Search results for: Matt P. Ashworth
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 37

Search results for: Matt P. Ashworth

37 A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

Authors: Noor Ayuni Che Zakaria, Takashi Komeda, Cheng Yee Low, Kaoru Inoue, Fazah Akhtar Hanapiah

Abstract:

Previous studies have shown that there are arguments regarding the reliability and validity of the Ashworth and Modified Ashworth Scale towards evaluating patients diagnosed with upper limb disorders. These evaluations depended on the raters’ experiences. This initiated us to develop an upper limb disorder part-task trainer that is able to simulate consistent upper limb disorders, such as spasticity and rigidity signs, based on the Modified Ashworth Scale to improve the variability occurring between raters and intra-raters themselves. By providing consistent signs, novice therapists would be able to increase training frequency and exposure towards various levels of signs. A total of 22 physiotherapists and occupational therapists participated in the study. The majority of the therapists agreed that with current therapy education, they still face problems with inter-raters and intra-raters variability (strongly agree 54%; n = 12/22, agree 27%; n = 6/22) in evaluating patients’ conditions. The therapists strongly agreed (72%; n = 16/22) that therapy trainees needed to increase their frequency of training; therefore believe that our initiative to develop an upper limb disorder training tool will help in improving the clinical education field (strongly agree and agree 63%; n = 14/22).

Keywords: upper limb disorder, clinical education tool, inter/intra-raters variability, spasticity, modified Ashworth scale

Procedia PDF Downloads 268
36 Phylogenetic Analysis and a Review of the History of the Accidental Phytoplankter, Phaeodactylum tricornutum Bohlin (Bacillariophyta)

Authors: Jamal S. M. Sabir, Edward C. Theriot, Schonna R. Manning, Abdulrahman L. Al-Malki, Mohammad, Mumdooh J. Sabir, Dwight K. Romanovicz, Nahid H. Hajrah, Robert K. Jansen, Matt P. Ashworth

Abstract:

The diatom Phaeodactylum tricornutum has been used as a model for cell biologists and ecologists for over a century. We have incorporated several new raphid pennates into a three-gene phylogenetic dataset (SSU, rbcL, psbC), and recover Gomphonemopsis sp. as sister to P. tricornutum with 100% BS support. This is the first time a close relative has been identified for P. tricornutum with robust statistical support. We test and reject a succession of hypotheses for other relatives. Our molecular data are statistically significantly incongruent with placement of either or both species among the Cymbellales, an order of diatoms with which both have been associated. We believe that further resolution of the phylogenetic position of P. tricornutum will rely more on increased taxon sampling than increased genetic sampling. Gomphonemopsis is a benthic diatom, and its phylogenetic relationship with P. tricornutum is congruent with the hypothesis that P. tricornutum is a benthic diatom with specific adaptations that lead to active recruitment into the plankton. We hypothesize that other benthic diatoms are likely to have similar adaptations and are not merely passively recruited into the plankton.

Keywords: benthic, diatoms; ecology, Phaeodactylum tricornutum, phylogeny, tychoplankton

Procedia PDF Downloads 193
35 Efficacy of Botulinum Toxin in Alleviating Pain Syndrome in Stroke Patients with Upper Limb Spasticity

Authors: Akulov M. A., Zaharov V. O., Jurishhev P. E., Tomskij A. A.

Abstract:

Introduction: Spasticity is a severe consequence of stroke, leading to profound disability, decreased quality of life and decrease of rehabilitation efficacy [4]. Spasticity is often associated with pain syndrome, arising from joint damage of paretic limbs (postural arthropathy) or painful spasm of paretic limb muscles. It is generally accepted that injection of botulinum toxin into a cramped muscle leads to decrease of muscle tone and improves motion range in paretic limb, which is accompanied by pain alleviation. Study aim: To evaluate the change in pain syndrome intensity after incections of botulinum toxin A (Xeomin) in stroke patients with upper limb spasticity. Patients and methods. 21 patients aged 47-74 years were evaluated. Inclusion criteria were: acute stroke 4-7 months before the inclusion into the study, leading to spasticity of wrist and/or finger flexors, elbow flexor or forearm pronator, associated with severe pain syndrome. Patients received Xeomin as monotherapy 90-300 U, according to spasticity pattern. Efficacy evaluation was performed using Ashworth scale, disability assessment scale (DAS), caregiver burden scale and global treatment benefit assessment on weeks 2, 4, 8 and 12. Efficacy criterion was the decrease of pain syndrome by week 4 on PQLS and VAS. Results: The study revealed a significant improvement of measured indices after 4 weeks of treatment, which persisted until the 12 week of treatment. Xeomin is effective in reducing muscle tone of flexors of wrist, fingers and elbow, forearm pronators. By the 4th week of treatment we observed a significant improvement on DAS (р < 0,05), Ashworth scale (1-2 points) in all patients (р < 0,05), caregiver burden scale (р < 0,05). A significant decrease of pain syndrome by the 4th week of treatment on PQLS (р < 0,05) и VAS (р < 0,05) was observed. No adverse effect were registered. Conclusion: Xeomin is an effective treatment of pain syndrome in postural upper limb spasticity after stroke. Xeomin treatment leads to a significant improvement on PQLS and VAS.

Keywords: botulinum toxin, pain syndrome, spasticity, stroke

Procedia PDF Downloads 272
34 Optimisation of the Input Layer Structure for Feedforward Narx Neural Networks

Authors: Zongyan Li, Matt Best

Abstract:

This paper presents an optimization method for reducing the number of input channels and the complexity of the feed-forward NARX neural network (NN) without compromising the accuracy of the NN model. By utilizing the correlation analysis method, the most significant regressors are selected to form the input layer of the NN structure. An application of vehicle dynamic model identification is also presented in this paper to demonstrate the optimization technique and the optimal input layer structure and the optimal number of neurons for the neural network is investigated.

Keywords: correlation analysis, F-ratio, levenberg-marquardt, MSE, NARX, neural network, optimisation

Procedia PDF Downloads 330
33 Spin One Hawking Radiation from Dirty Black Holes

Authors: Petarpa Boonserm, Tritos Ngampitipan, Matt Visser

Abstract:

A 'clean' black hole is a black hole in vacuum such as the Schwarzschild black hole. However in real physical systems, there are matter fields around a black hole. Such a black hole is called a 'dirty black hole'. In this paper, The effect of matter fields on the black hole and the greybody factor is investigated. The results show that matter fields make a black hole smaller. They can increase the potential energy to a black hole to obstruct Hawking radiation to propagate. This causes the greybody factor of a dirty black hole to be less than that of a clean black hole.

Keywords: dirty black hole, greybody factor, hawking radiation, matter fields.

Procedia PDF Downloads 568
32 Comparison of Two Transcranial Magnetic Stimulation Protocols on Spasticity in Multiple Sclerosis - Pilot Study of a Randomized and Blind Cross-over Clinical Trial

Authors: Amanda Cristina da Silva Reis, Bruno Paulino Venâncio, Cristina Theada Ferreira, Andrea Fialho do Prado, Lucimara Guedes dos Santos, Aline de Souza Gravatá, Larissa Lima Gonçalves, Isabella Aparecida Ferreira Moretto, João Carlos Ferrari Corrêa, Fernanda Ishida Corrêa

Abstract:

Objective: To compare two protocols of Transcranial Magnetic Stimulation (TMS) on quadriceps muscle spasticity in individuals diagnosed with Multiple Sclerosis (MS). Method: Clinical, crossover study, in which six adult individuals diagnosed with MS and spasticity in the lower limbs were randomized to receive one session of high-frequency (≥5Hz) and low-frequency (≤ 1Hz) TMS on motor cortex (M1) hotspot for quadriceps muscle, with a one-week interval between the sessions. To assess the spasticity was applied the Ashworth scale and were analyzed the latency time (ms) of the motor evoked potential (MEP) and the central motor conduction time (CMCT) of the bilateral quadriceps muscle. Assessments were performed before and after each intervention. The difference between groups was analyzed using the Friedman test, with a significance level of 0.05 adopted. Results: All statistical analyzes were performed using the SPSS Statistic version 26 programs, with a significance level established for the analyzes at p<0.05. Shapiro Wilk normality test. Parametric data were represented as mean and standard deviation for non-parametric variables, median and interquartile range, and frequency and percentage for categorical variables. There was no clinical change in quadriceps spasticity assessed using the Ashworth scale for the 1 Hz (p=0.813) and 5 Hz (p= 0.232) protocols for both limbs. Motor Evoked Potential latency time: in the 5hz protocol, there was no significant change for the contralateral side from pre to post-treatment (p>0.05), and for the ipsilateral side, there was a decrease in latency time of 0.07 seconds (p<0.05 ); for the 1Hz protocol there was an increase of 0.04 seconds in the latency time (p<0.05) for the contralateral side to the stimulus, and for the ipsilateral side there was a decrease in the latency time of 0.04 seconds (p=<0.05), with a significant difference between the contralateral (p=0.007) and ipsilateral (p=0.014) groups. Central motor conduction time in the 1Hz protocol, there was no change for the contralateral side (p>0.05) and for the ipsilateral side (p>0.05). In the 5Hz protocol for the contralateral side, there was a small decrease in latency time (p<0.05) and for the ipsilateral side, there was a decrease of 0.6 seconds in the latency time (p<0.05) with a significant difference between groups (p=0.019). Conclusion: A high or low-frequency session does not change spasticity, but it is observed that when the low-frequency protocol was performed, there was an increase in latency time on the stimulated side, and a decrease in latency time on the non-stimulated side, considering then that inhibiting the motor cortex increases cortical excitability on the opposite side.

Keywords: multiple sclerosis, spasticity, motor evoked potential, transcranial magnetic stimulation

Procedia PDF Downloads 43
31 Diagnostics via Biophysical Resistotrons

Authors: Matt Vellkorn, Mara Sarinski

Abstract:

The field of advanced diagnostics is a very rapidly changing one. A new technology that has not been fully used yet are resistotrons. A resistotron is a physical device thatis used to detect the presence of low energy alpha particles. It has been used for many years in nuclear physics as an alpha particle detector. Since they are used in nuclear physics, they have to be accurate. They have to be able to differentiate between alpha particles and other types of radiation. The resistotrons are primarily used for safety. They are used in areas where people or animals can get exposed to radiation. A typical example is in the treatment of nuclear waste. As it is with any nuclear physics instrument, a resistotron has to be very accurate and reliable. In the past, the instrument was very expensive because they were made out of copper. Today, they are made out of brass. The main difference is that brass is much less expensive than copper.

Keywords: biosensors, resistotrons, biophysics, diagnostics

Procedia PDF Downloads 78
30 Influence of the Paint Coating Thickness in Digital Image Correlation Experiments

Authors: Jesús A. Pérez, Sam Coppieters, Dimitri Debruyne

Abstract:

In the past decade, the use of digital image correlation (DIC) techniques has increased significantly in the area of experimental mechanics, especially for materials behavior characterization. This non-contact tool enables full field displacement and strain measurements over a complete region of interest. The DIC algorithm requires a random contrast pattern on the surface of the specimen in order to perform properly. To create this pattern, the specimen is usually first coated using a white matt paint. Next, a black random speckle pattern is applied using any suitable method. If the applied paint coating is too thick, its top surface may not be able to exactly follow the deformation of the specimen, and consequently, the strain measurement might be underestimated. In the present article, a study of the influence of the paint thickness on the strain underestimation is performed for different strain levels. The results are then compared to typical paint coating thicknesses applied by experienced DIC users. A slight strain underestimation was observed for paint coatings thicker than about 30μm. On the other hand, this value was found to be uncommonly high compared to coating thicknesses applied by DIC users.

Keywords: digital image correlation, paint coating thickness, strain

Procedia PDF Downloads 473
29 A Theoretical Framework on International Voluntary Health Networks

Authors: Benet Reid, Nina Laurie, Matt Baillie-Smith

Abstract:

Trans-national and tropical medicine, historically associated with colonial power and missionary activity, is now central to discourses of global health and development, thrust into mainstream media by events like the 2014 Ebola crisis and enshrined in the Sustainable Development Goals. Research in this area remains primarily the province of health professional disciplines, and tends to be framed within a simple North-to-South model of development. The continued role of voluntary work in this field is bound up with a rhetoric of partnering and partnership. We propose, instead, the idea of International Voluntary Health Networks (IVHNs) as a means to de-centre global-North institutions in these debates. Drawing on our empirical work with IVHNs in countries both North and South, we explore geographical and sociological theories for mapping the multiple spatial and conceptual dynamics of power manifested in these phenomena. We make a radical break from conventional views of health as a de-politicised symptom or corollary of social development. In studying health work as it crosses between cultures and contexts, we demonstrate the inextricably political nature of health and health work everywhere.

Keywords: development, global health, power, volunteering

Procedia PDF Downloads 293
28 Web-GIS Technology: A Tool for Farm-to-Market Road Project Profiling and Proposal Prioritization of the Philippines’ Department of Agriculture

Authors: Elbert S. Moyon, Edsel Matt O. Morales, Jaymer M. Jayoma, Kent C. Espejon, Jayson C. Dollete, Mark Phil B. Pacot

Abstract:

This research paper focuses on the potential of using Web-GIS technology in prioritizing farm-to-market road projects by the Philippines’ Department of Agriculture (DA). The study aimed to explore the benefits of Web-GIS in addressing the limitations faced by the DA in terms of Farm to Market Road profiling and project prioritization, which include a lack of access to updated data, limited spatial analysis capabilities, and difficulties in sharing information between stakeholders. The research methodology involves a comprehensive literature review and a case study of a Web-GIS application developed for the DA, which was used to profile and prioritize farm-to-market road projects in the Philippines. The results showed that the Web-GIS technology provides the DA with an effective tool for analyzing and visualizing data, which can help in profiling and prioritizing road projects based on various criteria such as economic, social, and environmental impacts. The study also showed that Web-GIS technology could help in reducing the time and effort required for road project prioritization and improve communication between stakeholders.

Keywords: GIS, web application, farm-to-market road, FMR prioritization, Django, GeoServer

Procedia PDF Downloads 45
27 The Effects of Mirror Therapy on Clinical Improvement in Hemiplegic Lower Extremity Rehabilitation in Subjects with Chronic Stroke

Authors: Hassan Abo-Salem, Huang Xiaolin

Abstract:

Background and Purpose: The effectiveness of mirror therapy (MT) has been investigated in acute hemiplegia. The present study examines whether MT, given during chronic stroke, was more effective in promoting motor recovery of the lower extremity and walking speed than standard rehabilitation alone. Methods: The study enrolled 30 patients with chronic stroke. Fifteen patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received mirror therapy for 4 weeks, 5 days a week. Main measures: Passive ankle joint dorsiflexion range of motion, gait speed, Brunnstrom stages of motor recovery, plantarflexor muscle tone by Modified Ashworth Scale. Results: Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation, mirror therapy improved Ankle ROM, Brunnstrom stages and waking speed (p < 0.05). However, there were no significant differences between two groups on MAS (P > 0.05). Conclusions: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and walking speed in chronic stroke patients.

Keywords: mirror therapy, stroke, MAS, walking speed

Procedia PDF Downloads 455
26 Effect of Nitrogen-Based Cryotherapy on the Calf Muscle Spasticity in Stroke Patients

Authors: Engi E. I. Sarhan, Usama M. Rashad, Ibrahim M. I. Hamoda, Mohammed K. Mohamed

Abstract:

Background: This study aimed to know the effect of nitrogen-based cryotherapy on the spasticity of calf muscle in stroke patients. Patients were selected from the outpatient clinic of Neurology, Al-Mansoura general hospital, Al-Mansoura University. Subjects and methods: Thirty Stroke Patients of both sexes ranged from 45 to 60 years old were divided randomly into two equal groups, a study group (A) received a nitrogen-based cryotherapy, a selective physical therapy program and ankle foot orthosis (AFO), while as patients in control group (B) received the same program and AFO only. The treatment duration was three times per week for four weeks for both groups. We assessed spasticity of calf muscle before and after treatment subjectively using modified Ashworth scale (MAS) and objectively via measuring H / M ratio on electromyography machine. We also assessed ankle dorsiflexion ROM objectively using two dimensions motion analysis (2D). Results: After treatment, there was a highly significant improvement in the study group compared to the control group regarding the score of MAS, no significant difference in the study group compared to the control group regarding the readings of H / M ratio, highly significant improvement in the study group compared to the control group regarding the 2D motion analysis findings. Conclusion: This modality considers effective in reducing spasticity in the calf muscle and improving ankle dorsiflexion of the affected limb.

Keywords: ankle foot orthosis, nitrogen-based cryotherapy, stroke, spasticity

Procedia PDF Downloads 169
25 Evaluation of Deformation for Deep Excavations in the Greater Vancouver Area Through Case Studies

Authors: Boris Kolev, Matt Kokan, Mohammad Deriszadeh, Farshid Bateni

Abstract:

Due to the increasing demand for real estate and the need for efficient land utilization in Greater Vancouver, developers have been increasingly considering the construction of high-rise structures with multiple below-grade parking. The temporary excavations required to allow for the construction of underground levels have recently reached up to 40 meters in depth. One of the challenges with deep excavations is the prediction of wall displacements and ground settlements due to their effect on the integrity of City utilities, infrastructure, and adjacent buildings. A large database of survey monitoring data has been collected for deep excavations in various soil conditions and shoring systems. The majority of the data collected is for tie-back anchors and shotcrete lagging systems. The data were categorized, analyzed and the results were evaluated to find a relationship between the most dominant parameters controlling the displacement, such as depth of excavation, soil properties, and the tie-back anchor loading and arrangement. For a select number of deep excavations, finite element modeling was considered for analyses. The lateral displacements from the simulation results were compared to the recorded survey monitoring data. The study concludes with a discussion and comparison of the available empirical and numerical modeling methodologies for evaluating lateral displacements in deep excavations.

Keywords: deep excavations, lateral displacements, numerical modeling, shoring walls, tieback anchors

Procedia PDF Downloads 138
24 Population Structure Analysis of Pakistani Indigenous Cattle Population by Using High Density SNP Array

Authors: Hamid Mustafa, Huson J. Heather, Kim Eiusoo, McClure Matt, Khalid Javed, Talat Nasser Pasha, Afzal Ali1, Adeela Ajmal, Tad Sonstegard

Abstract:

Genetic differences associated with speciation, breed formation or local adaptation can help to preserve and effective utilization of animals in selection programs. Analyses of population structure and breed diversity have provided insight into the origin and evolution of cattle. In this study, we used a high-density panel of SNP markers to examine population structure and diversity among ten Pakistani indigenous cattle breeds. In total, 25 individuals from three cattle populations, including Achi (n=08), Bhagnari (n=04) and Cholistani (n=13) were genotyped for 777, 962 single nucleotide polymorphism (SNP) markers. Population structure was examined using the linkage model in the program STRUCTURE. After characterizing SNP polymorphism in the different populations, we performed a detailed analysis of genetic structure at both the individual and population levels. The whole-genome SNP panel identified several levels of population substructure in the set of examined cattle breeds. We further searched for spatial patterns of genetic diversity among these breeds under the recently developed spatial principal component analysis framework. Overall, such high throughput genotyping data confirmed a clear partitioning of the cattle genetic diversity into distinct breeds. The resulting complex historical origins associated with both natural and artificial selection have led to the differentiation of numerous different cattle breeds displaying a broad phenotypic variety over a short period of time.

Keywords: Pakistan, cattle, genetic diversity, population structure

Procedia PDF Downloads 575
23 Effects of Virtual Reality on the Upper Extremity Spasticity and Motor Function in Patients with Stroke: A Single Blinded Randomized Controlled Trial

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini, Omid Seyed Esmaeili, Rouzbeh Kezemi, Noushin Mehrbod, Nazanin Vahed, Tahereh Hajiahmad, Noureddin Nakhostin Ansari

Abstract:

Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of VR beside conventional rehabilitation versus conventional rehabilitation alone on spasticity and motor function in stroke patients. Materials and Methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran, in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were modified Ashworth scale, recovery stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in the combination group (P=0.003). Only wrist extension was varied between groups and was better in the combination group. The variables generally had a statistically significant difference (P < 0.05). Conclusion: Virtual reality plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Keywords: stroke, virtual therapy, rehabilitation, treatment

Procedia PDF Downloads 176
22 Extracorporeal Shock Wave Therapy versus Functional Electrical Stimulation on Spasticity, Function and Gait Parameters in Hemiplegic Cerebral Palsy

Authors: Mohamed A. Eid, Sobhy M. Aly

Abstract:

Background: About 75% of children with spastic hemiplegic cerebral palsy walk independently, but most still show abnormal gait patterns because of contractures across the joints and muscle spasticity. Objective: The purpose of this study was to investigate and compare the effects of extracorporeal shock wave therapy (ESWT) versus functional electrical stimulation (FES) on spasticity, function, and gait parameters in children with hemiplegic cerebral palsy (CP). Methods: A randomized controlled trail was conducted for 45 children with hemiplegic CP ranging in age from 6 to 9 years. They were assigned randomly using opaque envelopes into three groups. Physical Therapy (PT) group consisted of 15 children and received the conventional physical therapy program (CPTP) in addition to ankle foot orthosis (AFO). ESWT group consisted of 15 children and received the CPTP, AFO in addition to ESWT. FES group also consisted of 15 children and received the CPTP, AFO in addition to FES. All groups received the program of treatment 3 days/week for 12 weeks. Evaluation of spasticity by using the Modified Ashworth Scale (MAS), function by using the Pediatric Evaluation Disability Inventory (PEDI) and gait parameters by using the 3-D gait analysis was conducted at baseline and after 12 weeks of the treatment program. Results: Within groups, significant improvements in spasticity, function, and gait (P = 0.05) were observed in both ESWT and FES groups after treatment. While between groups, ESWT group showed significant improvements in all measured variables compared with FES and PT groups (P ˂ 0.05) after treatment. Conclusion: ESWT induced significant improvement than FES in decreasing spasticity and improving function and gait in children with hemiplegic CP. Therefore, ESWT should be included as an adjunctive therapy in the rehabilitation program of these children.

Keywords: cerebral palsy, extracorporeal shock wave therapy, functional electrical stimulation, function, gait, spasticity

Procedia PDF Downloads 94
21 Investigating the Dynamic Plantar Pressure Distribution in Individuals with Multiple Sclerosis

Authors: Hilal Keklicek, Baris Cetin, Yeliz Salci, Ayla Fil, Umut Altinkaynak, Kadriye Armutlu

Abstract:

Objectives and Goals: Spasticity is a common symptom characterized with a velocity dependent increase in tonic stretch reflexes (muscle tone) in patient with multiple sclerosis (MS). Hypertonic muscles affect the normal plantigrade contact by disturbing accommodation of foot to the ground while walking. It is important to know the differences between healthy and neurologic foot features for management of spasticity related deformities and/or determination of rehabilitation purposes and contents. This study was planned with the aim of investigating the dynamic plantar pressure distribution in individuals with MS and determining the differences between healthy individuals (HI). Methods: Fifty-five individuals with MS (108 foot with spasticity according to Modified Ashworth Scale) and 20 HI (40 foot) were the participants of the study. The dynamic pedobarograph was utilized for evaluation of dynamic loading parameters. Participants were informed to walk at their self-selected speed for seven times to eliminate learning effect. The parameters were divided into 2 categories including; maximum loading pressure (N/cm2) and time of maximum pressure (ms) were collected from heal medial, heal lateral, mid foot, heads of first, second, third, fourth and fifth metatarsal bones. Results: There were differences between the groups in maximum loading pressure of heal medial (p < .001), heal lateral (p < .001), midfoot (p=.041) and 5th metatarsal areas (p=.036). Also, there were differences between the groups the time of maximum pressure of all metatarsal areas, midfoot, heal medial and heal lateral (p < .001) in favor of HI. Conclusions: The study provided basic data about foot pressure distribution in individuals with MS. Results of the study primarily showed that spasticity of lower extremity muscle disrupted the posteromedial foot loading. Secondarily, according to the study result, spasticity lead to inappropriate timing during load transfer from hind foot to forefoot.

Keywords: multiple sclerosis, plantar pressure distribution, gait, norm values

Procedia PDF Downloads 284
20 Food Bolus Obstruction: A Rural Hospital’s Experience

Authors: Davina Von Hagt, Genevieve Gibbons, Matt Henderson, Tom Bowles

Abstract:

Purpose: Food bolus obstructions are common emergency surgical presentations, but there is no established management guideline in a rural setting. Intervention usually involves endoscopic removal after initial medical management has failed. Within a rural setting, this falls upon the general surgeon. There are varied endoscopic techniques that may be used. Methodology: A review of the past fifty cases of food bolus obstruction managed at Albany Health Campus was retrospectively reviewed to assess endoscopic findings and techniques. Operation notes, histopathology, imaging, and patient notes were reviewed. Results: 50 patients underwent gastroscopy for food bolus obstruction from August 2017 to March 2021. Ages ranged from 11 months to 95 years, with the majority of patients aged between 30-70 years. 88% of patients were male. Meat was the most common bolus (20% unspecified, 20% steak, 10% chicken, 6% lamb, 4% sausage, 2% pork). At endoscopy, 12% were found not to have a food bolus obstruction. Two patients were found to have oesophageal cancer, and four patients had a stricture and required dilatation. A variety of methods were used to relieve oesophageal obstruction ranging from pushing through to stomach (24 patients), using an overtube (10 patients), raptor (13 patients), and less common instruments such as Roth net, basket, guidewire, and pronged grasper. One patient had an unsuccessful endoscopic retrieval and required theatre for laparoscopic assisted removal with rendezvous endoscopic piecemeal removal via oesophagus and gastrostomy. Conclusion: Food bolus obstruction is a common emergency presentation. Within the rural setting, management requires innovation and teamwork within the safety of the local experience.

Keywords: food bolus obstruction, regional hospital, surgical management, innovative surgical treatment

Procedia PDF Downloads 205
19 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

Procedia PDF Downloads 19
18 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

Abstract:

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

Procedia PDF Downloads 55
17 Impact of the COVID-19 Pandemic on the Maternal, Newborn, Child Health and Nutrition Indicators in Miagao, Iloilo and Sibunag, Guimaras, Philippines

Authors: Franco Miguel Nodado, Adrienne Marie Bugayong Janagap, Allen Claire Arances, Kirsten Anne Gerez, Frances Catherine Rosario, Charise Alvyne Samaniego, Matt Andrew Secular, Rommel Gestuveo, Marilyn Sumayo, Joseph Arbizo, Philip Ian Padilla

Abstract:

COVID-19 pandemic adversely affected the delivery of health care services, but its impacts on Maternal, Newborn, Child Health and Nutrition (MNCHN) programs in rural municipalities in the Philippines remains understudied. Thus, this study explored the effects of the pandemic on MNCHN indicators in the municipalities of Miagao, Iloilo and Sibunag, Guimaras. A cross-sectional design was employed to compare the MNCHN indicators before and during the pandemic, and between Miagao and Sibunag. Key informant interviews (KII) were performed to identify the factors affecting access to MNCHN programs. During the pandemic, Miagao had a significant increase in positive outcomes of eight out of ten maternal health indicators, while Sibunag showed a significant decrease in six indicators. For child health and nutrition, Miagao obtained significant improvements in five of seven indicators, while Sibunag showed a significant increase in positive outcomes for six. KII data showed that the primary concern of mothers in Miagao is accessibility, while mothers in Sibunag raised concerns on accessibility, availability, and affordability of these MNCHN services. Miagao MHO employed various strategies such as telemedicine, activation of barangay health workers, and decentralization of health services to Barangay Health Centers, which can explain the improvements in MNCHN indicators. Sibunag also decentralized its health services, but its limited resources might have led them to prioritize child health and nutrition services. The findings suggest that the impacts of the COVID-19 pandemic on MNCHN depend on local health measures employed by the municipality, while telemedicine is a very useful tool in mitigating the negative effects of disrupted health services.

Keywords: maternal, child, COVID-19, Miagao, Sibunag, nutrition

Procedia PDF Downloads 131
16 The Analgesic Impact of Adding Intrathecal Ketamine to Spinal Anaesthesia for Hip or Knee Arthroplasty: A Clinical Audit

Authors: Carl Ashworth, Matthys Campher

Abstract:

Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.

Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine

Procedia PDF Downloads 19
15 Potential of Irish Orientated Strand Board in Bending Active Structures

Authors: Matt Collins, Bernadette O'Regan, Tom Cosgrove

Abstract:

To determine the potential of a low cost Irish engineered timber product to replace high cost solid timber for use in bending active structures such as gridshells a single Irish engineered timber product in the form of orientated strand board (OSB) was selected. A comparative study of OSB and solid timber was carried out to determine the optimum properties that make a material suitable for use in gridshells. Three parameters were identified to be relevant in the selection of a material for gridshells. These three parameters are the strength to stiffness ratio, the flexural stiffness of commercially available sections, and the variability of material and section properties. It is shown that when comparing OSB against solid timber, OSB is a more suitable material for use in gridshells that are at the smaller end of the scale and that have tight radii of curvature. Typically, for solid timber materials, stiffness is used as an indicator for strength and engineered timber is no different. Thus, low flexural stiffness would mean low flexural strength. However, when it comes to bending active gridshells, OSB offers a significant advantage. By the addition of multiple layers, an increased section size is created, thus endowing the structure with higher stiffness and higher strength from initial low stiffness and low strength materials while still maintaining tight radii of curvature. This allows OSB to compete with solid timber on large scale gridshells. Additionally, a preliminary sustainability study using a set of sustainability indicators was carried out to determine the relative sustainability of building a large-scale gridshell in Ireland with a primary focus on economic viability but a mention is also given to social and environmental aspects. For this, the Savill garden gridshell in the UK was used as the functional unit with the sustainability of the structural roof skeleton constructed from UK larch solid timber being compared with the same structure using Irish OSB. Albeit that the advantages of using commercially available OSB in a bending active gridshell are marginal and limited to specific gridshell applications, further study into an optimised engineered timber product is merited.

Keywords: bending active gridshells, high end timber structures, low cost material, sustainability

Procedia PDF Downloads 348
14 The Role of Dynamic Ankle Foot Orthosis on Temporo-Spatial Parameters of Gait and Balance in Patients with Hereditary Spastic Paraparesis: Six-Months Follow Up

Authors: Suat Erel, Gozde Gur

Abstract:

Background: Recently a supramalleolar type of dynamic ankle foot orthosis (DAFO) has been increasingly used to support all of the dynamic arches of the foot and redistribute the pressure under the plantar surface of the foot to reduce the muscle tone. DAFO helps to maintain balance and postural control by providing stability and proprioceptive feedback in children with disease like Cerebral Palsy, Muscular Dystrophies, Down syndrome, and congenital hypotonia. Aim: The aim of this study was to investigate the role of Dynamic ankle foot orthosis (DAFO) on temporo-spatial parameters of gait and balance in three children with hereditary spastic paraparesis (HSP). Material Method: 13, 14, and 8 years old three children with HSP were included in the study. To provide correction on weight bearing and to improve gait, DAFO was made. Lower extremity spasticity (including gastocnemius, hamstrings and hip adductor muscles) using modified Ashworth Scale (MAS) (0-5), The temporo-spatial gait parameters (walking speed, cadence, base of support, step length) and Timed Up & Go test (TUG) were evaluated. All of the assessments about gait were compared with (with DAFO and shoes) and without DAFO (with shoes only) situations. Also after six months follow up period, assessments were repeated by the same physical therapist. Results: MAS scores for lower extremity were between “2-3” for the first child, “0-2” for the second child and “1-2” for the third child. TUG scores (sec) decreased from 20.2 to 18 for case one, from 9.4 to 9 for case two and from 12,4 to 12 for case three in the condition with shoes only and also from 15,2 to 14 for case one, from 7,2 to 7,1 for case two and from 10 to 7,3 for case three in the condition with DAFO and shoes. Gait speed (m/sec) while wearing shoes only was similar but while wearing DAFO and shoes increased from 0,4 to 0,5 for case one, from 1,5 to 1,6 for case two and from 1,0 to 1,2 for case three. Base of support scores (cm) wearing shoes only decreased from 18,5 to 14 for case one, from 13 to 12 for case three and were similar as 11 for case two. While wearing DAFO and shoes, base of support decreased from 10 to 9 for case one, from 11,5 to 10 for case three and was similar as 8 for case two. Conclusion: The use of a DAFO in a patient with HSP normalized the temporo-spatial gait parameters and improved balance. Walking speed is a gold standard for evaluating gait quality. With the use of DAFO, walking speed increased in this three children with HSP. With DAFO, better TUG scores shows that functional ambulation improved. Reduction in base of support and more symmetrical step lengths with DAFO indicated better balance. These encouraging results warrant further study on wider series.

Keywords: dynamic ankle foot orthosis, gait, hereditary spastic paraparesis, balance in patient

Procedia PDF Downloads 318
13 A Hedonic Valuation Approach to Valuing Combined Sewer Overflow Reductions

Authors: Matt S. Van Deren, Michael Papenfus

Abstract:

Seattle is one of the hundreds of cities in the United States that relies on a combined sewer system to collect and convey municipal wastewater. By design, these systems convey all wastewater, including industrial and commercial wastewater, human sewage, and stormwater runoff, through a single network of pipes. Serious problems arise for combined sewer systems during heavy precipitation events when treatment plants and storage facilities are unable to accommodate the influx of wastewater needing treatment, causing the sewer system to overflow into local waterways through sewer outfalls. CSOs (Combined Sewer Overflows) pose a serious threat to human and environmental health. Principal pollutants found in CSO discharge include microbial pathogens, comprising of bacteria, viruses, parasites, oxygen-depleting substances, suspended solids, chemicals or chemical mixtures, and excess nutrients, primarily nitrogen and phosphorus. While concentrations of these pollutants can vary between overflow events, CSOs have the potential to spread disease and waterborne illnesses, contaminate drinking water supplies, disrupt aquatic life, and effect a waterbody’s designated use. This paper estimates the economic impact of CSOs on residential property values. Using residential property sales data from Seattle, Washington, this paper employs a hedonic valuation model that controls for housing and neighborhood characteristics, as well as spatial and temporal effects, to predict a consumer’s willingness to pay for improved water quality near their homes. Initial results indicate that a 100,000-gallon decrease in the average annual overflow discharged from a sewer outfall within 300 meters of a home is associated with a 0.053% increase in the property’s sale price. For the average home in the sample, the price increase is estimated to be $18,860.23. These findings reveal some of the important economic benefits of improving water quality by reducing the frequency and severity of combined sewer overflows.

Keywords: benefits, hedonic, Seattle, sewer

Procedia PDF Downloads 130
12 Recognising the Importance of Smoking Cessation Support in Substance Misuse Patients

Authors: Shaine Mehta, Neelam Parmar, Patrick White, Mark Ashworth

Abstract:

Patients with a history of substance have a high prevalence of comorbidities, including asthma and chronic obstructive pulmonary disease (COPD). Mortality rates are higher than that of the general population and the link to respiratory disease is reported. Randomised controlled trials (RCTs) support opioid substitution therapy as an effective means for harm reduction. However, whilst a high proportion of patients receiving opioid substitution therapy are smokers, to the author’s best knowledge there have been no studies of respiratory disease and smoking intensity in these patients. A cross sectional prevalence study was conducted using an anonymised patient-level database in primary care, Lambeth DataNet (LDN). We included patients aged 18 years and over who had records of ever having been prescribed methadone in primary care. Patients under 18 years old or prescribed buprenorphine (because of uncertainty about the prescribing indication) were excluded. Demographic, smoking, alcohol and asthma and COPD coding data were extracted. Differences between methadone and non-methadone users were explored with multivariable analysis. LDN contained data on 321, 395 patients ≥ 18 years; 676 (0.16%) had a record of methadone prescription. Patients prescribed methadone were more likely to be male (70.7% vs. 50.4%), older (48.9yrs vs. 41.5yrs) and less likely to be from an ethnic minority group (South Asian 2.1% vs. 7.8%; Black African 8.9% vs. 21.4%). Almost all those prescribed methadone were smokers or ex-smokers (97.3% vs. 40.9%); more were non-alcohol drinkers (41.3% vs. 24.3%). We found a high prevalence of COPD (12.4% vs 1.4%) and asthma (14.2% vs 4.4%). Smoking intensity data shows a high prevalence of ≥ 20 cigarettes per day (21.5% vs. 13.1%). Risk of COPD, adjusted for age, gender, ethnicity and deprivation, was raised in smokers: odds ratio 14.81 (95%CI 11.26, 19.47), and in the methadone group: OR 7.51 (95%CI: 5.78, 9.77). Furthermore, after adjustment for smoking intensity (number of cigarettes/day), the risk was raised in methadone group: OR 4.77 (95%CI: 3.13, 7.28). High burden of respiratory disease compounded by the high rates of smoking is a public health concern. This supports an integrated approach to health in patients treated for opiate dependence, with access to smoking cessation support. Further work may evaluate the current structure and commissioning of substance misuse services, including smoking cessation. Regression modelling highlights that methadone as a ‘risk factor’ was independently associated with COPD prevalence, even after adjustment for smoking intensity. This merits further exploration, as the association may be related to unexplored aspects of smoking (such as the number of years smoked) or may be related to other related exposures, such as smoking heroin or crack cocaine.

Keywords: methadone, respiratory disease, smoking cessation, substance misuse

Procedia PDF Downloads 105
11 Shame and Pride in Moral Self-Improvement

Authors: Matt Stichter

Abstract:

Moral development requires learning from one’s failures, but that turnsout to be especially challenging when dealing with moral failures. The distress prompted by moral failure can cause responses ofdefensiveness or disengagement rather than attempts to make amends and work on self-change. The most potentially distressing response to moral failure is a shame. However, there appears to be two different senses of “shame” that are conflated in the literature, depending on whether the failure is appraised as the result of a global and unalterable self-defect, or a local and alterable self-defect. One of these forms of shame does prompt self-improvement in response to moral failure. This occurs if one views the failure as indicating only a specific (local) defect in one’s identity, where that’s something repairable, rather than asanoverall(orglobal)defectinyouridentity that can’t be fixed. So, if the whole of one’s identity as a morally good person isn’t being called into question, but only a part, then that is something one could work on to improve. Shame, in this sense, provides motivation for self-improvement to fix this part oftheselfinthe long run, and this would be important for moral development. One factor that looks to affect these different self-attributions in the wake of moral failure can be found in mindset theory, as reactions to moral failure in these two forms of shame are similar to how those with a fixed or growth mindset of their own abilities, such as intelligence, react to failure. People fall along a continuum with respect to how they view abilities – it is more of a fixed entity that you cannot do much to change, or it is malleable such that you can train to improve it. These two mindsets, ‘fixed’ versus ‘growth’, have different consequences for how we react to failure – a fixed mindset leads to maladaptive responses because of feelings of helplessness to do better; whereas a growth mindset leads to adaptive responses where a person puts forth effort to learn how to act better the next time. Here we can see the parallels between a fixed mindset of one’s own (im)morality, as the way people respond to shame when viewed as indicating a global and unalterable self-defect parallels the reactions people have to failure when they have a fixed mindset. In addition, it looks like there may be a similar structure to pride. Pride is, like shame, a self-conscious emotion that arises from internal attributions about the self as being the cause of some event. There are also paradoxical results from research on pride, where pride was found to motivate pro-social behavior in some cases but aggression in other cases. Research suggests that there may be two forms of pride, authentic and hubristic, that are also connected to different self-attributions, depending on whether one is feeling proud about a particular (local) aspect of the self versus feeling proud about the whole of oneself (global).

Keywords: emotion, mindset, moral development, moral psychology, pride, shame, self-regulation

Procedia PDF Downloads 56
10 The Changing Landscape of Fire Safety in Covered Car Parks with the Arrival of Electric Vehicles

Authors: Matt Stallwood, Michael Spearpoint

Abstract:

In 2020, the UK government announced that sales of new petrol and diesel cars would end in 2030, and battery-powered cars made up 1 in 8 new cars sold in 2021 – more than the total from the previous five years. The guidance across the UK for the fire safety design of covered car parks is changing in response to the projected rapid growth in electric vehicle (EV) use. This paper discusses the current knowledge on the fire safety concerns posed by EVs, in particular those powered by lithium-ion batteries, when considering the likelihood of vehicle ignition, fire severity and spread of fire to other vehicles. The paper builds on previous work that has investigated the frequency of fires starting in cars powered by internal combustion engines (ICE), the hazard posed by such fires in covered car parks and the potential for neighboring vehicles to become involved in an incident. Historical data has been used to determine the ignition frequency of ICE car fires, whereas such data is scarce when it comes to EV fires. Should a fire occur, then the fire development has conventionally been assessed to match a ‘medium’ growth rate and to have a 95th percentile peak heat release of 9 MW. The paper examines recent literature in which researchers have measured the burning characteristics of EVs to assess whether these values need to be changed. These findings are used to assess the risk posed by EVs when compared to ICE vehicles. The paper examines what new design guidance is being issued by various organizations across the UK, such as fire and rescue services, insurers, local government bodies and regulators and discusses the impact these are having on the arrangement of parking bays, particularly in residential and mixed-use buildings. For example, the paper illustrates how updated guidance published by the Fire Protection Association (FPA) on the installation of sprinkler systems has increased the hazard classification of parking buildings that can have a considerable impact on the feasibility of a building to meet all its design intents when specifying water supply tanks. Another guidance on the provision of smoke ventilation systems and structural fire resistance is also presented. The paper points to where further research is needed on the fire safety risks posed by EVs in covered car parks. This will ensure that any guidance is commensurate with the need to provide an adequate level of life and property safety in the built environment.

Keywords: covered car parks, electric vehicles, fire safety, risk

Procedia PDF Downloads 40
9 The Association between Prior Antibiotic Use and Subsequent Risk of Infectious Disease: A Systematic Review

Authors: Umer Malik, David Armstrong, Mark Ashworth, Alex Dregan, Veline L'Esperance, Lucy McDonnell, Mariam Molokhia, Patrick White

Abstract:

Introduction: The microbiota lining epithelial surfaces is thought to play an important role in many human physiological functions including defense against pathogens and modulation of immune response. The microbiota is susceptible to disruption from external influences such as exposure to antibiotic medication. It is thought that antibiotic-induced disruption of the microbiota could predispose to pathogen overgrowth and invasion. We hypothesized that antibiotic use would be associated with increased risk of future infections. We carried out a systematic review of evidence of associations between antibiotic use and subsequent risk of community-acquired infections. Methods: We conducted a review of the literature for observational studies assessing the association between antibiotic use and subsequent community-acquired infection. Eligible studies were published before April 29th, 2016. We searched MEDLINE, EMBASE, and Web of Science and screened titles and abstracts using a predefined search strategy. Infections caused by Clostridium difficile, drug-resistant organisms and fungal organisms were excluded as their association with prior antibiotic use has been examined in previous systematic reviews. Results: Eighteen out of 21,518 retrieved studies met the inclusion criteria. The association between past antibiotic exposure and subsequent increased risk of infection was reported in 16 studies, including one study on Campylobacter jejuni infection (Odds Ratio [OR] 3.3), two on typhoid fever (ORs 5.7 and 12.2), one on Staphylococcus aureus skin infection (OR 2.9), one on invasive pneumococcal disease (OR 1.57), one on recurrent furunculosis (OR 16.6), one on recurrent boils and abscesses (Risk ratio 1.4), one on upper respiratory tract infection (OR 2.3) and urinary tract infection (OR 1.1), one on invasive Haemophilus influenzae type b (Hib) infection (OR 1.51), one on infectious mastitis (OR 5.38), one on meningitis (OR 2.04) and five on Salmonella enteric infection (ORs 1.4, 1.59, 1.9, 2.3 and 3.8). The effect size in three studies on Salmonella enteric infection was of marginal statistical significance. A further two studies on Salmonella infection did not demonstrate a statistically significant association between prior antibiotic exposure and subsequent infection. Conclusion: We have found an association between past antibiotic exposure and subsequent risk of a diverse range of infections in the community setting. Our findings provide evidence to support the hypothesis that prior antibiotic usage may predispose to future infection risk, possibly through antibiotic-induced alteration of the microbiota. The findings add further weight to calls to minimize inappropriate antibiotic prescriptions.

Keywords: antibiotic, infection, risk factor, side effect

Procedia PDF Downloads 188
8 Strategies by a Teaching Assistant to Support the Classroom Talk of a Child with Communication and Interaction Difficulties in Italy: A Case for Promoting Social Scaffolding Training

Authors: Lorenzo Ciletti, Ed Baines, Matt Somerville

Abstract:

Internationally, supporting staff with limited training (Teaching Assistants (TA)) has played a critical role in the education of children with special educational needs and/or disabilities (SEND). Researchers have notably illustrated that TAs support the children’s classroom tasks while teachers manage the whole class. Rarely have researchers investigated the TAs’ support for children’s participation in whole-class or peer-group talk, despite this type of “social support” playing a significant role in children’s whole-class integration and engagement with the classroom curriculum and learning. Social support seems particularly crucial for a large proportion of children with SEND, namely those with communication and interaction difficulties (e.g., autism spectrum conditions and speech impairments). This study explored TA practice and, particularly, TA social support in a rarely examined context (Italy). The Italian case was also selected as it provides TAs, known nationally as “support teachers,” with the most comprehensive training worldwide, thus potentially echoing (effective) nuanced practice internationally. Twelve hours of video recordings of a single TA and a child with communication and interaction difficulties (CID) were made. Video data was converted into frequencies of TA multidimensional support strategies, including TA social support and pedagogical assistance. TA-pupil talk oriented to children’s participation in classroom talk was also analysed into thematic patterns. These multi-method analyses were informed by social scaffolding principles: in particular, the extent to which the TA designs instruction contingently to the child’s communication and interaction difficulties and how their social support fosters the child’s highest responsibility in dealing with whole-class or peer-group talk by supplying the least help. The findings showed that the TA rarely supported the group or whole class participation of the child with CID. When doing so, the TA seemed to highly control the content and the timing of the child’s contributions to the classroom talk by a) interrupting the teacher’s whole class or group conversation to start an interaction between themselves and the child and b) reassuring the child about the correctness of their talk in private conversations and prompting them to raise their hand and intervene in the whole-class talk or c) stopping the child from contributing to the whole-class or peer-group talk when incorrect. The findings are interpreted in terms of their theoretical relation to scaffolding. They have significant implications for promoting social scaffolding in TA training in Italy and elsewhere.

Keywords: children with communication and interaction difficulties, children with special educational needs and/or disabilities, social scaffolding, teaching assistants, teaching practice, whole-class talk participation

Procedia PDF Downloads 43