Search results for: imagined pain
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1187

Search results for: imagined pain

557 A Re-Evaluation of Green Architecture and Its Contributions to Environmental Sustainability

Authors: Po-Ching Wang

Abstract:

Considering the notable effects of natural resource consumption and impacts on fragile ecosystems, reflection on contemporary sustainable design is critical. Nevertheless, the idea of ‘green’ has been misapplied and even abused, and, in fact, much damage to the environment has been done in its name. In 1996’s popular science fiction film Independence Day, an alien species, having exhausted the natural resources of one planet, moves on to another —a fairly obvious irony on contemporary human beings’ irresponsible use of the Earth’s natural resources in modern times. In fact, the human ambition to master nature and freely access the world’s resources has long been inherent in manifestos evinced by productions of the environmental design professions. Ron Herron’s Walking City, an experimental architectural piece of 1964, is one example that comes to mind here. For this design concept, the architect imagined a gigantic nomadic urban aggregate that by way of an insect-like robotic carrier would move all over the world, on land and sea, to wherever its inhabitants want. Given the contemporary crisis regarding natural resources, recently ideas pertinent to structuring a sustainable environment have been attracting much interest in architecture, a field that has been accused of significantly contributing to ecosystem degradation. Great art, such as Fallingwater building, has been regarded as nature-friendly, but its notion of ‘green’ might be inadequate in the face of the resource demands made by human populations today. This research suggests a more conservative and scrupulous attitude to attempting to modify nature for architectural settings. Designs that pursue spiritual or metaphysical interconnections through anthropocentric aesthetics are not sufficient to benefit ecosystem integrity; though high-tech energy-saving processes may contribute to a fine-scale sustainability, they may ultimately cause catastrophe in the global scale. Design with frugality is proposed in order to actively reduce environmental load. The aesthetic taste and ecological sensibility of design professions and the public alike may have to be reshaped in order to make the goals of environmental sustainability viable.

Keywords: anthropocentric aesthetic, aquarium sustainability, biosphere 2, ecological aesthetic, ecological footprint, frugal design

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556 Atmospheres, Ghosts and Shells to Reform our Memorial Cultures

Authors: Tomas Macsotay

Abstract:

If monument removal and monument effacement may call to mind a Nietzschean proposal for vitalist disregard of conventional morality, it remains the case that it is often only by a willingness to go “beyond good and evil” in inherited monument politics that truthful, be it unexpected aspects of our co-existence with monuments can finally start to rise into fuller consciousness. A series of urgent questions press themselves in the panorama created by the affirmative idea that we can, as a community, make crucial decisions with regard to monumental preservation or discontinuation. Memorials are not the core concern for decolonial and racial dignity movements like Black Lives Matter (BLM), which have repeatedly shown they regard these actions as a welcome, albeit complementary, part of a reckoning with a past of racial violence and injustice, slavery, and colonial subaltern existence. As such, the iconoclastic issue of “rights and prohibitions of images” only tangentially touches on a cultural movement that seems rather question dominant ideas of history, pertinence, and the long life of the class, gender, and racial conflict through ossified memorial cultures. In the recent monument insurrection, we face a rare case of a new negotiation of rights of existence for this particular tract of material culture. This engenders a debate on how and why we accord rights to objects in public dominion ― indeed, how such rights impinge upon the rights of subjects who inhabit the public sphere. Incidentally, the possibility of taking away from monuments such imagined or adjoined rights has made it possible to tease open a sphere of emotionality that could not be expressed in patrimonial thinking: the reality of atmospheres as settings, often dependent on pseudo-objects and half-conscious situations, that situate individuals involuntarily in a pathic aesthetics. In this way, the unique moment we now witness ― full of the possibility of going “beyond good and evil” of monument preservation ― starts to look more like a moment of involuntary awaking: an awakening to the encrypted gaze of the monument and the enigma that the same monument or memorial site can carry day-to-day habits of life for some bystanders, while racialized and disenfranchised communities experience discomfort and erosion of subjective life in the same sites.

Keywords: monument, memorial, atmosphere, racial justice, decolonialism

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555 Design and Development of Small Peptides as Anti-inflammatory Agents

Authors: Palwinder Singh

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Beyond the conventional mode of working with anti-inflammatory agents through enzyme inhibition, herein, an alternate substrate of cyclooxygenase-2 was developed. Proline centered pentapeptide iso-conformational to arachidonic acid exhibited appreciable selectivity for COX-2 overcoming acetic acid and formalin induced pain in rats to almost 80% and was treated as a substrate by the enzyme. Remarkably, COX-2 metabolized the pentapeptide into small fragments consisting mainly of di- and tri-peptides that ensured the safe breakdown of the peptide under in-vivo conditions. The kinetic parameter Kcat/Km for COX-2 mediated metabolism of peptide 6.3 x 105 M-1 s-1 was quite similar to 9.5 x 105 M-1 s-1 for arachidonic acid. Evidenced by the dynamic molecular studies and the use of Y385F COX-2, it was observed that the breakage of the pentapeptide has probably taken place through H-bond activation of the peptide bond by the side chains of Y385 and S530.

Keywords: small peptides, anti-inflammatory agents, cyclooxygenase-2, unnatural substrates

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554 Juvenile Paget’s Disease(JPD) of Bone

Authors: Aftab Ahmed, Ghulam Mehboob

Abstract:

The object of presentation is to highlight the importance of condition which is a very rare genetic disorder although Paget’s disease is common but its juvenile type is very rare and a late presentation due to very slow onset and lack of earlier standard management. We present a case of 25 years old male with a chronic history of bone pain and a slow onset of mild swelling, later on diagnosed as juvenile Paget disease of bone. Rarity of this condition with inaccessibility for standard health treatment can lead to a significant delay in presentation and its management. There have been 50 reported cases worldwide according to Genetic Home Reference. There is increased osteoclastic activity along with osteoblastic activity related to gene alteration and osteoprotegrin deficiency. Morbidity of disease is very significant which lead children to become immobilize.

Keywords: juvenile, Paget’s disease, bone, Northern Area of Pakistan

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553 Prevalence of Positive Serology for Celiac Disease in Children With Autism Spectrum Disorder

Authors: A. Venkatakrishnan, M. Juneja, S. Kapoor

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Background: Gastrointestinal dysfunction is an emerging co morbidity seen in autism and may further strengthen the association between autism and celiac disease. This is supported by increased rates (22-70%) of gastrointestinal symptoms like diarrhea, constipation, abdominal discomfort/pain, and gastrointestinal inflammation in children with the etiology of autism is still elusive. In addition to genetic factors, environmental factors such as toxin exposure, intrauterine exposure to certain teratogenic drugs, are being proposed as possible contributing factors in the etiology of Autism Spectrum Disorders (ASD) in cognizance with reports of increased gut permeability and high rates of gastrointestinal symptoms noted in children with ASD, celiac disease has also been proposed as a possible etiological factor. Despite insufficient evidence regarding the benefit of restricted diets in Autism, GFD has been promoted as an alternative treatment for ASD. This study attempts to discern any correlation between ASD and celiac disease. Objective: This cross sectional study aims to determine the proportion of celiac disease in children with ASD. Methods: Study included 155 participants aged 2-12 yrs, diagnosed as ASD as per DSM-5 attending the child development center at a tertiary care hospital in Northern India. Those on gluten free diet or having other autoimmune conditions were excluded. A detailed Performa was filled which included sociodemographic details, history of gastrointestinal symptoms, anthropometry, systemic examination, and pertinent psychological testing was done using was assessed using Developmental Profile-3(DP-3) for Developmental Quotient, Childhood Autism Rating Scale-2 (CARS-2) for severity of ASD, Vineland Adaptive Behavior Scales (VABS) for adaptive behavior, Child Behavior Checklist (CBCL) for behavioral problems and BAMBI (Brief Autism Mealtime Behavior Scales) for feeding problems. Screening for celiac was done by TTG-IgA levels, and total serum IgA levels were measured to exclude IgA deficiency. Those with positive screen were further planned for HLA typing and endoscopic biopsy. Results: A total of 155 cases were included, out of which 5 had low IgA levels and were hence excluded from the study. The rest 150 children had TTG levels below the ULN and normal total serum IgA level. History of Gastrointestinal symptoms was present in 51 (34%) cases abdominal pain was the most frequent complaint (16.6%), followed by constipation (12.6%). Diarrhea was seen in 8 %. Gastrointestinal symptoms were significantly more common in children with ASD above 5 yrs (p-value 0.006) and those who were verbal (p = 0.000). There was no significant association between socio-demographic factors, anthropometric data, or severity of autism with gastrointestinal symptoms. Conclusion: None of the150 patients with ASD had raised TTG levels; hence no association was found between ASD and celiac disease. There is no justification for routine screening for celiac disease in children with ASD. Further studies are warranted to evaluate association of Non Celiac Gluten Sensitivity with ASD and any role of gluten-free diet in such patients.

Keywords: autism, celiac, gastrointestinal, gluten

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552 The Eloquent Importance of Knowing Fyodor Dostoevsky: An Understanding of The Dilettante

Authors: Ravi Teja Mandapaka

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Literary assonance and lexical consonance have always put the readers pondering, shirking away, at times too, and beefing on the baffling question that hardly invited any answer. ‘Why should we read Fyodor Mikhailovich Dostoevsky today?’ Does he, during a surreal life beneath his bruised and broken soul, writhing in pain, toying with the affirmatives of pleasure in an innate way, draw the readers any sheath of support? Alexithymia has ruled the time and space for a quite a long time as many a reader spent more time than required on reading his works of art in literature. Do his swirling theories of deism and laconic gushiness when put in black and white push us towards reading the lost pieces of exuberant dilettantism? With a view of that, and a hallucinated panorama of another, its best to say, thoughts and droughts’ glorious uncertainties in literature have come forward towards putting the pen on the eloquent importance of knowing Fyodor Dostoevsky, the Socrates of Literature.

Keywords: Dostoyevsky, dilettantism, gushiness, hallucinations, puissance

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551 Asymptomatic Intercostal Schwannoma in a Patient with COVID-19: The First of Its Kind

Authors: Gabriel Hunduma

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Asymptomatic intra-thoracic neurogenic tumours are rare. Tumours arising from the intercostal nerves of the chest wall are exceedingly rare. This paper reports an incidental discovery of a neurogenic intercostal tumour while being investigated for Coronavirus Disease 2019 (COVID-19). A 54-year-old female underwent a thoracotomy and resection for an intercostal tumour. Pre-operative images showed an intrathoracic mass, and the biopsy revealed a schwannoma. The most common presenting symptom recorded in literature is chest pain; however, our case remained asymptomatic despite the size of the mass and thoracic area it occupied. After an extensive search of the literature, COVID-19 was found to have an influence on the development of certain cells in breast cancer. Hence there is a possibility that COVID-19 played a role in progressing the development of the schwannoma cells.

Keywords: thoracic surgery, intercostal schwannoma, chest wall oncology, COVID-19

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550 Cultural Collisions, Ethics and HIV: On Local Values in a Globalized Medical World

Authors: Norbert W. Paul

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In 1988, parts of the scientific community still heralded findings to support that AIDS was likely to remain largely a ‘gay disease’. The value-ladden terminology of some of the articles suggested that rectum and fragile urethra are not sufficiently robust to provide a barrier against infectious fluids, especially body fluids contaminated with HIV while the female vagina, would provide natural protection against injuries and trauma facilitating HIV-infection. Anal sexual intercourse was constituted not only as dangerous but also as unnatural practice, while penile-vaginal intercourse would follow natural design and thus be relatively safe practice minimizing the risk of HIV. Statements like the latter were not uncommon in the early times of HIV/AIDS and contributed to captious certainties and an underestimation of heterosexual risks. Pseudo-scientific discourses on the origin of HIV were linked to local and global health politics in the 1980ies. The pathways of infection were related to normative concepts like deviant, subcultural behavior, cultural otherness, and guilt used to target, tag and separate specific groups at risk from the ‘normal’ population. Controlling populations at risk became the top item on the agenda rather than controlling modes of transmission and the virus. Hence, the Thai strategy to cope with HIV/AIDS by acknowledging social and sexual practices as they were – not as they were imagined – has become a role model for successful prevention in the highly scandalized realm of sexually transmitted disease. By accepting the globalized character of local HIV-risk and projecting the risk onto populations which are neither particularly vocal groups nor vested with the means to strive for health and justice Thailand managed to culturally implement knowledge-based tools of prevention. This paper argues, that pertinent cultural collisions regarding our strategies to cope with HIV/AIDS are deeply rooted in misconceptions, misreadings and scandalizations brought about in the early history of HIV in the 1980ties. The Thai strategy is used to demonstrate how local values can be balanced against globalized health risk and used to effectuated prevention by which knowledge and norms are translated into local practices. Issues of global health and injustice will be addressed in the final part of the paper dealing with the achievability of health as a human right.

Keywords: bioethics, HIV, global health, justice

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549 Hui as Religious over Ethnic Identity: A Case Study of Muslim Ethnic Interaction in Central Northwest China

Authors: Hugh Battye

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In recent years, Muslim identity in China has strengthened against the backdrop of a worldwide Islamic revival. One discussion arising from this has been focused around the Hui, an ethnicity created by the Communist government in the 1950s covering the Chinese speaking 'Sino-Muslims' as opposed to those with their own language. While the term Hui in Chinese has traditionally meant 'Muslim', the strengthening of Hui identity in recent decades has led to a debate among scholars as to whether this identity is primarily ethnically or religiously driven. This article looks at the case of a mixed ethnic community in rural Gansu Province, Central Northwest China, which not only contains the official Hui ethnicity but also members of the smaller Muslim Salar and Bonan minority groups. In analyzing the close interaction between these groups, the paper will argue that, despite government attempts to promote the Hui as an ethnicity within its modern ethnic paradigm, in rural Gansu and the general region, Hui is still essentially seen as a religious identity. Having provided an overview of the historical evolution of the Hui ethnonym in China and presented the views of some of the important scholars involved in the discussion, the paper will then offer its findings based on participant observation and survey work in Gansu. The results will show that, firstly, for the local Muslims, religious identity clearly dominates ethnic identity. On the ground, the term Hui continues to be used as a catch-all term for Muslims, whether they belong to the official 'Hui' nationality or not, and against this backdrop, the ethnic importance of being 'Hui', 'Bonan' or 'Salar' within the Muslim community itself is by contrast minimal. Secondly, however, this local Muslim solidarity is not at present pointing towards some kind of national pan-ethnic Islamic movement that could potentially set itself up in opposition to the Chinese government; rather it is better seen as part of an ongoing negotiation by local Muslims with the state in the context of its ascribed ethnic categories. The findings of this study in a region where many of the Muslims are more conservative in their beliefs is not necessarily replicated in other contexts, such as in urban areas and in eastern and southern China, and hence reification of the term Hui as one idea extending all across China should be avoided, whether in terms of a united religious 'ummah' or of a real or imagined 'ethnic group.' Rather, this localized case study seeks to demonstrate ways in which Muslims of rural Central Northwest China are 'being Hui,' as a contribution to the broader discussion on what it means to be Muslim and Chinese in the reform era.

Keywords: China, ethnicity, Hui, identity, Muslims

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548 Fundamental Study on Reconstruction of 3D Image Using Camera and Ultrasound

Authors: Takaaki Miyabe, Hideharu Takahashi, Hiroshige Kikura

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The Government of Japan and Tokyo Electric Power Company Holdings, Incorporated (TEPCO) are struggling with the decommissioning of Fukushima Daiichi Nuclear Power Plants, especially fuel debris retrieval. In fuel debris retrieval, amount of fuel debris, location, characteristics, and distribution information are important. Recently, a survey was conducted using a robot with a small camera. Progress report in remote robot and camera research has speculated that fuel debris is present both at the bottom of the Pressure Containment Vessel (PCV) and inside the Reactor Pressure Vessel (RPV). The investigation found a 'tie plate' at the bottom of the containment, this is handles on the fuel rod. As a result, it is assumed that a hole large enough to allow the tie plate to fall is opened at the bottom of the reactor pressure vessel. Therefore, exploring the existence of holes that lead to inside the RCV is also an issue. Investigations of the lower part of the RPV are currently underway, but no investigations have been made inside or above the PCV. Therefore, a survey must be conducted for future fuel debris retrieval. The environment inside of the RPV cannot be imagined due to the effect of the melted fuel. To do this, we need a way to accurately check the internal situation. What we propose here is the adaptation of a technology called 'Structure from Motion' that reconstructs a 3D image from multiple photos taken by a single camera. The plan is to mount a monocular camera on the tip of long-arm robot, reach it to the upper part of the PCV, and to taking video. Now, we are making long-arm robot that has long-arm and used at high level radiation environment. However, the environment above the pressure vessel is not known exactly. Also, fog may be generated by the cooling water of fuel debris, and the radiation level in the environment may be high. Since camera alone cannot provide sufficient sensing in these environments, we will further propose using ultrasonic measurement technology in addition to cameras. Ultrasonic sensor can be resistant to environmental changes such as fog, and environments with high radiation dose. these systems can be used for a long time. The purpose is to develop a system adapted to the inside of the containment vessel by combining a camera and an ultrasound. Therefore, in this research, we performed a basic experiment on 3D image reconstruction using a camera and ultrasound. In this report, we select the good and bad condition of each sensing, and propose the reconstruction and detection method. The results revealed the strengths and weaknesses of each approach.

Keywords: camera, image processing, reconstruction, ultrasound

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547 Atypical Clinical Presentation of Wallenberg Syndrome from Acute Right Lateral Medullary Infarct in a 37 Year Old Female

Authors: Sweta Das

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This case report highlights the atypical clinical manifestation of ipsilateral head, neck, shoulder, and eye pain with erythema and edema of right eyelid and conjunctiva, along with typical presentation of right sided Horner’s syndrome in a 37-year-old female, who was correctly diagnosed with Wallenberg syndrome due to collaborative effort from optometry, primary care, emergency, and neurology specialties in medicine. Horner’s syndrome is present in 75% of patients with Wallenberg syndrome. Given that patients with Wallenberg syndrome often first present to the Emergency Department with a vast variety of non-specific symptoms, and a normal MRI, a delayed diagnosis is common. Therefore, a collaborative effort between emergency department, optometry, primary care, and neurology is essential in correctly diagnosing Wallenberg’s syndrome in a timely manner.

Keywords: horner's syndrome, stroke, wallenberg syndrome, lateropulsion of eyes

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546 Discussion of Blackness in Wrestling

Authors: Jason Michael Crozier

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The wrestling territories of the mid-twentieth century in the United States are widely considered the birthplace of modern professional wrestling, and by many professional wrestlers, to be a beacon of hope for the easing of racial tensions during the civil rights era and beyond. The performers writing on this period speak of racial equality but fail to acknowledge the exploitation of black athletes as a racialized capital commodity who suffered the challenges of systemic racism, codified by a false narrative of aspirational exceptionalism and equality measured by audience diversity. The promoters’ ability to equate racial and capital exploitation with equality leads to a broader discussion of the history of Muscular Christianity in the United States and the exploitation of black bodies. Narratives of racial erasure that dominate the historical discourse when examining athleticism and exceptionalism redefined how blackness existed and how physicality and race are conceived of in sport and entertainment spaces. When discussing the implications of race and professional wrestling, it is important to examine the role of promotions as ‘imagined communities’ where the social agency of wrestlers is defined and quantified based on their ‘desired elements’ as a performer. The intentionally vague nature of this language masks a deep history of racialization that has been perpetuated by promoters and never fully examined by scholars. Sympathetic racism and the omission of cultural identity are also key factors in the limitations and racial barriers placed upon black athletes in the squared circle. The use of sympathetic racism within professional wrestling during the twentieth century defined black athletes into two distinct categorizations, the ‘black savage’ or the ‘black minstrel’. Black wrestlers of the twentieth century were defined by their strength as a capital commodity and their physicality rather than their knowledge of the business and in-ring skill. These performers had little agency in their ability to shape their own character development inside and outside the ring. Promoters would often create personas that heavily racialized the performer by tying them to a regional past or memory, such as that of slavery in the deep south using dog collar matches and adoring black characters in chains. Promoters softened cultural memory by satirizing the historic legacy of slavery and the black identity.

Keywords: sympathetic racism, social agency, racial commodification, stereotyping

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545 Rewriting the 'Sick Man' History: Imagining Chinese Masculinity in the Contemporary Military Action Genre

Authors: Yongde Dai

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The recent Chinese military action blockbusters, notably known as, Wolf Warrior/Zhan Lang (2015), Operation Mekong/Mei gong he xing dong (2016), Warrior 2/Zhan Lang 2 (2017) and Operation Red Sea/Hong hai xing dong (2018), have achieved phenomenal box-office successes and in particular, Wolf Warrior 2 became China’s highest-grossing film of all time. However, their yearly presence tends to show a paradigmic shift from China’s primacy of wen manliness (soft) to wu masculinity (hard). With the increasing cinematic exposure of a more muscular image manifesting in both the Chinese heroic soldiers and China itself as a rising global power, the backlash of the Chinese public against the proliferation of the feminized masculinity influenced by the ‘pretty-boy’ pop-culture and China’s harder approach to the current Sino-US tensions have correspondingly emerged and continued to brew. Chinese masculinity imagined in these films is one of the key factors that enable a gendered interpretation of the correlation between the Chinese on-screen fantasy and off-screen reality, that is, China’s public and official discourse about the hegemonic masculinity and non-hegemonic masculinity as well as China’s international profile on cinematic appearance and in today’s Sino-US relation. By reading closely at the four megahits as visual-audio texts with Chinese masculinity studies by Kam Louie and Geng Song, this paper attempts to examine the Chinese construction of manliness with historical accounts and argue why and how the recurrent emphasis of hard/military masculinity (wu) on screen are viewed as China’s contemporary rewriting of the ‘sick-man’ history in the film form. Through this investigation, the paper finds that the rewriting of the ‘sick-man’ history in the cinematic world through heroic brawny soldiers comes to resonate a collective anxiety of China in countering the real-life increasing feminized masculinity on the public appearance, particularly on the male celebrities. In addition, the superpower fantasy about China illuminates a hypermasculine imaginary of China as a global rising power and this coincidently echoes China’s current tougher diplomatic strategy tackling the Sino-US trade war, South China sea dispute and Huawei-US lawsuits.

Keywords: Chinese masculinity, Chinese military action film, feminized masculinity, manhood and nationhood, sick man of Asia

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544 Machine Learning for Aiding Meningitis Diagnosis in Pediatric Patients

Authors: Karina Zaccari, Ernesto Cordeiro Marujo

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This paper presents a Machine Learning (ML) approach to support Meningitis diagnosis in patients at a children’s hospital in Sao Paulo, Brazil. The aim is to use ML techniques to reduce the use of invasive procedures, such as cerebrospinal fluid (CSF) collection, as much as possible. In this study, we focus on predicting the probability of Meningitis given the results of a blood and urine laboratory tests, together with the analysis of pain or other complaints from the patient. We tested a number of different ML algorithms, including: Adaptative Boosting (AdaBoost), Decision Tree, Gradient Boosting, K-Nearest Neighbors (KNN), Logistic Regression, Random Forest and Support Vector Machines (SVM). Decision Tree algorithm performed best, with 94.56% and 96.18% accuracy for training and testing data, respectively. These results represent a significant aid to doctors in diagnosing Meningitis as early as possible and in preventing expensive and painful procedures on some children.

Keywords: machine learning, medical diagnosis, meningitis detection, pediatric research

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543 Psychological Well-Being Among the Freed Kamhalari Girls in Dang

Authors: Jug Maya Chaudhary

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The principal objective of this paper has been to assess the level of psychological well-being (PWB) of freed Kamhalari girls sheltered in a governmental rehabilitation center in the Dang district. All the girls (N=100) have been selected for a quantitative study, including 15 cases of in-depth interviews for qualitative study in 2013. The study results suggest that the level of psychological well-being of freed Kamhalaris has not been found to be high; rather they are moderate, with small incidences of a lower level of psychological well-being. Regarding the qualitative study, a total of six themes was identified: physical pain and fatigue then and now, the lasting experience of anxiety, unfair treatment, low self-esteem, depressed mood, and frustration due to current state and confusion. These themes reflected the unrelenting intrusive nature of painful experiences of those affected. This research will provide empathic insight into their past experience. It will add to the body of research on Psychological Well-being of Freed Kamhalari Girls and may generate ideas for intervention research.

Keywords: Kamhalari, Experiences, Tharu, Psychological Wellbeing

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542 Assessment of the Impact of Regular Pilates Exercises on Static Balance in Healthy Adult Women: Preliminary Report

Authors: Anna Słupik, Krzysztof Jaworski, Anna Mosiołek, Dariusz Białoszewski

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Background: Maintaining the correct body balance is essential in the prevention of falls in the elderly, which is especially important for women because of postmenopausal osteoporosis and the serious consequences of falls. One of the exercise methods which is very popular among adults, and which may affect body balance in a positive way is the pilates method. The aim of the study was to evaluate the effect of regular pilates exercises on the ability to maintain body balance in static conditions in adult healthy women. Material and methods: The study group consisted of 20 healthy women attending pilates twice a week for at least 1 year. The control group consisted of 20 healthy women physically inactive. Women in the age range from 35 to 50 years old without pain in musculoskeletal system or other pain were only qualified to the groups. Body balance was assessed using MatScan VersaTek platform with Sway Analysis Module based on Matscan Clinical 6.7 software. The balance was evaluated under the following conditions: standing on both feet with eyes open, standing on both feet with eyes closed, one-leg standing (separately on the right and left foot) with eyes open. Each test lasted 30 seconds. The following parameters were calculated: estimated size of the ellipse of 95% confidence, the distance covered by the Center of Gravity (COG), the size of the maximum shift in the sagittal and frontal planes and load distribution between the left and right foot, as well as between rear- and forefoot. Results: It was found that there is significant difference between the groups in favor of the study group in the size of the confidence ellipse and maximum shifts of COG in the sagittal plane during standing on both feet, both with the eyes open and closed (p < 0.05). While standing on one leg both on the right and left leg, with eyes opened there was a significant difference in favor of the study group, in terms of the size of confidence ellipse, the size of the maximum shifts in the sagittal and in the frontal plane (p < 0.05). There were no differences between the distribution of load between the right and left foot (standing with both feet), nor between fore- and rear foot (in standing with both feet or one-leg). Conclusions: 1. Static balance in women exercising regularly by pilates method is better than in inactive women, which may in the future prevent falls and their consequences. 2. The observed differences in maintaining balance in frontal plane in one-leg standing may indicate a positive impact of pilates exercises on the ability to maintain global balance in terms of the reduced support surface. 3. Pilates method can be used as a form preventive therapy for all people who are expected to have problems with body balance in the future, for example in chronic neurological disorders or vestibular problems. 4. The results have shown that further prospective randomized research on a larger and more representative group is needed.

Keywords: balance exercises, body balance, pilates, pressure distribution, women

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541 A Systematic Review on Assessing the Prevalence, Types, and Predictors of Sleep Disturbances in Childhood Traumatic Brain Injury

Authors: E. Botchway, C. Godfrey, V. Anderson, C. Catroppa

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Introduction: Sleep disturbances are common after childhood traumatic brain injury (TBI). This systematic review aimed to assess the prevalence, types, and predictors of sleep disturbances in childhood TBI. Methods: Medline, Pubmed, PsychInfo, Web of Science, and EMBASE databases were searched. Out of the 547 articles assessed, 15 met selection criteria for this review. Results: Sleep disturbances were common in children and adolescents with TBI, irrespective of injury severity. Excessive daytime sleepiness and insomnia were the most common sleep disturbances reported. Sleep disturbance was predicted by sex, injury severity, pre-existing sleep disturbances, younger age, pain, and high body mass index. Conclusions: Sleep disturbances are highly prevalent in childhood TBI, regardless of the injury severity. Routine assessment of sleep in survivors of childhood TBI is recommended.

Keywords: traumatic brain injury, sleep diatiurbances, childhood, systematic review

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540 The Old Man And The Sea: From A Gerotranscendence Perpective

Authors: Eng Lye, Ooi

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The Old Man and The Sea is a novella written by Ernest Hemingway that depicts an old fisherman’ journey out into the deep sea in his pursuit to catch a big fish. Through this novella, Hemingway creates a world for his protagonist, Santiago who is portrayed as an old man who has gone eighty-four days without catching a fish, at last hooks an eighteen-foot marlin, the largest he ever known. The old man endures pain and struggles to bring back to shore. Looking through the lens of gerotranscendence, we can see that the old man has his dreams, and goals in life. In his pursuit for happiness, he has fought tirelessly to ward off the shark attacks and finally he won even though only half of his fish is left. Hemingway has portrayed Santiago as an old man as a transcendent self leaping from the dimension of “The Self” to the cosmic dimension with the personal and social relationship dimension in tow. The Old Man and The Sea offers a glimpse of the struggles of an old man, who is old and gaunt but spiritually undefeated in his battle out in the sea. He is surprisingly strong and powerful despite his old age, he respects the sea, the birds. the turtles, the sharks and the fish. He can endure suffering and is focussed on achieving his goals. This is what Hemingway has portrayed Santiago to be a gerotranscendent in the eyes of the gerotranscendental approach in respect of the changes and development as seen in Santiago, the protagonist in this novella.

Keywords: gerotranscendence, gerotranscendenatal, old man, the sea, hemingway

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539 Herpetic Gingivostomatitis in Children: A Case Report

Authors: Miloud Abid Brahim

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Herpetic gingivostomatitis is a prevalent viral infection in children, predominantly caused by herpes simplex virus type 1 (HSV-1). This case report details the clinical presentation and management of a 9-year-old patient diagnosed with this condition. The child exhibited fever, oral pain, and vesicular lesions that progressed to painful erosions affecting the inner cheeks, tongue, lips, and gums. The diagnosis was established based on clinical findings. Treatment included symptomatic care with analgesics and antipyretics, antimicrobial therapy with antibiotics and antiseptics, and early administration of antiviral medication (aciclovir). The comprehensive approach led to complete resolution of symptoms within 10 days. This case underscores the significance of early recognition and prompt treatment to mitigate the impact of this condition on the patient’s quality of life and to prevent complications.

Keywords: gingivostomatitis, case report, pediatric oral health, herpes simplex virus (HSV-1)

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538 Assessment of Occupational Health and Safety Conditions of Health Care Workers in Barangay Health Centers in a Selected City in Metro Manila

Authors: Deinzel R. Uezono, Vivien Fe F. Fadrilan-Camacho, Bianca Margarita L. Medina, Antonio Domingo R. Reario, Trisha M. Salcedo, Luke Wesley P. Borromeo

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The environment of health care workers is considered one of the most hazardous settings due to the nature of their work. In developing countries especially, the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and impairs effective monitoring and assessment of interventions. To address this gap, there is a need to determine the current conditions of Filipino health care workers in their workplace. This descriptive cross-sectional study assessed the occupational health and safety conditions of health care workers in barangay health centers in a selected city in Metro Manila, Philippines by: (1) determining the hazards present in the workplace; (2) determining the most common self-reported medical problems; and (3) describing the elements of an OHS system based on the six building blocks of health system. Assessment was done through walkthrough survey, self-administered questionnaire, and key informant interview. Data analysis was done using Epi Info 7 and NVivo 11. Results revealed different health hazards present in the workplace particularly biological hazards (exposure to sick patients and infectious specimens), physical hazards (inadequate space and/or lighting), chemical hazards (toxic reagents and flammable chemicals), and ergonomic hazards (activities requiring repetitive motion and awkward posture). Additionally, safety hazards (improper capping of syringe and lack of fire safety provisions) were also observed. Meanwhile, the most commonly self-reported chronic diseases among health care workers (N=336) were hypertension (20.24%, n=68) and diabetes (12.50%, n=42). Top commonly self-reported symptoms were colds (66.07%, n=222), coughs (63.10%, n=212), headache (55.65%, n=187), and muscle pain (50.60%, n=170) while other diseases were influenza (16.96%, n=57) and UTI (15.48%, n=52). In terms of the elements of the OHS system, a general policy on occupational health and safety was found to be lacking and in effect, an absence of health and safety committee overseeing the implementing and monitoring of the policy. No separate budget specific for OHS programs and services was also found to be a limitation. As a result, no OHS personnel and trainings/seminar were identified. No established information system for OHS was in place. In conclusion, health and safety hazards were observed to be present across the barangay health centers visited in a selected city in Metro Manila. Medical conditions identified as most commonly self-reported were hypertension and diabetes for chronic diseases; colds, coughs, headache, and muscle pain for medical symptoms; and influenza and UTI for other diseases. As for the elements of the occupational health and safety system, there was a lack in the general components of the six building blocks of the health system.

Keywords: health hazards, occupational health and safety, occupational health and safety system, safety hazards

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537 Evaluation of Anti-inflammatory Activities of Extracts Obtained from Capparis Erythrocarpos In-Vivo

Authors: Benedict Ofori, Kwabena Sarpong, Stephen Antwi

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Background: Medicinal plants are utilized all around the world and are becoming increasingly important economically. The WHO notes that ‘inappropriate use of traditional medicines or practices can have negative or dangerous effects and that future research is needed to ascertain the efficacy and safety of such practices and medicinal plants used by traditional medicine systems. The poor around the world have limited access to palliative care or pain relief. Pharmacologists have been focused on developing safe and effective anti-inflammatory drugs. Most of the issues related to their use have been linked to the fact that numerous traditional and herbal treatments are classified in different nations as meals or dietary supplements. As a result, there is no need for evidence of the quality, efficacy, or safety of these herbal formulations before they are marketed. The fact that access to drugs meant for pain relief is limited in low-income countries means advanced studies should be done on home drugs meant for inflammation to close the gap. Methods: The ethanolic extracts of the plant were screened for the presence of 10 phytochemicals. The Pierce BCA Protein Assay Kit was used for the determination of the protein concentration of the egg white. The rats were randomly selected and put in 6 groups. The egg white was sub-plantar injected into the right-hand paws of the rats to induce inflammation. The animals were treated with the three plant extracts obtained from the root bark, stem, and leaves of the plant. The control groups were treated with normal saline, while the standard groups were treated with standard drugs indomethacin and celecoxib. Plethysmometer was used to measure the change in paw volume of the animals over the course of the experiment. Results: The results of the phytochemical screening revealed the presence of reducing sugars and saponins. Alkaloids were present in only R.L.S (1:1:1), and phytosterols were found in R.L(1:1) and R.L.S (1:1:1). The estimated protein concentration was found to be 103.75 mg/ml. The control group had an observable increase in paw volume, which indicated that inflammation was induced during the 5 hours. The increase in paw volume for the control group peaked at the 1st hour and decreased gradually throughout the experiment, with minimal changes in the paw volumes. The 2nd and 3rd groups were treated with 20 mg/kg of indomethacin and celecoxib. The anti-inflammatory activities of indomethacin and celecoxib were calculated to be 21.4% and 4.28%, respectively. The remaining 3 groups were treated with 2 dose levels of 200mg/kg plant extracts. R.L.S, R.L, and S.R.L had anti-inflammatory activities of 22.3%, 8.2%, and 12.07%, respectively. Conclusions: Egg albumin-induced paw model in rats can be used to evaluate the anti-inflammatory activity of herbs that might have potential anti-inflammatory activity. Herbal medications have potential anti-inflammatory activities and can be used to manage various inflammatory conditions if their efficacy and side effects are well studied. The three extracts all possessed anti-inflammatory activity, with R.L.S having the highest anti-inflammatory activity.

Keywords: inflammation, capparis erythrocarpos, anti-inflammatory activity, herbal medicine, paw volume, egg albumin

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536 Multi-Resistant Enterobacter Cloacae Dacryocystitis and Preseptal Cellulitis: Case and Review of Literature

Authors: Michael Kvopka, Ezekiel Kingston

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A 61-year-old man with no significant past medical history presented to a quaternary ophthalmic referral center with acute right-sided medial canthal pain, periorbital edema, and erythema despite oral antibiotic therapy. CT imaging confirmed the presence of right preseptal cellulitis and lacrimal sac aspiration identified multi-resistant Enterobacter cloacae. A diagnosis of acute right-sided dacryocystitis with preseptal cellulitis was made. He was successfully treated with broadening of antibiotic therapy to intravenous meropenem. The symptomatic resolution was noted on follow-up without evidence of disease recurrence. To the Authors’ best knowledge, this is the first reported case of multi-resistant E. cloacae dacryocystitis and preseptal cellulitis. The management of this patient required a multi-disciplinary approach, so the Authors believe this report is relevant to general ophthalmologists and oculoplastic sub-specialists.

Keywords: enterobacter, dacryocystitis, preseptal cellulitis, antibiotic resistance

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535 Psychosocial Factors in Relation to Musculoskeletal Disorders among Nursing Professionals in Kurdistan Region, Iraq

Authors: Karwan Khudhir

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A cross-sectional study was carried out to determine the prevalence of musculoskeletal disorders (MSDs) and psychosocial factors associated with it, among Kurdistan nursing professionals. Simple random sampling was used to select 220 nurses and data were collected by self-administrative questionnaire. Results of the study showed that the overall prevalence of MSDs among Kurdistan nurses was 74% in different body regions and, by body regions, neck pain was reported to be the highest complaint of twelve-month MSDs (48.4%) compared to other body parts. Logistic regression analysis indicated 6 variables that are significantly associated with musculoskeletal disorders: smoking (OR=19.472, 95% CI: 5.396, 70.273), BMI (OR= 5.106, 95% CI: 1.735, 15.025), physical activity (OR=8.639, 95% CI: 3.075, 24.271), psychological demand (OR=6.685, 95% CI: 3.318, 13.468), social support (OR=3.143, 95% CI: 1.202, 4.814) and job satisfaction (OR=2.44, 95% CI: 1.04, 5.63). Prevention strategies and health education which emphasizes on psychosocial risk factors and how to improve working conditions should be introduced.

Keywords: Kurdistan Region, Iraq, musculoskeletal disorders, nurses, psycho-social factors

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534 Combined Pneumomediastinum and Pneumothorax Due to Hyperemesis Gravidarum

Authors: Fayez Hanna, Viet Tran

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A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.

Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium

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533 Case Report: Massive Deep Venous Thrombosis in a Young Female: A Rare and Fatal Presentation of May-Thurner Syndrome

Authors: Mahmoud Eldeeb, Yousri Mohamed

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Background: May-Thurner Syndrome (MTS) is a rare vascular condition caused by the compression of the left common iliac vein by the overlying right common iliac artery, leading to venous stasis and an increased risk of deep vein thrombosis (DVT). While MTS typically presents in young adults, its diagnosis is often delayed due to its nonspecific presentation, which can lead to catastrophic complications like massive pulmonary embolism (PE). Early recognition and intervention are paramount to prevent fatal outcomes. Objectives: Highlight the importance of early recognition and management of critically ill patients presenting with life- and limb-threatening conditions. Raise awareness of May-Thurner Syndrome as a rare but significant cause of extensive DVT in young adults. Emphasize the necessity of a multidisciplinary approach to managing complex vascular emergencies. Methodology: A 21-year-old female presented with a 7-day history of progressive left leg swelling, pain, and skin discoloration following immobilization due to gastroenteritis. Clinical suspicion for massive DVT and compartment syndrome prompted immediate initiation of a heparin bolus and referrals to vascular and orthopedic surgery teams. Bedside Doppler ultrasound confirmed extensive DVT, and subsequent CT venography revealed thrombi extending to the inferior vena cava, consistent with MTS. Despite anticoagulation therapy, angioplasty and stenting were required to restore venous patency. Tragically, the patient experienced a massive PE during the procedure, requiring cardiopulmonary resuscitation (CPR) and transfer to a tertiary center for cardiothoracic intervention. Results: The case highlights the aggressive and life-threatening progression of MTS. The patient’s presentation was characterized by massive DVT with severe pain and discoloration, rapidly culminating in a PE during intervention. The combination of bedside imaging and CT venography facilitated an accurate diagnosis. Despite timely management, the patient’s course underscores the high mortality risk associated with MTS-related thromboembolism. Conclusion: May-Thurner Syndrome, though rare, can lead to devastating complications in young adults if not promptly recognized and treated. This case emphasizes the need for a high index of suspicion in patients presenting with unexplained extensive DVT, especially in the context of limited mobility or other precipitating factors. Multidisciplinary collaboration, including vascular imaging, anticoagulation, and interventional procedures, is critical to optimize outcomes. Urgent recognition and treatment of MTS are vital to prevent progression to massive PE and death.

Keywords: may-thurner syndrome, deep venous thrombosis, pulmonary embolism, vascular emergency, iliac vein compression syndrome

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532 Safety Profile of Human Papillomavirus Vaccines: A Post-Licensure Analysis of the Vaccine Adverse Events Reporting System, 2007-2017

Authors: Giulia Bonaldo, Alberto Vaccheri, Ottavio D'Annibali, Domenico Motola

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The Human Papilloma Virus (HPV) was shown to be the cause of different types of carcinomas, first of all of the cervical intraepithelial neoplasia. Since the early 80s to today, thanks first to the preventive screening campaigns (pap-test) and following to the introduction of HPV vaccines on the market; the number of new cases of cervical cancer has decreased significantly. The HPV vaccines currently approved are three: Cervarix® (HPV2 - virus type: 16 and 18), Gardasil® (HPV4 - 6, 11, 16, 18) and Gardasil 9® (HPV9 - 6, 11, 16, 18, 31, 33, 45, 52, 58), which all protect against the two high-risk HPVs (6, 11) that are mainly involved in cervical cancers. Despite the remarkable effectiveness of these vaccines has been demonstrated, in the recent years, there have been many complaints about their risk-benefit profile due to Adverse Events Following Immunization (AEFI). The purpose of this study is to provide a support about the ongoing discussion on the safety profile of HPV vaccines based on real life data deriving from spontaneous reports of suspected AEFIs collected in the Vaccine Adverse Events Reporting System (VAERS). VAERS is a freely-available national vaccine safety surveillance database of AEFI, co-administered by the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). We collected all the reports between January 2007 to December 2017 related to the HPV vaccines with a brand name (HPV2, HPV4, HPV9) or without (HPVX). A disproportionality analysis using Reporting Odds Ratio (ROR) with 95% confidence interval and p value ≤ 0.05 was performed. Over the 10-year period, 54889 reports of AEFI related to HPV vaccines reported in VAERS, corresponding to 224863 vaccine-event pairs, were retrieved. The highest number of reports was related to Gardasil (n = 42244), followed by Gardasil 9 (7212) and Cervarix (3904). The brand name of the HPV vaccine was not reported in 1529 cases. The two events more frequently reported and statistically significant for each vaccine were: dizziness (n = 5053) ROR = 1.28 (CI95% 1.24 – 1.31) and syncope (4808) ROR = 1.21 (1.17 – 1.25) for Gardasil. For Gardasil 9, injection site pain (305) ROR = 1.40 (1.25 – 1.57) and injection site erythema (297) ROR = 1.88 (1.67 – 2.10) and for Cervarix, headache (672) ROR = 1.14 (1.06 – 1.23) and loss of consciousness (528) ROR = 1.71 (1.57 – 1.87). In total, we collected 406 reports of death and 2461 cases of permanent disability in the ten-year period. The events consisting of incorrect vaccine storage or incorrect administration were not considered. The AEFI analysis showed that the most frequently reported events are non-serious and listed in the corresponding SmPCs. In addition to these, potential safety signals arose regarding less frequent and severe AEFIs that would deserve further investigation. This already happened with the referral of the European Medicines Agency (EMA) for the adverse events POTS (Postural Orthostatic Tachycardia Syndrome) and CRPS (Complex Regional Pain Syndrome) associated with anti-papillomavirus vaccines.

Keywords: adverse drug reactions, pharmacovigilance, safety, vaccines

Procedia PDF Downloads 165
531 Mood Symptom Severity in Service Members with Posttraumatic Stress Symptoms after Service Dog Training

Authors: Tiffany Riggleman, Andrea Schultheis, Kalyn Jannace, Jerika Taylor, Michelle Nordstrom, Paul F. Pasquina

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Introduction: Posttraumatic Stress (PTS) and Posttraumatic Stress Disorder (PTSD) remain significant problems for military and veteran communities. Symptoms of PTSD often include poor sleep, intrusive thoughts, difficulty concentrating, and trouble with emotional regulation. Unfortunately, despite its high prevalence, service members diagnosed with PTSD often do not seek help, usually because of the perceived stigma surrounding behavioral health care. To help address these challenges, non-pharmacological, therapeutic approaches are being developed to help improve care and enhance compliance. The Service Dog Training Program (SDTP), which involves teaching patients how to train puppies to become mobility service dogs, has been successfully implemented into PTS/PTSD care programs with anecdotal reports of improved outcomes. This study was designed to assess the biopsychosocial effects of SDTP from military beneficiaries with PTS symptoms. Methods: Individuals between the ages of 18 and 65 with PTS symptom were recruited to participate in this prospective study. Each subject completes 4 weeks of baseline testing, followed by 6 weeks of active service dog training (twice per week for one hour sessions) with a professional service dog trainer. Outcome measures included the Posttraumatic Stress Checklist for the DSM-5 (PCL-5), Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), social support/interaction, anthropometrics, blood/serum biomarkers, and qualitative interviews. Preliminary analysis of 17 participants examined mean scores on the GAD-7, PCL-5, and PHQ-9, pre- and post-SDTP, and changes were assessed using Wilcoxon Signed-Rank tests. Results: Post-SDTP, there was a statistically significant mean decrease in PCL-5 scores of 13.5 on an 80-point scale (p=0.03) and a significant mean decrease of 2.2 in PHQ-9 scores on a 27 point scale (p=0.04), suggestive of decreased PTSD and depression symptoms. While there was a decrease in mean GAD-7 scores post-SDTP, the difference was not significant (p=0.20). Recurring themes among results from the qualitative interviews include decreased pain, forgetting about stressors, improved sense of calm, increased confidence, improved communication, and establishing a connection with the service dog. Conclusion: Preliminary results of the first 17 participants in this study suggest that individuals who received SDTP had a statistically significant decrease in PTS symptom, as measured by the PCL-5 and PHQ-9. This ongoing study seeks to enroll a total of 156 military beneficiaries with PTS symptoms. Future analyses will include additional psychological outcomes, pain scores, blood/serum biomarkers, and other measures of the social aspects of PTSD, such as relationship satisfaction and sleep hygiene.

Keywords: post-concussive syndrome, posttraumatic stress, service dog, service dog training program, traumatic brain injury

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530 Factors Associated with Hand Functional Disability in People with Rheumatoid Arthritis: A Systematic Review and Best-Evidence Synthesis

Authors: Hisham Arab Alkabeya, A. M. Hughes, J. Adams

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Background: People with Rheumatoid Arthritis (RA) continue to experience problems with hand function despite new drug advances and targeted medical treatment. Consequently, it is important to identify the factors that influence the impact of RA disease on hand function. This systematic review identified observational studies that reported factors that influenced the impact of RA on hand function. Methods: MEDLINE, EMBASE, CINAL, AMED, PsychINFO, and Web of Science database were searched from January 1990 up to March 2017. Full-text articles published in English that described factors related to hand functional disability in people with RA were selected following predetermined inclusion and exclusion criteria. Pertinent data were thoroughly extracted and documented using a pre-designed data extraction form by the lead author, and cross-checked by the review team for completion and accuracy. Factors related to hand function were classified under the domains of the International Classification of Functioning, Disability, and Health (ICF) framework and health-related factors. Three reviewers independently assessed the methodological quality of the included articles using the quality of cross-sectional studies (AXIS) tool. Factors related to hand function that was investigated in two or more studies were explored using a best-evidence synthesis. Results: Twenty articles form 19 studies met the inclusion criteria from 1,271 citations; all presented cross-sectional data (five high quality and 15 low quality studies), resulting in at best limited evidence in the best-evidence synthesis. For the factors classified under the ICF domains, the best-evidence synthesis indicates that there was a range of body structure and function factors that were related with hand functional disability. However, key factors were hand strength, disease activity, and pain intensity. Low functional status (physical, emotional and social) level was found to be related with limited hand function. For personal factors, there is limited evidence that gender is not related with hand function; whereas, conflicting evidence was found regarding the relationship between age and hand function. In the domain of environmental factors, there was limited evidence that work activity was not related with hand function. Regarding health-related factors, there was limited evidence that the level of the rheumatoid factor (RF) was not related to hand function. Finally, conflicting evidence was found regarding the relationship between hand function and disease duration and general health status. Conclusion: Studies focused on body structure and function factors, highlighting a lack of investigation into personal and environmental factors when considering the impact of RA on hand function. The level of evidence which exists was limited, but identified that modifiable factors such as grip or pinch strength, disease activity and pain are the most influential factors on hand function in people with RA. The review findings suggest that important personal and environmental factors that impact on hand function in people with RA are not yet considered or reported in clinical research. Well-designed longitudinal, preferably cohort, studies are now needed to better understand the causality between personal and environmental factors and hand functional disability in people with RA.

Keywords: factors, hand function, rheumatoid arthritis, systematic review

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529 The Use of Nuclear Generation to Provide Power System Stability

Authors: Heather Wyman-Pain, Yuankai Bian, Furong Li

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The decreasing use of fossil fuel power stations has a negative effect on the stability of the electricity systems in many countries. Nuclear power stations have traditionally provided minimal ancillary services to support the system but this must change in the future as they replace fossil fuel generators. This paper explains the development of the four most popular reactor types still in regular operation across the world which have formed the basis for most reactor development since their commercialisation in the 1950s. The use of nuclear power in four countries with varying levels of capacity provided by nuclear generators is investigated, using the primary frequency response provided by generators as a measure for the electricity networks stability, to assess the need for nuclear generators to provide additional support as their share of the generation capacity increases.

Keywords: frequency control, nuclear power generation, power system stability, system inertia

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528 Applying Sociometer Theory to Different Age Groups and Groups Differences regarding State Self-Esteem Sensitivity

Authors: Yun Yu Stephanie Law

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Sociometer Theory is well tested among young adults in western population, however, limited research is found for other age groups, like adolescent and middle-adulthood in Asia population. Thus, one of the main purposes of this study is to verify the validity of Sociometer Theory in different age groups among Asian. To be specific, we hypothesized that an increase in one’s perceived social rejection is associated to a decrease in his/her state self-esteem among all age groups in Asian population. And we expected that this association can be found among all age groups including adolescent, young adults and middle-adults group in our first study. In this way, we can verify the validity of Sociometer Theory across different age groups as well as its significance in Asian population. Furthermore, those participants who received rejection about ‘mate-role’ would also receive some negative feedbacks regarding their current/future capacity of being a good mate. Results suggested that participants’ state self-esteem sensitivity for mating-capacity rejection is higher when comparing to that of friend-capacity rejection, i.e. greater drop in state self-esteem when receiving mating-capacity feedbacks then receiving friend-capacity feedbacks. These results, however, is just applicable on young adults. Thus, the main purpose of study two would be testing the state self-esteem sensitivity towards social rejection in different domains among three age groups. We hypothesized that group differences would be found for three age groups regarding state self-esteem sensitivity. Research question 1: perceived social rejection is associated to decrease in state self-esteem, is applicable among different age groups in Asia population. Research question 2: there are significant group differences for three age groups regarding state self-esteem sensitivity. Methods: 300 subjects are divided into three age groups, adolescents group, young adult group and middle-adult group, with 100 subjects in each group. Two questionnaires were used in testing this fundamental concept. Subjects were then asked to rate themselves on questionnaire in measuring their current state self-esteem in order to obtain the baseline measurements for later comparison. In order to avoid demand characteristics from subjects, other unrelated tasks like word matching were also given after the first test. Results: A positive correlation between scores in questionnaire 1 and questionnaire 2 among all age groups. Conclusion: State self-esteem decrease to both imagined social rejection (study1) and experienced social rejection (study2). Moreover, level of decrease in state self-esteem vary when receiving different domains of social rejection. Implications: a better understanding of self-esteem development for various age group might bring insights for education systems and policies for teaching approaches and learning methods among different age groups.

Keywords: state self-esteem, social rejection, stage theory, self-feelings

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