Search results for: upper extremity

Authors: Michinori Nakata, Hiroshi Sakai

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A rough set, which consists of lower and upper approximations, is formulated in information tables containing possibilistic information. First, lower and upper approximations on the basis of possible world semantics in the same way as Lipski did in the field of incomplete databases are shown in order to clarify fundamentals of rough sets under possibilistic information. Possibility and necessity measures are used, as is done in possibilistic databases. As a result, each object has certain and possible membership degrees to lower and upper approximations, which degrees are the lower and upper bounds. Therefore, the degree that the object belongs to lower and upper approximations is expressed by an interval value. And the complementary property linked with the lower and upper approximations holds, as is valid under complete information. Second, the approach based on indiscernibility relations, which is proposed by Dubois and Prade, are extended in three cases. The first case is that objects used to approximate a set of objects are characterized by possibilistic information. The second case is that objects used to approximate a set of objects with possibilistic information are characterized by complete information. The third case is that objects that are characterized by possibilistic information approximate a set of objects with possibilistic information. The extended approach create the same results as the approach based on possible world semantics. This justifies our extension.

Keywords: rough sets, possibilistic information, possible world semantics, indiscernibility relations, lower approximations, upper approximations

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Authors: Rada Somkhuean, Sa-aat Niwitpong, Suparat Niwitpong

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This paper presents the generalized p-values for testing the difference between two future population means when the variances are unknown, in both cases for when the variances are equal and unequal. We also derive a closed form expression of the upper bound of the proposed generalized p-value.

Keywords: generalized p-value, two future population means, upper bound, variances

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Authors: Hassan Abo-Salem, Huang Xiaolin

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

Keywords: mirror therapy, stroke, MAS, walking speed

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Authors: Ankush Raina, Ankush Anand

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Plyometric training is a form of specialised strength training that uses fast muscular contractions to improve power and speed in sports conditioning by coaches and athletes. Despite its useful role in sports conditioning programme, the information about plyometric training on the athletes cardiovascular health especially Electrocardiogram (ECG) has not been established in the literature. The purpose of the study was to determine the effects of lower and upper body plyometric training on ECG of athletes. The study was guided by three null hypotheses. Quasi–experimental research design was adopted for the study. Seventy-two university male athletes constituted the population of the study. Thirty male athletes aged 18 to 24 years volunteered to participate in the study, but only twenty-three completed the study. The volunteered athletes were apparently healthy, physically active and free of any lower and upper extremity bone injuries for past one year and they had no medical or orthopedic injuries that may affect their participation in the study. Ten subjects were purposively assigned to one of the three groups: lower body plyometric training (LBPT), upper body plyometric training (UBPT), and control (C). Training consisted of six plyometric exercises: lower (ankle hops, squat jumps, tuck jumps) and upper body plyometric training (push-ups, medicine ball-chest throws and side throws) with moderate intensity. The general data were collated and analysed using Statistical Package for Social Science (SPSS version 22.0). The research questions were answered using mean and standard deviation, while paired samples t-test was also used to test for the hypotheses. The results revealed that athletes who were trained using LBPT had reduced ECG parameters better than those in the control group. The results also revealed that athletes who were trained using both LBPT and UBPT indicated lack of significant differences following ten weeks plyometric training than those in the control group in the ECG parameters except in Q wave, R wave and S wave (QRS) complex. Based on the findings of the study, it was recommended among others that coaches should include both LBPT and UBPT as part of athletes’ overall training programme from primary to tertiary institution to optimise performance as well as reduce the risk of cardiovascular diseases and promotes good healthy lifestyle.

Keywords: boundary lubrication, copper oxide, friction, nano diamond

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Authors: Asrarul Fikri Abu Hassan, Muhammad Hafiz bin Hanafi, Jafri Malin Abdullah

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This study is to compare the motor evoked potential (MEP) changes using different settings of repetitive transcranial magnetic stimulation (rTMS) in the post-haemorrhagic stroke patient which treated conservatively. The goal of the study is to determine changes in corticomotor excitability and functional outcome after repetitive transcranial magnetic stimulation (rTMS) therapy regime. 20 post-stroke patients with upper limb hemiparesis were studied due to haemorrhagic stroke. One of the three settings; (I) Inhibitory setting, or (II) facilitatory setting, or (III) control group, no excitatory or inhibitory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. Functional outcomes were evaluated using the Barthel index score. We found pre-treatment MEP values of the lesional side were lower compared to post-treatment values in both settings. In contrast, we found that the pre-treatment MEP values of the non-lesional side were higher compared to post-treatment values in both settings. Interestingly, patients with treatment, either facilitatory setting and inhibitory setting have faster motor recovery compared to the control group. Our data showed both settings might improve the MEP of the upper extremity and functional outcomes in the haemorrhagic stroke patient.

Keywords: Barthel index, corticomotor excitability, motor evoked potential, repetitive transcranial magnetic stimulation, stroke

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Authors: Sana Bembli, Nahla Khraief Haddad, Safya Belghith

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This paper deals with a robust model free terminal sliding mode with gravity compensation approach used to control an exoskeleton-upper limb system. The considered system is a 2-DoF robot in interaction with an upper limb used for rehabilitation. The aim of this paper is to control the flexion/extension movement of the shoulder and the elbow joints in presence of matched disturbances. In the first part, we present the exoskeleton-upper limb system modeling. Then, we controlled the considered system by the model free terminal sliding mode with gravity compensation. A stability study is realized. To prove the controller performance, a robustness analysis was needed. Simulation results are provided to confirm the robustness of the gravity compensation combined with to the Model free terminal sliding mode in presence of uncertainties.

Keywords: exoskeleton- upper limb system, model free terminal sliding mode, gravity compensation, robustness analysis

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Authors: Agata Matuszewska, Małgorzata Syczewska

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The movement of the upper limbs contributes significantly to balance control while walking in humans. However, the impact of different arm swing modes on gait stability is yet to be determined. This work intends to establish numerical parameters for assessing the arm swing. Nineteen people, comprising fifteen young, healthy individuals, two middle-aged individuals, and two individuals with dysfunctions, were analyzed using the movement analysis system. Proposed parameters such as ASᵢₐ (reflecting the arm swing amplitude) and Pearson’s correlation coefficient between the right and left upper limbs can be used to classify the type of movement task each participant performs. The results indicate that the ASᵢₐ parameter could potentially detect any abnormalities in upper limb functions, which may be due to musculoskeletal disorders or other malfunctions.

Keywords: arm swing, human balance, interlimb coordination, motion analysis system

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Authors: K. K. A. Bakhti, D. Mottet, J. Froger, I. Laffont

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Background: After a cerebrovascular accident (or stroke), many patients use excessive trunk movements to move their paretic hand towards a target (while the elbow is maintained flexed) even though they can use the upper-limb when the trunk is restrained. This phenomenon is labelled learned non-use and is known to be detrimental to neuroplasticity and recovery. Objective: The aim of this study is to quantify learned non-use of the paretic upper limb during a hand reaching task using 3D movement analysis. Methods: Thirty-four participants post supratentorial stroke were asked to reach a cone placed in front of them at 80% of their arm length. The reaching movement was repeated 5 times with the paretic hand, and then 5 times with the less-impaired hand. This sequence was first performed with the trunk free, then with the trunk restrained. Learned non-use of the upper-limb (LNUUL) was obtained from the difference of the amount of trunk compensation between the free trunk condition and the restrained trunk condition. Results: LNUUL was significantly higher for the paretic hand, with individual values ranging from 1% to 43%, and one-half of the patients with an LNUUL higher than 15%. Conclusions: Quantification of LNUUL can be used to objectively diagnose patients who need trunk rehabilitation. It can be also used for monitoring the rehabilitation progress. Quantification of LNUUL may guide upper-limb rehabilitation towards more optimal motor recovery avoiding maladaptive trunk compensation and its consequences on neuroplasticity.

Keywords: learned non-use, rehabilitation, stroke, upper limb

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Authors: Madiha Ijaz, Muhammad Akram, Sima Mir

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Underground mining of coal is carried out manually in Pakistan. Exposure to ergonomic hazards (musculoskeletal disorders) are very common among the coal cutters of these mines. Cutting coal in narrow spaces poses a great threat to both upper and lower limbs of these workers. To observe the prevalence of such hazards, a thorough study was conducted on 600 workers from 30 mines (20 workers from 1 mine), located in two districts of province Punjab, Pakistan. Rapid Upper Limb Assessment sheet and Rapid Entire Body Assessment sheet were used for the study along with a standard Nordic Musculoskeleton disorder questionnaire. SPSS, 25, software was used for data analysis on upper and lower limb disorders, and regression analysis models were run for upper and lower back pain. According to the results obtained, it was found that work stages (drilling & blasting, coal cutting, timbering & supporting, etc.), wok experience and number of repetitions performed/minute were significant (with p-value 0.00,0.004 and 0.009, respectively) for discomfort in upper and lower limb. Age got p vale 0.00 for upper limb and 0.012 for lower limb disorder. The task of coal cutting was strongly associated with the pain in upper back (with odd ratios13.21, 95% confidence interval (CI)14.0-21.64)) and lower back pain (3.7, 95% confidence interval 1.3-4.2). scored on RULA and REBA sheets, every work-stage was ranked at 7-highest level of risk involved. Workers were young (mean value of age= 28.7 years) with mean BMI 28.1 kg/m2

Keywords: workplace hazards, ergonomic disorders, limb disorders, MSDs.

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Authors: Y. T. Ku, S. W. Chen, J. R. Wang, C. Shih, Y. F. Chang

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In order to respond the policy decision of non-nuclear homes, Tai Power Company (TPC) will provide the decommissioning project of Kuosheng Nuclear power plant (KSNPP) to meet the regulatory requirement in near future. In this study, the computational fluid dynamics (CFD) methodology has been employed to develop a flow prediction model for boiling water reactor (BWR) with upper pool under decommissioning stage. The model can be utilized to investigate the flow behavior as the vessel combined with upper pool and continuity cooling system. At normal operating condition, different parameters are obtained for the full fluid area, including velocity, mass flow, and mixing phenomenon in the reactor pressure vessel (RPV) and upper pool. Through the efforts of the study, an integrated simulation model will be developed for flow field analysis of decommissioning KSNPP under normal operating condition. It can be expected that a basis result for future analysis application of TPC can be provide from this study.

Keywords: CFD, BWR, decommissioning, upper pool

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Authors: Ammar Manaa

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The late Pleistocene raised coral reef terraces, 1 to 5 m above present sea level, are distinguished in Rabigh area into two marine terraces at elevations 0.5 m and 3.20 m, in addition to back-reef facies. The lower and upper terraces consist mainly of corals that increased in abundance and distribution in the upper terrace, with a minor occurrence of detrital quartz and feldspar. The back-reef facies consist mainly of coralline algae with a minor occurrence of corals. The upper terrace was interpreted as a reef crest or algal ridge due to the dominance of bindstone facies. The lower terrace indicates an outer reef flat with the occurrence of grainstone and rudstone facies. The coral framework in the upper terrace indicates a low energy environment. Within the back-reef terrace, calcareous mud was dominant, which indicates low energy, lagoon environment. The XRD results for the studied terraces revealed a variable abundance of aragonite, high-Mg calcite, and low-Mg calcite, with a slight increase in calcite and high-Mg calcite in the upper terrace. The dominant diagenetic processes in the terraces are cementation by fibrous and blocky calcite and dissolution that varied slightly between the lower and upper terraces. This study provides a coral reef model relevant to a low energy system in a dry and hot environment.

Keywords: late Pleistocene, Rabigh, reef terraces, Red Sea, Saudi Arabia.

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Authors: Thanaporn Chaimongkol

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The objective of this research was aimed to examine the factors that influence the development of community leadership strategies to further develop the career regarding the Benjarong pottery products in eight upper central provinces, Thailand. The sample included (1) 1200 Benjarong pottery operators, (2) 30 involved representatives at both the policy level and support, and (3) OTOP network of 24 people. In this quantitative study, investigating data was conducted on individual session basis. The research instruments used included questionnaires and interview. The results showed that the components of the development of the community leadership strategies for career development of the Benjarong pottery products in eight upper central provinces were high overall; the Five Competitive Forces were of the highest average, followed by bargaining power of suppliers, and McKinsey 7's framework, respectively; where the highest average was strategy.

Keywords: community leadership, strategy development, Benjarong Pottery, 8 upper central provinces

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Authors: Hsiao-Lung Chan, Ching-Yi Wu, Yan-Zou Lin, Yo Chiao, Ya-Ju Chang

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Robot-assisted bilateral arm training has demonstrated useful to improve motor control in stroke patients and save human resources. In clinics, the efficiency of this treatment is mostly performed by comparing functional scales before and after rehabilitation. However, most of these assessments are based on behavior evaluation. The underlying improvement of muscle activation and coordination is unknown. Moreover, stroke patients are easier to have muscle fatigue under robot-assisted rehabilitation due to the weakness of muscles. This safety issue is still less studied. In this study, EMG analysis was applied during training. Our preliminary results showed the co-contraction index and co-contraction area index can delineate the improved muscle coordination of biceps brachii vs. flexor carpiradialis. Moreover, the smoothed, normalized cycle-by-cycle median frequency of left and right extensor carpiradialis decreased as the training progress, implying the occurrence of muscle fatigue.

Keywords: robot-assisted rehabilitation, strokes, muscle coordination, muscle fatigue

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Authors: Sharifullah Ahmed

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Shallow foundation on soft soils without ground improvement can represent a high level of settlement. In such a case, an alternative to pile foundations may be shallow strip footings placed on a soil system in which the upper layer is untreated or cement-treated compacted sand to limit the settlement within a permissible level. This research work deals with a rigid plane-strain strip footing of 2.5m width placed on a soil consisting of untreated or cement treated sand layer underlain by homogeneous soft clay. Both the thin and thick compared the footing width was considered. The soft inorganic cohesive NC clay layer is considered undrained for plastic loading stages and drained in consolidation stages, and the sand layer is drained in all loading stages. FEM analysis was done using PLAXIS 2D Version 8.0 with a model consisting of clay deposits of 15m thickness and 18m width. The soft clay layer was modeled using the Hardening Soil Model, Soft Soil Model, Soft Soil Creep model, and the upper improvement layer was modeled using only the Hardening Soil Model. The system is considered fully saturated. The value of natural void ratio 1.2 is used. Total displacement fields of strip footing and subsoil layers in the case of Untreated and Cement treated Sand as Upper layer are presented. For Hi/B =0.6 or above, the distribution of major deformation within an upper layer and the influence zone of footing is limited in an upper layer which indicates the complete effectiveness of the upper layer in bearing the foundation effectively in case of the untreated upper layer. For Hi/B =0.3 or above, the distribution of major deformation occurred within an upper layer, and the function of footing is limited in the upper layer. This indicates the complete effectiveness of the cement-treated upper layer. Brittle behavior of cemented sand and fracture or cracks is not considered in this analysis.

Keywords: displacement, ground improvement, influence depth, PLAXIS 2D, primary and secondary settlement, sand mat, soft clay

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Authors: Hyo Seon Choi, Ju Sun Kim, DY Kim

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Introduction: This study was aimed to evaluate temporo-spatial patterns during the reach and grasp task in hemiplegic stroke patients and to identify movement pattern according to severity of motor impairment. Method: 29 subacute post-stroke patients were enrolled in this study. The temporo-spatial and kinematic data were obtained during reach and grasp task through 3D motion analysis (VICON). The reach and grasp task was composed of four sub-tasks: reach (T1), transport to mouth (T2), transport back to table (T3) and return (T4). The movement time, joint angle and sum of deviation angles from normative data were compared between affected side and unaffected side. They were also compared between two groups (mild to moderate group: 28~66, severe group: 0~27) divided by upper-Fugl-Meyer Assessment (FMA) scale. Result: In affected side, total time and durations of all four tasks were significantly longer than those in unaffected side (p < 0.001). The affected side demonstrated significant larger shoulder abduction, shoulder internal rotation, wrist flexion, wrist pronation, thoracic external rotation and smaller shoulder flexion during reach and grasp task (p < 0.05). The significant differences between mild to moderate group and severe group were observed in total duration, durations of T1, T2, and T3 in reach and grasp task (p < 0.01). The severe group showed significant larger shoulder internal rotation during T2 (p < 0.05) and wrist flexion during T2, T3 (p < 0.05) than mild to moderate group. In range of motion during each task, shoulder abduction-adduction during T2 and T3, shoulder internal-external rotation during T2, elbow flexion-extension during T1 showed significant difference between two groups (p < 0.05). The severe group had significant larger total deviation angles in shoulder internal-external rotation and wrist extension-flexion during reach and grasp task (p < 0.05). Conclusion: This study suggests that post-stroke hemiplegic patients have an unique temporo-spatial and kinematic patterns during reach and grasp task, and the movement pattern may be related to affected upper limb severity. These results may be useful to interpret the motion of upper extremity in stroke patients.

Keywords: Fugl-Meyer Assessment (FMA), motion analysis, reach and grasp, stroke

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Authors: Tadashi Watanabe

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The LSTF experiment simulating the SGTR accident at the Mihama Unit-2 reactor is analyzed using the RELAP5/MOD3.3 code. In the accident and thus in the experiment, the ECC water was injected not only into the cold legs but into the upper plenum. Overall transients during the experiment such as pressures and fluid temperatures are simulated well by the code. The cold-leg fluid temperatures are shown to decrease if the upper plenum injection system is connected to the cold leg. It is found that the cold-leg fluid temperatures also decrease if the upper-plenum injection is not used and the cold-leg injection alone is actuated.

Keywords: SGTR, LSTF, RELAP5, ECCS

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

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

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

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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: Debasis Sengupta, Sudipta Das

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The class of life distributions with decreasing mean residual life (DMRL) is well known in the field of reliability modeling. It contains the IFR class of distributions and is contained in the NBUE class of distributions. While upper and lower bounds of the reliability distribution function of aging classes such as IFR, IFRA, NBU, NBUE, and HNBUE have discussed in the literature for a long time, there is no analogous result available for the DMRL class. We obtain the upper and lower bounds for the reliability function of the DMRL class in terms of first order finite moment. The lower bound is obtained by showing that for any fixed time, the minimization of the reliability function over the class of all DMRL distributions with a fixed mean is equivalent to its minimization over a smaller class of distribution with a special form. Optimization over this restricted set can be made algebraically. Likewise, the maximization of the reliability function over the class of all DMRL distributions with a fixed mean turns out to be a parametric optimization problem over the class of DMRL distributions of a special form. The constructive proofs also establish that both the upper and lower bounds are sharp. Further, the DMRL upper bound coincides with the HNBUE upper bound and the lower bound coincides with the IFR lower bound. We also prove that a pair of sharp upper and lower bounds for the reliability function when the distribution is increasing mean residual life (IMRL) with a fixed mean. This result is proved in a similar way. These inequalities fill a long-standing void in the literature of the life distribution modeling.

Keywords: DMRL, IMRL, reliability bounds, hazard functions

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Authors: Sangbaek Park, Seungju Lee, Soo-Won Chae

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Unstable shoes are known to strengthen lower extremity muscles and improve gait ability and to change the user’s gait pattern. The change in gait pattern affects human body enormously because the walking is repetitive and steady locomotion in daily life. It is possible to estimate the joint motion including joint moment, force and inertia effect using kinematic and kinetic analysis. However, the change of internal stress at the articular cartilage has not been possible to estimate. The purpose of this research is to evaluate the internal stress of human body during gait with unstable shoes. In this study, FE analysis was combined with motion capture experiment to obtain the boundary condition and loading condition during walking. Motion capture experiments were performed with a participant during walking with normal shoes and with unstable shoes. Inverse kinematics and inverse kinetic analysis was performed with OpenSim. The joint angle and muscle forces were estimated as results of inverse kinematics and kinetics analysis. A detailed finite element (FE) lower extremity model was constructed. The joint coordinate system was added to the FE model and the joint coordinate system was coincided with OpenSim model’s coordinate system. Finally, the joint angles at each phase of gait were used to transform the FE model’s posture according to actual posture from motion capture. The FE model was transformed into the postures of three major phases (1st peak of ground reaction force, mid stance and 2nd peak of ground reaction force). The direction and magnitude of muscle force were estimated by OpenSim and were applied to the FE model’s attachment point of each muscle. Then FE analysis was performed to compare the stress at knee cartilage during gait with normal shoes and unstable shoes.

Keywords: finite element analysis, gait analysis, human model, motion capture

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Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

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Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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Authors: Amirul Adlan, Robert A McCulloch, Neil Jenkins, MIchael Parry, Jonathan Stevenson, Lee Jeys

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Background and Objectives: The current antibiotic prophylaxis for oncological patients is based upon evidence from primary arthroplasty despite significant differences in both patient group and procedure. The aim of this study was to compare the microbiology organisms responsible for PJI in patients who underwent two-stage revision for infected primary knee replacement with those of infected oncological endoprostheses of the lower limb in a single institution. This will subsequently guide decision making regarding antibiotic prophylaxis at primary implantation for oncological procedures and empirical antibiotics for infected revision procedures (where the infecting organism(s) are unknown). Patient and Methods: 118 patients were treated with two-stage revision surgery for infected knee arthroplasty and lower limb endoprostheses between 1999 and 2019. 74 patients had two-stage revision for PJI of knee arthroplasty, and 44 had two-stage revision of lower limb endoprostheses. There were 68 males and 50 females. The mean age for the knee arthroplasty cohort and lower limb endoprostheses cohort were 70.2 years (50-89) and 36.1 years (12-78), respectively (p<0.01). Patient host and extremity criteria were categorised according to the MSIS Host and Extremity Staging System. Patient microbiological culture, the incidence of polymicrobial infection and multi-drug resistance (MDR) were analysed and recorded. Results: Polymicrobial infection was reported in 16% (12 patients) from knee arthroplasty PJI and 14.5% (8 patients) in endoprostheses PJI (p=0.783). There was a significantly higher incidence of MDR in endoprostheses PJI, isolated in 36.4% of cultures, compared to knee arthroplasty PJI (17.2%) (p=0.01). Gram-positive organisms were isolated in more than 80% of cultures from both cohorts. Coagulase-negative Staphylococcus (CoNS) was the commonest gram-positive organism, and Escherichia coli was the commonest Gram-negative organism in both groups. According to the MSIS staging system, the host and extremity grade of knee arthroplasty PJI cohort were significantly better than endoprostheses PJI(p<0.05). Conclusion: Empirical antibiotic management of PJI in orthopaedic oncology is based upon PJI in arthroplasty despite differences in both host and microbiology. Our results show a significant increase in MDR pathogens within the oncological group despite CoNS being the most common infective organism in both groups. Endoprosthetic patients presented with poorer host and extremity criteria. These factors should be considered when managing this complex patient group, emphasising the importance of broad-spectrum antibiotic prophylaxis and preoperative sampling to ensure appropriate perioperative antibiotic cover.

Keywords: microbiology, periprosthetic Joint infection, knee arthroplasty, endoprostheses

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Authors: Fadimatou Ngounouno Yamgouota, Isaac Bertrand Gbambié Mbowoub, Ismaila Ngounounob

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Barium and titanium bearing biotite from alkaline trachyte of Upper Benue valley, Northern Cameroon is studied. The iron enrichment index of mica (average I.E.=0.40) is intermediate between annite and phlogopite. The biotite phenocrysts contain up to 6.2 wt. % BaO and 9.8 wt. % TiO2. The BaO content of electron-microprobe mica is positively correlated with the Al2O3, TiO2, and FeO contents, and negatively correlated with the SiO2, K2O, and MgO contents. Ba and Ti rich micas are generally found in in SiO2 deficient rocks, whereas Ba and Ti bearing mica in this study occur in silica-saturated rocks. Most of the phenocrysts analysed have deficiencies in their octahedral and interlayer sites. Deficiencies in the octahedral sites may arise from the Ti vacancy and partly the Ti tschermakite substitution. On the other hand, deficiencies in the interlayer-site are due to the replacement of K by Ba. The substitution mechanism in the Upper Benue valley mica is characterized by Ba + 2Ti + 3Al =(K + Na + Ca) + 3(Mg + Fe + Mn) + 3Si, with an excellent correlation coefficient. Biotite compositions from the Upper Benue valley area fall between the quartz-fayalite-magnetite (QFM) and nickel-nickel-oxide (NNO) oxygen fugacity buffers. All these show that Upper Benue valley mica with high Ba and Ti contents may be formed from magmas rich in these elements.

Keywords: Benue valley, trachyte, biotite, mineral chemistry, enrichment

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Authors: Stefanos Karanasios, Charkleia Koutri, Maria Moutzouri, Sofia A. Xergia, Vasiliki Sakellari, George Gioftsos

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The precise calculation of arterial occlusive pressure (AOP) is a critical step to accurately prescribe individualized pressures during blood flow restriction training (BFRT). AOP is usually measured in a supine position before training; however, previous reports suggested a significant influence in lower limb AOP across different body positions. The aim of the study was to investigate the effect of three different body positions on upper limb AOP and the reliability of the method for its standardization in clinical practice. Forty-two healthy participants (Mean age: 28.1, SD: ±7.7) underwent measurements of upper limb AOP in supine, seated, and standing positions by three blinded raters. A cuff with a manual pump and a pocket doppler ultrasound were used. A significantly higher upper limb AOP was found in seated compared with supine position (p < 0.031) and in supine compared with standing position (p < 0.031) by all raters. An excellent intraclass correlation coefficient (0.858- 0.984, p < 0.001) was found in all positions. Upper limb AOP is strongly dependent on body position changes. The appropriate measurement position should be selected to accurately calculate AOP before BFRT. The excellent inter-rater reliability and repeatability of the method suggest reliable and consistent results across repeated measurements.

Keywords: Kaatsu training, blood flow restriction training, arterial occlusion, reliability

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Authors: Amanpreet Kaur

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Wavelet transform (WT) is a powerful statistical tool used in applied mathematics for signal and image processing. The different mother, wavelet basis function, has been compared to select the optimal wavelet function that represents the electromyogram signal characteristics of upper limb amputees. Four different EMG electrode has placed on different location of shoulder muscles. Twenty one wavelet functions from different wavelet families were investigated. These functions included Daubechies (db1-db10), Symlets (sym1-sym5), Coiflets (coif1-coif5) and Discrete Meyer. Using mean square error value, the significance of the mother wavelet functions has been determined for teres, pectorals, and infraspinatus around shoulder muscles. The results show that the best mother wavelet is the db3 from the Daubechies family for efficient classification of the signal.

Keywords: Daubechies, upper limb amputation, shoulder muscles, Symlets, Coiflets

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Authors: Clement Ndoricimpa

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The expression of stance is highly expected in writing at tertiary level. Through a selection of linguistic and rhetorical elements, writers express commitment, critical distance and build a critically discerning reader in texts. Despite many studies on patterns of stance in students’ academic writing, little may not be known about how English as a Foreign Language students learns to build a critically discerning reader in their texts. Therefore, this study examines patterns of stance in essays written by students majoring in business administration at English-medium University in Burundi as part of classroom assignments. It draws on systemic functional linguistics to analyze qualitatively and quantitatively the data. The quantitative analysis is used to identify the differences in frequency of stance patterns in the essays. The results show a significant difference in the use of boosters by lower- and upper-level students. Lower-level students’ writing contains more boosters and many idiosyncratic sentence structures than do upper-level students’ writing, and upper-level students’ essays contain more hedging and few grammatical mistakes than do lower-level students’ essays. No significant difference in the use of attitude markers and concessive and contrastive expressions. Students in lower- and upper-level do not use attitude markers and disclaimer markers appropriately and accurately. These findings suggest that students should be taught the use of stance patterns in academic writing.

Keywords: academic writing, metadiscourse, stance, student corpora

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Authors: Reda Goweda, Mokhtar Shatla, Arawa Alzaidi, Arij Alzaidi, Bashair Aldhawani, Hibah Alharbi, Noran Sultan, Daniah Alnemari, Badr Rawa

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Background: 20.5% of Saudis between 20 and 79 years are diabetics. Diabetic foot is a chronic complication of diabetes. The incidence of non traumatic lower extremity amputations is at least 15 times greater in those with diabetes than non diabetics. Patient education is important to reduce lower extremity complications. Objective: To assess the knowledge and practices of the diabetic patients regarding foot care and diabetic foot complications. Methods: In Makkah hospitals, 350 diabetic patients who met the inclusion criteria were involved in this cross sectional study. Interviewing questionnaire and patients’ charts review were used to collect the data. Results: Mean age of patients was 53.0083±13.1 years, and mean duration of diabetes was 11.24±8.7 years. 35.1% had history of foot ulcer while 25.7% had ulcer on the time of interview. 11.7 % had history of amputation and 83.1% had numbness. 77.1 % examine their feet while 49.1% received foot care education and 34% read handouts on foot care. 34% walk around in bare feet. There is a significant statistical association between foot education, foot care practices, and diabetic foot ulcer (p-value < 0.022). Conclusion: Patient knowledge and practices regarding diabetic foot care is significantly associated with the reduction of diabetic foot ulcer.

Keywords: knowledge, practice, attitude, diabetes, foot, care

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Authors: Mohammad Karimizadehardakani, Hooman Minoonejad, Reza Rajabi, Ali Sharifnejad

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Background: Ankle sprain is one of the most important risk factor of anterior cruciate ligament (ACL) injury. Also, functional ankle instability (FAI) population has alterations in lower extremity sagittal plane biomechanics during landing task. We want to examine whether biomechanical alterations demonstrated by FAI patients are associated with the mechanism of ACL injury during high risk and sport related tasks. Methods: Sixteen basketball player with FAI and 16 non-injured control performed a single-leg cross drop landing. Knee sagittal and frontal (ATSF) was calculated. Independent t-tests, multiple linear regression, and Pearson correlation were used for analysis data. Result: Subject with FAI showed more peak ATFS, posterior ground reaction force (GRF) and less knee flexion, compared to the controls (P= 0.001, P= 0.004, P= 0.011). Knee flexion (r= −0.824, P = 0.011) and posterior GRF (r= 0.901, P = .001) were correlated with ATSF; Posterior GRF was factor that most explained the variance in ATSF (R2= 0.645; P = .001) in the FAI group. Conclusions: Result of our study showed there is a potential biomechanical relationship between the presence of FAI and risk factors associated with ACL injury mechanism.

Keywords: functional ankle instability, anterior cruciate ligament, biomechanics, risk factor

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Authors: Syed Hammad Ali, Rijan Bhakta Kayastha, Ahuti Shrestha, Iram Bano

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The hydrology of Upper Indus basin is not recognized well due to the intricacies in the climate and geography, and the scarcity of data above 5000 meters above sea level where most of the precipitation falls in the form of snow. The main objective of this study is to measure the contributions of different components of runoff in Upper Indus basin. To achieve this goal, the Modified positive degree-day model (MPDDM) was used to simulate the runoff and investigate its components in two catchments of Upper Indus basin, Hunza and Gilgit River basins. These two catchments were selected because of their different glacier coverage, contrasting area distribution at high altitudes and significant impact on the Upper Indus River flow. The components of runoff like snow-ice melt and rainfall-base flow were identified by the model. The simulation results show that the MPDDM shows a good agreement between observed and modeled runoff of these two catchments and the effects of snow-ice are mainly reliant on the catchment characteristics and the glaciated area. For Gilgit River basin, the largest contributor to runoff is rain-base flow, whereas large contribution of snow-ice melt observed in Hunza River basin due to its large fraction of glaciated area. This research will not only contribute to the better understanding of the impacts of climate change on the hydrological response in the Upper Indus, but will also provide guidance for the development of hydropower potential, water resources management and offer a possible evaluation of future water quantity and availability in these catchments.

Keywords: future discharge projection, positive degree day, regional climate model, water resource management

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Authors: Nafiseh Ebrahimi, Gautham Muthukumaran, Amir Jafari

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Human walking gait is considered to be the most efficient biped walking gait. There are various types of gait human follows during locomotion and arm swing is one of the most important factors which controls and differentiates human gaits. Earlier studies declared a 7% reduction in the metabolic cost due to the arm swing. In this research, we compared different types of arm swings in terms of metabolic cost reduction and then suggested, designed, fabricated and tested a quasi-passive upper body exoskeleton to study the metabolic cost reduction in the folded arm walking gate scenarios. Our experimental results validate a 10% reduction in the metabolic cost of walking aided by the application of the proposed exoskeleton.

Keywords: arm swing, MET (metabolic equivalent of a task), calorimeter, oxygen consumption, upper body quasi-passive exoskeleton

Procedia PDF Downloads 128