Search results for: acute toxicity
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1878

Search results for: acute toxicity

978 Enhanced Decolourization and Biodegradation of Textile Azo and Xanthene Dyes by Using Bacterial Isolates

Authors: Gimhani Madhushika Hewayalage, Thilini Ariyadasa, Sanja Gunawardena

Abstract:

In Sri Lanka, the largest contribution for the industrial export earnings is governed by textile and apparel industry. However, this industry generates huge quantities of effluent consists of unfixed dyes which enhance the effluent colour and toxicity thereby leading towards environmental pollution. Therefore, the effluent should properly be treated prior to the release into the environment. The biological technique has now captured much attention as an environmental-friendly and cost-competitive effluent decolourization method due to the drawbacks of physical and chemical treatment techniques. The present study has focused on identifying dye decolourizing potential of several bacterial isolates obtained from the effluent of the local textile industry. Yellow EXF, Red EXF, Blue EXF, Nova Black WNN and Nylosan-Rhodamine-EB dyes have been selected for the study to represent different chromophore groups such as Azo and Xanthene. The rates of decolorization of each dye have been investigated by employing distinct bacterial isolates. Bacterial isolate which exhibited effective dye decolorizing potential was identified as Proteus mirabilis using 16S rRNA gene sequencing analysis. The high decolorizing rates of identified bacterial strain indicate its potential applicability in the treatment of dye-containing wastewaters.

Keywords: azo, bacterial, biological, decolourization, xanthene

Procedia PDF Downloads 249
977 Dissipation of Tebuconazole in Cropland Soils as Affected by Soil Factors

Authors: Bipul Behari Saha, Sunil Kumar Singh, P. Padmaja, Kamlesh Vishwakarma

Abstract:

Dissipation study of tebuconazole in alluvial, black and deep-black clayey soils collected from paddy, mango and peanut cropland of tropical agro-climatic zone of India at three concentration levels were carried out for monitoring the water contamination through persisted residual toxicity. The soil-slurry samples were analyzed by capillary GC-NPD methods followed by ultrasound-assisted extraction (UAE) technique and cleanup process. An excellent linear relationship between peak area and concentration obtained in the range 1 to 50 μgkg-1. The detection (S/N, 3 ± 0.5) and quantification (S/N, 7.5 ± 2.5) limits were 3 and 10 μgkg-1 respectively. Well spiked recoveries were achieved from 96.28 to 99.33 % at levels 5 and 20 μgkg-1 and method precision (% RSD) was ≤ 5%. The soils dissipation of tebuconazole was fitted in first order kinetic-model with half-life between 34.48 to 48.13 days. The soil organic-carbon (SOC) content correlated well with the dissipation rate constants (DRC) of the fungicide Tebuconazole. An increase in the SOC content resulted in faster dissipation. The results indicate that the soil organic carbon and tebuconazole concentrations plays dominant role in dissipation processes. The initial concentration illustrated that the degradation rate of tebuconazole in soils was concentration dependent.

Keywords: cropland soil, dissipation, laboratory incubation, tebuconazole

Procedia PDF Downloads 248
976 Outcome of Obstetric Admission to General Intensive Care over a Period of 3 Years

Authors: Kamel Abdelaziz Mohamed

Abstract:

Intoduction:Inadequate knowledge about obstetric admission and infrequent dealing with the obstetric patients in ICU results in high mortality and morbidity. Aim of the work:To evaluate the indications, course, severity of illness, and outcome of obstetric patients admitted to the intensive care unit (ICU). Patients and Methods: We collected baseline data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome. Results: Seventy obstetric patients were admitted to the ICU over 3 years, 36 of these patients (51.4 %) were admitted during the antepartum period. The primary obstetric indication for ICU admission was pregnancy-induced hypertension (22 patients, 31.4%), followed by sepsis (8 patients, 11.4%) as the leading non-obstetric admission. The mean APACHE II score was 19.6. The predicted mortality rate based on the APACHE II score was 22%, however, only 4 maternal deaths (5.7%) were among the obstetric patients admitted to the ICU. Conclusion: Evaluation of obstetric patients by (APACHE II) scores showed higher predicted mortality rate, however the overall mortality was lower. Regular follow up, together with early detection of complications and prompt ICU admission necessitating proper management by specialized team can improve mortality.

Keywords: obstetric, complication, postpartum, sepsis

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975 Macroscopic Study of Reproductive Pathologies in Cows at the Souk-Ahras Communal Slaughterhouse

Authors: Besma Abdeltif, Chebabhi Imen

Abstract:

Introduction: it is important to define the genital pathologies encountered in Algeria in postpartum dairy cows. The objective was to identify the different pathologies of reproduction in cows found at the communal abattoir of Souk Ahras. Materials and Methods: Our study was carried at the communal slaughterhouse of Souk-Ahras on 63 genital tracts were examined macroscopically after slaughter. Results: The results obtained reveal a high frequency of pregnant females (14.28%), most of the gestations were at their beginning. Uterine anomalies ranked first in the genital lesions of the cow (20.37%). The frequencies of these abnormalities are in ascending order: aplasia of the horns = 1.85%, traumatic cervical = 1.85%, cervical tumors = 1.85%, chronic endometritis = 3.70% and Acute endometritis = 11.11%. The ovarian cyst is the most common lesion, with a frequency of 3.70%, followed by smooth ovaries (1.85%). These are single, thin-walled cysts more present on the right ovary than the left ovary. Salpingitis is the only tubal lesion found on 5.55% of the non-pregnant genital tract. Neoformation is the only vaginal lesion identified in this work (1.85%). Conclusion: Our result, in general, conforms to the data of the literature.

Keywords: genital tract, cow, slaughterhouse, pathology

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974 Toxicity Depletion Rates of Water Lettuce (Pistia stratoites) in an Aquaculture Effluent Hydroponic System

Authors: E. A. Kiridi, A. O. Ogunlela

Abstract:

The control of ammonia build-up and its by-product is a limiting factor for a successful commercial aquaculture in a developing country like Nigeria. The technology for an advanced treatment of fish tank effluent is uneconomical to local fish farmers which have led to indiscriminate disposal of aquaculture wastewater, thereby increasing the concentrations of these nitrogenous compound and other contaminants in surface and groundwater above the permissible level. Phytoremediation using water lettuce could offer cheaper and sustainable alternative. On the first day of experimentation, approximately 100 g of water lettuce were replicated in four hydroponic units containing aquaculture effluents. The water quality parameters measured were concentration of ammonium–nitrogen (NH4+-N), nitrite-nitrogen (NO2--N), nitrate-nitrogen (NO3--N), and phosphate–phosphorus (PO43--P). Others were total suspended solids (TSS), pH, electrical conductivity (EC), and biomass value. At phytoremediation intervals of 7, 14, 21 and 28 days, the biomass recorded were 361.2 g, 498.7 g, 561.2 g, and 623.7 g. Water lettuce was able to reduce the pollutant concentration of all the selected parameter. The percentage reduction of pH ranged from 3.9% to 14.4%, EC from 49.8% to 96.2%, TDS from 50.4% to 96.2%, TSS from 38.3% to 81.7%, NH4+-N from 38.9% to 90.7%, NO2--N from 0% to 74.9%, NO3--N from 63.2% to 95.9% and PO43--P from 0% to 76.3%. At 95% confidence level, the analysis of variance shows that F(critical) is less than F(cal) and p < 0.05; therefore, it can be concluded statistically that the inequality between the pre-treatment and post-treatment values are significant. This suggests the potency of water lettuce for remediation of aquaculture effluent.

Keywords: aquaculture effluent, nitrification, phytoremediation, water lettuce

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973 Acute Superior Mesenteric Artery Thrombosis Leading to Pneumatosis Intestinalis and Portal Venous Gas in a Young Adult after COVID-19 Vaccination

Authors: Prakash Dhakal

Abstract:

Hepatic portal venous gas (HPVG) is diagnosed via computed tomography due to unusual imaging features. HPVG, when linked with pneumatosis intestinalis, has a high mortality rate and requires urgent intervention. We present a case of a 26-year-old young adult with superior mesenteric artery thrombosis who presented with severe abdominal pain. He had a history of COVID vaccination (First dose of COVISHILED) 15 days back. On imaging, HPVG and pneumatosis intestinalis were seen owing to the urgent intervention of the patient. The reliable interpretation of the imaging findings along with quick intervention led to a favorable outcome in our case. Herein we present a thorough review of the patient with a history of COVID-19 vaccination with superior mesenteric artery thrombosis leading to bowel ischemia and hepatic portal venous gas. The patient underwent subtotal small bowel resection.

Keywords: COVID-19 vaccination, SMA thrombosis, portal venoius gas, pneumatosis intestinalis

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972 Naturally Occurring Chemicals in Biopesticides' Resistance Control through Molecular Topology

Authors: Riccardo Zanni, Maria Galvez-Llompart, Ramon Garcia-Domenech, Jorge Galvez

Abstract:

Biopesticides, such as naturally occurring chemicals, pheromones, fungi, bacteria and insect predators are often a winning choice in crop protection because of their environmental friendly profile. They are considered to have lower toxicity than traditional pesticides. After almost a century of pesticides use, resistances to traditional insecticides are wide spread, while those to bioinsecticides have raised less attention, and resistance management is frequently neglected. This seems to be a crucial mistake since resistances have already occurred for many marketed biopesticides. With an eye to the future, we present here a selection of new natural occurring chemicals as potential bioinsecticides. The molecules were selected using a consolidated mathematical paradigm called molecular topology. Several QSAR equations were depicted and subsequently applied for the virtual screening of hundred thousands molecules of natural origin, which resulted in the selection of new potential bioinsecticides. The most innovative aspect of this work does not only reside in the importance of the identification of new molecules overcoming biopesticides’ resistances, but on the possibility to promote shared knowledge in the field of green chemistry through this unique in silico discipline named molecular topology.

Keywords: green chemistry, QSAR, molecular topology, biopesticide

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971 A Study on the Computation of Gourava Indices for Poly-L Lysine Dendrimer and Its Biomedical Applications

Authors: M. Helen

Abstract:

Chemical graph serves as a convenient model for any real or abstract chemical system. Dendrimers are novel three dimensional hyper branched globular nanopolymeric architectures. Drug delivery scientists are especially enthusiastic about possible utility of dendrimers as drug delivery tool. Dendrimers like poly L lysine (PLL), poly-propylene imine (PPI) and poly-amidoamine (PAMAM), etc., are used as gene carrier in drug delivery system because of their chemical characteristics. These characteristics of chemical compounds are analysed using topological indices (invariants under graph isomorphism) such as Wiener index, Zagreb index, etc., Prof. V. R. Kulli motivated by the application of Zagreb indices in finding the total π energy and derived Gourava indices which is an improved version over Zagreb indices. In this paper, we study the structure of PLL-Dendrimer that has the following applications: reduction in toxicity, colon delivery, and topical delivery. Also, we determine first and second Gourava indices, first and second hyper Gourava indices, product and sum connectivity Gourava indices for PLL-Dendrimer. Gourava Indices have found applications in Quantitative Structure-Property Relationship (QSPR)/ Quantitative Structure-Activity Relationship (QSAR) studies.

Keywords: connectivity Gourava indices, dendrimer, Gourava indices, hyper GouravaG indices

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970 Influence of Chemical Pollution on Thermal Habitats of the Ciliate Tetrahymena thermophila

Authors: Doufoungognon C. Kone

Abstract:

Global change, in particular pollution and global warming, threatens ecosystems and the biodiversity they harbor. Due to pollutants exposure, organisms might modify their thermal niches in order to track the thermal conditions limiting the negative impacts of chemical stressors depending on their mode of action. This study tests the influence of different pollutants, copper, salt, and chloramphenicol, on the thermal preferences of the ciliate Tetrahymena thermophila. Six genotypes were exposed to a gradient of concentrations ranging from 0 to 500mg/L for copper, 0 to 300 mg/l for chloramphenicol, and 0 to 12g/l for salt in synthetic media at eight temperatures ranging from 11 to 39° C. The measured fitness proxies are the maximum growth rate and the 50% growth inhibitory concentration (IC50). The results show that the majority of genotypes are more resistant to chloramphenicol in temperatures below their thermal optimum without pollutants, while they better tolerate other salt and copper in temperatures above their thermal optimum. In addition, generalists reduce their niche width while specialists widen it in chloramphenicol. Overall, results suggest that global warming would have a particularly deleterious effect in the case of chemical pollution. This pollution would induce the full disruption of the thermal habitats.

Keywords: ciliate, thermal niche, growth rate, toxicity, multiple stressors

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969 Nutraceutical Potential of Mushroom Bioactive Metabolites and Their Food Functionality

Authors: Jackson Ishara, Ariel Buzera, Gustave N. Mushagalusa, Ahmed R. A. Hammam, Judith Munga, Paul Karanja, John Kinyuru

Abstract:

Numerous mushroom bioactive metabolites, including polysaccharides, eritadenine, lignin, chitosan, mevinolin, and astrakurkurone have been studied in life-threatening conditions and diseases such as diabetes, cardiovascular, hypertension, cancer, DNA damage, hypercholesterolemia, and obesity attempting to identify natural therapies. These bioactive metabolites have shown potential as antiviral and immune system strengthener natural agents through diverse cellular and physiological pathways modulation with no toxicity evidence, widely available, and affordable. In light of the emerging literature, this paper compiles the most recent information describing the molecular mechanisms that underlie the nutraceutical potentials of these mushroom metabolites suggesting their effectiveness if combined with existing drug therapies. The findings raise hope that these mushroom bioactive metabolites may be utilized as natural therapies considering their therapeutic potential while anticipating further research designing clinical trials and developing new drug therapies while encouraging their consumption as a natural adjuvant in preventing and controlling life-threatening conditions and diseases.

Keywords: bioactive metabolites, food functionality, health-threatening conditions, mushrooms, nutraceutical

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968 The Optimum Operating Conditions for the Synthesis of Zeolite from Waste Incineration Fly Ash by Alkali Fusion and Hydrothermal Methods

Authors: Yi-Jie Lin, Jyh-Cherng Chen

Abstract:

The fly ash of waste incineration processes is usually hazardous and the disposal or reuse of waste incineration fly ash is difficult. In this study, the waste incineration fly ash was converted to useful zeolites by the alkali fusion and hydrothermal synthesis method. The influence of different operating conditions (the ratio of Si/Al, the ratio of hydrolysis liquid to solid, and hydrothermal time) was investigated to seek the optimum operating conditions for the synthesis of zeolite from waste incineration fly ash. The results showed that concentrations of heavy metals in the leachate of Toxicity Characteristic Leaching Procedure (TCLP) were all lower than the regulatory limits except lead. The optimum operating conditions for the synthesis of zeolite from waste incineration fly ash by the alkali fusion and hydrothermal synthesis method were Si/Al=40, NaOH/ash=1.5, alkali fusion at 400 oC for 40 min, hydrolysis with Liquid to Solid ratio (L/S)= 200 at 105 oC for 24 h, and hydrothermal synthesis at 105 oC for 24 h. The specific surface area of fly ash could be significantly increased from 8.59 m2/g to 651.51 m2/g (synthesized zeolite). The influence of different operating conditions on the synthesis of zeolite from waste incineration fly ash followed the sequence of Si/Al ratio > hydrothermal time > hydrolysis L/S ratio. The synthesized zeolites can be reused as good adsorbents to control the air or wastewater pollutants. The purpose of fly ash detoxification, reduction and waste recycling/reuse is achieved successfully.

Keywords: alkali fusion, hydrothermal, fly ash, zeolite

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967 Assessment of the Efficacy of Oral Vaccination of Wild Canids and Stray Dogs against Rabies in Azerbaijan

Authors: E. N. Hasanov, K. Y. Yusifova, M. A. Ali

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Rabies is a zoonotic disease that causes acute encephalitis in domestic and wild carnivores. The goal of our investigation was to analyze the data on oral vaccination of wild canids and stray dogs in Azerbaijan. Before the start of the vaccination campaign conducted by the International Dialogue for Environmental Action (IDEA) Animal Care Center (IACC), all rabies cases in Azerbaijan for the period of 2017-2020 were analyzed. So, 30 regions for oral immunization with the Rabadrop vaccine were selected. In total, 95.9 thousand doses of baits were scattered in 30 regions, 970 (0.97%) remained intact. In addition, a campaign to sterilize and vaccinate stray dogs and cats undoubtedly had a positive impact on reducing the dynamics of rabies incidence. During the period 2017-2020, 2339 dogs and 2962 cats were sterilized and vaccinated under this program. It can be noted that the risk of rabies infection can be reduced through special preventive measures against disease reservoirs, which include oral immunization of wild and stray animals.

Keywords: rabies, vaccination, oral immunization, wild canids, stray dogs, baits, disease reservoirs

Procedia PDF Downloads 190
966 Enhanced Degradation of Endosulfan in Soil Using Lycopersicon esculentum L. (Tomato) and Endosulfan Tolerant Bacterium Strains

Authors: Rupa Rani, Vipin Kumar

Abstract:

Endosulfan, an organochlorine pesticide is of environmental concern due to its apparent persistence and toxicity. It has been reported as contaminants in soil, air, and water and is bioaccumulated and magnified in ecosystems. The combined use of microorganisms and plants has great potential for remediating soil contaminated with organic compounds such as pesticides. The objective of this study was to evaluate whether the bacterial inoculation influences plant growth promotion, endosulfan degradation in soil and endosulfan accumulation in different plant parts. Lycopersicon esculentum L. (Tomato) was grown in endosulfan spiked soil and inoculated with endosulfan tolerant bacterial strains. Endosulfan residues from different parts of plants and soil were extracted and estimated by using gas chromatograph equipped with 63Ni electron capture detector (GC-ECD). The inoculation of bacterial strains into the soil with plants showed a beneficial effect on endosulfan degradation and plant biomass production. Maximum endosulfan (90%) degradation was observed after 120 days of bacterial inoculation in the soil. Furthermore, there was significantly less endosulfan accumulation in roots and shoots of bacterial strains inoculated plants as compared to uninoculated plants. The results show the effectiveness of inoculated endosulfan tolerant bacterial strains to increase the remediation of endosulfan contaminated soil.

Keywords: organochlorine pesticides, endosulfan, degradation, plant-bacteria partnerships

Procedia PDF Downloads 147
965 Investigation of the Influencing Factors of Functional Communication Assessment for Adults with Aphasia

Authors: Yun-Ching Tu, Yu-Chun Chih

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People with aphasia (PWA) may have communicative difficulties in their daily lives, but research on functional communication in aphasia is still limited in Taiwan. The aim of the study was to investigate the impact of aphasia-related factors on functional communication assessment. This study adopted a convenience sampling method. Thirty aphasic participants participated in the study. During the test, the examiner would ask questions that are encountered in daily life and record the participant‘s responses. Some questions would provide pictures to simulate situations in daily life. The results showed that the non-fluent aphasia group performed significantly worse than the fluent aphasia group. In addition, patients with severe aphasia performed significantly lower scores than patients with moderate aphasia and mild aphasia. However, group differences in the chronic stage and acute stage were not significant. In sum, since communication in daily life is diverse and language is still needed in the communication process, patients with aphasia who have better language ability may have relatively better functional communication. In contrast, the more severely impaired the language ability of a patient with aphasia is, the more functional communication will be affected, resulting in poor communication performance in daily life.

Keywords: adult, aphasia, assessment, functional communication

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964 A Rare Case of Atypical Guillian-Barre Syndrome Following Antecedent Dengue Infection

Authors: Amlan Datta

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Dengue is an arboviral, vector borne infection, quite prevalent in tropical countries such as India. Approximately, 1 to 25% of cases may give rise to neurological complication, such as, seizure, delirium, Guillian-Barre syndrome (GBS), multiple cranial nerve palsies, intracranial thrombosis, stroke-like presentations, to name a few. Dengue fever, as an antecedent to GBS is uncommon, especially in adults.Here, we report a case about a middle aged lady who presented with an acute onset areflexic ascending type of polyradiculoneuropathy along with bilateral lower motor neuron type of facial nerve palsy, as well as abducens and motor component of trigeminal (V3) weakness. Her respiratory and neck muscles were spared. She had an established episode of dengue fever (NS1 and dengue IgM positive) 7 days prior to the weakness. Nerve conduction study revealed a demyelinating polyradiculopathy of both lower limbs and cerebrospinal fluid examination showed albuminocytological dissociation. She was treated with 5 days of intravenous immunoglobulin (IVIg), following which her limb weakness improved considerably. This case highlights GBS as a potential complication following dengue fever.

Keywords: areflexic, demyelinating, dengue, polyradiculoneuropathy

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963 Effects of Vitexin on Scopolamine-Induced Memory Impairment in Rats

Authors: Mehdi Sheikhi, Marjan Nassiri-Asl, Esmail Abbasi, Mahsa Shafiee

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Various synthetic derivatives of natural flavonoids are known to have neuroactive properties. The present study aimed to investigate the effects of vitexin (5, 7, 4-trihydroxyflavone-8-glucoside), a flavonoid found in such plants as tartary buckwheat sprouts, wheat leaves phenolome, Mimosa pudica Linn and Passiflora spp, on scopolamine-induced memory impairment in rats. To achieve this goal, we assessed the effects of vitexin on memory retrieval in the presence or absence of scopolamine using a step-through passive avoidance trial. In the first part of the study, vitexin (25, 50, and 100 μM) was administered intracerebroventricularly (i.c.v.) before acquisition trials. In the second part, vitexin, at the same doses, was administered before scopolamine (10 μg, i.c.v.) and before the acquisition trials. During retention tests, vitexin (100 μM) in the absence of scopolamine significantly increased the stepthrough latencies compared to scopolamine. In addition, vitexin (100 μM) significantly reversed the shorter step-through latencies induced by scopolamine (P < 0.05). These results indicate that vitexin has a potential role in enhancing memory retrieval. A possible mechanism is modulation of cholinergic receptors; however, other mechanisms may be involved in its effects in acute exposure.

Keywords: flavonoid, memory retrieval, passive avoidance, scopolamine, vitexin

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962 Dizziness in the Emergency: A 1 Year Prospective Study

Authors: Nouini Adrâa

Abstract:

Background: The management of dizziness and vertigo can be challenging in the emergency department (ED). It is important to rapidly diagnose vertebrobasilar stroke (VBS), as therapeutic options such as thrombolysis and anticoagulation require prompt decisions. Objective: This study aims to assess the rate of misdiagnosis in patients with dizziness caused by VBS in the ED. Methods and Results: The cohort was comprised of 82 patients with a mean age of 55 years; 51% were women and 49% were men. Among dizzy patients, 15% had VBS. We used Cohen’s kappa test to quantify the agreement between two raters – namely, emergency physicians and neurologists – regarding the causes of dizziness in the ED. The agreement between emergency physicians and neurologists is low for the final diagnosis of central vertigo disorders and moderate for the final diagnosis of VBS. The sensitivity of ED clinal examination for benign conditions such as BPPV was low at 56%. The positive predictive value of the ED clinical examination for VBS was also low at 50%. Conclusion: There is a substantial rate of misdiagnosis in patients with dizziness caused by VBS in the ED. To reduce the number of missing diagnoses of VBS in the future, there is a need to train emergency physicians in neuro vestibular examinations, including the HINTS examination for acute vestibular syndrome (AVS) and the Dix-Hallpike (DH) maneuver for episodic vestibular syndrome. Using video head impulse tests could help reduce the rate of misdiagnosis of VBS in the ED.

Keywords: dizziness, vertigo, vestibular disease, emergency

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961 A Review on Thermal Conductivity of Bio-Based Carbon Nanotubes

Authors: Gloria A. Adewumi, Andrew C. Eloka-Eboka, Freddie L. Inambao

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Bio-based carbon nanotubes (CNTs) have received considerable research attention due to their comparative advantages of high level stability, simplistic use, low toxicity and overall environmental friendliness. New potentials for improvement in heat transfer applications are presented due to their high aspect ratio, high thermal conductivity and special surface area. Phonons have been identified as being responsible for thermal conductivities in carbon nanotubes. Therefore, understanding the mechanism of heat conduction in CNTs involves investigating the difference between the varieties of phonon modes and knowing the kinds of phonon modes that play the dominant role. In this review, a reference to a different number of studies is made and in addition, the role of phonon relaxation rate mainly controlled by boundary scattering and three-phonon Umklapp scattering process was investigated. Results show that the phonon modes are sensitive to a number of nanotube conditions such as: diameter, length, temperature, defects and axial strain. At a low temperature (<100K) the thermal conductivity increases with increasing temperature. A small nanotube size causes phonon quantization which is evident in the thermal conductivity at low temperatures.

Keywords: carbon nanotubes, phonons, thermal conductivity, Umklapp process

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960 Environmental Fate and Toxicity of Aged Titanium Dioxide Nano-Composites Used in Sunscreen

Authors: Danielle Slomberg, Jerome Labille, Riccardo Catalano, Jean-Claude Hubaud, Alexandra Lopes, Alice Tagliati, Teresa Fernandes

Abstract:

In the assessment and management of cosmetics and personal care products, sunscreens are of emerging concern regarding both human and environmental health. Organic UV blockers in many sunscreens have been evidenced to undergo rapid photodegradation, induce dermal allergic reactions due to skin penetration, and to cause adverse effects on marine systems. While mineral UV-blockers may offer a safer alternative, their fate and impact and resulting regulation are still under consideration, largely related to the potential influence of nanotechnology-based products on both consumers and the environment. Nanometric titanium dioxide (TiO₂) UV-blockers have many advantages in terms of sun protection and asthetics (i.e., transparency). These UV-blockers typically consist of rutile nanoparticles coated with a primary mineral layer (silica or alumina) aimed at blocking the nanomaterial photoactivity and can include a secondary organic coating (e.g., stearic acid, methicone) aimed at favouring dispersion of the nanomaterial in the sunscreen formulation. The nanomaterials contained in the sunscreen can leave the skin either through a bathing of everyday usage, with subsequent release into rivers, lakes, seashores, and/or sewage treatment plants. The nanomaterial behaviour, fate and impact in these different systems is largely determined by its surface properties, (e.g. the nanomaterial coating type) and lifetime. The present work aims to develop the eco-design of sunscreens through the minimisation of risks associated with nanomaterials incorporated into the formulation. All stages of the sunscreen’s life cycle must be considered in this aspect, from its manufacture to its end-of-life, through its use by the consumer to its impact on the exposed environment. Reducing the potential release and/or toxicity of the nanomaterial from the sunscreen is a decisive criterion for its eco-design. TiO₂ UV-blockers of varied size and surface coating (e.g., stearic acid and silica) have been selected for this study. Hydrophobic TiO₂ UV-blockers (i.e., stearic acid-coated) were incorporated into a typical water-in-oil (w/o) formulation while hydrophilic, silica-coated TiO₂ UV-blockers were dispersed into an oil-in-water (o/w) formulation. The resulting sunscreens were characterised in terms of nanomaterial localisation, sun protection factor, and photo-passivation. The risk to the direct aquatic environment was assessed by evaluating the release of nanomaterials from the sunscreen through a simulated laboratory aging procedure. The size distribution, surface charge, and degradation state of the nano-composite by-products, as well as their nanomaterial concentration and colloidal behaviour were determined in a variety of aqueous environments (e.g., seawater and freshwater). Release of the hydrophobic nanocomposites into the aqueous environment was driven by oil droplet formation while hydrophilic nano-composites were readily dispersed. Ecotoxicity of the sunscreen by-products (from both w/o and o/w formulations) and their risk to marine organisms were assessed using coral symbiotes and tropical corals, evaluating both lethal and sublethal toxicities. The data dissemination and provided risk knowledge from the present work will help guide regulation related to nanomaterials in sunscreen, provide better information for consumers, and allow for easier decision-making for manufacturers.

Keywords: alteration, environmental fate, sunscreens, titanium dioxide nanoparticles

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959 Biodegradation of Chlorpyrifos in Real Wastewater by Acromobacter xylosoxidans SRK5 Immobilized in Calcium Alginate

Authors: Saira Khalid, Imran Hashmi

Abstract:

Agrochemical industries produce huge amount of wastewater containing pesticides and other harmful residues. Environmental regulations make it compulsory to bring pesticides to a minimum level before releasing wastewater from industrial units.The present study was designed with the objective to investigate biodegradation of CP in real wastewater using bacterial cells immobilized in calcium alginate. Bacterial strain identified as Acromobacter xylosoxidans SRK5 (KT013092) using 16S rRNA nucleotide sequence analysis was used. SRK5 was immobilized in calcium alginate to make calcium alginate microspheres (CAMs). Real wastewater from industry having 50 mg L⁻¹ of CP was inoculated with free cells or CAMs and incubated for 96 h at 37˚C. CP removal efficiency with CAMs was 98% after 72 h of incubation, and no lag phase was observed. With free cells, 12h of lag phase was observed. After 96 h of incubation 87% of CP removal was observed when inoculated with free cells. No adsorption was observed on vacant CAMs. Phytotoxicity assay demonstrated considerable loss in toxicity. Almost complete COD removal was achieved at 96 h with CAMs. Study suggests the use of immobilized cells of SRK5 for bioaugmentation of industrial wastewater for CP degradation instead of free cells.

Keywords: biodegradation, chlorpyrifos, immobilization, wastewater

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958 Dose Measurement in Veterinary Radiology Using Thermoluminescent Dosimeter

Authors: E. Saeedian, M. Shakerian, A. Zarif Sanayei, Z. Rakeb, F. N. Alizadeh, S. Sarshough, S. Sina

Abstract:

Radiological protection for plants and animals is an area of regulatory importance. Acute doses of 0.1 Gy/d (10 rad/d) or below are highly unlikely to produce permanent, measurable negative effects on populations or communities of plants or animals. The advancement of radio diagnostics for domestic animals, particularly dogs and cats, has gained popularity in veterinary medicine. As pets are considered to be members of the family worldwide, they are entitled to the same care and protection. It is important to have a system of radiological protection for nonhuman organisms that complies with the focus on human health as outlined in ICRP publication 19. The present study attempts to assess surface-skin entrance doses in small pets undergoing abdominal radio diagnostic procedures utilizing a direct measurements technique with a thermoluminescent dosimeter. These measurements allow the determination of the entrance skin dose (ESD) by calculating the amount of radiation absorbed by the skin during exposure. A group of Thirty TLD-100 dosimeters produced by Harshaw Company, each with repeatability greater than 95% and calibration using ¹³⁷Cs gamma source, were utilized to measure doses to ten small pets, including cats and dogs in the radiological department in a veterinary clinic in Shiraz, Iran. Radiological procedures were performed using a portable imaging unit (Philips Super M100, Philips Medical System, Germany) to acquire images of the abdomen; ten exams of abdomen images of different pets were monitored, measuring the thicknesses of the two projections (lateral and ventrodorsal) and the distance of the X-ray source from the surface of each pet during the exams. A group of two dosimeters was used for each pet which has been stacked on their skin on the abdomen region. The outcome of this study involved medical procedures with the same kVp, mAs, and nearly identical positions for different diagnostic X-ray procedures executed over a period of two months. The result showed the mean ESD value was 260.34±50.06 µGy due to the approximate size of pets. Based on the results, the ESD value is associated with animal size, and larger animals have higher values. If a procedure doesn't require repetition, the dose can be optimized. For smaller animals, the main challenge in veterinary radiology is the dose increase caused by repetitions, which is most noticeable in the ventrodorsal position due to the difficulty in immobilizing the animal. Animals are an area of regulatory importance. Acute doses of 0.1 Gy/d (10 rad/d) or below are highly unlikely to produce permanent, measurable negative effects on populations or communities of plants or animals. The advancement of radio diagnostics for domestic animals, particularly dogs and cats, has gained popularity in veterinary medicine. As pets are considered to be members of the family worldwide, they are entitled to the same care and protection. It is important to have a system of radiological protection for nonhuman organisms that complies with the focus on human health as outlined in ICRP publication 19. The present study attempts to assess surface-skin entrance doses in small pets undergoing abdominal radio diagnostic procedures utilizing direct measurements.

Keywords: direct dose measuring, dosimetry, radiation protection, veterinary medicine

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957 A Study of Emergency Nurses' Knowledge and Attitudes regarding Pain

Authors: Liqun Zou, Ling Wang, Xiaoli Chen

Abstract:

Objective: Through the questionnaire about emergency nurses’ knowledge and attitudes regarding pain management to understand whether they are well mastered and practiced the related knowledge about pain management, providing a reference for continuous improvement of the quality of nursing care in acute pain and for improving the effect of management on emergency pain patients. Method: The Chinese version questionnaire about KASRP (knowledge and attitudes survey regarding pain) was handed out to 132 emergency nurses to do a study about the knowledge and attitude of pain management. Meanwhile, SPSS17.0 was used to do a descriptive analysis and variance analysis on collected data. Results: The emergency nurses’ correct answer rate about KASRP questionnaire is from 25% to 65% and the average correct rate is (44.65 + 7.85)%. In addition, there are 10 to 26 items being given the right answer. Therefore, the average correct items are (17.86 ± 3.14). Moreover, there is no statistical significant on the differences about the correct rate for different age, gender and work experience to answer; however, the difference of the correct rate in different education background and the professional title is significant. Conclusion: There is a remarkable lack of knowledge and attitude towards pain management in emergency nurses, whose basic knowledge of pain is sufficient. Besides, there is a deviation between the knowledge of pain management and clinical practice, which needs to be improved.

Keywords: emergency nurse, pain, KASRP questionnaire, pain management

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956 The Stem Cell Transcription Co-factor Znf521 Sustains Mll-af9 Fusion Protein In Acute Myeloid Leukemias By Altering The Gene Expression Landscape

Authors: Emanuela Chiarella, Annamaria Aloisio, Nisticò Clelia, Maria Mesuraca

Abstract:

ZNF521 is a stem cell-associated transcription co-factor, that plays a crucial role in the homeostatic regulation of the stem cell compartment in the hematopoietic, osteo-adipogenic, and neural system. In normal hematopoiesis, primary human CD34+ hematopoietic stem cells display typically a high expression of ZNF521, while its mRNA levels rapidly decrease when these progenitors progress towards erythroid, granulocytic, or B-lymphoid differentiation. However, most acute myeloid leukemias (AMLs) and leukemia-initiating cells keep high ZNF521 expression. In particular, AMLs are often characterized by chromosomal translocations involving the Mixed Lineage Leukemia (MLL) gene, which MLL gene includes a variety of fusion oncogenes arisen from genes normally required during hematopoietic development; once they are fused, they promote epigenetic and transcription factor dysregulation. The chromosomal translocation t(9;11)(p21-22;q23), fusing the MLL gene with AF9 gene, results in a monocytic immune phenotype with an aggressive course, frequent relapses, and a short survival time. To better understand the dysfunctional transcriptional networks related to genetic aberrations, AML gene expression profile datasets were queried for ZNF521 expression and its correlations with specific gene rearrangements and mutations. The results showed that ZNF521 mRNA levels are associated with specific genetic aberrations: the highest expression levels were observed in AMLs involving t(11q23) MLL rearrangements in two distinct datasets (MILE and den Boer); elevated ZNF521 mRNA expression levels were also revealed in AMLs with t(7;12) or with internal rearrangements of chromosome 16. On the contrary, relatively low ZNF521 expression levels seemed to be associated with the t(8;21) translocation, that in turn is correlated with the AML1-ETO fusion gene or the t(15;17) translocation and in AMLs with FLT3-ITD, NPM1, or CEBPα double mutations. Invitro, we found that the enforced co-expression of ZNF521 in cord blood-derived CD34+ cells induced a significant proliferative advantage, improving MLL-AF9 effects on the induction of proliferation and the expansion of leukemic progenitor cells. Transcriptome profiling of CD34+ cells transduced with either MLL-AF9, ZNF521, or a combination of the two transgenes highlighted specific sets of up- or down-regulated genes that are involved in the leukemic phenotype, including those encoding transcription factors, epigenetic modulators, and cell cycle regulators as well as those engaged in the transport or uptake of nutrients. These data enhance the functional cooperation between ZNF521 and MA9, resulting in the development, maintenance, and clonal expansion of leukemic cells. Finally, silencing of ZNF521 in MLL-AF9-transformed primary CD34+ cells inhibited their proliferation and led to their extinction, as well as ZNF521 silencing in the MLL-AF9+ THP-1 cell line resulted in an impairment of their growth and clonogenicity. Taken together, our data highlight ZNF521 role in the control of self-renewal and in the immature compartment of malignant hematopoiesis, which, by altering the gene expression landscape, contributes to the development and/or maintenance of AML acting in concert with the MLL-AF9 fusion oncogene.

Keywords: AML, human zinc finger protein 521 (hZNF521), mixed lineage leukemia gene (MLL) AF9 (MLLT3 or LTG9), cord blood-derived hematopoietic stem cells (CB-CD34+)

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955 Speciation and Bioavailability of Heavy Metals in Greenhouse Soils

Authors: Bulent Topcuoglu

Abstract:

Repeated amendments of organic matter and intensive use of fertilizers, metal-enriched chemicals and biocides may cause soil and environmental pollution in greenhouses. Specially, the impact of heavy metal pollution of soils on food metal content and underground water quality has become a public concern. Due to potential toxicity of heavy metals to human life and environment, determining the chemical form of heavy metals in greenhouse soils is an important approach of chemical characterization and can provide useful information on its mobility and bioavailability. A sequential extraction procedure was used to estimate the availability of heavy metals (Zn, Cd, Ni, Pb and Cr) in greenhouse soils of Antalya Aksu. Zn was predominantly associated with Fe-Mn oxide fraction, major portion of Cd associated with carbonate and organic matter fraction, a major portion of (>65 %) Ni and Cr were largely associated with Fe-Mn oxide and residual fractions and Pb was largely associated with organic matter and Fe-Mn oxide fractions. Results of the present study suggest that the mobility and bioavailability of metals probably increase in the following order: Cr < Pb < Ni < Cd < Zn. Among the elements studied, Zn and Cd appeared to be the most readily soluble and potentially bioavailable metals and these metals may carry a potential risk for metal transfer in food chain and contamination to ground water.

Keywords: metal speciation, metal mobility, greenhouse soils, biosystems engineering

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954 The Correlation of Total Phenol Content with Free Radicals Scavenging Activity and Effect of Ethanol Concentration in Extraction Process of Mangosteen Rind (Garcinia mangostana)

Authors: Ririn Lestari Sri Rahayu, Mustofa Ahda

Abstract:

The use of synthetic antioxidants often causes a negative effect on health and increases the incidence of carcinogenesis. Development of the natural antioxidants should be investigated. However, natural antioxidants have a low toxicity and are safe for human consumption. Ethanol extract of mangosteen rind (Garcinia mangostana) contains natural antioxidant compounds that have various pharmacological activities. Antioxidants from the ethanol extract of mangosteen rind have free radicals scavenging activities. The scavenging activity of ethanol extract of mangosteen rind was determined by DPPH method. The phenolic compound from the ethanol extract of mangosteen rind is determined with Folin-Ciocalteu method. The results showed that the absolute ethanol extract of mangosteen rind has IC50 of 40.072 ug/mL. The correlation of total phenols content with free radical scavenging activity has an equation y: 5.207x + 205.51 and determination value (R2) of 0.9329. Total phenols content from the ethanol extract of mangosteen rind has a good correlation with free radicals scavenging activity of DPPH.

Keywords: Antioxidant, Garcinia mangostana, Inhibition concentration 50%, Phenolic.

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953 Hanta Virus Infection in a Child and Sequelae

Authors: Vijay Samuel, Tina Thekkekkara, Shoma Ganguly

Abstract:

There is no reported Hanta Seoul virus infection in children in the UK so far, making it quite challenging for clinicians in diagnosing, predicting and prognosticating the outcome of the infection to patients and parents. We report a case of a ten-year-old girl who presented with pyrexia associated with headache, photophobia and abdominal pain. The family had recently acquired two pet rats six weeks ago. She appeared flushed with peri-oral pallor, coated the strawberry tongue, inflamed tonsils and bilateral cervical lymphadenopathy. Her liver and splenic edges were palpable. Investigations showed that she was thrombocytopenic with deranged renal and liver functions. An ultrasound abdomen demonstrated a mildly enlarged spleen, peripancreatic lymph node and an acalculous cholecystitis. In view of her clinical presentation, a diagnosis of leptospirosis was considered and she was commenced on intravenous benzylpenicillin. The following day she became oliguric, developed significant proteinuria and her renal function deteriorated. Following conservative management, her urine output gradually improved along with her renal function, proteinuria and thrombocytopaenia. Serology for leptospirosis and various other viruses were negative. Following discussion with the Rare and Imported Pathogens Laboratory at Porton hanta virus serology was requested and found to be strongly positive for Seoul hanta virus. Following discharge she developed palpitations, fatigue, severe headache and cognitive difficulties including memory loss and difficulties in spelling, reading and mathematics. Extensive investigations including ECG, MRI brain and CSF studies were performed and revealed no significant abnormalities. Since 2012, there have been six cases of acute kidney injury due to Hantavirus infection in the UK. Two cases were from the Humber region and were exposure to wild rats and the other four were exposed to specially bred pet fancy rats. Hanta virus infections can cause mild flu like symptoms but two clinical syndromes are associated with severe disease including haemorrhagic fever with renal syndrome, which may be associated with thrombocytopenia and Hantavirus cardiopulmonary syndrome. Neuropsychological impairments reported following hantavirus pulmonary syndrome and following Puumala virus infection have been reported. Minor white matter lesions were found in about half of the patients investigated with MRI brain. Seoul virus has a global distribution owing to the dispersal of its carrier host rats, through global trade. Several ports in the region could explain the possible establishment of Seoul virus in local populations of rats in the Yorkshire and Humber region. The risk of infection for occupationally exposed groups is 1-3% compared to 32.9% for specialist pet rat owners. The report highlight’s the importance of routinely asking about pets in the family. We hope to raise awareness of the emergence of hantavirus infection in the UK, particularly in the Yorkshire and Humber region. Clinicians should consider hantavirus infection as a potential cause of febrile illness causing renal impairment in children. Awareness of the possible neuro-cognitive sequele would help the clinicians offer appropriate information and support to children and their families. Contacting Rare and Imported Pathogens Laboratory at Porton is a useful resource for clinicians in UK when they consider unusual infections.

Keywords: Seoul hantavirus in child Porton, UK Acute kidney injury

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952 Atomic Absorption Spectroscopic Analysis of Heavy Metals in Cancerous Breast Tissues among Women in Jos, Nigeria

Authors: Opeyemi Peter Idowu

Abstract:

Breast cancer is prevalent in northern Nigerian women, most especially in Jos, Plateau State, owing to anthropogenic activities such as solid earth mineral mining as far back as 1904. In this study, atomic absorption spectrometry was used to determine the concentration of eight heavy metals (Cd, As, Cr, Cu, Fe, Pb, Ni, and Zn) in cancerous and non-cancerous breast tissues of Jos Nigerian Women. The levels of heavy metals ranged from 1.08 to 29.34 mg/kg, 0.29 to 10.76 mg/kg, 0.35 to 51.93 mg/kg, 5.15 to 62.93 mg/kg, 11.64 to 51.10 mg/kg, 0.42 to 83.16 mg/kg, 2.08 to 43.07 mg/kg and 1.67 to 71.53 mg/kg for Cd, As, Cr, Cu, Fe, Pb, Ni and Zn respectively. Using MATLAB R2016a, significant differences (tᵥ = 0.0041 - 0.0317) existed between the levels of all the heavy metals in cancerous and non-cancerous breast tissues except Fe. At 0.01 level of significance, a positive significant correlation existed between Pb and Fe, Pb and Cu, Pb and Fe, Ni and Fe, Cr and Pb, as well as Ni and Cr (r = 0.583 – 0.998) in cancerous breast tissues. Using ANOVA, significant differences also occurred in the levels of these heavy metals in cancerous breast tissues (p = 1.910510×10⁻²⁶). The relatively high levels of the cancer-induced heavy metals (Cd, As, Cr, and Pb) compared with control indicated contamination or exposure to heavy metals, which could be the major cause of cancer in these female subjects. This was evidence of contamination as a result of exposure by ingestion, inhalation, or other means to one anthropogenic activity of the other. Therapeutic measures such as gastric lavage, ascorbic acid consumption, and divalent cation treatment are all effective ways to manage heavy metal toxicity in the subjects to lower the risk of breast cancer.

Keywords: breast cancer, heavy metals, spectroscopy, bio-accumulation

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951 Biodegradation Study of Diethyl Phthalate Using Bacteria Isolated from Plastic Industry Wastewater Discharge Site

Authors: Sangram Shamrao Patil, Hara Mohan Jena

Abstract:

Phthalates are among the most common organic pollutant since they have become widespread in the environment and found in sediments, natural waters, soils, plants, landfill leachates, biota including human tissue and aquatic organisms. Diethyl phthalate (DEP) is a low molecular weight phthalate which has wide applications as plasticizer and become a major cause of environmental pollution. Environmental protection agency (EPA) listed DEP as priority pollutant because of its toxicity and they recommended human health ambient water quality criterion for diethyl phthalate (DEP) as 4 mg/l. Therefore, wastes containing phthalates require proper treatment before being discharged into the environment. Biodegradation is attractive and efficient treatment method as it is cost effective and produces non-toxic end products. In the present study, a DEP degrading aerobic bacterium was isolated from soil contaminated with plastic industry wastewater. Morphological and biochemical characteristics of isolate were performed. 16S rRNA sequencing and phylogenetic analysis of isolate was carried out and it was identified as Empedobacter brevis. Isolate has been found to tolerate up to 1650 mg/l of DEP. This study will be significant for exploring an application of microbes for remediation of phthalates and development of a suitable bioreactor.

Keywords: diethyl phthalate, plasticizer, pollutant, biodegradation

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950 The Use and Safety of Leave from an Acute Inpatient Psychiatry Unit: A Retrospective Review of Pass Outcomes Over Four Years Abstract

Authors: Vasilis C. Hristidis, Ricardo Caceda, Ji Soo Kim, Brian Bronson, Emily A. Hill

Abstract:

Objective: Leave passes to provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Though providing day passes was once a relatively common practice, there is relatively little data describing their safety and efficacy. Methods: This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. Results: During the study period, ten patients with primary psychotic or mood disorders received 12 passes for either housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or elopements. One patient experienced severe agitation and engaged in non-suicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Conclusions: Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.

Keywords: passes, inpatient, psychiatry, inpatient leave, outcome

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949 Medical Decision-Making in Advanced Dementia from the Family Caregiver Perspective: A Qualitative Study

Authors: Elzbieta Sikorska-Simmons

Abstract:

Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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