), but others progress with minimal response. Missense mutations in the EGFR ectodomain (ECD) can be acquired under mAb therapy by mimicking the effect of large deletions on receptor untethering and activation. Little is known about the contribution of EGFR ECD mutations to EGFR activation and anti-EGFR response in HNSCC. Methods: We selected patient-derived HNSCC cells (UM-SCC-1) for resistance to mAb Cetuximab (CTX) by repeated, stepwise exposure to mimic what may occur clinically and identified two concurrent EGFR ECD mutations (UM-SCC-1R). We examined the competence of the mutants to bind EGF ligand or CTX. We assessed the potential impact of the mutations through visual analysis of space-filling models of the native sidechains in the original structures vs. their respective side-chain mutations. We performed CRISPR in combination with site-directed mutagenesis to test for the effect of the mutants on ligand-independent EGFR activation and sorting. We determined the effects on receptor internalization, endocytosis, downstream signaling, and radiation sensitivity. Results: UM-SCC-1R cells carried two non-synonymous missense mutations (G33S and N56K) mapping to domain I in or near the EGF binding pocket of the EGFR ECD. Structural modeling predicted that these mutants restrict the adoption of a tethered, inactive EGFR conformation while not permitting association of EGFR with the EGF ligand or CTX. Binding studies confirmed that the mutant, untethered receptor displayed a reduced affinity for both EGF and CTX but demonstrated sustained activation and presence at the cell surface with diminished internalization and sorting for endosomal degradation. Single and double-mutant models demonstrated that the G33S mutant is dominant over the N56K mutant in its effect on EGFR activation and EGF binding. CTX-resistant UM-SCC-1R cells demonstrated cross-resistance to mAb Panitumuab but, paradoxically, remained sensitive to the reversible receptor tyrosine kinase inhibitor Erlotinib. Conclusions: HNSCC cells can select for EGFR ECD mutations under EGFR mAb exposure that converge to trap the receptor in an open, constitutively activated state. These mutants impede the receptor’s competence to bind mAbs and EGF ligand and alter its endosomal trafficking, possibly explaining certain cases of clinical mAb and radiation resistance.

Keywords: head and neck cancer, EGFR mutation, resistance, cetuximab

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