Search results for: rehabilitation inpatient

Authors: S. Abbasi, M. R. Hadian, M. Abdolvahab, M. Jalili, S. H. Jalaei

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Background: Rehabilitation treatments have significant role in reducing the disabilities of Cerebro Vascular Accident (CVA). Due to great role of upper limb in the function of individuals particularly in Activity of Daily Living and the effect of stability of shoulder girdle on hand function, the aim of this study was to study the effects of Progressive Resistive Exercise on shoulder extensor and abductor muscles isometric strengths in adult hemiplegic. Methods: 17 adult hemiplegics patients (50-70 yrs., mean 60/52, SD7/22); with RT side dominancy and 6 months after stroke, participated in this study. All procedures were approved by ethical committee of TUMS and written consents were also taken. Patients were familiarized with the procedure and shoulder extensor and abductor muscles isometric strengths were measured by dynamometer. Results: according to result to our study, shoulder extensor and abductor muscles isometric strengths showed Significant differences between mean scores of pre and post intervention (P<0/05). Progressive Resistive Exercise improved 34% shoulder extensor muscles isometric strength and 27% shoulder abductor muscle isometric strength. Conclusion: Results of our research showed that progressive resistive exercise approach is a useful method for increasing the isometric strength of shoulder extensor and abductor muscles. Therefore, it might be concluded that improvement of strength of shoulder muscles could result in stability in shoulder girdle and consequently might effect on hand function in hemiplegic patients.

Keywords: shoulder extensor muscles isometric strength, shoulder abductor muscles isometric strength, hemiplegic, physical therapy

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Authors: Zeyad Suleiman Bataineh

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Introduction: civilian wars are associated with severe humanitarian effects that include loss of individuals and properties. Psychological dimensions are also included depression. Objectives: the main objectives of the present study were to investigate the depression level among Syrian patients who visited internal medicine clinics and other related variables. Methods and subjects: this study was conducted based on cross sectional study design. A total of 175 patients were involved. Patients were asked to fill a questionnaire to assess the level of depression that include demographic variables such as gender, age, educational level, and social status. Beck Aaron scale for depression was used. Participation in this study was voluntary, and all patients were informed about their rights to withdraw from the study without being negatively affected. Data were entered into excel spreading sheet for all participants. SPSS version 21 was used to analyze data. Data were described as means, the standard deviation for linear variables, frequencies, and percentages for categorical variables. The relationships between variables were evaluated using independent t test and One Way ANOVA test. Significance was considered at α≤0.05. Results: Depression was found in 152 (87%) of participants. The majority of participants with depression had moderate to severe depression. Depression was significantly associated gender, age, educational level, and social status (p<0.05). Conclusion: psychological rehabilitation is required for patients who experienced civilian wars.

Keywords: mental health, deprssion, health system, psychological dimension

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Authors: Mihail Nagea, Olivera Lupescu, Elena Taina Avramescu, Cristina Patru

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Classical education of orthopedic surgeons involves lectures, self study, workshops and cadaver dissections, and sometimes supervised practical training within surgery, which quite seldom gives the young surgeons the feeling of being unable to apply what they have learned especially in surgical practice. The purpose of this paper is to present a different approach from the classical one, which enhances the practical skills of the orthopedic trainees and prepare them for future practice. The paper presents the content of the research project 2015-1-RO01-KA202-015230, ERASMUS+ VET ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery’ which, using e learning as a basic tool , delivers to the trainees not only courses, but especially practical information through videos and case scenarios including gait analysis in order to build patient focused therapeutic plans, adapted to the characteristics of each patient. The outcome of this project is to enhance the practical skills in orthopedic surgery and the results are evaluated following the answers to the questionnaires, but especially the reactions within the case scenarios. The participants will thus follow the idea that any mistake within solving the cases might represent a failure of treating a real patient. This modern approach, besides using interactivity to evaluate the theoretical and practical knowledge of the trainee, increases the sense of responsibility, as well as the ability to react properly in real cases.

Keywords: interdisciplinary approach, gait analysis, orthopedic surgery, vocational training

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Authors: Thamer Kubat, Riadh Al-Mahaidi, Ahmad Shayan

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The alkali-aggregate reaction (AAR) in concrete has a negative influence on the mechanical properties and durability of concrete. Confinement by carbon fibre-reinforced polymer (CFRP) is an effective method of treatment for some AAR-affected elements. Eighteen reinforced columns affected by different levels of expansion due to AAR were confined using CFRP to evaluate the effect of expansion level on confinement efficiency. Strength and strain capacities (axial and circumferential) were measured using photogrammetry under uniaxial compressive loading to evaluate the efficiency of CFRP wrapping for the rehabilitation of affected columns. In relation to uniaxial compression capacity, the results indicated that the confinement of AAR-affected columns by one layer of CFRP is sufficient to reach and exceed the load capacity of unaffected sound columns. Parallel to the experimental study, finite element (FE) modeling using ATENA software was employed to predict the behavior of CFRP-confined damaged concrete and determine the possibility of using the model in a parametric study by simulating the number of CFRP layers. A comparison of the experimental results with the results of the theoretical models showed that FE modeling could be used for the prediction of the behavior of confined AAR-damaged concrete.

Keywords: carbon fiber reinforced polymer (CFRP), finite element (FE), ATENA, confinement efficiency

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Authors: Mutavhatsindi Tshinakaho

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Invasive alien plants (IAP’s) are referred to as species that are non-native to the ecosystem under consideration. Whose introduction causes or is likely to cause economic, ecological, or environmental harm. The integrated management of the invasive plant, Tithonia diversifolia, will be assessed through two herbicide trials (one on the seedlings and the other on matured plants) and a competitive trial between Tithonia and invasive grass species. The initial herbicide trial will be undertaken at the University of Venda Agricultural greenhouse facilities, where Tithonia will be planted in pot plants and watered every after two days until they reach at least 30 cm and will then be subjected to four different herbicide treatments (Metsulfuron methyl, Fluroxypyr, Picloram, Triclopyr), water will be utilised as a control. The percentage damage to foliar will be recorded. The second herbicide trial will be undertaken at Levubu road site, where matured Tithonia will be cut at at least 10cm above the ground and the subjected to herbicide treatments (Picloram, Fluroxypyr, Imazapyr, and Water as a control). The site will be visited post treatment for assessment. For the competition trial, tall grass species will be chosen as competitors (Panicum maximum and Eragrostis murvula), they will be grown at six densities per pot in the greenhouse facilities at the University of Venda, were they will be kept watered for the duration of the experiment. At the end of the experiment, plants will be removed from pots, and the above and below ground biomass will be weighed. The expected results are to know the effective integrated management strategy for T. diversifolia, the effective rehabilitation of T. diversifolia invaded habitats, and the effective chemical control of T. diversifolia

Keywords: foliar, biomass, competition, invasion

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Authors: Narupon Kunbootsri, P. Sirasaporn

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Frozen shoulder is a common problem present by pain and limit range of motion. The prevalence of frozen shoulder showed 18-31% of population. The effect of frozen shoulder lead to limit activities daily living life, high medical care cost and so on. Physiotherapy is one of the treatments for frozen shoulder but there was no data about the treatment of physiotherapy. Moreover, it is question about onset of symptom relate to physiotherapy program and obtaining physical modalities and delayed start physiotherapy program lead to delayed improvement. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder relate to onset of symptom, range of motion and obtaining physical modalities. A retrospective study design was conducted. 182 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of onset of symptom, range of motion and obtaining physical modalities were recorded. There was a statistically significant increase in shoulder flexion [mean difference 38.88 with 95%CI were [16.00-61.77], shoulder abduction [mean difference 48.47 with 95%CI were 16.07-90.59], shoulder internal rotation [mean difference 22.36 with 95%CI were 2.81-37.18] and shoulder external rotation [mean difference 32.12 with 95%CI were [(-2.47)-(46.91)]. In addition, the onset of symptom was 76.42±46.90 days. And the physical modalities used frequently were hot pack 14.8% and ultrasound diathermy 13.7%. In conclusion, the physiotherapy program including, hot pack and ultrasound diathermy seem to be useful for frozen shoulder. But onset of symptom is too long to start physiotherapy programs.

Keywords: frozen shoulder, range of motions, onset of symptom, physiotherapy, physical modality

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Authors: Basanta Raj Adhikari

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Large and small scale earthquakes are frequent in the Nepal, Himalaya, and many co-seismic landslides are resulted out of it. Recently, Gorkha earthquake-2015 has triggered many co-seismic landslides destroying many lives and properties. People have displaced their original places due to having many cracks and unstable ground. Therefore, Nepal has been adopting a pronged development strategy to address the earthquake issues through reconstruction and rehabilitation policy, plans and budgets. Landslides are major threat for the mountain livelihood, and it is very important to investigate and mitigate to improve human wellbeing factoring in considerations of economic growth, environmental safety, and sustainable development. Community based landslide investigation was carried with the involvement of the local community in the Sindhupalchowk District of Central Nepal. Landslide training and field orientation were the major methodological approach of this study. Combination of indigenous and modern scientific knowledge has created unique working environment which enhanced the local capacity and trained people for replication. Local topography of the landslide was created with the help of Total Station and bill of quantity was derived based on it. River training works, plantation of trees and grasses, support structures, surface and sub-surface drainage management are the recommended mitigative measures. This is a very unique example of how academia and local community can work together for sustainable development by reducing disaster risk at the local level with very low-cost technology.

Keywords: community, earthquake, landslides, Nepal

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Authors: Mohammad Abdullah Almalki

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Background: Despite the frequent usage of ankle arthroscopy, there is limited medical literature regarding its indications, patterns of admissions, surgical outcomes, and associated complicated at Saudi Arabia. Hence, this study would highlight the surgical outcomes of such surgical approach that will assist orthopedic surgeons to detect which surgical procedure needs to be done as well as to help them regarding their diagnostic workups. Methods: At the Orthopedic Division of King Abdul‑Aziz Medical City in Riyadh and through a cross‑sectional design and convenient sampling techniques, the present study had recruited 20 subjects who fulfill the inclusion and exclusion criteria between 2016 and 2018. Data collection was carried out by a questionnaire designed and revised by an expert panel of health professionals. Results: Twenty patients were reviewed (11M and 9F) with an average age of 40.1 ± 12.2. Only 30% of the patients (5M, 1F) have no comorbidity, but 70% of patients (7M, 8F) were having at least one comorbidity. The most common indications were osteochondritis dissecans (n = 7, 35%), ankle fracture without dislocation (n = 4, 20%), and tibiotalar impingement (n = 3, 15%). Patients recorded pain in all cases (100%). The top four symptoms after pain were instability (30%, n = 6), muscle weakness (15%, n = 3) swelling (15%, n = 3), and stiffness (5%, n = 1). Two‑third of cases reached to their full healthy status and toe‑touch weight‑bearing was seen in two patients (10%). Conclusion: Ankle arthroscopy improved the rehabilitation rates in our tertiary care center. In addition, the surgical outcomes are favorable in our hospital since it has a very short length of stay, unexpended surgery, and fewest physiotherapy sessions.

Keywords: ankle, arthroscopy, indications, patterns

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Authors: Mohammad Ali Fteiha, Ghanem Al Bustami

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The study aimed to identify the assessment of parents of children with Autism for services provided by the Center for special care in the United Arab Emirates, in terms of quality, comprehensive and the impact of some factors related to the diagnosis and place of service provision and efficient working procedures of service and the child age. In order to achieve the objective of the study, researchers used Parent’s Satisfaction Scale, and Parents Evaluation of Services Effectiveness, both the scale and the parents reports provided with accepted level of validity and reliability. Sample includes 300 families of children with Autism receiving educational and rehabilitation services, treatment and support services in both governmental and private centers in United Arab Emirates. ANOVA test was used through SPSS program to analyze the collected data. The results of the study have indicated that there are significant differences in the assessment of services provided by centers due to a place of service, the nature of the diagnosis, child's age at the time of the study, as well as statistically significance differences due to age when first diagnosed. The results also showed positive evaluation for the good level of services as international standard, and the quality of these services provided by autism centers in the United Arab Emirates, especially in governmental centers. At the same time, the results showed the presence of many needs problems faced by the parents do not have appropriate solutions. Based on the results the recommendations were stated.

Keywords: autism, evaluation, diagnosis, parents, autism programs, supportive services, government centers, private centers

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Authors: Joseph Salim

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This paper proposes the development of a supervised machine learning system to predict the consequences of untreated bruxism (teeth grinding) on gingival (gum) recession and jaw pain (most often bilateral jaw pain with possible headaches and limited ability to open the mouth). As a general dentist in a multi-specialty practice, the author has encountered many patients suffering from these issues due to uncontrolled bruxism (teeth grinding) at night. The most effective treatment for managing this problem involves wearing a nightguard during sleep and receiving therapeutic Botox injections to relax the muscles (the masseter muscle) responsible for grinding. However, some patients choose to postpone these treatments, leading to potentially irreversible and costlier consequences in the future. The proposed machine learning model aims to track patients who forgo the recommended treatments and assess the percentage of individuals who will experience worsening jaw pain, gingival (gum) recession, or both within a 3-to-5-year timeframe. By accurately predicting these outcomes, the model seeks to motivate patients to address the root cause proactively, ultimately saving time and pain while improving quality of life and avoiding much costlier treatments such as full-mouth rehabilitation to help recover the loss of vertical dimension of occlusion due to shortened clinical crowns because of bruxism, gingival grafts, etc.

Keywords: artificial intelligence, machine learning, predictive insights, bruxism, teeth grinding, therapeutic botox, nightguard, gingival recession, gum recession, jaw pain

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

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

Keywords: disability, flexibility, rehabilitation, quality of life

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Authors: Adriano Mortada

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Human history is rife with conflict, and the question of refugee status determination and their rehabilitation has been up for debate since. Refugee Status Determination is the administrative or legal process by which UNHCR or governments determine whether a person seeking international protection or asylum can be identified as a refugee under international, regional, or national law. Refugee Status Determination is considered to be a vital process in aiding refugees’ realization of their rights under international law. One of the major reasons why the refugee status determination is considered an “issue”, and is one that is much debated upon annually, is the fact that the national bureaucratic systems are rigid and unbending. This is particularly concerning in the 21st century despite human advancement in policy and diplomacy, working in tandem with the United Nations and their charters and resolutions on human rights and dignity. The paper seeks to criticize the European member states' response to the refugee crisis and their inflexible and prejudiced bureaucratic systems when it comes to refugee status determination. The paper looks at multiple case studies as primary evidence and the alternate case studies where the system helped refugees, like those in Jordan, Pakistan, Turkey, and Lebanon. The main concern of the paper is to highlight the bias in the selected European systems, which do not stem from the Human Rights Charter but rather on the basis of geographical backgrounds, cultural and religious affiliations of those seeking refugee status or asylum in their respective countries. The paper hopes to not only create awareness about this issue but also provide a research background to advocacy programs to bring a change in the systems.

Keywords: refugee status determination, human rights, bureaucracy, United Nations, European Union

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Authors: Akankunda Veronicah Karuhanga

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Dementia is an age mental disorder that makes victims lose normal functionality that needs delicate attention. It has been technically defined as a clinical syndrome that presents a number of difficulties in speech and other cognitive functions that change someone’s behaviors and can also cause impairments in activities of daily living, not forgetting a range of neurological disorders that bring memory loss and cognitive impairment. Family members are the primary healthcare givers and therefore, the way how they handle the situation in its early stages determines future deterioration syndromes like total memory loss. Unfortunately, most family members are ignorant about this condition and in most cases, the patients are brought to our facilities when their condition was already mismanaged by family members and we thus cannot do much. For example, incontinence can be managed at early stages through potty training or toilet scheduling before resorting to 24/7 diapers which are also not good. Professional Elderly care should be understood and practiced as an extension of homes, not a dumping place for people considered “abnormal” on account of ignorance. Immediate relatives should therefore be sensitized concerning the normalcy of dementia in the context of old age so that they can be understanding and supportive of dementia patients rather than discriminating against them as present-day lepers. There is a need to skill home-based caregivers on how to handle dementia in its early stages. Unless this is done, many of our elderly homes shall be filled with patients who should have been treated and supported from their homes. This skilling of home-based caregivers is a vital intervention because until elderly care is appreciated as a human moral obligation, many transactional rehabilitation centers will crop up and this shall be one of the worst moral decadences of our times.

Keywords: dementia, family, Alzheimers, relevancy

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Authors: Mohammadreza Baradaran, F. Hamzezarghani

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Every year in different points of the world it occurs with different strengths and thousands of people lose their lives because of this natural phenomenon. One of the reasons for destruction of buildings because of earthquake in addition to the passing of time and the effect of environmental conditions and the wearing-out of a building is changing the uses of the building and change the structure and skeleton of the building. A large number of structures that are located in earthquake bearing areas have been designed according to the old quake design regulations which are out dated. In addition, many of the major earthquakes which have occurred in recent years, emphasize retrofitting to decrease the dangers of quakes. Retrofitting structural quakes available is one of the most effective methods for reducing dangers and compensating lack of resistance caused by the weaknesses existing. In this article the foundation of a five-floor steel building with the moment frame system has been evaluated for quakes and the effect of adding a floor to this five-floor steel building has been evaluated and analyzed. The considered building is with a metallic skeleton and a piled roof and clayed block which after addition of a floor has increased to a six-floor foundation of 1416 square meters, and the height of the sixth floor from ground state has increased 18.95 meters. After analysis of the foundation model, the behavior of the soil under the foundation and also the behavior of the body or element of the foundation has been evaluated and the model of the foundation and its type of change in form and the amount of stress of the soil under the foundation for some of the composition has been determined many times in the SAFE software modeling and finally the need for retrofitting of the building's foundation has been determined.

Keywords: seismic, rehabilitation, steel building, foundation

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Authors: Nassim Salmi

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This study aimed to identify the administrative, social, cultural, economic and psychological challenges facing the nursing s ector in the Tebessa Algeria. It also seeks to identify whether there are differences between the opinions of managers in public and private hospitals about these challenges. To achieve the objectives of the study, the descriptive analytical method was adopted. The study also used the questionnaire as a tool for collecting the necessary data and information, which was applied to a sample of directors of public and private hospitals in the Tebessa, which amounted to (114) individuals. The study reached a set of results, including: that there are no statistically significant differences between the opinions of managers in public and private hospitals about the administrative, social, cultural, economic and psychological challenges facing the nursing sector in the Tebessa . The results also showed agreement between the views of managers in private public hospitals that the most important administrative challenges are the lack of training programs that affect the efficiency and performance of nursing work, and that the most important social and cultural challenges are the hospital’s failure to provide suitable nurseries for Saudi female nurses, and that the most important economic challenges are the lack of Availability of medical equipment and devices, and the most important psychological challenge is the tense relationship between the administration and the hospital's nursing staff. The study recommended focusing on the importance of rehabilitation and training together, activating the role of training in the ministry and making it compulsory and a condition of renewal for practicing and continuing the nursing profession, and providing the social and economic needs of the nursing staff.

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: Hesham Abd Elkhalek, Sherif M. Hafez, Yasser M. El Fahham

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Allocating limited budget to maintain bridge networks and selecting effective maintenance strategies for each bridge represent challenging tasks for maintenance managers and decision makers. In Egypt, bridges are continuously deteriorating. In many cases, maintenance works are performed due to user complaints. The objective of this paper is to develop a practical and reliable framework to manage the maintenance, repair, and rehabilitation (MR&R) activities of Bridges network considering performance and budget limits. The model solves an optimization problem that maximizes the average condition of the entire network given the limited available budget using Genetic Algorithm (GA). The framework contains bridge inventory, condition assessment, repair cost calculation, deterioration prediction, and maintenance optimization. The developed model takes into account multiple parameters including serviceability requirements, budget allocation, element importance on structural safety and serviceability, bridge impact on network, and traffic. A questionnaire is conducted to complete the research scope. The proposed model is implemented in software, which provides a friendly user interface. The framework provides a multi-year maintenance plan for the entire network for up to five years. A case study of ten bridges is presented to validate and test the proposed model with data collected from Transportation Authorities in Egypt. Different scenarios are presented. The results are reasonable, feasible and within acceptable domain.

Keywords: bridge management systems (BMS), cost optimization condition assessment, fund allocation, Markov chain

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Authors: Savaş Durduran, Ceren Yağci

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The nature of the events going on in the world, when people’s lives are considered significantly affects natural disasters. Considering thousands of years of earth history, it is seen that many natural disasters, particularly earthquakes located in our country. Behaving cautious, without occurring hazards, after being disaster is much easier and cost effective than returning to the normal life. The four phases of disaster management in the whole world has been described as; pre-disaster preparedness and mitigation, post-disaster response and rehabilitation studies. Pre-disaster and post-disaster phases has half the weight of disaster management. How much would be prepared for disaster, no matter how disaster damage reducing work gives important, we will be less harm from material and spiritual sense. To do this in a systematic way we use the Geographic Information Systems (GIS). The execution of the emergency services to be on time and emergency control mechanism against the development the most appropriate decision Geographic Information System GIS) can be useful. The execution of the emergency services to be on time and emergency control mechanism towards for developing to be the most appropriate decision Geographic Information System (GIS) can be useful. The results obtained by using products with GIS analysis of seismic data to the city, manager of the city required information and data that can be more healthy and satisfies the appropriate policy decisions can be produced. In this study, using ArcGIS software and benefiting reports of the earthquake that occurred in the Konya city, spatial and non-spatial data consisting databases created, by the help of this database a potential disaster management aimed in the city of Konya regard to urban earthquake, GIS-aided analyzes were performed.

Keywords: geographic information systems (GIS), disaster management, emergency control mechanism, Konya

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Authors: Özgür Öztürk, Cumhur Sipahi, Hande Yeşil

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Implant retained restorations commonly consist of a metal-framework veneered with ceramic or composite facings. The increasing and expanding use of indirect resin composites in dentistry is a result of innovations in materials and processing techniques. Of special interest to the implant restorative field is the possibility that composites present significantly lower peak vertical and transverse forces transmitted at the peri-implant level compared to metal-ceramic supra structures in implant-supported restorations. A 43-year-old male patient referred to the department of prosthodontics for an implant retained fixed prosthesis. The clinical and radiographic examination of the patient demonstrated the presence of an implant in the right mandibular first molar tooth region. A considerable amount of marginal bone loss around the implant was detected in radiographic examinations combined with a remarkable peri-implant soft tissue deficiency. To minimize the chewing loads transmitted to the implant-bone interface it was decided to fabricate an indirect composite resin veneered single metal crown over a screw-retained abutment. At the end of the treatment, the functional and aesthetic deficiencies were fully compensated. After a 6 months clinical and radiographic follow-up period the not any additional pathologic invasion was detected in the implant-bone interface and implant retained restoration did not reveal any vehement complication.

Keywords: dental implant, fixed partial dentures, indirect composite resin, peri-implant defects

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Authors: Sameen Masood, Muhammad Ali Jibran

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The frequent flood history in Pakistan has pronounced the need for disaster risk management. Various policies are formulated and steps are being taken by the government in order to cope with the flood effects. However, a much promising pro-active approach that is globally acknowledged is educating the masses regarding living with risk and uncertainty. Unfortunately, majority of the flood victims in Pakistan are poor and illiterate which also transpires as a significant cause of their distress. An illiterate population is not risk averse or equipped intellectually regarding how to prepare and protect against natural disasters. The current research utilizes a cross-disciplinary approach where the role of education (both formal and informal) and indigenous knowledge is explored with reference to disaster preparedness. The data was collected from the flood prone rural areas of Punjab. In the absence of disaster curriculum taught in formal schools, informal education disseminated by NGOs and relief and rehabilitation agencies was the only education given to the flood victims. However the educational attainment of flood victims highly correlated with their awareness regarding flood management and disaster preparedness. Moreover, lessons learned from past flood experience generated indigenous knowledge on the basis of which flood victims prepared themselves for any uncertainty. If the future policy regarding disaster preparation integrates indigenous knowledge and then delivers education on the basis of that, it is anticipated that the flood devastations can be much reduced. Education can play a vital role in amplifying perception of risk and taking precautionary measures for disaster. The findings of the current research will provide practical strategies where disaster preparedness through education has not yet been applied.

Keywords: education, disaster preparedness, illiterate population, risk management

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Authors: B. Kenny, M. Dixon, A. Boshell

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The use of alcoholic surgical prep was recently introduced into the Royal Newcastle Center for elective procedures. In the past 3 months there have been a significant number of burns believed to be related to ‘pooling’ of this surgical prep in patients undergoing procedures where they are placed in the lateral position with hip bolsters. The aim of the audit was to determine the reason for the burns, analyze what pre-existing factors may contribute to the development of the burns and what can be changed to prevent further burns occurring. All patients undergoing a procedure performed on the hip who were placed in the lateral position with sacral and anterior, superior iliac spine (ASIS) support with ‘bolsters’ were included in the audit. Patients who developed a ‘burn’ were recorded, details of the surgery, demographics, surgical prep used and length of surgery were obtained as well as photographs taken to document the burn. Measures were then taken to prevent further burns and the efficacy was documented. Overall 14 patients developed burns over the ipsilateral ASIS. Of these, 13 were Total Hip Arthroplasty (THA) and 1 was a removal of femoral nail. All patients had Chlorhexidine 0.5% in Alcohol 70% Tinted Red surgical preparation or Betadine Alcoholic Skin Prep (70% etoh). Patients were set up in the standard lateral decubitus position with sacral and bilateral ASIS bolsters with a valband covering. 86% of patients were found to have pre-existing hypersensitivities to various substances. There is very little literature besides a few case reports on surgical prep-related burns. The case reports that do exist are related to the use of tourniquet-related burns and there is no mention in the literature examining ‘bolster’ related burns. The burns are hypothesized to be caused by pooling of the alcoholic solution which is amplified by the use of Valband.

Keywords: arthroplasty, chemical burns, wounds, rehabilitation

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Authors: Jumel Christian P. Nicha, Severino G. Salmo III

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This study investigated the concentration of heavy metals (HM) in mangrove sediments of Lake Uacon, Zambales, Philippines. The relationship among the studied HM (Cr, Ni, Pb, Cu, Cd, Fe) and the mangrove vegetation and sediment characteristics were assessed. Fourteen sampling plots were designated across the lake (10 vegetated and 4 un-vegetated) based on distance from the mining effluents. In each plot, three sediment cores were collected at 20 cm depth. Among the dominant mangrove species recorded were (in order of dominance): Sonneratia alba, Rhizophora stylosa, Avicennia marina, Excoecaria agallocha and Bruguiera gymnorrhiza. Sediment samples were digested with aqua regia, and the HM concentrations were quantified using Atomic Absorption Spectroscopy (AAS). Results showed that HM concentrations were higher in the vegetated plots as compared to the un-vegetated sites. Vegetated sites had high Ni (mean: 881.71 mg/kg) and Cr (mean: 776.36 mg/kg) that exceeded the threshold values (cf. by the United States Environmental Protection Agency; USEPA). Fe, Pb, Cu and Cd had a mean concentration of 2597.92 mg/kg, 40.94 mg/kg, 36.81 mg/kg and 2.22 mg/kg respectively. Vegetation variables were not significantly correlated with HM concentration. However, the HM concentration was significantly correlated with sediment variables particularly pH, redox, particle size, nitrogen, phosphorus, moisture and organic matter contents. The Pollution Load Index (PLI) indicated moderate to high pollution in the lake. Risk assessment and management should be designed in order to mitigate the ecological risk posed by HM. The need of a regular monitoring scheme for lake and mangrove rehabilitation programs and management should be designed.

Keywords: heavy metals, mangrove vegetation, mining, Philippines, sediment

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Authors: Omid Khaiyat, David Hawkes

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Introduction: There remains a lack of information on sophisticated coordination patterns across shoulder girdle muscles. Considering the stability of the shoulder being heavily dependent on coordinated muscle activity during its wide-ranging movements, it is important that key intermuscular relationships are well-defined for a better understanding of underlying pathology. This study investigated shoulder intermuscular coordination during different planes of shoulder elevation. Materials and Methods: EMG was recorded from 14 shoulder muscles in 20 healthy participants during shoulder flexion, scapula plane elevation, abduction, and extension. Cross-correlation by means of Pearson Correlation Coefficient (PCC) was used to examine the coordination between different muscles and muscle groups. Results: Coordination between rotator cuff and deltoid muscle groups was significantly higher (p =0.020-0.035) during the initial (PCC) = 0.79) and final (PCC = 0.74) phases of elevation compared to the mid-range (PCC = 0.34). Furthermore, a high level of coordination (PCC = 0.89) was noted between the deltoid group and the adductor group (latissimus dorsi and teres major) during the initial stage of shoulder elevation. Conclusion: The destabilising force of the deltoid during the initial stage of shoulder elevation is balanced by coordinated activity of rotator cuff, latissimus dorsi, and teres major. This is also the case for the end-range of movement, where increased demand for stability again leads to higher coordination between the deltoid and rotator cuff muscle groups. Appreciation of the sophistication of normal shoulder function evidence-based rehabilitation strategies for conditions such as subacromial impingement syndrome or shoulder instability can be developed.

Keywords: shoulder, coordination, EMG, muscle activity, upper limb

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Authors: Radwa E. Sweif, Amira A. A. Abdallah

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Background: Evaluation of gait efficiency is used to examine energy consumption especially in patients with movement disorders. Hypothesis/Purpose: This study compared the physiological and mechanical measures of gait efficiency between patients with ACL reconstruction (ACLR) and healthy controls and correlated among these measures. Methods: Seventeen patients with ACLR and sixteen healthy controls with mean ± SD age 23.06±4.76 vs 24.85±6.47 years, height 173.93±6.54 vs 175.64±7.37cm, and weight 74.25±12.1 vs 76.52±10.14 kg, respectively, participated in the study. The patients were operated on six months prior to testing. They should have completed their accelerated rehabilitation program during this period. A 3D motion analysis system was used for collecting the mechanical measures (Biomechanical Efficiency Quotient (BEQ), the maximum degree of knee internal rotation during stance phase and speed of walking). The physiological measures (Physiological Cost Index (PCI) and Rate of Perceived Exertion (RPE)) were collected after performing the 6- minute walking test. Results: MANOVA showed that the maximum degree of knee internal rotation, PCI, and RPE increased and the speed decreased significantly (p<0.05) in the patients compared with the controls with no significant difference for the BEQ. Finally, there were significant (p<0.05) positive correlations between each of the PCI & RPE and each of the BEQ, speed of walking and the maximum degree of knee internal rotation in each group. Conclusion: It was concluded that there are alterations in both mechanical and physiological measures of gait efficiency in patients with ACLR after being rehabilitated, clarifying the need for performing additional endurance as well as knee stability training programs. Moreover, the positive correlations indicate that using either of the mechanical or physiological measures for evaluating gait efficiency is acceptable.

Keywords: ACL reconstruction, mechanical, physiological, gait efficiency

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Authors: Timir Baran Roy, Luis Guerreiro, Ashutosh Bagchi

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Dynamic study is important in order to design, repair and rehabilitation of structures. It has played an important role in the behavior characterization of structures; such as bridges, dams, high-rise buildings etc. There had been a substantial development in this area over the last few decades, especially in the field of dynamic identification techniques of structural systems. Frequency Domain Decomposition (FDD) and Time Domain Decomposition are most commonly used methods to identify modal parameters; such as natural frequency, modal damping, and mode shape. The focus of the present research is to study the dynamic characteristics of typical timber masonry walls commonly used in Portugal. For that purpose, a multi-storey structural prototypes of such walls have been tested on a seismic shake table at the National Laboratory for Civil Engineering, Portugal (LNEC). Signal processing has been performed of the output response, which is collected from the shaking table experiment of the prototype using accelerometers. In the present work signal processing of the output response, based on the input response has been done in two ways: FDD and Stochastic Subspace Identification (SSI). In order to estimate the values of the modal parameters, algorithms for FDD are formulated, and parametric functions for the SSI are computed. Finally, estimated values from both the methods are compared to measure the accuracy of both the techniques.

Keywords: frequency domain decomposition (fdd), modal parameters, signal processing, stochastic subspace identification (ssi), time domain decomposition

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

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

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

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Authors: Muna Slehat

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Jordan is endowed with over 14,500 productive archaeological sites and also a wealth of heritage sites that need to be protected from the pressing threat of destruction and damage. Archaeological sites in Jordan face significant threats, including insensitive development, urbanization, pollution, tourism, and vandalism, therefore an effective management plan is a key element, not only for the conservation of this heritage, but also to address issues such as tourism and sustainable development. This study highlights the obstacles that confront the management of the archaeological and tourism sites in Jordan, prior to and after the launch of the Strategies for Management of Jordan’s Archaeological Heritage by the Department of Antiquities (DoA) 2007-2010 and 2014-2018, as well as the establishment of the Directorate of the Management of Archaeological Sites in 2010, and instructions for the proper use of tourism sites, 2014, by the Ministry of Tourism and Antiquities (MoTA). The study has revealed that the management of the archaeological and tourism sites under the pretext of improvement of services for tourists and visitors to Jordan would allow access to so-called polarization tourism and facilitate tourism development that would be sustainable economically and provide attractive returns. The data required have been collected through conducting interviews with 18 specialists. The main findings of the study are that management is new in Jordan, and has become a vital and dynamic force in Jordan after 2000 but that there have also been many mistakes, with sustainability of the sites being ignored and a lack of awareness among local communities surrounding these sites. Management of the sites has also suffered from a lack of organizational vision, with no instructions for practical application and no legislative provisions which cater for the efficient management of the sites. All of this needs to be amended to remove gaps, overlaps and ambiguities, so that the authorities responsible for the rehabilitation and promotion, development and management of these sites can overcome the problems, such as lack of human resources (specialists) and financial resources.

Keywords: Jordan, management, archaeological sites, tourism, challenges

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Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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Authors: Carla Idely Palencia-Aguilar

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Mining in Colombia represents around 2% of the GDP (USD 8 billion in 2018), with main productions represented by coal, nickel, gold, silver, emeralds, iron, limestone, gypsum, among others. Sand and Gravel had been decreasing its participation of the GDP with a reduction of 33.2 million m3 in 2015, to 27.4 in 2016, 22.7 in 2017 and 15.8 in 2018, with a consumption of approximately 3 tons/inhabitant. However, with the new government policies it is expected to increase in the following years. Mining causes temporary environmental impacts, once restoration and rehabilitation takes place, social, environmental and economic benefits are higher than the initial state. A way to demonstrate how the mining interventions had contributed to improve the characteristics of the region after sand and gravel mining, the NDVI (Normalized Difference Vegetation Index) from MODIS and ASTER were employed. The histograms show not only increments of vegetation in the area (8 times higher), but also topographies similar to the ones before the intervention, according to the application for sustainable development selected: either agriculture, forestry, cattle raising, artificial wetlands or do nothing. The decision was based upon a Multicriteria analysis for optimal land use, with three main variables: geostatistics, evapotranspiration and groundwater characteristics. The use of remote sensing, meteorological stations, piezometers, sunphotometers, geoelectric analysis among others; provide the information required for the multicriteria decision. For cattle raising and agricultural applications (where various crops were implemented), conservation of products were tested by means of nanotechnology. The results showed a duration of 2 years with no chemicals added for preservation and concentration of vitamins of the tested products.

Keywords: ASTER, Geostatistics, MODIS, Multicriteria

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Authors: Muge Unal, Ahmet Cilek

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Urban identity, having a dynamic characteristic spatial and semantic aspects, is a phenomenon in an ever-changing. Urban identity formation includes not only a process of physical nature but also development and change processes that take place in the political, economic, social and cultural values, whether national and international level. Although the concept of urban transformation is basically regarded as the spatial transformation; in fact, it reveals a holistic perspective and transformation based on dialectical relationship existing between the spatial and social relationship. For this reason, urban renewal needs to address as not only spatial but also the impact of spatial transformation on social, cultural and economic. Implementation tools used in the perception of urban transformation are varied concepts such as urban renewal, urban resettlement, urban rehabilitation, urban redevelopment, and urban revitalization. The phenomenon of urban transformation begins with the Industrial Revolution. Until the 1980s, it was interpreted as reconsidering physical fossil on urban environment factor like occurring in rapid urbanization, changing in the spatial structure of the city, concentrating of the population in urban areas. However, after the 1980s, it has resided in a conceptual structure which requires to be addressed physical, economic, social, technological and integrity of information. In conclusion, urban transformation, when it enter the literature as a practice of planning, has been up to date in terms of the conceptual structure and content and also hasn’t remained behind converting itself. Urban transformation still maintains its simplest expression, while it transforms so fast converts the contents. In this study, the relationship between urban design and components of urban transformation were discussed with strategies used as a place in the historical process of urban transformation besides a general evaluation of the concept of urban renewal.

Keywords: conceptual approach, urban identity, urban regeneration, urban renewal

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Authors: Mehdi Razeghi

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Background: The purpose of this case series was to quantify gait to study muscular dystrophy disease. In this research, the quantitative differences between normal and waddling gaits were assessed by force plate analysis. Methods: Nineteen myopathy patients and twenty normal subjects serving as the control group participated in this research. In this study, quantitative analyses of gait have been used to investigate the differences between the mobility of normal subjects and myopathy patients. This study was carried out at the Iranian Muscular Dystrophy Association in Boali Hospital, Tehran, Iran, from October 2015 to July 2020. Patient data were collected from Iranian Muscular Dystrophy Association members. individuals signed an informed consent form approved by the ethics committee of the Azad University. All of the gait tests were performed using a Kistler force platform. Participants walked at a self-selected speed, barefoot, independently, and without assistive devices. Results: Our findings indicate that there were no significant differences between the patients and the control group in the anterior-posterior components of the ground reaction forces; however, there were considerable differences in the force components between the groups in the medial-lateral and vertical directions of the ground reaction force. In addition, there were significant differences in the time parameters between the groups in the vertical and medial-lateral directions.

Keywords: biomechanics, force plate analysis, gait disorder, ground reaction force, kinetic analysis, myopathy disease, rehabilitation engineering

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