Search results for: brief cognitive behavior therapy

Authors: V. Schmidt, L. Janovák, N. Wiegand, B. Patczai, K. Turzó

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Large bone defects are not able to heal spontaneously. Bioactive glasses seem to be appropriate (bio)materials for bone reconstruction. Bioactive glasses are osteoconductive and osteoinductive, therefore, play a useful role in bony regeneration and repair. Because of their not optimal mechanical properties (e.g., brittleness, low bending strength, and fracture toughness), their applications are limited. Bioactive glass can be used as a coating material applied on metal surfaces. In this way -when using them as implants- the excellent mechanical properties of metals and the biocompatibility and bioactivity of glasses will be utilized. Furthermore, ion release effects of bioactive glasses regarding osteogenic and angiogenic responses have been shown. Silicate bioactive glasses (45S5 Bioglass) induce the release and exchange of soluble Si, Ca, P, and Na ions on the material surface. This will lead to special cellular responses inducing bone formation, which is favorable in the biointegration of the orthopedic prosthesis. The incorporation of other additional elements in the silicate network such as fluorine, magnesium, iron, silver, potassium, or zinc has been shown, as the local delivery of these ions is able to enhance specific cell functions. Although hip and knee prostheses present a high success rate, bacterial infections -mainly implant associated- are serious and frequent complications. Infection can also develop after implantation of hip prostheses, the elimination of which means more surgeries for the patient and additional costs for the clinic. Prosthesis-related infection is a severe complication of orthopedic surgery, which often causes prolonged illness, pain, and functional loss. While international efforts are made to reduce the risk of these infections, orthopedic surgical infections (SSIs) continue to occur in high numbers. It is currently estimated that up to 2.5% of primary hip and knee surgeries and up to 20% of revision arthroplasties are complicated by periprosthetic joint infection (PJIs). According to some authors, these numbers are underestimated, and they are also increasing. Staphylococcus aureus is the leading cause of both SSIs and PJIs, and the prevalence of methicillin-resistant S. aureus (MRSA) is on the rise, particularly in the United States. These deep infections lead to implant removal and consequently increase morbidity and mortality. The study targets this clinical problem using our experience so far with the Ag-doped polymer coatings on Titanium implants. Non-modified or modified (e.g., doped with antibacterial agents, like Ag) bioactive glasses could play a role in the prevention of infections or the therapy of infected tissues. Bioactive glasses have excellent biocompatibility, proved by in vitro cell culture studies of human osteoblast-like MG-63 cells. Ag-doped bioactive glass-scaffold has a good antibacterial ability against Escherichia coli and other bacteria. It may be concluded that these scaffolds have great potential in the prevention and therapy of implant-associated bone infection.

Keywords: antibacterial agents, bioactive glass, hip and knee prosthesis, medical implants

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Authors: Hamid Kazemi, Abbasali Sadeghi

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Assessment of seismic behavior of frame structures is just done for evaluating life and financial damages or lost. The new structural seismic behavior assessment methods have been proposed, so it is necessary to define a formulation as a damage index, which the damage amount has been quantified and qualified. In this paper, four new steel moment-resisting frames with intermediate ductility and different height (2, 5, 8, and 12-story) with regular geometry and simple rectangular plan were supposed and designed. The three existing groups’ damage indices were studied, each group consisting of local index (Drift, Maximum Roof Displacement, Banon Failure, Kinematic, Banon Normalized Cumulative Rotation, Cumulative Plastic Rotation and Ductility), global index (Roufaiel and Meyer, Papadopoulos, Sozen, Rosenblueth, Ductility and Base Shear), and story (Banon Failure and Inter-story Rotation). The necessary parameters for these damage indices have been calculated under the effect of far-fault ground motion records by Non-linear Dynamic Time History Analysis. Finally, prioritization of damage indices is defined based on more conservative values in terms of more damageability rate. The results show that the selected damage index has an important effect on estimation of the damage state. Also, failure, drift, and Rosenblueth damage indices are more conservative indices respectively for local, story and global damage indices.

Keywords: damage index, far-fault ground motion records, non-linear time history analysis, SeismoStruct software, steel moment-resisting frame

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Authors: Reenu Yadav, S. K. Yadav

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Herbal therapy has been used for daily oral health care to prevent, treat or cure oral conditions from halitosis to periodontal diseases. The importance of mouth and teeth cleanliness has been recognized from the earliest days of civilization to the 21st century. In the present study, leaves and seeds of Cordia obliqua and barks and twigs of Beautea monosperma, which is used traditionally for oral diseases was evaluated for its antimicrobial activity. The antimicrobial activity tests indicated that the methanolic extract exhibited stronger activities against the commonly encountered oral bacterial and fungal pathogens. The mouthwash formulation prepared and it is compared with marketed formulation HiOra. The results indicated that the herbal mouthwash could inhibit the growth of oral pathogens and may prevent plaque and other periodontal diseases caused by dental pathogens.

Keywords: herbal mouthwash, bio medicine, life sciences, herbal extracts

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Authors: Anna Bak-Klimek, Emily Spencer, Siew Lee, Karen Campbell, Wendy McInally

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Background & Significance: Over half of Teenagers and Young Adults (TYAs) say that they experience psychological distress after cancer diagnosis and TYAs with cancer are at higher risk of developing distress compared to other age groups. Despite this there are no age-appropriate interventions to help TYAs manage distress and there is a lack of conceptual understanding of what causes distress in this population group. This makes it difficult to design a targeted, developmentally appropriate intervention. This review aims to identify the key determinants of distress in TYAs affected by cancer and to propose an integrative model of cancer-related distress for TYAs. Method: A literature search was performed in Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, EMBASE and PsycArticles in May-June, 2022. Quantitative literature was systematically reviewed on the relationship between psychological distress experienced by TYAs affected by cancer and a wide range of factors i.e. individual (demographic, psychological, developmental, and clinical factors) and contextual (social/environmental) factors. Evidence was synthesized and correlates were categorized using the Biopsychosocial Model. The full protocol is available from PROSPERO (CRD42022322069) Results: Thirty eligible quantitative studies met criteria for the review. A total of twenty-six studies were cross-sectional, three were longitudinal and one study was a case control study. The evidence on the relationship between the socio-demographic, illness and treatment-related factors and psychological distress is inconsistent and unclear. There is however consistent evidence on the link between psychological factors and psychological distress. For instance, the use of cognitive and defence coping, negative meta-cognitive beliefs, less optimism, a lack of sense of meaning and lower resilience levels were significantly associated with higher psychological distress. Furthermore, developmental factors such as poor self-image, identity issues and perceived conflict were strongly associated with higher distress levels. Conclusions: The current review suggests that psychological and developmental factors such as ineffective coping strategies, poor self-image and identity issues may play a key role in the development of psychological distress in TYAs affected by cancer. The review proposes a Positive Developmental Psychology Model of Distress for Teenagers and Young Adults affected by cancer. The review highlights that implementation of psychological interventions that foster optimism, improve resilience and address self-image may result in reduced distress in TYA’s with cancer.

Keywords: cancer, determinant, psychological distress, teenager and young adult, theoretical model

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Authors: Roien Qiam, Shoshi Mizokami

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Parking demand in the Central Business District (CBD) has enlarged with the increase of the number of private vehicles due to rapid economic growth, lack of an efficient public transport and traffic management system. This has resulted in low mobility, poor accessibility, serious congestion, high rates of traffic accident fatalities and injuries and air pollution, mainly because people have to drive slowly around to find a vacant spot. With parking pricing and enforcement policy, considerable advancement could be found, and on-street parking spaces could be managed efficiently and effectively. To evaluate parking demand and making parking policy, it is required to understand the current parking condition and driver’s behavior, understand how drivers choose their parking type and location as well as their behavior toward finding a vacant parking spot under parking charges and search times. This study illustrates the result from an observational, revealed and stated preference surveys and experiment. Attained data shows that there is a gap between supply and demand in parking and it has maximized. For the modeling of the parking decision, a choice model was constructed based on discrete choice modeling theory and multinomial logit model estimated by using SP survey data; the model represents the choice of an alternative among different alternatives which are priced on-street, off-street, and illegal parking. Individuals choose a parking type based on their preference concerning parking charges, searching times, access times and waiting times. The parking assignment model was obtained directly from behavioral model and is used in parking simulation. The study concludes with an evaluation of parking policy.

Keywords: CBD, parking demand forecast, parking policy, parking choice model

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Authors: Muhammad Idnan, Arshad Javid, Muhammad Nadeem

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The present study was conducted from April 2013 to March 2014 to observe the behavioral parameters of Chinkara (Gazella bennettii) under captive conditions by comparing the captive-born and wild-caught animals for conservation strategies. Understanding the behavioral conformations plays a significant role in captive management. Due to human population explosion and mechanized hunting, the captive breeding seems to be the best way for sports hunting, bush meat, for leather industry and horns for traditional medicinal usage. Primarily, captive management has been used on trial and error basis due to deficiency of ethology of this least concerned species. Behavior of [(20 wild-caught (WC) and 10 captive-bred (CB)] adult Chinkara was observed at captive breeding facilities for ungulates at Ravi Campus, University of Veterinary and Animal Sciences at Kasur district which is situated on southeast side of Lahore. The average annual rainfall is about 650 mm, with frequent raining during monsoon. A focal sample was used to observe the various behavioral patterns for CB and WC chinkara. A similarity was observed in behavioral parameters in WC and CB animals, however, when the differences were considered, WC male deer showed a significantly higher degree of agonistic interaction as compared to the CB male chinkara. These findings suggest that there is no immediate impact of captivity on behavior of chinkara nevertheless 10 generations of captivity. It is suggested that the Chinkara is not suitable for domestication and for successful deer farming, a further study is recommended for ethology of chinkara.

Keywords: Chinkara (Gazella bennettii), domestication, deer farming, ex-situ conservation

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Authors: Ciaran Friel, Jerry Suls, Mark Butler, Patrick Robles, Samantha Gordon, Frank Vicari, Karina W. Davidson

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Physical activity guidelines focus on increasing moderate-intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant engagement. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit® fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7 but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by Fitbit for two weeks. In the 8-week intervention phase of the study, participants received each of the four BCTs, in random order, for a two-week period. Text message prompts were delivered daily each morning at a consistent time. All prompts required participant engagement to acknowledge receipt of the BCT message. Engagement is dependent upon the BCT message and may have included recording that a detailed plan for walking has been made or confirmed a daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves to their baseline average step count (self-monitoring, feedback). At the end of each two-week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances, and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. The analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, five days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of an N-of-1 study design to effectively promote physical activity as a component of healthy aging.

Keywords: aging, exercise, habit, walking

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Authors: Syue-Wen Lin

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Objective: This article explores the nursing experience of an 84-year-old male lung cancer patient who underwent a thoracoscopic right lower lobectomy and treatment. The patient has multiple medical histories, including hypertension and diabetes. The nursing process involved cancer treatment, postoperative pain management, as well as wound care and healing. Methods: The nursing period is from February 10 to February 17, 2024. During the nursing process, pain management strategies are implemented, including morphine drugs and non-drug methods, and music therapy, essential oil massage, and extended reception time are used to make patients feel physically and mentally comfortable so as to reduce postoperative pain and encourage active participation in rehabilitation. Strict sterile wound dressing procedures and advanced wound care techniques are used to promote wound healing and prevent infection. Due to septic shock, dialysis is used to relieve worsening symptoms. Taking into account the patient's cancer status, the nursing team provides comprehensive cancer care based on the patient's physical and psychological needs. Given the complexity of the patient's condition, including advanced cancer, palliative care is also incorporated throughout the care process to relieve discomfort and provide psychological support. Results: Through comprehensive health assessment, the nursing team fully understood the patient's condition and developed a personalized care plan based on the patient's condition. The interprofessional critical care team provides respiratory therapy and lung expansion exercises to reduce muscle loss while addressing the patient's psychological status, pain management, and vital sign stabilization needs, resulting in a comprehensive approach to care. Lung expansion exercises and the use of a high-frequency chest wall oscillation vest successfully improved sputum drainage and facilitated weaning from mechanical ventilation. In addition, helping patients stabilize their vital signs and the integration of cancer care, pain management, wound care and palliative care helps the patient be fully supported throughout the recovery process, ultimately improving his quality of life. Conclusion: Lung cancer and septic shock present significant challenges to patients, and the nursing team not only provides critical care but also addresses the unique needs of patients through comprehensive infection control, cancer care, pain management, wound care, and palliative care interventions. These measures effectively improve patients' quality of life, promote recovery, and provide compassionate palliative care for terminally ill patients. Nursing staff work closely with family members to develop a comprehensive care plan to ensure that patients receive high-quality medical care as well as psychological support and a comfortable recovery environment.

Keywords: septic shock, lung cancer, palliative care, nursing experience

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Authors: Aloysius Hardoko, Susilo

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The root cause of the problem after the environmental damage due to coal mining activities defined as the province of East Kalimantan corridor masterplan economic activity accelerated the expansion of Indonesia's economic development (MP3EI) is the behavior of adults. Adult behavior can be changed through knowledge management and attitude. Based on the root of the problem, the objective of the research is to apply knowledge management and attitude based on holistic approach in learning andragogy as an effort to solve environmental problems after coal mining activities. Research methods to achieve the objective of using quantitative research with pretest postes group design. Knowledge management and attitudes based on a holistic approach in adult learning are applied through initial learning activities, core and case-based cover of environmental damage. The research instrument is a description of the case of environmental damage. The data analysis uses t-test to see the effect of knowledge management attitude based on holistic approach before and after adult learning. Location and sample of representative research of adults as many as 20 people in Kutai Kertanegara District, one of the districts in East Kalimantan province, which suffered the worst environmental damage. The conclusion of the research result is the application of knowledge management and attitude in adult learning influence to adult knowledge and attitude to overcome environmental problem post-coal mining activity.

Keywords: knowledge management and attitude, holistic approach, andragogy learning, environmental Issue

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Patcharapa Thaweekul, Paskorn Sritipsukho

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Background: During the training period of the 6-year medical curriculum, medical students seem to have many risk behaviors of developing obesity. This study aims to demonstrate the prevalence and risk behavior of obesity and related metabolic disorders among the final-year medical students of Thammasat University as well as the change in nutritional status during studying program. Methods: 123 participants were asked to complete the self-report questionnaires. Weight, height, waist circumference and blood pressure were obtained. Blood samples were drawn for total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides and plasma glucose. Body weight and height of the medical students in the first year were obtained from the medical report at the entry. Results: The prevalence of overweight and obesity at the entry to medical school was 22.0% and increased to 30.1% in the final year. Two obese students (5.4%) was diagnosed as metabolic syndrome. During 6-year curriculum, the BMI gained in male medical students were more significant as compared to female students (1.76±1.74 and 0.43±1.82 kg/m2, respectively; p <.001). The current BMI is significantly correlated with the BMI at entry. Serum LDL-C in the overweight/obese students was significantly higher as compared to the normal weight and underweight group. Sleep deprivation was a significantly frequent behavior in the overweight/obese students. Conclusion: Medical students, as having high-risk behaviors, should be assessed for the nutritional status and metabolic parameters. Medical schools should promote the healthy behaviors to increase the healthy eating and exercise habits and reduced the risk behaviors among them.

Keywords: medical students, metabolic syndrome, obesity, risk behaviors

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Authors: Yuqing Zou, Chunrui Zou, Yichong Cao

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Previous research has revealed relationships between self-efficacy (SE), engagement, and academic achievement among students in Western countries, but these relationships remain unknown in college math courses among college students in China. In addition, previous research has shown that test anxiety has a direct effect on engagement and academic achievement. However, how test anxiety affects the relationships between SE, engagement, and academic achievement is still unknown. In this study, the authors aimed to explore the mediating roles of behavioral engagement (BE), emotional engagement (EE), and cognitive engagement (CE) in the association between SE and academic achievement and the moderating role of test anxiety in college math courses. Our hypotheses are that the association between SE and academic achievement was mediated by engagement and that test anxiety played a moderating role in the association. To explore the research questions, the authors collected data through self-reported surveys among 147 students at a northwestern university in China. Self-reported surveys were used to collect data. The motivated strategies for learning questionnaire (MSLQ) (Pintrich, 1991), the metacognitive strategies questionnaire (Wolters, 2004), and the engagement versus disaffection with learning scale (Skinner et al., 2008) were used to assess SE, CE, and BE and EE, respectively. R software was used to analyze the data. The main analyses used were reliability and validity analysis of scales, descriptive statistics analysis of measured variables, correlation analysis, regression analysis, and structural equation modeling (SEM) analysis and moderated mediation analysis to look at the structural relationships between variables at the same time. The SEM analysis indicated that student SE was positively related to BE, EE, and CE and academic achievement. BE, EE, and CE were all positively associated with academic achievement. That is, as the authors expected, higher levels of SE led to higher levels of BE, EE, and CE, and greater academic achievement. Higher levels of BE, EE, and CE led to greater academic achievement. In addition, the moderated mediation analysis found that the path of SE to academic achievement in the model was as significant as expected, as was the moderating effect of test anxiety in the SE-Achievement association. Specifically, test anxiety was found to moderate the association between SE and BE, the association between SE and CE, and the association between EE and Achievement. The authors investigated possible mediating effects of BE, EE, and CE in the associations between SE and academic achievement, and all indirect effects were found to be significant. As for the magnitude of mediations, behavioral engagement was the most important mediator in the SE-Achievement association. This study has implications for college teachers, educators, and students in China regarding ways to promote academic achievement in college math courses, including increasing self-efficacy and engagement and lessening test anxiety toward math.

Keywords: academic engagement, self-efficacy, test anxiety, academic achievement, college math courses, behavioral engagement, cognitive engagement, emotional engagement

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Authors: Ishan Naidu, Jessica Ryvlin, Devin Videlefsky

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Introduction: Back pain is a leading cause of years lived with disability and economic burden, exceeding over $20 billion in healthcare costs not including indirect costs such as absence from work and caregiving. The multifactorial nature of back pain leads to treatment modalities administered by a variety of specialists, which are often disjointed. Multiple studies have found that patients receiving delayed physical therapy for lower back pain had higher medical-related costs from increased health service utilization as well as a reduced improvement in pain severity compared to early management. Uncoordinated health care delivery can exacerbate the physical and economic toll of the chronic condition, thus improvements in interdisciplinary, shared decision-making may improve outcomes. Objective: To assess whether a multidisciplinary spine clinic (MSC), consisting of orthopedic surgery, neurosurgery, pain medicine, and physiatry, alters interventional and non-interventional planning and treatment compared to a traditional unidisciplinary spine clinic (USC) including only orthopedic surgery. Methods: We conducted a retrospective cohort study with patients initially presenting for spine care to orthopedic surgeons between July 1, 2018 to June 30, 2019. Time to treatment recommendation, time to treatment and rates of treatment recommendations were assessed, including physical therapy, injections and surgery. Treatment rates were compared between MSC and USC using Pearson’s chi-square test logistic regression. Time to treatment recommendation and time to treatment were compared using log-rank test and Cox proportional hazard regression. All analyses were repeated for the propensity score (PS) matched subsample. Results: This study included 1,764 patients, with 692 at MSC and 1,072 at USC. Patients in MSC were more likely to be recommended injection when compared to USC (8.5% vs. 5.4%, p=0.01). When adjusted for confounders, the likelihood of injection recommendation remained greater in MSC than USC (Odds ratio [OR]=2.22, 95% CI: (1.39, 3.53), p=0.001). MSC was also associated with a shorter time to receiving injection recommendation versus USC (median: 21 vs. 32 days, log-rank: p<0.001; hazard ratio [HR]=1.90, 95% CI: (1.25, 2.90), p=0.003). MSC was associated with a higher likelihood of injection treatment (OR=2.27, 95% CI: (1.39, 3.73), p=0.001) and shorter lead time (HR=1.98, 95% CI: (1.27, 3.09), p=0.003). PS-matched analyses yielded similar conclusions. Conclusions: Care delivered at a multidisciplinary spine clinic was associated with a higher likelihood of recommending injection and a shorter lead time to injection administration when compared to a traditional unidisciplinary spine surgery clinic. Multidisciplinary clinics may facilitate coordinated care amongst different specialties resulting in increased utilization of less invasive treatment modalities while also improving care efficiency. The multidisciplinary clinic model is an important advancement in care delivery and communication, which can be used as a powerful method of improving patient outcomes as treatment guidelines evolve.

Keywords: coordinated care, epidural steroid injection, multi-disciplinary, non-invasive

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Authors: Corbel Camille, Le Cerf Flora, Corveleyn Xavier

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Introduction: Aging is a physiological phenomenon accompanied by anatomical and cognitive changes leading to anxiety and pain. This could have significant impacts on quality of life, life expectancy, and the progression of cognitive disorders. Virtual Reality Intervention (VRI) is increasingly recognized as a non-pharmacological approach to alleviate pain and anxiety in children and young adults. However, while recent studies have explored the feasibility of applying VRI in the older population, confirmation through studies is still required to establish its benefits in various contexts. Objective: This pilot study, following a clinical trial methodology international recommendation for VRI in healthcare, aims to evaluate the feasibility and effects of using VRI with a 101-year-old woman residing in a nursing home undergoing weekly painful and anxious wound dressing changes. Methods: Following the international recommendations, this study focused on feasibility and preliminary results. A Single Case Experimental Design protocol consists of two distinct phases: control (Phase A) and personalized VRI (Phase B), each lasting for 6 sessions. Data were collected before, during and after the care, using measures of pain (Algoplus and numerical scale), anxiety (Hospital anxiety scale and numerical scale), VRI experience (semi-structured interview) and physiological measures. Results: The results suggest that the utilization of VRI is both feasible and well-tolerated by the participant. VRI contributed to a decrease in pain and anxiety during care sessions, with a more significant impact on pain compared to anxiety, which showed a gradual and slight decrease. Physiological data, particularly those related to stress, also indicate a reduction in physiological activity during VRI. Conclusion: This pilot study confirms the feasibility and benefits of using virtual reality in managing pain and anxiety in an older adult in a nursing home. In light of these results, it is essential that future studies focus on setting up randomized controlled trials (RCTs). These studies should involve a representative number of older adults to ensure generalizable data. This rigorous, controlled methodology will enable us to assess the effectiveness of virtual reality more accurately in various care settings, measure its impact on clinical parameters such as pain and anxiety, and explore the long-term implications of this intervention.

Keywords: anxiety reduction, nursing home, older adult, pain management, virtual reality

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Authors: George Mahalu

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The Chua diode has been configured over time in various ways, using electronic structures like as operational amplifiers (OAs) or devices with gas or semiconductors. When discussing the use of semiconductor devices, tunnel diodes (Esaki diodes) are most often considered, and more recently, transistorized configurations such as lambda diodes. The paper-work proposed here uses in the modeling a lambda diode type configuration consisting of two Junction Field Effect Transistors (JFET). The original scheme is created in the MULTISIM electronic simulation environment and is analyzed in order to identify the conditions for the appearance of evolutionary unpredictability specific to nonlinear dynamic systems with chaos-induced behavior. The chaotic deterministic oscillator is one autonomous type, a fact that places it in the class of Chua’s type oscillators, the only significant and most important difference being the presence of a nonlinear device like the one mentioned structure above. The chaotic behavior is identified both by means of strange attractor-type trajectories and visible during the simulation and by highlighting the hypersensitivity of the system to small variations of one of the input parameters. The results obtained through simulation and the conclusions drawn are useful in the further research of ways to implement such constructive electronic solutions in theoretical and practical applications related to modern small signal amplification structures, to systems for encoding and decoding messages through various modern ways of communication, as well as new structures that can be imagined both in modern neural networks and in those for the physical implementation of some requirements imposed by current research with the aim of obtaining practically usable solutions in quantum computing and quantum computers.

Keywords: chaos, lambda diode, strange attractor, nonlinear system

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Authors: Alireza Moghtaderi, Negin Khakpour

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Hallux Valgus is a kind of Toes aberration where the Metatarsophalangeal joint that connects the big toe to the foot, leading to the inner side and a protrusion on the inner surface of toe arise. This study aimed to determine the effect of botulinum toxin A injection to reduce pain and deviation angle of the thumb in Hallux Valgus and to increase outcomes of treatment as an adjuvant therapy. Randomized clinical study was performed on 18 patients at the Clinic of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences. In this study the Halgvs valgus angle (HVA) between the metatarsals (IMA) and cartilage distal metatarsal angle (DMAA) and pain were assessed before and after injection. Average of Hallux Valgus angle before and after Botox injections were 28/89 ± 10/21 and 21/56 ± 8/22 degrees and the angle deviation in the 6 months after treatment was significantly improved (p <0.001). Injection of botulinum toxin A is a suitable and acceptable method to reform the skeleton deformities and also to reduce the pain in patients with Hallux valgus.

Keywords: metatasal, hallux valgus, pain, botulinum toxuin

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Authors: Ali Asgary, Haopeng Zhou, Ghassem Tofighi

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Use of virtual (VR), augmented reality (AR), and extended reality technologies for training and education has increased in recent years as more hardware and software tools have become available and accessible to larger groups of users. Similarly, the applications of these technologies in earthquake related training and education are on the rise. Several studies have reported promising results for the use of VR and AR for evacuation behaviour and training under earthquake situations. They simulate the impacts that earthquake has on buildings, buildings’ contents, and how building occupants and users can find safe spots or open paths to outside. Considering that considerable number of earthquake injuries and fatalities are linked to the behaviour, our goal is to use these technologies to reduce the impacts of building contents on people. Building on our artificial intelligence (AI) based indoor earthquake risk assessment application that enables users to use their mobile device to assess the risks associated with building contents during earthquakes, we develop a virtual reality application to demonstrate the behavior of different building contents during earthquakes, their associate moving, spreading, falling, and collapsing risks, and their risk mitigation methods. We integrate realistic seismic models, building contents behavior with and without risk mitigation measures in virtual reality environment. The application can be used for training of architects, interior design experts, and building users to enhance indoor safety of the buildings that can sustain earthquakes. This paper describes and demonstrates the application development background, structure, components, and usage.

Keywords: virtual reality, earthquake damage, building content, indoor risks, earthquake risk mitigation, interior design, unity game engine, oculus

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Authors: Priyanka Sharma, Rajeshwar Nath Srivastava

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Hydrogen has a high level of efficacy in suppressing tumour growth. The role of hydrogen in cancer treatment is unclear. This groundbreaking research will focus on the most effective therapeutic approach for osteosarcoma. Recent data reveals that hydrogen, a naturally occurring gaseous chemical, can protect cells from death. However, little is known about the signalling pathways that regulate cardiac cell death and individual apoptosis signalling by H2 and its downstream targets. According to certain research, the anti-tumor effect of H2 released by magnesium-based biomaterials is mediated by the P53-mediated lysosome-mitochondria apoptosis signalling pathway, bolstering the biomaterial's therapeutic potential as a localised anti-tumor treatment. The role of the H2 molecule in the signalling of apoptotic, autophagic, necroptotic, and pyroptotic cell death in Osteosarcoma is discussed in this paper. Potential Hydrogen-based therapy techniques will broaden the treatment horizon for Osteosarcoma.

Keywords: osteosarcoma, metastasis, hhydrogen, therapeutic

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Authors: Fatemeh Abbasi, Arne Hofemeier, Timo Betz

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Muscle growth and regeneration critically depend on satellite cells (SCs) which are muscle stem cells located between the basal lamina and myofibres. Upon damage, SCs become activated, enter the cell cycle, and give rise to myoblasts that form new myofibres, while a sub-population self-renew and re-populate the muscle stem cell niche. In aged muscle as well as in certain muscle diseases such as muscular dystrophy, some of the SCs lose their regenerative ability. Although it is demonstrated that the chemical composition of SCs quiescent niche is different from the activated niche, the mechanism initially activated in the SCs remains unknown. While extensive research efforts focused on potential chemical activation, no such factor has been identified to the author’s best knowledge. However, it is substantiated that niche mechanics affects SCs behaviors, such as stemness and engraftment. We hypothesize that mechanical stress in the healthy niche (homeostasis) is different from the regenerative niche and that this difference could serve as an early signal activating SCs upon fiber damage. To investigate this hypothesis, we develop a biomimetic system to reconstitute both, the mechanical and the chemical environment of the SC niche. Cells will be confined between two elastic polyacrylamide (PAA) hydrogels with controlled elastic moduli and functionalized surface chemistry. By controlling the distance between the PAA hydrogel surfaces, we vary the compression forces exerted by the substrates on the cells, while the lateral displacement of the upper hydrogel will create controlled shear forces. To establish such a system, a simplified system is presented. We engineered a sandwich-like configuration of two elastic PAA layer with stiffnesses between 1 and 10 kPa and confined a precursor myoblast cell line (C2C12) in between these layers. Our initial observations in this sandwich model indicate that C2C12 cells show different behaviors under mechanical compression if compared to a control one-layer gel without compression. Interestingly, this behavior is stiffness-dependent. While the shape of C2C12 cells in the sandwich consisting of two stiff (10 kPa) layers was much more elongated, showing almost a neuronal phenotype, the cell shape in a sandwich situation consisting of one stiff and one soft (1 kPa) layer was more spherical. Surprisingly, even in proliferation medium and at very low cell density, the sandwich situation stimulated cell differentiation with increased striation and myofibre formation. Such behavior is commonly found for confluent cells in differentiation medium. These results suggest that mechanical changes in stiffness and applied pressure might be a relevant stimulation for changes in muscle cell behavior.

Keywords: C2C12 cells, compression, force, satellite cells, skeletal muscle

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Authors: A. B. Chehreh, M. Grätzel, M. Klein, J. P. Bergmann, F. Walther

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Friction stir welding (FSW) is an advantageous method in the thermal joining processes, featuring the welding of various dissimilar and similar material combinations, joining temperatures below the melting point which prevents irregularities such as pores and hot cracks as well as high strengths mechanical joints near the base material. The FSW process consists of a rotating tool which is made of a shoulder and a probe. The welding process is based on a rotating tool which plunges in the workpiece under axial pressure. As a result, the material is plasticized by frictional heat which leads to a decrease in the flow stress. During the welding procedure, the material is continuously displaced by the tool, creating a firmly bonded weld seam behind the tool. However, the mechanical properties of the weld seam are affected by the design and geometry of the tool. These include in particular microstructural and surface properties which can favor crack initiation. Following investigation compares the dynamic properties of FSW weld seams with conventional and stationary shoulder geometry based on load increase test (LIT). Compared to classical Woehler tests, it is possible to determine the fatigue strength of the specimens after a short amount of time. The investigations were carried out on a robotized welding setup on 2 mm thick EN AW 5754 aluminum alloy sheets. It was shown that an increased tensile and fatigue strength can be achieved by using the stationary shoulder concept. Furthermore, it could be demonstrated that the LIT is a valid method to describe the fatigue behavior of FSW weld seams.

Keywords: aluminum alloy, fatigue performance, fracture, friction stir welding

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Authors: Mariam Shah

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This paper will examine the potential influence and role of unconscious cognition on judicial decision making. The theoretical underpinnings of this paper rest on phenomenological theory grounded predominantly in Schutzian phenomenology. Aspects of Husserlian and Gadamerian phenomenology will be included within the phenomenological framework put forward in this paper, in an attempt to provide a more complete and thorough account of how unconscious cognition can influence judicial decision making. This paper has far reaching implications, as the framework provides a foundation for unconscious cognitive factors which can work to influence decision making more generally.

Keywords: decision making, Gadamer, Gadamerian, Husserl, Husserlian, judicial decision making, phenomenology, Schutz, Schutzian

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Authors: Tai Yuan Yu, Pei-Jen Wang

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Oil-free turbomachinery is considered one of the critical technologies for future green power generation systems as rotor machinery systems. Oil-free technology allows clean, compact, and maintenance-free working, and gas foil bearings, abbreviated as GFBs, are important for the technology. Since the first applications in the auxiliary power units and air cycle machines in the 1970s, obvious improvement has been created to the computational models for dynamic rotor behavior. However, many technical issues are still poorly understood or remain unsolved, and some of those are thermal management and the pattern of how pressure will be distributed in bearing clearance. This paper presents a three-dimensional, abbreviated as 3D, fluid-structure interaction model of single pad foil bearings and three pad foil bearings to predict bearing working behavior that researchers could compare characteristics of those. The coupling analysis model involves dynamic working characteristics applied to all the gas film and mechanical structures. Therefore, the elastic deformation of foil structure and the hydrodynamic pressure of gas film can both be calculated by a finite element method program. As a result, the temperature distribution pattern could also be iteratively solved by coupling analysis. In conclusion, the working fluid state in a gas film of various pad forms of bearings working characteristic at constant rotational speed for both can be solved for comparisons with the experimental results.

Keywords: fluid-structure interaction, multi-physics simulations, gas foil bearing, oil-free, transient thermo-hydrodynamic

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Authors: Hossein Panahi, Firouz Fallahi, Sima Nasibparast

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Background & Aim: Unnecessary growth in health expenditures of developing countries in recent decades, and also the importance of physicians’ behavior in health market, have made the theory of physician-induced demand (PID) as one of the most important issues in health economics. Therefore, the main objective of this study is to investigate the hypothesis of induced demand among mental patients who receive services from either psychologists or psychiatrists in East Azerbaijan province. Methods: Using data from questionnaires in 2020 and employing the theoretical model of Jaegher and Jegers (2000) and hierarchical linear modeling (HLM), this study examines the PID hypothesis of selected psychologists and psychiatrists. The sample size of the study, after removing the questionnaires with missing data, is 45 psychologists and 203 people of their patients, as well as 30 psychiatrists and 160 people of their patients. Results: The results show that, although psychiatrists are ‘profit-oriented physicians’, there is no evidence of inducing unnecessary demand by them (PID), and the difference between the behavior of employers and employee doctors is due to differences in practice style. However, with regard to psychologists, the results indicate that they are ‘profit-oriented’, and there is a PID effect in this sector. Conclusion: According to the results, it is suggested that in order to reduce competition and eliminate the PID effect, the admission of students in the field of psychology should be reduced, patient information on mental illness should be increased, and government monitoring and control over the national health system must be increased.

Keywords: physician-induced demand, national health system, hierarchical linear modeling methods, multilevel modela

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Authors: Vivian A. Galindo, Maria C. Galvis, Jaime R. Obando, Alvaro Guarin

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In Colombia, most of the roads of the national tertiary road network are unpaved roads with granular rolling surface. These are very important ways of guaranteeing the mobility of people, products, and inputs from the agricultural sector from the most remote areas to urban centers; however, it has not paid much attention to the search for alternatives to avoid the occurrence of deteriorations that occur shortly after its commissioning. In recent years, geosynthetics have been used satisfactorily to reinforce unpaved roads on soft soils, with geotextiles and geogrids being the most widely used. The interaction of the geogrid and the aggregate minimizes the lateral movement of the aggregate particles and increases the load capacity of the material, which leads to a better distribution of the vertical stresses, consequently reducing the vertical deformations in the subgrade. Taking into account the above, the research aimed at the mechanical behavior of the granular material, used in unpaved roads with and without the presence of geogrids, from the development of laboratory tests through the loaded wheel tester (LWT). For comparison purposes, the reinforced conditions and traffic conditions to which this type of material can be accessed in practice were simulated. In total four types of geogrids, were tested with granular material; this means that five test sets, the reinforced material and the non-reinforced control sample were evaluated. The results of the numbers of load cycles and depth rutting supported by each test body showed the influence of the properties of the reinforcement on the mechanical behavior of the assembly and the significant increases in the number of load cycles of the reinforced specimens in relation to those without reinforcement.

Keywords: geosynthetics, load wheel tester LWT, tertiary roads, unpaved road, vertical deformation

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Authors: Fatima Zahra Mahjoubi, Abderrahim Khalidi, Mohammed Abdennouri, Noureddine Barka

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Zn-Al layered double hydroxides containing carbonate, nitrate and dodecylsulfate as the interlamellar anions have been prepared through a coprecipitation method. The resulting compounds were characterized using XRD, ICP, FTIR, TGA/DTA, TEM/EDX and pHPZC analysis. The XRD patterns revealed that carbonate and nitrate could be intercalated into the interlayer structure with basal spacing of 22.74 and 26.56 Å respectively. Bilayer intercalation of dodecylsulfate molecules was achieved in Zn-Al LDH with a basal spacing of 37.86 Å. The TEM observation indicated that the materials synthesized via coprecipitation present nanoscale LDH particle. The average particle size of Zn-AlCO3 is 150 to 200 nm. Irregular circular to hexagonal shaped particles with 30 to 40 nm in diameter was observed in the Zn-AlNO3 morphology. TEM image of Zn-AlDs display nanostructured sheet like particles with size distribution between 5 to 10 nm. The sorption characteristics and mechanisms of methyl orange dye on organic LDH were investigated and were subsequently compared with that on the inorganic Zn-Al layered double hydroxides. Adsorption experiments for MO were carried out as function of solution pH, contact time and initial dye concentration. The adsorption behavior onto inorganic LDHs was obviously influenced by initial pH. However, the adsorption capacity of organic LDH was influenced indistinctively by initial pH and the removal percentage of MO was practically constant at various value of pH. As the MO concentration increased, the curve of adsorption capacity became L-type onto LDHs. The adsorption behavior for Zn-AlDs was proposed by the dissolution of dye in a hydrophobic interlayer region (i.e., adsolubilization). The results suggested that Zn-AlDs could be applied as a potential adsorbent for MO removal in a wide range of pH.

Keywords: adsorption, dodecylsulfate, kinetics, layered double hydroxides, methyl orange removal

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Authors: Shedy Maharani Nariswari, Prima Agustia Nova, I. Made Kariasa

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Background. Heart Failure (HF) is a chronic and progressive condition associated with significant morbidity, mortality, health care expenditures, and a high readmission rate over the years. Self‐care is essential to manage chronic heart failure in the long term, and it is related to better outcomes and can enhance the quality of life. Objective. The aims of this study were to describe the relationship between self-care behavior and quality of life among heart failure patients in East Jakarta, Indonesia. Methods. This study used a correlational-descriptive design with a cross-sectional study, the sampling method used purposive sampling method. Self-care was measured using Self-care Heart Failure Index version 6.2, and quality of life was measured using The Minnesota Living with Heart Failure. Pearson correlation and Spearman-rho correlations are used to analyze the data. Results. We recruited 103 patients with HF in both outpatient and inpatient ward: mean age 59.26 ± 11.643 years, 63.1% male. Patients with higher levels of education were associated with higher self-care maintenance (p= 0.007). The patient's average quality of life is quite high, with a score of 72,07 ± 16,89. There were a significant relationship among self-care maintenance (r=0,305, p=0,001), self-care management (r=0,330, p=0,001), and self-care confidence (r=0,335, p=0,001) towards the quality of life. Most participants have inadequate self-care maintenance, self-care management, and self-care confidence (score < 70), while the score of quality of life is categorized as poor. Conclusion. The self-care behaviors were limited among patients living with HF in Indonesia yet was associated with better quality of life. It is necessary to promote health related to knowledge and adherence to self-care behavior so that it can improve the quality of life of heart failure patients. This study can be used as a reference to promote self-care among patients with heart failure, it can help to enhance their quality of life.

Keywords: heart failure, self-care maintenance, self-care management, self-care confidence, quality of life

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Authors: Dhyaalddin Bahaalddin Noori Zangana

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This study involves the behavior of reinforced sand under a square footing. A series of bearing capacity tests were performed on a small-scale laboratory model, which filled with a poorly-graded homogenous bed of sand, which was placed in a medium dense state using sand raining technique. The sand was reinforced with 40 mm wide household aluminum foil strips. The main studied parameters was to consider the effect of reinforcing strip length, with various linear density of reinforcement, number of reinforcement layers and depth of top layer of reinforcement below the footing, on load-settlement behavior, bearing capacity ratio and settlement reduction factor. The relation of load-settlement generally showed similar trend in all the tests. Failure was defined as settlement equal to 10% of the footing width. The recommended optimum reinforcing strip length, linear density of reinforcement, number of reinforcement layers and depth of top layer of reinforcing strips that give the maximum bearing capacity improvement and minimum settlement reduction factor were presented and discussed. Different bearing capacity ration versus length of the reinforcing strips and settlement reduction factor versus length of the reinforcing strips relations at failure were showed improvement of bearing capacity ratio by a factor of 3.82 and reduction of settlement reduction factor by a factor of 0.813. The optimum length of reinforcement was found to be 7.5 times the footing width.

Keywords: square footing, relative density, linear density of reinforcement, bearing capacity ratio, load-settlement behaviour

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Authors: Jingjue Bao, Ye Li, Yujie Qi

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The explosive growth of ride-hailing has reshaped residents' travel behavior and plays a crucial role in urban mobility within the built environment. Contributing to the research of the spatial variation of ride-hailing demand and its relationship to the built environment and socioeconomic factors, this study utilizes multi-source data from Haikou, China, to construct a Multi-scale Geographically Weighted Regression model (MGWR), considering spatial scale heterogeneity. The regression results showed that MGWR model was demonstrated superior interpretability and reliability with an improvement of 3.4% on R2 and from 4853 to 4787 on AIC, compared with Geographically Weighted Regression model (GWR). Furthermore, to precisely identify the surrounding environment of sampling point, DeepLabv3+ model is employed to segment street-level images. Features extracted from these images are incorporated as variables in the regression model, further enhancing its rationality and accuracy by 7.78% improvement on R2 compared with the MGWR model only considered region-level variables. By integrating multi-scale geospatial data and utilizing advanced computer vision techniques, this study provides a comprehensive understanding of the spatial dynamics between ride-hailing demand and the urban built environment. The insights gained from this research are expected to contribute significantly to urban transportation planning and policy making, as well as ride-hailing platforms, facilitating the development of more efficient and effective mobility solutions in modern cities.

Keywords: travel behavior, ride-hailing, spatial relationship, built environment, street-level image

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Authors: Baboo Ali, Avni Ugur

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Pesticide namely, Diflubenzuron, is tremendously used in pear orchards against different insect pests of pear fruit trees in Turkey. The predatory bug, Anthocoris nemoralis (F.) is found in pear orchard feeding on Cacopsylla pyri (L.) (Homoptera: Psyllidae), is an insect pest of pear fruit trees. In this study, the effectiveness of the above mentioned pesticide on various biological stages of predatory bug were investigated under laboratory conditions of 25±1˚C, 75±5% RH, and photoperiod of 16L: 8D h. Newly emerged 1st, 2nd, 3rd, 4th and 5th instars as well as the female and male stages of the predatory bug were placed on treated petri dishes and their mortality was checked after every 24 hours till the survival of the last individual. Prey consumption of surviving instars as well as the adult stages was determined simultaneously. All biological stages of the predatory bug were fed with eggs of Ephestia kuehniella during the whole research work. Percent hatch of treated eggs was recorded after every 24 hours, and the behavioral test of the male and female stages against Diflubenzuron was also determined using Y-tube olfactometer. Consequently, the mortality rate of 1st, 2nd, 3rd, 4th, and 5th instars was 61.32 %, 67.50%, 74. 91%, 80.11%, and 83.04%, respectively. In case of male and female stages, it has been recorded as 95.47% and 95.50%, respectively. Thus, a significant difference was not found between female and male mortality rates. Prey consumption of 1st, 2nd, 3rd, 4th and 5th surviving instars was noted as 8.01, 11. 72, 13.24, 16.93 and 20.49 number of eggs/day while in females and males, it was 12.05 and 12.71 number of eggs/day, respectively. Hatching ratio of treated eggs of predator was 25.32±4.08. As far as the behavioral test is concerned, it has been indicated that Diflubenzuron has 65% repellent effect on the newly emerged male and female stages of the predatory bug while using Y-tube olfactometer under laboratory conditions.

Keywords: behavior, biological stages, diflubenzuron, effectiveness, pesticide, predatory bug

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Authors: Sara Malik, Andreea. S. Calude, Joseph Ulatowski

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This paper explores how speakers from New Zealand and Pakistan with breast cancer use violence metaphors to communicate the intensity of their experiences during various stages of illness. With the theoretical foundation in Conceptual Metaphor Theory and the use of Metaphor Identification Procedure for metaphor analysis, this study investigates how speakers with breast cancer use violence metaphors in different cultural contexts. it collected a corpus of forty-six personal narratives from New Zealand and thirty-six from Pakistan, posted between 2011 and 2023 on YouTube by breast cancer organisations, such as ‘NZ Breast Cancer Foundation’ and ‘Pink Ribbon Pakistan’. The data was transcribed using the Whisper AI tool and then curated to include only patients’ discourse, further organised into eight narrative topics: testing phase, treatment phase, remission phase, family support, campaigns and awareness efforts, government support and funding, general information and religious discourse. In this talk, it discuss two aspects of the use of violence metaphors, a) differences in the use of violence metaphors across various narrative topics, and b) lexical variations in the choice of such metaphors. The findings suggest that violence metaphors were used differently across various stages of illness experience. For instance, during the ‘testing phase,’ violence metaphors were employed to convey a sense of punishment as reflected in statements like, ‘Feeling like it was a death sentence, an immediate death sentence’ (NZ Example) and ‘Jese hi aap ko na breast cancer ka pata chalta hai logon ko yeh hona shuru ho jata hai ke oh bas ab to moat ka parwana mil gaya hai’ (Because as soon as you find out you have breast cancer people start to feel that you have received a death warrant) (PK Example). On the other hand, violence metaphor during the ‘treatment phase’ highlighted negative experiences related to chemotherapy as seen in statements like ‘The first lot of chemo I had was disastrous’ (NZ Example) and ‘...chemotherapy ke to, it's the worst of all, it's like a healing poison’ (chemotherapy, it's the worst of all, it's like a healing poison) (PK Example). Second, lexical variations revealed how ‘sunburn’ (a common phenomenon in the NZ) was used as a metaphor to describe the effects of radiotherapy, whereas in the discourse from Pakistan, a more general term, 'burn,' was used instead. In this talk, we will explore the possible reasons behind the different word choices made by speakers from both countries to describe the same process. This study contributes to understanding the use of violence metaphors across various narrative topics of the illness experience and explains how and why speakers from two different countries use lexical variations to describe the same process.

Keywords: metaphors, breast cancer discourse, cognitive linguistics, lexical variations, New zealand english, pakistani urdu

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