Search results for: vulval skin condition

Authors: Katharina Ninaus, Ralf Terlutter, Sandra Diehl

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Information and communication technologies (ICT) have become pervasive in all areas of modern life, both in work and leisure. Technological developments and particularly the ubiquity of smartphones have made it possible for ICT consumers to be constantly connected to work, fostering an always-on mentality and increasing the pressure to be accessible at all times. However, performing work tasks outside of working hours using ICT results in a lack of mental detachment and recovery from work. It is, therefore, necessary to develop effective behavioral interventions to increase risk awareness of a constant connection to the workplace in the employed population. Drawing on regulatory focus theory, this study aims to investigate the persuasiveness of tailoring messages to individuals’ chronic regulatory focus in order to encourage ICT consumers to set boundaries by defining fixed times for professional accessibility outside of working hours in order to contribute to the well-being of ICT consumers with high ICT involvement in their work life. The experimental study examines the interaction effect between consumers’ chronic regulatory focus (i.e. promotion focus versus prevention focus) and positive or negative message framing (i.e. gain frame versus loss frame) on consumers’ intention to perform the advocated behavior. Based on the assumption that congruent messages create regulatory fit and increase message effectiveness, it is hypothesized that behavioral intention will be higher in the condition of regulatory fit compared to regulatory non-fit. It is further hypothesized that ad believability and attitude toward the ad will mediate the effect of regulatory fit on behavioral intention given that ad believability and ad attitude both determine consumer behavioral responses. Results confirm that the interaction between regulatory focus and message frame emerged as a predictor of behavioral intention such as that consumers’ intentions to set boundaries by defining fixed times for professional accessibility outside of working hours increased as congruency with their regulatory focus increased. The loss-framed ad was more effective for consumers with a predominant prevention focus, while the gain-framed ad was more effective for consumers with a predominant promotion focus. Ad believability and attitude toward the ad both emerged as predictors of behavioral intention. Mediation analysis revealed that the direct effect of the interaction between regulatory focus and message frame on behavioral intention was no longer significant when including ad believability and ad attitude as mediators in the model, indicating full mediation. However, while the indirect effect through ad believability was significant, the indirect effect through attitude toward the ad was not significant. Hence, regulatory fit increased ad believability, which then increased behavioral intention. Ad believability appears to have a superior effect indicating that behavioral intention does not depend on attitude toward the ad, but it depends on whether or not the ad is perceived as believable. The study shows that the principle of regulatory fit holds true in the context of ICT consumption and responds to calls for more research on mediators of health message framing effects.

Keywords: always-on mentality, Information and communication technologies (ICT) consumption, message framing, regulatory focus

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Authors: Scott Rawlings

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Victoria’s first State of the Bays report is an historic baseline study of the health of Port Phillip Bay and Western Port. The report includes 50 assessments of 36 indicators across a broad array of topics from the nitrogen cycle and water quality to key marine species and habitats. This paper discusses the processes for determining and assessing the indicators and comments on future priorities identified to maintain and improve the health of these water ways. Victoria’s population is now at six million, and growing at a rate of over 100,000 people per year - the highest increase in Australia – and the population of greater Melbourne is over four million. Port Phillip Bay and Western Port are vital marine assets at the centre of this growth and will require adaptive strategies if they are to remain in good condition and continue to deliver environmental, economic and social benefits. In 2014, it was in recognition of these pressures that the incoming Victorian Government committed to reporting on the state of the bays every five years. The inaugural State of the Bays report was issued by the independent Victorian Commissioner for Environmental Sustainability. The report brought together what is known about both bays, based on existing research. It was a baseline on which future reports will build and, over time, include more of Victoria’s marine environment. Port Phillip Bay and Western Port generally demonstrate healthy systems. Specific threats linked to population growth are a significant pressure. Impacts are more significant where human activity is more intense and where nutrients are transported to the bays around the mouths of creeks and drainage systems. The transport of high loads of nutrients and pollutants to the bays from peak rainfall events is likely to increase with climate change – as will sea level rise. Marine pests are also a threat. More than 100 introduced marine species have become established in Port Phillip Bay and can compete with native species, alter habitat, reduce important fish stocks and potentially disrupt nitrogen cycling processes. This study confirmed that our data collection regime is better within the Marine Protected Areas of Port Phillip Bay than in other parts. The State of the Bays report is a positive and practical example of what can be achieved through collaboration and cooperation between environmental reporters, Government agencies, academic institutions, data custodians, and NGOs. The State of the Bays 2016 provides an important foundation by identifying knowledge gaps and research priorities for future studies and reports on the bays. It builds a strong evidence base to effectively manage the bays and support an adaptive management framework. The Report proposes a set of indicators for future reporting that will support a step-change in our approach to monitoring and managing the bays – a shift from reporting only on what we do know, to reporting on what we need to know.

Keywords: coastal science, marine science, Port Phillip Bay, state of the environment, Western Port

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Authors: Neritan Shkodrani

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On November 26, 2019, an earthquake hit the central western part of Albania. It was assessed as Mw 6.4. Its epicenter was located offshore north western Durrës, about 7 km north of the city. In this paper, the consequences of settlements of very soft soils have been discussed for the case of a residential building, mentioned as “K Building”, which was suffering a significant tilting after the earthquake. “KBuilding” is an RC framed building having 12+1 (basement) storiesand a floor area of 21000 m2. The construction of the building was completed in 2012. “KBuilding”, located in Durres city, suffered severe non-structural damage during November 26, 2019, Durrës Earthquake sequences. During the in-site inspections immediately after the earthquake, the general condition of the buildings, the presence of observable settlements on the ground, and the crack situation in the structure were determined, and damage inspection were performed. It was significant to note that the “K Building” presented tilting that might be attributed, as it was believed at the beginning, partially to the failure of the columns of the ground floor and partially to liquefaction phenomena, but it did not collapse. At the first moment was not clear if the foundation had a bearing capacity failure or the foundation failed because of the soil liquefaction. Geotechnical soil investigations by using CPTU test were executed, and their data are usedto evaluatebearing capacity, consolidation settlement of the mat foundation, and soil liquefaction since they were believed to be the main reasons of this building tilting.Geotechnical soil investigation consist in 5 (five) Static Cone Penetration tests with pore pressure measurement (piezocone test). They reached a penetration depth of 20.0 m to 30.0 mand, clearly shown the presence of very soft and organic soils in the soil profile of the site. Geotechnical CPT based analysis of bearing capacity, consolidation, and secondary settlement are applied, and results are reported for each test. These results shown very small values of allowable bearing capacity and very high values of consolidation and secondary settlements. Liquefaction analysis based on the data of CPTU tests and the characteristics of ground shaking of the mentioned earthquake has shown the possibility of liquefaction for some layers of the considered soil profile, but the estimated vertical settlements are at a small range and clearly shown that the main reason of the building tilting was not related to the consequences of liquefaction, but was an existing settlement caused from the applied bearing pressure of this building. All the CPTU tests were carried out on August 2021, almost two years after the November 26, 2019, Durrës Earthquake and when the building itself was demolished. After removing the mat foundation on September 2021, it was possible to carry out CPTU tests even on the footprint of the existing building, which made possible to observe the effects of long time applied of foundation bearing pressure to the consolidation on the considered soil profile.

Keywords: bearing capacity, cone penetration test, consolidation settlement, secondary settlement, soil liquefaction, etc

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Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Ummeh Saika, Toshio Kikuchi

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Population growth and urbanization is a global phenomenon. As the rapid progress of technology, many cities in the international community are facing serious problems of urbanization. There is no doubt that the urbanization will proceed to have significant impact on the ecology, economy and society at local, regional, and global levels. The inhabitants of Dhaka city suffer from lack of proper urban facilities. The green spaces are needed for different functional and leisure activities of the urban dwellers. Again growing densification, a number of green space are transferred into open space in the Dhaka city. As a result greenery of the city's decreases gradually. Moreover, the existing green space is frequently threatened by encroachment. The role of green space, both at community and city level, is important to improve the natural environment and social ties for future generations. Therefore, it seems that the green space needs to be more effective for public interaction. The main objective of this study is to address the effectiveness of urban green space (Urban Park) of Dhaka City. Two approaches are selected to fulfill the study. Firstly, analyze the long-term spatial changes of urban green space using GIS and secondly, investigate the relationship of urban park network with physical and social environment. The case study site covers eight urban parks of Dhaka metropolitan area of Bangladesh. Two aspects (Physical and Social) are applied for this study. For physical aspect, satellite images and aerial photos of different years are used to find out the changes of urban parks. And for social aspect, methods are used as questionnaire survey, interview, observation, photographs, sketch and previous information of parks to analyze about the social environment of parks. After calculation of all data by descriptive statistics, result is shown by maps using GIS. According to physical size, parks of Dhaka city are classified into four types: Small, Medium, Large and Extra Large parks. The observed result showed that the physical and social environment of urban parks varies with their size. In small size parks physical environment is moderate by newly tree plantation and area expansion. However, in medium size parks physical environment are poor, example- tree decrease, exposed soil increase. On the other hand, physical environment of large size and extra large size parks are in good condition, because of plenty of vegetation and well management. Again based on social environment, in small size parks people mainly come from surroundings area and mainly used as waiting place. In medium-size parks, people come to attend various occasion from different places. In large size and extra large size parks, people come from every part of the city area for tourism purpose. Urban parks are important source of green space. Its influence both physical and social environment of urban area. Nowadays green space area gradually decreases and transfer into open space. The consequence of this research reveals that changes of urban parks influence both physical and social environment and also impact on urban life.

Keywords: physical environment, social environment, urban life, urban parks

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Authors: Partha Sarathi Nayek, Abhiparna Dasgupta, Maheshreddy Gade

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Earth retaining structure plays a vital role in stabilizing unstable road cuts and slopes in the mountainous region. The retaining structures located in seismically active regions like the Himalayas may experience moderate to severe earthquakes. An earthquake produces two kinds of ground motion: permanent quasi-static displacement (fault rapture) on the fault rupture plane and transient vibration, traveling a long distance. There has been extensive research work to understand the dynamic behavior of retaining structures subjected to transient ground motions. However, understanding the effect caused by fault rapture phenomena on retaining structures is limited. The presence of shallow crustal active faults and natural slopes in the Himalayan region further highlights the need to study the response of retaining structures subjected to fault rupture phenomena. In this paper, an attempt has been made to understand the dynamic response of the cantilever retaining wall subjected to surface fault rupture. For this purpose, a 2D finite element model consists of a retaining wall, backfill and foundation have been developed using Abaqus 6.14 software. The backfill and foundation material are modeled as per the Mohr-Coulomb failure criterion, and the wall is modeled as linear elastic. In this present study, the interaction between backfill and wall is modeled as ‘surface-surface contact.’ The entire simulation process is divided into three steps, i.e., the initial step, gravity load step, fault rupture step. The interaction property between wall and soil and fixed boundary condition to all the boundary elements are applied in the initial step. In the next step, gravity load is applied, and the boundary elements are allowed to move in the vertical direction to incorporate the settlement of soil due to the gravity load. In the final step, surface fault rupture has been applied to the wall-backfill system. For this purpose, the foundation is divided into two blocks, namely, the hanging wall block and the footwall block. A finite fault rupture displacement is applied to the hanging wall part while the footwall bottom boundary is kept as fixed. Initially, a numerical analysis is performed considering the reverse fault mechanism with a dip angle of 45°. The simulated result is presented in terms of contour maps of permanent displacements of the wall-backfill system. These maps highlighted that surface fault rupture can induce permanent displacement in both horizontal and vertical directions, which can significantly influence the dynamic behavior of the wall-backfill system. Further, the influence of fault mechanism, dip angle, and surface fault rupture position is also investigated in this work.

Keywords: surface fault rupture, retaining wall, dynamic response, finite element analysis

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Authors: Chien Yang Erdem

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This paper takes up the proliferating historical dramas and children’s programs featuring the Ottoman-Islamic legacy on Turkish television as a locus where the processes of subjectification take place. A critical analysis of this emergent cultural phenomenon reveals an alliance of neoliberal and neoconservative political rationalities based on which the Turkish media is restructured to transform society. The existing debates have focused on how the Ottoman historical dramas manifest the Justice and Development Party’s (Adalet ve Kalkınma Partisi) neo-Ottomanist ideology and foreign policy. However, this approach tends to overlook the more complex relationship between the media, government, and society. Employing Michel Foucault’s notion of 'technologies of the self,' this paper aims to examine the governing practices that are deployed to regulate the media and to transform individual citizens into governable subjects in contemporary Turkey. First, through a brief discussion of recent development of the Turkish media towards an authoritarian model, the paper suggests that the relation between the Ottoman television drama and the political subject in question cannot be adequately examined without taking into account the force of the market. Second, by focusing on the managerial restructuring of the Turkish Television and Radio Corporation (Türkiye Radyo ve Televizyon Kurumu), the paper aims to illustrate the rationale and process through which the Turkish media sector is transformed into an integral part of the free market where the government becomes a key actor. The paper contends that this new sphere of free market is organized in a way that enables direct interference of the government and divides media practitioners and consumers into opposing categories through their own participation in the media market. On the one hand, a 'free subject' is constituted based on the premise that the market is a sphere where individuals are obliged to exercise their right to freedom (of choice, lifestyle, and expression). On the other hand, this 'free subject' is increasingly subjugated to such disciplinary practices as censorship for being on the wrong side of the government. Finally, the paper examines the relation between the restructured Turkish media market and the proliferation of Ottoman television drama in the 2010s. The study maintains that the reorganization of the media market has produced a condition where private sector is encouraged to take an active role in reviving Turkey’s Ottoman-Islamic cultural heritage and promulgating moral-religious values. Paying specific attention to the controversial case of Magnificent Century (Muhteşem Yüzyıl) in contrast with TRT’s Ottoman historical drama and children’s programs, the paper aims to identify the ways in which individual citizens are directed to conduct themselves as a virtuous citizenry. It is through the double movement between the governing practices associated with the media market and those concerning the making of a 'conservative generation' that a subject of citizenry of new Turkey is constituted.

Keywords: neoconservatism, neoliberalism, ottoman historical drama, technologies of the self, Turkish television

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Authors: Masoud Mirzaee, Ghobad Behzadi Pour

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An aircraft tire is designed to tolerate extremely heavy loads for a short duration. The number of tires increases with the weight of the aircraft, as it is needed to be distributed more evenly. Generally, aircraft tires work at high pressure, up to 200 psi (14 bar; 1,400 kPa) for airliners and higher for business jets. Tire assemblies for most aircraft categories provide a recommendation of compressed nitrogen that supports the aircraft’s weight on the ground, including a mechanism for controlling the aircraft during taxi, takeoff; landing; and traction for braking. Accurate tire pressure is a key factor that enables tire assemblies to perform reliably under high static and dynamic loads. Concerning ambient temperature change, considering the condition in which the temperature between the origin and destination airport was different, tire pressure should be adjusted and inflated to the specified operating pressure at the colder airport. This adjustment superseding the normal tire over an inflation limit of 5 percent at constant ambient temperature is required because the inflation pressure remains constant to support the load of a specified aircraft configuration. On the other hand, without this adjustment, a tire assembly would be significantly under/over-inflated at the destination. Due to an increase of human errors in the aviation industry, exorbitant costs are imposed on the airlines for providing consumable parts such as aircraft tires. The existence of an intelligent system to adjust the aircraft tire pressure based on weight, load, temperature, and weather conditions of origin and destination airports, could have a significant effect on reducing the aircraft maintenance costs, aircraft fuel and further improving the environmental issues related to the air pollution. An intelligent tire pressure regulation system (ITPRS) contains a processing computer, a nitrogen bottle with 1800 psi, and distribution lines. Nitrogen bottle’s inlet and outlet valves are installed in the main wheel landing gear’s area and are connected through nitrogen lines to main wheels and nose wheels assy. Controlling and monitoring of nitrogen will be performed by a computer, which is adjusted according to the calculations of received parameters, including the temperature of origin and destination airport, the weight of cargo loads and passengers, fuel quantity, and wind direction. Correct tire inflation and deflation are essential in assuring that tires can withstand the centrifugal forces and heat of normal operations, with an adequate margin of safety for unusual operating conditions such as rejected takeoff and hard landings. ITPRS will increase the performance of the aircraft in all phases of takeoff, landing, and taxi. Moreover, this system will reduce human errors, consumption materials, and stresses imposed on the aircraft body.

Keywords: avionic system, improve efficiency, ITPRS, human error, reduced cost, tire pressure

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Authors: Atefeh Omidkhah, Mohammadreza Bemanian

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The issue of way-finding earmarks a wide range of literature in architecture and despite the 50 year background of way-finding studies, it still lacks a comprehensive theory for indoor settings. Way-finding has a notable role in emergency evacuation as well. People in the panic situation of a fire emergency need to find the safe egress route correctly and in as minimum time as possible. In this regard the parameters of an appropriate way-finding are mentioned in the evacuation related researches albeit scattered. This study reviews the fire safety related literature to extract a way-finding related framework for architectural purposes of the design of a safe evacuation route. In this regard a research trend review in addition with applied methodological approaches review is conducted. Then by analyzing eight original researches related to way-finding parameters in fire evacuation, main parameters that affect way-finding in emergency situation of a fire incident are extracted and a framework was developed based on them. Results show that the issues related to exit route and emergency evacuation can be chased in task oriented studies of way-finding. This research trend aims to access a high-level framework and in the best condition a theory that has an explanatory capability to define differences in way-finding in indoor/outdoor settings, complex/simple buildings and different building types or transitional spaces. The methodological advances demonstrate the evacuation way-finding researches in line with three approaches that the latter one is the most up-to-date and precise method to research this subject: real actors and hypothetical stimuli as in evacuation experiments, hypothetical actors and stimuli as in agent-based simulations and real actors and semi-real stimuli as in virtual reality environment by adding multi-sensory simulation. Findings on data-mining of 8 sample of original researches in way-finding in evacuation indicate that emergency way-finding design of a building should consider two level of space cognition problems in the time of emergency and performance consequences of them in the built environment. So four major classes of problems in way-finding which are visual information deficiency, confusing layout configuration, improper navigating signage and demographic issues had been defined and discussed as the main parameters that should be provided with solutions in design and interior of a building. In the design phase of complex buildings, which face more reported problem in way-finding, it is important to consider the interior components regarding to the building type of occupancy and behavior of its occupants and determine components that tend to become landmarks and set the architectural features of egress route in line with the directions that they navigate people. Research on topological cognition of environmental and its effect on way-finding task in emergency evacuation is proposed for future.

Keywords: architectural design, egress route, way-finding, fire safety, evacuation

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Authors: Reshu Yadav, Himanshu Joshi, S. K. Tripathi

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Fresh water is a scarce resource which is essential for humans and ecosystems, but its distribution is uneven. Agricultural production accounts for 70% of all surface water supplies. It is projected that against the expansion in the area equipped for irrigation by 0.6% per year, the global potential irrigation water demand would rise by 9.5% during 2021-25. This would, on one hand, have to compete against the sharply rising urban water demand. On the other, it would also have to face the fear of climate change, as temperatures rise and crop yields could drop from 10-30% in many large areas. The huge demand for irrigation combined with fresh water scarcity encourages to explore the reuse of wastewater as a resource. However, the use of such wastewater is often linked to the safety issues when used non judiciously or with poor safeguards while irrigating food crops. Paddy is one of the major crops globally and amongst the most important in South Asia and Africa. In many parts of the world, use of municipal wastewater has been promoted as a viable option in this regard. In developing and fast growing countries like India, regularly increasing wastewater generation rates may allow this option to be considered quite seriously. In view of this, a pilot field study was conducted at the Jagjeetpur Municipal Sewage treatment plant situated in the Haridwar town of Uttarakhand state, India. The objectives of the present study were to study the effect of treated wastewater on the production of various paddy varieties (Sharbati, PR-114, PB-1, Menaka, PB1121 and PB 1509) and emission of GHG gases (CO2, CH4 and N2O) as compared to the same varieties grown in the control plots irrigated with fresh water. Of late, the concept of water footprint assessment has emerged, which explains enumeration of various types of water footprints of an agricultural entity from its production to processing stages. Paddy, the most water demanding staple crop of Uttarakhand state, displayed a high green water footprint value of 2966.538 m3/ton. Most of the wastewater irrigated varieties displayed upto 6% increase in production, except Menaka and PB-1121, which showed a reduction in production (6% and 3% respectively), due to pest and insect infestation. The treated wastewater was observed to be rich in Nitrogen (55.94 mg/ml Nitrate), Phosphorus (54.24 mg/ml) and Potassium (9.78 mg/ml), thus rejuvenating the soil quality and not requiring any external nutritional supplements. Percentage increase of GHG gases on irrigation with treated municipal waste water as compared to control plots was observed as 0.4% - 8.6% (CH4), 1.1% - 9.2% (CO2), and 0.07% - 5.8% (N2O). The variety, Sharbati, displayed maximum production (5.5 ton/ha) and emerged as the most resistant variety against pests and insects. The emission values of CH4 ,CO2 and N2O were 729.31 mg/m2/d, 322.10 mg/m2/d and 400.21 mg/m2/d in water stagnant condition. This study highlighted a successful possibility of reuse of wastewater for non-potable purposes offering the potential for exploiting this resource that can replace or reduce existing use of fresh water sources in agricultural sector.

Keywords: greenhouse gases, nutrients, water footprint, wastewater irrigation

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Authors: Debraj Gangopadhyay, Moumita Das, Ranjan K. Singh, Poonam Tandon

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Creatinine is a toxic chemical waste generated from muscle metabolism. Abnormally high levels of creatinine in the body fluid indicate possible malfunction or failure of the kidneys. This leads to a condition termed as creatinine induced nephrotoxicity. N-acetylcysteine is an antioxidant drug which is capable of preventing creatinine induced nephrotoxicity and is helpful to treat renal failure in its early stages. Taurine is another antioxidant drug which serves similar purpose. The kidneys have a natural power that whenever reactive oxygen species radicals increase in the human body, the kidneys make an antioxidant shell so that these radicals cannot harm the kidney function. Taurine plays a vital role in increasing the power of that shell such that the glomerular filtration rate can remain in its normal level. Thus taurine protects the kidneys against several diseases. However, taurine also has some negative effects on the body as its chloramine derivative is a weak oxidant by nature. N-acetylcysteine is capable of inhibiting the residual oxidative property of taurine chloramine. Therefore, N-acetylcysteine is given to a patient along with taurine and this combination is capable of suppressing the negative effect of taurine. Both N-acetylcysteine and taurine being affordable, safe, and widely available medicines, knowledge of the mechanism of their combined effect on creatinine, the favored route of administration, and the proper dose may be highly useful in their use for treating renal patients. Raman spectroscopy is a precise technique to observe minor structural changes taking place when two or more molecules interact. The possibility of formation of a complex between a drug molecule and an analyte molecule in solution can be explored by analyzing the changes in the Raman spectra. The formation of a stable complex of creatinine with N-acetylcysteinein vitroin aqueous solution has been observed with the help of Raman spectroscopic technique. From the Raman spectra of the mixtures of aqueous solutions of creatinine and N-acetylcysteinein different molar ratios, it is observed that the most stable complex is formed at 1:1 ratio of creatinine andN-acetylcysteine. Upon drying, the complex obtained is gel-like in appearance and reddish yellow in color. The complex is hygroscopic and has much better water solubility compared to creatinine. This highlights that N-acetylcysteineplays an effective role in reducing the toxic effect of creatinine by forming this water soluble complex which can be removed through urine. Since the drug taurine is also known to be useful in reducing nephrotoxicity caused by creatinine, the aqueous solution of taurine with those of creatinine and N-acetylcysteinewere mixed in different molar ratios and were investigated by Raman spectroscopic technique. It is understood that taurine itself does not undergo complexation with creatinine as no additional changes are observed in the Raman spectra of creatinine when it is mixed with taurine. However, when creatinine, N-acetylcysteine and taurine are mixed in aqueous solution in molar ratio 1:1:3, several changes occurring in the Raman spectra of creatinine suggest the diminishing toxic effect of creatinine in the presence ofantioxidant drugs N-acetylcysteine and taurine.

Keywords: creatinine, creatinine induced nephrotoxicity, N-acetylcysteine, taurine

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Authors: Budur Almutairi

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Introduction: There is an alarming increase in the number of diabetic patients in Saudi Arabia during the last twenty years. The World Health Organization (WHO) reports that the country ranks seventh in the world for the rate of diabetes. It is also estimated that around 7 million of the population are diabetic and almost around 3 million have pre-diabetes. The prevalence is more in urban area than in rural and more in women than in men and it is closely associated with the parallel rise in obesity rates. Diabetes is found to be contributing to the increasing mortality, morbidity and vascular complications and becoming a significant cause of medical complications and even death. The trends shown by the numbers are worrying as the prevalence is steadily doubling every two decades and particularly in Saudi Arabia, this could soon reach 50% in those over 50 years of age. The economic growth and prosperity have shown notable changes in the lifestyle of the people. Most importantly, along with an increased consumption of fast foods and sugar-rich carbonated soft drinks, eating habits became less healthy and the level of physical activity is decreased. The simultaneous technological advancement and the introduction of new mechanical devices like, elevators, escalators, remotes and vehicles pushed people to a situation of leading a more sedentary life. This study is attempting to evaluate the success of the campaign that introduced through popular social media in the country. Methodology: The Ministry of Health (MoH) has initiated a novel method of campaign activity to generate discussion among public about diabetes. There were mythical monsters introduced through popular social media with disguised messages about the condition of diabetes has generated widespread discussions about the disease among the general public. The characters that started appearing in social media About 600 retweets of the original post was testimonial for the success of the Twitter campaign. The second most successful form of campaign was a video that adopted a very popular approach of using Dark Comedy in which, the diabetes was represented through a twisted negative character that talks about his meticulous plans of how he is going to take the common people into his clutches. This fictional character gained more popularity when introduced into twitter and people started interacting with him raising various questions and challenging his anti-social activities. Major findings: The video generated more than 3,200,000 views ranking 9th in You Tube’s most popular video in Saudi Arabia and was shared 7000 times in a single week. Also, the hashtag got over 4,500,000impressions and over one million visits. Conclusion: Diabetes mellitus in Saudi Arabia is emerging as an epidemic of massive proportions, threatening to negate the benefits of modernization and economic revival. It is highly possible that healthy practices connected with the prevention and management of DM can easily be implemented in a manner that does not conflict with the cultural milieu of Saudi Arabia.

Keywords: campaign, diabetes, Saudi, social media

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Authors: Yen-Fen Shen, Meng-Fan Li

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The study aims to investigate the effect of full-body vertical rhythmic training on fatigue, physical activity, and quality of life among middle-aged and elderly hemodialysis patients. The study adopted a quasi-experimental research method and recruited 43 long-term hemodialysis patients from a medical center in northern Taiwan, with 23 and 20 participants in the experimental and control groups, respectively. The experimental group received full-body vertical rhythmic training as an intervention, while the control group received standard hemodialysis care without any intervention. Both groups completed the measurements by using "Fatigue Scale", "Physical Activity Scale" and "Chinese version of the Kidney Disease Quality of Life Questionnaire" before and after the study. The experimental group underwent a 10-minute full-body vertical rhythmic training three times per week, which lasted for eight weeks before receiving regular hemodialysis treatment. The data were analyzed by SPSS 25 software, including descriptive statistics such as frequency distribution, percentages, means, and standard deviations, as well as inferential statistics, including chi-square, independent samples t-test, and paired samples t-test. The study results are summarized as follows: 1. There were no significant differences in demographic variables, fatigue, physical activity, and quality of life between the experimental and control groups in the pre-test. 2. After the intervention of the “full-body vertical rhythmic training,” the experimental group showed significantly better results in the category of "feeling tired and fatigued in the lower back", "physical functioning role limitation", "bodily pain", "social functioning", "mental health", and "impact of kidney disease on life quality." 3. The paired samples t-test results revealed that the control group experienced significant differences between the pre-test and post-test in the categories of feeling tired and fatigued in the lower back, bodily pain, social functioning mental health, and impact of kidney disease on life quality, with scores indicating a decline in life quality. Conversely, the experimental group only showed a significant worsening in bodily pain" and the impact of kidney disease on life quality, with lower change values compared to the control group. Additionally, there was an improvement in the condition of "feeling tired and fatigued in the lower back" for the experimental group. Conclusion: The intervention of the “full-body vertical rhythmic training” had a certain positive effect on the quality of life of the experimental group. While it may not entirely enhance patients' quality of life, it can mitigate the negative impact of kidney disease on certain aspects of the body. The study provides clinical practice, nursing education, and research recommendations based on the results and discusses the limitations of the research.

Keywords: hemodialysis, full-body vertical rhythmic training, fatigue, physical activity, quality of life

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Authors: Avi Shrivastava

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Our world continues to grapple with a lot of social issues. Economic growth and scientific advancements have not completely eradicated poverty, homelessness, discrimination and bias, gender inequality, health issues, mental illness, addiction, and other social issues. So, how do we improve the human condition in a world driven by advanced technology? The answer is simple: we will have to leverage technology to address some of the most important social challenges of the day. AI, or artificial intelligence, has emerged as a critical tool in the battle against issues that deprive marginalized and disadvantaged groups of the right to enjoy benefits that a society offers. Social work professionals can transform their lives by harnessing it. The lack of reliable data is one of the reasons why a lot of social work projects fail. Social work professionals continue to rely on expensive and time-consuming primary data collection methods, such as observation, surveys, questionnaires, and interviews, instead of tapping into AI-based technology to generate useful, real-time data and necessary insights. By leveraging AI’s data-mining ability, we can gain a deeper understanding of how to solve complex social problems and change lives of people. We can do the right work for the right people and at the right time. For example, AI can enable social work professionals to focus their humanitarian efforts on some of the world’s poorest regions, where there is extreme poverty. An interdisciplinary team of Stanford scientists, Marshall Burke, Stefano Ermon, David Lobell, Michael Xie, and Neal Jean, used AI to spot global poverty zones – identifying such zones is a key step in the fight against poverty. The scientists combined daytime and nighttime satellite imagery with machine learning algorithms to predict poverty in Nigeria, Uganda, Tanzania, Rwanda, and Malawi. In an article published by Stanford News, Stanford researchers use dark of night and machine learning, Ermon explained that they provided the machine-learning system, an application of AI, with the high-resolution satellite images and asked it to predict poverty in the African region. “The system essentially learned how to solve the problem by comparing those two sets of images [daytime and nighttime].” This is one example of how AI can be used by social work professionals to reach regions that need their aid the most. It can also help identify sources of inequality and conflict, which could reduce inequalities, according to Nature’s study, titled The role of artificial intelligence in achieving the Sustainable Development Goals, published in 2020. The report also notes that AI can help achieve 79 percent of the United Nation’s (UN) Sustainable Development Goals (SDG). AI is impacting our everyday lives in multiple amazing ways, yet some people do not know much about it. If someone is not familiar with this technology, they may be reluctant to use it to solve social issues. So, before we talk more about the use of AI to accomplish social work objectives, let’s put the spotlight on how AI and social work can complement each other.

Keywords: social work, artificial intelligence, AI based social work, machine learning, technology

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Authors: Ramprasad Srinivasan

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Engineers create inventions and put their ideas in concrete terms to design new products. Design drivers must be established, which requires, among other things, a complete understanding of the product design, load paths, etc. For Aerospace Vehicles, weight/strength ratio, strength, stiffness and stability are the important design drivers. A complex built-up structure is made up of an assemblage of primitive structural forms of arbitrary shape, which include 1D structures like beams and frames, 2D structures like membranes, plate and shell structures, and 3D solid structures. Justification through simulation involves a check for all the quantities of interest, namely stresses, deformation, frequencies, and buckling loads and is normally achieved through the finite element (FE) method. Over the past few decades, Fiber-reinforced composites are fast replacing the traditional metallic structures in the weight-sensitive aerospace and aircraft industries due to their high specific strength, high specific stiffness, anisotropic properties, design freedom for tailoring etc. Composite panel constructions are used in aircraft to design primary structure components like wings, empennage, ailerons, etc., while thin-walled composite beams (TWCB) are used to model slender structures like stiffened panels, helicopter, and wind turbine rotor blades, etc. The TWCB demonstrates many non-classical effects like torsional and constrained warping, transverse shear, coupling effects, heterogeneity, etc., which makes the analysis of composite structures far more complex. Conventional FE formulations to model 1D structures suffer from many limitations like shear locking, particularly in slender beams, lower convergence rates due to material coupling in composites, inability to satisfy, equilibrium in the domain and natural boundary conditions (NBC) etc. For 2D structures, the limitations of conventional displacement-based FE formulations include the inability to satisfy NBC explicitly and many pathological problems such as shear and membrane locking, spurious modes, stress oscillations, lower convergence due to mesh distortion etc. This mandates frequent re-meshing to even achieve an acceptable mesh (satisfy stringent quality metrics) for analysis leading to significant cycle time. Besides, currently, there is a need for separate formulations (u/p) to model incompressible materials, and a single unified formulation is missing in the literature. Hence coupled field formulation (CFF) is a unified formulation proposed by the author for the solution of complex 1D and 2D structures addressing the gaps in the literature mentioned above. The salient features of CFF and its many advantages over other conventional methods shall be presented in this paper.

Keywords: coupled field formulation, kinematic and material coupling, natural boundary condition, locking free formulation

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Authors: Celine Shi Ying Lee, Jong Jian Lee

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Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

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Authors: Anita Bajpai, Sarah Duan, Ashlee Erskine, Shehzein Khan, Raymond Kramer

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Introduction: This research focuses on exploring the beneficial effects if any, of Vitamin-D in reducing the need for supplemental oxygen among hospitalized COVID-19 patients. Two questions are investigated – Q1)Doeshaving a healthy level of baselineVitamin-D 25-OH (≥ 30ng/ml) help,andQ2) does administering Vitamin-D therapy after-the-factduring inpatient hospitalization help? Methods/Study Design: This is a comprehensive, retrospective, observational study of all inpatients at RUHS from March through December 2020 who tested positive for COVID-19 based on real-time reverse transcriptase–polymerase chain reaction assay of nasal and pharyngeal swabs and rapid assay antigen test. To address Q1, we looked atall N1=182 patients whose baseline plasma Vitamin-D 25-OH was known and who needed supplemental oxygen. Of this, a total of 121 patients had a healthy Vitamin-D level of ≥30 ng/mlwhile the remaining 61 patients had low or borderline (≤ 29.9ng/ml)level. Similarly, for Q2, we looked at a total of N2=893 patients who were given supplemental oxygen, of which713 were not given Vitamin-D and 180 were given Vitamin-D therapy. The numerical value of the maximum amount of oxygen flow rate(dependent variable) administered was recorded for each patient. The mean values and associated standard deviations for each group were calculated. Thesetwo sets of independent data served as the basis for independent, two-sample t-Test statistical analysis. To be accommodative of any reasonable benefitof Vitamin-D, ap-value of 0.10(α< 10%) was set as the cutoff point for statistical significance. Results: Given the large sample sizes, the calculated statistical power for both our studies exceeded the customary norm of 80% or better (β< 0.2). For Q1, the mean value for maximumoxygen flow rate for the group with healthybaseline level of Vitamin-D was 8.6 L/min vs.12.6L/min for those with low or borderline levels, yielding a p-value of 0.07 (p < 0.10) with the conclusion that those with a healthy level of baseline Vitamin-D needed statistically significant lower levels of supplemental oxygen. ForQ2, the mean value for a maximum oxygen flow rate for those not administered Vitamin-Dwas 12.5 L/min vs.12.8L/min for those given Vitamin-D, yielding a p-valueof 0.87 (p > 0.10). We thereforeconcludedthat there was no statistically significant difference in the use of oxygen therapy between those who were or were not administered Vitamin-D after-the-fact in the hospital. Discussion/Conclusion: We found that patients who had healthy levels of Vitamin-D at baseline needed statistically significant lower levels of supplemental oxygen. Vitamin-D is well documented, including in a recent article in the Lancet, for its anti-inflammatory role as an adjuvant in the regulation of cytokines and immune cells. Interestingly, we found no statistically significant advantage for giving Vitamin-D to hospitalized patients. It may be a case of “too little too late”. A randomized clinical trial reported in JAMA also did not find any reduction in hospital stay of patients given Vitamin-D. Such conclusions come with a caveat that any delayed marginal benefits may not have materialized promptly in the presence of a significant inflammatory condition. Since Vitamin-D is a low-cost, low-risk option, it may still be useful on an inpatient basis until more definitive findings are established.

Keywords: COVID-19, vitamin-D, supplemental oxygen, vitamin-D in primary care

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Authors: Jiujie Cai, Fengxia LI, Haibo Wang

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After years of research, offshore oil and gas development now are shifted to unconventional reservoirs, where multi-stage hydraulic fracturing technology has been widely used. However, the simulation of complex hydraulic fractures in tight reservoirs is faced with geological and engineering difficulties, such as large burial depths, sand-shale interbeds, and complex stress barriers. The objective of this work is to simulate the hydraulic fracture propagation in the tight sandstone matrix of the marine-continental transitional reservoirs, where the Shanxi Formation in Tianhuan syncline of the Dongsheng gas field was used as the research target. The characteristic parameters of the vertical rock samples with rich beddings were clarified through rock mechanics experiments. The influence of rock mechanical parameters, vertical stress difference of pay-zone and bedding layer, and fracturing parameters (such as injection rates, fracturing fluid viscosity, and number of perforation clusters within single stage) on fracture initiation and propagation were investigated. In this paper, a 3-D fracture propagation model was built to investigate the complex fracture propagation morphology by boundary element method, considering the strength of bonding surface between layers, vertical stress difference and fracturing parameters (such as injection rates, fluid volume and viscosity). The research results indicate that on the condition of vertical stress difference (3 MPa), the fracture height can break through and enter the upper interlayer when the thickness of the overlying bedding layer is 6-9 m, considering effect of the weak bonding surface between layers. The fracture propagates within the pay zone when overlying interlayer is greater than 13 m. Difference in fluid volume distribution between clusters could be more than 20% when the stress difference of each cluster in the segment exceeds 2MPa. Fracture cluster in high stress zones cannot initiate when the stress difference in the segment exceeds 5MPa. The simulation results of fracture height are much higher if the effect of weak bonding surface between layers is not involved. By increasing the injection rates, increasing fracturing fluid viscosity, and reducing the number of clusters within single stage can promote the fracture height propagation through layers. Optimizing the perforation position and reducing the number of perforations can promote the uniform expansion of fractures. Typical curves of fracture height estimation were established for the tight sandstone of the Lower Permian Shanxi Formation. The model results have good consistency with micro-seismic monitoring results of hydraulic fracturing in Well 1HF.

Keywords: fracture propagation, boundary element method, fracture height, offshore oil and gas, marine-continental transitional reservoirs, rock mechanics experiment

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Authors: Kraiem Khadija, Hamadi Kallali, Naceur Jedidi

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Constructed wetland systems are eco-technology recognized as environmentally friendly and emerging innovative solutions remediation as these systems are cost-effective and sustainable wastewater treatment systems. The performance of these biological system is affected by various factors such as plant, substrate, wastewater type, hydraulic loading rate, hydraulic retention time, water depth, and operation mood. The objective of this study was to to assess the alters of plant species on pollutants reduction and enrichment of anammox and nitrifing denitrifing bacteria in a modified vertical flow (VFCW) constructed wetland. This tests were carried out using three modified vertical constructed wetlands with a surface of 0.23 m² and depth 80 cm. It was a saturated vertical constructed wetland at the bottom. The saturation zone is maintained by the siphon structure at the outlet. The VFCW (₁) system was unplanted, VFCW (₂) planted with Typha angustofolia, and VFCW(₃) planted with Phragmites australis. The experimental units were fed with domestic wastewater and were operated by batch mode during 8 months at an average hydraulic loading rate around 20 cm day− 1. The operation cycle was two days feeding and five days rest. Results indicated that plants presence improved the removal efficiency; the removal rates of organic matter (85.1–90.9%; COD and 81.8–88.9%; BOD5), nitrogen (54.2–73%; NTK and 66–77%; NH4 -N) were higher by 10.7–30.1% compared to the unplanted vertical constructed wetland. On the other hand, the plant species had no significant effect on removal efficiency of COD, The removal of COD was similar in VFCW (₂) and VFCW (₃) (p > 0.05), attaining average removal efficiencies of 88.7% and 85.2%, respectively. Whereas it had a significant effect on NTK removal (p > 0.05), with an average removal rate of 72% versus 51% for VFCW (₂) and VFCW (₃), respectively. Among the three sets of vertical flow constructed wetlands, the VFCW(₂) removed the highest percent of total streptococcus, fecal streptococcus total coliforms, fecal coliforms, E. coli as 59, 62, 52, 63, and 58%, respectively. The presence and the plant species alters the community composition and abundance of the bacteria. The abundance of bacteria in the planted wetland was much higher than that in the unplanted one. VFCW(₃) had the highest relative abundance of nitrifying bacteria such as Nitrosospira (18%), Nitrosospira (12%), and Nitrobacter (8%). Whereas the vertical constructed wetland planted with typha had larger number of denitrifying species, with relative abundances of Aeromonas (13%), Paracoccus (11%), Thauera (7%), and Thiobacillus (6%). However, the abundance of nitrifying bacteria was very lower in this system than VFCW(₂). Interestingly, the presence of Thypha angustofolia species favored the enrichment of anammox bacteria compared to unplanted system and system planted with phragmites australis. The results showed that the middle layer had the most accumulation of anammox bacteria, which the anaerobic condition is better and the root system is moderate. Vegetation has several characteristics that make it an essential component of wetlands, but its exact effects are complex and debated.

Keywords: wastawater, constructed wetland, anammox, removal

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Authors: Anthony S. Machi, Joseph Minardi

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We present a case report of left atrial myxoma diagnosed by bedside transesophageal (TEE) ultrasound. Left atrial myxoma is the most common benign cardiac tumor and can obstruct blood flow and cause valvular insufficiency. Common symptoms consist of dyspnea, pulmonary edema and other features of left heart failure in addition to thrombus release in the form of tumor fragments. The availability of bedside ultrasound equipment is essential for the quick diagnosis and treatment of various emergency conditions including cardiac neoplasms. A 48-year-old Caucasian female with a four-year history of an untreated renal mass and anemia presented to the ED with two months of sharp, intermittent, bilateral flank pain radiating into the abdomen. She also reported intermittent vomiting and constipation along with generalized body aches, night sweats, and 100-pound weight loss over last year. She had a CT in 2013 showing a 3 cm left renal mass and a second CT in April 2016 showing a 3.8 cm left renal mass along with a past medical history of diverticulosis, chronic bronchitis, dyspnea on exertion, uncontrolled hypertension, and hyperlipidemia. Her maternal family history is positive for breast cancer, hypertension, and Type II Diabetes. Her paternal family history is positive for stroke. She was a current everyday smoker with an 11 pack/year history. Alcohol and drug use were denied. Physical exam was notable for a Grade II/IV systolic murmur at the right upper sternal border, dyspnea on exertion without angina, and a tender left lower quadrant. Her vitals and labs were notable for a blood pressure of 144/96, heart rate of 96 beats per minute, pulse oximetry of 96%, hemoglobin of 7.6 g/dL, hypokalemia, hypochloremia, and multiple other abnormalities. Physicians ordered a CT to evaluate her flank pain which revealed a 7.2 x 8.9 x 10.5 cm mixed cystic/solid mass in the lower pole of the left kidney and a filling defect in the left atrium. Bedside TEE was ordered to follow up on the filling defect. TEE reported an ejection fraction of 60-65% and visualized a mobile 6 x 3 cm mass in the left atrium attached to the interatrial septum extending into the mitral valve. Cardiothoracic Surgery and Urology were consulted and confirmed a diagnosis of left atrial myxoma and clear cell renal cell carcinoma. The patient returned a week later due to worsening nausea and vomiting and underwent emergent nephrectomy, lymph node dissection, and colostomy due to a necrotic colon. Her condition declined over the next four months due to lung and brain metastases, infections, and other complications until she passed away.

Keywords: bedside ultrasound, echocardiography, emergency medicine, left atrial myxoma

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Authors: Sigal Portnoy, Jason Friedman, Eitan Raveh

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Introduction: Sensory substitution is possible due to the capacity of our brain to adapt to information transmitted by a synthetic receptor via an alternative sensory system. Practical sensory substitution systems are being developed in order to increase the functionality of individuals with sensory loss, e.g. amputees. For upper limb prosthetic-users the loss of tactile feedback compels them to allocate visual attention to their prosthesis. The effect of adding vibrotactile feedback (VTF) to the applied force has been studied, however its effect on the allocation if visual attention during dual-tasking and the response during misleading visual feedback have not been studied. We hypothesized that VTF will improve the performance and reduce visual attention during dual-task assignments in healthy individuals using a robotic hand and improve the performance in a standardized functional test, despite the presence of misleading visual feedback. Methods: For the dual-task paradigm, twenty healthy subjects were instructed to toggle two keyboard arrow keys with the left hand to retain a moving virtual car on a road on a screen. During the game, instructions for various activities, e.g. mix the sugar in the glass with a spoon, appeared on the screen. The subject performed these tasks with a robotic hand, attached to the right hand. The robotic hand was controlled by the activity of the flexors and extensors of the right wrist, recorded using surface EMG electrodes. Pressure sensors were attached at the tips of the robotic hand and induced VTF using vibrotactile actuators attached to the right arm of the subject. An eye-tracking system tracked to visual attention of the subject during the trials. The trials were repeated twice, with and without the VTF. Additionally, the subjects performed the modified box and blocks, hidden from eyesight, in a motion laboratory. A virtual presentation of a misleading visual feedback was be presented on a screen so that twice during the trial, the virtual block fell while the physical block was still held by the subject. Results: This is an ongoing study, which current results are detailed below. We are continuing these trials with transradial myoelectric prosthesis-users. In the healthy group, the VTF did not reduce the visual attention or improve performance during dual-tasking for the tasks that were typed transfer-to-target, e.g. place the eraser on the shelf. An improvement was observed for other tasks. For example, the average±standard deviation of time to complete the sugar-mixing task was 13.7±17.2s and 19.3±9.1s with and without the VTF, respectively. Also, the number of gaze shifts from the screen to the hand during this task were 15.5±23.7 and 20.0±11.6, with and without the VTF, respectively. The response of the subjects to the misleading visual feedback did not differ between the two conditions, i.e. with and without VTF. Conclusions: Our interim results suggest that the performance of certain activities of daily living may be improved by VTF. The substitution of visual sensory input by tactile feedback might require a long training period so that brain plasticity can occur and allow adaptation to the new condition.

Keywords: prosthetics, rehabilitation, sensory substitution, upper limb amputation

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Authors: Elyria Kemp, Kelly Cowart, My Bui

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According to the National Institute of Mental Health, an estimated 31.9% of adolescents have had an anxiety disorder. Several environmental factors may help to contribute to high levels of anxiety and depression in young people (i.e., Generation Z, Millennials). However, as young people negotiate life on social media, they may begin to evaluate themselves using excessively high standards and adopt self-perfectionism tendencies. Broadly defined, self-perfectionism involves very critical evaluations of the self. Perfectionism may also come from others and may manifest as socially prescribed perfectionism, and young adults are reporting higher levels of socially prescribed perfectionism than previous generations. This rising perfectionism is also associated with anxiety, greater physiological reactivity, and a sense of social disconnection. However, theories from psychology suggest that improvement in emotion regulation can contribute to enhanced psychological and emotional well-being. Emotion regulation refers to the ways people manage how and when they experience and express their emotions. Cognitive reappraisal and expressive suppression are common emotion regulation strategies. Cognitive reappraisal involves changing the meaning of a stimulus that involves construing a potentially emotion-eliciting situation in a way that changes its emotional impact. By contrast, expressive suppression involves inhibiting the behavioral expression of emotion. The purpose of this research is to examine the efficacy of social marketing initiatives which promote emotion regulation strategies to help young adults regulate their emotions. In Study 1 a single factor (emotional regulation strategy: a cognitive reappraisal, expressive, control) between-subjects design was conducted using an online, non-student consumer panel (n=96). Sixty-eight percent of participants were male, and 32% were female. Study participants belonged to the Millennial and Gen Z cohort, ranging in age from 22 to 35 (M=27). Participants were first told to spend at least three minutes writing about a public speaking appearance which made them anxious. The purpose of this exercise was to induce anxiety. Next, participants viewed one of three advertisements (randomly assigned) which promoted an emotion regulation strategy—cognitive reappraisal, expressive suppression, or an advertisement non-emotional in nature. After being exposed to one of the ads, participants responded to a measure composed of two items to access their emotional state and the efficacy of the messages in fostering emotion management. Findings indicated that individuals in the cognitive reappraisal condition (M=3.91) exhibited the most positive feelings and more effective emotion regulation than the expressive suppression (M=3.39) and control conditions (M=3.72, F(1,92) = 3.3, p<.05). Results from this research can be used by institutions (e.g., schools) in taking a leadership role in attacking anxiety and other mental health issues. Social stigmas regarding mental health can be removed and a more proactive stance can be taken in promoting healthy coping behaviors and strategies to manage negative emotions.

Keywords: emotion regulation, anxiety, social marketing, generation z

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Authors: Faith O. Olanrewaju

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Internal displacement and the vulnerability of women are two critical aspects of forced migration that have dominated both global and local discourses. Statistics show that in November 2021, there were over 2.1 million internally displaced persons (IDPs) in Nigeria. Literature also states that displaced women and girls are more vulnerable than displaced men. They are susceptible to adversative experiences, including various forms of sexual violence and rape. As a result, the displaced women and girls are faced with psychological and physical traumas, including HIV/AIDS as well as unexpected or poorly spaced pregnancies. In addition, the poor condition of living of internally displaced women in IDP camps affects their reproductive health, pregnancy outcomes, and maternal mortality levels. Incontrovertibly, internally displaced women constitute an imperative contributor to the ills of Nigeria's maternal health status, which is the second worse globally and the worst in Africa. World Health Organisation statistics showed that approximately 536,000 girls and women die from pregnancy-related causes globally, and Nigeria accounts for 14% of the global maternal deaths. Undeniably, this supports the claims that maternal mortality remains a challenge in Nigeria and can be exacerbated by internal displacement crises. Therefore, maternal mortality remains a critical impediment to the actualisation of the 3.1 SDG target. Owing to this, concerns arise about the quality of the policy in Nigeria’s health sector. More specifically, this study is concerned with the maternal health care services displaced women receive in IDP camps in the three states affected by internal displacement in north-central Nigeria, an understudied area. The novelty of the study also lies in its comparative investigation of maternal healthcare service delivery in three different camp structures (faith-based, government, and informal IDP camps), a pattern that is absent in literature. Therefore, this study will investigate how the camp structures affect access to maternal health services in the study areas; analyse the successes and challenges in the delivery of maternal health care services to displaced women in the various camps; and recommendation and strategies for reducing maternal healthcare disparities/gaps across IDP camps in Nigeria (should they exist). It will adopt a mixed-method approach and multi-stage sampling technique. A total of 1,152 copies of the study questionnaire will be distributed to displaced pregnant and nursing mothers (PNM); nine focus group discussions will also be held with the displaced PNM; in-depth interviews will be conducted with humanitarian actors, policymakers, and health professionals. The quantitative and qualitative data will be analysed using Statistical Package for Social Science (SPSS) 21.0 and thematic analysis, respectively. The findings of the study will be used to develop a model of care that will address the fragmentations in Nigeria's healthcare system. The findings will also inform the development of best policies and practices in the maternal health of displaced women.

Keywords: forced displacement, internally displaced women, maternal healthcare, maternal mortality

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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: Kaushalendra Kumar, Abhishek Kumar, Chandra Moni, Sanjay Kumar, P. K. Singh, Ajeet Kumar

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Present study investigated the dietary inclusion of Moringa oleifera leaf meal (MOLM) on production efficiency, hemato-biochemical profile and economy of Vanaraja birds under tropical condition. Experiment was conducted for a period of 56 days on 300 Vanaraja birds randomly divided in to five different experimental groups including control of 60 birds each group replicated with 20 chicks in each replicate. T1, T2, T3, T4, and T5 were offered with 0, 5, 10, 15, and 20% Moringa oleifera leaf meal along with basal ration. All the standard managemental practices were followed during experimental period including vaccination schedule. Locally available Moringa oleifera leaves were harvested at mature stage and allowed to dry under shady and aerated conditions. Thereafter, dried leaves were milled to make a leaf meal and stored in the airtight nylon bags to avoid any possible contamination from foreign material and use for experiment. Production parameters were calculated based on the amount of feed consumed and weight gain every weeks. The body weight gain of T2 group was significantly (P < 0.05) higher side whereas T3 group was comparable with control. The feed conversion ratio for T2 group was found to be significantly (P < 0.05) lower than all other treatment groups, while none of the group was comparable with each other. At the end of the experiment blood samples were collected from birds for haematology study while serum biochemistry performed using spectrophotometer following statndard protocols. The haematological attributes were significantly (P > 0.05) not differed among the groups. However, serum biochemistry showed significant reduction (P < 0.05) of blood urea nitrogen, uric acid and creatinine level with higher level of MOLM diet, indicates better utilization of protein supplemented through MOLM. The total cholesterol and triglyceride level was declined significantly (P < 0.05) as compare to control group with increased level of MOLM in basal diet, decreasing trend of serum cholesterol noted. However, value of HDL for T3 group was highest and for T1 group was lowest but no significant difference (P < 0.05) found among the groups. It might be due to presence of β-sitosterol a bioactive compound present in MOLM which causes lowering of plasma concentration of LDL. During experiment total, LDL and VLDL level was found to be decreased significantly (P < 0.05) as compare to control group. It was observed that the production efficiency of birds significantly improved with 5% followed by 10% Moringa oleifera leaf meal among the treatment groups. However, the maximum profit per kg live weight was noted in 10 % level and least profit observed in 20% MOLM fed group. It was concluded that the dietary inclusion of MOLM improved overall performances without affecting metabolic status and effective in reducing cholesterol level reflects healthy chicken production for human consumption.

Keywords: hemato biochemistry, Moringa oleifera leaf meal, performance, Vanaraja birds

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Authors: Hatem Abou-Senna, Essam Radwan

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With increasing traffic and limited resources, accommodating left-turning traffic has been a challenge for traffic engineers as they seek balance between intersection capacity and safety; these are two conflicting goals in the operation of a signalized intersection that are mitigated through signal phasing techniques. Hence, to increase the left-turn capacity and reduce the delay at the intersections, the Florida Department of Transportation (FDOT) moves forward with a vision of optimizing intersection control using innovative intersection designs through the Transportation Systems Management & Operations (TSM&O) program. These alternative designs successfully eliminate the left-turn phase, which otherwise reduces the conventional intersection’s (CI) efficiency considerably, and divide the intersection into smaller networks that would operate in a one-way fashion. This study focused on the Crossover Displaced Left-turn intersections (XDL), also known as Continuous Flow Intersections (CFI). The XDL concept is best suited for intersections with moderate to high overall traffic volumes, especially those with very high or unbalanced left turn volumes. There is little guidance on determining whether partial XDL intersections are adequate to mitigate the overall intersection condition or full XDL is always required. The primary objective of this paper was to evaluate the overall intersection performance in the case of different partial XDL designs compared to a full XDL. The XDL alternative was investigated for 4 different scenarios; partial XDL on the east-west approaches, partial XDL on the north-south approaches, partial XDL on the north and east approaches and full XDL on all 4 approaches. Also, the impact of increasing volume on the intersection performance was considered by modeling the unbalanced volumes with 10% increment resulting in 5 different traffic scenarios. The study intersection, located in Orlando Florida, is experiencing recurring congestion in the PM peak hour and is operating near capacity with volume to a capacity ratio closer to 1.00 due to the presence of two heavy conflicting movements; southbound and westbound. The results showed that a partial EN XDL alternative proved to be effective and compared favorably to a full XDL alternative followed by the partial EW XDL alternative. The analysis also showed that Full, EW and EN XDL alternatives outperformed the NS XDL and the CI alternatives with respect to the throughput, delay and queue lengths. Significant throughput improvements were remarkable at the higher volume level with percent increase in capacity of 25%. The percent reduction in delay for the critical movements in the XDL scenarios compared to the CI scenario ranged from 30-45%. Similarly, queue lengths showed percent reduction in the XDL scenarios ranging from 25-40%. The analysis revealed how partial XDL design can improve the overall intersection performance at various demands, reduce the costs associated with full XDL and proved to outperform the conventional intersection. However, partial XDL serving low volumes or only one of the critical movements while other critical movements are operating near or above capacity do not provide significant benefits when compared to the conventional intersection.

Keywords: continuous flow intersections, crossover displaced left-turn, microscopic traffic simulation, transportation system management and operations, VISSIM simulation model

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Authors: Sara Rejeb, Catherine Duveau, Tabea Rebafka

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To monitor the production process of turbofan aircraft engines, multiple measurements of various geometrical parameters are systematically recorded on manufactured parts. Engine parts are subject to extremely high standards as they can impact the performance of the engine. Therefore, it is essential to analyze these databases to better understand the influence of the different parameters on the engine's performance. Self-organizing maps are unsupervised neural networks which achieve two tasks simultaneously: they visualize high-dimensional data by projection onto a 2-dimensional map and provide clustering of the data. This technique has become very popular for data exploration since it provides easily interpretable results and a meaningful global view of the data. As such, self-organizing maps are usually applied to aircraft engine condition monitoring. As databases in this field are huge and complex, they naturally contain multiple missing entries for various reasons. The classical Kohonen algorithm to compute self-organizing maps is conceived for complete data only. A naive approach to deal with partially observed data consists in deleting items or variables with missing entries. However, this requires a sufficient number of complete individuals to be fairly representative of the population; otherwise, deletion leads to a considerable loss of information. Moreover, deletion can also induce bias in the analysis results. Alternatively, one can first apply a common imputation method to create a complete dataset and then apply the Kohonen algorithm. However, the choice of the imputation method may have a strong impact on the resulting self-organizing map. Our approach is to address simultaneously the two problems of computing a self-organizing map and imputing missing values, as these tasks are not independent. In this work, we propose an extension of self-organizing maps for partially observed data, referred to as missSOM. First, we introduce a criterion to be optimized, that aims at defining simultaneously the best self-organizing map and the best imputations for the missing entries. As such, missSOM is also an imputation method for missing values. To minimize the criterion, we propose an iterative algorithm that alternates the learning of a self-organizing map and the imputation of missing values. Moreover, we develop an accelerated version of the algorithm by entwining the iterations of the Kohonen algorithm with the updates of the imputed values. This method is efficiently implemented in R and will soon be released on CRAN. Compared to the standard Kohonen algorithm, it does not come with any additional cost in terms of computing time. Numerical experiments illustrate that missSOM performs well in terms of both clustering and imputation compared to the state of the art. In particular, it turns out that missSOM is robust to the missingness mechanism, which is in contrast to many imputation methods that are appropriate for only a single mechanism. This is an important property of missSOM as, in practice, the missingness mechanism is often unknown. An application to measurements on one type of part is also provided and shows the practical interest of missSOM.

Keywords: imputation method of missing data, partially observed data, robustness to missingness mechanism, self-organizing maps

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Authors: Bing Chen, Xiang Ni, Eric Li

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With the population ageing, the number of patients suffering from chronic diseases is increasing, among which stroke is a high incidence for the elderly. In addition, there is a gradual increase in the number of patients with orthopedic or neurological conditions such as spinal cord injuries, nerve injuries, and other knee injuries. These diseases are chronic, with high recurrence and complications, and normal walking is difficult for such patients. Nowadays, robotic knee exoskeletons have been developed for individuals with knee impairments. However, the currently available robotic knee exoskeletons are generally developed with heavyweight, which makes the patients uncomfortable to wear, prone to wearing fatigue, shortening the wearing time, and reducing the efficiency of exoskeletons. Some lightweight materials, such as carbon fiber and titanium alloy, have been used for the development of robotic knee exoskeletons. However, this increases the cost of the exoskeletons. This paper illustrates the design of a new ultra-light and ultra-stiff truss type of lattice structure. The lattice structures are arranged in a fan shape, which can fit well with circular arc surfaces such as circular holes, and it can be utilized in the design of rods, brackets, and other parts of a robotic knee exoskeleton to reduce the weight. The metamaterial is formed by continuous arrangement and combination of small truss structure unit cells, which changes the diameter of the pillar section, geometrical size, and relative density of each unit cell. It can be made quickly through additive manufacturing techniques such as metal 3D printing. The unit cell of the truss structure is small, and the machined parts of the robotic knee exoskeleton, such as connectors, rods, and bearing brackets, can be filled and replaced by gradient arrangement and non-uniform distribution. Under the condition of satisfying the mechanical properties of the robotic knee exoskeleton, the weight of the exoskeleton is reduced, and hence, the patient’s wearing fatigue is relaxed, and the wearing time of the exoskeleton is increased. Thus, the efficiency and wearing comfort, and safety of the exoskeleton can be improved. In this paper, a brief description of the hardware design of the prototype of the robotic knee exoskeleton is first presented. Next, the design of the ultra-light and ultra-stiff truss type of lattice structures is proposed, and the mechanical analysis of the single-cell unit is performed by establishing the theoretical model. Additionally, simulations are performed to evaluate the maximum stress-bearing capacity and compressive performance of the uniform arrangement and gradient arrangement of the cells. Finally, the static analysis is performed for the cell-filled rod and the unmodified rod, respectively, and the simulation results demonstrate the effectiveness and feasibility of the designed ultra-light and ultra-stiff truss type of lattice structures. In future studies, experiments will be conducted to further evaluate the performance of the designed lattice structures.

Keywords: additive manufacturing, lattice structures, metamaterial, robotic knee exoskeleton

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Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Nikitha Francis, Anjana Hoode, Vinitha George, Jayashree S. Bhat

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The interaction between cognition and language, referred as cognitive-communication, is very intricate, involving several mental processes such as perception, memory, attention, lexical retrieval, decision making, motor planning, self-monitoring and knowledge. Cognitive-communication disorders are difficulties in communicative competencies that result from underlying cognitive impairments of attention, memory, organization, information processing, problem solving, and executive functions. Traumatic brain injury (TBI) is an acquired, non - progressive condition, resulting in distinct deficits of cognitive communication abilities such as naming, word-finding, self-monitoring, auditory recognition, attention, perception and memory. Cognitive-communication intervention in TBI is individualized, in order to enhance the person’s ability to process and interpret information for better functioning in their family and community life. The present case report illustrates the cognitive-communicative behaviors and the intervention outcomes of an adult with TBI, who was brought to the Department of Audiology and Speech Language Pathology, with cognitive and communicative disturbances, consequent to road traffic accident. On a detailed assessment, she showed naming deficits along with perseverations and had severe difficulty in recalling the details of the accident, her house address, places she had visited earlier, names of people known to her, as well as the activities she did each day, leading to severe breakdowns in her communicative abilities. She had difficulty in initiating, maintaining and following a conversation. She also lacked orientation to time and place. On administration of the Manipal Manual of Cognitive Linguistic Abilities (MMCLA), she exhibited poor performance on tasks related to visual and auditory perception, short term memory, working memory and executive functions. She attended 20 sessions of cognitive-communication intervention which followed a domain-general, adaptive training paradigm, with tasks relevant to everyday cognitive-communication skills. Compensatory strategies such as maintaining a dairy with reminders of her daily routine, names of people, date, time and place was also recommended. MMCLA was re-administered and her performance in the tasks showed significant improvements. Occurrence of perseverations and word retrieval difficulties reduced. She developed interests to initiate her day-to-day activities at home independently, as well as involve herself in conversations with her family members. Though she lacked awareness about her deficits, she actively involved herself in all the therapy activities. Rehabilitation of moderate to severe head injury patients can be done effectively through a holistic cognitive retraining with a focus on different cognitive-linguistic domains. Selection of goals and activities should have relevance to the functional needs of each individual with TBI, as highlighted in the present case report.

Keywords: cognitive-communication, executive functions, memory, traumatic brain injury

Procedia PDF Downloads 347