Search results for: injuries and disability

Authors: Donatien Niragira

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The progress of technology creates new expectations for patients. The world of deafness is no exception. In recent years, there have been considerable advances in the field of technologies aimed at assisting failing hearing. According to the usual medical vocabulary, hearing aids are actually orthotics. They do not replace an organ but compensate for a functional impairment. The Amplifier Hearing amplification is useful for a large number of people with hearing loss. Hearing aids restore speech audibility. However, their benefits vary depending on the quality of residual hearing. The hearing aid is not a "cure" for deafness. It cannot correct all affected hearing abilities. It should be considered as an aid to communication. The urge to judge from the audiogram alone should be resisted here, as audiometry only indicates the ability to detect non-verbal sounds. To prevent hearing aids from ending up in the drawer, it is important to ensure that the patient's disability situations justify the use of this type of orthosis. If the problems of receptive Pre-fitting counseling are crucial: the person with hearing loss must be informed of the advantages and disadvantages of amplification in his or her case. Their expectations must be realistic. They also need to be aware that the adaptation process requires a good deal of patience and perseverance. They should be informed about the various models and types of hearing aids, including all the aesthetic, functional and financial considerations. If the person's motivation "survives" pre-fitting counseling, we are in the presence of a good candidate for amplification. In addition to its relevance, it shows that the results found in this study significantly improve the quality of audibility in the patient, from where this technology must be made accessible everywhere in the world.

Keywords: auditives protheses, hearing, aids, no medicaly treatable deafnes

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Authors: Brittany Joi B. Kirsch

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Textbooks carry a crucial role in imparting ideologies that stimulate inclusivity and social diversity. In the Philippines, a law on inclusive education (IE) for differently-abled learners has recently been signed in order to ensure their rights to quality and IE are protected and upheld (Republic Act No. 11650, 2022). With the presence of ableism in textbooks, the promotion of IE may be challenged. A considerable amount of research has been done on disability representation and ableism in foreign countries; however, none, to the extent of the researcher’s knowledge, has been conducted on ableist ideologies in primary education English language textbooks in the Philippines. Hence, this paper aims to investigate the negotiation of ableist ideologies in primary education English language textbooks in the Philippines. Utilizing Fairclough’s (1995) three-dimensional model of critical discourse analysis (CDA) as the framework, six prescribed primary education English language textbooks from different grade levels were analyzed to examine instances of ableism in the texts. To further support the analysis of the study, supplemental data were gathered from the accounts of six public elementary school English language teachers. Findings reveal that the textbooks contain ableist ideologies with a limited representation of differently-abled people; by disclosing them as (1) invisible, (2) equipped with negative abilities, and (3) plagued with delicate health. By identifying ableist ideologies in textbooks, educational institutions and publishers may benefit in assessing and reforming instructional materials to resolve the presence of such ideologies, thereby abiding by the country’s law on IE and strengthening its overall implementation.

Keywords: textbooks, ideologies, inclusive education, critical discourse analysis, ableism

Procedia PDF Downloads 89

Authors: Badino Manuel, Farias María Alejandra

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Anxiety and depression are considered the main mental health issues found in people with substance-related disorders. Furthermore, substance-related disorders, anxiety-related and depressive disorders are among the leading causes of disability and are associated with increased mortality. The co-occurrence of substance-related disorders and these mental health conditions affect the accuracy in diagnosis, treatment plan, and recovery process. The aim is to describe the prevalence of anxiety and depression in patients with substance-related disorders in a mental health service in Córdoba, Argentina. A descriptive cross-sectional study was conducted among patients with substance-related disorders (N=305). Anxiety and depression were assessed using the Patient Health Questionnaire-4 (PHQ-4) during the period from December 2021 to March 2022. For a total of 305 participants, 71,8% were male, 25,6% female and 2,6% non-binary. As regards marital status, 51,5% were single, 21,6% as a couple, 5,9% married, 15,4% separated and 5,6% divorced. In relation to education status, 26,2% finished university, 56,1% high school, 16,4% only primary school and 1,3% no formal schooling. Regarding age, 10,8% were young, 84,3% were adults, and 4,9% were elderly. In-person treatment represented 64,6% of service users, and 35,4% were conducted through teleconsultation. 15,7% of service users scored 3 or higher for anxiety, and 32,1% scored 3 or higher for depression in the PHQ-4. 13,1% obtained a score of 3 or higher for both anxiety and depression. It is recommended to identify anxiety and depression among patients with substance-related disorders to improve the quality of diagnosis, treatment, and recovery. It is suggested to apply PHQ-4, PHQ-9 within the protocol of care for these patients.

Keywords: addiction, anxiety, depression, mental health

Procedia PDF Downloads 83

Authors: J. X. Dong, C. J. An, Z. Chen, E. H. Owens, M. C. Boufadel, E. Taylor, K. Lee

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Shorelines are vulnerable to significant environmental impacts from oil spills. Stranded oil can cause potential short- to long-term detrimental effects along beaches that include injuries to the ecosystem, socio-economic and cultural resources. In this study, a three-dimensional (3D) numerical modeling approach is developed to evaluate the fate and transport of spilled oil for hypothetical oiled shoreline cases under various combinations of beach geomorphology and environmental conditions. The developed model estimates the spatial and temporal distribution of spilled oil for the various test conditions, using the finite volume method and considering the physical transport (dispersion and advection), sinks, and sorption processes. The model includes a user-friendly interface for data input on variables such as beach properties, environmental conditions, and physical-chemical properties of spilled oil. An experimental mesoscale tank design was used to test the developed model for dissolved petroleum hydrocarbon within shorelines. The simulated results for effects of different sediment substrates, oil types, and shoreline features for the transport of spilled oil are comparable to those obtained with a commercially available model. Results show that the properties of substrates and the oil removal by shoreline effects have significant impacts on oil transport in the beach area. Sensitivity analysis, through the application of the one-step-at-a-time method (OAT), for the 3D model identified hydraulic conductivity as the most sensitive parameter. The 3D numerical model allows users to examine the behavior of oil on and within beaches, assess potential environmental impacts, and provide technical support for decisions related to shoreline clean-up operations.

Keywords: dissolved petroleum hydrocarbons, environmental multimedia model, finite volume method, sensitivity analysis, total petroleum hydrocarbons

Procedia PDF Downloads 191

Authors: Bara Yousef

Abstract:

The development of independency and functional participation is an important therapeutic goal for many children with cerebral palsy,They was many therapeutic approach have been used for treatment those children like neurodevelopment treatment, balance training strengthening and stretching exercise. More recently, therapy for children with cerebral palsy has focused on achieving functional goals using task-oriented interventions and summer camping model, which focus on activities that relevant and meaningful to the child, to learn more efficient and effective motor skills. We explore the effectiveness of using functional rehabilitation comparing with regular rehabilitation among 40 Saudi children with cerebral palsy in pediatric unit at Sultan Bin Abdul Aziz Humanitarian City-Ksa ,where 20 children randomly assign in control group who received rehabilitation based on regular therapy approach and other 20 children assign on experiment group who received rehabilitation based on functional therapy approach with an average of 45min OT treatment and 45 min PT treatment- daily within a period of 6 week. Our finding reported that children in experiment group has improved in gross motor function with an average from 49.4 to 57.6 based on GMFM 66 as primary outcome measure and improved in WeeFIM with an average from 52 to 62 while children in control group has improved with an average from 48.4 to 53.7 in GMFM and from 53 to and 58 in WeeFIM. Consequently, there has been growing interest in determining the effects of functional training programs as promising approach for these children.

Keywords: Cerebral Palsy (CP), gross motor function measure (GMFM66), pediatric Functional Independent Measure (WeeFIM), rehabilitation, disability

Procedia PDF Downloads 363

Authors: Yeliz Karaca, Rana Karabudak

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Multifractal Denoising techniques are used in the identification of significant attributes by removing the noise of the dataset. Magnetic resonance (MR) image technique is the most sensitive method so as to identify chronic disorders of the nervous system such as Multiple Sclerosis. MRI and Expanded Disability Status Scale (EDSS) data belonging to 120 individuals who have one of the subgroups of MS (Relapsing Remitting MS (RRMS), Secondary Progressive MS (SPMS), Primary Progressive MS (PPMS)) as well as 19 healthy individuals in the control group have been used in this study. The study is comprised of the following stages: (i) L2 Norm Multifractal Denoising technique, one of the multifractal technique, has been used with the application on the MS data (MRI and EDSS). In this way, the new dataset has been obtained. (ii) The new MS dataset obtained from the MS dataset and L2 Multifractal Denoising technique has been applied to the K-Means and Fuzzy C Means clustering algorithms which are among the unsupervised methods. Thus, the clustering performances have been compared. (iii) In the identification of significant attributes in the MS dataset through the Multifractal denoising (L2 Norm) technique using K-Means and FCM algorithms on the MS subgroups and control group of healthy individuals, excellent performance outcome has been yielded. According to the clustering results based on the MS subgroups obtained in the study, successful clustering results have been obtained in the K-Means and FCM algorithms by applying the L2 norm of multifractal denoising technique for the MS dataset. Clustering performance has been more successful with the MS Dataset (L2_Norm MS Data Set) K-Means and FCM in which significant attributes are obtained by applying L2 Norm Denoising technique.

Keywords: clinical decision support, clustering algorithms, multiple sclerosis, multifractal techniques

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Authors: Zasha Romero, Joe Paschall

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This poster will detail the importance of physical activity for the Visually Impaired students and how to promote inclusion in fitness through way of social gatherings and jogging. Furthermore, it will demonstrate how a Health & Kinesiology University Club cooperated in the journey of visually impaired students from participating in physical activity to completing their first 10K fun run. Purpose: The poster will detail how a university’s Health & Kinesiology Club developed a program to promote participation in fitness activities for visually impaired individuals. Also, it will detail their journey from participation in physical activity to completing a 10K fun run. Methods: In an effort to promote inclusion of all into physical activity, a university’s Health & Kinesiology Club developed a non-profit program to challenge visually impaired students to train and complete a 10 kilometer fun run in a South Texas town. The idea was to promote physical fitness through way of social interaction. In order to maintain runners interested, Club students developed training plans and strategies to be able to navigate in a race that was attended by over 18,000 runners. The idea was to promote interaction and life-long fitness amongst participants. Implications: This strategy was done in collaboration with different non-profit institutions to create awareness and provide opportunities for physical fitness, social interaction and life-long fitness skills associated with the jogging. The workshop provided collaboration amongst different entities and novel ideas to create opportunities for a typically underserved population.

Keywords: inclusion, participation, management, disability, fitness

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Authors: Asmaa Hamdy, Israa Nassar, Tarek Aly

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Introduction: Femoral fractures are the most common presentation in the Emergency Department (ED), and they can present as isolated injuries or as part of a polytrauma situation. To provide optimum pain management care to these patients, practitioners must be well prepared and current with utilizing modern evidence-based knowledge and practices. Management of pain associated with fracture femur in the emergency department has a critical role in the satisfaction of patients and preventing further complications. This study aimed to evaluate the analgesic efficacy of ultrasound-guided femoral nerve block compared with intravenous fentanyl in fractures of the femur in patients presented to the Emergency Department. Patients and Methods: Fifty patients with femur fractures were divided into two groups: Group A: In this group (twenty-five patients) were given intravenous fentanyl 2 micro-grams/kg and re-assessed for pain by Visual Analogue Score (VAS). Group B: In this group (twenty-five patients) underwent ultrasonography-guided femoral nerve block and were re-assessed for pain by VAS. Results: VAS score on the movement of the fractured limb between group A and group B at a 10-minute post-intervention period shows P= 0.043, and hence the difference is significant. VAS score on the movement of the fractured limb between group A and group B during a 10-minute post-intervention period showed a significant difference. Seventeen patients in group A had major PID with a percentage of 63% VS 10 patients in group B with a percentage of 37%. conclusion: both femoral nerve block and intravenous fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and more intense analgesia and major pain intensity difference in less time. Moreover, the use of FNB had fewer side effects and more Hemodynamics stability compared to opioids.

Keywords: femur fracture, nerve block, fentanyl, ultrasound guided

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Authors: H. Sebai, M. A. Jabria, D. Wannes, H. Tounsi, L. Marzouki

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We aimed in the present study to investigate the protective effects of Tunisian Rosa canina aqueous extract (RCAE) against ethanol-induced gastric ulceration and oxidative stress in a rat model. In this respect, adult male Wistar rats were used and divided into six groups of ten each: control, EtOH, EtOH plus various doses of RCAE, EtOH plus famotidine and EtOH + gallic acid. Phytochemical and biochemical analysis were performed using colorimetric methods. We found that RCAE is rich in total polyphenols, total flavonoids, and condensed tannins, and exhibited an importance in vitro antioxidant activity on 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. In vivo, the results showed that oral administration of EtOH caused macroscopic and histological changes in gastric mucosa. These injuries are accompanied by an oxidative stress status as assessed by an increase of lipid peroxidation as well as a decrease of antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Alcohol intoxication also induced intracellular mediators deregulation as assessed by an increase of hydrogen peroxide (H2O2), calcium and free iron levels in gastric mucosa. More, importantly, RCAE pretreatment reversed all macroscopic, histological and biochemical changes induced by EtOH administration. In conclusion, we suggest that RCAE has potent protective effects on acute ethanol-induced gastric ulceration related in part in part its antioxidant properties and its opposite effect on intracellular mediators. Indeed, Rosa canina can be offered as a food additive to protect against alcohol consumption-induced gastric and oxidative damage.

Keywords: alcohol, antioxidant properties, food additive, gastric ulceration, rat model, Rosa canina

Procedia PDF Downloads 178

Authors: Esther Liyanage, Indrajith Liyanage, A. A. J. Rajaratne

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During the 30 year civil war in Sri Lanka, a large number of individuals were injured and disabled. These disabilities have reduced their daily physical activities which may cause reduction in flexibility of upper limb, shoulder girdle, lower back and lower limb. Muscle flexibility is important for a healthy lifestyle. The main objective of the study was to assess the upper limb, shoulder girdle and lower back, hamstring flexibility of the intact lower limb in disabled individuals in the North and Eastern parts of Sri Lanka. Back saver sits and reach test and shoulder scratch test described in FITNESS GRAM was used in the study. A total of 125 disabled soldiers with lower limb disabilities were recruited for the study. Flexibility of the lower back and hamstring muscles of uninjured lower limb was measured using back saver sit and reach test described by Wells and Dillon (1952). Upper limb and shoulder girdle flexibility was assessed using shoulder stretch test. Score 0-3 was given according to the ability to reach Superior medial angle of the opposite scapula, top of the head or the mouth. The results indicate that 31 (24.8%) disabled soldiers have lower limb flexibility less than 8, 2 (1.6 % ) have flexibility of 8, 2 (1.6 %) have flexibility of 8.5, 11 ( 8.8% ) have flexibility of 9, 14 (11.2 %) have flexibility of 9.5, 23 (18.4 %) have flexibility of 10, 17 (13.6 %) have 10.5 flexibility, 13 (10.4%) have 11 flexibility, 2 (1.6%) have 11.5 flexibility, 10 (8 %) have flexibility of 12 and 3 (2.34 %) have flexibility of 12.5. Six disabled soldiers (4.8%) have upper limb flexibility of 2 and remaining 95.2% have normal upper limb flexibility (score 3). A reduction in the flexibility of muscles in lower body and lower limbs was seen in 25% disabled soldiers which could be due to reduction in their daily physical activities.

Keywords: disability, flexibility, rehabilitation, quality of life

Procedia PDF Downloads 448

Authors: Karim Hajjar, Luis Lillo, Diego Martinez, Manuel Hermosilla, Nicholas Risko

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Objectives: This study examines the relationship between universal health coverage (UCH) and the burden of emergency diseases at a global level. Methods: Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables, 1) coverage of essential health services and 2) proportion of population spending more than 10% of household income on out-of-pocket health care expenditure, was extracted from the World Bank Database for years preceding our outcome of interest. Linear regression was performed, analyzing the effect of the UHC variables on the DALYs of emergency diseases, controlling for other variables. Results: A total of 133 countries were included. 44.4% of the analyzed countries had coverage of essential health services index of at least 70/100, and 35.3% had at least 10% of their population spend greater than 10% of their household income on healthcare. For every point increase in the coverage of essential health services index, there was a 13-point reduction in DALYs of emergency medical diseases (95% CI -16, -11). Conversely, for every percent decrease in the population with large household expenditure on healthcare, there was a 0.48 increase in DALYs of emergency medical diseases (95% CI -5.6, 4.7). Conclusions: After adjusting for multiple variables, an increase in coverage of essential health services was significantly associated with improvement in DALYs for emergency conditions. There was, however, no association between catastrophic health expenditure and DALYs.

Keywords: emergency medicine, universal healthcare, global health, health economics

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Authors: Dona Pamoda W. Jayatunga, Veer Bala Gupta, Eugene Hone, Ralph N. Martins

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Being a neurodegenerative disorder, Alzheimer’s disease (AD) affects a majority of the elderly demented worldwide. The key risk factors for AD are age, metabolic syndrome, allele status of APOE gene, head injuries and lifestyle. The progressive nature of AD is characterized by symptoms of multiple cognitive deficits exacerbated over time, leading to death within a decade from clinical diagnosis. However, it is revealed that AD originates via a prodromal phase that spans from one to few decades before symptoms first manifest. The key pathological hallmarks of AD brains are deposition of amyloid beta (Aβ) plaques and neurofibrillary tangles (NFT). However, the yet unknown etiology of the disease fails to distinguish mitochondrial dysfunction between a cause or an outcome. The absence of early diagnosis tools and definite therapies for AD have permitted recruits of nutraceutical-based approaches aimed at reducing the risk of AD by modulating lifestyle or be used as preventive tools during AD prodromal state before widespread neurodegeneration begins. The objective of the present study was to investigate beneficial effects of luteolin, a plant-based flavone compound, against AD. The neuroprotective effects of luteolin on amyloid beta (Aβ) (1-42)-induced neurotoxicity was measured using cultured human neuroblastoma BE(2)-M17 cells. After exposure to 20μM Aβ (1-42) for 48 h, the neuroblastoma cells exhibited marked apoptotic death. Co-treatment of 20μM Aβ (1-42) with luteolin (0.5-5μM) significantly protected the cells against Aβ (1-42)-induced toxicity, as assessed by the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2(4sulfophenyl)-2H-tetrazolium, inner salt; MTS] reduction assay and the lactate dehydrogenase (LDH) cell death assay. The results suggest that luteolin prevents Aβ (1-42)-induced apoptotic neuronal death. However, further studies are underway to determine its protective mechanisms in AD including the activity against tau hyperphosphorylation and mitochondrial dysfunction.

Keywords: Aβ (1-42)-induced toxicity, Alzheimer’s disease, luteolin, neuroblastoma cells

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Authors: Khawaja A. Wahaj Wani, Aykut Erkal

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Pakistan's construction industry, a key player in economic development, has experienced remarkable growth. However, the surge in activities has been accompanied by dangerous working conditions, attributed to legislative gaps and flaws. Unhealthy construction practices, uncertain site conditions, and hazardous environments contribute to a concerning rate of injuries and fatalities. The principal aim of this research study is to undertake a thorough evaluation based on the assessment of the current situation of Health & Safety policies and the surveys performed by stakeholders of Pakistan with the aim of providing solution-centric methodologies for the enforcement of health and safety regulations within construction companies operating on project sites. Recognizing the pivotal role that the construction industry plays in bolstering a nation's economy, it is imperative to address the pressing need for heightened awareness among site engineers and laborers. The study adopts a robust approach, utilizing questionnaire surveys and interviews. As an exclusive investigative study, it encompasses all stakeholders: clients, consultants, contractors, and subcontractors. Targeting PEC-registered companies. Safety performance was assessed through the examination of sixty safety procedures using SPSS-18. A high Cronbach's alpha value of 0.958 ensures data reliability, and non-parametric tests were employed due to the non-normal distribution of data. The safety performance evaluation revealed significant insights. "Using Hoists and Cranes" and "Precautionary Measures (Shoring and Excavation)" exhibited commendable safety levels. Conversely, "Trainings on Safety" displayed a lower safety performance, alongside areas such as "Safety in Contract Documentation," "Meetings for Safety," and "Worker Participation," indicating room for improvement. These findings provide stakeholders with a detailed understanding of current safety measures within Pakistan's construction industry.

Keywords: construction industry, health and safety regulations, Pakistan, risk management

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Authors: Nuralam Sam, Irawan Yusuf, Irfan Idris, Endi Adnan

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The most case in the shoulder in the the adult is the frozen shoulder. It make an uncomfortable sensation which disturbance daily activity. The studies of frozen shoulder are still limited. This study used a true experimental pre and post test design with a group design. The participant underwent dextrose prolotherapy injection in the rotator cuff, intraarticular glenohumeral joint, long head tendon biceps, and acromioclavicular joint injections with 15% dextrose, respectively, at week 2, week 4, and week 6. Participants were followed for 12 weeks. The specific biomarker MMP and TIMP, ROM, DASH score were measured at baseline, at week 6, and week 12. The data were analyzed by multivariate analysis (repeated measurement ANOVA, Paired T-Test, and Wilcoxon) to determine the effect of the intervention. The result showed a significant decrease in The Disability of the Arm, Shoulder, and Hand (DASH) score in prolo injection patients in each measurement week (p < 0.05). While the measurement of Range of Motion (ROM), each direction of shoulder motion showed a significant difference in average each week, from week 0 to week 6 (p <0.05).Dextrose prolotherapy injection results give a significant improvement in functional outcome of the shoulder joint, and ROMand did not show significant results in assessing the specific biomarker, MMP-1, and TIMP-1 in tissue repair. This study suggestion an alternative to the use of injection prolotherapy in Frozen shoulder patients, which has fewer side effects and better effectiveness than the use of corticosteroid injections.

Keywords: frozen shoulder, ROM, DASH score, prolotherapy, MMP-1, TIMP-1

Procedia PDF Downloads 88

Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

Procedia PDF Downloads 78

Authors: Zahra Esmaeily, Zahra Tajari, Shahrzad Daei, Mahshid Rezaei, Atefeh Eyvazkhani, Marjan Mansouri Dara, Ahmad Reza Dorosty Motlagh, Andriko Palmowski

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Objective: Sarcopenia (SPA) is associated with frailty and disability in the elderly. Adherence to current dietary guidelines in addition to physical activity could play a role in the prevention of muscle wasting and weakness. The Healthy Eating Index-2015 (HEI) is a tool to assess diet quality as recommended in the U.S. Dietary Guidelines for Americans. This study aimed to investigate whether there is a relationship between HEI scores and the probability of SPA (PS) among the Tehran elderly. Method: A previously validated semi-quantitative food frequency questionnaire was used to assess HEI and the dietary intake of randomly selected elderly people living in Tehran, Iran. Handgrip strength (HGS) was measured to evaluate the PS. Statistical evaluation included descriptive analysis and standard test procedures. Result: 201 subjects were included. Those probably suffering from SPA (as determined by HGS) had significantly lower HEI scores (p = 0.02). After adjusting for confounders, HEI scores and HGS were still significantly associated (adjusted R2 = 0.56, slope β = 0.03, P = 0.09). Elderly people with a low probability of SPA consumed more monounsaturated and polyunsaturated fatty acids (P = 0.06) and ingested less added sugars and saturated fats (P = 0.01 and P = 0.02, respectively). Conclusion: In this cross-sectional study, HEI scores are associated with the probability of SPA. Adhering to current dietary guidelines might contribute to ameliorating muscle strength and mass in aging individuals.

Keywords: aging, HEI-2015, Iranian, sarcopenic

Procedia PDF Downloads 177

Authors: Sahar M. El-Gowilly, Mai M. Helmy, Hanan M. El-Gowelli

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Methotrexate (MTX) is widely used in treatment of cancers and autoimmune diseases. However, nephrotoxicity is one of the most important side effects of MTX. The peroxisome proliferator-activated receptor gamma agonist, pioglitazone (PIO), is known to exert anti-inflammatory and reno-protective effects in various kidney injuries. The purpose of this study was to investigate the potential involvement of endothelial damage in MTX-induced renal injury and to elaborate the possible protective effect of PIO against MTX-induced nephropathy. Compared with saline-treated rats, treatment with MTX (7 mg/kg for 3 day) caused significant elevations in serum levels of urea and creatinine, increased renal nitrate/nitrite level and impaired renovascular responsiveness of isolated perfused kidney to endothelium-dependent vasodilations induced by acetylcholine (0.01-2.43 nmol) and isoprenaline (1µmol). These effects were abolished by concurrent treatment with PIO (2.5 mg/kg, for 5 days starting two days before MTX). Alternatively, MTX treatment did not affect endothelium-independent renovascular relaxation induced by sodium nitroprusside (1-30 μmole). The possibility that alterations in renal antioxidants, circulating cytokine and apoptotic factor (Fas) levels contributed to MTX-PIO interaction was assessed. PIO treatment abrogated renal oxidative stress (decreased reduced glutathione and catalase activity and increased malondialdehyde), elevated serum cytokine (interleukin-6, interleukin-10, tumor necrosis factor-alpha and transforming growth factor-beta1) and Fas induced by MTX. Histologically, MTX caused defused tubular cells swelling and vacuolization associated with endothelial damage in renal arterioles. These effects disappeared upon co-treated with PIO. Collectively, PIO abolished MTX-induced endothelium dysfunction and nephrotoxicity via ameliorating oxidative stress and rectifying cytokines and Fas abnormalities caused by MTX.

Keywords: methotrexate, pioglitazone, endothelium, kidney

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Authors: Susana Aragoneses Garrido

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Every day, the roads are scenery of numerous accidents involving vehicles, producing thousands of deaths and serious injuries all over the world. Investigations have revealed that Human Factors (HF) are one of the main causes of road accidents in modern societies. Distracted driving (including external or internal aspects of the vehicle), which is considered as a human factor, is a serious and emergent risk to road safety. Consequently, a further analysis regarding this issue is essential due to its transcendence on today’s society. The objectives of this investigation are the detection and assessment of the HF in order to provide solutions (including a better vehicle design), which might mitigate road accidents. The methodology of the project is divided in different phases. First, a statistical analysis of public databases is provided between Spain and The UK. Second, data is classified in order to analyse the major causes involved in road accidents. Third, a simulation between different paths and vehicles is presented. The causes related to the HF are assessed by Failure Mode and Effects Analysis (FMEA). Fourth, different car models are evaluated using the Rapid Upper Body Assessment (RULA). Additionally, the JACK SIEMENS PLM tool is used with the intention of evaluating the Human Factor causes and providing the redesign of the vehicles. Finally, improvements in the car design are proposed with the intention of reducing the implication of HF in traffic accidents. The results from the statistical analysis, the simulations and the evaluations confirm that accidents are an important issue in today’s society, especially the accidents caused by HF resembling distractions. The results explore the reduction of external and internal HF through the global analysis risk of vehicle accidents. Moreover, the evaluation of the different car models using RULA method and the JACK SIEMENS PLM prove the importance of having a good regulation of the driver’s seat in order to avoid harmful postures and therefore distractions. For this reason, a car redesign is proposed for the driver to acquire the optimum position and consequently reducing the human factors in road accidents.

Keywords: analysis vehicles, asssesment, ergonomics, car redesign

Procedia PDF Downloads 312

Authors: Sahar M. El-Gowilly, Mai M. Helmy, Hanan M. El-Gowelli

Abstract:

Methotrexate (MTX) is widely used in treatment of cancers and autoimmune diseases. However, nephrotoxicity is one of its most important side effects. The peroxisome proliferator-activated receptor gamma agonist, pioglitazone, is known to exert antiinflammatory and reno-protective effects in various kidney injuries. The purpose of this study was to investigate the potential involvement of endothelial damage in MTX-induced renal injury and to elaborate the possible protective effect of pioglitazone against MTX-induced endothelial impairment. Compared with saline-treated rats, treatment with MTX (7 mg/kg for 3 day) caused significant elevations in serum levels of urea and creatinine, increased renal nitrate/nitrite level and impaired renovascular responsiveness of isolated perfused kidney to endothelium-dependent vasodilations induced by acetylcholine (0.01-2.43 nmol) and isoprenaline (1µmol). These effects were abolished by concurrent treatment with pioglitazone (2.5 mg/kg, for 5 days starting two days before MTX). Alternatively, MTX treatment did not affect endothelium-independent renovascular relaxation induced by sodium nitroprusside (0.001-10 μmole). The possibility that alterations in renal antioxidants, circulating cytokine and apoptotic factor (Fas) levels contributed to MTX-pioglitazone interaction was assessed. Pioglitazone treatment abrogated renal oxidative stress (decreased reduced glutathione and catalase activity and increased malondialdehyde), elevated serum cytokine (interleukin-6, interleukin-10, tumor necrosis factor-alpha and transforming growth factor-beta1) and Fas induced by MTX. Histologically, MTX caused defused tubular cells swelling and vacuolization associated with endothelial damage in renal arterioles. These effects disappeared upon co-treated with pioglitazone. Collectively, pioglitazone abolished MTX-induced endothelium dysfunction and nephrotoxicity via ameliorating oxidative stress and rectifying cytokines and Fas abnormalities caused by MTX.

Keywords: methotrexate, pioglitazone, endothelium, kidney

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Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

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Globally, the death rate from cardiovascular disease has risen over the past 20 years, but especially in low and middle-income countries (LMICS), reports the World Health Organization (WHO). Around 17.5 million deaths, or 31% of all deaths worldwide in 2012, were attributed to CVD, 80% of which occurred in low- and middle-income nations, and eighty five percent of all worldwide disability is attributable to cardiovascular disease. This study assessed the dietary habit and Cardiovascular Risk factors among the patients of coronary artery disease against matched controls. The research was a case-control study. Sample size for this case-control study was 410 CAD cases and 410 healthy controls. The case-control ratio was 1:1. Patients diagnosed with coronary artery disease were recruited from the outpatient departments and emergency rooms of four hospitals in Pakistan. The ages of people who were diagnosed with coronary artery disease were not significantly different from (mean 57.97 7.39 years) the healthy controls (mean 57.12 6.73 years). In order to determine the relationship between food consumption and the two binary outcomes, logistic regression analysis was carried out. Chicken (0.340 (0.245-0.47), p-value 0.0001), beef (0.38 (0.254-0.56), p-value 0.0001), eggs (0.297 (0.208-0.426), p-value 0.0001), and junk food (0.249 (0.167-0.372), p-value 0.0001)) were protective, while yogurt consumption more than twice weekly was risk. Conclusion: In conclusion, poor dietary habits are closely linked to the risk of CAD. Investigations based on dietary trends offer vital and practical knowledge about societal patterns.

Keywords: dietary habbits, cardiovasculardisease, CVD risk factors, hypercholesterolemia

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Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

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Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

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Authors: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

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Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

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Authors: Jareeluk Ratanaphan

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The purposed of this research were; 1. To survey the teacher’s needs on knowledge about special education management for special needs student 2. Development of distance training packages for teacher on special education management for special needs student 3. to study the effects of using the packages on trainee’s achievement 4. to study the effects of using the packages on trainee’s opinion on the distance training packages. The design of the experiment was research and development. The research sample for survey were 86 teachers, and 22 teachers for study the effects of using the packages on achievement and opinion. The research instrument comprised: 1) training packages on special education management for special needs student 2) achievement test 3) questionnaire. Mean, percentage, standard deviation, t-test and content analysis were used for data analysis. The findings of the research were as follows: 1. The teacher’s needs on knowledge about teaching for a learner with learning disability, mental retardation, autism, physical and health impairment and research in special education. 2. The package composed of special education management for special needs student document and manual of distance training packages. The document consisted by the name of packages, the explanation for the educator, content’s structure, concept, objectives, content and activities. Manual of distance training packages consisted by the explanation about a document, objectives, explanation about using the package, training schedule, and evaluation. The efficiency of packages was established at 79.50/81.35. 3. The results of using the packages were the posttest average scores of trainee’s achievement were higher than the pretest. 4. The trainee’s opinion on the package was at the highest level.

Keywords: distance training package, teacher, learner with special needs

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Authors: Aigul Abduldayeva, Gulnar Tuleshova

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Osteoporosis (OP) is a major socio-economic problem and is a major cause of disability, reduced quality of life and premature death of elderly people. In Astana, the study involved 93 respondents, of whom 17 were men (18.3%), and 76 were women (81.7%). Age distribution of the respondents is as follows: 40-59 (66.7%), 60-75 (29.0%), 75-90 (4.3%). In the city of Astana general breach of bone mass (CCM) was determined in 83.8% (nationwide figure - RRP - 79.0%) of the patients, and normal levels of ultrasound densitometry were detected in 16.1% (RRP 21.0%) of the patients. OP was diagnosed in 20.4% of people over 40 (RRP for citizens is 19.0%), 25.4% in the group older than 50 (23.4% PIU), 22,6% in the group older than 60 (RRP 32.6%), 25.0% in the group older than 70 (47.6% of RRP). OPN was detected in 63.4% (RRP 59.6%) of the surveyed population. These data indicate that, there is no sharp difference between Astana and other cities in the country regarding the incidence of OP, that is, the situation with the OP is not aggravated by any regional characteristics. In the distribution of respondents by clusters it was found that 80.0% of the respondents with CCM were in the "best urban cluster", 93.8% were in "average urban cluster", and 77.4% were in a "poor urban cluster". There is a high rate construction of new buildings in Astana, presumably, that the new settlers inhabit the outskirts of the city, and very difficult to trace the socio-economic differences there. Based on these data the following conclusions can be made: 1. According to the ultrasound densitometry of the calcaneus the prevalence rate of NCM among the residents of Astana is 83.3%, OP - 20.4%, which generally coincides with data elsewhere in the country. 2. The urban population of Astana is under a high degree of risk for low energetic fracture, 46.2% of the population had medium and high risks of fracture, while the nationwide index is 26.7%. 3. In the development of CCM residents of Akmola region play a significant role gender, age, ethnic factors. According to the ultrasound densitometry women are more prone to Astana OP - 22.4% of respondents than men - 11.8% of respondents.

Keywords: nutrition, osteoporosis, elderly, urban population

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Authors: Johannes Matiasek

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Introduction and Aims: Octenidine is a common antiseptic agent in the area of surgical interventions because of its antimicrobial efficacy and outstanding biocompatibility index. We investigate the direct postoperative application of octenilin® on typical procedures in the field of plastic surgery in a prospective, randomized controlled intervention study. The aim of this study is to determine the influence of a direct postoperative application of an octenidine-containing wound gel on wound healing and scarring after abdominoplasty. Material and Methods: In this study, we enrolled 33 patients who underwent abdominoplasty because of medical indications (e.g. Cutis laxa abdominis). To ensure an intraindividual comparison, each patient received both dressings (study-group: octenilin® wound gel; control-group: Omnistrip® dry plaster) immediately after surgery. We evaluate wound-healing tendency, pain during dressing changes and scar formation after two weeks, three, six and twelve months. Regarding scar-evaluation skin-elasticity, sebum on the skin, transepidermal waterloss, skin hydration, melanin content and erythema level were determined with special probes. Furthermore the Vancouver Scar Scale (VSS) and pain level during dressing change are determined. Results: At the time of surgery the mean patient’s age was 44.1 years. On average 5.6 dressing changes were necessary. Wound healing disorders occurred more often in the control-group. In the control-group (dry plaster Omnistrip®) patients reported significantly more pain and superficial skin injuries during dressing changes occurred. Objective scar-evaluation after 3, 6 and 12 months resulted in a significant higher skin-elasticity and significant lower transepidermal water loss in the octenilin® group which is confirmed in the VSS. Conclusion: The immediate postoperative application of the octenidine-containing hydrogel octenilin® after abdominoplasty results in favoured scar formation compared to our actual standard therapy. Less hypertrophic scar formation was observed in the study-group.

Keywords: abdominoplasty, octenidine, scarring, wound healing

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Authors: Sawitree Wongkittirungrueang

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The objectives of this research were: 1) to study the effect of social stories on social interaction of students with autism. The sample was Pratomsuksa level 5 student with autism, Khon Kaen University Demonstration School, who was diagnosed by the Physician as High Functioning Autism since he was able to read, write, calculate and was studying in inclusive classroom. However, he still had disability in social interaction to participate in social activity group and communication. He could not learn how to develop friendship or create relationship. He had inappropriate behavior in social context. He did not understand complex social situations. In addition, he did seemed not know time and place. He was not able to understand feeling of oneself as well as the others. Consequently, he could not express his emotion appropriately. He did not understand or express his non-verbal language for communicating with friends. He lacked of common interest or emotion with nearby persons. He greeted inappropriately or was not interested in greeting. In addition, he did not have eye contact. He used inadequate language etc. He was elected by Purposive Sampling. His parents were willing to allow them to participate in this study. The research instruments were the lesson plan of social stories, and the picture book of social stories. The instruments used for data collection, were the social interaction evaluation of autistic students. This research was Quasi Experimental Research as One Group Pre-test, Post-test Design. For the Pre-test, the experiment was conducted by social stories. Then, the Post-test was implemented. The statistic used for data analysis, included the Mean, and Standard Deviation. The research findings were shown by Graph. The findings revealed hat the autistic students taught by social stories indicated better social interaction after being taught by social stories.

Keywords: social story, autism spectrum disorder (ASD), autism, social interaction

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Authors: Yu-Wen Cheng, Jau-Der Ho, Liang-Huan Wu, Fan-Li Lin, Li-Huei Chen, Hung-Ming Chang, Yueh-Hsiung Kuo, George Hsiao

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Retina glial activation and neuroinflammation have been confirmed to cause devastating responses in retinodegenerative diseases. The expression and activation of matrix metalloproteinase (MMP)-9 and inducible nitric oxide synthase (iNOS) could be exerted as the crucial pathological factors in glaucoma- and blue light-induced retinal injuries. The present study aimed to investigate the retinoprotective effects and mechanisms of fungal ingredient 3,4-dihydroxybenzalacetone (DBL) isolated from Phellinus linteus in the retinal glial activation and retinodegenerative animal models. According to the cellular studies, DBL significantly and concentration-dependently abrogated MMP-9 activation and expression in TNFα-stimulated retinal Müller (rMC-1) cells. We found the inhibitory activities of DBL were strongly through the STAT- and ERK-dependent pathways. Furthermore, DBL dramatically attenuated MMP-9 activation in the stimulated Müller cells exposed to conditioned media from LPS-stimulated microglia BV-2 cells. On the other hand, DBL strongly suppressed LPS-induced production of NO and ROS and expression of iNOS in microglia BV-2 cells. Consistently, the phosphorylation of STAT was substantially blocked by DBL in LPS-stimulated microglia BV-2 cells. In the evaluation of retinoprotective functions, the high IOP-induced scotopic electroretinographic (ERG) deficit and blue light-induced abnormal pupillary light response (PLR) were assessed. The deficit scotopic ERG responses markedly recovered by DBL in a rat model of glaucoma-like ischemia/reperfusion (I/R)-injury. DBL also reduced the aqueous gelatinolytic activity and retinal MMP-9 expression in high IOP-injured conditions. Additionally, DBL could restore the abnormal PLR and reduce retinal MMP-9 activation. In summary, DBL could ameliorate retinal neuroinflammation and MMP-9 activation by predominantly inhibiting STAT3 activation in the retinal Müller cells and microglia, which exhibits therapeutic potential for glaucoma and other retinal degenerative diseases.

Keywords: glaucoma, blue light, DBL, retinal Müller cell, MMP-9, STAT, Microglia, iNOS, ERG, PLR

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Despite improvements in stroke management, it remains the leading cause of disability worldwide. It has been suggested that enhancing brain angiogenesis after stroke will improve stroke outcome. Promoting post stroke angiogenesis requires the upregulation of angiogenic factors with a simultaneous reduction of anti-angiogenic factors. Thrombospondin-1 is the main anti-angiogenic protein in the living cells. Counterintuitively, it has been shown that animals with Thrombospondin-1 knockdown will have better stroke outcome. Data about the clinical significance of Thrombspondin-1 levels at the time of admission is still lacking. The objective of this work is to assess the association between serum Thrombospondin-1 levels measured at the time of admission and baseline neurologic severity after stroke. Patients and Methods: Blood samples were collected from patients admitted to the King Abdullah University Hospital (KAUH) with ischemic stroke at the time of admission and serum Thrombopsondin-1 levels were measured using ELISA. Patients neurologic severity was evaluated using the National Institute of Health Stroke Scale (NIHSS). Results: Samples from 50 patients admitted between January 2016 and December 2016 were collected. The median age of participants was 68 years and the median NIHSS was 3. Multinomial regression identified serum Thrombospondin-1 as an independent predictor of stroke outcome (p=0.003). Baseline serum Thrombsopondin-1 was negatively associated with NIHSS at the time of admission (spearman rho correlation coefficient=0.272, p=0.032). Conclusion: Serum Thrombospondin-1 at the time of admission may be a useful marker of stroke severity that predicts more severe neurologic severity.

Keywords: thrombospondin, stroke, neuroprotection, biomarkers

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Authors: Naznine Anwar, Kim Cornish, Izelle Labuschagne, Nellie Georgiou-Karistianis

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Falls and subsequent injuries are common features in symptomatic Huntington’s disease (symp-HD) individuals. As part of daily walking, navigating around obstacles may incur a greater risk of falls in symp-HD. We designed obstacle-crossing experiment to examine adaptive gait dynamics and to identify underlying spatiotemporal gait characteristics that could increase the risk of falling in symp-HD. This experiment involved navigating around one or two ground-based obstacles under two conditions (walking while navigating around one obstacle, and walking while navigating around two obstacles). A total of 32 participants were included, 16 symp-HD and 16 healthy controls with age and sex matched. We used a GAITRite electronic walkway to examine the spatiotemporal gait characteristics and inter-trail gait variability when participants walked at their preferable speed. A minimum of six trials were completed which were performed for baseline free walk and also for each and every condition during navigating around the obstacles. For analysis, we separated all walking steps into three phases as approach steps, navigating steps and recovery steps. The mean and inter-trail variability (within participant standard deviation) for each step gait variable was calculated across the six trails. We found symp-HD individuals significantly decreased their gait velocity and step length and increased step duration variability during the navigating steps and recovery steps compared with approach steps. In contrast, HC individuals showed less difference in gait velocity, step time and step length variability from baseline in both respective conditions as well as all three approaches. These findings indicate that increasing spatiotemporal gait variability may be a possible compensatory strategy that is adopted by symp-HD individuals to effectively navigate obstacles during walking. Such findings may offer benefit to clinicians in the development of strategies for HD individuals to improve functional outcomes in the home and hospital based rehabilitation program.

Keywords: Huntington’s disease, gait variables, navigating around obstacle, basal ganglia dysfunction

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Authors: Shri Dubey, Jamal Ghorieshi

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Instability of the lumbar spine is caused by various factors that include degenerative disc, herniated disc, traumatic injuries, and other disorders. Pedicle screws are widely used as a main fixation device to construct rigid linkages of vertebrae to provide a fully functional and stable spine. Various technologies and methods have been used to restore the stabilization. However, loosening of pedicle screws is the main cause of concerns for neurosurgeons. This could happen due to poor bone quality with osteoporosis as well as types of pedicle screw used. Compatibilities and stabilities of pedicle screws with bone depend on design (thread design, length, and diameter) and material. Grip length and pullout strength affect the motion and stability of the spine when it goes through different phases such as extension, flexion, and rotation. Pullout strength of augmented pedicle screws is increased in both primary and salvage procedures by 119% (p = 0.001) and 162% (p = 0.01), respectively. Self-centering pedicle screws at different trajectories (0°, 10°, 20°, and 30°) show the same pullout strength as insertion in a straight-ahead trajectory. The outer cylindrical and inner conical shape of pedicle screws show the highest pullout strength in Grades 5 and 15 foams (synthetic bone). An outer cylindrical and inner conical shape with a V-shape thread exhibit the highest pullout strength in all foam grades. The maximum observed pullout strength is at axial pullout configuration at 0°. For Grade 15 (240 kg/m³) foam, there is a decline in pull out strength. The largest decrease in pullout strength is reported for Grade 10 (160 kg/m³) foam. The maximum pullout strength of 2176 N (0.32-g/cm³ Sawbones) on all densities. Type 1 Pedicle screw shows the best fixation due to smaller conical core diameter and smaller thread pitch (Screw 2 with 2 mm; Screws 1 and 3 with 3 mm).

Keywords: polymethylmethacrylate, PMMA, classical pedicle screws, CPS, expandable poly-ether-ether-ketone shell, EPEEKS, includes translaminar facet screw, TLFS, poly-ether-ether-ketone, PEEK, transfacetopedicular screw, TFPS

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