bluuebunny/crossref_metadata_2025 huggingface dataset:
Conception of a Multi-Component Water System with Individually Adaptable Modules for Measuring Diverse Parameters and a Variability of the Purification Output Quality
Authors: Heinrich Moritz Paul Philipp , Hauschultz Mike Thomas , Di Vona Maria Luisa , Pizzoferrato Roberto , Foitzik Andreas H.
Published: December 2023

This work deals with an adaptable water reactor design built from different modules as a basis for research. These modules are selected according to the application and are used for sensor related cleaning and supporting tasks. For example, to produce a specific water quality or for pharmaceutical applications. Sensor related modules are used to measure various parameters such as temperature, TOC, flow parameters and others. In addition to simple membrane filter modules, UV-C disinfection and experimental modules are integrated into the setup. Modules for pumping processes, for power supply such as solar, for control tasks and the connection systems of water and electricity between modules are also outlined. This system is described on the basis of scientific examples that use this system. In more detail the modules for temperature, TOC measurement, and UV-C disinfection as well as the supply and control modules are shown.
Dynamic Modulus Anomaly in Metallic Alloys Prepared by Additive Manufacturing
Authors: Cabibbo Marcello , de Crescenzo Chiara , Fava Alessandra , Montanari Roberto , Palombi Alessandra , Pola Annalisa , Tocci Marialaura , Varone Alessandra
Published: December 2023

Dynamic modulus vs. temperature was measured in different alloys (stainless steels, Al alloys, Ti alloys, Ni-base superalloys) prepared by additive manufacturing and an anomalous trend was observed in some of them. Dynamic modulus, measured in successive mechanical spectroscopy test runs with heating-cooling cycles, exhibits an anomalous trend in the first test run that is no longer present in the successive runs. The phenomenon consists in the inversion of the decreasing trend of modulus occurring during heating and gives rise to its permanent increase at the end of the complete heating-cooling cycle. The temperature range where the modulus anomaly takes place and the permanent increase observed after cooling depend on the specific alloy. Scanning electron microscopy (SEM) observations and density measurements revealed that the irreversible process causing the anomalous behavior is the closure of pores of nanometric size leading to material densification. This result has been discussed by considering lattice diffusion.
A Unique Hall-Petch Relation of Harmonic Structure Designed Pure Ni
Authors: Matsuzaka Daichi , Nagano Kentaro , Kambara Taiki , Kawabata Mie , Kuno Tomoko , Fujiwara Hiroshi , Ameyama Kei
Published: December 2023

Harmonic structure has a heterogeneous microstructure consisting of bimodal grain size together with a controlled and specific topological 3D distribution of fine and coarse grains. These microstructural features of the harmonic structure materials lead to unique mechanical properties. In this study, harmonic structure was designed using the severe plastic deformation powder metallurgy process at room and cryogenic temperatures on pure nickel. There is no difference in appearance between mechanically milled (MM) powder at room and cryogenic temperatures. The compacts of the MM powder show the harmonic structure with a network fine grained area and the dispersed coarse grain area. The MM at cryogenic temperature affects the compact of the MM powder milled for 86.4 ks and its effects include an increase in shell fraction and a decrease in core grain size. Moreover, the harmonic structure materials show a synergy extra hardening in Hall-Petch relation. It is noteworthy that the harmonic structure materials exhibit a higher Hall-Petch coefficient than the homogeneous compacts despite of the same material.
Development of a Thermal Cycler for a Low-Cost Real-Time PCR Application
Authors: Just Verena Magdalena , Welzel Felix , Jacobs Hannes , Gau Grigorij , Hauschultz Mike Thomas , Friedo Maria Helene , Foitzik Andreas H.
Published: December 2023

With the COVID 19 pandemic and the rise of polymerase chain reaction (PCR) testing in its wake, affordable large-scale testing became necessary. A thermal cycler for PCR has been developed that is affordable, fast, and accurate. The thermocycler must follow a specific temperature profile consisting of three different temperature levels. To ensure the success of any PCR, the tempering elements must accurately follow the tempering profile and be stable heat sources to maintain any given temperature. A control mechanism is required to approximate this prescribed temperature behavior. The basis for this is a Proportional-Integral-Differential (PID) controller, whose functionality is ensured by a feedback mechanism consisting of a temperature sensor. The PID controller provides precise attainment and maintenance of the temperature levels. A high performance Peltier element is used to heat and cool the PCR system. This is controlled by a programmable power supply and, in combination with a heat dissipation system, achieves heating and cooling powers in excess of 200 W. In addition, different design variants of the thermal cycler were created and their temperature behavior was simulated. These were then implemented, tested and the PID controller tuned accordingly. These tests help to find the best design for the thermal cycler with the optimal heat distribution.
Additive Layer Manufacturing of Carbon Fiber/PEKK Composites for Aeronautic Application
Authors: Quadrini Fabrizio , Bellisario Denise , Iorio Leandro , Proietti Alice , Santo Loredana
Published: December 2023

A 3d printer has been prototyped for additive manufacturing of carbon fiber (CF) poly-ether-ketone-ketone (PEKK) composites. The machine consisted of a SCARA robot, equipped with an extrusion device. The nozzle was designed to allow the deposition of thin unidirectional (UD) tapes without affecting the fiber continuity. An elastic connection between the robot end-effector and the extruder was used for allowing tape agglomeration during manufacturing. Deposition tests were carried out at the extrusion temperature of 400°C and the rate of 130 mm/min, for a maximum number of 3 layers on a CF-epoxy laminate as substrate. The good agglomeration of the 3d printed parts and their adhesion on the composite substrate are shown by the resulted final thickness, and the ability to machine them by end milling. Results show the feasibility of using this technology for the manufacturing of composite shims in the aeronautic sector.
Difference between skin incision size at the start and at the end of external dacryocystorhinostomy
Authors: Bakr Karim , Gouda Jylan , Eldin Alia Nour
Published: December 2023

Purpose

To study the difference between the intended skin incision size at the start of the surgery in Ex-DCR and the actual final intraoperative incision size after its closure at the end of the surgery, and to look for a correlation between this difference and the patient’s age, gender and side of surgery.

Methods

A prospective Observational case series study was performed on 50 patients with unilateral nasolacrimal duct obstruction. The incision will be measured in millimeters using a caliper. The incision size was measured again after wound closure at the end of the surgery in millimeters. The difference between both sizes was correlated to the age, gender and side of surgery.

Results

The mean age of the patients was 45.6±16.6 years. Twenty-nine were females (58%). There was a statistically significant increase in the mean incision size at the end of the surgery (10.5±0.6 vs. 12.9±1.3 mm). This change was related to female gender, age above 50 years of age and procedures done on the left side.

Conclusions

Size of skin incision increases inevitably at the end of the surgery. The amount of increase is related to age, sex and side of the procedure.
Steel, Maraging, Bars, Forgings, Mechanical Tubing, Rings, and Stock for Forgings and Rings, 18.5Ni - 12.0Co - 4.9Mo - 1.40Ti - 0.10Al, Premium Aircraft Quality, Double Vacuum Melted, Annealed (Maraging 350)
Authors:   AMS E Carbon and Low Alloy Steels Committee
Published: December 2023

This specification covers a premium aircraft-quality steel in the form of bars, forgings, mechanical tubing, and flash-welded rings up to 5.000 inches (127.00 mm), inclusive, in diameter or least distance between parallel sides, and stock of any size for forging or flash-welded rings.
In vitro and in vivo analysis of the antioxidant potentials of methanolic extract of Tamarindus indica leaves
Authors: Garba Yusuf , Bello Naja'atu U. , Bashir Musa , Mohammed Salisu Y.
Published: December 2023

This study evaluated the antioxidant potentials of methanolic extract of Tamarindus indica leaves using in vitro and in vivo assays. reliminary qualitative screening of phytochemicals revealed the presence of alkaloids, flavonoids, saponins, tannins, cardiac glycosides and steroids. The result of the acute toxicity test of the extracts revealed the LD50 to be above 5000 mg/kg through both oral and intra-peritoneal routes. Both the in vitro and in vivo assays were carried out. The reducing power (0.45±0.007 μg/ml) was recorded for T. indica with a difference of 0.77% in comparison to the control and DPPH value (68.10 ± 0.007%) with a significant increase compared to ascorbic acid. The in vivo analysis shows that lipid peroxidation, superoxide dismutase and catalase activities have values of 22.75 ± 9.29 nmol/mg, 1.60 ± 0.03 U/ml and 0.003±0.001 μmol/mg, respectively. The values for superoxide dismutase and lipid peroxidation were significantly different compared to the control (1.48 ± 0.03 U/ml and 24.54 ± 9.29 nmol/mg, respectively) while the value for catalase activity was not significant compared to the control (0.0025 ± 0.001 μmol/mg). The liquid chromatography mass spectrometry revealed the presence of some important metabolite; linoleic acid and quassin, among others, which are antioxidant. Based on the results obtained, the T. indica leaves contain vital metabolites with antioxidant potential that could be useful in health management.
Poster (Knowledge Generation) ID 1969163
Authors: Furlan Julio C. , Hitzig Sander L. , Boulos Mark I.
Published: December 2023

Background

This ongoing study aims to examine the potential cognitive and psycho-social benefits of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep apnea (SA).

Methods

This study included adults with chronic SCI who underwent a 4-month trial of CPAP therapy for management of recently diagnosed moderate-to-severe SA. Outcome measures included the Epworth Sleepiness Scale (ESS), Medical Outcomes Study Sleep Scale (MOS-SS), Fatigue Severity Scale (FSS), Depression, Anxiety & Stress Scale-21 (DASS-21), Montreal Cognitive Assessment (MoCA), SF-36, and Craig Handicap Assessment & Reporting Technique (CHART). The participants were also asked about their lived experience before and after CPAP trial (qualitative analysis).

Results

By February 2023, we screened 33 individuals (10 females, 23 males; age range: 37-79 years; mean age: 58.3 years) with motor complete (n=15) or incomplete SCI at cervical (n=22) or thoracic levels. Time since SCI varied from 4 to 793 months. The apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events/hour. Of the 33 individuals, 25 participants with moderate-to-severe SA initiated CPAP therapy; 19 individuals have completed the CPAP trial. Daytime sleepiness and sleep quality, fatigue and quality of life significantly improved with CPAP therapy. There was a trend for improvement of cognitive, mental health and participation scores, but they have not reached significance yet (p=0.079, p=0.207, p=0.221, respectively).

Conclusions

Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and quality of life, and mitigates daytime sleepiness, fatigue, and anxiety in people with chronic SCI.
Poster (Health Services, Economics and Policy Change) ID 1969166
Authors: Furlan Julio C. , Hitzig Sander L. , Milligan James , Athanasopoulos Peter , Boulos Mark I.
Published: December 2023

Background

We studied the feasibility of a home-based screening sleep test (HBSST), the validity of four questionnaires used to screen for sleep-related breathing disorders (SRBDs), and the potential association between SRBD and clinical features in individuals with spinal cord injury (SCI).

Methods

Adults with subacute/chronic (>1 month post-injury) SCI were recruited for the cross-sectional study and qualitative analysis. Feasibility of the HBSST was objectively evaluated and participants shared their experience. We also examined the validity of the Berlin, STOP, Medical Outcomes Study Sleep Scale [MOS-SS], and STOP-Bang screening questionnaires. We investigated the association between the degree of SRBD and three features (i.e., neck circumference, body mass index [BMI] and oropharynx opening as assessed using the Modified Mallampati classification [MMC]).

Results

There were 13 females and 18 males with ages varying from 20 to 86 years (mean age: 54.7 years) with motor complete (n=8) or incomplete SCI at cervical (n=21) or thoraco-lumbar levels. Time since SCI varied from 1.5 to 474 months. Overall, 28 individuals completed the HBSST and endorsed its feasibility. Mean apnea-hypopnea index (AHI) was 17.3 events/hour (range: 0.5-83.7). AHI was significantly correlated with Berlin (p=0.036) and STOP-Bang scores (p=0.009). There was no significant correlation between AHI and MOS-SS (p=0.348) or STOP (p=0.165). AHI was not associated with neck circumference (p=0.614), BMI (p=0.958), or MMC (p=0.335).

Conclusions

Our results suggest that HBSST is a feasible screening method, and Berlin and STOP-Bang are valid screening questionnaires for the SCI population. AHI was not correlated with BMI, neck circumference, or MMC.
Poster (Knowledge Generation) ID 1969461
Authors: Mohammadi Somayyeh , Bogle Victoria , Cathcart Heather , Park Sarah , Miller William C.
Published: December 2023

Background

Individuals with SCI often receive care from their family members. Caregiving responsibilities lead to caregiver burden. Receiving social support may mitigate the negative impacts of caregiving. Caregivers can obtain support from people they meet in-person, such as family members and people with whom they interact through social platforms.

Objectives

Our objective was to investigate the moderating effect of in-person and online social supports on the association between relationship quality, caregiver competence, caregiver distress and caregiver burden.

Methods/Overview

115 caregivers who resided in Canada or the United States, understood and spoke English, and self-identified as primary family caregivers of an individual with SCI were sampled. Participants completed measures assessing relationship quality, competence, distress, burden, and in-person and online social support. Three separate moderation analyses for each outcome variable (i.e. relationship quality, competence, and distress), were conducted. In analyses, burden was the predictor, and online and in-person support were moderators.

Results

Moderation analyses showed that online support moderates the link between caregiver burden and distress. Slope analyses revealed that the positive relationship between burden and distress was weaker when caregivers reported lower levels of online support (p=0.005); this relationship was more robust when caregivers reported higher levels of online support (p <.001). Other moderation analyses were not statistically significant.

Conclusions

Online support increases distress in family caregivers. It is likely that comparing their life with other caregivers or being exposed to other caregivers’ grief negatively affects caregivers. More research is needed to understand how online support impacts caregivers negatively.
Student Competition (Clinical/Best Practice Implementation) ID 1974598
Authors: Cesca Nicole , Lin Chantal , Abu-Jurji Zeina , Wexler Aaron , Mark Jonas , McCullum Shane , Kamran Rija , Chan Brian , Musselman Kristin E.
Published: December 2023

Background/Objective

Rehabilitation after spinal cord injury (SCI) is a life-long process with individuals accessing care in a variety of settings, including centres without SCI-specific services (i.e., non-SCI-specialized centres). Activity-based Therapy (ABT) is a relatively new neurorestorative approach that involves intensive, task-specific movement practice below the level of injury. This study aimed to understand current knowledge, perceptions, and use of ABT by physical and occupational therapists at non-SCI-specialized centres.

Design/Methods

A qualitative exploratory study using semi-structured interviews was conducted. The Theoretical Domains Framework was used to develop an interview guide that queried therapists’ experiences providing SCI rehabilitation, perceptions of ABT and ABT implementation. Canadian therapists who worked with at least one SCI patient in the last 18 months and practiced at non-SCI-specialized centres participated. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.

Results

Four physical and three occupational therapists from acute, inpatient, long-term care and outpatient settings participated. Three themes were determined: 1) Perceived challenges of working with SCI in non-SCI-specialized centres, 2) Current therapy techniques used and 3) Desire for ABT knowledge and implementation strategies specific to non-SCI-specialized centres. It was identified that participants were unknowingly incorporating some components of ABT in their practice. Participants emphasized challenges to ABT implementation, such as knowledge gaps, and expressed a keenness to learn more about ABT.

Conclusions

Current implementation of ABT in non-SCI-specialized centres is limited, with a variety of challenges and therapist needs identified. Tailoring ABT education to therapists at non-SCI-specialized centres may increase implementation of ABT at these centres.
Student Competition (Health Services, Economics and Policy Change) ID 1977283
Authors: Desai Chaitali , Wang Rosalie , Pakosh Maureen , Chan Brian
Published: December 2023

Background/Objective

Assistive technologies (AT) span a large range of products from mobility aides such as canes to electronic systems that provide reminders. These technologies are important in facilitating independence, recovery and improved quality of life for individuals with spinal cord injury (SCI). However, clinical and economic outcomes for AT evaluated in the scientific literature is unclear. Thus, the aim of this study is to review the clinical and economic evidence for AT in the SCI population.

Design/Methods

Scientific literature databases including EMBASE, MEDLINE and CINAHL will be searched using terms identified in collaboration with a Medical Librarian. In the first stage, the titles and abstracts of clinical studies and economic analyses of AT focused in SCI will be screened by two reviewers. This will be followed by a second stage full-text screening for inclusion in the review by the same reviewers. The types of ATs evaluated will be identified along with the outcomes measured. Where applicable, study results will be presented using summary statistics.

Results

Work is currently underway to identify the citations. Two reviewers will then screen the titles and abstracts. It is anticipated that a large majority of the citations will be screened out with a small number of studies remaining. Most studies are also expected to be for the clinical evaluation of AT with variable outcomes.

Conclusions

The results of this scoping review will provide valuable insight on the types of AT where clinical and economic evidence is available and identify where the current research gaps are.
Poster (Clinical/Best Practice Implementation) ID 1978673
Authors: Savoie Jo Anne L. , Qiu Serene , Crockford Chelsea M. , Kabbash Laura
Published: December 2023

Background/Objectives

To address gaps in peer-supported services for those with a mobility disability, a virtual group was designed to have trained mentors with lived experience working alongside rehabilitation professionals to share resources and strategies that promote healthy living.

Method

Sessions offered knowledge and support in goal setting, healthy eating, physical activity, adapted recreation, emotional well-being, and social connectedness. Three rounds of the group were offered with 12 participants completing the group in its entirety. Pre- and post-measures included the Self-Efficacy to Manage Scale (Lorig, et al, 2001), the Life Satisfaction Questionnaire-11 (Fugl-Meyer, et al., 1991), and the Readiness Ruler adapted to each wellness topic (Moyers, et al., 2009).

Findings

Analyses before and after group showed a slight increase (Cohen’s d = 0.3) in their subjective well-being on the life satisfaction scale and a moderately higher sense of self-efficacy (Cohen’s d = 0.6) in managing symptoms. Although perceived importance for change was similar, participants reported higher confidence in their ability to change (Cohen’s d = 0.4) and greater readiness to make changes (Cohen’s d = 0.4) after the group.

Conclusions

The program resulted in several successes including slight increase in life satisfaction and moderately higher sense of self-efficacy in managing symptoms. Confidence in ability and readiness to make change also increased. The project had a small sample size, but the outcomes support the value of embedding a peer-support element into traditional healthcare delivery.
Student Competition (Clinical/Best Practice Implementation) ID 1983939
Authors: Gazzellone Giuseppe , Lanteigne Sarah , Gammage Kimberley , Fajardo Val A. , Ditor David S.
Published: December 2023

Background

Previous research has shown that an anti-inflammatory diet can reduce inflammation and improve health outcomes in individuals with neurological disability; however, long term dietary adherence has proven to be challenging. Accordingly, we have designed a 2-part consultation targeted at identified barriers for adherence to an anti-inflammatory diet in this population.

Objectives

This study aimed to determine the effects of the consultation on self-efficacy for adhering to an anti-inflammatory diet, as well as adherence and health outcomes one month post-intervention.

Design/Methods

Eleven individuals (10 female, age 51.5±12.6 years) with neurological disability (7 multiple sclerosis, 3 spinal cord injury, 1 muscular dystrophy; 20.5±10.6 years post-injury/diagnosis) participated. The intervention group (n=7) received recipes for an anti-inflammatory diet and the 2-part consultation, while controls (n=4) received the recipes only. The consultation consisted of a home-visit that included cooking and accessible kitchen equipment demonstrations, and an accompanied trip to the grocery store.

Results

Both task and barrier self-efficacy improved immediately following the consultation and tended to stay above baseline one month post-intervention. The consultation was also associated with increased dietary adherence one month post-intervention and decreased depressive symptoms as measured by the Centre for Epidemiological Studies Depression Scale (CES-D). Changes in dietary adherence (r=-0.61; p=0.045), and barrier self-efficacy (r=-0.77; p=0.009) were negatively correlated to changes in CES-D scores.

Conclusions

A consultation targeted at barriers related to anti-inflammatory eating can improve self-efficacy for adherence as well as actual adherence and depressive symptomology one month later. Further follow-up studies to determine the persistence of these effects are warranted.
Student Competition (Clinical/Best Practice Implementation) ID 1984705
Authors: Stoikos Joshua , Unger Janelle
Published: December 2023

Background

The foremost reported unmet health need for Canadians with chronic neurological conditions is linked to physical maintenance. One way to address this issue is through activity programing offered through public institutions, where rehabilitation can be integrated into secondary health care settings. Parkwood Institute in London, Ontario has developed several programs, including virtual exercise classes, day programs, and a community fitness center. People who have participated in these initiatives can provide insights that could be used to create more robust person-centered rehabilitation physical activity programing.

Objectives

To explore the lived experiences of individuals participating in activity programs offered through Parkwood Institute to develop recommendations for future program development.

Methods

Using purposive sampling of individuals with a chronic neurological health condition who have participated in a physical activity program offered through Parkwood, we will use a grounded theory methodology to explore individual perspectives. Data will be collected using semi-structured interviews to gather critical perspectives and data will be analyzed using constant comparative analysis. Data collection and analysis will be an iterative process, meaning codes and categories will be developed from initial interviews, with subsequent data being continuously compared to identify similarities and differences.

Results

The findings of this research will, once completed, describe the impact of various physical activity programs, including benefits, challenges, and recommendations for future development.

Conclusions

The theoretical interpretations of the findings will be presented as a list of recommendations for activity programs offered through rehabilitation centers to assist researchers, clinicians, and policy makers in decision-making.
Student Competition (Knowledge Generation) ID 1984770
Authors: Parameswaran Shajaky , Walden Thomas P. , Brisbois Louise , Craven B. Catharine
Published: December 2023

Background

Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life.

Methods

Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex.

Results

SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p<0.001) for LMN, but no relationship for UMN (r2= 0.17, p<0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59).

Conclusion

Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.
Poster (Clinical/Best Practice Implementation) ID 1984775
Authors: Chase Andrea , Sreenivasan Vidya , Curran Dorothyann , Robichaud Monica , Maddigan Lorraine , Bowman Tory
Published: December 2023

Background/Objectives

Monitoring skin integrity is a critical issue for patients with spinal cord injury. Damage to the skin can go unnoticed due to sensory loss or diminution and can result in pressure injuries or wounds that can be difficult to heal. A team of inpatient clinicians and people with lived experience worked together to create a ‘SkIn-fo-Graphic’ that would be used to teach all new inpatients how to do a full body skin check.

Methods

A full picture of the body, contributed by Spinal Cord Injury Ontario (SCIO), was marked with the names of specific bony prominences and areas which should be viewed daily to ensure a skin check is complete. Staff at our Centre modified the graphic and created step-by-step instructions. Patients provided feedback on terminology and placement of words/ arrows for clarity. Further refinement was completed by SCIO and clinical staff to create the final tool and instructions.

Results

A graphic was developed iteratively by a community organization, physicians, allied health professionals and patients to provide a tool with instructions that can be used by both clinical staff (to teach daily skin check) and patients (as a reference for doing their own checks). A QR Code link was also created to directly link patients to more in-depth skin education on the community partner website.

Conclusion

Engaging all stakeholders in the development of a key tool for instruction of skin check in patients with spinal cord injury is important to ensure complete clarity and utility.
Workshop (Clinical/Best Practice Implementation) ID 1984795
Authors: Kaiser Anita , Donkers Sarah , Rademeyer Hope Jervis , Walden Kristen , Wolfe Dalton L.
Published: December 2023

Background/Objectives

Following an initial summit in March 2019, various Canadian stakeholders have collaborated within a Community of Practice (CoP) with a vision to increase the access to, and quality of activity-based therapies (ABT) for persons with spinal cord injury/disease (SCI/D). This workshop will describe key knowledge products and study findings emanating from working groups of the ABT CoP as well as a study initiated through the Canadian SCI Standing and Walking Module Group.

Design/Methods

Priority areas were identified by consensus across the ABT CoP, leading to several studies and development of specific knowledge products. Key challenges included defining and standardizing ABT, gaps in knowledge/training and practice variation with a focus on achieving optimal timing, dosage and intensity of ABT. Various knowledge products and study findings related to these challenges will be presented, with audience interaction encouraged through polls and open discussion.

Results

Presentation highlights include a framework for structured reporting of ABT and a series of videos, pod-casts and information cards promoting ABT. In addition, a mixed methods study of Canadian physiotherapists demonstrated that ABTs were a much desired, yet not fully available treatment option. Therapists identified needs for more fulsome research partnerships, improved and more creative staffing models, enhanced training methods and the importance of a strong therapeutic alliance.

Conclusion

The work of the ABT CoP will continue to focus on these and other priorities, with the ultimate goal of universal access and identification of approaches that will enhance outcomes for persons with SCI/D.
Poster (Clinical/Best Practice Implementation) ID 1984967
Authors: Kangatharan Suban , Amiri Mohammadreza , Brisbois Louise , Farahani Farnoosh , Craven Beverley C.
Published: December 2023

Background

Assessment of physical activity (PA) prescription recall and serum screening for dyslipidemia are critical to describe and mitigate Cardiometabolic Disease (CMD) risk among adults with spinal cord injury or disease (SCI/D).

Objectives

To report: 1) the frequency of PA prescription recall; and, 2) the frequency of lipid profile assessment and interpretation recall among inpatients with SCI/D during rehabilitation.

Methods

Adults with SCI/D completed the SCI-HIGH CMD intermediary outcome indicators. A Kinesiologist collected data via interview and chart abstraction among UHN inpatients. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics were used to characterize the participant’s age, sex, impairment characteristics, and report recall rates and the frequency of lipid screening/interpretation. Based on the participant’s needs, either educational materials to increase future adherence to PA guidelines and/or a Mediterranean diet were provided.

Results

Adult inpatients (n=124), mean age 59 years, 64% paraplegic, and 36% female participated. In total, 14% of participants (16/117) reported being taught the benefits of PA for their heart health; of whom 69% (11/16) recalled exercise instruction. Similarly, 15% of inpatients (17/114) recalled lipid screening during rehabilitation, although chart abstraction revealed that 30% (37/124) had completed lipid screening. Clinical interpretation of their lipid values was recalled by 30% of inpatients.

Conclusion

There is a significant opportunity to advance PA instruction and lipid profile education and management among inpatients with SCI/D to reduce CMD risk. Inclusion of PA and lipid management instructions in patient-oriented discharge summaries may enhance patient recall/adherence.
Poster (Clinical/Best Practice Implementation) ID 1984972
Authors: Amiri Mohammadreza , Kangatharan Suban , Brisbois Louise , Farahani Farnoosh , Khasiyeva Natavan , Burley Meredith , Casemore Sheila , Murphy Margaret , Walker Stacy-Ann , Craven Beverley C.
Published: December 2023

Background

Heart disease is the most common cause of death after spinal cord injury or disease (SCI/D), with Cardiometabolic Disease (CMD) risk a primary contributor.

Objectives

1) To report the frequency of Physical Activity guideline adherence; 2) To report the frequency of serum lipid screening recall and their recollection of the result interpretation; among adults living with SCI/D in the community.

Methods

A Kinesiologist collected the SCI-High outcome data via in person or phone 1:1 interviews, and chart abstraction among UHN outpatients. A Provincial Intake Coordinator collected data via phone interview among outpatients affiliated with SCI Ontario. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics characterize the participant’s age, sex, impairment characteristics, and adherence to physical activity guidelines and the frequency of lipid screening/interpretation recall. Best practice education materials were used to increase future PA guideline adherence, prompt lipid screening, and healthy food choices.

Results

Adult outpatients (n=127, 67% male), mean age 61 years, and 55% paraplegic consented to participate. In total, 48% (60/126) of outpatients reported engaging in some form of aerobic exercise; of whom 50% (30/60) of these individuals were meeting current PA guidelines. About 51% of outpatients recalled lipid screening within the last year, 33% indicated they had not had an assessment. Clinical interpretation of lipid values was recalled by 71% (53/75) of outpatients.

Conclusion

Physical activity guideline adherence and routine lipid assessments are integral to CMD risk modification – substantial education resources and recall aids may help to modify CMD risk after SCI/D.
Poster (Clinical/Best Practice Implementation) ID 1985003
Authors: Seliman Merna , Giurleo Charlie , Elliott Stacy , Carlson Marie , Kras-Dupuis Anna , Wolfe Dalton L. , McBride Kate
Published: December 2023

Background

Sexual health is an important component of overall health. Yet, sexuality is often neglected in rehabilitation. Studies indicate that typically clinicians do not address the sexual health concerns of patients because of lack of adequate training, comfort, and knowledge in this area.

Objectives

The purpose of this initiative was to develop and implement an e-learning module to address the current gap in rehabilitation practice.

Methods

In 2021, an interdisciplinary team of rehab clinicians worked with an Instructional Designer based at Parkwood Institute to develop e-Learning modules aimed to introduce rehab teams to sexual health rehab and application to practice. The modules were launched at Parkwood Institute in January 2022 and were compulsory education for all rehabilitation staff in Spinal Cord, Acquired Brain Injury and Stroke programs. They were subsequently launched more broadly at Vancouver Coastal Health in March 2022. Surveys were conducted to assess the impact of the modules on clinical application.

Results

To date,186/209 (89%) of rehabilitation staff at Parkwood Institute and a total of 55 clinicians from Vancouver Coastal Health have completed the modules. Preliminary results show improvement in confidence, knowledge, and ability to address the sexual health needs of rehabilitation patients.

Conclusions

The e-Learning modules help fill the current practice gap and facilitate sustainability of sexual health practice in clinical settings. Accessible educational opportunities such as the e-modules are valuable tools in enhancing self-efficacy of staff when addressing sexual health concerns of patients.
Student Competition (Knowledge Generation) ID 1985014
Authors: Cadel Lauren , Hitzig Sander L , McCarthy Lisa M , Hahn-Goldberg Shoshana , Packer Tanya L , Ho Chester H , Lofters Aisha K , Patel Tejal , Cimino Stephanie R , Guilcher Sara JT
Published: December 2023

Background

Adults with spinal cord injury/dysfunction (SCI/D) are commonly prescribed multiple medications to manage secondary complications. Significant challenges managing medications have been highlighted, with the need for more support with medication self-management.

Objective

The objective of this study is to co-develop a toolkit to assist with medication self-management for persons with SCI/D.

Methods

Adults with SCI/D, caregivers, and healthcare providers will participate in the three steps of concept mapping – brainstorming, sorting and rating, and mapping to identify key components of the toolkit. Participants will generate statements about what should be incorporated into a toolkit to help persons with SCI/D manage their medications. Participants will rate the final list of statements on importance and feasibility and sort the statements into thematic piles. A visual map will be developed by a subset of participants, representing the thematic piles.

Findings

To date, participants have generated over 500 statements. Ideas generated around the content of the toolkit focus on information about: pharmacological and non-pharmacological options for managing secondary complications, side effects, communicating with providers, and medication access. Ideas specific to the delivery of the toolkit focus on: ensuring an individualized approach, accessibility, and the use of visuals. Statements will be synthesized for sorting and rating and mapping.

Conclusion

Subsequent phases of this research will refine the toolkit through interviews and input from our working group. A mixed methods pilot evaluation will then be conducted to assess the feasibility, acceptability, and appropriateness of the toolkit, as well medication knowledge, self-efficacy, and quality of life.
Post Doc Competition (Health Services, Economics and Policy Change) ID 1985179
Authors: Senthinathan Arrani , Tadrous Mina , Hussain Swaleh , Craven B. Catharine , Jaglal Susan B. , Moineddin Rahim , Shepherd John , Cadel Lauren , Noonan Vanessa K. , McKay Sandra , Tu Karen , Guilcher Sara
Published: December 2023

Background/Objectives

The COVID-19 pandemic has significantly impacted healthcare utilization; however, research has not investigated the impact in the spinal cord injury/dysfunction (SCI/D) population in Canada. To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with SCI/D.

Methods/Overview

A repeated-cross sectional retrospective longitudinal cohort study design was conducted using health administrative database in Ontario, Canada. In 5,754 individuals with SCI/D, healthcare utilization and delivery (in-person, and virtual) were determined at the 1) pre-pandemic (March 2015 to February 2020), 2) initial pandemic onset (March 2020-May 2020), and 3) pandemic (June 2020 to March 2022) phases. Autoregressive integrated moving average (ARIMA) modelling were conducted to determine pandemic impact on monthly healthcare utilization and delivery.

Results

The initial pandemic onset period had a significant reduction of 24% in physician (p=0.0081), 35% in specialist (p<0.0001), and 30% in urologist (p<0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p<0.0001) for virtual visits for physician, specialist, urologist, and primary care was found. The initial pandemic onset period had a 46% decrease in ED visits (p=0.0764) and 58% decrease in hospital admissions (p=0.0011), compared to the pre-pandemic period.

Conclusion

Healthcare utilization dropped in the initial pandemic onset period as physician, specialist, urologist, and ED visits, as well as hospitalization decreased significantly (p<0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.
Workshop (Health Services, Economics and Policy Change) ID 1985330
Authors: Craven B. Catharine , Farahani Farnoosh , Wiest Matheus J. , Gargaro Judith , Bayley Mark T.
Published: December 2023

Background

Spinal cord injury or disease (SCI/D) are complex chronic conditions associated with multiple morbidities and many social and emotional challenges. Understanding the current gaps in care, the health services and policy priorities of Ontarians with SCI/D is integral to transforming services and meeting their needs over time.

Objectives

Workshop participants will gain: 1) Insight into the current inequities in SCI care; 2) A shared understanding of the current gaps, regional service priorities, and policy needs of people with lived experience in the community.

Design/Methods

The intended audience includes people with lived experience, family/friends, clinicians, community service providers, funders, advocacy groups, health system planners, administrators, and policymakers. Synthesized results from the Neurotrauma Care Pathways Project (neurotraumapathways.ca) and the SCI Implementation and Evaluation Quality Care Consortium (sciconsortium.ca) will be shared using infographics and lay language. These Ontario Ministry of Health funded projects are intended to inform practice and drive innovations in care. Participants will have an opportunity to discuss priorities regarding inclusion and service equity. The dilemmas of marginalized groups and special populations will be highlighted and the planned next steps shared with workshop attendees.

Results/Findings

Our hope is that participants will take away a shared understanding that might influence their near term health policy, advocacy, and health behaviours.
Poster (Knowledge Generation) ID 1985362
Authors: Craven B. Catharine , Blencowe Lindsie , Giangregorio Lora , Carbone Laura , Weaver Frances M. , Jaglal Susan , Munro Barry , Boag Lynn , Noonan Vanessa K. , Humphreys Suzanne , Alavinia Mohammad
Published: December 2023

Objective

To develop a lower extremity (LE) fragility fracture risk score estimation method among adults with chronic spinal cord injury (SCI).

Methods

Adults (≥18) with chronic traumatic SCI (n=90, C2-T12, AIS:A-D) participated in a 2-year prospective cohort study. We used a literature search and practice expertise to identify LE fracture predictors. Reference categories (i.e., risk score = 0) were: no prior fracture, 0-9 years post-injury, AIS-CD, no parental history of osteoporosis, and no opioid use. Using logistic regression coefficients, we calculated how far each category is from the base category and computed βi (Wij-WiREF) for each risk factor. In this model, B was the increase in risk associated with each year post injury. The point value for each fracture risk category was calculated by Pointsij=βi (Wij-WiREF)/B. The total points range from 0-21, and the probability of LE fracture is calculated for each point to determine the probability of developing a LE fracture using the formula:

Results

Most participants had an AIS-A impairment (60.0%), the mean time post-injury=15.23 years (SD=9.58). For the points system (0-17), prior fracture, years post-injury, AIS, Benzodiazepine use, Opioid use, and parental osteoporosis were defined risk factors. An individual’s risk profile can estimate LE fracture risk. A score of 11 equates to 20% or high fracture risk over a 5-year time period.

Conclusion

We describe our preliminary model to estimate LE fracture risk among those with chronic SCI. We plan to apply statistical and machine learning algorithms using Canadian RHSCIR data and US VHA data to validate the model, and increase the model’s predictability.
Poster (Health Services, Economics and Policy Change) ID 1985397
Authors: Farahani Farnoosh , Craven B. Catharine ,   SCI-IEQCC
Published: December 2023

Background

The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI-IEQCC) is a quality improvement initiative (began in 2019) with a mission to provide optimal and equitable rehabilitation services for all Canadians regardless of where they live, and to ensure the functional recovery, health and well-being for individuals living with spinal cord injury and disease (SCI/D).

Objective

To highlight the growing needs of an expanding multisite network and the importance of governance and organizational structures to support the execution of current deliverables while addressing emerging challenges.

Design/Methods

The SCI-IEQCC has a central team for network management. Administrators/leaders, clinicians with implementation science training, local site implementation teams, and individuals with lived experience comprise the SCI-IEQCC. Implementation and evaluation of indicators and best practices across 10 participating organizations requires: operational oversite; monitoring of project milestones; adherence to regulatory requirements; sustained data quality with linkage for analyses; report card dissemination; information sharing and network updates; strategic planning to map future directions; identification of priorities; and, meeting academic/funding deliverables.

Results/Findings

SCI-IEQCC has driven improvements in rehabilitation service delivery, performance, utilization of best practices, and increments in staff engagement, training, and knowledge exchange. SCI-IEQCC challenges are derived from the diversity of participating organizations, turnover in leaders, staff shortages, reducing variation in documentation and data management, and ensuring resource continuity.

Conclusion

The growing complexity of this multisite network necessitate innovative approaches to streamline processes across sites, ensure uniform adherence to regulatory requirements, disseminate innovations in informatics, and assure dedication to its mission and vision.