Search results for: upper limb amputation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1369

Search results for: upper limb amputation

1129 Executive Functions Directly Associated with Severity of Perceived Pain above and beyond Depression in the Context of Medical Rehabilitation

Authors: O. Elkana, O Heyman, S. Hamdan, M. Franko, J. Vatine

Abstract:

Objective: To investigate whether a direct link exists between perceived pain (PP) and executive functions (EF), above and beyond the influence of depression symptoms, in the context of medical rehabilitation. Design: Cross-sectional study. Setting: Rehabilitation Hospital. Participants: 125 medical records of hospitalized patients were screened for matching to our inclusion criteria. Only 60 patients were found fit and were asked to participate. 19 decline to participate on personal basis. The 41 neurologically intact patients (mean age 46, SD 14.96) that participated in this study were in their sub-acute stage of recovery, with fluent Hebrew, with intact upper limb (to neutralize influence on psychomotor performances) and without an organic brain damage. Main Outcome Measures: EF were assessed using the Wisconsin Card Sorting Test (WCST) and the Stop-Signal Test (SST). PP was measured using 3 well-known pain questionnaires: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Perceived pain index (PPI) was calculated by the mean score composite from the 3 pain questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results: The results indicate that irrespective of the presence of depression symptoms, PP is directly correlated with response inhibition (SST partial correlation: r=0.5; p=0.001) and mental flexibility (WSCT partial correlation: r=-0.37; p=0.021), suggesting decreased performance in EF as PP severity increases. High correlations were found between the 3 pain measurements: SF-MPQ with PDI (r=0.62, p<0.001), SF-MPQ with PCS (r=0.58, p<0.001) and PDI with PCS (r=0.38, p=0.016) and each questionnaire alone was also significantly associated with EF; thus, no specific questionnaires ‘pulled’ the results obtained by the general index (PPI). Conclusion: Examining the direct association between PP and EF, beyond the contribution of depression symptoms, provides further clinical evidence suggesting that EF and PP share underlying mediating neuronal mechanisms. Clinically, the importance of assessing patients' EF abilities as well as PP severity during rehabilitation is underscored.

Keywords: depression, executive functions, mental-flexibility, neuropsychology, pain perception, perceived pain, response inhibition

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1128 Effects of Listening to Pleasant Thai Classical Music on Increasing Working Memory in Elderly: An Electroencephalogram Study

Authors: Anchana Julsiri, Seree Chadcham

Abstract:

The present study determined the effects of listening to pleasant Thai classical music on increasing working memory in elderly. Thai classical music without lyrics that made participants feel fun and aroused was used in the experiment for 3.19-5.40 minutes. The accuracy scores of Counting Span Task (CST), upper alpha ERD%, and theta ERS% were used to assess working memory of participants both before and after listening to pleasant Thai classical music. The results showed that the accuracy scores of CST and upper alpha ERD% in the frontal area of participants after listening to Thai classical music were significantly higher than before listening to Thai classical music (p < .05). Theta ERS% in the fronto-parietal network of participants after listening to Thai classical music was significantly lower than before listening to Thai classical music (p < .05).

Keywords: brain wave, elderly, pleasant Thai classical music, working memory

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1127 Extreme Temperature Forecast in Mbonge, Cameroon Through Return Level Analysis of the Generalized Extreme Value (GEV) Distribution

Authors: Nkongho Ayuketang Arreyndip, Ebobenow Joseph

Abstract:

In this paper, temperature extremes are forecast by employing the block maxima method of the generalized extreme value (GEV) distribution to analyse temperature data from the Cameroon Development Corporation (CDC). By considering two sets of data (raw data and simulated data) and two (stationary and non-stationary) models of the GEV distribution, return levels analysis is carried out and it was found that in the stationary model, the return values are constant over time with the raw data, while in the simulated data the return values show an increasing trend with an upper bound. In the non-stationary model, the return levels of both the raw data and simulated data show an increasing trend with an upper bound. This clearly shows that although temperatures in the tropics show a sign of increase in the future, there is a maximum temperature at which there is no exceedance. The results of this paper are very vital in agricultural and environmental research.

Keywords: forecasting, generalized extreme value (GEV), meteorology, return level

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1126 Energy Efficient Autonomous Lower Limb Exoskeleton for Human Motion Enhancement

Authors: Nazim Mir-Nasiri, Hudyjaya Siswoyo Jo

Abstract:

The paper describes conceptual design, control strategies, and partial simulation for a new fully autonomous lower limb wearable exoskeleton system for human motion enhancement that can support its weight and increase strength and endurance. Various problems still remain to be solved where the most important is the creation of a power and cost efficient system that will allow an exoskeleton to operate for extended period without batteries being frequently recharged. The designed exoskeleton is enabling to decouple the weight/mass carrying function of the system from the forward motion function which reduces the power and size of propulsion motors and thus the overall weight, cost of the system. The decoupling takes place by blocking the motion at knee joint by placing passive air cylinder across the joint. The cylinder is actuated when the knee angle has reached the minimum allowed value to bend. The value of the minimum bending angle depends on usual walk style of the subject. The mechanism of the exoskeleton features a seat to rest the subject’s body weight at the moment of blocking the knee joint motion. The mechanical structure of each leg has six degrees of freedom: four at the hip, one at the knee, and one at the ankle. Exoskeleton legs are attached to subject legs by using flexible cuffs. The operation of all actuators depends on the amount of pressure felt by the feet pressure sensors and knee angle sensor. The sensor readings depend on actual posture of the subject and can be classified in three distinct cases: subject stands on one leg, subject stands still on both legs and subject stands on both legs but transit its weight from one leg to other. This exoskeleton is power efficient because electrical motors are smaller in size and did not participate in supporting the weight like in all other existing exoskeleton designs.

Keywords: energy efficient system, exoskeleton, motion enhancement, robotics

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1125 Evaluating the Impact of Future Scenarios on Water Availability and Demand Based on Stakeholders Prioritized Water Management Options in the Upper Awash Basin, Ethiopia

Authors: Adey Nigatu Mersha, Ilyas Masih, Charlotte de Fraiture, Tena Alamirew

Abstract:

Conflicts over water are increasing mainly as a result of water scarcity in response to higher water demand and climatic variability. There is often not enough water to meet all demands for different uses. Thus, decisions have to be made as to how the available resources can be managed and utilized. Correspondingly water allocation goals, practically national water policy goals, need to be revised accordingly as the pressure on water increases from time to time. A case study is conducted in the Upper Awash Basin, Ethiopia, to assess and evaluate prioritized comprehensive water demand management options based on the framework of integrated water resources management in account of stakeholders’ knowledge and preferences as well as practical prominence within the Upper Awash Basin. Two categories of alternative management options based on policy analysis and stakeholders' consultation were evaluated against the business-as-usual scenario by using WEAP21 model as an analytical tool. Strong effects on future (unmet) demands are observed with major socio-economic assumptions and forthcoming water development plans. Water management within the basin will get more complex with further abstraction which may lead to an irreversible damage to the ecosystem. It is further confirmed through this particular study that efforts to maintain users’ preferences alone cannot insure economically viable and environmentally sound development and vice versa. There is always a tradeoff between these factors. Hence, all of these facets must be analyzed separately, related with each other in equal footing, and ultimately taken up in decision making in order for the whole system to function properly.

Keywords: water demand, water availability, WEAP21, scenarios

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1124 Sclerobiont Assemblages on Macro-Invertebrates from the Cenomanian Strata of Djebel Bouarif (Aurès Range, Algeria)

Authors: Salmi-laouar Sihem, Kara Ahmed Imad

Abstract:

The ichnological study of the Djebel BouarifCenomaniandeposits(Northern Aurès Range, Algeria) revealed relatively abundant and diverse sclerobiont communities that are preserved in corals, bivalves, and gastropods ; all are described herein. Fossil traces are dominated by exceptionally preserved Gastrochaenolitesoften with tracemakers (bivalves), which are preserved in situ, Entobia, and Maeandropolydora. Other borings are rare and are represented by a single specimen of Rogerella, Nihilichnus, and Spirolites. Amongsclerozoans, encrustingjuvenile oysters, and non-oyster bivalves (Pseudolimea?granulata) are the mostabundant groups. Otherepibionts, such as gastropods and polychaetes (Glomerulaserpentina), are lesscommon; dwarfgastropods were located on a single oyster Costagyraolisiponensis, whereas Glomerula specimens were clustered on the lower and upper surfaces of coral Aspidiscuscristatus. Gastrochaenoliteswith original tracemakers and all the epibionts studied herein have not been described from the Djebel BouarifCenomaniandeposits to date. The rare occurrences of Spirolites and Nihilichnus are reported from Algeria for the first time.

Keywords: bioerosion, sclerobionts, upper creataceous, southern tethys, atlasic domain

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1123 The Effect of Mean Pressure on the Performance of a Low-Grade Heat-Driven Thermoacoustic Cooler

Authors: Irna Farikhah

Abstract:

Converting low-grade waste heat into useful energy such as sound energy which can then be used to generate acoustic power in a thermoacoustic engine has become an attracting issue for researchers. The generated power in thermoacoustic engine can be used for driving a thermoacoustic cooler when they are installed in a tube. This cooler system can be called as a heat-driven thermoacoustic cooler. In this study, low heating temperature of the engine is discussed. In addition, having high efficiency of the whole cooler is also essential. To design a thermoacoustic cooler having high efficiency with using low-grade waste heat for the engine, the effect of mean pressure is investigated. By increasing the mean pressure, the heating temperature to generate acoustic power can be decreased from 557 °C to 300 °C. Moreover, the efficiency of the engine and cooler regenerators attain 67% and 47% of the upper limit values, respectively and 49% of the acoustical work generated by the engine regenerator is utilized in the cooler regenerator. As a result, the efficiency of the whole cooler becomes 15% of the upper limit value.

Keywords: cooler, mean pressure, performance, thermoacoustic

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1122 Personal and Household Hygiene Measures for Prevention of Upper Respiratory Tract Infections among Children: A Cross Sectional Survey on Parental Knowledge, Attitudes and Practices

Authors: Man Wai Leung, Margaret O’Donoghue, Lorna K. P. Suen

Abstract:

Personal and household hygiene measures are important to prevent upper respiratory tract infections (URTIs) and other infectious diseases, including coronavirus disease 2019 (COVID-19). An online survey recruited 414 eligible parents in Hong Kong to study their hygiene knowledge, attitudes, and practices (KAP) in the prevention of URTIs among their children. The average knowledge score was high (10.2/12.0), but some misconceptions were identified. The majority of participants agreed that good personal hygiene (93.5%) and good environmental hygiene (92.8%) can prevent URTIs. The average score for hand hygiene practices was high (3.78/4.00), but only 56.8% of parents always perform hand hygiene before touching their mouth, nose, or eyes. For environmental hygiene, only some household items were disinfected with disinfectants (69.8%: door handles, 60.4%: toilet seats, 42.8%: floor, 24.2%: dining chairs, 20.5%: dining tables). Higher knowledge score was associated with parents having a tertiary educational level or above, working as healthcare professionals, living at private residential flat or staff quarter, and having a household income of $70,000 or above. Hand hygiene practices varied significantly with parents’ age and income. During the 5th wave of the COVID-19 epidemic, misconceptions about hygiene knowledge were found among parents. Health promotion programs should target parents, especially those who are in old age, obtain lower educational levels, live in public housing, or have a lower income. Hand hygiene moments and proper use of disinfectants could be one of the targeted educational topics.

Keywords: hygiene, upper respiratory tract infection, parents, children, COVID-19

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1121 Design and Construction of a Home-Based, Patient-Led, Therapeutic, Post-Stroke Recovery System Using Iterative Learning Control

Authors: Marco Frieslaar, Bing Chu, Eric Rogers

Abstract:

Stroke is a devastating illness that is the second biggest cause of death in the world (after heart disease). Where it does not kill, it leaves survivors with debilitating sensory and physical impairments that not only seriously harm their quality of life, but also cause a high incidence of severe depression. It is widely accepted that early intervention is essential for recovery, but current rehabilitation techniques largely favor hospital-based therapies which have restricted access, expensive and specialist equipment and tend to side-step the emotional challenges. In addition, there is insufficient funding available to provide the long-term assistance that is required. As a consequence, recovery rates are poor. The relatively unexplored solution is to develop therapies that can be harnessed in the home and are formulated from technologies that already exist in everyday life. This would empower individuals to take control of their own improvement and provide choice in terms of when and where they feel best able to undertake their own healing. This research seeks to identify how effective post-stroke, rehabilitation therapy can be applied to upper limb mobility, within the physical context of a home rather than a hospital. This is being achieved through the design and construction of an automation scheme, based on iterative learning control and the Riener muscle model, that has the ability to adapt to the user and react to their level of fatigue and provide tangible physical recovery. It utilizes a SMART Phone and laptop to construct an iterative learning control (ILC) system, that monitors upper arm movement in three dimensions, as a series of exercises are undertaken. The equipment generates functional electrical stimulation to assist in muscle activation and thus improve directional accuracy. In addition, it monitors speed, accuracy, areas of motion weakness and similar parameters to create a performance index that can be compared over time and extrapolated to establish an independent and objective assessment scheme, plus an approximate estimation of predicted final outcome. To further extend its assessment capabilities, nerve conduction velocity readings are taken by the software, between the shoulder and hand muscles. This is utilized to measure the speed of response of neuron signal transfer along the arm and over time, an online indication of regeneration levels can be obtained. This will prove whether or not sufficient training intensity is being achieved even before perceivable movement dexterity is observed. The device also provides the option to connect to other users, via the internet, so that the patient can avoid feelings of isolation and can undertake movement exercises together with others in a similar position. This should create benefits not only for the encouragement of rehabilitation participation, but also an emotional support network potential. It is intended that this approach will extend the availability of stroke recovery options, enable ease of access at a low cost, reduce susceptibility to depression and through these endeavors, enhance the overall recovery success rate.

Keywords: home-based therapy, iterative learning control, Riener muscle model, SMART phone, stroke rehabilitation

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1120 Rare Earth Element (REE) Geochemistry of Tepeköy Sandstones (Central Anatolia, Turkey)

Authors: Mehmet Yavuz Hüseyinca, Şuayip Küpeli

Abstract:

Sandstones from Upper Eocene - Oligocene Tepeköy formation (Member of Mezgit Group) that exposed on the eastern edge of Tuz Gölü (Salt Lake) were analyzed for their rare earth element (REE) contents. Average concentrations of ΣREE, ΣLREE (Total light rare earth elements) and ΣHREE (Total heavy rare earth elements) were determined as 31.37, 26.47 and 4.55 ppm respectively. These values are lower than UCC (Upper continental crust) which indicates grain size and/or CaO dilution effect. The chondrite-normalized REE pattern is characterized by the average ratios of (La/Yb)cn = 6.20, (La/Sm)cn = 4.06, (Gd/Lu)cn = 1.10, Eu/Eu* = 0.99 and Ce/Ce* = 0.94. Lower values of ΣLREE/ΣHREE (Average 5.97) and (La/Yb)cn suggest lower fractionation of overall REE. Moreover (La/Sm)cn and (Gd/Lu)cn ratios define less inclined LREE and almost flat HREE pattern when compared with UCC. Almost no Ce anomaly (Ce/Ce*) emphasizes that REE were originated from terrigenous material. Also depleted LREE and no Eu anomaly (Eu/Eu*) suggest an undifferentiated mafic provenance for the sandstones.

Keywords: central Anatolia, provenance, rare earth elements, REE, Tepeköy sandstone

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1119 Attraction and Retention of Newly Graduated Medical Doctors to Deprived Regions in Ghana: A Qualitative Case Study

Authors: Lily Yarney, Emmanuel M. Y. Seidu, Thomas Chireh Kuusaanu, Belinda Adzimah-Yeboah

Abstract:

Healthcare delivery is labor-intensive; the role of the health worker is, therefore, indispensable in maintaining and improving individual and population health. In Ghana, doctor-patient ratio is 1:10,450, with a disproportionate tilt in favor of the relatively resource rich southern part of the country. The Upper West Region located in Northern Ghana, is among the poorest regions in the country. The study was aimed at finding out the reasons why medical doctors are unwilling to accept postings to the Upper West Region where their services are needed most despite some efforts to attract, motivate and retain them. Current initiatives by the Ministry of Health and its partners to attract and retain doctors in the region were also examined. Qualitative methodology was employed with an in-depth interview guide to collect data. Sixteen respondents comprising medical doctors, health managers, and other health-related partners purposively selected took part in the study. Data were recorded, transcribed, coded, and categorized into themes in tandem with the objectives of the study. The study found that medical doctors are unwilling to take up appointments in the Upper West Region because of limited opportunities for career and continuing professional development, poor financial inducement, and weak leadership, among other important contextual social and cultural factors. Critical success factors to surmount these challenges include concessions and sponsorship for medical specialization training for doctors and clear implementable national and local policies on postings.

Keywords: attraction, retention, medical doctors, deprived regions, Ghana

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1118 The Extent of Proliferation, Apoptosis and Angiogenesis at the Site of Injury Determine the Course of Healing Either as Scar Free or as Scarred One in the Appendages of Lizard

Authors: Isha Ranadive, Sonam Patel, Suresh Balakrishnan

Abstract:

It has been observed that in lizards wound can be healed by either a scar free mechanism or by scarring. The animal model used to study both these healing processes was Northern House Gecko. In lizard, the tail when amputated heals by scar free mechanism which allows it to regenerate, the same is not seen when the limb is amputated. Proliferation, apoptosis, and angiogenesis are the main events which succeed an injury. We observed that proliferation of the cells beneath the wound epidermis was much higher in case of wound healing in tail. This could be because after the wound gets covered by the epithelium, it enters in to a cross-talk with the underlying mesenchyme to recruit a pool of blastemal cells which proliferate and later differentiate to form the lost part through epimorphic regeneration. This was substantiated by mRNA expression levels of various FGFs which facilitate the cross-talk and also by PCNA which is a marker for proliferation. Western blot result reaffirms the same notion. However, in case of the limb, the rate of apoptosis was more than proliferation as there are a lot of debris that needs to be removed. We came to this conclusion as we observed that p53 the apoptotic gene was highly upregulated in case of the scarred tissue. Further, we confirmed this result by checking the anti-apoptotic gene bcl2 and found it to be significantly down-regulated. As we noticed heightened proliferation in the case of scar-free wound healing in tail, angiogenesis was targeted for the study. This is because, when the cells are proliferating they require constant supply of blood and hence neo-vascularization is inevitable. It was observed that the marker of angiogenesis, VEGF, was expressed more during wound healing as compared to the resting stage of tail. Moreover, a high up-regulation was seen in KDR, a receptor of VEGF. Thus, this study reveals how proliferation, apoptosis, and angiogenesis play a key role in the scar-free as well as scarred wound healing.

Keywords: epimorphic regeneration, injury, northern house gecko, wound healing

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1117 The Impact of Barefoot versus Shod Running on Lower Limb Gait Cycle Pattern among Recreational Club Runners in Durban, South Africa

Authors: Siyabonga Kunene, Calvin Shipley

Abstract:

Introduction: Despite health benefits that come with running, injuries are common with prevalence ranging between 18.2% and 92.4% worldwide. Differences in gait patterns between barefoot and shod running, can determine traits that could lead to running injuries. The aim was to assess and compare lower limb gait cycle patterns between barefoot and shod running among runners. Methods: An experimental same-subject study design was used. The study population consisted of male and female adult recreational runners who were injury free from a running club in Durban. A convenience sampling method was used and 14 participants were recruited. The study was conducted in the physiotherapy performance laboratory at the University of KwaZulu-Natal. A Woodway Desmo Treadmill and KinePro gait analysis system were used. Descriptive & inferential statistics were analysed using Microsoft Excel and Intercooled Stata. Results: Participants included a greater percentage of females (57.1%, n = 8) than males (42.9%, n = 6). The mean population age was 38.57. A significant difference (p < 0.0009) between barefoot cadence (177.9236steps/min) and shod cadence (171.9445steps/min) was observed. Right (0.261s) and left (0.257s) barefoot stand phase was shorter than right (0.273s) and left (0.270s) shod stand phase. Right barefoot swing phase exhibited less significant (0.420s) results when compared to right shod swing phase (0.427s), whereas left barefoot swing phase was quicker (0.416s) than left shod swing phase (0.432s). Significant differences between barefoot and shod stand (p < 0.009) and swing (p < 0.040) phase symmetry occurred. Conclusion: A considerable difference was found between barefoot and shod running gait cycle patterns among participants. This difference may play a role in prevention of running related injuries.

Keywords: barefoot running, shod running, gait cycle pattern, same-subject study design

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1116 Moderation Effects of Legal Origin on Corruption and Corporate Performance

Authors: S. Sundarasen, I. Ibrahim

Abstract:

This study examines whether the legal origin of a country alters the association between corruption and corporate performance in the East Asia and South East Asia Region. A total of 18,286 companies from 14 countries in the East Asia and South East Asia Region are tested using Generalized Least Square (GLS) panel and pool data analysis with the cross-section being the income level. The data is further analyzed in terms of high income, upper middle income and low-income countries within the East and South Asia region. The empirical results indicate that legal origin positively moderates the relationship between a country’s corruption level and firm performance. As for the sub-analysis, legal origin positively moderates only in the high and upper middle-income countries. As for the low-income countries, no significance is documented in both the common and civil law.

Keywords: corruption, performance, legal origin, East Asia and South East Asia Region

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1115 Calling Persons with Disability as Divine: Exploring and Critiquing Meanings of Divyang (The One with a Divine Limb) in the Indian Context

Authors: Vinay Suhalka

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In India, the official nomenclature used by the State for persons with disability is divyang (literally, the one with a divine limb), a word coming from the Sanskrit language. Disability thus gets portrayed as divine, at least in the welfare sector from where it flows down even to the popular imagination where it gets equated to divinity. This paper looks at reference to persons with disabilities as divyangs and goes on to discusses what such usage for an already marginalized group achieves and misses out. The issue of nomenclature and language has always been a contested one when it comes to disability. At the same time, there is also an issue of who determines these labels for the persons with disability. Nomenclature and language used for disability can have real consequences for the population of persons with disability as it may empower or disempower them. Thus, this paper looks at the issue of what it means for persons with disabilities as ‘exceptionally gifted’ and hence divyang. Language can be a powerful tool to communicate meanings and messages associated with a term. When the persons with disabilities as a group are described as ‘exceptionally gifted, talented and the source of inspiration’, it essentially stereotypes and marginalizes them by putting a burden of performance that all of them ought to be achievers, and it is only then that they would be assimilated in the larger society. This paper also argues that such a situation creates a ‘double bind’ where the person is always trying to match up to the labels (the disabled as ‘achiever, overcomer, inspirational’) created by somebody else and looks at self through the eyes of others. This conceptual paper also presents an overview of disability labels while simultaneously looking at projecting disability as divinity which has the potential to wrongly portray the lives of persons with disability in India due to the official usage of the term. It also explores the question of visibility of disability since the idea of divyang implicitly assumes that all disabilities are visible. In reality, however, it may not be the case simply because all forms of disabilities are not visible, people may choose not to visibilize their disabilities if they can and pass as able-bodied, fearing the stigma that surrounds disability. Finally, it argues for an increased focus on understanding the everyday lived realities of those with disability in order to regard it as an important form of difference which could be a potential resource for the society.

Keywords: persons with disability, labels, language use, divinity

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1114 Stratigraghy and Identifying Boundaries of Mozduran Formation with Magnetite Method in East Kopet-Dagh Basin

Authors: Z. Kadivar, M. Vahidinia, A. Mousavinia

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Kopet-Dagh Mountain Range is located in the north and northeast of Iran. Mozduran Formation in the east of Kopet-Dagh is mainly composed of limestone, dolomite, with shale and sandstone interbedded. Mozduran Formation is reservoir rock of the Khangiran gas field. The location of the study was east Kopet-Dagh basin (Northeast Iran) where the deliberate thickness of formation is 418 meters. In the present study, a total of 57 samples were gathered. Moreover, 100 thin sections were made out of 52 samples. According to the findings of the thin section study, 18 genera and nine species of foraminifera and algae were identified. Based on the index fossils, the age of the Mozduran Formation was identified as Upper Jurassic (Kimmerdgian-Tithonian) in the east of Kopet-Dagh basin. According to the magnetite data (total intensity and RTP map), there is a disconformity (low intensity) between the Kashaf-Rood Formation and Mozduran Formation. At the top, where among Mozduran Formation and Shurijeh Formation, is high intensity and a widespread disconformity (high intensity).

Keywords: upper jurassic, magnetometre, mozduran formation, stratigraphy

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1113 Exploring Error-Minimization Protocols for Upper-Limb Function During Activities of Daily Life in Chronic Stroke Patients

Authors: M. A. Riurean, S. Heijnen, C. A. Knott, J. Makinde, D. Gotti, J. VD. Kamp

Abstract:

Objectives: The current study is done in preparation for a randomized controlled study investigating the effects of an implicit motor learning protocol implemented using an extension-supporting glove. It will explore different protocols to find out which is preferred when studying motor learn-ing in the chronic stroke population that struggles with hand spasticity. Design: This exploratory study will follow 24 individuals who have a chronic stroke (> 6 months) during their usual care journey. We will record the results of two 9-Hole Peg Tests (9HPT) done during their therapy ses-sions with a physiotherapist or in their home before and after 4 weeks of them wearing an exten-sion-supporting glove used to employ the to-be-studied protocols. The participants will wear the glove 3 times/week for one hour while performing their activities of daily living and record the times they wore it in a diary. Their experience will be monitored through telecommunication once every week. Subjects: Individuals that have had a stroke at least 6 months prior to participation, hand spasticity measured on the modified Ashworth Scale of maximum 3, and finger flexion motor control measured on the Motricity Index of at least 19/33. Exclusion criteria: extreme hemi-neglect. Methods: The participants will be randomly divided into 3 groups: one group using the glove in a pre-set way of decreasing support (implicit motor learning), one group using the glove in a self-controlled way of decreasing support (autonomous motor learning), and the third using the glove with constant support (as control). Before and after the 4-week period, there will be an intake session and a post-assessment session. Analysis: We will compare the results of the two 9HPTs to check whether the protocols were effective. Furthermore, we will compare the results between the three groups to find the preferred one. A qualitative analysis will be run of the experience of participants throughout the 4-week period. Expected results: We expect that the group using the implicit learning protocol will show superior results.

Keywords: implicit learning, hand spasticity, stroke, error minimization, motor task

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1112 Awarness the Effect of Quality Food and Nutrition on Health Will Help Develop a Healthy Lifestyle

Authors: Hamnah Nisar

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As food is something which is particularly important for survival, in fact, it improves the quality of life and promotes health. Quality food is a key to a healthy life. Consumption of food depends on the knowledge we have regarding the nutrients it contains. Moreover, the awareness and knowledge about something is an initial stage for its improvement. We cannot work on anything unless we have knowledge about it. The pros and cons, effects, causes, dos, and don'ts, especially for an important things like food, are a necessity to learn. That is why my research would be all about analyzing what difference awareness makes on people and how making people more aware about a certain thing can help them improve their lifestyles and bring a positive change for them. The research would be done through questionnaires and interviews among two classes, one would be the upper class and the other would-be lower class. Because the upper class can easily access learning facilities and can know about the new things than the lower class. The questions would be related to what kind of food do they consume, what health issues they face, or what health issues are common among their regions. The results of the research would be helpful to know firstly the effects of awareness and education regarding food on health, how a basic thing like knowledge can have a significant effect on health and can be the cause of several diseases.

Keywords: nutrition, awareness, quality food, knowledge

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1111 Modification of Underwood's Equation to Calculate Minimum Reflux Ratio for Column with One Side Stream Upper Than Feed

Authors: S. Mousavian, A. Abedianpour, A. Khanmohammadi, S. Hematian, Gh. Eidi Veisi

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Distillation is one of the most important and utilized separation methods in the industrial practice. There are different ways to design of distillation column. One of these ways is short cut method. In short cut method, material balance and equilibrium are employed to calculate number of tray in distillation column. There are different methods that are classified in short cut method. One of these methods is Fenske-Underwood-Gilliland method. In this method, minimum reflux ratio should be calculated by underwood equation. Underwood proposed an equation that is useful for simple distillation column with one feed and one top and bottom product. In this study, underwood method is developed to predict minimum reflux ratio for column with one side stream upper than feed. The result of this model compared with McCabe-Thiele method. The result shows that proposed method able to calculate minimum reflux ratio with very small error.

Keywords: minimum reflux ratio, side stream, distillation, Underwood’s method

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1110 Comparative Study of Analgesic Efficacy of Ultrasound Guided Femoral Nerve Block Versus Intravenous Fentanyl Injection in Fracture Femur Patients at Emergency Department

Authors: Asmaa Hamdy, Israa Nassar, Tarek Aly

Abstract:

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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1109 Application of the Concept of Comonotonicity in Option Pricing

Authors: A. Chateauneuf, M. Mostoufi, D. Vyncke

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Monte Carlo (MC) simulation is a technique that provides approximate solutions to a broad range of mathematical problems. A drawback of the method is its high computational cost, especially in a high-dimensional setting, such as estimating the Tail Value-at-Risk for large portfolios or pricing basket options and Asian options. For these types of problems, one can construct an upper bound in the convex order by replacing the copula by the comonotonic copula. This comonotonic upper bound can be computed very quickly, but it gives only a rough approximation. In this paper we introduce the Comonotonic Monte Carlo (CoMC) simulation, by using the comonotonic approximation as a control variate. The CoMC is of broad applicability and numerical results show a remarkable speed improvement. We illustrate the method for estimating Tail Value-at-Risk and pricing basket options and Asian options when the logreturns follow a Black-Scholes model or a variance gamma model.

Keywords: control variate Monte Carlo, comonotonicity, option pricing, scientific computing

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1108 Synoptic Analysis of a Heavy Flood in the Province of Sistan-Va-Balouchestan: Iran January 2020

Authors: N. Pegahfar, P. Ghafarian

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In this research, the synoptic weather conditions during the heavy flood of 10-12 January 2020 in the Sistan-va-Balouchestan Province of Iran will be analyzed. To this aim, reanalysis data from the National Centers for Environmental Prediction (NCEP) and National Center for Atmospheric Research (NCAR), NCEP Global Forecasting System (GFS) analysis data, measured data from a surface station together with satellite images from the European Organization for the Exploitation of Meteorological Satellites (EUMETSAT) have been used from 9 to 12 January 2020. Atmospheric parameters both at the lower troposphere and also at the upper part of that have been used, including absolute vorticity, wind velocity, temperature, geopotential height, relative humidity, and precipitation. Results indicated that both lower-level and upper-level currents were strong. In addition, the transport of a large amount of humidity from the Oman Sea and the Red Sea to the south and southeast of Iran (Sistan-va-Balouchestan Province) led to the vast and unexpected precipitation and then a heavy flood.

Keywords: Sistan-va-Balouchestn Province, heavy flood, synoptic, analysis data

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1107 Fast Track to the Physical Internet: A Cross-Industry Project from Upper Austria

Authors: Laura Simmer, Maria Kalt, Oliver Schauer

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Freight transport is growing fast, but many vehicles are empty or just partially loaded. The vision and concepts of the Physical Internet (PI) proposes to eliminate these inefficiencies. Aiming for a radical sustainability improvement, the PI – inspired by the Digital Internet – is a hyperconnected global logistic system, enabling seamless asset sharing and flow consolidation. The implementation of a PI in its full expression will be a huge challenge: the industry needs innovation and implementation support including change management approaches, awareness creation and good practices diffusion, legislative actions to remove antitrust and international commerce barriers, standardization and public incentives policies. In order to take a step closer to this future the project ‘Atropine - Fast Track to the Physical Internet’ funded under the Strategic Economic and Research Program ‘Innovative Upper Austria 2020’ was set up. The two-year research project unites several research partners in this field, but also industrial partners and logistics service providers. With Atropine, the consortium wants to actively shape the mobility landscape in Upper Austria and make an innovative contribution to an energy-efficient, environmentally sound and sustainable development in the transport area. This paper should, on the one hand, clarify the questions what the project Atropine is about and, on the other hand, how a proof of concept will be reached. Awareness building plays an important role in the project as the PI requires a reorganization of the supply chain and the design of completely new forms of inter-company co-operation. New business models have to be developed and should be verified by simulation. After the simulation process one of these business models will be chosen and tested in real life with the partner companies. The developed results - simulation model and demonstrator - are used to determine how the concept of the PI can be applied in Upper Austria. Atropine shall pave the way for a full-scale development of the PI vision in the next few decades and provide the basis for pushing the industry toward a new level of co-operation with more shared resources and increased standardization.

Keywords: Atropine, inter-company co-operation, Physical Internet, shared resources, sustainable logistics

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1106 Effects of Urbanization on Land Use/Land Cover and Stream Flow of a Sub-Tropical River Basin of India

Authors: Satyavati Shukla, Lakhan V. Rathod, Mohan V. Khire

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Rapid urbanization changes the land use/land cover pattern of a developing region. Due to these land surface changes, stream flow of the rivers also changes. It is important to investigate the factors affecting hydrological characteristics of the river basin for better river basin management planning. This study is aimed to understand the effect of Land Use/Land Cover (LU/LC) changes on stream flow of Upper Bhima River basin which is highly stressed in terms of water resources. In this study, Upper Bhima River basin is divided into two adjacent sub-watersheds: Mula-Mutha (urbanized) sub-watershed and Bhima (non-urbanized) sub-watershed. First of all, LU/LC changes were estimated over 1980, 2002, and 2009 for both Mula-Mutha and Bhima sub-watersheds. Further, stream flow simulations were done using Soil and Water Assessment Tool (SWAT) for the streams draining both watersheds. Results revealed that stream flow was relatively higher for urbanized sub-watershed. Through Sensitivity Analysis it was observed that out of all the parameters used, base flow was the most sensitive parameter towards LU/LC changes.

Keywords: land use/land cover, remote sensing, stream flow, urbanization

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1105 An Epidemiological Study on Cutaneous Melanoma, Basocellular and Epidermoid Carcinomas Diagnosed in a Sunny City in Southeast Brazil in a Five-Year Period

Authors: Carolina L. Cerdeira, Julia V. F. Cortes, Maria E. V. Amarante, Gersika B. Santos

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Skin cancer is the most common cancer in several parts of the world; in a tropical country like Brazil, the situation isn’t different. The Brazilian population is exposed to high levels of solar radiation, increasing the risk of developing cutaneous carcinoma. Aimed at encouraging prevention measures and the early diagnosis of these tumors, a study was carried out that analyzed data on cutaneous melanomas, basal cell, and epidermoid carcinomas, using as primary data source the medical records of 161 patients registered in one pathology service, which performs skin biopsies in a city of Minas Gerais, Brazil. All patients diagnosed with skin cancer at this service from January 2015 to December 2019 were included. The incidence of skin carcinoma cases was correlated with the identification of histological type, sex, age group, and topographic location. Correlation between variables was verified by Fisher's exact test at a nominal significance level of 5%, with statistical analysis performed by R® software. A significant association was observed between age group and type of cancer (p=0.0085); age group and sex (0.0298); and type of cancer and body region affected (p < 0.01). Those 161 cases analyzed comprised 93 basal cell carcinomas, 66 epidermoid carcinomas, and only two cutaneous melanomas. In the group aged 19 to 30 years, the epidermoid form was most prevalent; from 31 to 45 and from 46 to 59 years, the basal cell prevailed; in 60-year-olds or over, both types had higher frequencies. Associating age group and sex, in groups aged 18 to 30 and 46 to 59 years, women were most affected. In the 31-to 45-year-old group, men predominated. There was a gender balance in the age group 60-year-olds or over. As for topography, there was a high prevalence in the head and neck, followed by upper limbs. Relating histological type and topography, there was a prevalence of basal cell and epidermoid carcinomas in the head and neck. In the chest, the basal cell form was most prevalent; in upper limbs, the epidermoid form prevailed. Cutaneous melanoma affected only the chest and upper limbs. About 82% of patients 60-year-olds or over had head and neck cancer; from 46 to 59 and 60-year-olds or over, the head and neck region and upper limbs were predominantly affected; the distribution was balanced in the 31-to 45-year-old group. In conclusion, basal cell carcinoma was predominant, whereas cutaneous melanoma was the rarest among the types analyzed. Patients 60-year-olds or over were most affected, showing gender balance. In young adults, there was a prevalence of the epidermoid form; in middle-aged patients, basal cell carcinoma was predominant; in the elderly, both forms presented with higher frequencies. There was a higher incidence of head and neck cancers, followed by malignancies affecting the upper limbs. The epidermoid type manifested significantly in the upper limbs. Body regions such as the thorax and lower limbs were less affected, which is justified by the lower exposure of these areas to incident solar radiation.

Keywords: basal cell carcinoma, cutaneous melanoma, skin cancer, squamous cell carcinoma, topographic location

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1104 The Application of Transcranial Direct Current Stimulation (tDCS) Combined with Traditional Physical Therapy to Address Upper Limb Function in Chronic Stroke: A Case Study

Authors: Najmeh Hoseini

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Strokerecovery happens through neuroplasticity, which is highly influenced by the environment, including neuro-rehabilitation. Transcranial direct current stimulation (tDCS) may enhance recovery by modulating neuroplasticity. With tDCS, weak direct currents are applied noninvasively to modify excitability in the cortical areas under its electrodes. Combined with functional activities, this may facilitate motor recovery in neurologic disorders such as stroke. The purpose of this case study was to examine the effect of tDCS combined with 30 minutes of traditional physical therapy (PT)on arm function following a stroke. A 29-year-old male with chronic stroke involving the left middle cerebral artery territory went through the treatment protocol. Design The design included 5 weeks of treatment: 1 week of traditional PT, 2 weeks of sham tDCS combined with traditional PT, and 2 weeks of tDCS combined with traditional PT. PT included functional electrical stimulation (FES) of wrist extensors followed by task-specific functional training. Dual hemispheric tDCS with 1 mA intensity was applied on the sensorimotor cortices for the first 20 min of the treatment combined with FES. Assessments before and after each treatment block included Modified Ashworth Scale, ChedokeMcmaster Arm and Hand inventory, Action Research Arm Test (ARAT), and the Box and Blocks Test. Results showed reduced spasticity in elbow and wrist flexors only after tDCS combination weeks (+1 to 0). The patient demonstrated clinically meaningful improvements in gross motor and fine motor control over the duration of the study; however, components of the ARAT that require fine motor control improved the greatest during the experimental block. Average time improvement compared to baseline was26.29 s for tDCS combination weeks, 18.48 s for sham tDCS, and 6.83 for PT standard of care weeks. Combining dual hemispheric tDCS with the standard of care PT demonstrated improvements in hand dexterity greater than PT alone in this patient case.

Keywords: tDCS, stroke, case study, physical therapy

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1103 Preoperative versus Postoperative Radiation Therapy in Patients with Soft Tissue Sarcoma of the Extremity

Authors: AliAkbar Hafezi, Jalal Taherian, Jamshid Abedi, Mahsa Elahi, Behnam Kadkhodaei

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Background: Soft tissue sarcomas (STS) are generally treated with a combination of limb preservation surgery and radiation therapy. Today, preoperative radiation therapy is considered for accurate treatment volume and smaller field size. Therefore, this study was performed to compare preoperative with postoperative radiation therapy in patients with extremity STS. Methods: In this non-randomized clinical trial, patients with localized extremity STS referred to the orthopedic clinics in Iran from 2021 to 2023 were studied. Patients were randomly divided into two groups: preoperative and postoperative radiation therapy. The two groups of patients were compared in terms of acute (wound dehiscence and infection) and late (limb edema, subcutaneous fibrosis, and joint stiffness) complications and their severity, as well as local recurrence and other one-year outcomes. Results: A total of 80 patients with localized extremity STS were evaluated in two treatment groups. The groups were matched in terms of age, sex, history of diabetes mellitus, hypertension, smoking, involved side, involved extremity, lesion location, and tumor histopathology. The acute complications of treatment in the two groups of patients did not differ significantly (P > 0.05). Of the late complications, only joint stiffness between the two groups had significant statistical differences (P < 0.001). The severity of all three late complications in the postoperative radiation therapy group was significantly higher (P < 0.05). There was no significant difference between the two groups in terms of the rate of local recurrence of other one-year outcomes (P > 0.05). Conclusion: This study showed that in patients with localized extremity STS, the two therapeutic approaches of adjuvant and neoadjuvant radiation therapy did not differ significantly in terms of local recurrence and distant metastasis during the one-year follow-up period and due to fewer late complications in preoperative radiotherapy group, this treatment approach can be a better choice than postoperative radiation therapy.

Keywords: soft tissue sarcoma, extremity, preoperative radiation therapy, postoperative radiation therapy

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1102 PostureCheck with the Kinect and Proficio: Posture Modeling for Exercise Assessment

Authors: Elham Saraee, Saurabh Singh, Margrit Betke

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Evaluation of a person’s posture while exercising is important in physical therapy. During a therapy session, a physical therapist or a monitoring system must assure that the person is performing an exercise correctly to achieve the desired therapeutic effect. In this work, we introduce a system called POSTURECHECK for exercise assessment in physical therapy. POSTURECHECK assesses the posture of a person who is exercising with the Proficio robotic arm while being recorded by the Microsoft Kinect interface. POSTURECHECK extracts unique features from the person’s upper body during the exercise, and classifies the sequence of postures as correct or incorrect using Bayesian estimation and majority voting. If POSTURECHECK recognizes an incorrect posture, it specifies what the user can do to correct it. The result of our experiment shows that POSTURECHECK is capable of recognizing the incorrect postures in real time while the user is performing an exercise.

Keywords: Bayesian estimation, majority voting, Microsoft Kinect, PostureCheck, Proficio robotic arm, upper body physical therapy

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1101 Effectiveness of Imagery Compared with Exercise Training on Hip Abductor Strength and EMG Production in Healthy Adults

Authors: Majid Manawer Alenezi, Gavin Lawrence, Hans-Peter Kubis

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Imagery training could be an important treatment for muscle function improvements in patients who are facing limitations in exercise training by pain or other adverse symptoms. However, recent studies are mostly limited to small muscle groups and are often contradictory. Moreover, a possible bilateral transfer effect of imagery training has not been examined. We, therefore, investigated the effectiveness of unilateral imagery training in comparison with exercise training on hip abductor muscle strength and EMG. Additionally, both limbs were assessed to investigate bilateral transfer effects. Healthy individuals took part in an imagery or exercise training intervention for two weeks and were assesses pre and post training. Participants (n=30), after randomization into an imagery and an exercise group, trained 5 times a week under supervision with additional self-performed training on the weekends. The training consisted of performing, or to imagine, 5 maximal isometric hip abductor contractions (= one set), repeating the set 7 times. All measurements and trainings were performed laying on the side on a dynamometer table. The imagery script combined kinesthetic and visual imagery with internal perspective for producing imagined maximal hip abduction contractions. The exercise group performed the same number of tasks but performing the maximal hip abductor contractions. Maximal hip abduction strength and EMG amplitudes were measured of right and left limbs pre- and post-training period. Additionally, handgrip strength and right shoulder abduction (Strength and EMG) were measured. Using mixed model ANOVA (strength measures) and Wilcoxen-tests (EMGs), data revealed a significant increase in hip abductor strength production in the imagery group on the trained right limb (~6%). However, this was not reported for the exercise group. Additionally, the left hip abduction strength (not used for training) did not show a main effect in strength, however, there was a significant interaction of group and time revealing that the strength increased in the imagery group while it remained constant in the exercise group. EMG recordings supported the strength findings showing significant elevation of EMG amplitudes after imagery training on right and left side, while the exercise training group did not show any changes. Moreover, measures of handgrip strength and shoulder abduction showed no effects over time and no interactions in both groups. Experiments showed that imagery training is a suitable method for effectively increasing functional parameters of larger limb muscles (strength and EMG) which were enhanced on both sides (trained and untrained) confirming a bilateral transfer effect. Indeed, exercise training did not reveal any increases in the parameters above omitting functional improvements. The healthy individuals tested might not easily achieve benefits from exercise training within the time tested. However, it is evident that imagery training is effective in increasing the central motor command towards the muscles and that the effect seems to be segmental (no increase in handgrip strength and shoulder abduction parameters) and affects both sides (trained and untrained). In conclusion, imagery training was effective in functional improvements in limb muscles and produced a bilateral transfer on strength and EMG measures.

Keywords: imagery, exercise, physiotherapy, motor imagery

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1100 Peripheral Neuropathiy After Locoregional Anesthesia

Authors: Dalila Chaid, Yacine Houmel, Mohamed Lamine Belloulou

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Peripheral neuropathy is a rare but worrying complication of peripheral local anaesthesia. It is caused either by needle contact with the nerve root or by the direct toxicity of local anaesthetics, leading to nerve damage, injury or irritation. Although uncommon, it remains a major concern for anaesthetists. The aim of the study was to assess the prevalence of nerve block-associated neuropathy in knee surgery and to identify the contributing factors in order to minimise the occurrence of this complication. The study also assessed the severity and evolution of lesions, as well as the factors leading to neuropathic pain. Methodology: It is a retrospective observational study on cases of neuropathy related to nerve blocks of the lower limb for knee surgery over a period of seven years (2016-2022). The study included a total of 6,000 patients Analyse the anaesthetic and neuropathic pain-related parameters received from these patients to determine the prevalence and severity of neuropathy. Findings: the prevalence of nerve block-related neuropathy in our study is 5.8‰ for the sciatic nerve and 0.9‰ for the femoral nerve. This was higher compared to the reported rates in the literature, which were between 0.0 to 5‰ for the Sciatic nerve and 0.0 to 3.4‰ for the femoral nerve. These findings highlight the importance of identifying and implementing an ideal anesthesia procedure to reduce the risk of neuropathy associated with nerve blocks. Theoretical Importance: The findings of this study contribute to the existing literature on peripheral neuropathy following locoregional anesthesia. By identifying the prevalence and severity of neuropathy related to nerve blocks, as well as the underlying factors, we provide valuable insights for anesthetists to improve patient safety. This study also emphasizes the need for compliance with technical safety rules to minimize the occurrence of neuropathy. Data Collection and Analysis Procedures: For this study, 25 clinics with retrospective data were collected of neuropathy associated with nerve blocks for knee surgery over a span of seven years. Parameters related to anaesthesia and neuropathic pain were analysed to determine prevalence,severity, and progression of neuropathy. Comparison of our results with the existing literature in order to assess their significance. Questions Addressed: This study aims to define the following points: 1. The prevalence of neuropathy associated with nerve blocks for knee surgery. 2. The factors underlying the development of neuropathy after nerve blocks. 3. Reducing the risk of neuropathy by complying with technical safety rules. 4. Assessing the severity and evolution of neuropathic pain in these cases. Conclusion: this study highlights the need for careful consideration and implementation of anesthesia procedures during nerve blocks for knee surgery. The prevalence of neuropathy linked to these blocks was higher compared to the literature, emphasizing the importance of identifying and minimizing contributing factors. Compliance with technical safety rules is crucial to reduce the risk of peripheral neuropathy. This study provides valuable insights to anesthetists and contributes to improving patient safety in the field of locoregional anesthesia.

Keywords: phantom limb, neuropathic pain, lower limb amputee, ultrasound-guided locoreginal anesthesia

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