Single Case Study Design Research Articles

When time is of the essence: The use of rational emotive behavior therapy (REBT) informed single-session therapy (SST) to alleviate social and golf-specific anxiety, and improve wellbeing and performance, in amateur golfers

Anxieties associated with the social evaluative nature of golf are present in the majority of athletes and impact directly on their wellbeing and objective performance. One potential intervention that could reduce social anxiety in golfers is rational emotive behavior therapy (REBT). There is limited research into the effectiveness of REBT in reducing social anxiety and even less research to assess if REBT can be delivered in time-constricted situations when the expectations for immediate results are high, as is the case with many handicap golfers. The current study used an idiographic single-case study design to assess the effects of REBT-informed single-session therapy (SST) on the social anxiety of five amateur golfers. REBT was employed in a short telephone call to target the performance issue, followed up with a single face-to-face session. Data were collected prior to, immediately following, and four weeks after the REBT intervention. Visual analysis following single-case guidelines revealed substantial reductions in irrational beliefs and social anxiety as well as improvements in wellbeing, scoring average, competition placings and handicap reductions in four out of five golfers. Discussion with golfers at a telephone follow-up indicated the positive receipt of REBT by the golfers and supported the visual analysis findings. This current study supports the effectiveness of REBT and also extends the research by demonstrating that REBT-informed SST can be an effective intervention, in a time-restricted environment, for those golfers with a clear target problem and who are ready to take care of business, providing clear implications for future research and practice.

Software Process Evaluation from User Perceptions and Log Data

AbstractCompanies often claim to follow specific software development methodologies (SDM) when performing their software development process. These methodologies are often supported by dedicated tools that keep track of work activities carried out by developers. The purpose of this paper is to provide a novel approach that integrates analytical insights from both the perceptions of SDM stakeholders and software development tools logs to provide SDM improvement recommendations. This paper develops a new process improvement approach that combines two significantly different sources of data on the same phenomenon. First, it uses a questionnaire to gather software development stakeholder SDM perceptions (managers and developers). Second, it leverages process mining to analyze software development tools logs to obtain additional information on software development activities. Finally, it develops recommendations based on concurrent analysis of both sources. Our novel process improvement approach is evaluated in three directions: Does the presented approach (RQ1) enable managers to gain additional insights into employees' performance, (RQ2) deliver additional insights into project performance, and (RQ3) enable development of additional SDM improvement recommendations? We find that integrated analysis of software development perception data and software development tools logs opens new possibilities to more precisely identify and improve specific SDM elements. The evaluation of our novel process improvement approach follows a single case study design. Our approach can only be used in enterprises in which software development tools logs are available. The study should be repeated in different cultural settings. We practically show how concurrently analyzing data about developer SDM perceptions and event log data from software development tools enables management to gain additional insights in the software development process regarding the performance of individual developers. The main theoretical contribution of our paper is a novel process improvement approach that effectively integrates data from management and developer perspectives and software development tools logs.

Treatment for School-Age Children Who Stutter: A Systematic Review of Japanese Literature.

This systematic review identified and synthesized published research articles, written in Japanese, on the clinical effectiveness of a broad range of nonpharmacological interventions for school-age children who stutter. A systematic review of Japanese literature published between January 1, 1980, and July 7, 2020, reporting interventions for school-age children who stutter, was carried out through a search of two databases (CiNii Article database and Japan Medical Abstract Society database) using the key words "stuttering" and "school-age" or "child" or "primary school students" or "children" or "school child" in Japanese. To be included in the review, the articles must report studies where data were subjectively reported by clinicians, where school-age participants were treated for developmental stuttering, where participants received interventions conducted by clinicians, and where quantitative outcomes (pre- and/or posttreatment) were measured; and they must be published in Japanese. Forty articles met all the inclusion criteria. Most articles adopted a case series or single-case study design. A total of 179 intervention programs were identified from all the articles and broadly classified into speech therapy, psychological therapy, interventions for modifying the child's environment, and others. Our systematic review provided a broad overview of the treatments used for school-age children who stutter in Japan. Future research should focus on gathering more reliable, systematic, and rigorous evidence to establish the effectiveness of stuttering treatments for school-age children and thereby develop evidence-based practices.

An Investigation of Mathematics Teachers' Specialized Content Knowledge Related to Basic Concepts about Sets

This research was carried out in order to examine the specialized content knowledge of mathematics teachers related to teaching basic concepts about sets within the MKT Model. In this study, a holistic single-case study design is used in qualitative research methods. The study group consists of 18 mathematics teachers at different educational background and professional experience in teaching sets selected through the sampling of criterion, which is working in different high schools in one province in the Mediterranean region in the academic year 2016-2017. Research data were obtained using semi-structured interview, observation and document analysis techniques. In the analysis of obtained data, descriptive analysis, content analysis, continuous comparison techniques and special data analysis methods were used together with each data collection tool. The findings of the research show that teachers gave correct answers to the questions asked about the basic concepts of "Why?" in the sets. However, it is clear that the teachers cannot write sufficient reason why the asked questions are "Why?". As a result of the research, it has been determined that the teachers have superficial knowledge about the concepts of "Set, Universal Set, Infinite Set" and "Equal Set". However, it was determined that teachers made explanations with a general mathematical knowledge based on the characteristics of the concept rather than providing persuasive mathematical explanations to the questions asked.

Deep-Breathing Biofeedback Trainability in a Virtual-Reality Action Game: A Single-Case Design Study With Police Trainers.

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability (HRV) biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality (VR) breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design (i.e., alternating sessions with and without biofeedback). Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context.

The effect of big data in transforming to learning organization a single-case study in IT sector

PurposeThe purpose of this paper is to examine the contribution of big data in the transforming process of an IT firm to a learning organization.Design/methodology/approachThe authors adopted a qualitative research approach to define and interpret the ideas and experiences of the IT firms’ employees and to present them to the readers directly. For this purpose, they followed a single-case study design. They researched on a small and medium enterprise operating in the IT sector in Düzce province, Turkey. This paper used a semi-structured interview and document analysis as data collecting methods. In all, eight interviews were conducted with employees. Brochures and website of the organization were used as data sources for the document analysis.FindingsAs a result of in-depth interviews and document analysis, the authors formed five main themes that describe perception of big data and learning organization concepts, methods and practices adopted in transforming process, usage areas of big data in organization and how the sample organization uses big data as a learning organization. The findings of this paper show that the sample organization is a learning IT firm that has used big data in transforming to learning organization and in maintaining the learning culture.Research limitations/implicationsThe findings contribute to literature as it is one of the first studies that examine the influence of big data on the transformation process of an IT firm to a learning organization. The findings reveal that IT firms benefit from the solutions of big data while learning. However, as the design of the research is single-case study, the findings may be specific to the sample organization. Future studies are required that examine the subject in different samples and by different research designs.Originality/valueIn literature, research on how IT firms’ managers and employees use big data in organizational learning process is limited. The authors expect that this paper will shed light on future research that examines the effect of big data on the learning process of the organization.

Transferring knowledge and innovations through village knowledge center in Tanzania: approaches, impact and impediments

PurposeFarmers in rural areas are generally not well empowered with knowledge and innovations to solve their agricultural problems in spite of the growing presence of such knowledge resulting from research and innovation activities across the globe. This study aims to document approaches, impact and impediments of using village knowledge centers (VKCs) to transfer agricultural knowledge and innovations.Design/methodology/approachTo achieve the objective of the study, a case study research design was used to investigate the impact of a selected VKC as institutional innovation in agricultural technology outreach and extension in rural Tanzania. Primary data was collected through semi-structured interviews, focus group discussions and observation methods. Besides, secondary sources such as reports were used to complement primary data during fieldwork.FindingsThe study reveals that various approaches are used by the VKC to transfer knowledge and innovation to farmers. The use of the multi-actor platform (MAP) to run the VKC ensures inclusive knowledge production and sharing among different actors. The findings also suggest that knowledge and innovation co-creation is constructed with various knowledge systems actors to enhance the use of research generated. Accordingly, the findings show that the university efforts are an important catalyst for integrated knowledge, technology and innovation systems in rural settings.Research limitations/implicationsThe present study reveals different limitations associated with the use of a single case study design. The single-case design provided researchers with little basis for generalisation of the study findings and conclusions. Aside from that, the use of a cross-sectional design did not help the researchers to validate the findings and conclusions. To address these limitations, the study recommends similar studies that will adopt different types of longitudinal design such as cohort and diary methods. Apart from this, a future study to investigate the tangible impact of VKC on knowledge and innovation transfer is recommended.Originality/valueConsidering the novelty of the MAP approach in Tanzania and the dearth of studies reporting on how the village knowledge center works and how effective it is, the present study provides insights on the approaches, impact and impediments.

Playing Games to Promote Fluency: Making Products to Make Gains

ABSTRACT Mathematical fluency supports maintenance of mathematical skills (Shurr et al., 2019). Multiple interventions support fluency, including the use of games. However, limited research exists exploring games as a means of increasing student fluency in mathematics. In this single case design study, researchers examined the relation between four elementary students’ fluency with single-digit multiplication problems and playing the Product Game, which is a game focused on whole number multiplication facts. Researchers found a functional relation between the intervention of playing the game for 10 min and student accuracy with digits and answers on a 1 min multiplication fluency probe. Overall, students also maintained higher digit and answer rates.

Free trade areas as cross-cultural knowledge-sharing platforms: evidence from the Sino-Vietnam case

Purpose A free trade area (FTA) is the designated economic area where bilateral trades between membership nations are tax-free. An FTA provides an important knowledge-sharing platform across cultures. Most studies discuss FTA issues from the perspectives of economics and international law. However, this study aims to analyse the challenges and opportunities relating to FTAs from a novel, integrative perspective of culture and knowledge management. Design/methodology/approach This study used a single-case study design to investigate the Sino-Vietnam bilateral trade conditions in the FTA of the Regional Economic Comprehensive Partnership. Semi-structured interviews were conducted in Yunnan province, China, with government officials and firm managers involved in Sino-Vietnam trade. Findings This study identifies three major challenges in the China-Vietnam case: the existence of a knowledge iceberg, the lack of deep mutual trust and the inconsistency of bilateral port policies. This study identifies three possible solutions to these challenges: creating different communication channels for knowledge sharing, building mutual trust and respect for knowledge sharing and reducing inconsistencies in the two border gate management systems. Research limitations/implications Considering cross-cultural knowledge sharing, this study provides new insight and feasible guidance for better cooperation of member countries of FTAs all over the world. Originality/value This research is novel because it considers the FTA as a knowledge-sharing platform where the intersection of diverse cultural values and judgement may result in a variety of knowledge icebergs. Thus, this study enriches the FTA research by focussing on the intersection of culture and knowledge management.

THE LAKATOSIAN METHODOLOGY IN TEACHING THE SURFACE AREA OF A CONE AND A STUDENT’S CONCEPTUAL TRANSITION

Although many scholars support the Lakatosian method of mathematics education for enhancing students learning, the use of the method to foster students’ transition from alternative to scientific conceptions in mathematics does not seem to have been a focus of any research. This study explored if the Lakatosian heuristic method of teaching could foster a students’ transition from alternative to scientific conceptions of the surface area of a cone. The study used a qualitative, exploratory single case study design to undertake an in-depth study of a student in the 11th grade at a secondary school in Cyprus. Data was collected through lesson observation and analyzed using deductive content analysis. The study found that beginning from informal conjectures and proofs to more formal proofs the student was able to transit from alternative conception to the scientific conception of the surface area of a cone. The finding suggests that the Lakatosian method of mathematics can foster students’ conceptual understanding of some mathematical concepts.

Management of Education Services in Prisons: A Case Study

In this paper we assess the management of education services in Uganda prisons, taking a case study of Luzira Upper Prison. Specifically, this study established the kind of education services provided to inmates in Luzira Upper prison, as well as sought to establish the relationship between jail term and the type of education services offered to inmates in Luzira Upper prison. The study adopted both qualitative and quantitative approaches to gather the necessary data. With a single case study design. A questionnaire and an interview guide were used to collect data from inmates accessing education services, teachers, Prison Warders and senior prison staff purposively selected who composed the sample. (n=104) The study findings pointed to Vocational trainings, basic education in form of general subjects; creative art teaching lessons to the inmates among others. To establish whether jail term had a relationship with type of education service in Luzira Upper Prisons a correlation was computed, examined and interpreted using the Chi-Square Test. The results also pointed to a positive relationship between jail term and type of education program undertaken at Luzira Upper Prison by the inmates as indicated by (p = 0.565). This relationship is significant since the significance of 0.565 is discovered to be greater than 0.05. The study concluded that management of prison education services has a well-established curriculum with both vocational and academic courses being offered, the policy of voluntary participation to education is a major shortcoming leading to recidivism. We concluded that government needs to effectively increase finances to mitigate shortages arising from the education provision to inmates, strategically plan an expansion of the curricula to include skills targeting psycho social aspect in a restricted environment to allow complete rehabilitation after the inmate tenure. The study recommended that ministry of education and sports should not only make inmate education compulsory to all inmates but also take the leading role in adopting prison schools in on the list of community public schools in Uganda.

An Analysis of a Teacher Education Programme at a Namibian Tertiary Institution

Teacher quality is a crucial element of quality education, and it is dependent on the quality of teacher education. Thus, this study analyses the teacher training programme at a Namibian university to determine its quality. Four quality determining components were analysed: students and teacher educator qualities; curriculum materials; teaching and learning process; and teaching practice. This qualitative study employed a single case study design. Four research instruments were used to collect data: document analysis, focus group interviews, questionnaires, and observations. The sample comprised one hundred and sixty (160) pre-service students, one (1) focus group of fifteen (15) graduates, sixteen (16) teacher educators, and three (3) focus groups with a total of thirty (30) pre-service students. The significant findings of this study were that average students enrol for the teacher education programme because of extrinsic and other motives other than intrinsic and altruistic reasons. In addition, the teacher education curriculum was found to be overcrowded with fragmented modules. Further, the subject matter content was not aligned with the school curriculum; students exit with little subject matter knowledge. The study also found that the assessment of pre-service students lacked authenticity as assessment questions do not test the understanding and application of knowledge. Additionally, the lecture method dominated the pedagogies employed, promoting rote learning. Another factor was poor teaching practices characterised by inadequate time allocation and lack of mentoring support from the school. Thus, a lot is desired from the teacher education programme; hence, the study recommends a longitudinal study to be carried out involving all higher education institutions in Namibia that offer a teacher education programme to see if the findings would be the same.

Improving the Science of Annotation for Natural Language Processing: The Use of the Single-Case Study for Piloting Annotation Projects

Researchers need guidance on how to obtain maximum efficiency and accuracy when annotating training data for text classification applications. Further, given wide variability in the kinds of annotations researchers need to obtain, they would benefit from the ability to conduct low-cost experiments during the design phase of annotation projects. To this end, our study proposes the single-case study design as a feasible and causally-valid experimental design for determining the best procedures for a given annotation task. The key strength of the design is its ability to generate causal evidence at the individual level, identifying the impact of competing annotation techniques and interfaces for the specific annotator(s) included in an annotation project. In this paper, we demonstrate the application of the single-case study in an applied experiment and argue that future researchers should incorporate the design into the pilot stage of annotation projects so that, over time, a causally-valid body of knowledge regarding the best annotation techniques is built.

EXPLORING RELATIONSHIP POWER IN SUPPLY CHAIN SUSTAINABILITY PRACTICES: A CASE STUDY OF A SOUTH AFRICAN HOSPITAL GROUP

Buyers and suppliers of healthcare products and services are more dependent on each other than ever before for the provision of scarce and unique resources, which highlights the need to implement supply chain sustainability practices. Firms controlling these resources hold excessive power over others. This study adopted resource dependence theory as a theoretical lens to explore the role of relationship power in supply chain sustainability practices between a South African private healthcare provider and its suppliers. The study employed a generic qualitative single-case study design. Semi-structured interviews were used to collect data from 12 participants at various levels of the case organisation’s hierarchy. The main findings revealed several types of environmental and social practice used in the supply chain of the private healthcare provider. Some of the environmental practices were effective waste management and recycling, while the social practices included supplier selection and periodic reviews. The healthcare provider exercised extensive power over its suppliers to implement these practices. By exploring the advantages and disadvantages of sustainability practices, the findings showed that relationship power acted as a driver of supply chain sustainability. Mutual commitment, continuous communication, and training support these practices. Healthcare managers must be aware of the importance of relationship power for supply chain sustainability practices implementation, and are advised to invest time and effort in building buyer—supplier relationships to aid sustainability. This study expands the literature on relationship power in supply chain sustainability practices in an underexplored developing country healthcare context. Keywords Sustainability; supply chain relationships; power; private hospital; single case-study

AKULTURASI BUDAYA SOSIAL DAN MAKNA SIMBOLIK TARI DERO

The process of acculturation runs very quickly or slowly depending on the perception of the local community towards the incoming foreign culture. The purpose of the study is to find out the cultural acculturation and symbolic meaning of dero dance. Research methods use a qualitative approach, with a single case study design. Data collection techniques through observation, interviews, and documentation studies. The results of the study that dero dance has a common meaning as a form of gratitude and a sense of community unity regardless of social strata but the meaning and value shifted due to the acculturation of foreign cultures using modern music collaborated with other cultures. The special meaning of the dero dance movement is a simple and simultaneous presentation of motion in doing and has its attraction that can give suggestions and feel the desire of everyone to participate in doing dero dance moves. This type of dance is a popular traditional dance that can be followed and pulled with the whole community in the event of a traditional party and dero dance is a social dance from various circles considering that this dero dance aims to unite the movement. Dero dance is performed at the traditional ceremony of the wedding and thanksgiving party. The meaning of the floor pattern of the circle shape that is not broken and well maintained as a form of mutual help.

Exploring Strategies to Establish an Effective Organizational Culture to Enhance Corporate Performance: A Concept Paper

Maintaining an effective organizational culture within the corporate group is indeed a must to enhance organizational performance and shareholder return. A concept is proposed for a qualitative study aimed to explore prominent strategies that one corporate group deploys to establish an effective organizational culture to enhance performance. Denison organizational culture model is served as the theoretical underpinning for the study. “What strategies do senior managers deploy to establish an effective organizational culture to enhance performance” is identified as the research problem of the study in order to bridge the prevailing research gap. The research problem is answered through four research questions. An exploratory single-case study design is used for the study. A purposive sample of 20 senior managers from a leading corporate group in Sri Lanka participate in semi structured face-toface interviews. The study corporate group has 47 companies belongs to six main sectors, which is one of the largest corporate groups in Sri Lanka. The chosen participants conform the criteria of a minimum of 5 years of experience with strategies in establishing an effective organizational culture in the corporate group. The findings of this study would reveal a new model for business managers to enhance corporate performance by establishing an effective organizational culture.

Outcomes of Telepractice Speech Therapy for an Adult Who Covertly Stutters: A Case Study

Purpose: The purpose of this study was to report on telepractice-based holistic speech-language therapy services to reduce avoidance of stuttering and increase positive self-image as a communicator for an adult who covertly stutters as compared with baseline. Method: A single case study design was employed with baseline, intervention, and maintenance phases completed via telepractice. The participant received biweekly speech-language pathology services, including both individual and group sessions. The Overall Assessment of the Speaker's Experience of Stuttering–Adult and Stuttering Severity Instrument–Fourth Edition assessed the participant's overt and covert stuttering behaviors at pretreatment and posttreatment time frames. Weekly data points of participant's self-report of avoidance of stuttering during therapy sessions and during the week between therapy sessions as well as researcher-calculated frequency of stuttering were measured. Visual inspection was utilized to analyze treatment outcomes. Results: The participant demonstrated a reduction in avoidance of stuttering within sessions as well as the week prior to a session, as compared with baseline. Additionally, the participant presented with an increased percent of words stuttered following into maintenance as compared with baseline. Visual inspection of weekly data points of frequency of stuttering and self-report of avoidance appeared to present promising results throughout the intervention phase with potential treatment effects continuing into the maintenance phase. Conclusion: Results of this study demonstrate preliminary evidence for potential positive outcomes of holistic speech therapy via telepractice for people who covertly stutter.

The effect of project on children attitude toward environmental balance

Abstract The purpose of this study is to explore the effect of project on children’s attitude toward environmental balance. This study is a qualitative study using a holistic single case study design involving “compost cases”, at a kindergarten in Perak, Malaysia. The participants consisted of a focus group of 18 children and an educator. The data was obtained through triangulation results from unstructured interview, observation, and unofficial documents such as children notebooks, sketches, and pictures of investigative activities. The findings showed that the children understand the negative impact of using chemicals on Earth. The finding also showed that children able to give suggestions on producing compost, burying food scraps in the soil and use the compost dining set for banquet to deal with waste management problems. In addition, the finding showed that children able to classify waste materials which is easily decompose for compost production. The finding also showed that activities project able to develop entrepreneurial attitudes in children to sell the product produced. The valuable experience through observation and hands-on activities from early childhood will help the continuity of learning process throughout their lives.

Exploring the relationship between corporate social responsibility actions and employee retention: A human resource management perspective

BACKGROUND: This study builds on the little guidance in the existing literature to analyze the relationship between employee-oriented CSR actions and employee retention in a business context, while using Freeman’s stakeholders model as a theoretical research framework. This research also aims to shed light on significant behavioral factors facilitating the relationship between CSR endeavors and turnover rate. OBJECTIVE: This paper builds on the existing research gap in the literature and suggests that behavioral factors, including job satisfaction, organizational identification, and motivation facilitate the relationship between employee-oriented CSR actions and employee retention, which contributes to laying the foundations of a theoretical framework that has the potential to advance both research and practitioner debates and disentangle the complexity of such a relationship, while offering strategically-focused development venues in the CSR and HRM fields. METHODS: This research uses a single case study design to ensure an in-depth and detailed analysis of the phenomenon under scrutiny, while relying on a triangulation methodology for data collection, including a questionnaire used as exploratory approach, interviews to generate explanatory data, and archival data to bring confirmatory insights. Data analysis followed the procedures of a deductive approach. RESULTS: The research results show a positive relationship between employee-oriented CSR actions and employee retention, while demonstrating the facilitating role of job satisfaction, organizational identification, and motivation in moderating such a relationship. The findings also stress the importance of framing CSR interventions within the organization’s strategy and goals, while ensuring employee participation in such decision making processes to maximize the effect of CSR interventions on employee commitment and reduce turnover. CONCLUSIONS: This research has the potential to better clarify the nature of the relationship involving CSR interventions, from an employee perspective, retention, and turnover, while laying the foundations of a theoretical framework linking such constructs and other behavioral factors that underpin and support such a relationship. Building on the study’s findings and assumptions, future research is needed to gain a more comprehensive understanding of how HR-related CSR actions affect behavioral performance dimensions, resulting in employee commitment and retention. Future research should also consider multiple case study, multicultural, and ethnographic approaches for the sake of generalizability and theory building.

Covert Conditioning for Persistent Aggressive Behaviors: A Case Illustration.

In psychotherapy practice and training, single case study design plays an indispensable role by effectively articulating the application of textbook knowledge, thereby bridging the gap between theory and practice. This article, on similar lines, illustrates one such successful example of the application of the classical behavioral technique of covert conditioning modified with a component of verbal challenging. A woman in her late-thirties reported with long-standing seemingly-resistant-to-treat symptoms of aggressive behavior of beating children. The client had a total of 10 daily sessions of 60-90 minutes each. By the end of one week, she reported not beating children in this period. She felt extremely relieved because it had happened for the first time in 10 years. The intensity of anger had decreased drastically, and she was not shouting any longer. She had to discontinue sessions abruptly due to unavoidable circumstances. Although she was suggested to follow up the intensive sessions again, she was not able to do it due to feasibility issues. The improvement was maintained on follow-up visits after two weeks, four weeks, and three months.