Search results for: upper limb
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1340

Search results for: upper limb

1160 Community Re-Integrated Soldiers’ Perceptions of Barriers and Facilitators to A Home-Based Physical Rehabilitation Programme Following Lower-Limb Amputation

Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

Abstract:

Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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1159 Current Status of Nitrogen Saturation in the Upper Reaches of the Kanna River, Japan

Authors: Sakura Yoshii, Masakazu Abe, Akihiro Iijima

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Nitrogen saturation has become one of the serious issues in the field of forest environment. The watershed protection forests located in the downwind hinterland of Tokyo Metropolitan Area are believed to be facing nitrogen saturation. In this study, we carefully focus on the balance of nitrogen between load and runoff. Annual nitrogen load via atmospheric deposition was estimated to 461.1 t-N/year in the upper reaches of the Kanna River. Annual nitrogen runoff to the forested headwater stream of the Kanna River was determined to 184.9 t-N/year, corresponding to 40.1% of the total nitrogen load. Clear seasonal change in NO3-N concentration was still observed. Therefore, watershed protection forest of the Kanna River is most likely to be in Stage-1 on the status of nitrogen saturation.

Keywords: atmospheric deposition, nitrogen accumulation, denitrification, forest ecosystems

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1158 Effects of Lower and Upper Body Plyometric Training on Electrocardiogram Parameters of University Athletes

Authors: T. N. Uzor, C. O. Akosile, G. O. Emeahara

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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: concentric, eccentric, electrocardiogram, plyometric

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1157 Anatomically-Based Oropharyngeal Rehabilitation for the Patients with Obstructive Sleep Apnea Using a Multilevel Approach

Authors: Hsin-Yu Lin, Ching-Hsia Hung

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Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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1156 MAGNI Dynamics: A Vision-Based Kinematic and Dynamic Upper-Limb Model for Intelligent Robotic Rehabilitation

Authors: Alexandros Lioulemes, Michail Theofanidis, Varun Kanal, Konstantinos Tsiakas, Maher Abujelala, Chris Collander, William B. Townsend, Angie Boisselle, Fillia Makedon

Abstract:

This paper presents a home-based robot-rehabilitation instrument, called ”MAGNI Dynamics”, that utilized a vision-based kinematic/dynamic module and an adaptive haptic feedback controller. The system is expected to provide personalized rehabilitation by adjusting its resistive and supportive behavior according to a fuzzy intelligence controller that acts as an inference system, which correlates the user’s performance to different stiffness factors. The vision module uses the Kinect’s skeletal tracking to monitor the user’s effort in an unobtrusive and safe way, by estimating the torque that affects the user’s arm. The system’s torque estimations are justified by capturing electromyographic data from primitive hand motions (Shoulder Abduction and Shoulder Forward Flexion). Moreover, we present and analyze how the Barrett WAM generates a force-field with a haptic controller to support or challenge the users. Experiments show that by shifting the proportional value, that corresponds to different stiffness factors of the haptic path, can potentially help the user to improve his/her motor skills. Finally, potential areas for future research are discussed, that address how a rehabilitation robotic framework may include multisensing data, to improve the user’s recovery process.

Keywords: human-robot interaction, kinect, kinematics, dynamics, haptic control, rehabilitation robotics, artificial intelligence

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1155 Differential Effect of Technique Majors on Isokinetic Strength in Youth Judoka Athletes

Authors: Chungyu Chen, Yi-Cheng Chen, Po-Hsian Hsu, Hsin-Ying Chen, Yen-Po Hsiao

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The purpose of this study was to assess the muscular strength performance of upper and lower extremity in isokinetic system for the youth judo players, and also to compare the strength difference between major techniques. Sixteen male and 20 female judo players (age: 16.7 ± 1.6 years old, training age: 4.5 ± 0.8 years) were served as the volunteers for this study. There were 21 players major hand techniques and 15 players major foot techniques. The Biodex S4 Pro was used to assess the strength performance of extensor and flexor of concentric action under the load condition of 30 degree/sec, 60 degree/sec, and 120 degree/sec for elbow joints and knee joints. The strength parameters were included the maximal torque, the normalized maximal torque, the average power, and the average maximal torque. A t test for independent groups was used to evaluate whether hand major and foot major differ significantly with an alpha level of .05. The result showed the maximal torque of left knee extensor in foot major players (243.5 ± 36.3 Nm) was higher significantly than hand major (210.7 ± 21.0 Nm) under the load of 30 degree/sec (p < .05). There were no differences in upper extremity strength between the hand and foot techniques major in three loads (ps < .05). It indicated that the judo player is required to develop the upper extremity strength overall to secure the execution of major techniques.

Keywords: knee, elbow, power, judo

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1154 Efficacy of Self-Assessment Metacognitive Strategy on Academic Performance Among Upper Basic Students in Ankpa, Kogi State, Nigeria

Authors: Daodu Joshua Rotimi

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This study investigated the Efficacy of Self-Assessment Metacognitive Strategy on Academic performance in Energy Concepts among Upper Basic Science Students in Ankpa, Kogi State, Nigeria. The research design adopted for the study was a Quasi-experimental control group design which employed a pretest, posttest of the experimental and control groups. The population of the study consisted of one hundred and twenty-four (124) JSSII Students; sixty-five (65) for the experimental group and (59) for the control group. The instrument used for the study was the Energy Concept Performance Test (ECPT), with a reliability coefficient of 0.80. Two research questions were answered using descriptive statistics of mean and standard deviation, while two hypotheses were tested using a t-test at P≤0.05 level of significance. The findings of the study revealed that the use of the Self-Assessment Metacognitive Strategy has a positive effect on students’ performance in energy concepts among upper Basic Science Students leading to high academic performance; also, there is no significant difference in the mean Academic Performance scores between Male and Female students taught Energy Concept using Self-Assessment Metacognitive Strategy. Based on the research findings, recommendations were made, which include that Secondary school teachers should be encouraged the use Self-Assessment Metacognitive strategy so as to make the learning process attractive, interactive and enriching to the learners.

Keywords: metacognition, self-assessment, performance, efficacy

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1153 The Sr-Nd Isotope Data of the Platreef Rocks from the Northern Limb of the Bushveld Igneous Complex: Evidence of Contrasting Magma Composition and Origin

Authors: Tshipeng Mwenze, Charles Okujeni, Abdi Siad, Russel Bailie, Dirk Frei, Marcelene Voigt, Petrus Le Roux

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The Platreef is a platinum group element (PGE) deposit in the northern limb of the Bushveld Igneous Complex (BIC) which was emplaced as a series of mafic and ultramafic sills between the Main Zone (MZ) and the country rocks. The PGE mineralisation in the Platreef is hosted in different rock types, and its distribution and style vary with depth and along strike. This study contributes towards understanding the processes involved in the genesis of the Platreef. Twenty-four Platreef (2 harzburgites, 4 olivine pyroxenites, 17 feldspathic pyroxenites and 1 gabbronorite) and few MZ (1 gabbronorite and 1 leucogabbronorite) quarter core samples were collected from four drill cores (e.g., TN754, TN200, SS339, and OY482) and analysed for whole-rock Sr-Nd isotope data. The results show positive ɛNd values (+3.53 to +7.51) for harzburgites suggesting their parental magmas derived from the depleted Mantle. The remaining Platreef rocks have negative ɛNd values (-2.91 to -22.88) and show significant variations in Sr-Nd isotopic compositions. The first group of Platreef samples has relatively high isotopic compositions (ɛNd= -2.91 to -5.68; ⁸⁷Sr/⁸⁶Sri= 0.709177 - 0.711998). The second group of Platreef samples has Sr ratios (⁸⁷Sr/⁸⁶Sri= 0.709816-0.712106) overlapping with samples of the first group but slightly lower ɛNd values (-7.44 to -8.39). Lastly, the third group of Platreef samples has low ɛNd values (-10.82 to -14.32) and low Sr ratios (⁸⁷Sr/⁸⁶Sri= 0.707545-0.710042) than those from samples of the two Platreef groups mentioned above. There is, however, a Platreef sample with ɛNd value (-5.26) in range with the Platreef samples of the first group, but its Sr ratio (0.707281) is the lowest even when compared to samples of the third Platreef group. There are also five other Platreef samples which have either anomalous ɛNd or Sr ratios which make it difficult to assess their isotopic compositions relative to other samples. These isotopic variations for the Platreef samples indicate both multiple sources and multiple magma chambers where varying crustal contamination styles have operated during the evolution of these magmas prior their emplacements into the Platreef setting as sills. Furthermore, the MZ rocks have different Sr-Nd isotopic compositions (For OY482 gabbronorite [ɛNd= +0.65; ⁸⁷Sr/⁸⁶Sri= 0.711746]; for TN754 leucogabbronorite [ɛNd= -7.44; ⁸⁷Sr/⁸⁶Sri= 0.709322]) which do not only indicate different MZ magma chambers, but also different magmas from those of the Platreef. Although the Platreef is still considered a single stratigraphic unit in the northern limb of the BIC, its genesis involved multiple magmatic processes which evolved independently from each other.

Keywords: crustal contamination styles, magma chambers, magma sources, multiple sills emplacement

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1152 Gloria Naylor's Linden Hills: A Fine Description of Burdens and Misguided Notions of the Middle Black Community

Authors: Kalluru Maheswaramma, Putta Padma

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This study makes an attempt to demonstrate the wondrous world of the upwardly middle black community in Gloria Naylor’s Linden Hills. Gloria Naylor’s first novel The Women of Brewster Place is about the working class and Linden Hills about middle-class Black America. Naylor believes their serenity that is lost in the middle or working class black people as they move into the upper patriarchal society. Naylor challenges the different forms of superiority, homophobia, and chauvinism, interracial bias, and the like, which plague a community so significantly trying to be acceptable in the larger white community. In an ironic twist, Naylor creates characters that recognize their desire for a solid black community but who in reality ignore blackness and negate any emergent sign of its development. Linden Hills is an expose of the wealthy and spiritually dissolute upper class. Linden Hills is an examination of an upper-middle-class African American community in which women are largely exploited or invisible and in which men have, in the course of upward mobility, sacrificed their racial identity and their essence. Linden Hills is a social world, which includes firm stratification, false values, and an immobilizing impact on its residents. Touching a brief note upon the origin and development of African American Literature as well a note on the chosen writer and her works, the paper proceeds to depict the middle-class black community of Linden Hills.

Keywords: gloria naylor, linden hills, African American community, the middle black community

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1151 Discursivity and Creativity: Implementing Pigrum's Multi-Mode Transitional Practices in Upper Division Creative Production Courses

Authors: Michael Filimowicz, Veronika Tzankova

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This paper discusses the practical implementation of Derek Pigrum’s multi-mode model of transitional practices in the context of upper division production courses in an interaction design curriculum. The notion of teaching creativity directly was connected to a general notion of “discursivity” by which is meant students’ overall ability to discuss, describe, and engage in dialogue about their creative work. We present a study of how Pigrum’s transitional modes can be mapped onto a variety of course activities, and discuss challenges and outcomes of directly engaging student discursivity in their creative output.

Keywords: teaching creativity, multi-mode transitional practices, discursivity, rich dialogue, art and design education, pedagogy

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1150 Comparison of Two Online Intervention Protocols on Reducing Habitual Upper Body Postures: A Randomized Trial

Authors: Razieh Karimian, Kim Burton, Mohammad Mehdi Naghizadeh, Maryam Karimian

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Introduction: Habitual upper body postures are associated with online learning during the COVID-19 pandemic. This study explored whether adding an exercise routine to an ergonomic advice intervention improves these postures. Methods: In this randomized trial, 42 male adolescent students with a forward head posture were randomly divided into two equal groups, one allocated to ergonomic advice alone and the other to ergonomic advice plus an exercise routine. The angles of forward head, shoulder, and back postures were measured with a photogrammetric profile technique before and after the 8-week intervention period. Findings: During home quarantine, 76% of the students used their mobile phones, while 35% used a table-chair-computer for online learning. While significant reductions of the forward, shoulder, and back angles were found in both groups (P < 0.001), the effect was significantly greater in the exercise group (P < 0.001: forward head, shoulder, and back angles reduced by some 9, 6, and 5 degrees respectively, compared with 4 degrees in the forward head, and 2 degrees in the shoulder and back angles for ergonomic advice alone. Conclusion: The exercise routine produced a greater improvement in habitual upper body postures than ergonomic advice alone, a finding that may extend beyond online learning at home.

Keywords: randomized trial, online learning, adolescent, posture, exercise, ergonomic advice

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1149 Association of Extremity Injuries with Safety Gear and Clothing of Hospitalized Motorcycle Riders: A Prospective Study

Authors: Sanjaya N. Munasinghe, R. Gnanasekeram, Dimuthu Tennakoon

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During the last few years there has been a dramatic increase in the number of motorcyclists in Sri Lankan roads and thus an increase of motorcycle accidents (MCAs) with a heavy death and casualty toll. Extremity injuries due to MCAs cause a heavy burden on government hospitals. However, data on MCA injuries are limited. This study tries to determine the relationship between extremity injuries with protective gears and clothing motorcycle riders were wearing at the time of the accident. Data were collected from 410 motorcycle riders and passengers involved with MCAs and admitted to orthopedic and emergency observation wards in Teaching Hospital Kurunegala with extremity injuries between 1st February 2015 and 31st July 2015 using an interviewer administered questioner. Data were analyzed using SPSS version 17.0. Distal radial fracture is the most common upper extremity injury (12%), and Tibial fracture is the most common and severe lower extremity injury (23%). Very few participants were wearing safety gloves (2%) and jackets (10%). Most of the participants were wearing slippers (66%), short sleeved upper clothing (96%) and light cloth trousers (49%). According to Chi-square test associations were found between footwear and foot injuries (p-value - 0.001, Cramer's v-value - 0.203) and safety jacket and upper extremity injuries (p-value - 0.002, Cramer's v-value - 0.177). The results indicate that using safety gear can minimize the number of injuries in MCA victims. Thus it is necessary to ensure that motorcycle riders and pillion riders use proper safety gear.

Keywords: extremity injuries, fractures, motorcycle accidents, safety gear

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1148 Investigation on Microfacies and Electrofacies of Upper Dalan and Kangan Formations in One of Costal Fars Gas Fields

Authors: Babak Rezaei, Arash Zargar Shoushtari

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Kangan anticline is located in the Coastal Fars area, southwest of Nar and west of west Assaluyeh anticlines and north of Kangan harbor in Boushehr province. The Kangan anticline is nearly asymmetric and with 55Km long and 6Km wide base on structural map of Kangan Formation. The youngest and the oldest Formations on surface are Bakhtiyari (Pliocene) and Sarvak (Cenomanian) respectively. The highest dip angles of 30 and 40 degree were observed in north and south flanks of Kangan anticline respectively and two reverse faults cut these flanks parallel to structure strike. Existence of sweet gas in Kangan Fm. and Upper Dalan in this structure is confirmed with probable Silurian shales origin. Main facies belts in these formations include super tidal and intertidal flat, lagoon, oolitic-bioclastic shoals and open marine sub environments that expand in a homoclinal and shallow water carbonate ramp under the arid climates. Digenetic processes studies, indicates the influence of all digenetic environments (marine, meteoric, burial) in the reservoir succession. These processes sometimes has led to reservoir quality improvement (such as dolomitization and dissolution) but in many instances reservoir units has been destroyed (such as compaction, anhydrite and calcite cementation). In this study, petrophysical evaluation is made in Kangan and upper Dalan formations by using well log data of five selected wells. Probabilistic method is used for petrophysical evaluation by applying appropriate soft wares. According to this evaluation the lithology of Kangan and upper Dalan Formations mainly consist of limestone and dolomite with thin beds of Shale and evaporates. In these formations 11 Zones with different reservoir characteristic have been identified. Based on wire line data analyses, in some part of these formations, high porosity can be observed. The range of porosity (PHIE) and water saturation (Sw) are estimated around 10-20% and 20-30%, respectively.

Keywords: microfacies, electrofacies, petrophysics, diagenese, gas fields

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1147 Brain Stem Posterior Reversible Encephalopathy Syndrome in Nephrotic Syndrome

Authors: S. H. Jang

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Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurologic symptoms (visual loss, headache, altered mentality and seizures) and by typical imaging findings (bilateral subcortical and cortical edema with predominatly posterior distribution). Nephrotic syndrome is a syndrome comprising signs of proteinuria, hypoalbuminemia, and edema. It is well known that hypertension predispose patient with nephrotic syndrome to PRES. A 45-year old male was referred for suddenly developed vertigo, disequilibrium. He had previous history of nephrotic syndrome. His medical history included diabetes controlled with medication. He was hospitalized because of generalized edema a few days ago. His vital signs were stable. On neurologic examination, his mental state was alert. Horizontal nystagmus to right side on return to primary position was observed. He showed good grade motor weakness and ataxia in right upper and lower limbs without other sensory abnormality. Brain MRI showed increased signal intensity in FLAIR image, decreased signal intensity in T1 image and focal enhanced lesion in T1 contrast image at whole midbrain, pons and cerebellar peduncle symmetrically, which was compatible with vasogenic edema. Laboratory findings showed severe proteinuria and hypoalbuminemia. He was given intravenous dexamethasone and diuretics to reduce vasogenic edema and raise the intra-vascular osmotic pressure. Nystagmus, motor weakness and limb ataxia improved gradually over 2 weeks; He recovered without any neurologic symptom and sign. Follow-up MRI showed decreased vasogenic edema fairly. We report a case of brain stem PRES in normotensive, nephrotic syndrome patient.

Keywords: posterior reversible encephalopathy syndrome, MRI, nephrotic syndrome, vasogenic brain edema

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1146 Macrocephaly-Cutis Marmorata Telangiectatica Congenita Associated with Epilepsy: Case Report

Authors: Atitallah Sofien, Bouyahia Olfa, Krifi Farah, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Cutis marmorata telangiectatica congenita (CMTC) is a rare cutaneous vascular malformation. It most often appears at birth or during the first days of life. Its origin is still unknown. It associates a livedo with telangiectasias of diffuse or segmental topography. In rare cases, it can be associated with neurological disorders such as macrocephaly and, less frequently, with epilepsy. Methodology: We report a case of an infant with Macrocephaly- Cutis marmorata telangiectatica congenita syndrome associated with epilepsy. Results: This is the case of a one month and 15 days old female infant from a non-consanguineous marriage, admitted for a status epilepticus in the context of apyrexia. Infectious and metabolic causes had been eliminated. Physical examination had shown non-infiltrated and reticular livedoid erythematous patches affecting the left upper limb and atrophic on the back of the left hand. Cerebral magnetic resonance imaging (MRI) showed thin layers of bifrontal, temporal, and left parietal hygromas associated with the widening of the bifrontal subarachnoid spaces. The electroencephalogram showed a well-organized sleep tracing with a single right occipital paroxysmal abnormality. Antiepileptic treatment has been administered with good clinical evolution and regression of the skin lesion and a control electroencephalogram without abnormality. Conclusion: This observation illustrates an association of CMTC with both macrocephaly and epilepsy. This pathology, which is relatively benign and has a good prognosis, generally does not require treatment. However, a detailed examination must be carried out, and a follow-up plan must be put in place for each patient presenting with CMTC, given the risk of association with other abnormalities, which can be potentially serious.

Keywords: cutis marmorata telangiectatica congenita, macrocephaly, epilepsy, children

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1145 Aging-Related Changes in Calf Muscle Function: Implications for Venous Hemodynamic and the Role of External Mechanical Activation

Authors: Bhavatharani S., Boopathy V., Kavin S., Naveethkumar R.

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Context: Resistance training with blood flow restriction (BFR) has increased in clinical rehabilitation due to the substantial benefits observed in augmenting muscle mass and strength using low loads. However, there is a great variability of training pressures for clinical populations as well as methods to estimate it. The aim of this study was to estimate the percentage of maximal BFR that could result by applying different methodologies based on arbitrary or individual occlusion levels using a cuff width between 9 and 13 cm. Design: A secondary analysis was performed on the combined databases of 2 previous larger studies using BFR training. Methods: To estimate these percentages, the occlusion values needed to reach complete BFR (100% limb occlusion pressure [LOP]) were estimated by Doppler ultrasound. Seventy-five participants (age 24.32 [4.86] y; weight: 78.51 [14.74] kg; height: 1.77 [0.09] m) were enrolled in the laboratory study for measuring LOP in the thigh, arm, or calf. Results: When arbitrary values of restriction are applied, a supra-occlusive LOP between 120% and 190% LOP may result. Furthermore, the application of 130% resting brachial systolic blood pressure creates a similar occlusive stimulus as 100% LOP. Conclusions: Methods using 100 mm Hg and the resting brachial systolic blood pressure could represent the safest application prescriptions as they resulted in applied pressures between 60% and 80% LOP. One hundred thirty percent of the resting brachial systolic blood pressure could be used to indirectly estimate 100% LOP at cuff widths between 9 and 13 cm. Finally, methodologies that use standard values of 200 and, 300 mm Hg far exceed LOP and may carry additional risk during BFR exercise.

Keywords: lower limb rehabilitation, ESP32, pneumatics for medical, programmed rehabilitation

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1144 Orbital Tuning of Marl-Limestone Alternations (Upper Tithonian to Upper Berriasian) in North-South Axis (Tunisia): Geochronology and Sequence Implications

Authors: Hamdi Omar Omar, Hela Fakhfakh, Chokri Yaich

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This work reflects the integration of different techniques, such as field sampling and observations, magnetic susceptibility measurement, cyclostratigaraphy and sequence stratigraphy. The combination of these results allows us to reconstruct the environmental evolution of the Sidi Khalif Formation in the North-South Axis (NOSA), aged of Upper Tithonian, Berriasian and Lower Valanginian. Six sedimentary facies were identified and are primarily influenced by open marine sedimentation receiving increasing terrigenous influx. Spectral analysis, based on MS variation (for the outcropped section) and wireline logging gamma ray (GR) variation (for the sub-area section) show a pervasive dominance of 405-kyr eccentricity cycles with the expression of 100-kyr eccentricity, obliquity and precession. This study provides (for the first time) a precise duration of 2.4 myr for the outcropped Sidi Khalif Formation with a sedimentation rate of 5.4 cm/kyr and the sub-area section to 3.24 myr with a sedimentation rate of 7.64 cm/kyr. We outlined 27 5th-order depositional sequences, 8 Milankovitch depositional sequences and 2 major 3rd-order cycles for the outcropping section, controlled by the long eccentricity (405 kyr) cycles and the precession index cycles. This study has demonstrated the potential of MS and GR to be used as proxies to develop an astronomically calibrated time-scale for the Mesozoic era.

Keywords: Berriasian, magnetic susceptibility, orbital tuning, Sidi Khalif Formation

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1143 Developing Mathematical Relationships to Evaluate the Amount of Added Ease to the Basic Pattern of Weft Knitting Fabrics and Its Fitting to the Upper Part of Egyptian Women's Bodies

Authors: Hebatullah Ali Abdel-Aleem Abdel-Hamid, Camellia Mousa Mohamed Elzean

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Knitted garments recently became a key component in wardrobes of the Egyptian woman. Many Egyptian women depend on garments made of knitted fabrics in their outer appearance because of its specific properties including flexibility. Through observation and application, it was noticed that knitwear blocks that used for knitted fabrics somehow does not fit the figures of the Egyptian women. Moreover, the pattern makers are usually confused and unable to choose the suitable blocks for different knitting fabrics taking into consideration its physical and mechanical properties. This study seeks to develop mathematical relationships for evaluation of the amount of added- or subtracted ease to Aldrich’s basic fitting blocks for some weft knitting fabrics and its fitting to the upper part of Egyptian women's bodies. To achieve this goal, 12 samples were used to evaluate fitting of Aldrich’s Basic Fitting Block to the upper part of Egyptian women's bodies. The samples were evaluated before and after alterations, through wear trials on the standard mannequins of size 48 and 56, and judged by experienced assessors using fit evaluation scale. The data obtained were statistically analyzed to identify the efficiency of the adjustments. The Aldrich’s Basic Fitting Block was selected because his method is known internationally and easy to use.

Keywords: Aldrich basic fitting block, clothing industry, knitted fabrics, pattern construction

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1142 Groundwater Potential in the Central Part of Al Jabal Al Akhdar Area, Ne Libya

Authors: Maged El Osta, Milad Masoud

Abstract:

Al Jabal Al Akhdar in the north-eastern part of Libya represents a region with promising ecological underpinning for grazing and other agricultural developments. The groundwater potential of both Upper Cretaceous and Eocene aquifers was studied based the available literature and a complete database for about 112 water wells drilled in the period 2003-2009. In this research, the hydrogeological methods will be integrated with the Geographic Information System (GIS) that played a main role in highlighting the spatial characteristics of the groundwater system. The results indicate that the depth to water for the Upper Cretaceous aquifer ranges from 150 to 458 m, and the piezometric surface decreases from over 500 m (m.s.l) in the northern parts to -20 m (m.s.l) in southeastern part. Salinity ranges between 303 and 1329 mg/l indicating that groundwater belongs to the slightly fresh water class. In the Eocene aquifer, the depth to groundwater ranges from 120 to 290.5 m and the potentiometric level decreases gradually southwards from 220 to -51 m (m.s.l) and characterized by steep slope in the southeastern part of the study area, where the aquifer characterized by relatively high productivity (specific capacity ranges between 10.08 and 332.3 m2/day). The groundwater salinity within this aquifer ranges between 198 and 2800 mg/l (fresh to brackish water class). The annual average rainfall (from 280 to 500 mm) plays a significant role in the recharge of the two aquifers. The priority of groundwater quality and potentiality increases towards the central and northern portions of the concerned area.

Keywords: Eocene and Upper Cretaceous aquifers, rainfall, potentiality, Geographic Information System (GIS)

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1141 Investigation of the Effects of Dry Needling With Stretching Upper Trapezius Muscle on Clinical Outcomes in Participants With Active Myofascial Trigger Point.

Authors: Marzieh Yassin, Fereshteh Navaee, Javad Sarrafzadeh, Reza Salehi

Abstract:

Introduction: Myofascial trigger point (MTrP) is one of the most common sources of musculoskeletal pain. Approximately 30-85% of the patients with musculoskeletal pains would experience MTrP in their life. The prevalence of MTrP has reported in the patients seen in a general orthopedic clinic, general medical clinic and specialty pain management centers, 21%, 30% and 93% respectively. Nowadays, dry needling is suggested as a standard treatment for MTrPs. The purpose of the present study was to examine the effectiveness of dry needling with stretching upper trapezius muscle on pain and pain pressure threshold in participants with active myofascial trigger point. Methods: Thirty participants with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the treatments for three weeks. The outcomes were pain intensity and pain pressure threshold that were assessed with visual analogue scale and algometer respectively. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. Also, the results showed a significant difference in measurements between two groups (P<0.05). Conclusion: Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in participants with active myofascial trigger points.

Keywords: dry needling, myofascial pain syndrome, myofascial trigger point, stretching

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1140 GIS Application in Surface Runoff Estimation for Upper Klang River Basin, Malaysia

Authors: Suzana Ramli, Wardah Tahir

Abstract:

Estimation of surface runoff depth is a vital part in any rainfall-runoff modeling. It leads to stream flow calculation and later predicts flood occurrences. GIS (Geographic Information System) is an advanced and opposite tool used in simulating hydrological model due to its realistic application on topography. The paper discusses on calculation of surface runoff depth for two selected events by using GIS with Curve Number method for Upper Klang River basin. GIS enables maps intersection between soil type and land use that later produces curve number map. The results show good correlation between simulated and observed values with more than 0.7 of R2. Acceptable performance of statistical measurements namely mean error, absolute mean error, RMSE, and bias are also deduced in the paper.

Keywords: surface runoff, geographic information system, curve number method, environment

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1139 Virtual Reality in COVID-19 Stroke Rehabilitation: Preliminary Outcomes

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

Abstract:

Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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1138 Corporate Voluntary Greenhouse Gas Emission Reporting in United Kingdom: Insights from Institutional and Upper Echelons Theories

Authors: Lyton Chithambo

Abstract:

This paper reports the results of an investigation into the extent to which various stakeholder pressures influence voluntary disclosure of greenhouse-gas (GHG) emissions in the United Kingdom (UK). The study, which is grounded on institutional theory, also borrows from the insights of upper echelons theory and examines whether specific managerial (chief executive officer) characteristics explain and moderates various stakeholder pressures in explaining GHG voluntary disclosure. Data were obtained from the 2011 annual and sustainability reports of a sample of 216 UK companies on the FTSE350 index listed on the London Stock Exchange. Generally the results suggest that there is no substantial shareholder and employee pressure on a firm to disclose GHG information but there is significant positive pressure from the market status of a firm with those firms with more market share disclosing more GHG information. Consistent with the predictions of institutional theory, we found evidence that coercive pressure i.e. regulatory pressure and mimetic pressures emanating in some industries notably industrials and consumer services have a significant positive influence on firms’ GHG disclosure decisions. Besides, creditor pressure also had a significant negative relationship with GHG disclosure. While CEO age had a direct negative effect on GHG voluntary disclosure, its moderation effect on stakeholder pressure influence on GHG disclosure was only significant on regulatory pressure. The results have important implications for both policy makers and company boards strategizing to reign in their GHG emissions.

Keywords: greenhouse gases, voluntary disclosure, upper echelons theory, institution theory

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1137 Caste of Women: An Inquiry into the Differences in Inter-Caste Marriages in an Adivasi Samaj

Authors: Dhiraj Kumar

Abstract:

The paper attempts to argue that the regulation of the rural lower caste woman’s life-world is at the core of the reproduction of hierarchy in an Adivasi samaj (society). It has been established in studies on caste and Adivasi that the two societies are distinct and operate through different structures, norms, rituals, beliefs, etc. This is as opposed to the colonial and certain post-independence anthropology in/of India that collapsed the two into single categories for analysis. However, how the two seemingly different social structures affect each other has attracted little attention. The paper is inspired by an action-research at Gadh-Bansla, an Adivasi village in the Kanker district of Chhattisgarh that houses different caste groups – OBCs and SCs, as well as two different Adivasi groups: Gond and Halba. The action-research, taken place across a year, has worked with six families of the different groups present (i.e., Gond, Halba, OBCs, and SCs) in which inter-caste marriages have taken place. Through in-depth interviews and free association discussions with these six families, the paper presents the ways in which the samaj and caste society have interacted. It has been observed that there is a difference in treatment in marriages between a lower caste woman marrying into an upper caste or Halba household, and an upper caste or Halba woman marrying into a lower caste household. While the upper caste woman is easily accepted into the Adivasi samaj and the husband’s family, the same does not hold true for the lower caste woman. The lower caste woman has to face humiliation through untouchability, fine on the family, or in some cases excommunication of the couple. The paper concludes with a need to use caste as a central analytic to understand gender discrimination even in Adivasi contexts.

Keywords: caste, Adivasi, Samaj, humiliation, woman

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1136 Percentage Contribution of Lower Limb Moments to Vertical Ground Reaction Force in Normal Walking

Authors: Salam M. Elhafez, Ahmed A. Ashour, Naglaa M. Elhafez, Ghada M. Elhafez, Azza M. Abdelmohsen

Abstract:

Patients suffering from gait disturbances are referred by having muscle group dysfunctions. There is a need for more studies investigating the contribution of muscle moments of the lower limb to the vertical ground reaction force using 3D gait analysis system. The purpose of this study was to investigate how the hip, knee and ankle moments in the sagittal plane contribute to the vertical ground reaction force in healthy subjects during normal speed of walking. Forty healthy male individuals volunteered to participate in this study. They were filmed using six high speed (120 Hz) Pro-Reflex Infrared cameras (Qualisys) while walking on an AMTI force platform. The data collected were the percentage contribution of the moments of the hip, knee and ankle joints in the sagittal plane at the instant of occurrence of the first peak, second peak, and the trough of the vertical ground reaction force. The results revealed that at the first peak of the ground reaction force (loading response), the highest contribution was generated from the knee extension moment, followed by the hip extension moment. Knee flexion and ankle plantar flexion moments produced high contribution to the trough of the ground reaction force (midstance) with approximately equal values. The second peak of the ground reaction force was mainly produced by the ankle plantar flexion moment. Conclusion: Hip and knee flexion and extension moments and ankle plantar flexion moment play important roles in the supporting phase of normal walking.

Keywords: gait analysis, ground reaction force, moment contribution, normal walking

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1135 Lateral Sural Artery Perforators: A Cadaveric Dissection Study to Assess Perforator Surface Anatomy Variability and Average Pedicle Length for Flap Reconstruction

Authors: L. Sun, O. Bloom, K. Anderson

Abstract:

The medial and lateral sural artery perforator flaps (MSAP and LSAP, respectively) are two recently described flaps that are less commonly used in lower limb trauma reconstructive surgeries compared to flaps such as the anterolateral thigh (ALT) flap or the gastrocnemius flap. The LSAP flap has several theoretical benefits over the MSAP, including the ability to be sensate and being more easily manoeuvred into position as a local flap for coverage of lateral knee or leg defects. It is less commonly used in part due to a lack of documented studies of the anatomical reliability of the perforator, and an unquantified average length of the pedicle used for microsurgical anastomosis (if used as a free flap) or flap rotation (if used as a pedicled flap). It has been shown to have significantly lower donor site morbidity compared to other flaps such as the ALT, due to the decreased need for intramuscular dissection and resulting in less muscle loss at the donor site. 11 cadaveric lower limbs were dissected, with a mean of 1.6 perforators per leg, with an average pedicle length of 45mm to the sural artery and 70mm to the popliteal artery. While the majority of perforating arteries lay close to the midline (average of 19mm lateral to the midline), there were patients whose artery was significantly lateral and would have been likely injured by the initial incision during an operation. Adding to the literature base of documented LSAP dissections provides a greater understanding of the anatomical basis of these perforator flaps, and the authors hope this will establish them as a more commonly used and discussed option when managing complicated lower limb trauma requiring soft tissue reconstruction.

Keywords: cadaveric, dissection, lateral, perforator flap, sural artery, surface anatomy

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1134 The Use of STIMULAN Resorbable Antibiotic Beads in Conjunction with Autologous Tissue Transfer to Treat Recalcitrant Infections and Osteomyelitis in Diabetic Foot Wounds

Authors: Hayden R Schott, John M Felder III

Abstract:

Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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1133 Near Bottom Concentrations of Krill in Two Arctic Fjords, Spitsbergen

Authors: Kajetan Deja, Katarzyna Draganska-Deja, Mateusz Ormanczyk, Michał Procajlo

Abstract:

Two glaciated fjords on Spitsbergen (Hornsund 77°N) and Kongsfjorden (79°N) were studied for the occurrence of macroplankton (mostly euphausids, hyperiids, chaetognaths) with the use of drop down the camera. The underwater imagery demonstrates that closer to the glacier front, where turbid and freshwater occurs, most of the macroplankters leave the upper water column and descends to the bottom (about 100m depth). Concentrations of macroplankton in the immediate vicinity of the sediment reach over 500 specimens per m² - what corresponds to the biomass of 10g C/m³. Such concentrations of macroplankton are of prime interest for fish, seals and other carnivores. Conditions in the near-bottom waters are in many respects better than in the upper water column- better oxygenated, cold, fully saline and transparent waters with rich food deposited on the seabed from the surface (sinking microplankton). We suggest that near bottom occurrence of macroplankton is related to the increase of glacier melt and freshwater discharge intensity.

Keywords: arctic, ecosystem, fjords, Krill

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1132 Wearable Jacket for Game-Based Post-Stroke Arm Rehabilitation

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

Abstract:

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

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

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1131 Family Support in Combating Extreme Stress: The Experience of Entrance Examinations Candidates in Greek Universities

Authors: Marianna De Almeida

Abstract:

Greek secondary education is a highly selective system with regard to the access of students to Greek universities. Since access from elementary to lower secondary education and afterward to upper secondary education is rather liberal and almost free of selective mechanisms, the basic selection process comes after graduating from upper secondary school into play when students go through a highly selective process for university entry. This structure is responsible for the experience of extreme stress on the part of the candidates during a period of at least two years before the entrance examination leading to a radical change in students' everyday life routines. Instead of the school being an important agent for academic and psychological support, it seems that other agents, such as the informal private preparatory school and the student's families, take on the supportive role.

Keywords: stress, entrance examinations, family support, secondary education

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