Search results for: circadian rhythm
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 174

Search results for: circadian rhythm

24 A Construction Management Tool: Determining a Project Schedule Typical Behaviors Using Cluster Analysis

Authors: Natalia Rudeli, Elisabeth Viles, Adrian Santilli

Abstract:

Delays in the construction industry are a global phenomenon. Many construction projects experience extensive delays exceeding the initially estimated completion time. The main purpose of this study is to identify construction projects typical behaviors in order to develop a prognosis and management tool. Being able to know a construction projects schedule tendency will enable evidence-based decision-making to allow resolutions to be made before delays occur. This study presents an innovative approach that uses Cluster Analysis Method to support predictions during Earned Value Analyses. A clustering analysis was used to predict future scheduling, Earned Value Management (EVM), and Earned Schedule (ES) principal Indexes behaviors in construction projects. The analysis was made using a database with 90 different construction projects. It was validated with additional data extracted from literature and with another 15 contrasting projects. For all projects, planned and executed schedules were collected and the EVM and ES principal indexes were calculated. A complete linkage classification method was used. In this way, the cluster analysis made considers that the distance (or similarity) between two clusters must be measured by its most disparate elements, i.e. that the distance is given by the maximum span among its components. Finally, through the use of EVM and ES Indexes and Tukey and Fisher Pairwise Comparisons, the statistical dissimilarity was verified and four clusters were obtained. It can be said that construction projects show an average delay of 35% of its planned completion time. Furthermore, four typical behaviors were found and for each of the obtained clusters, the interim milestones and the necessary rhythms of construction were identified. In general, detected typical behaviors are: (1) Projects that perform a 5% of work advance in the first two tenths and maintain a constant rhythm until completion (greater than 10% for each remaining tenth), being able to finish on the initially estimated time. (2) Projects that start with an adequate construction rate but suffer minor delays culminating with a total delay of almost 27% of the planned time. (3) Projects which start with a performance below the planned rate and end up with an average delay of 64%, and (4) projects that begin with a poor performance, suffer great delays and end up with an average delay of a 120% of the planned completion time. The obtained clusters compose a tool to identify the behavior of new construction projects by comparing their current work performance to the validated database, thus allowing the correction of initial estimations towards more accurate completion schedules.

Keywords: cluster analysis, construction management, earned value, schedule

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23 Audit Outcome Cardiac Arrest Cases (2019-2020) in Emergency Department RIPAS Hospital, Brunei Darussalam

Authors: Victor Au, Khin Maung Than, Zaw Win Aung, Linawati Jumat

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Background & Objectives: Cardiac arrests can occur anywhere or anytime, and most of the cases will be brought to the emergency department except the cases that happened in at in-patient setting. Raja IsteriPangiran Anak Saleha (RIPAS) Hospital is the only tertiary government hospital which located in Brunei Muara district and received all referral from other Brunei districts. Data of cardiac arrests in Brunei Darussalam scattered between Emergency Medical Ambulance Services (EMAS), Emergency Department (ED), general inpatient wards, and Intensive Care Unit (ICU). In this audit, we only focused on cardiac arrest cases which had happened or presented to the emergency department RIPAS Hospital. Theobjectives of this audit were to look at demographic of cardiac arrest cases and the survival to discharge rate of In-Hospital Cardiac Arrest (IHCA) and Out-Hospital Cardiac Arrest (OHCA). Methodology: This audit retrospective study was conducted on all cardiac arrest cases that underwent Cardiopulmonary Resuscitation (CPR) in ED RIPAS Hospital, Brunei Muara, in the year 2019-2020. All cardiac arrest cases that happened or were brought in to emergency department were included. All the relevant data were retrieved from ED visit registry book and electronic medical record “Bru-HIMS” with keyword diagnosis of “cardiac arrest”. Data were analyzed and tabulated using Excel software. Result: 313 cardiac arrests were recorded in the emergency department in year 2019-2020. 92% cases were categorized as OHCA, and the remaining 8% as IHCA. Majority of the cases were male with age between 50-60 years old. In OHCA subgroup, only 12.4% received bystander CPR, and 0.4% received Automatic External Defibrillator (AED) before emergency medical personnel arrived. Initial shockable rhythm in IHCA group accounted for 12% compare to 4.9% in OHCA group. Outcome of ED resuscitation, 32% of IHCA group achieved return of spontaneous circulation (ROSC) with a survival to discharge rate was 16%. For OHCA group, 12.35% achieved ROSC, but unfortunately, none of them survive till discharge. Conclusion: Standardized registry for cardiac arrest in the emergency department is required to provide valid baseline data to measure the quality and outcome of cardiac arrest. Zero survival rate for out hospital cardiac arrest is very concerning, and it might represent the significant breach in cardiac arrest chains of survival. Systematic prospective data collection is needed to identify contributing factors and to improve resuscitation outcome.

Keywords: cardiac arrest, OHCA, IHCA, resuscitation, emergency department

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22 Learning with Music: The Effects of Musical Tension on Long-Term Declarative Memory Formation

Authors: Nawras Kurzom, Avi Mendelsohn

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The effects of background music on learning and memory are inconsistent, partly due to the intrinsic complexity and variety of music and partly to individual differences in music perception and preference. A prominent musical feature that is known to elicit strong emotional responses is musical tension. Musical tension can be brought about by building anticipation of rhythm, harmony, melody, and dynamics. Delaying the resolution of dominant-to-tonic chord progressions, as well as using dissonant harmonics, can elicit feelings of tension, which can, in turn, affect memory formation of concomitant information. The aim of the presented studies was to explore how forming declarative memory is influenced by musical tension, brought about within continuous music as well as in the form of isolated chords with varying degrees of dissonance/consonance. The effects of musical tension on long-term memory of declarative information were studied in two ways: 1) by evoking tension within continuous music pieces by delaying the release of harmonic progressions from dominant to tonic chords, and 2) by using isolated single complex chords with various degrees of dissonance/roughness. Musical tension was validated through subjective reports of tension, as well as physiological measurements of skin conductance response (SCR) and pupil dilation responses to the chords. In addition, music information retrieval (MIR) was used to quantify musical properties associated with tension and its release. Each experiment included an encoding phase, wherein individuals studied stimuli (words or images) with different musical conditions. Memory for the studied stimuli was tested 24 hours later via recognition tasks. In three separate experiments, we found positive relationships between tension perception and physiological measurements of SCR and pupil dilation. As for memory performance, we found that background music, in general, led to superior memory performance as compared to silence. We detected a trade-off effect between tension perception and memory, such that individuals who perceived musical tension as such displayed reduced memory performance for images encoded during musical tension, whereas tense music benefited memory for those who were less sensitive to the perception of musical tension. Musical tension exerts complex interactions with perception, emotional responses, and cognitive performance on individuals with and without musical training. Delineating the conditions and mechanisms that underlie the interactions between musical tension and memory can benefit our understanding of musical perception at large and the diverse effects that music has on ongoing processing of declarative information.

Keywords: musical tension, declarative memory, learning and memory, musical perception

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21 The Quantum Theory of Music and Human Languages

Authors: Mballa Abanda Luc Aurelien Serge, Henda Gnakate Biba, Kuate Guemo Romaric, Akono Rufine Nicole, Zabotom Yaya Fadel Biba, Petfiang Sidonie, Bella Suzane Jenifer

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The main hypotheses proposed around the definition of the syllable and of music, of the common origin of music and language, should lead the reader to reflect on the cross-cutting questions raised by the debate on the notion of universals in linguistics and musicology. These are objects of controversy, and there lies its interest: the debate raises questions that are at the heart of theories on language. It is an inventive, original, and innovative research thesis. A contribution to the theoretical, musicological, ethno musicological, and linguistic conceptualization of languages, giving rise to the practice of interlocution between the social and cognitive sciences, the activities of artistic creation, and the question of modeling in the human sciences: mathematics, computer science, translation automation, and artificial intelligence. When you apply this theory to any text of a folksong of a world-tone language, you do not only piece together the exact melody, rhythm, and harmonies of that song as if you knew it in advance but also the exact speaking of this language. The author believes that the issue of the disappearance of tonal languages and their preservation has been structurally resolved, as well as one of the greatest cultural equations related to the composition and creation of tonal, polytonal, and random music. The experimentation confirming the theorization, I designed a semi-digital, semi-analog application that translates the tonal languages of Africa (about 2,100 languages) into blues, jazz, world music, polyphonic music, tonal and anatonal music, and deterministic and random music). To test this application, I use music reading and writing software that allows me to collect the data extracted from my mother tongue, which is already modeled in the musical staves saved in the ethnographic (semiotic) dictionary for automatic translation ( volume 2 of the book). The translation is done (from writing to writing, from writing to speech, and from writing to music). Mode of operation: you type a text on your computer, a structured song (chorus-verse), and you command the machine a melody of blues, jazz, and world music or variety, etc. The software runs, giving you the option to choose harmonies, and then you select your melody.

Keywords: language, music, sciences, quantum entenglement

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20 Architecture for Hearing Impaired: A Study on Conducive Learning Environments for Deaf Children with Reference to Sri Lanka

Authors: Champa Gunawardana, Anishka Hettiarachchi

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Conducive Architecture for learning environments is an area of interest for many scholars around the world. Loss of sense of hearing leads to the assumption that deaf students are visual learners. Comprehending favorable non-hearing attributes of architecture can lead to effective, rich and friendly learning environments for hearing impaired. The objective of the current qualitative investigation is to explore the nature and parameters of a sense of place of deaf children to support optimal learning. The investigation was conducted with hearing-impaired children (age: between 8-19, Gender: 15 male and 15 female) of Yashodhara deaf and blind school at Balangoda, Sri Lanka. A sensory ethnography study was adopted to identify the nature of perception and the parameters of most preferred and least preferred spaces of the learning environment. The common perceptions behind most preferred places in the learning environment were found as being calm and quiet, sense of freedom, volumes characterized by openness and spaciousness, sense of safety, wide spaces, privacy and belongingness, less crowded, undisturbed, availability of natural light and ventilation, sense of comfort and the view of green colour in the surroundings. On the other hand, the least preferred spaces were found to be perceived as dark, gloomy, warm, crowded, lack of freedom, smells (bad), unsafe and having glare. Perception of space by deaf considering the hierarchy of sensory modalities involved was identified as; light - color perception (34 %), sight - visual perception (32%), touch - haptic perception (26%), smell - olfactory perception (7%) and sound – auditory perception (1%) respectively. Sense of freedom (32%) and sense of comfort (23%) were the predominant psychological parameters leading to an optimal sense of place perceived by hearing impaired. Privacy (16%), rhythm (14%), belonging (9%) and safety (6%) were found as secondary factors. Open and wide flowing spaces without visual barriers, transparent doors and windows or open port holes to ease their communication, comfortable volumes, naturally ventilated spaces, natural lighting or diffused artificial lighting conditions without glare, sloping walkways, wider stairways, walkways and corridors with ample distance for signing were identified as positive characteristics of the learning environment investigated.

Keywords: deaf, visual learning environment, perception, sensory ethnography

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19 Women Writing Group as a Mean for Personal and Social Change

Authors: Michal Almagor, Rivka Tuval-Mashiach

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This presentation will explore the main processes identified in women writing group, as an interdisciplinary field with personal and social effects. It is based on the initial findings of a Ph.D. research focus on the intersection of group processes with the element of writing, in the context of gender. Writing as a therapeutic mean has been recognized and found to be highly effective. Additionally, a substantial amount of research reveals the psychological impact of group processes. However, the combination of writing and groups as a therapeutic tool was hardly investigated; this is the contribution of this research. In the following qualitative-phenomenological study, the experiences of eight women participating in a 10-sessions structured writing group were investigated. We used the meetings transcripts, semi-structured interviews, and the texts to analyze and understand the experience of participating in the group. The two significant findings revealed were spiral intersubjectivity and archaic level of semiotic language. We realized that the content and the process are interwoven; participants are writing, reading and discussing their texts in a group setting that enhanced self-dialogue between the participants and their own narratives and texts, as well as dialogue with others. This process includes working through otherness within and between while discovering and creating a multiplicity of narratives. A movement of increasing shared circles from the personal to the group and to the social-cultural environment was identified, forming what we termed as spiral intersubjectivity. An additional layer of findings was revealed while we listened to the resonance of the group-texts, and discourse; during this process, we could trace the semiotic level in addition to the symbolic one. We were witness to the dominant presence of the body, and primal sensuality, expressed by rhythm, sound and movements, signs of pre-verbal language. Those findings led us to a new understanding of the semiotic function as a way to express the fullness of women experience and the enabling role of writing in reviving what was repressed. The poetic language serves as a bridge between the symbolic and the semiotic. Re-reading the group materials, exposed another layer of expression, an old-new language. This approach suggests a feminine expression of subjective experience with personal and social importance. It is a subversive move, encouraging women to write themselves, as a craft that every woman can use, giving voice to the silent and hidden, and experiencing the power of performing 'my story'. We suggest that women writing group is an efficient, powerful yet welcoming way to raise the awareness of researchers and clinicians, and more importantly of the participants, to the uniqueness of the feminine experience, and to gender-sensitive curative approaches.

Keywords: group, intersubjectivity, semiotic, writing

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18 MigrationR: An R Package for Analyzing Bird Migration Data Based on Satellite Tracking

Authors: Xinhai Li, Huidong Tian, Yumin Guo

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Bird migration is fantastic natural phenomenon. In recent years, the use of GPS transmitters has generated a vast amount of data, and the Movebank platform has made these data publicly accessible. For researchers, what they need are data analysis tools. Although there are approximately 90 R packages dedicated to animal movement analysis, the capacity for comprehensive processing of bird migration data remains limited. Hence, we introduce a novel package called migrationR. This package enables the calculation of movement speed, direction, changes in direction, flight duration, daily and annual movement distances. Furthermore, it can pinpoint the starting and ending dates of migration, estimate nest site locations and stopovers, and visualize movement trajectories at various time scales. migrationR distinguishes individuals through NMDS (non-metric multidimensional scaling) coordinates based on movement variables such as speed, flight duration, path tortuosity, and migration timing. A distinctive aspect of the package is the development of a hetero-occurrences species distribution model that takes into account the daily rhythm of individual birds across different landcover types. Habitat use for foraging and roosting differs significantly for many waterbirds. For example, White-naped Cranes at Poyang Lake in China typically forage in croplands and roost in shallow water areas. Both of these occurrence types are of equal importance. Optimal habitats consist of a combination of crop lands and shallow waters, whereas suboptimal habitats lack both, which necessitates birds to fly extensively. With migrationR, we conduct species distribution modeling for foraging and roosting separately and utilize the moving distance between crop lands and shallow water areas as an index of overall habitat suitability. This approach offers a more nuanced understanding of the habitat requirements for migratory birds and enhances our ability to analyze and interpret their movement patterns effectively. The functions of migrationR are demonstrated using our own tracking data of 78 White-naped Crane individuals from 2014 to 2023, comprising over one million valid locations in total. migrationR can be installed from a GitHub repository by executing the following command: remotes::install_github("Xinhai-Li/migrationR").

Keywords: bird migration, hetero-occurrences species distribution model, migrationR, R package, satellite telemetry

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17 Reading as Moral Afternoon Tea: An Empirical Study on the Compensation Effect between Literary Novel Reading and Readers’ Moral Motivation

Authors: Chong Jiang, Liang Zhao, Hua Jian, Xiaoguang Wang

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The belief that there is a strong relationship between reading narrative and morality has generally become the basic assumption of scholars, philosophers, critics, and cultural critics. The virtuality constructed by literary novels inspires readers to regard the narrative as a thinking experiment, creating the distance between readers and events so that they can freely and morally experience the positions of different roles. Therefore, the virtual narrative combined with literary characteristics is always considered as a "moral laboratory." Well-established findings revealed that people show less lying and deceptive behaviors in the morning than in the afternoon, called the morning morality effect. As a limited self-regulation resource, morality will be constantly depleted with the change of time rhythm under the influence of the morning morality effect. It can also be compensated and restored in various ways, such as eating, sleeping, etc. As a common form of entertainment in modern society, literary novel reading gives people more virtual experience and emotional catharsis, just as a relaxing afternoon tea that helps people break away from fast-paced work, restore physical strength, and relieve stress in a short period of leisure. In this paper, inspired by the compensation control theory, we wonder whether reading literary novels in the digital environment could replenish a kind of spiritual energy for self-regulation to compensate for people's moral loss in the afternoon. Based on this assumption, we leverage the social annotation text content generated by readers in digital reading to represent the readers' reading attention. We then recognized the semantics and calculated the readers' moral motivation expressed in the annotations and investigated the fine-grained dynamics of the moral motivation changing in each time slot within 24 hours of a day. Comprehensively comparing the division of different time intervals, sufficient experiments showed that the moral motivation reflected in the annotations in the afternoon is significantly higher than that in the morning. The results robustly verified the hypothesis that reading compensates for moral motivation, which we called the moral afternoon tea effect. Moreover, we quantitatively identified that such moral compensation can last until 14:00 in the afternoon and 21:00 in the evening. In addition, it is interesting to find that the division of time intervals of different units impacts the identification of moral rhythms. Dividing the time intervals by four-hour time slot brings more insights of moral rhythms compared with that of three-hour and six-hour time slot.

Keywords: digital reading, social annotation, moral motivation, morning morality effect, control compensation

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16 Transmedia and Platformized Political Discourse in a Growing Democracy: A Study of Nigeria’s 2023 General Elections

Authors: Tunde Ope-Davies

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Transmediality and platformization as online content-sharing protocols have continued to accentuate the growing impact of the unprecedented digital revolution across the world. The rapid transformation across all sectors as a result of this revolution has continued to spotlight the increasing importance of new media technologies in redefining and reshaping the rhythm and dynamics of our private and public discursive practices. Equally, social and political activities are being impacted daily through the creation and transmission of political discourse content through multi-channel platforms such as mobile telephone communication, social media networks and the internet. It has been observed that digital platforms have become central to the production, processing, and distribution of multimodal social data and cultural content. The platformization paradigm thus underpins our understanding of how digital platforms enhance the production and heterogenous distribution of media and cultural content through these platforms and how this process facilitates socioeconomic and political activities. The use of multiple digital platforms to share and transmit political discourse material synchronously and asynchronously has gained some exciting momentum in the last few years. Nigeria’s 2023 general elections amplified the usage of social media and other online platforms as tools for electioneering campaigns, socio-political mobilizations and civic engagement. The study, therefore, focuses on transmedia and platformed political discourse as a new strategy to promote political candidates and their manifesto in order to mobilize support and woo voters. This innovative transmedia digital discourse model involves a constellation of online texts and images transmitted through different online platforms almost simultaneously. The data for the study was extracted from the 2023 general elections campaigns in Nigeria between January- March 2023 through media monitoring, manual download and the use of software to harvest the online electioneering campaign material. I adopted a discursive-analytic qualitative technique with toolkits drawn from a computer-mediated multimodal discourse paradigm. The study maps the progressive development of digital political discourse in this young democracy. The findings also demonstrate the inevitable transformation of modern democratic practice through platform-dependent and transmedia political discourse. Political actors and media practitioners now deploy layers of social media network platforms to convey messages and mobilize supporters in order to aggregate and maximize the impact of their media campaign projects and audience reach.

Keywords: social media, digital humanities, political discourse, platformized discourse, multimodal discourse

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15 Music as Source Domain: A Cross-Linguistic Exploration of Conceptual Metaphors

Authors: Eleanor Sweeney, Chunyuan Di

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The metaphors people use in everyday discourse do not arise randomly; rather, they develop from our physical experiences in our social and cultural environments. Conceptual Metaphor Theory (CMT) explains that through metaphor, we apply our embodied understanding of the physical world to non-material concepts to understand and express abstract concepts. Our most productive source domains derive from our embodied understanding and allow us to develop primary metaphors, and from primary metaphors, an elaborate, creative world of culturally constructed complex metaphors. Cognitive Linguistics researchers draw upon individual embodied experience for primary metaphors. Socioculturally embodied experience through music has long furnished linguistic expressions in diverse languages, as conceptual metaphors or everyday expressions.  Can a socially embodied experience function in the same way as an individually embodied experience in the creation of conceptual metaphors? The authors argue that since music is inherently social and embodied, musical experiences function as a richly motivated source domain. The focus of this study is socially embodied musical experience which is then reflected and expressed through metaphors. This cross-linguistic study explores music as a source domain for metaphors of social alignment in English, French, and Chinese. The authors explored two public discourse sites, Facebook and Linguée, in order to collect linguistic metaphors from three different languages. By conducting this cross-linguistic study, cross-cultural similarities and differences in metaphors for which music is the source domain can be examined. Different musical elements, such as melody, speed, rhythm and harmony, are analyzed for their possible metaphoric meanings of social alignment. Our findings suggest that the general metaphor cooperation is music is a productive metaphor with some subcases, and that correlated social behaviors can be metaphorically expressed with certain elements in music. For example, since performance is a subset of the category behavior, there is a natural mapping from performance in music to behavior in social settings: social alignment is musical performance. Musical performance entails a collective social expectation that exerts control over individual behavior.  When individual behavior does not align with the collective social expectation, music-related expressions are often used to express how the individual is violating social norms. Moreover, when individuals do align their behavior with social norms, similar musical expressions are used. Cooperation is a crucial social value in all cultures, indeed it is a key element of survival, and music provides a coherent, consistent, and rich source domain—one based upon a universal and definitive cultural practice.

Keywords: Chinese, Conceptual Metaphor Theory, cross-linguistic, culturally embodied experience, English, French, metaphor, music

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14 Hypoglossal Nerve Stimulation (Baseline vs. 12 months) for Obstructive Sleep Apnea: A Meta-Analysis

Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Hamza Al-Salhi, Salameh Alarood, Ibraheem Alkhawaldeh, Obada Abunar, Adam Abdallah

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Obstructive sleep apnea (OSA) is a disorder caused by the repeated collapse of the upper airway during sleep. It is the most common cause of sleep-related breathing disorder, as OSA can cause loud snoring, daytime fatigue, or more severe problems such as high blood pressure, cardiovascular disease, coronary artery disease, insulin-resistant diabetes, and depression. The hypoglossal nerve stimulator (HNS) is an implantable medical device that reduces the occurrence of obstructive sleep apnea by electrically stimulating the hypoglossal nerve in rhythm with the patient's breathing, causing the tongue to move. This stimulation helps keep the patient's airways clear while they sleep. This systematic review and meta-analysis aimed to assess the clinical outcome of hypoglossal nerve stimulation as a treatment of obstructive sleep apnea. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until August 2022. Studies assessing the following clinical outcomes (Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Oxygen Desaturation Indices (ODI), (Oxygen Saturation (SaO2)) were pooled in the meta-analysis using Review Manager Software. We assessed the quality of studies according to the Cochrane risk-of-bias tool for randomized trials (RoB2), Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I), and a modified version of NOS for the non-comparative cohort studies.13 Studies (Six Clinical Trials and Seven prospective cohort studies) with a total of 817 patients were included in the meta-analysis. The results of AHI were reported in 11 studies examining OSA 696 patients. We found that there was a significant improvement in the AHI after 12 months of HNS (MD = 18.2 with 95% CI, (16.7 to 19.7; I2 = 0%); P < 0.00001). Further, 12 studies reported the results of ESS after 12 months of intervention with a significant improvement in the range of sleepiness among the examined 757 OSA patients (MD = 5.3 with 95% CI, (4.75 to 5.86; I2 = 65%); P < 0.0001). Moreover, nine studies involving 699 participants reported the results of FOSQ after 12 months of HNS with a significant reported improvement (MD = -3.09 with 95% CI, (-3.41 to 2.77; I2 = 0%); P < 0.00001). In addition, ten studies reported the results of ODI with a significant improvement after 12 months of HNS among the 817 examined patients (MD = 14.8 with 95% CI, (13.25 to 16.32; I2 = 0%); P < 000001). The Hypoglossal Nerve Stimulation showed a significant positive impact on obstructive sleep apnea patients after 12 months of therapy in terms of apnea-hypopnea index, oxygen desaturation indices, manifestations of the behavioral morbidity associated with obstructive sleep apnea, and functional status resulting from sleepiness.

Keywords: apnea, meta-analysis, hypoglossal, stimulation

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13 Explaining Irregularity in Music by Entropy and Information Content

Authors: Lorena Mihelac, Janez Povh

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In 2017, we conducted a research study using data consisting of 160 musical excerpts from different musical styles, to analyze the impact of entropy of the harmony on the acceptability of music. In measuring the entropy of harmony, we were interested in unigrams (individual chords in the harmonic progression) and bigrams (the connection of two adjacent chords). In this study, it has been found that 53 musical excerpts out from 160 were evaluated by participants as very complex, although the entropy of the harmonic progression (unigrams and bigrams) was calculated as low. We have explained this by particularities of chord progression, which impact the listener's feeling of complexity and acceptability. We have evaluated the same data twice with new participants in 2018 and with the same participants for the third time in 2019. These three evaluations have shown that the same 53 musical excerpts, found to be difficult and complex in the study conducted in 2017, are exhibiting a high feeling of complexity again. It was proposed that the content of these musical excerpts, defined as “irregular,” is not meeting the listener's expectancy and the basic perceptual principles, creating a higher feeling of difficulty and complexity. As the “irregularities” in these 53 musical excerpts seem to be perceived by the participants without being aware of it, affecting the pleasantness and the feeling of complexity, they have been defined as “subliminal irregularities” and the 53 musical excerpts as “irregular.” In our recent study (2019) of the same data (used in previous research works), we have proposed a new measure of the complexity of harmony, “regularity,” based on the irregularities in the harmonic progression and other plausible particularities in the musical structure found in previous studies. We have in this study also proposed a list of 10 different particularities for which we were assuming that they are impacting the participant’s perception of complexity in harmony. These ten particularities have been tested in this paper, by extending the analysis in our 53 irregular musical excerpts from harmony to melody. In the examining of melody, we have used the computational model “Information Dynamics of Music” (IDyOM) and two information-theoretic measures: entropy - the uncertainty of the prediction before the next event is heard, and information content - the unexpectedness of an event in a sequence. In order to describe the features of melody in these musical examples, we have used four different viewpoints: pitch, interval, duration, scale degree. The results have shown that the texture of melody (e.g., multiple voices, homorhythmic structure) and structure of melody (e.g., huge interval leaps, syncopated rhythm, implied harmony in compound melodies) in these musical excerpts are impacting the participant’s perception of complexity. High information content values were found in compound melodies in which implied harmonies seem to have suggested additional harmonies, affecting the participant’s perception of the chord progression in harmony by creating a sense of an ambiguous musical structure.

Keywords: entropy and information content, harmony, subliminal (ir)regularity, IDyOM

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12 Multiple Intelligences to Improve Pronunciation

Authors: Jean Pierre Ribeiro Daquila

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This paper aims to analyze the use of the Theory of Multiple Intelligences as a tool to facilitate students’ learning. This theory, proposed by the American psychologist and educator Howard Gardner, was first established in 1983 and advocates that human beings possess eight intelligence and not only one, as defended by psychologists prior to his theory. These intelligence are bodily-kinesthetic intelligence, musical, linguistic, logical-mathematical, spatial, interpersonal, intrapersonal, and naturalist. This paper will focus on bodily-kinesthetic intelligence. Spatial and bodily-kinesthetic intelligences are sensed by athletes, dancers, and others who use their bodies in ways that exceed normal abilities. These are intelligences that are closely related. A quarterback or a ballet dancer needs to have both an awareness of body motions and abilities as well as a sense of the space involved in the action. Nevertheless, there are many reasons which make classical ballet dance more integrated with other intelligences. Ballet dancers make it look effortless as they move across the stage, from the lifts to the toe points; therefore, there is acting both in the performance of the repertoire and in hiding the pain or physical stress. The ballet dancer has to have great mathematical intelligence to perform a fast allegro; for instance, each movement has to be executed in a specific millisecond. Flamenco dancers need to rely as well on their mathematic abilities, as the footwork requires the ability to make half, two, three, four or even six movements in just one beat. However, the precision of the arm movements is freer than in ballet dance; for this reason, ballet dancers need to be more holistically aware of their movements; therefore, our experiment will test whether this greater attention required by ballet dancers makes them acquire better results in the training sessions when compared to flamenco dancers. An experiment will be carried out in this study by training ballet dancers through dance (four years of experience dancing minimum – experimental group 1); a group of flamenco dancers (four years of experience dancing minimum – experimental group 2). Both experimental groups will be trained in two different domains – phonetics and chemistry – to examine whether there is a significant improvement in these areas compared to the control group (a group of regular students who will receive the same training through a traditional method). However, this paper will focus on phonetic training. Experimental group 1 will be trained with the aid of classical music plus bodily work. Experimental group 2 will be trained with flamenco rhythm and kinesthetic work. We would like to highlight that this study takes dance as an example of a possible area of strength; nonetheless, other types of arts can and should be used to support students, such as drama, creative writing, music and others. The main aim of this work is to suggest that other intelligences, in the case of this study, bodily-kinesthetic, can be used to help improve pronunciation.

Keywords: multiple intelligences, pronunciation, effective pronunciation trainings, short drills, musical intelligence, bodily-kinesthetic intelligence

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11 A Multi-Scale Approach to Space Use: Habitat Disturbance Alters Behavior, Movement and Energy Budgets in Sloths (Bradypus variegatus)

Authors: Heather E. Ewart, Keith Jensen, Rebecca N. Cliffe

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Fragmentation and changes in the structural composition of tropical forests – as a result of intensifying anthropogenic disturbance – are increasing pressures on local biodiversity. Species with low dispersal abilities have some of the highest extinction risks in response to environmental change, as even small-scale environmental variation can substantially impact their space use and energetic balance. Understanding the implications of forest disturbance is therefore essential, ultimately allowing for more effective and targeted conservation initiatives. Here, the impact of different levels of forest disturbance on the space use, energetics, movement and behavior of 18 brown-throated sloths (Bradypus variegatus) were assessed in the South Caribbean of Costa Rica. A multi-scale framework was used to measure forest disturbance, including large-scale (landscape-level classifications) and fine-scale (within and surrounding individual home ranges) forest composition. Three landscape-level classifications were identified: primary forests (undisturbed), secondary forests (some disturbance, regenerating) and urban forests (high levels of disturbance and fragmentation). Finer-scale forest composition was determined using measurements of habitat structure and quality within and surrounding individual home ranges for each sloth (home range estimates were calculated using autocorrelated kernel density estimation [AKDE]). Measurements of forest quality included tree connectivity, density, diameter and height, species richness, and percentage of canopy cover. To determine space use, energetics, movement and behavior, six sloths in urban forests, seven sloths in secondary forests and five sloths in primary forests were tracked using a combination of Very High Frequency (VHF) radio transmitters and Global Positioning System (GPS) technology over an average period of 120 days. All sloths were also fitted with micro data-loggers (containing tri-axial accelerometers and pressure loggers) for an average of 30 days to allow for behavior-specific movement analyses (data analysis ongoing for data-loggers and primary forest sloths). Data-loggers included determination of activity budgets, circadian rhythms of activity and energy expenditure (using the vector of the dynamic body acceleration [VeDBA] as a proxy). Analyses to date indicate that home range size significantly increased with the level of forest disturbance. Female sloths inhabiting secondary forests averaged 0.67-hectare home ranges, while female sloths inhabiting urban forests averaged 1.93-hectare home ranges (estimates are represented by median values to account for the individual variation in home range size in sloths). Likewise, home range estimates for male sloths were 2.35 hectares in secondary forests and 4.83 in urban forests. Sloths in urban forests also used nearly double (median = 22.5) the number of trees as sloths in the secondary forest (median = 12). These preliminary data indicate that forest disturbance likely heightens the energetic requirements of sloths, a species already critically limited by low dispersal ability and rates of energy acquisition. Energetic and behavioral analyses from the data-loggers will be considered in the context of fine-scale forest composition measurements (i.e., habitat quality and structure) and are expected to reflect the observed home range and movement constraints. The implications of these results are far-reaching, presenting an opportunity to define a critical index of habitat connectivity for low dispersal species such as sloths.

Keywords: biodiversity conservation, forest disturbance, movement ecology, sloths

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10 The Quantum Theory of Music and Languages

Authors: Mballa Abanda Serge, Henda Gnakate Biba, Romaric Guemno Kuate, Akono Rufine Nicole, Petfiang Sidonie, Bella Sidonie

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The main hypotheses proposed around the definition of the syllable and of music, of the common origin of music and language, should lead the reader to reflect on the cross-cutting questions raised by the debate on the notion of universals in linguistics and musicology. These are objects of controversy, and there lies its interest: the debate raises questions that are at the heart of theories on language. It is an inventive, original and innovative research thesis. The main hypotheses proposed around the definition of the syllable and of music, of the common origin of music and language, should lead the reader to reflect on the cross-cutting questions raised by the debate on the notion of universals in linguistics and musicology. These are objects of controversy, and there lies its interest: the debate raises questions that are at the heart of theories on language. It is an inventive, original and innovative research thesis. A contribution to the theoretical, musicological, ethno musicological and linguistic conceptualization of languages, giving rise to the practice of interlocution between the social and cognitive sciences, the activities of artistic creation and the question of modeling in the human sciences: mathematics, computer science, translation automation and artificial intelligence. When you apply this theory to any text of a folksong of a world-tone language, you do not only piece together the exact melody, rhythm, and harmonies of that song as if you knew it in advance but also the exact speaking of this language. The author believes that the issue of the disappearance of tonal languages and their preservation has been structurally resolved, as well as one of the greatest cultural equations related to the composition and creation of tonal, polytonal and random music. The experimentation confirming the theorization, It designed a semi-digital, semi-analog application which translates the tonal languages of Africa (about 2,100 languages) into blues, jazz, world music, polyphonic music, tonal and anatonal music and deterministic and random music). To test this application, I use a music reading and writing software that allows me to collect the data extracted from my mother tongue, which is already modeled in the musical staves saved in the ethnographic (semiotic) dictionary for automatic translation ( volume 2 of the book). Translation is done (from writing to writing, from writing to speech and from writing to music). Mode of operation: you type a text on your computer, a structured song (chorus-verse), and you command the machine a melody of blues, jazz and world music or variety etc. The software runs, giving you the option to choose harmonies, and then you select your melody.

Keywords: music, entanglement, langauge, science

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9 Working Memory and Audio-Motor Synchronization in Children with Different Degrees of Central Nervous System's Lesions

Authors: Anastasia V. Kovaleva, Alena A. Ryabova, Vladimir N. Kasatkin

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Background: The most simple form of entrainment to a sensory (typically auditory) rhythmic stimulus involves perceiving and synchronizing movements with an isochronous beat with one level of periodicity, such as that produced by a metronome. Children with pediatric cancer usually treated with chemo- and radiotherapy. Because of such treatment, psychologists and health professionals declare cognitive and motor abilities decline in cancer patients. The purpose of our study was to measure working memory characteristics with association with audio-motor synchronization tasks, also involved some memory resources, in children with different degrees of central nervous system lesions: posterior fossa tumors, acute lymphoblastic leukemia, and healthy controls. Methods: Our sample consisted of three groups of children: children treated for posterior fossa tumors (PFT-group, n=42, mean age 12.23), children treated for acute lymphoblastic leukemia (ALL-group, n=11, mean age 11.57) and neurologically healthy children (control group, n=36, mean age 11.67). Participants were tested for working memory characteristics with Cambridge Neuropsychological Test Automated Battery (CANTAB). Pattern recognition memory (PRM) and spatial working memory (SWM) tests were applied. Outcome measures of PRM test include the number and percentage of correct trials and latency (speed of participant’s response), and measures of SWM include errors, strategy, and latency. In the synchronization tests, the instruction was to tap out a regular beat (40, 60, 90 and 120 beats per minute) in synchrony with the rhythmic sequences that were played. This meant that for the sequences with an isochronous beat, participants were required to tap into every auditory event. Variations of inter-tap-intervals and deviations of children’s taps from the metronome were assessed. Results: Analysis of variance revealed the significant effect of group (ALL, PFT and control) on such parameters as short-term PRM, SWM strategy and errors. Healthy controls demonstrated more correctly retained elements, better working memory strategy, compared to cancer patients. Interestingly that ALL patients chose the bad strategy, but committed significantly less errors in SWM test then PFT and controls did. As to rhythmic ability, significant associations of working memory were found out only with 40 bpm rhythm: the less variable were inter-tap-intervals of the child, the more elements in memory he/she could retain. The ability to audio-motor synchronization may be related to working memory processes mediated by the prefrontal cortex whereby each sensory event is actively retrieved and monitored during rhythmic sequencing. Conclusion: Our results suggest that working memory, tested with appropriate cognitive methods, is associated with the ability to synchronize movements with rhythmic sounds, especially in sub-second intervals (40 per minute).

Keywords: acute lymphoblastic leukemia (ALL), audio-motor synchronization, posterior fossa tumor, working memory

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8 Effect of Noise at Different Frequencies on Heart Rate Variability - Experimental Study Protocol

Authors: A. Bortkiewcz, A. Dudarewicz, P. Małecki, M. Kłaczyński, T. Wszołek, Małgorzata Pawlaczyk-Łuszczyńska

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Low-frequency noise (LFN) has been recognized as a special environmental pollutant. It is usually considered a broadband noise with the dominant content of low frequencies from 10 Hz to 250 Hz. A growing body of data shows that LFN differs in nature from other environmental noises, which are at comparable levels but not dominated by low-frequency components. The primary and most frequent adverse effect of LFN exposure is annoyance. Moreover, some recent investigations showed that LFN at relatively low A-weighted sound pressure levels (40−45 dB) occurring in office-like areas could adversely affect the mental performance, especially of high-sensitive subjects. It is well documented that high-frequency noise disturbs various types of human functions; however, there is very little data on the impact of LFN on well-being and health, including the cardiovascular system. Heart rate variability (HRV) is a sensitive marker of autonomic regulation of the circulatory system. Walker and co-workers found that LFN has a significantly more negative impact on cardiovascular response than exposure to high-frequency noise and that changes in HRV parameters resulting from LFN exposure tend to persist over time. The negative reactions of the cardiovascular system in response to LFN generated by wind turbines (20-200 Hz) were confirmed by Chiu. The scientific aim of the study is to assess the relationship between the spectral-temporal characteristics of LFN and the activity of the autonomic nervous system, considering the subjective assessment of annoyance, sensitivity to this type of noise, and cognitive and general health status. The study will be conducted in 20 male students in a special, acoustically prepared, constantly supervised room. Each person will be tested 4 times (4 sessions), under conditions of non-exposure (sham) and exposure to noise of wind turbines recorded at a distance of 250 meters from the turbine with different frequencies and frequency ranges: acoustic band 20 Hz-20 kHz, infrasound band 5-20 Hz, acoustic band + infrasound band. The order of sessions of the experiment will be randomly selected. Each session will last 1 h. There will be a 2-3 days break between sessions to exclude the possibility of the earlier session influencing the results of the next one. Before the first exposure, a questionnaire will be conducted on noise sensitivity, general health status using the GHQ questionnaire, hearing organ status and sociodemographic data. Before each of the 4 exposures, subjects will complete a brief questionnaire on their mood and sleep quality the night before the test. After the test, the subjects will be asked about any discomfort and subjective symptoms during the exposure. Before the test begins, Holter ECG monitoring equipment will be installed. HRV will be analyzed from the ECG recordings, including time and frequency domain parameters. The tests will always be performed in the morning (9-12) to avoid the influence of diurnal rhythm on HRV results. Students will perform psychological tests 15 minutes before the end of the test (Vienna Test System).

Keywords: neurovegetative control, heart rate variability (HRV), cognitive processes, low frequency noise

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7 Yu Kwang-Chung vs. Yu Kwang-Chung: Untranslatability as the Touchstone of a Poet

Authors: Min-Hua Wu

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The untranslatability of an established poet’s tour de force is thoroughly explored by Matthew Arnold (1822-1888). In his On Translating Homer (1861), Arnold lists the four most striking poetic qualities of Homer, namely his rapidity, plainness and directness of style and diction, plainness and directness of ideas, and nobleness. He concludes that such celebrated English translators as Cowper, Pope, Chapman, and Mr. Newman are all doomed, due to their respective failure in rendering the totality of the four Homeric poetic qualities. Why poetic translation always amounts to being proven such a mission impossible for the translator? According to Arnold, it is because there constantly exists a mist interposed between the translator’s own literary self-obsession and the objective artistic qualities that reside in the work of the original author. Foregrounding such a seemingly empowering yet actually detrimental poetic mist, he explains why the aforementioned translators fail in their attempts to bring the Homeric charm to the British reader. Drawing on Arnold’s analytical study on Homeric translation, the research attempts to bring Yu Kwang-chung the poet vis-à-vis Yu Kwang-chung the translator, with an aim not so much to find any similar mist as revealed by Arnold between his Chinese poetry and English translation as to probe into a latent and veiled literary and lingual mist interposed between Chinese and English, if not between Chinese and English literatures. The major work studied and analyzed for this study is Yu’s own Chinese poetry and his own English translation collected in The Night Watchman: Yu Kwang-chung 1958-2004. The research argues that the following critical elements that characterizes Yu’s poetics are to a certain extent 'transformed,' if not 'lost,' in his English translation: a. the Chinese pictographic and ideographic unit terms which so unfailingly characterize the poet’s incredible creativity, allowing him to habitually and conveniently coin concrete textual images or word-scapes almost at his own will; b. the subtle wordplay and punning which appear at a reasonable frequency; c. the parallel contrastive repetitive syntactic structure within a single poetic line; d. the ambiguous and highly associative diction in the adjective and noun categories; e. the literary allusion that harks back to the old times of Chinese literature; f. the alliteration that adds rhythm and smoothness to the lines; g. the rhyming patterns that bring about impressive sonority and lingering echo to the ears of the reader; h. the grandeur-imposing and sublimity-arousing word-scaping which hinges on the employment of verbs; i. the meandering cultural heritage that embraces such elements as Chinese medicine and kung fu; and j. other features of the like. Once we appeal to the Arnoldian tribunal and resort to the strict standards of such a Victorian cultural and literary critic who insists 'to see the object as in itself it really is,' we may serve as a potential judge for the tug of war between Yu Kwang-chung the poet and Yu Kwang-chung the translator, a tug of war that will not merely broaden our understating of Chinese poetics but deepen our apprehension of Chinese-English translatology.

Keywords: Yu Kwang-chung, The Night Watchman, poetry translation, Chinese-English translation, translation studies, Matthew Arnold

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6 Visual Representation of Ancient Chinese Rites with Digitalization Technology: A Case of Confucius Worship Ceremony

Authors: Jihong Liang, Huiling Feng, Linqing Ma, Tianjiao Qi

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Confucius is the first sage in Chinese culture. Confucianism, the theories represented by Confucius, has long been at the core of Chinese traditional society, as the dominating political ideology of centralized feudal monarchy for more than two thousand years. Confucius Worship Ceremony held in the Confucian Temple in Qufu (Confucius’s birthplace), which is dedicated to commemorate Confucius and other 170 elites in Confucianism with a whole set of formal rites, pertains to “Auspicious Rites”, which worship heaven and earth, humans and ghosts. It was first a medium-scaled ritual activity but then upgraded to the supreme one at national level in the Qing Dynasty. As a national event, it was celebrated by Emperor as well as common intellectuals in traditional China. The Ceremony can be solemn and respectful, with prescribed and complicated procedures, well-prepared utensil and matched offerings operated in rhythm with music and dances. Each participant has his place, and everyone follows the specified rules. This magnificent ritual Ceremony, while embedded with rich culture connotation, actually symbolizes the social acknowledgment for orthodox culture represented by Confucianism. Rites reflected in this Ceremony, is one of the most important features of Chinese culture, serving as the key bond in the identification and continuation of Chinese culture. These rites and ritual ceremonies, as culture memories themselves, are not only treasures of China, but of the whole world. However, while the ancient Chinese Rite has been one of the thorniest and most complicated topics for academics, the more regrettable is that due to their interruption in practice and historical changes, these rites and ritual ceremonies have already become a vague language in today’s academic discourse and strange terms of the past for common people. Luckily, we, today, by virtue of modern digital technology, may be able to reproduce these ritual ceremonies, as most of them can still be found in ancient manuscripts, through which Chinese ancestors tell the beauty and gravity of their dignified rites and more importantly, their spiritual pursuits with vivid language and lively pictures. This research, based on review and interpretation of the ancient literature, intends to construct the ancient ritual ceremonies, with the Confucius Worship Ceremony as a case and by use of digital technology. Using 3D technology, the spatial scenes in the Confucian Temple can be reconstructed by virtual reality; the memorial tablet exhibited in the temple by GIS and different rites in the ceremonies by animation technology. With reference to the lyrics, melodies and lively pictures recorded in ancient scripts, it is also possible to reproduce the live dancing site. Also, image rendering technology can help to show the life experience and accomplishments of Confucius. Finally, lining up all the elements in a multimedia narrative form, a complete digitalized Confucius Worship Ceremony can be reproduced, which will provide an excellent virtual experience that goes beyond time and space by bringing its audience back to that specific historical time. This digital project, once completed, will play an important role in the inheritance and dissemination of cultural heritage.

Keywords: Confucius worship ceremony, multimedia narrative form, GIS, visual representation

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5 Effectiveness of Simulation Resuscitation Training to Improve Self-Efficacy of Physicians and Nurses at Aga Khan University Hospital in Advanced Cardiac Life Support Courses Quasi-Experimental Study Design

Authors: Salima R. Rajwani, Tazeen Ali, Rubina Barolia, Yasmin Parpio, Nasreen Alwani, Salima B. Virani

Abstract:

Introduction: Nurses and physicians have a critical role in initiating lifesaving interventions during cardiac arrest. It is important that timely delivery of high quality Cardio Pulmonary Resuscitation (CPR) with advanced resuscitation skills and management of cardiac arrhythmias is a key dimension of code during cardiac arrest. It will decrease the chances of patient survival if the healthcare professionals are unable to initiate CPR timely. Moreover, traditional training will not prepare physicians and nurses at a competent level and their knowledge level declines over a period of time. In this regard, simulation training has been proven to be effective in promoting resuscitation skills. Simulation teaching learning strategy improves knowledge level, and skills performance during resuscitation through experiential learning without compromising patient safety in real clinical situations. The purpose of the study is to evaluate the effectiveness of simulation training in Advanced Cardiac Life Support Courses by using the selfefficacy tool. Methods: The study design is a quantitative research design and non-randomized quasi-experimental study design. The study examined the effectiveness of simulation through self-efficacy in two instructional methods; one is Medium Fidelity Simulation (MFS) and second is Traditional Training Method (TTM). The sample size was 220. Data was compiled by using the SPSS tool. The standardized simulation based training increases self-efficacy, knowledge, and skills and improves the management of patients in actual resuscitation. Results: 153 students participated in study; CG: n = 77 and EG: n = 77. The comparison was done between arms in pre and post-test. (F value was 1.69, p value is <0.195 and df was 1). There was no significant difference between arms in the pre and post-test. The interaction between arms was observed and there was no significant difference in interaction between arms in the pre and post-test. (F value was 0.298, p value is <0.586 and df is 1. However, the results showed self-efficacy scores were significantly higher within experimental group in post-test in advanced cardiac life support resuscitation courses as compared to Traditional Training Method (TTM) and had overall (p <0.0001) and F value was 143.316 (mean score was 45.01 and SD was 9.29) verses pre-test result showed (mean score was 31.15 and SD was 12.76) as compared to TTM in post-test (mean score was 29.68 and SD was 14.12) verses pre-test result showed (mean score was 42.33 and SD was 11.39). Conclusion: The standardized simulation-based training was conducted in the safe learning environment in Advanced Cardiac Life Suport Courses and physicians and nurses benefited from self-confidence, early identification of life-threatening scenarios, early initiation of CPR, and provides high-quality CPR, timely administration of medication and defibrillation, appropriate airway management, rhythm analysis and interpretation, and Return of Spontaneous Circulation (ROSC), team dynamics, debriefing, and teaching and learning strategies that will improve the patient survival in actual resuscitation.

Keywords: advanced cardiac life support, cardio pulmonary resuscitation, return of spontaneous circulation, simulation

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4 Modification of Hyrax Expansion Screw to Be Used as an Intro-Oral Distractor for Anterior Maxillary Distraction in a Patient with Cleft Lip and Palate: A Case Report

Authors: Ananya Hazare, Ranjit Kamble

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Introduction: Patients with Cleft lip and palate (CL/P) can present with a maxillary retrution after cleft repair. Anterior Maxillary distraction osteogenesis (AMD) is a technique that provides simultaneous skeletal advancement and expansion of the soft tissues related to an anterior segment of the maxilla. This case presented is a case of AMD. The advantage of this technique is that the occlusion in the posterior segment can be maintained, and only the segment in cross bite is advanced for correction of the midfacial deficiency. The other alternative treatment is anterior movement by a Lefort 1 osteotomy. When a Lefort 1 osteotomy is compared with the Distraction osteogenesis or AMD, the disadvantages of the Le Fort 1 include a higher risk of morbidity, requirement of fixation, relapse tendency and unexpected changes in the nasal form. These complications were eliminated by AMD technique. This was followed by placement of the implant in the bone formed after AMD. Hence complete surgical, orthodontic and prosthodontics rehabilitation of the patient was done by an interdisciplinary approach. Methods: Patient presented with repaired UCL/P of the right side with midfacial retrusion. Intro-oral examination revealed a good occlusion in the posterior arch and anterior Crossbite from canine to canine. Patient's both maxillary lateral incisors were missing. The lower arch was well aligned with all teeth present. The study models when scored according to GOSLON yardstick received a score of 4. After pre-surgical orthodontic phase was completed an intraoral distractor was fabricated by modification of HYRAX expansion screw. After surgery, low subapical osteotomy cuts were placed and the distractor was fixed. The latency period of 5 days was observed after which the distraction was started. Distraction was done at a rate of 1 mm/day with a rhythm of 0.5mm in morning and 0.5mm in the evening. The total distraction of 12 mm was done. After a consolidation period, the distractor was removed, and retention by a removable partial denture was given. Radiographic examination confirmed mature bone formation in the distracted segment. Implants were placed and allowed to osseointegrate for approximately 4 months and were then loaded with abutments. Results: Total distraction done was 12mm and after relapse it was 8mm. After consolidation phase the radiographic examination revealed a B2 quality of bone according to the Misch's classification and sufficient height from the maxillary sinus. These findings were indicative for placement of implants in the distracted bone formed in premolar region. Implants were placed and after radiographic evidence of osseointegration was seen they were loaded with abutments. Thus resulting in a complete rehabilitation of a cleft patient by an interdisciplinary approach. Conclusion: Anterior maxillary distraction can be used as an alternative method instead of complete distraction osteogenesis or Lefort 1 advancement of maxilla in cases where the advancement needed is minimum. Use of HYRAX expansion screw modified as intra-oral distractor can be used in such cases, which significantly reduces the cost of treatment, as expensive distractors are not used. This technique is very useful and efficient in countries like India where the patient cannot afford expensive treatment options.

Keywords: cleft lip and palate, distraction osteogenesis, anterior maxillary distraction, orthodontics and dentofacial orthopaedics, hyrax expansion screw modification

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3 Sustainable Urban Regenaration the New Vocabulary and the Timless Grammar of the Urban Tissue

Authors: Ruth Shapira

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Introduction: The rapid urbanization of the last century confronts planners, regulatory bodies, developers and most of all the public with seemingly unsolved conflicts regarding values, capital, and wellbeing of the built and un-built urban space. There is an out of control change of scale of the urban form and of the rhythm of the urban life which has known no significant progress in the last 2-3 decades despite the on-growing urban population. It is the objective of this paper to analyze some of these fundamental issues through the case study of a relatively small town in the center of Israel (Kiryat-Ono, 36,000 inhabitants), unfold the deep structure of qualities versus disruptors, present some cure that we have developed to bridge over and humbly suggest a practice that may bring about a sustainable new urban environment based on timeless values of the past, an approach that can be generic for similar cases. Basic Methodologies:The object, the town of Kiryat Ono, shall be experimented upon in a series of four action processes: De-composition, Re-composition, the Centering process and, finally, Controlled Structural Disintegration. Each stage will be based on facts, analysis of previous multidisciplinary interventions on various layers – and the inevitable reaction of the OBJECT, leading to the conclusion based on innovative theoretical and practical methods that we have developed and that we believe are proper for the open ended network, setting the rules for the contemporary urban society to cluster by – thus – a new urban vocabulary based on the old structure of times passed. The Study: Kiryat Ono, was founded 70 years ago as an agricultural settlement and rapidly turned into an urban entity. In spite the massive intensification, the original DNA of the old small town was still deeply embedded, mostly in the quality of the public space and in the sense of clustered communities. In the past 20 years, the recent demand for housing has been addressed to on the national level with recent master plans and urban regeneration policies mostly encouraging individual economic initiatives. Unfortunately, due to the obsolete existing planning platform the present urban renewal is characterized by pressure of developers, a dramatic change in building scale and widespread disintegration of the existing urban and social tissue.Our office was commissioned to conceptualize two master plans for the two contradictory processes of Kiryat Ono’s future: intensification and conservation. Following a comprehensive investigation into the deep structures and qualities of the existing town, we developed a new vocabulary of conservation terms thus redefying the sense of PLACE. The main challenge was to create master plans that should offer a regulatory basis to the accelerated and sporadic development providing for the public good and preserving the characteristics of the place consisting of a tool box of design guidelines that will have the ability to reorganize space along the time axis in a sustainable way. In conclusion: The system of rules that we have developed can generate endless possible patterns making sure that at each implementation fragment an event is created, and a better place is revealed. It takes time and perseverance but it seems to be the way to provide a healthy and sustainable framework for the accelerated urbanization of our chaotic present.

Keywords: sustainable urban design, intensification, emergent urban patterns, sustainable housing, compact urban neighborhoods, sustainable regeneration, restoration, complexity, uncertainty, need for change, implications of legislation on local planning

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2 The Procedural Sedation Checklist Manifesto, Emergency Department, Jersey General Hospital

Authors: Jerome Dalphinis, Vishal Patel

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The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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1 Musictherapy and Gardentherapy: A Systemic Approach for the Life Quality of the PsychoPhysical Disability

Authors: Adriana De Serio, Donato Forenza

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Aims. In this experimental research the Authors present the methodological plan “Musictherapy and Gardentherapy” that they created interconnected with the garden landscape ecosystems and aimed at PsychoPhysical Disability (MusGarPPhyD). In the context of the environmental education aimed at spreading the landscape culture and its values, it’s necessary to develop a solid perception of the environment sustainability to implement a multidimensional approach that pays attention to the conservation and enhancement of gardens and natural environments. The result is an improvement in the life quality also in compliance with the objectives of the European Agenda 2030. The MusGarPPhyD can help professionals such as musictherapists and environmental and landscape researchers strengthen subjects' motivation to learn to deal with the psychophysical discomfort associated with disability and to cope with the distress and the psychological fragility and the loneliness and the social seclusion and to promote productive social relationships. Materials and Methods. The MusGarPPhyD was implemented in multiple spaces. The musictherapy treatments took place first inside residential therapeutic centres and then in the garden landscape ecosystem. Patients: twenty, set in two groups. Weekly-sessions (50’) for three months. Methodological phases: - Phase P1. MusicTherapy treatments for each group in the indoor spaces. - Phase P2. MusicTherapy sessions inside the gardens. After each Phase, P1 and P2: - a Questionnaire for each patient (ten items / liking-indices) was administrated at t0 time, during the treatment and at tn time at the end of the treatment. - Monitoring of patients' behavioral responses through assessment scales, matrix, table and graph system. MusicTherapy methodology: pazient Sonorous-Musical Anamnesis, Musictherapy Assessment Document, Observation Protocols, Bodily-Environmental-Rhythmical-Sonorous-Vocal-Energy production first indoors and then outside, sonorous-musical instruments and edible instruments made by the Author/musictherapist with some foods; Administration of Patient-Environment-Music Index at time to and tn, to estimate the patient’s behavior evolution, Musictherapeutic Advancement Index. Results. The MusGarPPhyD can strengthen the individual sense of identity and improve the psychophysical skills and the resilience to face and to overcome the difficulties caused by the congenital /acquired disability. The multi-sensory perceptions deriving from contact with the plants in the gardens improve the psychological well-being and regulate the physiological parameters such as blood pressure, cardiac and respiratory rhythm, reducing the cholesterol levels. The secretions of the peptide hormones endorphins and the endogenous opioids enkephalins increase and bring a state of patient’s tranquillity and a better mood. The subjects showed a preference for musictherapy treatments within a setting made up of gardens and peculiar landscape systems. This resulted in greater health benefits. Conclusions. The MusGarPPhyD contributes to reduce psychophysical tensions, anxiety, depression and stress, facilitating the connections between the cerebral hemispheres, thus also improving intellectual performances, self-confidence, motor skills and social interactions. Therefore it is necessary to design hospitals, rehabilitation centers, nursing homes, surrounded by gardens. Ecosystems of natural and urban parks and gardens create fascinating skyline and mosaics of landscapes rich in beauty and biodiversity. The MusGarPPhyD is useful for the health management promoting patient’s psychophysical activation, better mood/affective-tone and relastionships and contributing significantly to improving the life quality.

Keywords: musictherapy, gardentherapy, disability, life quality

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