Search results for: attentive walk

Authors: Soleen Karim, Meira Yasin, Rezhin Qader

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Children’s books present a colorful life for kids around the world, their current environment or what they could potentially have- a home, two loving parents, a playground, and a safe school within a short walk or bus ride. These images are only pages in a donated book for children displaced by war. The environment they live in is significantly different. Displaced children are faced with a temporary life style filled with fear and uncertainty. Children of war associate various structural institutions with a trauma and cannot enter the space, even if it is for their own future development, such as a school. This paper is a collaborative effort with students of the Kennesaw State University architecture department, architectural designers and a mental health professional to address and link the design challenges and the psychological trauma for children of war. The research process consists of a) interviews with former refugees, b) interviews with current refugee children, c) personal understanding of space through one’s own childhood, d) literature review of tested design methods to address various traumas. Conclusion: In addressing the built environment for children of war, it is necessary to address mental health and well being through the creation of space that is sensitive to the needs of children. This is achieved by understanding critical design cues to evoke normalcy and safe space through program organization, color, and symbiosis of synthetic and natural environments. By involving the children suffering from trauma in the design process, aspects of the design are directly enhanced to serve the occupant. Neglecting to involve the participants creates a nonlinear design outcome and does not serve the needs of the occupant to afford them equal opportunity learning and growth experience as other children around the world.

Keywords: activist architecture, childhood education, childhood psychology, adverse childhood experiences

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: Ayse Ozbil, Gorsev Argin, Demet Yesiltepe

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Data for this cross-sectional study were drawn from questionnaires conducted in 10 elementary schools (1000 students, ages 12-14) located in Istanbul, Turkey. School environments (1600 meter buffers around the school) were evaluated through GIS-based land-use data (parcel level land use density) and street-level topography. Street networks within the same buffers were evaluated by using angular segment analysis (Integration and Choice) implemented in Depthmap as well as two segment-based connectivity measures, namely Metric and Directional Reach implemented in GIS. Segment Angular Integration measures how accessible each space from all the others within the radius using the least angle measure of distance. Segment Angular Choice which measures how many times a space is selected on journeys between all pairs of origins and destinations. Metric Reach captures the density of streets and street connections accessible from each individual road segment. Directional Reach measures the extent to which the entire street network is accessible with few direction changes. In addition, socio-economic characteristics (annual income, car ownership, education-level) of parents, obtained from parental questionnaires, were also included in the analysis. It is shown that surrounding street network configuration is strongly associated with both walk-mode shares and average walking distances to/from schools when controlling for parental socio-demographic attributes as well as land-use compositions and topographic features in school environments. More specifically, findings suggest that the scale at which urban form has an impact on pedestrian travel is considerably larger than a few blocks around the school.

Keywords: Istanbul, street network layout, urban form, walking to/from school

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

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This paper proposes a method to optimize the layout of an emergency department (ED) based on real executions of care processes by considering several planning objectives simultaneously. Recently, demand for healthcare services has been dramatically increased. As the demand for healthcare services increases, so do the need for new healthcare buildings as well as the need for redesign and renovating existing ones. The importance of implementation of a standard set of engineering facilities planning and design techniques has been already proved in both manufacturing and service industry with many significant functional efficiencies. However, high complexity of care processes remains a major challenge to apply these methods in healthcare environments. Process mining techniques applied in this study to tackle the problem of complexity and to enhance care process analysis. Process related information such as clinical pathways extracted from the information system of an ED. A 0-1 goal programming approach is then proposed to find a single layout that simultaneously satisfies several goals. The proposed model solved by optimization software CPLEX 12. The solution reached using the proposed method has 42.2% improvement in terms of walking distance of normal patients and 47.6% improvement in walking distance of critical patients at minimum cost of relocation. It has been observed that lots of patients must unnecessarily walk long distances during their visit to the emergency department because of an inefficient design. A carefully designed layout can significantly decrease patient walking distance and related complications.

Keywords: healthcare operation management, goal programming, facility layout problem, process mining, clinical processes

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Authors: Ramuel Spirituel Mattathiah A. San Juan, Neil Ambasing

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Background: Reversal of vision metamorphopsia is a transient form of metamorphopsia described as an upside-down alteration of the visual field in the coronal plane. Patients would describe objects, such as cups, upside down, but the tea would not spill, and people would walk on their heads. It is extremely rare as a stable finding, lasting days or weeks. We report a case wherein this type of metamorphopsia occurred only in written words and lasted for six months. Objective: To the best of our knowledge, we report the first rare occurrence of reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke. Case Presentation: We report a 59-year-old male with poorly controlled hypertension and diabetes mellitus who presented with a 3-day history of difficulty reading, described as the words were turned upside down as if the words were inverted horizontally then with the progression of deficits such as right homonymous hemianopia and achromatopsia, prosopagnosia. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. Follow-up after six months revealed improvement of the visual field cut but with the persistence of the higher cortical function deficits. Conclusion: We report the first rare occurrence of metamorphopsia described as purely inverted words as the sole initial presentation of an underlying stroke. The differential diagnoses of a patient presenting with text reversal metamorphopsia should include stroke in the occipitotemporal areas. It further expands the landscape of metamorphopsias due to its exclusivity to written words and prolonged duration. Knowing these clinical features will help identify the lesion locus and improve subsequent stroke care, especially in time-bound management like intravenous thrombolysis.

Keywords: rare presentation, text reversal metamorphopsia, ischemic stroke, stroke

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Authors: Yasemin İlkay

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Street is not only a crucial spatial unit in urban design and planning discipline but also the context of walking practice in urban space. Moreover, psychogeography concentrates on both ‘walking’ and, therefore, the differentiated forms of (urban) streets to examine the influence of the built environment on the feelings and attitudes of human beings. This paper focuses on ‘walking practice’ in university campuses with reference to spatial appropriation forms via a psychogeographic lens on the phenomenon of alle in two different cities of Turkey, Ankara, the capital city, and Van, in the eastern part of the country. Alle, as an extension of ‘street’ in university campuses, is the constructive spatial structure in university campuses, and as a result, it should be the (both physical and mental) spine of design policy while conceiving and constructing a university campus. The main question of the paper is: How does the interrelation of ‘campus design’ and ‘walking practice’ on alle penetrate reciprocally on the spatial representations of citizens within their urban daily lives. The body contacts with and at urban space (with other objects and subjects) via its movements and stops; this interaction occurs through the spatial pattern of occupancy and vacancy. Walking practice leads to a set of cognitive mental representations in relation to the repertoire of place attachment and spatial appropriation. University campuses are autonomous and fruitful urban spaces to investigate such an interaction. There are both physical/real and psychogeographic representations of the same urban spaces and urban spatial practices. This separation would indicate the invisible dimensions of the difference between ‘what is conceived’ and ‘what is perceived.’ This study aims to compare and contrast the role of alle in both campus design and spatial appropriation via walking at two differentiated university campuses by collecting the mental representations, doing in-depth interviews, and attending walks with the interviewees by psychogeographic techniques. Campus design and spatial appropriation will be compared [with reference to the conception and perception of alle] in three scales: (1) the historical spatial development stories and design approaches of university campuses, (2) the spatial pattern of campuses on the basis of alle, and (3) sub-behavioral regions of the alle in campuses in relation with mental representations and psychogeographic attentive walks. The sub-questions of the research are: [1] How and why do the design approaches differentiate in two university campuses in Turkey, [2] How the interrelation among alle design and spatial appropriation differs in these two cases, and [3] What do the differentiated gaps among real and psychographic maps indicate about the design and spatial appropriation interrelation. METU, as a well-designed, readable campus with its alle, promise a rich walking practice with in-depth and fruitful spatial appropriation regions; however, Van YYÜ limits both the practice and place attachment with its partial design with an alle which is later added to the campus. This research both displays the role of alle in the campus design, walking practice and spatial appropriation and opens a new methodological path to discover hidden knowledge within urban spaces.

Keywords: alle, campus design, cognitive geography, psychogeography, spatial appropriation, Turkey

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Authors: Nazim Mir-Nasiri, Hudyjaya Siswoyo Jo

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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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Authors: Mohamed A. Eid, Sobhy M. Aly

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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

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Authors: A. Abdulla Khairi Mohamed, Mohamed Gamal Abdelmonem, Gehan Selim

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Walkability in civic and public spaces in Libyan cities is challenging due to the lack of accessibility design, informal merging into car traffic, and the general absence of adequate urban and space planning. The lack of accessible and pedestrian-friendly public spaces in Libyan cities has emerged as a major concern for the government if it is to develop smart and sustainable spaces for the 21st century. A walkable urban space has become a driver for urban development and redistribution of land use to ensure pedestrian and walkable routes between sites of living and workplaces. The characteristics of urban open space in the city centre play a main role in attracting people to walk when attending their daily needs, recreation and daily sports. There is significant gap in the understanding of perceptions, feasibility and capabilities of Libyan urban space to accommodate enhance or support the smart design of a walkable pedestrian-friendly environment that is safe and accessible to everyone. The paper aims to undertake observations of walkability and walkable space in the city of Tripoli as a benchmark for Libyan cities; assess the validity and consistency of the seven principal aspects of smart design, safety, accessibility and 51 factors that affect the walkability in open urban space in Tripoli, through the analysis of 10 local urban spaces experts (town planner, architect, transport engineer and urban designer); and explore user groups’ perceptions of accessibility in walkable spaces in Libyan cities through questionnaires. The study sampled 200 respondents in 2015-16. The results of this study are useful for urban planning, to classify the walkable urban space elements which affect to improve the level of walkability in the Libyan cities and create sustainable and liveable urban spaces.

Keywords: walkability, sustainability, liveability, accessibility

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Authors: Noa Nelson, Orit Appel, Rachel Ben-ari

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Organizational Citizenship Behavior (OCB) is voluntary employee behavior that contributes to the organization beyond formal job requirements. It can take different forms, such as helping teammates (OCB toward individuals; hence, OCB-I), or staying after hours to attend a task force (OCB toward the organization; hence, OCB-O). Generally, OCB contributes substantially to organizational climate, goals, productivity, and resilience, so organizations need to understand what encourages it. This is particularly challenging in security organizations. Security work is characterized by high levels of stress and burnout, which is detrimental to OCB, and security organizational design emphasizes formal rules and clear hierarchies, leaving employees with less freedom for voluntary behavior. The current research explored the role of Perceived Procedural Justice (PPJ) in enhancing OCB in a security organization. PPJ refers to how fair decision-making processes are perceived to be. It involves the sense that decision makers are objective, attentive to everyone's interests, respectful in their communications and participatory - allowing individuals a voice in decision processes. Justice perceptions affect motivation, and it was specifically suggested that PPJ creates an attachment to one's organization and personal interest in its success. Accordingly, PPJ had been associated with OCB, but hardly any research tested their association with security organizations. The current research was conducted among prison guards in the Israel Prison Service, to test a correlational and a causal association between PPJ and OCB. It differentiated between perceptions of direct commander procedural justice (CPJ), and perceptions of organization procedural justice (OPJ), hypothesizing that CPJ would relate to OCB-I, while OPJ would relate to OCB-O. In the first study, 336 prison guards (305 male) from 10 different prisons responded to questionnaires measuring their own CPJ, OPJ, OCB-I, and OCB-O. Hierarchical linear regression analyses indicated the significance of commander procedural justice (CPJ): It associated with OCB-I and also associated with OPJ, which, in turn, associated with OCB-O. The second study tested CPJ's causal effects on prison guards' OCB-I and OCB-O; 311 prison guards (275 male) from 14 different prisons read scenarios that described either high or low CPJ, and then evaluated the likelihood of that commander's prison guards performing OCB-I and OCB-O. In this study, CPJ enhanced OCB-O directly. It also contributed to OCB-I, indirectly: CPJ enhanced the motivation for collaboration with the commander, which respondents also evaluated after reading scenarios. Collaboration, in turn, associated with OCB-I. The studies demonstrate that procedural justice, especially commander's PJ, promotes OCB in security work environments. This is important because extraordinary teamwork and motivation are needed to deal with emergency situations and with delicate security challenges. Following the studies, the Israel Prison Service implemented personal procedural justice training for commanders and unit level programs for procedurally just decision processes. From a theoretical perspective, the studies extend the knowledge on PPJ and OCB to security work environments and contribute evidence on PPJ's causal effects. They also call for further research, to understand the mechanisms through which different types of PPJ affect different types of OCB.

Keywords: organizational citizenship behavior, perceived procedural justice, prison guards, security organizations

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Authors: A. Raj Kumar, A. Okunseinde, P. Raghavan, V. Kapila

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Stroke is the leading cause of adult disability worldwide. With recent advances in immediate post-stroke care, there is an increasing number of young stroke survivors, under the age of 65 years. While most stroke survivors will regain the ability to walk, they often experience long-term arm and hand motor impairments. Long term upper limb rehabilitation is needed to restore movement and function, and prevent deterioration from complications such as learned non-use and learned bad-use. We have developed a novel virtual coach, a wearable instrumented rehabilitation jacket, to motivate individuals to participate in long-term skill re-learning, that can be personalized to their impairment profile. The jacket can estimate the movements of an individual’s arms using embedded off-the-shelf sensors (e.g., 9-DOF IMU for inertial measurements, flex-sensors for measuring angular orientation of fingers) and a Bluetooth Low Energy (BLE) powered microcontroller (e.g., RFduino) to non-intrusively extract data. The 9-DOF IMU sensors contain 3-axis accelerometer, 3-axis gyroscope, and 3-axis magnetometer to compute the quaternions, which are transmitted to a computer to compute the Euler angles and estimate the angular orientation of the arms. The data are used in a gaming environment to provide visual, and/or haptic feedback for goal-based, augmented-reality training to facilitate re-learning in a cost-effective, evidence-based manner. The full paper will elaborate the technical aspects of communication, interactive gaming environment, and physical aspects of electronics necessary to achieve our stated goal. Moreover, the paper will suggest methods to utilize the proposed system as a cheaper, portable, and versatile system vis-à-vis existing instrumentation to facilitate post-stroke personalized arm rehabilitation.

Keywords: feedback, gaming, Euler angles, rehabilitation, augmented reality

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Authors: Dalya M. Hassan

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Marketplaces and commercial streets represent some of the most used and lively urban public spaces. Not only do they provide an outlet for commercial exchange, but they also facilitate social and recreational encounters. Such encounters can be influenced by both formal as well as informal vending activities. This paper explores and documents forms of informal vending practices and how they relate to social patterns that occur along the sidewalks of Commercial Streets in Cairo. A qualitative single case study approach of ‘Midan El Gami’ marketplace in Heliopolis, Cairo is adopted. The methodology applied includes direct and walk-by observations for two main commercial streets in the marketplace. Four zoomed-in activity maps are also done for three sidewalk segments that displayed varying vending and social features. Main findings include a documentation and classification of types of informal vending practices as well as a documentation of vendors’ distribution patterns in the urban space. Informal vending activities mainly included informal street vendors and shop spillovers, either as product or seating spillovers. Results indicated that staying and lingering activities were more prevalent in sidewalks that had certain physical features, such as diversity of shops, shaded areas, open frontages, and product or seating spillovers. Moreover, differences in social activity patterns were noted between sidewalks with street vendors and sidewalks with spillovers. While the first displayed more buying, selling, and people watching activities, the latter displayed more social relations and bonds amongst traders’ communities and café patrons. Ultimately, this paper provides a documentation, which suggests that informal vending can have a positive influence on creating a lively commercial street and on resulting patterns of use on the sidewalk space. The results can provide a basis for further investigations and analysis concerning this topic. This could aid in better accommodating informal vending activities within the design of future commercial streets.

Keywords: commercial streets, informal vending practices, sidewalks, social encounters

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Authors: Carolina Gheller Miguens

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Feeding is, and should be, pleasurable for living beings so they desire to nourish themselves while preserving the continuity of the species. Social rites usually revolve around the table and are closely linked to the cultural traditions of each region and social group. Since the beginning, food has been closely linked with the products each region provides, and, also, related to the respective seasons of production. With the globalization and facilities of modern life we are able to find an ever increasing variety of products at any time of the year on supermarket shelves. These lifestyle changes end up directly influencing food traditions. With the era of uncontrolled obesity caused by the dazzle with the large and varied supply of low-priced to ultra-processed industrial products now in the past, today we are living a time when people are putting aside the pleasure of eating to exclusively eat food dictated by the media as healthy. Recently the medicalization of food in our society has become so present in daily life that almost without realizing we make food choices conditioned to the studies of the properties of these foods. The fact that people are more attentive to their health is interesting. However, when this care becomes an obsessive disorder, which imposes itself on the pleasure of eating and extinguishes traditional customs, it becomes dangerous for our recognition as citizens belonging to a culture and society. This new way of living generates a rupture with the social environment of origin, possibly exposing old traditions to oblivion after two or three generations. Based on these facts, the presented study analyzes these social transformations that occur in our society that triggered the current medicalization of food. In order to clarify what is actually a healthy diet, this research proposes a critical analysis on the subject aiming to understand nutritional rationality and relate how it acts in the medicalization of food. A wide bibliographic review on the subject was carried out followed by an exploratory research in online (especially social) media, a relevant source in this context due to the perceived influence of such media in contemporary eating habits. Finally, this data was crossed, critically analyzing the current situation of the concept of healthy eating and medicalization of food. Throughout this research, it was noticed that people are increasingly seeking information about the nutritional properties of food, but instead of seeking the benefits of products that traditionally eat in their social environment, they incorporate external elements that often bring benefits similar to the food already consumed. This is because the access to information is directed by the media and exalts the exotic, since this arouses more interest of the population in general. Efforts must be made to clarify that traditional products are also healthy foods, rich in history, memory and tradition and cannot be replaced by a standardized diet little concerned with the construction of taste and pleasure, having a relationship with food as if it were a Medicinal product.

Keywords: food traditions, food transformations, healthy eating, medicalization of food

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Authors: Siah Koka, Rony Swennen

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Arumeru district is located in Arusha region in Upper Pangani basin in Tanzania. Economically it is dominated with agricultural activities. Banana, coffee, maize, beans, tomatoes, and cassava are the most important food and cash crops. This paper characterized the banana-based farming system of Arumeru district, evaluates its sustainability as well as research needs. The household questionnaire was performed on-site and on farm observation. Transect walk also involved to identify different agro- ecological zones. Results show that farm holdings (home gardens) are smaller than a hectare (0.7 ha) and continue to fragment as population continues to grow. Banana cultivation is the backbone of the farming systems present both in the upland and plains. In the upper belt banana found their place in the forest, which form the home garden structure typical to East African highland banana production systems. However, in the plains, cultivation is done in monoculture and depends heavily on irrigation. We found slightly less cultivars present and hypothetically more pest and disease pressure. This was mainly seen for Fusarium oxysporum species, which eradicates susceptible cultivars such as Mchare cultivars rapidly given the method of irrigation. The smaller permanent upland home garden plots provide thus a more suitable environment where banana perform better. It should be noted that findings indicated good performance to occur in the less suitable plains too. Good management is believed to be the most influencing factor, although our survey failed in identifying them. Population pressure is currently pushing the sustainable system in the uplands to its boundaries. Nutrient mining, deforestation and changing rain patterns threat production not only on Mt. Meru but on a global scale.

Keywords: Arumeru district, banana-based farming system, Tanzania, Arumeru district

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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

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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

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Authors: Okan Cakir, Okan Tatli

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Acute motor and sensory axonal neuropathy (AMSAN) syndrome usually occurs following a postviral infection in two to four weeks and is a polyneuropathy characterized by axonal and sensorial degeneration as a rare variant of Gullian-Barre syndrome. In our case, we wanted to mention that a rare case of AMSAN Syndrome due to prior surgery. A 61-year-old male case admitted to emergency department with complaints of weakness in feet, numbness and incapability to walk. In his history, it was learned that endovascular aneurysm repair (EVAR) had applied for abdominal aort aneurysm two weeks ago before admission, his complaints had been for a couple of days increasingly and bilaterally, and there had been no infection disease history for four weeks. In physical examination, general status was good, vital signs were stable, and there was a mild paresis in dorsal flexion of feet in bilaterally lower extremities. No nuchal rigidity was determined. Other system examinations were normal. Urea:52 mg/dL (normal range: 15-44 mg/dL), creatinine: 1,05 mg/dL (normal range: 0,81-1,4 mg/dL), potassium: 3,68 mmol/L (normal range: 3,5-5,5 mmol/L), glycaemia: 142 mg/dL, calcium: 9,71 mg/dL (normal range: 8,5-10,5 mg/dL), erythrocyte sedimentation rate (ESR): 74 mm/h (normal range: 0-15 mm/h) were determined in biochemical tests. The case was consulted to neurology department and hospitalized. In performing electromyography, it was reported as a bilateral significant axonal degeneration with sensory-motor polyneuropathy. Normal ranges of glycaemia and protein levels were detected in lumbal punction. Viral markers and bucella, toxoplasma, and rubella markers were in normal range. Intravenous immunoglobulin (IVIG) was applied as a treatment, physical treatment programme was planned and the case discharged from neurology department. In our case, we mentioned that it should be considered polyneuropathy as an alternative diagnosis in cases admitting symptoms like weakness and numbness had a history of prior surgery.

Keywords: AMSAN Syndrome, emergency department, prior surgery, weakness

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

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

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

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Authors: Maria Inês Faria, João Miguel Simão

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Frequently, the Sustainable Development paradigm is considered the contemporary societies flag and is has been assuming different nuances on local and global dialogues. This reveals the ambivalent character associated to its implementation due, namely, to the kind of synergies that political institutions, social organizations and citizenry can actually create. The Sustainable Development concept needs further discussion so that it can be useful in decision-making processes. In fact, the polysemic nature of this concept has consistently undermined its credibility leading, among other factors, to the talk and action gap, as well as to misappropriations of this notion. The present study focuses on the importance in questioning the sustainable development operationalization, "To walk the talk", and intends, in a broad sense, identify prospects and the elements of sustainability that are included in strategic plans (global, national and local) and, in the strict sense, confront discourse and practice in the context of local public policies for sustainable development, in particular with regard to the implementation of Local Agenda 21 in the municipality of Beja (Portugal) in order to analyze at what extent the strategies adopted and implemented are aligned with the paradigm of sustainable development. The method is based on critical analysis of literature and official documentation, using three complementary approaches: a) exploratory review of literature in order to identify publications on sustainability and sustainable development; b) this second approach complements the first, focused on the official documentation for the adoption and implementation of sustainable development, which is produced in the global plan, regional, national and local levels; c) and the approach which is focused on official documentation that expresses the policy options, the strategic lines and actions for sustainable development implementation Beja´s Municipality. The main results of this study highlight the type of alignment of the Beja´s Municipality sustainable policies, concerning the officially stipulated for the promotion of sustainable development on the international agenda, stressing the potentialities, constraints and challenges of Agenda 21 Local implementation.

Keywords: sustainable development, Local Agenda 21, sustainable local public policies, Beja

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Authors: Abdul Rashid, Varsha Rokade

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Service Quality within retail units is pivotal for satisfying customers and retaining them. This study on customer perception towards Service Quality variables in Retail aims to identify the dimensions and their impact on customers. An analytical study of the different retail service quality variables was done to understand the relationship between them. The study tries exploring the factors that attract the customers towards the organised and unorganised retail stores in the capital city of Madhya Pradesh, India. As organised retailers are seen as offering similar products in the outlets, improving service quality is seen as critical to ensuring competitive advantage over unorganised retailers. Data were collected through a structured questionnaire on a five-point Likert scale from existing walk-in customers of selected organised and unorganised retail stores in Bhopal City of Madhya Pradesh, India. The data was then analysed by factor analysis using (SPSS) Statistical Package for the Social Sciences especially Percentage analysis, ANOVA and Chi-Square. This study tries to find interrelationship between various Retail Service Quality dimensions, which will help the retailers to identify the steps needed to improve the overall quality of service. Thus, the findings of the study prove to be helpful in understanding the service quality variables which should be considered by organised and unorganised retail stores in Capital city of Madhya Pradesh, India.Also, findings of this empirical research reiterate the point of view that dimensions of Service Quality in Retail play an important role in enhancing customer satisfaction – a sector with high growth potential and tremendous opportunities in rapidly growing economies like India’s. With the introduction of FDI in multi-brand retailing, a large number of international retail players are expected to enter the Indian market, this intern will bring more competition in the retail sector. For benchmarking themselves with global standards, the Indian retailers will have to improve their service quality.

Keywords: organized retail, unorganised retail, retail service quality, service quality dimension

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Authors: Yuko Hiramatsu, Fumihiro Sato, Atsushi Ito, Hiroyuki Hatano, Mie Sato, Yu Watanabe, Akira Sasaki

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This paper presents a mobile phone application developed for sightseeing in Nikko, one of the cultural world heritages in Japan, using the BLE (Bluetooth Low Energy) beacon. Based on our pre-research, we decided to design our application for young people who walk around the area actively, but know little about the tradition and culture of Nikko. One solution is to construct many information boards to explain; however, it is difficult to construct new guide plates in cultural world heritage sites. The smartphone is a good solution to send such information to such visitors. This application was designed using a combination of the smartphone and beacons, set in the area, so that when a tourist passes near a beacon, the application displays information about the area including a map, historical or cultural information about the temples and shrines, and local shops nearby as well as a bus timetable. It is useful for foreigners, too. In addition, we developed quizzes relating to the culture and tradition of Nikko to provide information based on the Zeigarnik effect, a psychological effect. According to the results of our trials, tourists positively evaluated the basic information and young people who used the quiz function were able to learn the historical and cultural points. This application helped young visitors at Nikko to understand the cultural elements of the site. In addition, this application has a function to send notifications. This function is designed to provide information about the local community such as shops, local transportation companies and information office. The application hopes to also encourage people living in the area, and such cooperation from the local people will make this application vivid and inspire young visitors to feel that the cultural heritage site is still alive today. This is a gateway for young people to learn about a traditional place and understand the gravity of preserving such areas.

Keywords: BLE beacon, smartphone application, Zeigarnik effect, world heritage site, school trip

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Authors: Monireh Ahmadi Bani, Adel Khorramrouz, Lalenoor Morvarid, Bagheri Mahtab

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Background:- Foot disorders are common in musculoskeletal problems. Plantar pressure distribution measurement is one the most important part of foot disorders diagnosis for quantitative analysis. However, the association of plantar pressure and foot disorders is not clear. With the growth of dataset and machine learning methods, the relationship between foot disorders and plantar pressures can be detected. Significance of the study:- The purpose of this study was to predict the probability of common foot disorders based on peak plantar pressure distribution and center of pressure during walking. Methodologies:- 2323 participants were assessed in a foot therapy clinic between 2015 and 2021. Foot disorders were diagnosed by an experienced physician and then they were asked to walk on a force plate scanner. After the data preprocessing, due to the difference in walking time and foot size, we normalized the samples based on time and foot size. Some of force plate variables were selected as input to a deep neural network (DNN), and the probability of any each foot disorder was measured. In next step, we used support vector machine (SVM) and run dataset for each foot disorder (classification of yes or no). We compared DNN and SVM for foot disorders prediction based on plantar pressure distributions and center of pressure. Findings:- The results demonstrated that the accuracy of deep learning architecture is sufficient for most clinical and research applications in the study population. In addition, the SVM approach has more accuracy for predictions, enabling applications for foot disorders diagnosis. The detection accuracy was 71% by the deep learning algorithm and 78% by the SVM algorithm. Moreover, when we worked with peak plantar pressure distribution, it was more accurate than center of pressure dataset. Conclusion:- Both algorithms- deep learning and SVM will help therapist and patients to improve the data pool and enhance foot disorders prediction with less expense and error after removing some restrictions properly.

Keywords: deep neural network, foot disorder, plantar pressure, support vector machine

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Authors: Loubna Khalile, Hicham Lahlaoi, Hassan Rhinane, A. Kaoukaya, S. Fal

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Green spaces is an essential element, they contribute to improving the quality of lives of the towns around them. They are a place of relaxation, walk and rest a playground for sport and youths. According to United Nations Organization Forests cover 31% of the land. In Morocco in 2013 that cover 12.65 % of the total land area, still, a small proportion compared to the natural needs of forests as a green lung of our planet. The Benslimane Forest is a large green area It belongs to Chaouia-Ouardigha Region and Greater Casablanca Region, it is located geographically between Casablanca is considered the economic and business Capital of Morocco and Rabat the national political capital, with an area of 12261.80 Hectares. The essential problem usually encountered in suburban forests, is visitation and tourism pressure it is anthropogenic actions, as well as other ecological and environmental factors. In recent decades, Morocco has experienced a drought year that has influenced the forest with increasing human pressure and every day it suffers heavy losses, as well as over-exploitation. The Moroccan forest ecosystems are weak with intense ecological variation, domanial and imposed usage rights granted to the population; forests are experiencing a significant deterioration due to forgetfulness and immoderate use of forest resources which can influence the destruction of animal habitats, vegetation, water cycle and climate. The purpose of this study is to make a model of the degree of degradation of the forest and know the causes for prevention by using remote sensing and geographic information systems by introducing climate and ancillary data. Analytic hierarchy process was used to find out the degree of influence and the weight of each parameter, in this case, it is found that anthropogenic activities have a fairly significant impact has thus influenced the climate.

Keywords: analytic hierarchy process, degradation, forest, geographic information system

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Authors: Parul Kapoor, Dheeraj Bhardwaj

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Delhi and other Indian cities accommodate thousands of Central Government employees in housing complexes called ‘General Pool Residential Accommodation’ (GPRA), located in prime parcels of the city. These residential colonies are now undergoing redevelopment at a massive scale, significantly impacting the ecology of the surrounding areas. Essentially, these colonies were low-rise, low-density planned developments with a dense tree cover and minimal parking requirements. But with increasing urbanisation and spike in parking demand, the proposed built form is an aggregate of high-rise gated complexes, redefining the skyline of the city which is a huge departure from the mediocre setup of Low-rise Walk-up apartments. The complexity of these developments is further aggravated by the need for parking which necessitates cutting huge number of trees to accommodate multiple layers of parking beneath the structures thus sidelining the authentic character of these areas which is laden with a dense tree cover. The aftermath of this whole process is the generation of a huge carbon footprint on the surrounding areas, which is unaccounted for, in the planning and design practice. These developments are currently planned as mix-use compounds with large commercial built-up spaces which have additional parking requirements over and above the residential parking. Also, they are perceived as gated complexes and not as neighborhood units, thus project isolated images of high-rise, dense systems with little context to the surroundings. The paper would analyze case studies of GPRA Redevelopment projects in Delhi, and the lack of relevant development control regulations which have led to abnormalities and complications in the entire redevelopment process. It would also suggest policy guidelines which can establish comprehensive codes for effective planning of these settlements.

Keywords: gated complexes, GPRA Redevelopment projects, increased densities, huge carbon footprint, mixed-use development

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Authors: Rolando Volzone

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The Congregation of Saint Paul of Serra de Ossa (Ossa Mountain) was founded in 1482, originated by the eremitic movement of the homens da pobre vida (poor life men), which is documented since 1366. The community of hermits expanded up to the first half of the 15th century, mostly in southern Portugal in the Alentejo region. In 1578, following a process of institutionalization led by the Church, an autonomous congregation was set up, affiliated in the Hungarian Order of Saint Paul the First Hermit, until 1834, when the decree of dissolution of the religious orders disbanded all the convents and monasteries in Portugal. The architectural evidences that reached our days as a legacy of the hermitical movement in Serra de Ossa, although studied and analysed from an historical point of view, are still little known with respect to the architectural characteristics of its physical implantation and its relationship with the natural systems. This research intends to expose the appropriation process of the locus eremus as a starting point for the interpretation of this landscape, evidencing the close relationship between the religious experience and the physical space chosen to reach the perfection of the soul. The locus eremus is thus determined not only by practical aspects such as the absolute and relative location, orography, existence of water resources, or the King’s favoring to the religious and settlement action of the hermits, but also by spiritual aspects related to the symbolism of the physical elements present and the solitary walk of these men. These aspects, combined with the built architectural elements and other exerted human action, may be fertile ground for the definition of a hypothetical hermitical landscape based on the sufficiently distinctive characteristics that sustain it. The landscape built by these hermits is established as a cultural and material heritage, and its preservation is of utmost importance. They deeply understood this place and took advantage of its natural resources, manipulating them in an ecological and economically sustainable way, respecting the place, without overcoming its own genius loci but becoming part of it.

Keywords: architecture, congregation of Saint Paul of Serra de Ossa, heremitical landscape, locus eremus

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Authors: Sonda Jallouli, Omar Hammouda, Imen Ben Dhia, Salma Sakka, Chokri Mhiri, Mohamed Habib Elleuch, Abedlmoneem Yahia, Sameh Ghroubi

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Multiple sclerosis (MS) is characterized by gender differences with affecting women two to four times more than men, but the disease progression is faster and more severe in men. Fatigue represents one of the most frequent and disabling symptoms related to MS. Results of previous studies regarding gender differences in fatigue perception in MS persons are contradictory. Besides, fatigue has been shown to affect negatively postural balance and functional mobility in MS persons. However, no study has taken into account gender differences in the response of these physical parameters to a fatiguing protocol in MS persons. Given the reduction of autonomy due to the alteration of these parameters induced by fatigue and the importance of gender differences in postural balance training programs in fatigued men and women with MS, the aim of this study was to investigate the effect of gender difference on unipedal postural balance and functional mobility after performing a fatiguing task in MS adults. Methods: Eleven women (30.29 ± 7.99 years) and seven men (30.91 ± 8.19 years) with relapsing-remitting MS performed a fatiguing protocol: three sets of the 5×sit to stand test (5-STST), six-minute walk test (6MWT) followed by three sets of the 5-STST. Unipedal balance, functional mobility, and fatigue perception were measured prefatigue (T0) and post fatigue (T3) using a clinical unipedal balance test, timed up and go test (TUGT), and analogic visual scale of fatigue (VASF), respectively. Heart rate (HR) and rate of perceived exertion (RPE) were recorded before, during and after the fatiguing task. Results: Compared to women, men showed an impairment of unipedal balance on the dominant leg (p<0.001, d=0.52) and mobility (p<0.001, d=3) via reducing unipedal stance time and increasing duration of TUGT execution, respectively. No gender differences were observed in 6MWT, 5-STST, HR, RPE and VASF scores. Conclusion: Fatiguing protocol negatively affected unipedal postural balance and mobility only in men. These gender differences were inconclusive but can be taken into account in postural balance rehabilitation programs for persons with MS.

Keywords: functional mobility, fatiguing exercises, multiple sclerosis, sex differences, unipedal balance

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Authors: Kyungsuk Cho, Seungun Chae, Jihun Choi

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Elevators are examined as one of evacuation methods in super-tall buildings. However, data on the use of elevators for evacuation at a fire are extremely scarce. Therefore, a test to measure delay time in using an evacuation elevator was conducted. In the test, time taken to get on and get off an elevator was measured and the case in which people gave up boarding when the capacity of the elevator was exceeded was also taken into consideration. 170 men and women participated in the test, 130 of whom were young people (20 ~ 50 years old) and 40 were senior citizens (over 60 years old). The capacity of the elevator was 25 people and it travelled between the 2nd and 4th floors. A video recording device was used to analyze the test. An elevator at an ordinary building, not a super-tall building, was used in the test to measure delay time in getting on and getting off an elevator. In order to minimize interference from other elements, elevator platforms on the 2nd and 4th floors were partitioned off. The elevator travelled between the 2nd and 4th floors where people got on and off. If less than 20 people got on the elevator which was empty, the data were excluded. If the elevator carrying 10 passengers stopped and less than 10 new passengers got on the elevator, the data were excluded. Getting-on an empty elevator was observed 49 times. The average number of passengers was 23.7, it took 14.98 seconds for the passengers to get on the empty elevator and the load factor was 1.67 N/s. It took the passengers, whose average number was 23.7, 10.84 seconds to get off the elevator and the unload factor was 2.33 N/s. When an elevator’s capacity is exceeded, the excessive number of people should get off. Time taken for it and the probability of the case were measure in the test. 37% of the times of boarding experienced excessive number of people. As the number of people who gave up boarding increased, the load factor of the ride decreased. When 1 person gave up boarding, the load factor was 1.55 N/s. The case was observed 10 times, which was 12.7% of the total. When 2 people gave up boarding, the load factor was 1.15 N/s. The case was observed 7 times, which was 8.9% of the total. When 3 people gave up boarding, the load factor was 1.26 N/s. The case was observed 4 times, which was 5.1% of the total. When 4 people gave up boarding, the load factor was 1.03 N/s. The case was observed 5 times, which was 6.3% of the total. Getting-on and getting-off time data for people who can walk freely were obtained from the test. In addition, quantitative results were obtained from the relation between the number of people giving up boarding and time taken for getting on. This work was supported by the National Research Council of Science & Technology (NST) grant by the Korea government (MSIP) (No. CRC-16-02-KICT).

Keywords: evacuation elevator, super tall buildings, evacuees, delay time

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Authors: Marybec Griffin

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Purpose: The purpose of this cross-sectional study was to get a better understanding of healthcare usage and satisfaction among young adult gay men (YAGM), including the facility used as the usual source of healthcare, preference for coordinated healthcare, and if their primary care provider (PCP) adequately addressed the health needs of gay men. Methods: Interviews were conducted among n=800 YAGM in New York City (NYC). Participants were surveyed about their sociodemographic characteristics and healthcare usage and satisfaction access using multivariable logistic regression models. The surveys were conducted between November 2015 and June 2016. Results: The mean age of the sample was 24.22 years old (SD=4.26). The racial and ethnic background of the participants is as follows: 35.8% (n=286) Black Non-Hispanic, 31.9% (n=225) Hispanic/Latino, 20.5% (n=164) White Non-Hispanic, 4.4% (n=35) Asian/Pacific Islander, and 6.9% (n=55) reporting some other racial or ethnic background. 31.1% (n=249) of the sample had an income below $14,999. 86.7% (n=694) report having either public or private health insurance. For usual source of healthcare, 44.6% (n=357) of the sample reported a private doctor’s office, 16.3% (n=130) reported a community health center, and 7.4% (n=59) reported an urgent care facility, and 7.6% (n=61) reported not having a usual source of healthcare. 56.4% (n=451) of the sample indicated a preference for coordinated healthcare. 54% (n=334) of the sample were very satisfied with their healthcare. Findings from multivariable logistical regression models indicate that participants with higher incomes (AOR=0.54, 95% CI 0.36-0.81, p < 0.01) and participants with a PCP (AOR=0.12, 95% CI 0.07-0.20, p < 0.001) were less likely to use a walk-in facility as their usual source of healthcare. Results from the second multivariable logistic regression model indicated that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare (AOR=0.63, 95% CI 0.42-0.96, p < 0.05). In the final multivariable logistic model, results indicated that participants who had disclosed their sexual orientation to their PCP (AOR=2.57, 95% CI 1.25-5.21, p < 0.01) and were comfortable discussing their sexual activity with their PCP (AOR=8.04, 95% CI 4.76-13.58, p < 0.001) were more likely to agree that their PCP adequately addressed the healthcare needs of gay men. Conclusion: Understanding healthcare usage and satisfaction among YAGM is necessary as the healthcare landscape changes, especially given the relatively recent addition of urgent care facilities. The type of healthcare facility used as a usual source of care influences the ability to seek comprehensive and coordinated healthcare services. While coordinated primary and sexual healthcare may be ideal, individual preference for this coordination among YAGM is desired but may be limited due to experiences of discrimination in primary care settings.

Keywords: healthcare policy, gay men, healthcare access, Affordable Care Act

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Authors: A. Raj Kumar, S. Bilaloglu

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Stroke is a leading cause of adult disability worldwide. We depend on our hands for our activities of daily living(ADL). Although many patients regain the ability to walk, they continue to experience long-term hand motor impairments. As the number of individuals with young stroke is increasing, there is a critical need for effective approaches for rehabilitation of hand function post-stroke. Motor relearning for dexterity requires task-specific kinesthetic, tactile and visual feedback. However, when a stroke results in both sensory and motor impairment, it becomes difficult to ascertain when and what type of sensory substitutions can facilitate motor relearning. In an ideal situation, real-time task-specific data on the ability to learn and data-driven feedback to assist such learning will greatly assist rehabilitation for dexterity. We have found that kinesthetic and tactile information from the unaffected hand can assist patients re-learn the use of optimal fingertip forces during a grasp and lift task. Measurement of fingertip grip force (GF), load forces (LF), their corresponding rates (GFR and LFR), and other metrics can be used to gauge the impairment level and progress during learning. Currently ATI mini force-torque sensors are used in research settings to measure and compute the LF, GF, and their rates while grasping objects of different weights and textures. Use of the ATI sensor is cost prohibitive for deployment in clinical or at-home rehabilitation. A cost effective mechatronic device is developed to quantify GF, LF, and their rates for stroke rehabilitation purposes using off-the-shelf components such as load cells, flexi-force sensors, and an Arduino UNO microcontroller. A salient feature of the device is its integration with an interactive gaming environment to render a highly engaging user experience. This paper elaborates the integration of kinesthetic and tactile sensing through computation of LF, GF and their corresponding rates in real time, information processing, and interactive interfacing through augmented reality for visual feedback.

Keywords: feedback, gaming, kinesthetic, rehabilitation, tactile

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Authors: Da Kuang

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Resilience is a hotly debated topic in many research fields (e.g., engineering, ecology, society, psychology). In flood management studies, we are experiencing the paradigm shift from flood resistance to flood resilience. Flood resilience refers to tolerate flooding through adaptation or transformation. It is increasingly argued that our city as a social-ecological system holds the ability to learn from experience and adapt to flood rather than simply resist it. This research aims to investigate what kinds of adaptation knowledge the frequently flooded village learned from past experience and its advantages and limitations in coping with floods. The study area – Xinnongcun village, located in the west of Wuhan city, is a linear village and continuously suffered from both flash flood and drainage flood during the past 30 years. We have a field trip to the site in June 2017 and conducted semi-structured interviews with local residents. Our research summarizes two types of adaptation knowledge that people learned from the past floods. Firstly, at the village scale, it has formed a collective urban form which could help people live during both flood and dry season. All houses and front yards were elevated about 2m higher than the road. All the front yards in the village are linked and there is no barrier. During flooding time, people walk to neighbors through houses yards and boat to outside village on the lower road. Secondly, at individual scale, local people learned tacit knowledge of preparedness and emergency response to flood. Regarding the advantages and limitations, the adaptation knowledge could effectively help people to live with flood and reduce the chances of getting injuries. However, it cannot reduce local farmers’ losses on their agricultural land. After flood, it is impossible for local people to recover to the pre-disaster state as flood emerges during June and July will result in no harvest. Therefore, we argue that learning from past flood experience could increase people’s adaptive capacity. However, once the adaptive capacity cannot reduce people’s losses, it requires a transformation to a better regime.

Keywords: adaptation, flood resilience, tacit knowledge, transformation

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