bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Standard Operational Procedures and Supervision on The Performance of Employees of PT. Swadharma Sarana Informatika Denpasar
Authors: SAKA I Made Agus Hoki Teges , SUDIVIA Ni Kadek Adinda Putri , DHARMANEGARA I.B Agung
Published: December 2023

This research aims to determine and analyze the influence of standard operational procedures and supervision on the performance of PT employees. Swadharma Sarana Informatika Denpasar. The population uses PT employees. Swadharma Sarana Informatika Denpasar and a sample of 54 respondents. The data collection methods used are questionnaires, observation, and documentation studies. Data analysis techniques use instrument tests, classical assumption tests, multiple linear regression analysis, hypothesis testing (F and T tests), and coefficient of determination tests (R²). The research results show that standard operational procedures and supervision positively and significantly affect employee performance at PT. Swadharma Sarana Informatika Denpasar, Standard operational procedures positively and significantly affect employee performance at PT. Swadharma Sarana Informatika Denpasar. This means that the more standard operational procedures are improved, the more employee performance at PT will increase. Swadharma Sarana Informatika Denpasar, Supervision positively and significantly affects employee performance at PT. Swadharma Sarana Informatika Denpasar. This means that the more supervision is improved, the more employee performance at PT will increase. Swadharma Sarana Informatika Denpasar.
The Influence of Savings and Deposits on The Credit Position of Village Kredit Institutions (LPD) in Gianyar District During The COVID-19 Pandemic
Authors: KUSUMA Gusti Ngurah Putu Angga , MARTIN I Made Verry , DARMA I Ketut
Published: December 2023

The background of this research is to analyze the influence of savings and deposits on the credit position of LPDs in Gianyar District during the COVID-19 pandemic. The data used in this research is quantitative data, which includes the value of savings, deposits, and credit. Research on the Effect of Savings and Deposits on the Credit Position of Village Credit Institutions (LPD) in Gianyar District During the Covid-19 Pandemic. The object of this research is community savings funds (Savings and Deposits) and (Credit) in LPDs in Gianyar District.  The data analysis technique used is Panel Data Regression Analysis, where the independent variables are Savings and Deposits while the dependent variable is Credit. The test results explain Savings and deposits, together with all the independent variables used in the research, can influence the credit position of Village Credit Institutions (LPD) in Gianyar District during the COVID-19 pandemic.  Savings have had a significant effect on the credit position of Village Credit Institutions (LPD) in Gianyar District during the COVID-19 pandemic. Deposits have had a significant effect on the credit position of Village Credit Institutions (LPD) in Gianyar District during the COVID-19 pandemic.
Particle-in-Cell Simulations of Sunward and Anti-sunward Whistler Waves in the Solar Wind
Authors: Kuzichev Ilya V. , Vasko Ivan Y. , Artemyev Anton V. , Bale Stuart D. , Mozer Forrest S.
Published: December 2023

We present particle-in-cell simulations of a combined whistler heat flux and temperature anisotropy instability that is potentially operating in the solar wind. The simulations are performed in a uniform plasma and initialized with core and halo electron populations typical of the solar wind beyond about 0.3 au. We demonstrate that the instability produces whistler-mode waves propagating both along (anti-sunward) and opposite (sunward) to the electron heat flux. The saturated amplitudes of both sunward and anti-sunward whistler waves are strongly correlated with their initial linear growth rates,

B

w

/

B

0

∼

(
γ

/

ω

ce

)

ν

, where for typical electron betas we have 0.6 ≲ ν ≲ 0.9. We show that because of the relatively large spectral width of the whistler waves, the instability saturates through the formation of quasi-linear plateaus around the resonant velocities. The revealed correlations of whistler wave amplitudes and spectral widths with electron beta and temperature anisotropy are consistent with solar wind observations. We show that anti-sunward whistler waves result in an electron heat flux decrease, while sunward whistler waves actually lead to an electron heat flux increase. The net effect is the electron heat flux suppression, whose efficiency is larger for larger electron betas and temperature anisotropies. The electron heat flux suppression can be up to 10%–60% provided that the saturated whistler wave amplitudes exceed about 1% of the background magnetic field. The experimental applications of the presented results are discussed.
A Possible Mechanism for the “Late Phase” in Stellar White-light Flares
Authors: Yang 杨 Kai E. 凯 , Sun 孙 Xudong 旭东 , Kerr Graham S. , Hudson Hugh S.
Published: December 2023

M dwarf flares observed by the Transiting Exoplanet Survey Satellite (TESS) sometimes exhibit a peak-bump light-curve morphology, characterized by a secondary, gradual peak well after the main, impulsive peak. A similar late phase is frequently detected in solar flares observed in the extreme ultraviolet from longer hot coronal loops distinct from the impulsive flare structures. White-light emission has also been observed in off-limb solar flare loops. Here, we perform a suite of one-dimensional hydrodynamic loop simulations for M dwarf flares inspired by these solar examples. Our results suggest that coronal plasma condensation following impulsive flare heating can yield high electron number density in the loop, allowing it to contribute significantly to the optical light curves via free-bound and free–free emission mechanisms. Our simulation results qualitatively agree with TESS observations: the longer evolutionary timescale of coronal loops produces a distinct, secondary emission peak; its intensity increases with the injected flare energy. We argue that coronal plasma condensation is a possible mechanism for the TESS late-phase flares.
Surface Volatile Composition as Evidence for Hydrothermal Processes Lasting Longer in Triton’s Interior than Pluto’s
Authors: Mandt Kathleen , Luspay-Kuti Adrienn , Mousis Olivier , Anderson Sarah E.
Published: December 2023

Ocean worlds, or icy bodies in the outer solar system that have or once had subsurface liquid water oceans, are among the most compelling topics of astrobiology. Typically, confirming the existence of a subsurface ocean requires close spacecraft observations. However, combining our understanding of the chemistry that takes place in a subsurface ocean with our knowledge of the building blocks that formed potential ocean worlds provides an opportunity to identify tracers of endogenic activity in the surface volatiles of Pluto and Triton. We show here that the current composition of the volatiles on the surfaces and in the atmospheres of Pluto and Triton are deficient in carbon, which can only be explained by the loss of CH4 through a combination of aqueous chemistry and atmospheric processes. Furthermore, we find that the relative nitrogen and water abundances are within the range observed in building block analogs, comets, and chondrites. A lower limit for N/Ar in Pluto’s atmosphere also suggests source building blocks that have a cometary or chondritic composition, all pointing to an origin for their nitrogen as NH3 or organics. Triton’s lower abundance of CH4 compared to Pluto, and the detection of CO2 at Triton but not at Pluto points to aqueous chemistry in a subsurface ocean that was more efficient at Triton than Pluto. These results have applications to other large Kuiper Belt objects as well as the assessment of formation locations and times for the four giant planets given future probe measurements of noble gas abundances and isotope ratios.
Poursuivre le plaisir de penser ensemble : logique gestionnaire et legs coloniaux au Brésil
Authors: Lafraia Luciana , Castanho Pablo
Published: December 2023

Cet article témoigne du « plaisir de penser ensemble » à partir de la collaboration scientifique établie ces dernières années entre Jean-Pierre Pinel et l’Université de São Paulo, notamment au sein du groupe de recherche « Clinique de groupe et institutions : approche psychanalytique » ( cligiap ). Nous débuterons par une brève synthèse des activités développées à l’Université dans le cadre de cette collaboration, et par la référence aux travaux du groupe adossés de façon fondamentale à ces apports. Nous poursuivrons en relatant l’expérience du penser ensemble, en son absence. Les auteurs souligneront quelques contributions de Jean-Pierre Pinel autour des menaces qui pèsent sur les fonctions intermédiaires dans notre hypermodernité, et leurs incidences sur les équipes soignantes. Ceci interroge les spécificités de la réalité sociopolitique et institutionnelle brésilienne, notamment son héritage colonial toujours actif. Le plaisir de penser ensemble ainsi que la capacité de rêverie partagée des équipes constituent des sources de créativité et de résistance face aux mouvements de déliaison et de désubjectivation.
Les institutions d’accueil des mineurs isolés : un site pour ressaisir et élaborer les répercussions subjectives des effondrements et des ruptures des cadres culturels
Authors: Pinel Jean-Pierre
Published: December 2023

Ce texte, inédit en français, est la transcription d’une communication prononcée par Jean-Pierre Pinel à Ischia, en 2018, lors des journée scientifiques de l’Association européenne pour l’analyse transculturelle de groupe. Adossé à une vignette clinique principale, l’auteur y déploie de manière originale le concept de répondant, tantôt indisponible, refusé, défaillant, et les effets psychiques mais aussi institutionnels, notamment de retournement, pour les adolescents comme pour les professionnels confrontés à une telle « déprivation du répondant ». À partir de ces conceptions, s’opère un renouvèlement des problématiques de la transmission entre générations au sein de cadres culturels complexes et invitent à comprendre les adolescents (et la clinique afférente) comme des « révélateurs et portes symptômes » susceptibles de nous permettre de nous « ressaisir des répercussions subjectives liées à l’empilement des catastrophes collectives qui ont jalonné le xx e  et le xxi e  siècle ».
Violence mortifère, destructrice, et violence créatrice, au service de la vie
Authors: Kaës René , Pinel Jean-Pierre
Published: December 2023

Ce texte est la transcription d’un extrait des plus saillants d’un entretien de René Kaës mené par Jean-Pierre Pinel à l’occasion du colloque de la Fédération française des psychologues et de psychologie «  Aux sources de la violence : de l’enfance à l’adolescence  » qui s’est tenu à Paris en octobre 2009. À l’invitation de Jean-Pierre Pinel, René Kaës y développe quelques aspects d’une « théorie de la violence et de la négativité » et simultanément d’une « violence au service de la vie ». Soutenu par les apports de nombreux auteurs (Anzieu, Aulagnier, Bergeret, Zaltzman, Gibello, Puget…), René Kaës dresse progressivement les lignes de force d’un processus de symbolisation de la violence qui ne serait pas uniquement représentation de l’origine mais bien représentation de la violence des origines.
Social Development: Synthesizing Theory and Practice
Authors: Gray Mel
Published: December 2023

This paper traces the trajectory of my thinking on social development shaped, initially, by the huge changes that swept South Africa in the 1990s. It describes my early focus on discerning what the policy-driven changes to a developmental welfare system meant for social work and the subsequent critical turn, as social development proved extremely difficult to translate to practice. It traces the changes in my thinking on coming to Australia in 1999, when the country was undergoing a period of massive welfare reform, firmly embedding neoliberal privatization policy. In reflecting on switching concepts in the social development discourse, the discussion turns to its embrace of neoliberalism. Thereafter, it considers three models to highlight the turn from centralized planning, which held the government responsible for social development, to social enterprise, which divested government of its responsibility, and a critical development model that linked national policy to the wider international system. Noting critiques of neoliberal social development, the discussion ends with the current trajectory of my thinking outlined in a critical model for developmental practice with the core foci being the structural–political, cultural–contextual, critical–developmental, and environmental–spiritual dimensions of social development.
Influence of Green Plantain Peel Ash and Alumina Reinforcement on the Physio-Mechanical Properties of Aluminium Matrix Hybrid Composites
Authors: Ben Festus , Amodu Funke Roseline , Olubambi Peter Apata
Published: December 2023

Hybrid composites are gaining increasing interest in the development of aluminium metal matrix (AMCs) for various industrial applications owing to their ability to integrate multiple functionalities within a single material matrix with enhanced physio-mechanical properties as opposed to single-fibre reinforced composites. Green plantain peel ash (GPPA) is an agricultural waste with potential for reinforcement purposes. However, no study has investigated GPPA natural filler as a reinforcement for AMCs. This study, therefore, aims at assessing the influence of variations in GPPA particles and alumina as reinforcements in the fabrication of hybrid composites using Al-Mg-Si alloy as a matrix. This study also reassessed the chemical composition of the GPPA particles and investigated their mechanical properties. However, enhanced mechanical properties, including hardness, tensile strength, and ductility, were observed at varying weight ratios. Results obtained in this study suggest a promising potential application of GPPA particulates as complementing reinforcements in the production of lightweight, strong, and high-performance AMCs well-suited for engineering, aerospace, construction, and packaging applications.
Do we need to re-think growth assessment in Sri Lankan children from birth to 2 years?
Authors: Lucas Marianne Nishani
Published: December 2023

No abstract available
The Teleost CXCL13–CXCR5 Axis Induces Inflammatory Cytokine Expression through the Akt–NF-κB, p38–AP-1, and p38–NF-κB Pathways
Authors: Ding Chunhua , Xiao Tiaoyi , Deng Yadong , Yang Hong , Xu Baohong , Li Junhua , Lv Zhao
Published: December 2023

The ancestors of chemokines originate in the most primitive of vertebrates, which has recently attracted great interest in the immune functions and the underlying mechanisms of fish chemokines. In the current study, we identified an evolutionarily conserved chemokine, CiCXCL13, from a teleost fish, grass carp. CiCXCL13 was characterized by a typical SCY (small cytokine CXC) domain and four cysteine residues (C34, C36, C61, C77), with the first two cysteines separated by a random amino acid residue, although it shared 24.2–54.8% identity with the counterparts from other vertebrates. CiCXCL13 was an inducible chemokine, whose expression was significantly upregulated in the immune tissues of grass carps after grass carp reovirus infection. CiCXCL13 could bind to the membrane of grass carp head kidney leukocytes and promote cell migration, NO release, and the expression of >15 inflammatory cytokines, including IL-1β, TNF-α, IL-10 and TGF-β1, thus regulating the inflammatory response. Mechanistically, CiCXCL13 interacted with its evolutionarily conserved receptor CiCXCR5 and activated the Akt–NF-κB and p38–AP-1 pathways, as well as a previously unrevealed p38–NF-κB pathway, to efficiently induce inflammatory cytokine expression, which was distinct from that reported in mammals. Zebrafish CXCL13 induced inflammatory cytokine expression through Akt, p38, NF-κB, and AP-1 as CiCXCL13. Meanwhile, the CiCXCL13–CiCXCR5 axis–mediated inflammatory activity was negatively shaped by grass carp atypical chemokine receptor 2 (CiACKR2). The present study is, to our knowledge, the first to comprehensively define the immune function of CXCL13 in inflammatory regulation and the underlying mechanism in teleosts, and it provides a valuable perspective on the evolution and biology of fish chemokines.
Student Competition (Technology Innovation) ID 1970388
Authors: Dousty Mehdy , Fleet David J. , Zariffa José
Published: December 2023

Background

The evaluation of hand function after spinal cord injury (SCI) is conducted in clinical settings, which may not accurately reflect hand function in the real world, thereby limiting the efficacy assessment of new treatments. Wearable cameras, also known as egocentric video, are a novel method to evaluate hand function in non-clinical environments. Nonetheless, manual processing of vast quantities of complex video data is difficult, highlighting the need for automated data analysis. The objective of this study was to automatically identify distinct hand postures in egocentric video using unsupervised machine learning.

Methods

Seventeen participants with cervical SCI recorded activities of daily living in a home simulation laboratory. A hand pose estimation algorithm was applied on detected hands to determine 2D joint locations, which were lifted to 3D coordinates. The resulting hand posture information was subjected to a number of clustering techniques. Hand grasps were manually labelled into four categories for evaluation purposes: power, precision, intermediate, and non-prehensile.

Results

K-Means clustering consistently exhibited the highest Silhouette score, which reflects the presence of discrete clusters in the data. When comparing with manual annotations, Spectral Clustering applied to a feature space consisting of 2D pose estimation with confidence scores yield the best performance as quantified by maximum match (0.48), Fowlkes-Mallows score (0.46), and normalized mutual information (0.22).

Conclusions

This is the first attempt to develop an unsupervised, data-driven hand taxonomy for individuals with SCI using wearable technology. The findings suggest that the method is capable of grouping similar hand grasps.
Student Competition (Knowledge Generation) ID 1975184
Authors: Kaiser Anita , Chan Katherine , Sessford James , McCullum Shane , Athanasopoulos Peter , Rice Chris , MacRitchie Iona , Zariffa José , Musselman Kristin E.
Published: December 2023

Background/Objectives

Implementing activity-based therapy (ABT) across the continuum of care in Canada has proved challenging. The objective of this study was to understand and compare multi-group perspectives on the challenges that hinder implementation of ABT in Canada for people living with spinal cord injury or disease (SCI/D).

Methods

Individuals from six key interest groups (i.e., researchers; persons living with SCI/D; administrators; physical and occupational therapists; community-based exercise trainers; and funders, advocates, and policy experts) who had knowledge of and/or experience with ABT were recruited to participate in focus group interviews that were held over web conferencing. Participants were asked about the barriers and facilitators to practicing ABT. Interview transcripts were analyzed using conventional content analysis followed by a comparative analysis across groups.

Results

Forty-eight individuals participated in interviews lasting 30-80 minutes. Six themes were identified: 1) Challenge of defining ABT and addressing gaps in knowledge/training. 2) Challenge of standardizing ABT. 3) Challenge of determining the optimal timing of ABT. 4) Challenge of defining, characterizing and achieving high dosage and intensity. 5) Challenge of funding ABT. 6) Challenge of measuring participation and performance in ABT. While all groups acknowledged these six challenges, therapists and community trainers viewed knowledge/training gaps and achieving high dosage and intensity as key challenges. Researchers and advocates emphasized funding as a key challenge.

Conclusion

Participants highlighted the challenges that limit adoption of ABT into practice within hospital and community settings. Future research should explore avenues to address these challenges to support successful implementation of ABT in Canada.
Poster (Health Services, Economics and Policy Change) ID 1977284
Authors: Chan Brian , Lam Natascha , Rafael Verena , Pakosh Maureen , Musselman Kristin
Published: December 2023

Background/Objective

Activity-based therapies (ABT) are task specific, repetitive and intensive active movement interventions that may improve function and independence for individuals with spinal cord injury. The cost of implementing ABT is an important consideration for rehabilitation facilities interested in providing this intervention. Thus, a scoping review was conducted to evaluate the economic evidence for ABT for the rehabilitation of upper or lower limb impairment.

Design/Methods

A search of various scientific literature databases (including EMBASE, MEDLINE and CINAHL) was conducted using search terms developed in collaboration with a Medical Librarian. Studies were included if they were economic analyses of an ABT conducted for individuals with upper or lower limb mobility impairment. Titles and abstracts were initially screened by two of the authors followed by a full-text review of remaining articles. Articles included in the review were evaluated for methodological quality and presented descriptively because of the heterogeneity in study design, populations and outcomes.

Results

Of the 6,031 unique citations originally identified, 14 articles were included after full-text screening. Two-third of the studies were for stroke and half of the studies originated from the US. Robot-assisted therapies represented half of the studies and about a quarter were locomotor training programs. In the stroke and spinal cord injured population, robot-assisted therapies and body supported treadmill therapy appear to be cost-effective respectively.

Conclusions

There is some evidence to support the cost-effectiveness of robot-assisted therapies and body supported treadmill therapy. However, the evidence is very limited and additional research is needed.
Poster (Clinical/Best Practice Implementation) ID 1981325
Authors: Oldford Laura M. , Casey Lauren E. , Campbell Samuel , McCullum Shane A. , de Passillé Erica J. , O’Connell Colleen M.
Published: December 2023

Background

Many barriers prevent those with spinal cord injury or disease (SCI/D) from adhering to recommended exercise guidelines, thus increasing risks of secondary health conditions. Mainstream technology options, such as virtual reality (VR), have the potential to facilitate needed exercise participation. However, further research on VR exercise modalities is needed to determine feasibility, effectiveness and to ultimately guide practice recommendations.

Objectives

The goal of this pilot feasibility study was to determine whether VR exergaming is non-inferior to the current standard of care (SoC) upper extremity aerobic exercise for individuals with SCI/D.

Methods/Overview

25 participants with SCI/D completed 10-minute exercise sessions with either VR or the SoC, and after a rest break, then completed 10 minutes of exercise with the other modality. Primary outcomes of heart rate (HR) and rate of perceived exertion (RPE) were collected at baseline, 5 minutes into exercise, and at 10 min (end of the exercise session) for each modality. Secondary exploratory measures included a Numeric Pain Rating Scale measured pre- and post- each exercise session, and a post-study likeability survey.

Results

There were no significant differences in HR or RPE between virtual reality exergaming and the standard of care, and 100% of participants preferred the VR over SoC for the exercise.

Conclusions

VR exergaming was non-inferior to the SoC for short duration upper extremity exercise in those with SCI/D. Implementing VR for patients with SCI/D should be studied further to observe the longer term effect on cardiovascular health and to determine feasibility and compliance for home use.
Student Competition (Knowledge Generation) ID 1985151
Authors: Cadel Lauren , Cimino Stephanie R , Bradley-Ridout Glyneva , Hitzig Sander L , Packer Tanya L , McCarthy Lisa M , Patel Tejal , Lofters Aisha K , Hahn-Goldberg Shoshana , Ho Chester H , Guilcher Sara JT
Published: December 2023

Background

Persons with traumatic spinal cord injury (SCI) are often experience polypharmacy, the use of multiple medications, to manage secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support persons with SCI with medication self-management.

Objective

The purpose of this scoping review was to identify and summarize what is reported in the literature on medication self-management interventions for adults with traumatic SCI.

Methods

Articles were searched on electronic databases and grey literature. For inclusion, articles were required to include an adult population with a traumatic SCI and an intervention targeting medication management. They had to incorporate a component of self-management. Articles were independently screened and data were extracted and synthesized using descriptive approaches.

Findings

Three studies were included in this scoping review. Interventions included a mobile app and two education-based interventions to address self-management of SCI, medication management, and pain management. None of the identified interventions addressed medication self-management comprehensively. Learning outcomes (perceived knowledge and confidence), behavioural outcomes (management strategies, data entry), and clinical outcomes (number of medications, pain scores, functional outcomes) were evaluated. Results of the interventions varied, but some positive outcomes were noted, with improvements in perceived knowledge and confidence and a reduction in the use of multiple pain medications.

Conclusion

Overall, there are limited interventions targeting medication self-management for persons with SCI. There is an opportunity better support this population through the co-design and implementation of an intervention that comprehensively addresses self-management.
Student Competition (Knowledge Generation) ID 1985158
Authors: O’Sullivan Carly L. , Tyreman Neil , Shanti Rofyontsa F. , O’Steen Wilbur A. , Mirkiani Soroush , Boakye Maxwell , Howland Dena R. , Mushahwar Vivian K.
Published: December 2023

Background

Spinal cord injury (SCI) affects locomotion and quality of life. Two spinal cord stimulation approaches are currently under investigation for restoring standing and walking following SCI: epidural spinal cord stimulation (ESCS) and intraspinal microstimulation (ISMS). In ESCS, electrodes are placed on the dura mater and in ISMS, ultrafine wires are inserted into the cord. These modalities likely activate the locomotor regions in the ventral horn through different pathways.

Objective

The goal of this study is to examine the difference in the distribution of neuronal activation and the type of neurons activated by ESCS and ISMS.

Methods

The first step was to establish the needed immunohistochemical (IHC) staining protocols. Domestic pigs were divided into naïve (n=2) and positive control (n=1) groups. The naïve control animals were anesthetized for 5 hrs. The positive control animal was anesthetized for 2 hrs and injected with hypertonic saline in hindlimb muscles. The animals were then euthanized, and the spinal cord removed for IHC analysis. Antibodies against cFos, a maker of neuronal activation, and NeuN, a neuronal marker were used.

Results

Preliminary results indicate that ESCS activates neurons in the dorsal horn with scattered activation in the intermediate and ventral regions. ISMS primarily activates neurons in the intermediate and ventral regions where locomotor-related networks reside.

Significance

To the best of our knowledge, this is the first time the type and sites of activation of ESCS and ISMS are investigated. This will provide a foundational understanding of the mechanism of action of these stimulation modalities.
Poster (Knowledge Generation) ID 1985172
Authors: Seliman Merna , Hong Julianne , Marrocco Stephanie , Lo Erica , Walden Kristen , Chase Andrea , Lemay Jean François , Donkers Sarah , Wolfe Dalton L.
Published: December 2023

Background

Rehabilitation approaches after Spinal Cord Injury (SCI) differ across rehabilitation centres and between therapists. Differences may be influenced by factors such as therapeutic approaches, equipment availability, training provided for therapists, or demographics of admitted patients. A measure of physical function that is widely used within Canadian rehabilitation centres is the Standing and Walking Assessment Tool (SWAT). It is not clear what factors or therapeutic approaches lead to optimal standing and walking outcomes in the SCI population.

Objectives

To explore the perspectives of physio-therapists on factors that affect standing and walking outcomes in inpatient SCI rehabilitation.

Methods

Three focus groups were conducted with nine physiotherapists representing seven inpatient rehabilitation centres across Canada to provide their perspectives on current practices and to gain in-depth insights into centre-specific factors that may influence standing and walking outcomes. Thematic analysis was used to analyze the focus group data.

Results

Thematic analysis revealed that high treatment intensity and frequency are needed for optimal standing and walking outcomes. Physiotherapists emphasized that appropriate length of stay was essential to deliver an effective treatment plan. They noted, however, that there is pressure to discharge patients quickly leading to shorter length of stays and a perceived compromise in outcomes. Physiotherapists emphasized the importance of building rapport with patients, creating an exciting therapeutic environment, and the availability of enough staff for optimal recovery.

Conclusions

The findings of this qualitative study will inform the implementation and development of opportunities to optimize standing and walking outcomes across rehabilitation centres in Canada.
Post-Doc Competition (Knowledge Generation) ID 1985177
Authors: Tsang Philemon , Souza Wagner H , Walden Thomas , Miyatani Masae , Craven Cathy
Published: December 2023

Background

Heart Disease is the leading cause of death after spinal cord injury (SCI). Individuals with paraplegia develop hypertension and elevated arterial stiffness prior to their age matched peers. Overground exoskeleton training is becoming an increasingly prevalent form of exercise. In the general population, exercise training has been shown to reduce arterial stiffness. Recent RCT failed to show changes in arterial stiffness with arm ergometry or body weight supported treadmill training.

Objectives

The aim of this project is to determine the effect of Exoskeleton Exercise on changing arterial stiffness.

Study Design

The study setting will take place at a rehabilitation facility. The study will involve 34 sessions over the span of approximately 18-20 weeks. The key intervention utilized in the investigation will be an Overground EksoNR gait and balance training program. The primary outcome measure will be carotid-femoral pulse wave velocity (cfPWV) and secondary measures will include heart rate (HR), blood pressure (BP), waist circumference (WC), and oxygen saturation (SpO2). Statistical Analysis will involve mean changes at baseline, midway, and end of study.

Methods

The 34-session (2x/week for ∼18 weeks) rehabilitation protocol will focus on using the EksoNR for overground gait and balance activities. For measurement of cfPWV, two transcutaneous Doppler flowmeters will be used at the common carotid and femoral artery. To calculate cfPWV, the distance travelled by the pulse is divided by the average pulse transit time (PTT).

Hypothesis

The 18-week Exoskeleton Program would improve arterial stiffness (cfPWV) in individuals with chronic incomplete SCI/D.
Student Competition (Knowledge Generation) ID 1985185
Authors: Hemakumara Sisuri G. , Karamzadeh Zahra , Mann Darren J. , Barss Trevor S. , Mushahwar Vivian K.
Published: December 2023

Background/Objective

Transcutaneous spinal cord stimulation (tSCS) facilitates spinal networks involving motor function. The purpose of this study is to compare the effect of stimulators used and amplitude of tSCS, applied at the cervical region of the spinal cord, on propriospinal modulation of lower limbs. Corticospinal and spinal reflex excitability were assessed with lower limb motor evoked potentials (MEPs), and Hoffman (H-) reflexes, respectively.

Methods

Neurologically intact participants (n=6) were recruited. Two stimulators (NeoStim-5 and DS8R) were used, and different tSCS amplitudes at threshold (thresh) and maximum tolerance (max) were applied. The effect of tSCS on the amplitude of the H-reflex evoked in the soleus muscle was assessed, as well as the effect of cervical tSCS on MEPs evoked in the tibialis anterior muscle. Participants completed five conditions including: 1) Control (no stimulation) 2) DS8R Thresh 3) DS8R Max 4) NeoStim-5 Thresh 5) NeoStim-5 Max.

Results

At the same tSCS amplitude, the participants subjectively tolerated the NeoStim-5 better than the DS8R. The maximum tolerated amplitude for NeoStim-5 was higher than that of the DS8R, for all participants. Preliminary analysis suggests changes in tSCS amplitude delivered, do not appear to have an effect on the H-reflex and MEP in this small sample of participants.

Conclusions

Preliminary findings indicate that different stimulators produce different sensations at the same tSCS amplitudes. Changes in stimulator amplitudes do not appear to have an effect on the electrophysiological outcome on propriospinal modulation. This study sets the basis for understanding mechanisms of tSCS, including cutaneous activation.
Student Competition (Technology Innovation) ID 1985239
Authors: Abeywardane Dilshan , Mushahwar Vivian , Rahemtulla Kahir
Published: December 2023

Background

Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins and is the third most common cardiovascular disease today. One of the causes of DVT is venous stasis. Current methods of DVT prevention include anticoagulants and mechanical prophylaxis. Anticoagulant use is contraindicated in individuals with bleeding risks and mechanical interventions are often cumbersome and uncomfortable.

Objective

The overall goal of this project is to investigate a novel method for DVT prevention, termed intermittent electrical stimulation (IES). The current study investigated the effects of IES on healthy typical as well as post-stroke persons.

Method

Of the 32 participants, 22 were healthy subjects from Edmonton, and 10 were inpatient post-stroke subjects at the Glenrose Rehabilitation Hospital, Edmonton. A two-channel stimulator was used to administer IES through electrodes placed on the posterior and anterior sides of the leg and was applied in increasing stimulation amplitudes to the gastrocnemius muscle and the resulting plantar flexion force and changes in popliteal and femoral venous velocities were recorded for each stimulation respectively using B-mode ultrasound.

Results

IES-induced contractions produced significant increases in venous flow compared to baseline. Small contractions induced by comfortable levels of stimulation in typical and in post-stroke persons were sufficient to increase flow in the popliteal and femoral veins.

Conclusion

The results indicate that IES can sufficiently increase venous flow to prevent venous stasis and is comfortable for end users. Incorporation of IES into a clinical device could provide a feasible and effective alternative for DVT prophylaxis.
Student Competition (Knowledge Generation) ID 1986472
Authors: Gautam Srijana , Mushahwar Vivian , Baniya Mandira , Manhas Kiran Pohar , Dhakal Raju , Groves Christine Cain , Ho Chester
Published: December 2023

Background

Spinal cord injury (SCI) results in physical impairments and psychosocial issues that generate challenges to individuals, families, and society. Understanding the acute care hospital experience after SCI is important as it may have an impact on persons with spinal cord injuries’ (PWSCI) subsequent journey to the rehabilitation center and community. This experience has not been studied in Nepal, especially from the perspective of PWSCI.

Objectives

To understand how PWSCI (1) are involved in decision-making for their care; (2) are educated about secondary complications and, (3) perceive overall positive and negative experiences regarding their care during their acute care hospital stay in Nepal.

Methods

Qualitative study based on Van Manen’s phenomenology using purposive sampling at the Spinal Injury Rehabilitation Center, the only dedicated SCI center in Nepal. We interviewed participants (n=24) who were referred from nine different acute hospitals using a semi-structured interview guide co-developed with SCI experts and PWSCI. Using thematic analysis, we extracted the findings with Manen’s approach.

Results

We identified three preliminary themes: (1) Families, but not PWSCI, are often included in the decision-making process; (2) For education on secondary complications, only pressure injury prevention was recalled; (3) Timeliness of spinal surgery was a concern.

Conclusion

There are opportunities to improve the acute care experience for PWSCI in Nepal. PWSCI desired to be more engaged in the decision-making process and more involved in their own care. Concerns regarding the timeliness of surgery correlated with the findings of previous Nepali studies.
Student Competition (Clinical/Best Practice Implementation) ID 1986706
Authors: Nepomuceno Patrik , Souza Wagner H. , Musselman Kristin E. , Craven B. Catharine.
Published: December 2023

Background/objective

Exoskeletons are promising tools for motor rehabilitation in spinal cord injury/disease (SCI/D); however, optimal therapeutic dose parameters are unknown. This study aimed to identify the dose and dosage of exoskeleton training for functional gait restoration in individuals with SCI/D.

Design/Methods

A systematic review (inception-03/31/2022) included CINAHL Complete Embase, Emcare Nursing, MedLine and Web of Science databases. Studies with ≥ 5 adults (≥16 years, any level/nature) who underwent exoskeleton-based overground gait rehabilitation and reporting 3 of 4 dose (e.g., session duration and number of sessions) and dosage (e.g., frequency of sessions, intervention duration) parameters, and at least one gait outcome measure were included.

Results

Of 977 studies, 964 were excluded. With 19 studies remaining, 13 included functional restoration as their therapeutic intent. Of those, 11 reported statistically significant changes and were considered for recommendation. The functional restoration ranged from 10 to 51.5 sessions, 2 to 5 sessions a week, for 3 to 12 weeks, with a duration of 45-90-minutes per session. Altogether, the data suggest that exoskeleton-based functional gait restoration would be best achieved using protocols that encompass 60-minute sessions, 3 times a week, for over 8 weeks (total of 24 sessions).

Conclusions

Despite the high variability of dose and dosage parameters reported, significant improvements in functional performance were associated with overground exoskeleton use in most studies. The lack of therapeutic standards, however, compromises translation to clinical settings. This review provides evidence-based clinical practice recommendations for functional restoration in individuals with SCI/D to inform future functional restoration training paradigms.
Post Doc Competition (Knowledge Generation) ID 1987817
Authors: Walden Thomas P. , Parameswaran Shajaky , Brisbois Louise , Craven B. Catharine
Published: December 2023

Background

Individuals with a neurologic level of injury (NLI) C1-T10 have an UMN bowel and propensity for external anal sphincter spasm and need chemical/mechanical stimuli to evacuate their bowels versus those with an NLI T11-S5 and LMN bowel whom have a patulous sphincter and complete manual bowel disimpaction. We describe the associations between independence in sphincter control for 5 years following discharge among individuals with traumatic SCI (tSCI).

Methods

Adults with tSCI (n=113, 80 men) whom completed baseline, 1, 2, and 5-year community follow-up interviews (2014-2021) were included. Responses to the Spinal Cord Independence Measure (SCIM-III) Sphincter Control and Respiration subscores were extracted. Participants were separated into UMN and LMN groups. A linear mixed model determined longitudinal differences in SCIM subscores. NLI and follow-up time points were assigned as fixed effects, age a random effect, and sex as a covariate. Observed differences were compared to the minimal clinically importance difference (MCID) in SCIM-III subscores.

Results

The mean difference in SCIM-III subscores was 4.85 between the UMN and LMN bowel groups, with UMN group scoring lower at all-time points (p≤0.017). The mean group difference was equal to the MCID, constituting a substantial meaningful difference. No differences in SCIM subscores were noted across time (p≥0.9), regardless of NLI or bowel impairment.

Conclusion

Self-reported sphincter control remains stable for 5 years post-injury, emphasizing the need to maximizing bowel independence before discharge. Individuals with UMN bowel have lower sphincter control scores than individuals with a LMN bowel.
Poster (Knowledge Generation) ID 2001062
Authors: Richard-Denis A , Hong H , Dionne A , Guidea M , Mac-Thiong JM
Published: December 2023

Background/objectives

Research participation for individuals with spinal cord injury (SCI) is important to develop and receive promising interventions. It has been suggested that consenting to participate may also be associated with improved long-term outcomes. The objectives of this study are twofold and consisted of 1) verifying whether consenting to participate in a national SCI registry is associated with improved outcomes, and 2) determining predictors of enrolling in the registry.

Methods/overview

This population-based retrospective cohort study was performed on 3854 individuals with acute traumatic SCI approached to participate in the Canadian patient registry (Rick Hansen SCI Registry) between 2014 and 2019. The status of consent (consent vs. declined/withdrew) consisted in the main independent variable. Outcomes included length of stay, in-hospital mortality, discharge destination, occurrence of complications. Multivariable analyses were performed to identify predictors of consenting and its association with each outcome, while accounting for important covariables (demographic-, trauma- and institution-related).

Results

2998 individuals provided consent and 856 individuals declined/withdrew. Older age at injury and living farther away was associated with decreased likelihood for enrollment. While adjusting for covariables, declining participation was associated with increased acute length of stay, higher incidence of acute complications during acute care and decrease likelihood of being discharged home.

Conclusions

Approximately 20% of individuals declined participation in a national registry following an acute SCI, particularly elderly individuals and those living away from the hospital. It is possible that engagement in care and/or care delivery was altered for these individuals, leading to poorer patient outcomes. Enhanced opportunities should be given to subgroups not inclined to participate in research to optimize inclusivity in care delivery, therefore improving outcomes.
Workshop (Clinical/Best Practice Implementation) ID 2002364
Authors: Cowley Kristine , Athanasopoulos Peter , Ho Chester , Ripat Jacquie , Rademeyer Hope Jervis , Warkentin Peter , Gregory John ,   The National SCI Model of Care Committee
Published: December 2023

Background

Spinal cord injury (SCI) affects every aspect of a person’s bodily functions. As such, for a person to survive and strive in the community after SCI, both a comprehensive and effective rehabilitation program, as well as life-sustaining healthcare (i.e., SCI-specific medical services, equipment, and supplies) is needed. Although Canada has a publicly funded universal healthcare system, provinces have flexibility in determining how rehabilitation is delivered and in defining ‘essential’ healthcare.

Methods/Overview

This workshop will consist of two lectures on current standards of care in acute SCI rehabilitation and provision of life-sustaining SCI healthcare services, equipment, and supplies in Canada, followed by an initial overview of standards in other comparable countries and discussion of next steps for developing equity and consistency in Canada for SCI rehabilitation and provision of SCI-related healthcare needs.

Learning Objectives

Upon completion of this workshop, attendees will understand:
Workshop (Health Services, Economics and Policy Change) ID 2012040
Authors: Short Christine , O’Connell Colleen
Published: December 2023

Background/Objectives

According to the WHO nearly one billion people worldwide live with some form of disability and one fifth of those have significant difficulty functioning as a result.

Climate change is a reality and the impacts on healthcare and the care of our communities is significant. From food and water supply, housing emergency preparedness and safety to the effects on our health, climate change has a disproportionate impact on persons with disabilities.

The purpose of this workshop is to provide attendees with a review of the issues that climate change has created for persons with disabilities with a focus on traumatic and non-traumatic spinal cord injury. We will then move to a group discussion on what we can do individually and as health systems to address these challenges and make sure the rights and safety of persons with disabilities are protected as we navigate our world with Climate Change.

Methods/Overview

We will use powerpoint slides, polls and group discussion to explore this topic.

Results

This workshop will further educate SCI experts nationally/internationally and collect their thoughts and ideas on climate impact on persons with disabilities.

Conclusions

Our hope is that this information will help inform a more formal position statement from the CSCIRA.
Fallen Sanctuary: A Higher-Order and Leakage-Resilient Rekeying Scheme
Authors: Ueno Rei , Homma Naofumi , Inoue Akiko , Minematsu Kazuhiko
Published: December 2023

This paper presents a provably secure, higher-order, and leakage-resilient (LR) rekeying scheme named LR Rekeying with Random oracle Repetition (LR4), along with a quantitative security evaluation methodology. Many existing LR primitives are based on a concept of leveled implementation, which still essentially require a leak-free sanctuary (i.e., differential power analysis (DPA)-resistant component(s)) for some parts. In addition, although several LR pseudorandom functions (PRFs) based on only bounded DPA-resistant components have been developed, their validity and effectiveness for rekeying usage still need to be determined. In contrast, LR4 is formally proven under a leakage model that captures the practical goal of side-channel attack (SCA) protection (e.g., masking with a practical order) and assumes no unbounded DPA-resistant sanctuary. This proof suggests that LR4 resists exponential invocations (up to the birthday bound of key size) without using any unbounded leak-free component, which is the first of its kind. Moreover, we present a quantitative SCA success rate evaluation methodology for LR4 that combines the bounded leakage models for LR cryptography and a state-of-the-art information-theoretical SCA evaluation method. We validate its soundness and effectiveness as a DPA countermeasure through a numerical evaluation; that is, the number of secure calls of a symmetric primitive increases exponentially by increasing a security parameter under practical conditions.