Search results for: family therapy

Authors: Alka Yadav, Mayank Jain, Rajan Saxena, Niraj Kumari, Narendra Krishnani, Ashok Kumar

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Purpose: To study the mismatch repair (MMR) protein expression and its clinicopathological correlation in colorectal cancer patients in North India. Methods: A prospective study was conducted on histologically proven 52 (38 males and 14 females) patients with adenocarcinoma of colorectum. MMR protein loss was determined by using immunohistochemistry for MLH1, MSH2, PMS2 and MSH6. Results: 52 patients (38 males and 14 females) underwent resection for colorectal cancer with the median age of 52 years (16-81 years). 35% of the patients (n=18) were younger than 50 years of the age. 3 patients had associated history of malignancy in the family. 29 (56%) patients had right colon cancer, 9 (17%) left colon cancer and 14 (27%) rectal cancer. 2 patients each had synchronous and metachronous cancer. Histology revealed well-differentiated tumour in 16, moderately differentiated in 10 and poorly differentiated tumour in 26 patients. MMR protein loss was seen in 15 (29%) patients. Seven (46%) of these patients were less than 50 years of age. Combined loss of MSH2 and MSH6 was seen most commonly and it was found in 6 patients. 12 (80%) patients with MMR protein loss had tumour located proximal to the splenic flexure compared to 3 (20%) located distal to the splenic flexure. There was no difference in MMR protein loss based on patients' age, gender, degree of tumour differentiation, stage of the disease and tumour histological characteristics. Conclusions: This study revealed that there was less than 30% MMR protein loss in colorectal cancer patients. The loss was most commonly seen in right sided colon cancer than left. A larger study is further required to validate these findings.

Keywords: colorectal cancer, mismatch repair protein, immunohitochemistry, clinicopathological correlation

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Authors: Rana F. Obeidat, Suzanne S. Dickerson, Gregory G. Homish, Nesreen M. Alqaissi, Robin M. Lally

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Background: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early stage breast cancer and surgical treatment. Objective: To gain understanding of the diagnosis and surgical treatment experience of Jordanian women diagnosed with early stage breast cancer. Methods: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. Results: Fear had a profound effect on Jordanian women’s stories of diagnosis and surgical treatment of early stage breast cancer. Women’s experience with breast cancer and its treatment was shaped by their pre-existing fear of breast cancer, the disparity in the quality of care at various health care institutions, and sociodemographic factors (e.g., education, age). Conclusions: Early after the diagnosis, fear was very strong and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the health care system, surgeons, family, friends, and/or neighbors, and often accepted treatment offered by their surgeons without questioning. Implications for practice: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and support necessary to help them cope with their illness.

Keywords: breast cancer, early stage, Jordanian, experience, phenomenology

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Authors: Gerald H. Artisen, Miah Joy O Awing, Elydia O. Ayat, Rachel L. Ayangwa, Zeah D. Baggas, Aspen S. Baguiyac, Delight D. Baguiyac, Kristine G. Bakidan, Nemesis B. Bakidan, Ketly B. Balanggao, Rhea G. Bala-Is, Hope Lulet A. Lomioan

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The study investigated the prevalence and risk factors associated with postpartum depression among mothers in the Pasil, Kalinga, contributing to a better understanding of the mental health challenges faced by this specific population. This research utilized a cross-sectional descriptive study to assess postpartum depression prevalence and identify contributing factors in Pasil, utilizing a quantitative approach and collecting data on sociodemographic characteristics, obstetric data, and the Edinburgh Postnatal Depression Scale. The study concluded that probable depression can be seen among mothers in the Pasil, which resulted in a risk of suicidality with a percentage of 40.08. Additionally, most of the respondents are aged 28–32, married, have a college degree, are unemployed, have a monthly income of 1,000–5,000, are female, have hypertension, gave birth naturally, have two children, have a planned pregnancy, and are currently breastfeeding. Lastly, the study found that mothers in Pasil who have unplanned pregnancies under obstetric factors are at high risk of developing postpartum depression, with a p-value below the 0.05 level. The study recommends barangay health professionals develop initiatives to inform aspiring mothers about postpartum depression (PPD) and resources to help them adjust to motherhood. It also recommends frequent check-ins with new mothers to identify special healthcare needs. Programs should be independently funded by LGUs, and support from family and relatives is recommended to prevent PPD.

Keywords: maternal health, postpartum depression, mothers, Pasil

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Authors: Alireza Fard Kashani

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This study reports on the experiences and attitudes of six Iranian migrant families, from two groups of asylum seekers and skilled workers, with regard to their language, identity, and acculturation in Australia. The participants included first generation parents and 1.5-generation adolescents, who had lived in Australia for a minimum of three years. For this investigation, Mendoza’s (1984, 2016) acculturation model, as well as poststructuralist views of identity, were employed. The semi-structured interview results have highlighted that Iranian parents and adolescents face low degrees of intergenerational conflicts in most domains of their acculturation. However, the structural and lawful patterns in Australia have caused some internal conflicts for the parents, especially fathers (e.g., their power status within the family or their children’s freedom). Furthermore, while most participants reported ‘cultural eclecticism’ as their preferred acculturation orientation, female participants seemed to be more eclectic than their male counterparts who showed inclination towards keeping more aspects of their home culture. This finding, however, highlights a meaningful effort on the part of husbands that in order to make their married lives continue well in Australia they need to re-consider the traditional male-dominated customs they used to have in Iran. As for identity, not only the parents but also the adolescents proudly identified themselves as Persians. In addition, with respect to linguistic behaviour, almost all adolescents showed enthusiasm to retain the Persian language at home to be able to maintain contacts with their relatives and friends in Iran and to enjoy many other benefits the language may offer them in the future.

Keywords: acculturation, asylum seekers, identity, intergenerational conflicts, language, skilled workers, 1.5 generation

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Authors: Khizar Hayat Bhatti, Fiza Javed, Misbah Zafar

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Oat (Avena sativa L.) is a major cereal plant belonging to the family Poaceae. It is a very important source of carbohydrates, starch, minerals, vitamins and proteins that are beneficial for general health. Plants grow in the heavy metals contaminated soils that results in decline in growth. Glycine betaine application may improve plant growth, survival and resistance to metabolic disturbances due to stresses. Heavy metals, like nickels, have been accumulated for a long time in the soil because of industrial waste and sewage. The experiment was intended to alleviate the detrimental effects of heavy metal nickel stress on two oat varieties ‘Sgd-2011 and Hay’ using Glycine betain. Nickel was induced through soil application while GB was applied as foliar spray. After 10 days of nickel treatment, an exogenous spray of glycine betaine on the intact plant leaves. Data analysis was carried out using a Completely Randomized Design (CRD) with three replications in this study. For the analysis of all the data of the current research, Mini-Tab 19 software was used to compare the mean value of all treatments and Microsoft Excel software for generating the bars graphs. Significant accelerated plant growth was recorded when Ni exposed plants were treated with GB. Based on data findings, 3mM GB caused significant recovery from Ni stress doses. Overall results also demonstrated that the sgd-2011 variety of oats had the greatest outcomes for all parameters.

Keywords: CRD, foliar spray method, glycine betaine, heavy metals, nickel, ROS

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Authors: Genesis Julyus T. Agcaoili, Esperanza C. Cabrera

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Thirty (30) isolates of lactic acid bacteria (LAB) from traditionally-prepared fermented products specifically fermented soy-bean paste, fermented mustard and fermented rice-fish mixture were studied for their in vitro antimicrobial and cytotoxic activities. Seventeen (17) isolates were identified as Lactobacillus plantarum, while 13 isolates were identified as Enterococcus spp using 16s rDNA sequences. Disc diffusion method was used to determine the antibacterial activity of LAB against Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922), while the modified agar overlay method was used to determine the antifungal activity of LAB isolates on the yeast Candida albicans, and the dermatophytes Microsporum gypseum, Trichophyton rubrum and Epidermophyton floccosum. The filter-sterilized LAB supernatants were evaluated for their cytotoxicity to mammalian colon cancer cell lines (HT-29 and HCT116) and normal human dermal fibrolasts (HDFn) using resazurin assay (PrestoBlueTM). Colchicine was the positive control. No antimicrobial activity was observed against the bacterial test organisms and the yeast Candida albicans. On the other hand, all of the tested LAB strains were fungicidal for all the test dermatophytes. Cytotoxicity index profiles of the supernatants of the 15 randomly picked LABs and negative control (brain heart infussion broth) suggest nontoxicity to the cells when compared to colchicine, whereas all LAB supernatants were found to be cytotoxic to HT-29 and HCT116 colon cancer cell lines. Results provide strong support for the role of the lactic acid bacteria studied in antimicrobial treatment and anticancer therapy.

Keywords: antimicrobial, fermented products, fungicidal activity, lactic acid bacteria, probiotics

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Authors: Benyapa Thitimapong

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Teenage pregnancy and adolescent mothers have become a matter of increasing concern in Thailand. Since adolescent mothers have been a big problem for two main consequences; health outcomes and socio-economic impacts. Adolescent mothers often endure poor living conditions; limited financial resources while also experience high stress, family instability, and limited educational opportunities. These disadvantages are negative and have long-term effects on adolescent mothers, their families, and the community. The majority of pregnant students and adolescent mothers dropped out of school after becoming pregnant, and some of them return to study again after they gave birth. This research aimed to explain the meaning of adolescent mothers who had undergone with childrearing and studying simultaneously after childbirth. A phenomenological qualitative approach was undertaken to investigate this study. The participants were 20 adolescent mothers each of whom became a mother and a student concurrently within less than 2 years after giving birth to a healthy baby and had also undergone the experience of childrearing and studying in non-formal education. In-depth interview was carried out for data collection, and the data were analyzed using content analysis method. ‘Learning to move forward’ was the meaning of adolescent mothers who experienced with childrearing and studying simultaneously. Their expressions were classified into two categories 1) having more responsibility, and 2) conceding and going on. The result of this study can be used as evidence for health care providers, especially nurses to facilitate and support pregnant adolescents and adolescent mothers to continue their education. Also, it can be used to guide policy to promote in all educational system to enable these groups to remain in school for their life-long success in the future.

Keywords: adolescent mothers, childrearing, studying, teenage pregnancy

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Authors: Moustafa Elwan, Sohier Shehata, Fatma Sedek, Manar Hussine

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One of the most risky factors that lead to a foot injury during physical activities are both high and low arched feet. Normally the medial longitudinal arch of the foot develops in the first 10 years of life, so flexible flat foot has an inversely relationship with age in the first decade, all over the world, the prevalence of flat foot is increasing. In approximately 15% of foot deformities cases, the deformity does not disappear and remains throughout adulthood, 90% of the clinical cases are complaining from foot problems are due to flatfoot. Flatfoot creates subtalar over pronation, which creates tibial and femoral medial rotation, and that is accompanied with increases of pelvic tilting anteriorly, which may influence the lumbar vertebrae alignment by increasing muscle tension and rotation. Objective: To study the impact of the flexible flatfoot on lumbosacral angle (angle of Ferguson). Methods: This experiment included 40 volunteers (14 females &26 males) gathered from the Faculty of Physical Therapy, Modern University of Technology and Information, Cairo, Egypt, for each participant, four angles were measured in the foot( talar first metatarsal angle, lateral talocalcaneal angle, , Calcaneal first metatarsal angle, calcaneal inclination angle) and one angle in the lumbar region (lumbosacral angle). Measurement of these angles was conducted by using Surgimap Spine software (version 2.2.9.6). Results: The results demonstrated that there was no significant correlation betweenFerguson angle and lateral talocalcaneal (r=0.164, p=0.313). Also, there was no significant correlation between Ferguson angle and talo first metatarsal “Meary’s angle" (r=0.007, p=0.968). Moreover, there was no significant correlation between Ferguson angle and calcaneal-first metatarsal angle (r=0.083, p=0.612). Also, there was no significant correlation between Ferguson angle and calcaneal inclination angle (r= 0.032, p= 0.846). Conclusion: It can be concluded that there is no significant correlation between the flexible flat foot and lumbosacral angle So, more study should be conducted in large sample and different ages and conditions of foot problems.

Keywords: calcaneal first metatarsal, calcaneal inclination, flatfoot, ferguson’s angle, lateral talocalcaneal angle, lumbosacral angle, and talar first metatarsal angle

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Authors: Wen-Chyan Tsai, Syed S. H. Rizvi

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Organic solvent residues are always associated with liposomes produced by the traditional techniques like the thin film hydration and reverse phase evaporation methods, which limit the applications of these vesicles in the pharmaceutical, food and cosmetic industries. Our objective was to develop a novel and benign process of liposomal microencapsulation by using supercritical carbon dioxide (SC-CO2) as the sole phospholipid-dissolving medium and a green substitute for organic solvents. This process consists of supercritical fluid extraction followed by rapid expansion via a nozzle and automatic cargo suction. Lecithin and cholesterol mixed in 10:1 mass ratio were dissolved in SC-CO2 at 20 ± 0.5 MPa and 60 oC. After at least two hours of equilibrium, the lecithin/cholesterol-laden SC-CO2 was passed through a 1000-micron nozzle and immediately mixed with the cargo solution to form liposomes. Liposomal micro-encapsulation was conducted at three pressures (8.27, 12.41, 16.55 MPa), three temperatures (75, 83 and 90 oC) and two flow rates (0.25 ml/sec and 0.5 ml/sec). Liposome size, zeta potential and encapsulation efficiency were characterized as functions of the operating parameters. The average liposomal size varied from 400-500 nm to 1000-1200 nm when the pressure was increased from 8.27 to 16.55 MPa. At 12.41 MPa, 90 oC and 0.25 ml per second of 0.2 M glucose cargo loading rate, the highest encapsulation efficiency of 31.65 % was achieved. Under a confocal laser scanning microscope, large unilamellar vesicles and multivesicular vesicles were observed to make up a majority of the liposomal emulsion. This new approach is a rapid and continuous process for bulk production of liposomes using a green solvent. Based on the results to date, it is feasible to apply this technique to encapsulate hydrophilic compounds inside the aqueous core as well as lipophilic compounds in the phospholipid bilayers of the liposomes for controlled release, solubility improvement and targeted therapy of bioactive compounds.

Keywords: liposome, micro encapsulation, supercritical carbon dioxide, non-toxic process

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Authors: Xin Li, Yan-Rong Guo, Jin-Fang Lin, Yi Feng, Håkan Billig, Ruijin Shao

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Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin. Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment. Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

Keywords: PCOS, progesterone resistance, insulin resistance, steroid hormone receptors, endometrial carcinoma

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Authors: Marah El-Beeli, Abdullah Balkhair, Zakaryia Al Muharmi, Samir Al Adawi, Mansoor Al-Jabri, Abdullah Al Rawahi, Hazaa Al Yahyae, Eman Al Balushi, Yahya M. Al-Farsi

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The health care service and the anticancer chemotherapeutics has changed the natural history of cancer into manageable chronic disease and improve the cancer patient’s lifestyle and increase the survival time. Despite that, still, infection is the major dilemma opposing the cancer patient either because of the clinical presentation of the cancer type and impaired immune system or as a consequence of anticancer therapy. This study has been conducted to1) track changes in the epidemiology of hospital-acquired bloodstream infections among patients with malignancies in the last five years. 2) To explore the causative pathogens and 3) the outcome of HA-BSIs in patients with a different types of malignancies. An ampi-directional study (retrospective and prospective follow up) of patients with malignancies admitted at Sultan Qaboos University hospital (570-bed tertiary hospital) during the study period (from January 2015 to December 2019). The cumulative frequency and prevalence rates of HA-BSIs by patients and isolates were calculated. In addition, the cumulative frequency of participants with single versus mixed infections and types of causative micro-organisms of HA-BSIs were obtained. A total of 1246 event of HA-BSIs has occurred during the study period. Nearly the third (30.25%) of the HA-BSI events was identified among 288 patients with malignancies. About 20% of cases were mixed infections (more than one isolate). Staphylococcus spp were the predominant isolated pathogen (24.7%), followed by Klebsiella spp (15.8%), Escherichia spp (13%), and Pseudomonas spp (9.3%). About half (51%) of cases died in the same year, and (64%) of the deaths occur within two weeks after the infection. According to the observations, no changes in the trends of epidemiology, causative pathogens, morbidity, and mortality rates in the last five years.

Keywords: epidemiology, haematological malignancies, hospital acquired bloodstream infections, solid malignancies

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Authors: J. Van der Walt, N. A. Plastow, M. Unger

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Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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Authors: Fatemeh Ghaemi, Padideh Feyzi, Zohreh Dortaj

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Cancer is one of the common diseases that may cause death due to malignancy. The physical problems of cancer patients can have an impact on the psychological and social aspects of their lives. Depression is one of these problems that threaten the lives of these patients and can also reduce their quality of life. Helping patients with cancer to find meaning in life can increase their level of health and improve their quality of life. This study thus examines the effectiveness of group logotherapy on the depression and quality of life of women with cancer. Depression was measured using the Beck Depression Inventory (BDI) and quality of life was measured using Quality of Life Questionnaire (WHOQL) with acceptable and reliable indicators in the pre-test and post-test stages. The experimental group received group therapy in eight, sixty-minute sessions and the control group did not receive any intervention. After collecting the questionnaires, the mean and standard deviations were used to describe the data and the statistical method of multivariate analysis of covariance was used at the significant level (P≤0.05). The results were analyzed using SPSS(22). The results showed that there was a significant difference between post-test depression scores in the experimental group and the control group. Also, there was a significant difference between the post-test scores of quality of life and its components (psychological, physical, social and environmental health) in the experimental group and control group. The findings of this study showed the effectiveness of group logotherapy in decreasing depression and improving the quality of life of cancer patients. By focusing the minds of the people on the present and changing the attitude of the human being towards themselves, life and environment can help the depressed people, and by influencing the individual's view of himself, accepting responsibility, accepting life with purpose, paying attention to life uniformly, it allows a person to maintain his quality of life even with cancer. Therefore, it is recommended that this approach be used as a group intervention in hospitals and care units for cancer patients and even in people with certain diseases.

Keywords: cancer, depression, group psychiatry, quality of life

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Authors: Talal Asif, Maya Kosinska, Lucas Georger, Krish Sardesai, Muhammad Shah Miran

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This article presents a case review and literature review focused on the challenges of managing subaortic membranes (SAM) in young adult patients with mild aortic regurgitation (AR) or aortic stenosis (AS). The study aims to discuss the diagnosis of SAM, imaging studies used for assessment, management strategies in young patients, the risk of valvular damage, and the controversy surrounding prophylactic resection in mild AR. The management of SAM in adults poses challenges due to limited treatment options and potential complications, necessitating further investigation into the progression of AS and AR in asymptomatic SAM patients. The case presentation describes a 40-year-old male with muscular dystrophy who presented with symptoms and was diagnosed with SAM. Various imaging techniques, including CT chest, transthoracic echocardiogram (TTE), and transesophageal echocardiogram (TEE), were used to confirm the presence and severity of SAM. Based on the patient's clinical profile and the absence of surgical indications, medical therapy was initiated, and regular outpatient follow-up was recommended to monitor disease progression. The discussion highlights the challenges in diagnosing SAM, the importance of imaging studies, and the potential complications associated with SAM in young patients. The article also explores the management options for SAM, emphasizing surgical resection as the definitive treatment while acknowledging the limited success rates of alternative approaches. Close monitoring and prompt intervention for complications are crucial in the management of SAM. The concluding statement emphasizes the need for further research to explore alternative treatments for SAM in young patients.

Keywords: subaortic membrane, management, case report, literature review, aortic regurgitation, aortic stenosis, left ventricular outflow obstruction, guidelines, heart failure

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Authors: Munira Al-Azraqi

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Modern South Arabian Languages (MSAL) belong to the Semitic language family and are believed to be either a southern member of the west Semitic branch (Rubin 2010; Moscati et al 1969) or an eastern member of the south Semitic branch (Faber 1997), (Watson 2012). They are six languages which are still spoken in southern Arabia. They are used in Oman, Yemen, Saudi Arabia and in some of the Gulf states. Mehri is one of them however it has the highest number of speakers comparing to the other members of MSAL. It is used in Yemen, Oman, in parts of southern and eastern Saudi Arabia and in some of the Gulf states. The number of Mehri speakers is estimated at between 100,000 and 180,000. The problem that this language might face is that its speakers live in different places which are belonging to different countries. This might cause the language to change rapidly due to education and communication. There are some studies on Omani and Yemeni Mehri but not in Saudi Mehri. In the nineteenth century, travelers, western scholars and explorers played their parts in the discovery of these peoples and their languages. The historical turning point for the knowledge of the MSAL is 1898, when the Südarabische Expedition of the Imperial Academy of Vienna started. The three scholars, Müller, Jahn and Hein began their systematic collection of texts, which were later studied grammatically and lexically by Bittner (1908-1917), Jahn (1915), Leslau (1938) and Wagner (1953). Saudi Mehri has not been studied. This might be caused by the lack of information or the difficulty in collecting the data which this paper aims to shed light on.

Keywords: Modern South Arabian, Mehri, Saudi Arabia, endangered languages

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Authors: Shenghui Wu, Patricia Chalela, Amelie G. Ramirez

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Background: Cervical cancer (CC), colorectal cancer (CRC), and breast cancer (BC) are diseases that can be prevented/detected through early test. Through educational programs, individuals can become better informed about these cancers and understand the importance of screening and early detection. A community-based educational program was developed to improve knowledge and awareness toward the screening of the three cancer types in a South Texas underserved population. Methods: Residents living in Laredo, Texas were invited to participate in the present study. From January 2020 to April 2021, participants were recruited using social media and flyer distributions in general community. Participants received a free live web cancer education presentation delivered by bilingual community health educators, and online pre- and post-education surveys for CC, CRC, and BC separately. Pre-post changes in knowledge for individual items were compared using McNemar’s chi-squared tests. Results: Overall, participants demonstrated increases in CC (n=237), CRC (n=59), and BC (n=56) screening knowledge and awareness after receiving the cancer screening education (Ps<0.05). After receiving the cancer screening education, 85-97% of participants had an intent to talk to a healthcare provider about CC/CRC/BC screening, 88-97% had an intent to get a CC/CRC/BC screening test in the next 12 months or at the next routine appointment, and 90-97% had an intent to talk about CC/CRC/BC with their family members or friends. Conclusion: A community-based educational program can help increase knowledge and awareness about cervical, colorectal, and breast cancer screening, promote positive changes in population's knowledge and awareness about the benefits of cancer screening.

Keywords: cervical cancer, colorectal cancer, breast cancer, educational program, health knowledge, awareness, Hispanics, screening, health education

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Authors: Natividad Natalia Angeles Manuel

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In the Dominican Republic, American-Dominican veterans face unique challenges due to their dual identities and wartime experiences. This case study examines an 85-year-old veteran with memory impairments and emotional distress linked to military service. A neuropsychological assessment using standardized tools evaluated cognitive domains and functional abilities. Significant deficits in memory, orientation, semantic memory, and executive functions, alongside symptoms of Post-Traumatic Stress Disorder and depression, were identified. A six-month cognitive stimulation program included tailored interventions to enhance memory, attention, and executive skills through weekly sessions and group activities. Medical and physical therapy support aimed to improve overall cognitive, functional, and emotional outcomes. Follow-up evaluations showed improvements in memory retention, attention, task proficiency, and reduced depressive symptoms, highlighting the program's effectiveness in promoting emotional well-being and quality of life. Despite ongoing memory challenges and military-related nightmares, the veteran responded positively to interventions, demonstrating resilience and motivation. This study emphasizes the importance of personalized neuropsychological interventions for American-Dominican veterans in the Dominican Republic. Through assessment tools and focused cognitive stimulation strategies, healthcare providers can successfully alleviate cognitive and emotional challenges stemming from traumatic experiences in elderly veterans. Overall, integrated neuropsychological assessment and stimulation programs are shown to enhance cognitive resilience and emotional well-being, thus contributing to an enhanced quality of life for aging American-Dominican veterans.

Keywords: neuropsychology, cognitive stimulation, American-Dominican veterans, Dominican Republic, PTSD, memory deficits

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Authors: Hiroko Komatsu, Kaori Yagasaki

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Background: Cancer-related cognitive impairment is a common problem seen in cancer patients undergoing chemotherapy. Physical activity may show beneficial effects on the cognitive function in such patients. Therefore, we have developed a self-directed home yoga program for cancer patients with cognitive symptoms during chemotherapy. This program involves a DVD presenting a combination of yoga courses based on patient preferences to be practiced at home. This study was performed to examine the feasibility of this program. In addition, we also examined changes in cognitive function and quality of life (QOL) in these patients participating in the program. Methods: This prospective feasibility study was conducted in a 500-bed general hospital in Tokyo, Japan. The study population consisted of breast cancer patients undergoing chemotherapy as the initial therapy. This feasibility study used a convenience sample with estimation of recruitment rate in a single facility with the availability of trained nurses and physicians to ensure safe yoga intervention. The aim of the intervention program was to improve cognitive function by means of both physical and mental activation via yoga, consisting of physical practice, breathing exercises, and meditation. Information on the yoga program was provided as a booklet, with an instructor-guided group yoga class during the orientation, and a self-directed home yoga program on DVD with yoga logs. Results: The recruitment rate was 44.7%, and the study population consisted of 18 women with a mean age of 43.9 years. This study showed high rates of retention, adherence, and acceptability of the yoga program. Improvements were only observed in the cognitive aspects of fatigue, and there were serious adverse events during the program. Conclusion: The self-directed home yoga program discussed here was both feasible and safe for breast cancer patients showing cognitive symptoms during chemotherapy. The patients also rated the program as useful, interesting, and satisfactory. Participation in the program was associated with improvements in cognitive fatigue but not cognitive function.

Keywords: yoga, cognition, breast cancer, chemotherapy, quality of life

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Authors: Irma Nool, Katriin Saueauk, Ebe Siimson, Vlada Žukova, Elise Gertrud Vellet

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Background: Asthma is one of themostcommonchronicdiseases in children, whichcansignificantlyaffectchildren, and challengetheirfamilies. The unpredictability, frequency, and control of asthma attacks have a profound effect on the daily lives of familieswithasthmaticchildren. Thereis a growing body of researchshowingthatthequality of life of parents and childrenislinkedtothedevelopment of asthma. Theoretical and clinicalstudiesprovethat a positive and well-functioningfamilysystemhelpstocopebetterwiththediagnosis of the chronic disease. The aim of theresearchwastodescribethecopingstrategies of parents of a childwithasthmaconcerningthechild'sillness. Method: Theresearchwasanempirical, quantitative, descriptive study. Thesamplewastheparents of a child with asthma at the Tallinn Children'sHospital, whose child was in inpatienttreatmentbetween 07.04.2021 and 12.09.2021. This is a convenient sample. 59 parentsrepliedtothequestionnaire. The questionnaire “CopingInventoryforStressfulSituations” wasusedtocollectthedata, whichwastranslatedinto Estonian and Russian using a back-and-forthtranslationtechnique. Thequestionnairewasanswered on a 5-point Likert scale. Dataanalysiswasperformedusing SPSS 26.0, descriptive statistics, with mean values and standard deviation. The Mann-Whitney U test wasusedtocomparefathers and motherscopingstrategies. PermissiontoconductresearchhasbeenobtainedfromtheEthicsCommitteeforHuman Research of theInstituteforHealthDevelopment. Results: The mean age of the respondents was 40 ± 6.2 years (median 40), withtheyoungestbeing 27 yearsold and the oldest being 57 yearsold. Of the respondents, 51 (86.4%) were mothers, and 8 (13.6%) werefathers. Parentsusedthemosttask-orientedcopingstrategies (mean 3.35 ± 0.602) and theleastemotion-orientedcopingstrategies (mean 1.97 ± 0.526). Mothersusedmoretask-orientedcopingstrategies (p = 0.001) than fathers. Fathersusedemotion-orientedcopingstrategiesless (p = 0.024) than mothers. mothersplantheirtimebetter (p = 0.043), focus on the problem and look at how to solve it (p = 0.007), and makeanefforttogetthingsdone (p = 0.045). mothersblamethemselvesmorefornotknowingwhattodo (p = 0.045) and worryaboutwhattheyshoulddo (p = 0.027). mothers look more at the goods displayed in the shop windows (p = 0.018) and go for a walk (p = 0.007) compared to fathers. Conclusions: The results of theresearchshowedthatproblem-orientedcopingstrategiesare used the most and there are differences in the behavior of fathers and mothers. Thisshouldbetakenintoaccountwhenprovidingfamily-centered nursing care.

Keywords: asthma, coping strategies, parents, family

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Authors: Zahra Tork

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Before the spread of the Internet and the use of mobile phones, women were generally far from society and many restrictions were applied to them, but after the spread of the Internet and the cultural and social changes brought about by it, women in society got a new one and many restrictions regarding them disappeared; As we can see today, many women, like men, have a high social base, they earn for themselves, they can travel alone, stay out late at night, take personal and family photos or videos on virtual pages. Publish themselves (while before this, showing or publishing photos of women was considered dishonorable or indecent). In this article, an attempt is made to examine the effect of the internet on mobile phones and virtual social networks in changing beliefs, norms and social values and their relationship with the social mobility of women and the effect of these factors on social and human development be paid. For this reason, social and human development is discussed first, and then the role of the media in development is explained, and finally, the social mobility of women is discussed. Since the purpose of this study is to better understand the social mobility of Iranian women through the development of the Internet in mobile phones, a qualitative study using focus groups has been adopted. The results of this research indicated that the Internet has caused changes in the value and cultural system of the Iranian people, and women have also redefined their roles and identity. In this new definition, many of the past restrictions have disappeared and women have gained the same freedoms as men. Finally, these factors (change in values and norms and redefinition of the role of women) joined hands and caused the social mobility of women in Iran.

Keywords: development of communication in Iran, development of mobile phones, development of the Internet, women's social group, social mobility

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Authors: Molly Gerrish

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This work explores the physical, emotional, social, and cognitive risks and benefits related to nature-based teaching and highlights the importance of promoting a sustainable workforce within early childhood programs. Assessing and managing risks can help programs reimagine their approach to teaching, learning, recruitment, family connectivity, and staff motivation. The importance of staff sustainability and motivation/engagement related to social justice and the environment will be discussed. We will explore ways to manage fears and limitations faced by early childhood programs regarding nature experiences and risky play in a variety of locations using a lens of place-based learning. We will also examine the alignment of sustainability and social-emotional development, mental health supports, social awareness, and risk assessment. The work will discuss the varied perceptions of risk in diverse areas and the impact on the early childhood workforce. Motivational theory and compassion resiliency are hallmarks of both recruiting and retaining high-quality early childhood educators; the work will discuss how to balance programmatic constraints and healthy motivation for students and teachers while empowering individuals to advocate for their mental health and well-being. Finally, the work will highlight the positive impact of nature-based teaching practices and the overall benefit to young children and their educators.

Keywords: child’s rights, inclusion, nature-based education, risk assessment

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Authors: Wei Qu, Cassandra Agius, Nikki Varvazovsky, Angela Meade

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The goals of the case study are to address the importance of early diagnosis of osmotic demyelination syndrome (ODS) and to analyse the types, duration, and intensities of the rehabilitation program to promote neurological and functional recovery. It can be associated with biphasic course of disease and severe neurological and neuropsychiatric symptoms. Although a few treatment modalities, such as plasmapheresis, immunoglobulin therapy, steroid, and thyrotrophin-releasing hormone, have been suggested, there is no effective treatment for ODS. The overall prognosis of established ODS is generally poor. A high proportion of patients have a severe permanent disability, which has led to social, economic, and emotional burdens to carers and societies. In this case, a 69-year-old retired pensioner with chronic alcoholism was admitted to the hospital with a reduced level of consciousness and tonic-clonic seizure. He had severe hyponatraemia (serum sodium 118 mmol/L) and hypokalemia (serum potassium 2.8 mmol/L). He was treated with anticonvulsants, 150ml 3% hypertonic saline over one hour, and 40 mmol potassium chloride over one hour, and his sodium was increased by 11 mmol/L in the first 24 hours. However, he had worsened neurological symptoms with quadriplegia, dysphagia, anarthria, and confusion, and the radiological features suggested the diagnosis of ODS. He had minimal neurological recovery during the first four weeks of hospital admission. He was treated with seven weeks of a multi-disciplinary intensive rehabilitation program. On discharge, he had made a significant cognitive and functional recovery and could mobilize independently without a walking aid. In conclusion, ODS can still occur despite correcting sodium following the current clinical guidelines. Patients with severe neurological deficits in the context of osmotic demyelination syndrome would benefit from intensive rehabilitation to facilitate their functional improvement and to promote their quality of life.

Keywords: osmotic demyelination syndrome, hyponatremia, central pontine and extrapontine myelinolysis, rehabilitation

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Authors: Catarina Isabel Ramos Pereira, Jorge Machado, Begona Alonso Criado, Maria João Santos

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Introduction: Gait disorders are one of the symptoms that have severe implications on the quality of life in Parkinson's disease (PD). Currently, there is no therapy to reverse or treat this condition. None of the drugs used in conventional medical treatment is entirely efficient, and all have a high incidence of side effects. Acupuncture treatment is believed to improve motor ability, but there is still little scientific evidence in individuals with PD. Aim: The aim of the study is to investigate the acute effect of acupuncture on gait parameters in Parkinson's disease. Methods: This is a randomized and controlled crossover study. The same individual patient was part of both the experimental (real acupuncture) and control group (false acupuncture/sham), and the sequence was randomized. Gait parameters were measured at two different moments, before and after treatment, using four force platforms as well as the collection of 3D markers positions taken by 11 cameras. Images were quantitatively analyzed using Qualisys Track Manager software that let us extract data related to the quality of gait and balance. Seven patients with the diagnosis of Parkinson's disease were included in the study. Results: Statistically significant differences were found in gait speed (p = 0.016), gait cadence (p = 0.006), support base width (p = 0.0001), medio-lateral oscillation (p = 0.017), left-right step length (p = 0.0002), and stride length: right-right (p = 0.0000) and left-left (p = 0.0018), time of left support phase (p = 0.029), right support phase (p = 0.025) and double support phase (p = 0.015), between the initial and final moments for the experimental group. Differences in right-left stride length were found for both groups. Conclusion: Our results show that acupuncture could enhance gait in Parkinson's disease patients. Deep research involving a larger number of volunteers should be accomplished to validate these encouraging findings.

Keywords: acupuncture, traditional Chinese medicine, Parkinson's disease, gait

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Authors: Manal M. Hamed, Mosad A. Ghareeb, Abdel-Aleem H. Abdel-Aleem, Amal M. Saad, Mohamed S. Abdel-Aziz, Asmaa H. Hadad

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Natural products derived from medicinal plants provide unlimited opportunities for a new medication leads because of the unmatched accessibility of chemical variation. Six compounds were isolated from the n-butanol extract of Callistemon citrinus (Family Myrtaceae), they were identified as; nepetolide (1), callislignan A (2), 6,8-dimethoxy-4,5-dimethyl-3-methyleneisochroman-1-one (3), 3-methyl-7-O-benzoyl-β-D-glucopyranoside (4), 5, 7, 3', 5'-tetrahydroxy-6, 8-di-C-methyl flavanone (5), and (2R,3R,4S,5S)-2,4-bis(4-hydroxyphenyl)-3,5-dihydroxy-tetrahydropyran (6). The isolated compounds were evaluated as antioxidant and antimicrobial agents. The antioxidant activities of the compounds were determined using DPPH-radical scavenging and total antioxidant capacity (TAC) assays. The results indicated that compound (5) was most active in its capacity to scavenge free radicals in the DPPH assay [SC50 value, 4.65 ± 0.74μg/mL] compared to the standard ascorbic acid and exhibited the highest activity in the TAC assay (610.45 ± 1.67mg AAE/g compound). The pure isolates were tested for their antimicrobial activity against four pathogenic microbial strains including Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Candida albicans. Also, the GC/MS analysis of its leaves essential oil presented nine identified compounds representing 91% of the total oil constituents. The outcomes got from this study give a reasonable justification for the medicinal uses of Callistemon citrinus plant.

Keywords: Callistemon citrinus, flavanone, antioxidant activity, antimicrobial activity, essential oil, Myrtaceae

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Authors: Praveen Adusumilli, Meher Lakshmi Konatam, Sadashivudu Gundeti, Stalin Bala

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The invention of trastuzumab has changed the treatment of breast cancer and lives of many patients all over the world. Despite many patients getting benefitted from the drug, it is out of reach for most of the patients. There is very limited real world data regarding the epidemiology and clinical outcome of Her2neu positive breast cancer patients. Materials and Methods: This is a retrospective analysis of breast cancer patients presenting to a tertiary care cancer centre in Southern India from 2007 to2013. All early and locally advanced breast cancer patients, who were Her2neu 3+ on IHC are included in the study and evaluated in terms of epidemiology, 3-year disease free survival (DFS)and 5-year overall survival(OS). Chemotherapy regimens used were-FAC 6 cycles or AC 4 cycles followed by 12 cycles of weekly paclitaxel . Trastuzumab was given after 6 cycles of FAC or weekly with paclitaxel followed by 3weekly maintenance until 1 year. Results: Over the period of this study there were 885 newly diagnosed cases of carcinoma breast, of which 242 (27%) were Her2neu positive, 360(40%) were hormone receptor positive, and 212(24%) were triple negative. A total of 71(8%) were Her2neu equivocal of which only 10 patients got FISH test done. Of the 212 newly diagnosed patients, only 74 (29%) opted to have standard of care therapy with trastuzumab at our centre, out of which 52(24%), 8(3%), received under insurance, paying basis respectively. 14(9%) patients received the care as part of clinical trial program (ALTTO trial). 7 (9.72%) patients developed decrease of ejection fraction by greater than 10%, requiring stoppage of trastuzumab out of which 5 were restarted in 2 months. Patients receiving trastuzumab along with chemotherapy had longer 3year DFS 92% vs. 60% (p value<0.0001) when compared to chemotherapy alone. 5 year OS was 87% vs 44% (p-value <0.0001) compared to chemotherapy alone. Conclusion: Trastuzumab with chemotherapy improves the DFS and OS in Her2neu positive patients. The biggest constraint is the cost of the treatment and absence of universal health security net to treat all patients with this diagnosis.

Keywords: breast cancer, Her 2 neu positive, real world data, Trastuzumab

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Authors: Chiou-Fang Liou

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Cancer has been one of the most life-threaten diseases worldwide for 30+ years. The influences of cancer illness include symptoms from cancer itself along with its treatments. The quality of life among patients diagnosed with cancer during cancer treatments has been conceptualized within four domains: Functional Well-Being, Social Well-Being, Physical Well-Being, and Emotional Well-Being. Patients with cancer often need to make adjustments to face all the challenges. The middle-range theory of Resourcefulness and Quality of life has been applied to explore factors contributing to cancer patients’ needs. Resourcefulness is defined as sets of skills that can be learned and consisted of Person and Social Resourcefulness. Empirical evidence also supported a possible relationship between Resourcefulness and Quality of Life. However, little is known about the extent to which the two concepts are related to each other. This study, therefore, applied a multivariate technique, Canonical Correlation Analysis, to identify the relationship between the two sets of variables with multi-dimensional measures, the Resourcefulness and Quality of Life in Cancer patients receiving treatments. After IRB approval, this multi-centered study took place at two medical centers in the Central Region of Taiwan. Sample A total of 186 patients with various cancer diagnoses and either receiving radiation therapy or chemotherapy consented to and answered questionnaires. The Import findings of the Generalized F test identified two typical sets with several linear relations and explained a total of 79.1% of the total variance. The first typical set found Personal Resourcefulness negatively related to Social Well-being, Functional being, Emotional Well-being, and Physical, in that order. The second typical set found Social Resourcefulness negatively related to Functional Well-being and Physical-being yet positively related to Social Well-being and Emotional Well-being. Discussion and Conclusion, The results of this presented study supported the statistically significant relationship between two sets of variables that are consistent with the theory. In addition, the results are considerably important in cancer patients receiving cancer treatments.

Keywords: cancer, canonical correlation analysis, quality of life, resourcefulness

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Authors: Chodidjah, Edi Dharmana, Hardhono, Sarjadi

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Breast cancer treatment options including surgery, radiation therapy, chemotherapy, and immunotherapy have not been effective. Besides, they have side effects. Keladi Tikus (Typhonium flagelliforme) has been shown to improve immune system, suppress tumor growth and induce apoptosis. One of the parameters for immune system, tumor growth and apoptosis is IFNγ (Interferon γ), VEGF (Vascular Endothelial Growth Factor) and Caspase 3 respectively. The aim of this study was to examine the effect of the administration of Keladi Tikus tuber extract at the dose of 200 mg/kgBW, 400 mg/KgBW, and 800 mg/kgBW on the level of IFNγ, VEGF and caspase 3 expression. In this experimental study using post test randomized control group design, 24 CH3 mice with tumor were randomly divided into 4 groups including control group and treated groups: Treated with 0.2 cc extract of Keladi Tikus at the dose of 200 mg/kgBW, 400 mg/kgBW, 800 mg/kgBW, respectively for 30 days. On day 31 the lymphatic tissue was taken and evaluated for its level of IFNγ, using ELISA. The tumor tissue was taken and subjected to immunohistochemistry staining for VEGF and caspase 3 expression evaluation. The data on IFNγ, VEGF and Caspase 3 expression were analyzed using One Way Anova with significant level of 0.05. One Way Anova resulted in p<0.05. LSD test showed that the level of IFNγ and Caspase 3 for control group was different from that of treated groups. There was no significant different between the treated group of 400 mg/KgBW and 800mg/KgBW. VEGF expressions for all the treated groups were significant. In conclusion, the oral administration of ethanolic extract of Keladi Tikus (Typhonium flagelliforme) at the dose of 200mg/kgBW, 400 mg/kgBW,800 mg/kgBW increases IFNγ, Caspase 3 and decreases VEGF expression in C3H mice with adenocarsinoma mamma.

Keywords: Typhonium flagelliforme, IFNγ, caspase 3, VEGF

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Authors: Misganaw Abebe Baye, Ji-Woo Park, Beom-Soo Kang

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The product quality of multi-point dieless forming (MDF) is identified to be dependent on the process parameters. Moreover, a certain variation of friction and material properties may have a substantially worse influence on the final product quality. This study proposed on how to compensate the MDF product defects by minimizing the sensitivity of noise parameter variations. This can be attained by reliability-based robust optimization (RRO) technique to obtain the optimal process setting of the controllable parameters. Initially two MDF Finite Element (FE) simulations of AA3003-H14 saddle shape showed a substantial amount of dimpling, wrinkling, and shape error. FE analyses are consequently applied on ABAQUS commercial software to obtain the correlation between the control process setting and noise variation with regard to the product defects. The best prediction models are chosen from the family of metamodels to swap the computational expensive FE simulation. Genetic algorithm (GA) is applied to determine the optimal process settings of the control parameters. Monte Carlo Analysis (MCA) is executed to determine how the noise parameter variation affects the final product quality. Finally, the RRO FE simulation and the experimental result show that the amendment of the control parameters in the final forming process leads to a considerably better-quality product.

Keywords: dimpling, multi-point dieless forming, reliability-based robust optimization, shape error, variation, wrinkling

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Authors: S. Rajeswari

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Medicinal Plant extracts and their bioactive compounds have been used for antimicrobial activities and have significant remedial properties. In the recent years, a wide range of investigations have been carried out throughout the world to confirm antimicrobial properties of different medicinally important plants. A number of plants showed efficient antimicrobial activities, which were comparable to that of synthetic standard drugs or antimicrobial agents. The large family Euphorbiaceae contains nearly about 300 genera and 7,500 speciesand one among is Ricinus communis or castor plant which has high traditional and medicinal value for disease free healthy life. Traditionally the plant is used as laxative, purgative, fertilizer and fungicide etc. whereas the plant possess beneficial effects such as anti-oxidant, antihistamine, antinociceptive, antiasthmatic, antiulcer, immunomodulatory anti diabetic, hepatoprotective, anti inflammatory, antimicrobial, and many other medicinal properties. This activity of the plant possess due to the important phytochemical constituents like flavonoids, saponins, glycosides, alkaloids and steroids. The presents study includes the phytochemical properties of Ricinus communis and to prediction of the anti-microbial activity of Ricinus communis using DNA gyrase of Staphylococcus aureus as molecular target. Docking results of varies chemicals compounds of Ricinus communis against DNA gyrase of Staphylococcus aureus by maestro 9.8 of Schrodinger show that the phytochemicals are effective against the target protein DNA gyrase. our studies suggest that the phytochemical from Ricinus communis such has INDICAN (G.Score 4.98) and SUPLOPIN-2(G.Score 5.74) can be used as lead molecule against Staphylococcus infections.

Keywords: euphorbiaceae, antimicrobial activity, Ricinus communis, Staphylococcus aureus

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Authors: Fadzai Munyuki

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Parental divorce is one of youth's most stressful life events and is associated with long-lasting emotional and behavioral problems. Over the last few decades, research has consistently found strong associations between divorce and adverse health effects in adolescents. Parental divorce has been hypothesized to lead to psychosocial development problems, mental health challenges, internalizing and externalizing behavior problems, and low academic performance among adolescents. This is supported by the Positive youth development theory, which states that a family setup has a major role to play in adolescent development and well-being. So, the focus of this research will be to test this hypothesized process model among adolescents in five provinces in Zimbabwe. A cross-sectional study will be conducted to test this hypothesis, and 1840 (n = 1840) adolescents aged between 14 to 17 will be employed for this study. A Stress and Questionnaire scale, a Child behavior checklist scale, and an academic concept scale will be used for this study. Data analysis will be done using Structural Equations Modeling. This study has many limitations, including the lack of a 'real-time' study, a few cross-sectional studies, a lack of a thorough and validated population measure, and many studies that have been done that have focused on one variable in relation to parental divorce. Therefore, this study seeks to bridge this gap between past research and current literature by using a validated population measure, a real-time study, and combining three latent variables in this study.

Keywords: mental health, internalizing and externalizing behavior, divorce, academic achievements

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