Search results for: post cancer maxillary reconstruction
4537 Place of Radiotherapy in the Treatment of Intracranial Meningiomas: Experience of the Cancer Center Emir Abdelkader of Oran Algeria
Authors: Taleb L., Benarbia M., Boutira F. M., Allam H., Boukerche A.
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Introduction and purpose of the study: Meningiomas are the most common non-glial intracranial tumors in adults, accounting for approximately 30% of all central nervous system tumors. The aim of our study is to determine the epidemiological, clinical, therapeutic, and evolutionary characteristics of a cohort of patients with intracranial meningioma treated with radiotherapy at the Emir Abdelkader Cancer Center in Oran. Material and methods: This is a retrospective study of 44 patients during the period from 2014 to 2020. The overall survival and relapse-free survival curves were calculated using the Kaplan-Meier method. Results and statistical analysis: The median age of the patients was 49 years [21-76 years] with a clear female predominance (sex ratio=2.4). The average diagnostic delay was seven months [2 to 24 months], the circumstances of the discovery of which were dominated by headaches in 54.5% of cases (n=24), visual disturbances in 40.9% (n=18), and motor disorders in 15.9% (n=7). The seat of the tumor was essentially at the level of the base of the skull in 52.3% of patients (n=23), including 29.5% (n=13) at the level of the cavernous sinus, 27.3% (n=12) at the parasagittal level and 20.5% (n=9) at the convexity. The diagnosis was confirmed surgically in 36 patients (81.8%) whose anatomopathological study returned in favor of grades I, II, and III in respectively 40.9%, 29.5%, and 11.4% of the cases. Radiotherapy was indicated postoperatively in 45.5% of patients (n=20), exclusive in 27.3% (n=12) and after tumor recurrence in 27.3% of cases (n=18). The irradiation doses delivered were as follows: 50 Gy (20.5%), 54 Gy (65.9%), and 60 Gy (13.6%). With a median follow-up of 69 months, the probabilities of relapse-free survival and overall survival at three years are 93.2% and 95.4%, respectively, whereas they are 71.2% and 80.7% at five years. Conclusion: Meningiomas are common primary brain tumors. Most often benign but can also progress aggressively. Their treatment is essentially surgical, but radiotherapy retains its place in specific situations, allowing good tumor control and overall survival.Keywords: diagnosis, meningioma, surgery, radiotherapy, survival
Procedia PDF Downloads 1004536 Preparation and Characterization of Recycled Polyethylene Terephthalate/Polypropylene Blends from Automotive Textile Waste for Use in the Furniture Edge Banding Sector
Authors: Merve Ozer, Tolga Gokkurt, Yasemen Gokkurt, Ezgi Bozbey
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In this study, we investigated the recovery of Polyethylene terephthalate/Polypropylene (PET/PP)-containing automotive textile waste from post-product and post-consumer phases in the automotive sector according to the upcycling technique and the methods of formulation and production that would allow these wastes to be substituted as PP/PET alloys instead of original PP raw materials used in plastic edge band production. The laminated structure of the stated wastes makes it impossible to separate the incompatible PP and PET phases in content and thus produce a quality raw material or product as a result of recycling. Within the scope of a two-stage production process, a comprehensive process was examined using block copolymers and maleic grafted copolymers with different features to ensure that these two incompatible phases are compatible. The mechanical, thermal, and morphological properties of the plastic raw materials, which will be referred to as PP/PET blends obtained as a result of the process, were examined in detail and discussed their substitutability instead of the original raw materials.Keywords: mechanical recycling, melt blending, plastic blends, polyethylene, polypropylene, recycling of plastics, terephthalate, twin screw extruders
Procedia PDF Downloads 724535 Oral Antibiotics in Trans-Rectal Prostate Biopsy and Its Efficacy to Reduce Infectious Complications: Systematic Review
Authors: Mohand Yaghi, O. Kehinde
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Background: For the diagnosis of prostate cancer Trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. Aim: To systematically review different regimens of prophylactic oral antibiotics in TRPB. Design: Medline, Embase, Clinical trials site, and Cochrane library were searched, experts were consulted about relevant studies. Randomized clinical trials (RCT) conducted in the last twenty years, which investigated different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Measurements: Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, sepsis. Secondary outcomes were hospitalization rate, and the prevalence of ABx-resistant bacteria. Results: Nine trials were eligible with 3012 patients. Antibiotics prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple dose except in Bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other antibiotics. Lastly, Ciprofloxacin is the best Quinolone to prevent UTI, and hospitalization. Conclusion: it is essential to prescribe prophylactic Antibiotics in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria was identified more often in the single dose cohorts.Keywords: infection, prostate cancer, sepsis, TRPB
Procedia PDF Downloads 3684534 Using a Train-the-Trainer Model to Deliver Post-Partum Haemorrhage Simulation in Rural Uganda
Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones
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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer
Procedia PDF Downloads 1774533 Risk Management in Islamic Micro Finance Credit System for Poverty Alleviation from Qualitative Perspective
Authors: Liyu Adhi Kasari Sulung
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Poverty has been a major problem in Indonesia. Islamic micro finance (IMF) named Baitul Maal Wat Tamwil (Bmt) plays a prominent role to eradicate this. Indonesia as the biggest muslim country has many successful applied products such as worldwide adopt group-based lending approach, flexible financing for farmers, and gold pawning. The Problems related to these models are operation risk management and internal control system (ICS). A proper ICS will help an organization in preventing the occurrence of bad financing through detecting error and irregularities in its operation. This study aims to seek a proper risk management scheme of credit system in Bmt and internal control system’s rank for every stage. Risk management variables are obtained at the first In-Depth Interview (IDI) and Focus Group Discussion (FGD) with Shariah supervisory boards, boards of directors, and operational managers. Survey was conducted covering nationwide data; West Java, South Sulawesi, and West Nusa Tenggara. Moreover, Content analysis is employed to build the relationship among these variables. Research Findings shows that risk management Characteristics in Indonesia involves ex ante, credit process, and ex post strategies to deal with risk in credit system. Ex-ante control consists of Shariah compliance, survey, group leader reference, and islamic forming orientation. Then, credit process involves saving, collateral, joint liability, loan repayment, and credit installment controlling. Finally, ex-post control includes shariah evaluation, credit evaluation, grace period and low installment provisions. In addition, internal control order sort three stages by its priority; Credit process as first rank, then ex-post control as second, and ex ante control as the last rank.Keywords: internal control system, islamic micro finance, poverty, risk management
Procedia PDF Downloads 4084532 Effect of Sanitary-Environmental Conditions of Diabetic Hypertension Incidence of Displaced Persons
Authors: Radmila Maksimovic, Sonja Ketin, Rade Biocanin, Jelena Maksimovic
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The abnormal conditions of life and work genetic factors often play a major role in incidence of diabetes-diabetes, heart disease and vascular disease, jaundice, and post traumatic stress. Trauma and post traumatic stress are most common in the displaced persons,and the focus of this paper is to shed light on this issue in former Yugoslavia, Yugoslavia and now in our country. This is caused by increased beta-cell sensitivity to viruses, the development of autoimmune antibodies against its own pancreascells, degenerative changes in cells that r esult in change of structure and insulin. In this paper, we dealt with traumatic events and long-term psycho social consequences for internally displaced persons, several years after displacement, and found a high level of PTSD symptoms. This stress is present in almost 1/3 of internally displaced persons, and every sixth person is suffering from PTSD in the past. Respondents generally suffer from symptoms of intrusion, but there was a large number of symptoms, avoidance and increased arousal. We also found that gender, age andeducation related to the symptoms. Females, and older respondents and internally displaced persons with lower levels of education how a higher level of PTSD symptoms, especially symptoms of intrusion and increase darousal. It is a highly traumatized sample in which more than 1/2 of respondents experienced more than three traumatic events in life,although the number of traumas experienced before, during and after the conflict varies.We found that during the war, internally displaced persons haveexperienced more traumatic events compared with the periodbefore and after the conflict. Trauma are different in type. No significant correlation between the number of experienced trauma and PTSD, suggesting that it is necessary to further study the structure of past traumas and the intermediary effects of certain risk factors and protective factors.Keywords: living environment, displaced persons, jaundice, diabetes, trauma, diabetic hypertension, post-traumatic stress (PTSD), treatment
Procedia PDF Downloads 3934531 China-Africa Diplomatic Discourse: Reconstructing the Principle of “Yi” as a Framework for Analyzing Sino-Africa Cooperation
Authors: Modestus Queen
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As we know, diplomatic languages carry the political ideology and cultural stance of the country. Knowing that China's diplomatic discourse is complicated and is heavily flavored with Chinese characteristics, one of the core goals of President Xi's administration is to properly tell the story of China. This cannot be done without proper translation or interpretation of major Chinese diplomatic concepts. Therefore, this research seeks to interpret the relevance of "Yi" as used in "Zhèngquè Yì Lì Guān". The author argues that it is not enough to translate a document but that it must be properly interpreted to portray it as political, economic, cultural and diplomatic relevant to the target audience, in this case, African people. The first finding in the current study indicates that literal translation is a bad strategy, especially in Chinese diplomatic discourses. The second finding indicates that "Yi" can be used as a framework to analyze Sino-Africa relations from economic, social and political perspectives, and the third finding indicates that "Yi" is the guiding principle of China's foreign policy towards Africa.Keywords: Yi, justice, China-Africa, interpretation, diplomatic discourse, discourse reconstruction
Procedia PDF Downloads 1414530 The Effect of Expressive Therapies on Children and Youth Impacted by Refugee Trauma: A Meta-Analysis
Authors: Brian Kristopher Cambra
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Millions of displaced families are seeking refuge in countries that are not their own due to war, violence, persecution, political unrest, and natural disasters. This global crisis is forcing researchers and practitioners to consider how refugees are coping with the trauma associated with their migration process. Effective therapeutic approaches are needed in a global effort to address the traumatic impact of forced migration. This meta-analytical study investigates the effectiveness of expressive therapeutic modalities, including play, art, music, sandplay, theatre, and writing therapies, in helping children and adolescents cope with refugee trauma. Seventeen pre-post and between-group comparison studies were analyzed using a random-effects model. The combined effect size for pre-post comparisons was medium (g = 0.58), whereas the combined effect size for between-group comparisons was small (g = 0.32). Overall, art therapy was found to be most effective in treating stress symptoms. Heterogeneity tests, however, suggest effect sizes cannot be interpreted as meaningful due to substantial variance. Nevertheless, findings of this meta-analysis indicate that expressive therapies may be among beneficial modalities to integrate with other trauma-informed approaches.Keywords: expressive therapies, forced migration, meta-analysis, refugees, trauma
Procedia PDF Downloads 1474529 A 3D Cell-Based Biosensor for Real-Time and Non-Invasive Monitoring of 3D Cell Viability and Drug Screening
Authors: Yuxiang Pan, Yong Qiu, Chenlei Gu, Ping Wang
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In the past decade, three-dimensional (3D) tumor cell models have attracted increasing interest in the field of drug screening due to their great advantages in simulating more accurately the heterogeneous tumor behavior in vivo. Drug sensitivity testing based on 3D tumor cell models can provide more reliable in vivo efficacy prediction. The gold standard fluorescence staining is hard to achieve the real-time and label-free monitoring of the viability of 3D tumor cell models. In this study, micro-groove impedance sensor (MGIS) was specially developed for dynamic and non-invasive monitoring of 3D cell viability. 3D tumor cells were trapped in the micro-grooves with opposite gold electrodes for the in-situ impedance measurement. The change of live cell number would cause inversely proportional change to the impedance magnitude of the entire cell/matrigel to construct and reflect the proliferation and apoptosis of 3D cells. It was confirmed that 3D cell viability detected by the MGIS platform is highly consistent with the standard live/dead staining. Furthermore, the accuracy of MGIS platform was demonstrated quantitatively using 3D lung cancer model and sophisticated drug sensitivity testing. In addition, the parameters of micro-groove impedance chip processing and measurement experiments were optimized in details. The results demonstrated that the MGIS and 3D cell-based biosensor and would be a promising platform to improve the efficiency and accuracy of cell-based anti-cancer drug screening in vitro.Keywords: micro-groove impedance sensor, 3D cell-based biosensors, 3D cell viability, micro-electromechanical systems
Procedia PDF Downloads 1284528 Different Ergonomic Exposures and Infrared Thermal Temperature on Low Back
Authors: Sihao Lin
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Objectives: Infrared thermography (IRT) has been little documented in the objective measurement of ergonomic exposure. We aimed to examine the association between different ergonomic exposures and low back skin temperature measured by IRT. Methods: A total of 114 subjects among sedentary students, sports students and cleaning workers were selected as different ergonomic exposure levels. Low back skin temperature was measured by infrared thermography before and post ergonomic exposure. Ergonomic exposure was assessed by Quick Exposure Check (QEC) and quantitative scores were calculated on the low back. Multiple regressions were constructed to examine the possible associations between ergonomic risk exposures and the skin temperature over the low back. Results: Compared to the two student groups, clean workers had significantly higher ergonomic exposure scores on the low back. The low back temperature variations were different among the three groups. The temperature decreased significantly among students with ergonomic exposure (P < 0.01), while it increased among cleaning workers. With adjustment of confounding, the post-exposure temperature and the temperature changes after exposure showed a significantly negative association with ergonomic exposure scores. For maximum temperature, one increasing ergonomic score decreased -0.23◦C (95% CI -0.37, -0.10) of temperature after ergonomic exposure over the low back. Conclusion: There was a significant association between ergonomic exposures and infrared thermal temperature over low back. IRT could be used as an objective assessment of ergonomic exposure on the low back.Keywords: ergonomic exposure, infrared thermography, musculoskeletal disorders, skin temperature, low back
Procedia PDF Downloads 1034527 Jitter Based Reconstruction of Transmission Line Pulse Using On-Chip Sensor
Authors: Bhuvnesh Narayanan, Bernhard Weiss, Tvrtko Mandic, Adrijan Baric
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This paper discusses a method to reconstruct internal high-frequency signals through subsampling techniques in an IC using an on-chip sensor. Though there are existing methods to internally probe and reconstruct high frequency signals through subsampling techniques; these methods have been applicable mainly for synchronized systems. This paper demonstrates a method for making such non-intrusive on-chip reconstructions possible also in non-synchronized systems. The TLP pulse is used to demonstrate the experimental validation of the concept. The on-chip sensor measures the voltage in an internal node. The jitter in the input pulse causes a varying pulse delay with respect to the on-chip sampling command. By measuring this pulse delay and by correlating it with the measured on-chip voltage, time domain waveforms can be reconstructed, and the influence of the pulse on the internal nodes can be better understood.Keywords: on-chip sensor, jitter, transmission line pulse, subsampling
Procedia PDF Downloads 1454526 Seed Germination, Seedling Emergence and Response to Herbicides of Papaver Species (Papaver rhoeas and P. dubium)
Authors: Faezeh Zaefarian1, Sajedeh Golmohammadzadeh, Mohammad Rezvani
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Weed management decisions for weed species can be derived from knowledge of seed germination biology. Experiments were conducted in laboratory and greenhouse to determine the effects of light, temperature, salt and water stress, seed burial depth on seed germination and seedling emergence of Papaver rhoeas and P.dubium and to assay the response of these species to commonly available POST herbicides. Germination of the Papaver seeds was influenced by the tested temperatures (day/night temperatures of 20 and 25 °C) and light. The concentrations of sodium chloride, ranging from 0 to 80 mM, influence germination of seeds. The osmotic potential required for 50% inhibition of maximum germination of P. rhoeas was -0.27 MPa and for P. dubium species was 0.25 MPa. Seedling emergence was greatest for the seeds placed at 1 cm and emergence declined with increased burial depth in the soil. No seedlings emerged from a burial depth of 6 cm. The herbicide 2,4-D at 400 g ai ha-1 provided excellent control of both species when applied at the four-leaf and six-leaf stages. However, at the six-leaf stage, percent control was reduced. The information gained from this study could contribute to developing components of integrated weed management strategies for Papaver species.Keywords: germination, papaver species, planting depth, POST herbicides
Procedia PDF Downloads 2444525 Field Study of Chlorinated Aliphatic Hydrocarbons Degradation in Contaminated Groundwater via Micron Zero-Valent Iron Coupled with Biostimulation
Authors: Naijin Wu, Peizhong Li, Haijian Wang, Wenxia Wei, Yun Song
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Chlorinated aliphatic hydrocarbons (CAHs) pollution poses a severe threat to human health and is persistent in groundwater. Although chemical reduction or bioremediation is effective, it is still hard to achieve their complete and rapid dechlorination. Recently, the combination of zero-valent iron and biostimulation has been considered to be one of the most promising strategies, but field studies of this technology are scarce. In a typical site contaminated by various types of CAHs, basic physicochemical parameters of groundwater, CAHs and their product concentrations, and microbial abundance and diversity were monitored after a remediation slurry containing both micron zero-valent iron (mZVI) and biostimulation components were directly injected into the aquifer. Results showed that groundwater could form and keep low oxidation-reduction potential (ORP), a neutral pH, and anoxic conditions after different degrees of fluctuations, which was benefit for the reductive dechlorination of CAHs. The injection also caused an obvious increase in the total organic carbon (TOC) concentration and sulfate reduction. After 253 days post-injection, the mean concentration of total chlorinated ethylene (CEE) from two monitoring wells decreased from 304 μg/L to 8 μg/L, and total chlorinated ethane (CEA) decreased from 548 μg/L to 108 μg/L. Occurrence of chloroethane (CA) suggested that hydrogenolysis dechlorination was one of the main degradation pathways for CEA, and also hints that biological dechlorination was activated. A significant increase of ethylene at day 67 post-injection indicated that dechlorination was complete. Additionally, the total bacterial counts increased by 2-3 orders of magnitude after 253 days post-injection. And the microbial species richness decreased and gradually changed to anaerobic/fermentative bacteria. The relative abundance of potential degradation bacteria increased corresponding to the degradation of CAHs. This work demonstrates that mZVI and biostimulation can be combined to achieve the efficient removal of various CAHs from contaminated groundwater sources.Keywords: chlorinated aliphatic hydrocarbons, groundwater, field study, zero-valent iron, biostimulation
Procedia PDF Downloads 1654524 Heart Rate Variability Responses Pre-, during, and Post-Exercise among Special Olympics Athletes
Authors: Kearney Dover, Viviene Temple, Lynneth Stuart-Hill
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Heart Rate Variability (HRV) is the beat-to-beat variation in adjacent heartbeats. HRV is a non-invasive measure of the autonomic nervous system (ANS) and provides information about the sympathetic (SNS) and parasympathetic (PNS) nervous systems. The HRV of a well-conditioned heart is generally high at rest, whereas low HRV has been associated with adverse outcomes/conditions, including congestive heart failure, diabetic neuropathy, depression, and hospital admissions. HRV has received very little research attention among individuals with intellectual disabilities in general or Special Olympic athletes. Purpose: 1) Having a longer post-exercise rest and recovery time to establish how long it takes for the athletes’ HRV components to return to pre-exercise levels, 2) To determine if greater familiarization with the testing processes influences HRV. Participants: Two separate samples of 10 adult Special Olympics athletes will be recruited for 2 separate studies. Athletes will be between 18 and 50 years of age and will be members of Special Olympics BC. Anticipated Findings: To answer why the Special Olympics athletes display poor cardiac responsiveness to changes in autonomic modulation during exercise. By testing the cortisol levels in the athletes, we can determine their stress levels which will then explain their measured HRV.Keywords: 6MWT, autonomic modulation, cortisol levels, intellectual disability
Procedia PDF Downloads 3084523 Coping in Your Profession: An Exploratory Analysis of Healthcare Students’ Perceptions of Burnout
Authors: Heather Clark, Jon Kelly
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Burnout among healthcare professionals has been elevated to a high level of concern. The descriptions of the healthcare workplace often include language such as, stressful, long hours, rotating shifts, weekends and holidays, and exhausting. New graduate healthcare professionals are being sent into the workplace with little to no coping skills, knowledge of signs and symptoms of burnout, or resources that are available. The authors of this study created a university course entitled 'coping in your profession' that enrolled registered nurses, licensed practical nurses, EMTs, nurse assistants, and medical assistants. The course addresses burnout, self-analysis, incivility, coping mechanisms, and organizational responsibilities for employee well-being. The students were surveyed using QualtricsXM that included a pre-course and post-course analysis. Pre-course results showed high levels of individual experiences with burnout and limited knowledge of resources to combat burnout. Post-course results included personal growth and that students’ perception of burnout can be prevented at both the individual and the organization levels. Students also indicated that few to no resources to combat burnout existed at their place of employment. Addressing burnout at the educational level helps prepare graduates with the knowledge and tools to combat burnout at the individual and organization level.Keywords: burnout, coping, healthcare workers, incivility, resilience
Procedia PDF Downloads 1364522 Design and Development of an Expanded Polytetrafluoroethylene Valved Conduit with Sinus of Valsalva
Authors: Munirah Ismail, Joon Hock Yeo
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Babies born with Tetralogy of Fallot, a congenital heart defect, are required to undergo reconstruction surgery to create a valved conduit. As the child matures, the partially reconstructed pulmonary conduit increases in diameter, while the size of the reconstructed valve remains the same. As a result, follow up surgery is required to replace the undersized valve. Thus, in this project, we evaluated the in-vitro performance of a bi-leaflet valve design in terms of percentage regurgitation with increasing artery (conduit) diameters. Results revealed percentage regurgitations ranging from 13% to 34% for conduits tested. It was observed that percentage of regurgitation increased exponentially with increasing diameters. While the amount of regurgitation may seem severe, it is deemed acceptable, and this valve could potentially reduce the frequency of re-operation in the lifetime of pediatric patients.Keywords: pulmonary heart valve, tetralogy of fallot, expanded polytetrafluoroethylene valve, pediatric heart valve replacement
Procedia PDF Downloads 1734521 Reducing the Length of Stay and Mortality in COVID-19 Patients with Diabetes
Authors: Sara Alzahrani, Samia Bokari, Patan Khan, Muneera Alshareef, Rania Safwat, Mohammed Galal, Hamdi Alqadi, Ameerah Alzahrani, Rehab Alboraie
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Introduction & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized .Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated via Microsoft Excel tool. Mortality rates were calculated by percentages. The results monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study. Financial saving come from rapid turnover of beds. The mortality was 2.5 % compared to reported 7.3% in a major study, reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.Keywords: diabetes, covid-19, management, mortality
Procedia PDF Downloads 1774520 A Review of Current Practices in Tattooing of Colonic Lesion at Endoscopy
Authors: Dhanashree Moghe, Roberta Bullingham, Rizwan Ahmed, Tarun Singhal
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Aim: The NHS Bowel Screening Programme recommends the use of endoscopic tattooing for suspected malignant lesions that later require surgical or endoscopic localisation, using local protocols as guidance. This is in accordance with guidance from the BSG (The British Society of Gastroenterologists). We used a well-recognised local protocol as a standard to audit current tattooing practice in a large district general hospital with no current local guidelines. Method: A retrospective quantitative analysis of 50 patients who underwent segmental colonic resection for cancer over a 6-month period in 2021. We reviewed historic electronic endoscopy reports recording relevant data on tattoo indication and placement. Secondly, we carried out an anonymous survey of 16 independent lower GI endoscopists on self-reported details of their practice. Results: In our study, 28 patients (56%) had a tattoo placed at the time of their colonoscopy. Of these, only 53% (n=15) had the tattoo distal to the lesion, with the measured distance of the tattoo from the lesion only being documented in 8 reports. Only seven patients (25%) had a circumferential (4 quadrant) placement of the tattoo. 13 patients had lesions either in the caecum or rectum, locations deemed unnecessary as per BSG guidelines. Of the survey responses collected, there were four different protocols being used to guide practice. Only 50% of respondents placed tattoos at the correct distance from the lesion, and 83% placed the correct number of tattoos. Conclusion: There is a lack of standardisation of practices in colonic tattooing demonstrated in our study with incomplete compliance to our standard. The inadequate documentation of tattoo location can contribute to confusion and inaccuracy in the intraoperative localisation of lesions. This has the potential to increase operation length and morbidity. There is a need to standardise both technique and documentation in colonoscopic tattooing practice.Keywords: colorectal cancer, endoscopic tattooing, colonoscopy, NHS BSCP
Procedia PDF Downloads 1204519 Impact of Dairy Polysaccharides on Caloric Intake and Postprandial Metabolic Responses in Young Adults
Authors: Muhammad Umair Arshad, Saima Ishtiaq, Ali Imran
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Different polysaccharides contribute towards the management of glycemic and satiety and consequently manage the metabolic syndrome. In the present study, we compared the postprandial glycemic and satiety responses of different dietary polysaccharides when added to milk (2% Milk Fat). The objective of this study was to evaluate different polysaccharides against postprandial glucose, appetite responses, and food intake at subsequent meals. In a repeated measures crossover design, 30 females (18–30 years) consumed 250 ml milk with 2% M.F. (control), or milk with carrageenan (2.5 g), guar gum (2.5 g) and alginate (2.5 g), followed by an ad libitum pizza meal after 120 min. Alginate and guar gum addition resulted in lower caloric intake at subsequent pizza meal. The post-treatment (0–120 min) glucose and average appetite were suppressed by alginate and guar gum (p < 0.0001), with a more pronounced effect of guar gum. However, alginate resulted in lower blood glucose (p < 0.0001) compared with control and carrageenan during post-treatment. Alginate and guar gum, added milk, and other beverages would be beneficial in the short-term regulation of postprandial glycemia and satiety.Keywords: satiety, glycemic control, milk polysaccharides, food intake
Procedia PDF Downloads 694518 First Step into a Smoke-Free Life: The Effectivity of Peer Education Programme of Midwifery Students
Authors: Rabia Genc, Aysun Eksioglu, Emine Serap Sarican, Sibel Icke
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Today the habit of cigarette smoking is among one of the most important public health concerns because of the health problems it leads to. The most important and hazardous group to use tobacco and tobacco products is adolescents and teenagers. And one of the most effective ways to prevent them from starting to smoke is education. This research is a kind of educational intervention study which was carried out in order to evaluate the effect of peer education on the teenagers' knowledge about smoking. The research was carried out between October 15, 2013 and September 9, 2015 at Ege University Ataturk Vocational Health School. The population of the research comprised of the students that have been studying at Ege University Atatürk Vocational Health School, Midwifery Department (N=390). The peer educator group that would give training on smoking consisted of 10 people, and the peer groups that would be trained were divided into two groups via simple randomization as experimental group (n=185) and control group (n=185). Questionnaire, information evaluation form, and informed consent forms were used as date collection tools. The analysis of the data which were collected in the study was carried out on Statistical Package for Social Science (SPSS 15.0). It was found out that 62.5 % of the students who were in peer educator group had smoked in some period of their lives; however, none of them continued to smoke. When they were asked about their reasons to start smoking, 25% said they just wanted to try it, and 25% of them answered that it was because of their friend groups. When the pre-peer education and post-peer education point averages of peer educator group were evaluated, the results showed that there was a significant difference between the point averages (p < 0.05). When the cigarette use of experimental group and the control group were evaluated, it was clear that 18.2% of the experimental group and 24.2%of the control group still smokes. 9.1% of the experimental group and 14.8% of control group stated that they started smoking because of their friend groups. Among the students who smoke 15.9% of the ones who belongs to the experimental group and 21.9% of the ones who belong to the control group stated they are thinking of quitting smoking. It was clear that there is a significant difference between the pre-education and post-education point averages of experimental group statistically (p ≤ 0.05); however, in terms of control group, there were no significant differences between the pre-test post-test averages statistically. Between the pre-test post-test averages of experimental and control groups there were not any statistically significant differences (p > 0.05). It was found out in the study that the peer education programme is not effective on the smoking habit of Vocational Health School students. When the future studies are being planned in order to evaluate the peer education activity, it can be taken into consideration that the peer education takes a long term and the students in the educator group will be more enthusiastic and a kind of leader in their environment.Keywords: midwifery, peer, peer education, smoking
Procedia PDF Downloads 2224517 Study on Co-Relation of Prostate Specific Antigen with Metastatic Bone Disease in Prostate Cancer on Skeletal Scintigraphy
Authors: Muhammad Waleed Asfandyar, Akhtar Ahmed, Syed Adib-ul-Hasan Rizvi
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Objective: To evaluate the ability of serum concentration of prostate specific antigen between two cutting points considering it as a predictor of skeletal metastasis on bone scintigraphy in men with prostate cancer. Settings: This study was carried out in department of Nuclear Medicine at Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan. Materials and Method: From August 2013 to November 2013, forty two (42) consecutive patients with prostate cancer who underwent technetium-99m methylene diphosphonate (Tc-99mMDP) whole body bone scintigraphy were prospectively analyzed. The information was collected from the scintigraphic database at a Nuclear medicine department Sindh institute of urology and transplantation Karachi Pakistan. Patients who did not have a serum PSA concentration available within 1 month before or after the time of performing the Tc-99m MDP whole body bone scintigraphy were excluded from this study. A whole body bone scintigraphy scan (from the toes to top of the head) was performed using a whole-body Moving gamma camera technique (anterior and posterior) 2–4 hours after intravenous injection of 20 mCi of Tc-99m MDP. In addition, all patients necessarily have a pathological report available. Bony metastases were determined from the bone scan studies and no further correlation with histopathology or other imaging modalities were performed. To preserve patient confidentiality, direct patient identifiers were not collected. In all the patients, Prostate specific antigen values and skeletal scintigraphy were evaluated. Results: The mean age, mean PSA, and incidence of bone metastasis on bone scintigraphy were 68.35 years, 370.51 ng/mL and 19/42 (45.23%) respectively. According to PSA levels, patients were divided into 5 groups < 10ng/mL (10/42), 10-20 ng/mL (5/42), 20-50 ng/mL (2/42), 50-100 (3/42), 100- 500ng/mL (3/42) and more than 500ng/mL (0/42) presenting negative bone scan. The incidence of positive bone scan (%) for bone metastasis for each group were O1 patient (5.26%), 0%, 03 patients (15.78%), 01 patient (5.26%), 04 patients (21.05%), and 10 patients (52.63%) respectively. From the 42 patients 19 (45.23%) presented positive scintigraphic examination for the presence of bone metastasis. 1 patient presented bone metastasis on bone scintigraphy having PSA level less than 10ng/mL, and in only 1 patient (5.26%) with bone metastasis PSA concentration was less than 20 ng/mL. therefore, when the cutting point adopted for PSA serum concentration was 10ng/mL, a negative predictive value for bone metastasis was 95% with sensitivity rates 94.74% and the positive predictive value and specificities of the method were 56.53% and 43.48% respectively. When the cutting point of PSA serum concentration was 20ng/mL the observed results for Positive predictive value and specificity were (78.27% and 65.22% respectively) whereas negative predictive value and sensitivity stood (100% and 95%) respectively. Conclusion: Results of our study allow us to conclude that serum PSA concentration of higher than 20ng/mL was the most accurate cutting point than a serum concentration of PSA higher than 10ng/mL to predict metastasis in radionuclide bone scintigraphy. In this way, unnecessary cost can be avoided, since a considerable part of prostate adenocarcinomas present low serum PSA levels less than 20 ng/mL and for these cases radionuclide bone scintigraphy could be unnecessary.Keywords: bone scan, cut off value, prostate specific antigen value, scintigraphy
Procedia PDF Downloads 3194516 Impact of Fire on Bird Diversity in Oil Palm Plantation: Case Study in South Sumatra Province
Authors: Yanto Santosa, Windi Sugiharti
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Fires occur annually in oil palm plantations. The objective of the study was to identify the impact of fire on bird diversity in oil palm plantations. Data of bird diversity were collected using the line transect method. Data were collected from February to March 2017. To estimate species richness, we used the Margalef index, to determine the evenness of species richness between site, we used an Evenness index, and to estimate the similarity of bird communities between different habitat, we used the Sørensen index. The result showed that the number of bird species and species richness in the post burned area was higher than those in unburned area. Different results were found for the Evenness Index, where the value was higher in unburned area that was in post burned area. These results indicate that fires did not decrease bird diversity as alleged by many parties whom stated that fires caused species extinction. Fire trigger the emerging of belowground plant and population of insects as a sources of food for the bird community. This result is consistent with several research findings in the United States and Australia that used controlled fires as one of regional management tools.Keywords: bird, fire, index of similarity, oil palm, species diversity
Procedia PDF Downloads 2474515 Effect of Large English Studies Classes on Linguistic Achievement and Classroom Discourse at Junior Secondary Level in Yobe State
Authors: Clifford Irikefe Gbeyonron
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Applied linguists concur that there is low-level achievement in English language use among Nigerian secondary school students. One of the factors that exacerbate this is classroom feature of which large class size is obvious. This study investigated the impact of large classes on learning English as a second language (ESL) at junior secondary school (JSS) in Yobe State. To achieve this, Solomon four-group experimental design was used. 382 subjects were divided into four groups and taught ESL for thirteen weeks. 356 subjects wrote the post-test. Data from the systematic observation and post-test were analyzed via chi square and ANOVA. Results indicated that learners in large classes (LLC) attain lower linguistic progress than learners in small classes (LSC). Furthermore, LSC have more chances to access teacher evaluation and participate actively in classroom discourse than LLC. In consequence, large classes have adverse effects on learning ESL in Yobe State. This is inimical to English language education given that each learner of ESL has their individual peculiarity within each class. It is recommended that strategies that prioritize individualization, grouping, use of language teaching aides, and theorization of innovative models in respect of large classes be considered.Keywords: large classes, achievement, classroom discourse
Procedia PDF Downloads 4094514 The Impact of Teaching Critical Reading Strategies on Students' Performance in English and Communication Skills in College of Education, Azare, Bauchi State Nigeria
Authors: Musa Galadima Toro
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The study focused on the impact of teaching critical reading strategies on students’ performance in English and communication skills at the college of education Azare Bauchi state, Nigeria. It adopted a pre-test, post-test experimental group design. A sample of two hundred and forty (240) students was randomly selected from four departments within the school. The students were randomized into two groups: experimental and control groups. The experimental group was taught critical reading strategies as a form of treatment, while the control group involved in normal reading comprehension exercises. The findings of the study showed a significant difference in the performance of students who were taught critical reading strategies at the post- test level. Recommendations based on the findings of the study were proffered such as placing more emphasis on teaching critical reading strategies in order to improve students’ creative thinking skills and also encouraging students to read articles in science and humanities to improve their reading skills among others.Keywords: English, communication skill, critical reading, strategies
Procedia PDF Downloads 2724513 Protection and Immune Responses of DNA Vaccines Targeting Virulence Factors of Streptococcus iniae in Nile Tilapia (Oreochromis niloticus)
Authors: Pattanapon Kayansamruaj, Ha Thanh Dong, Nopadon Pirarat, Channarong Rodkhum
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Streptococcus iniae (SI) is a devastating pathogenic bacteria causing heavy mortality in farmed fish. The application of commercialized bacterin vaccine has been reported failures as the outbreaks of the new serotype of SI were emerged in farms after vaccination and subsequently caused severe losses. In the present study, we attempted to develop effective DNA vaccines against SI infection using Nile tilapia (Oreochromis niloticus) as an animal model. Two monovalent DNA vaccines were constructed by the insertion of coding sequences of cell wall-associated virulence factors-encoding genes, comprised of eno (α-enolase) and mtsB (hydrophobic membrane protein), into cytomegalovirus expression vector (pCI-neo). In the animal trial, 30-g Nile tilapia were injected intramuscularly with 15 µg of each vaccine (mock vaccine group was injected by naked pCI-neo) and maintained for 35 days prior challenging with pathogenic SI at the dosage of 107 CFU/fish. At 13 days post-challenge, the relative percent survival of pEno, pMtsB and mock vaccine were 57%, 45% and 27%, respectively. The expression levels of immune responses-associated genes, namely, IL1β, TNF-α, TGF-β, COX2, IL-6, IL-12 and IL-13, were investigated from the spleen of experimental animal at 7 days post-vaccination (PV) and 7 days post-challenge (PC) using quantitative RT-PCR technique. Generally, at 7 days PV, the pEno vaccinated group exhibited highest level of up-regulation (1.7 to 2.9 folds) of every gene, but TGF-β, comparing to pMtsB and mock vaccine groups. However, at 7 days PC, pEno group showed significant up-regulation (1.4 to 8.5 folds) of immune-related genes as similar as mock vaccine group, while pMtsB group had lowest level of up-regulation (0.7 to 3.3 folds). Summarily, this study indicated that the pEno and pMtsB vaccines could elicit the immune responses of the fish and the magnitude of gene expression at 7 days PV was also consistent with the protection level conferred by the vaccine.Keywords: gene expression, DNA vaccine, Nile tilapia, Streptococcus iniae
Procedia PDF Downloads 3294512 Sparse Signal Restoration Algorithm Based on Piecewise Adaptive Backtracking Orthogonal Least Squares
Authors: Linyu Wang, Jiahui Ma, Jianhong Xiang, Hanyu Jiang
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the traditional greedy compressed sensing algorithm needs to know the signal sparsity when recovering the signal, but the signal sparsity in the practical application can not be obtained as a priori information, and the recovery accuracy is low, which does not meet the needs of practical application. To solve this problem, this paper puts forward Piecewise adaptive backtracking orthogonal least squares algorithm. The algorithm is divided into two stages. In the first stage, the sparsity pre-estimation strategy is adopted, which can quickly approach the real sparsity and reduce time consumption. In the second stage iteration, the correction strategy and adaptive step size are used to accurately estimate the sparsity, and the backtracking idea is introduced to improve the accuracy of signal recovery. Through experimental simulation, the algorithm can accurately recover the estimated signal with fewer iterations when the sparsity is unknown.Keywords: compressed sensing, greedy algorithm, least square method, adaptive reconstruction
Procedia PDF Downloads 1484511 Reducing Falls in Memory Care through Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Program
Authors: Cory B. Lord
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Falls among the elderly population has become an area of concern in healthcare today. The negative impacts of falls lead to increased morbidity, mortality, and financial burdens for both patients and healthcare systems. Falls in the United States is reported at an annual rate of 36 million in those aged 65 and older. Each year, one out of four people in this age group will suffer a fall, with 20% of these falls causing injury. The setting for this Doctor of Nursing Practice (DNP) project was a memory care unit in an assisted living community, as these facilities house cognitively impaired older adults. These communities lack fall prevention programs; therefore, the need exists to add to the body of knowledge to positively impact this population. The objective of this project was to reduce fall rates through the implementation of the Center for Disease Control and Prevention (CDC) STEADI (stopping elderly accidents, deaths, and injuries) program. The DNP project performed was a quality improvement pilot study with a pre and post-test design. This program was implemented in the memory care setting over 12 weeks. The project included an educational session for staff and a fall risk assessment with appropriate resident referrals. The three aims of the DNP project were to reduce fall rates among the elderly aged 65 and older who reside in the memory care unit, increase staff knowledge of STEADI fall prevention measures after an educational session, and assess the willingness of memory care unit staff to adopt an evidence-based a fall prevention program. The Donabedian model was used as a guiding conceptual framework for this quality improvement pilot study. The fall rate data for 12 months before the intervention was evaluated and compared to post-intervention fall rates. The educational session comprised of a pre and post-test to assess staff knowledge of the fall prevention program and the willingness of staff to adopt the fall prevention program. The overarching goal was to reduce falls in the elderly population who live in memory care units. The results of the study showed, on average that the fall rate during the implementation period of STEADI (μ=6.79) was significantly lower when compared to the prior 12 months (μ= 9.50) (p=0.02, α = 0.05). The mean staff knowledge scores improved from pretest (μ=77.74%) to post-test (μ=87.42%) (p=0.00, α= 0.05) after the education session. The results of the willingness to adopt a fall prevention program were scored at 100%. In summation, implementing the STEADI fall prevention program can assist in reducing fall rates for residents aged 65 and older who reside in a memory care setting.Keywords: dementia, elderly, falls, STEADI
Procedia PDF Downloads 1294510 Generation-Based Travel Decision Analysis in the Post-Pandemic Era
Authors: Hsuan Yu Lai, Hsuan Hsuan Chang
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The consumer decision process steps through problems by weighing evidence, examining alternatives, and choosing a decision path. Currently, the COVID 19 made the tourism industry encounter a huge challenge and suffer the biggest amount of economic loss. It would be very important to reexamine the decision-making process model, especially after the pandemic, and consider the differences among different generations. The tourism industry has been significantly impacted by the global outbreak of COVID-19, but as the pandemic subsides, the sector is recovering. This study addresses the scarcity of research on travel decision-making patterns among generations in Taiwan. Specifically targeting individuals who frequently traveled abroad before the pandemic, the study explores differences in decision-making at different stages post-outbreak. So this study investigates differences in travel decision-making among individuals from different generations during/after the COVID-19 pandemic and examines the moderating effects of social media usage and individuals' perception of health risks. The study hypotheses are “there are significant differences in the decision-making process including travel motivation, information searching preferences, and criteria for decision-making” and that social-media usage and health-risk perception would moderate the results of the previous study hypothesis. The X, Y, and Z generations are defined and categorized based on a literature review. The survey collected data including their social-economic background, travel behaviors, motivations, considerations for destinations, travel information searching preferences, and decision-making criteria before/after the pandemic based on the reviews of previous studies. Data from 656 online questionnaires were collected between January to May 2023 and from Taiwanese travel consumers who used to travel at least one time abroad before Covid-19. SPSS is used to analyze the data with One-Way ANOVA and Two-Way ANOVA. The analysis includes demand perception, information gathering, alternative comparison, purchase behavior, and post-travel experience sharing. Social media influence and perception of health risks are examined as moderating factors. The findings show that before the pandemic, the Y Generation preferred natural environments, while the X Generation favored historical and cultural sites compared to the Z Generation. However, after the outbreak, the Z Generation displayed a significant preference for entertainment activities. This study contributes to understanding changes in travel decision-making patterns following COVID-19 and the influence of social media and health risks. The findings have practical implications for the tourism industry.Keywords: consumer decision-making, generation study, health risk perception, post-pandemic era, social media
Procedia PDF Downloads 604509 China's Role in Promoting Regionalism in East Asia in Post-Maoist Era: An Analysis through Uneven and Combined Development
Authors: Ali Jibran
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China was considered as a revisionist state by the countries of East Asia during Maoist era; but China’s role changed from a revisionist state to a constructive member of East Asian Community in post-Maoist era. This research will mainly investigate the two phenomena: what were reasons of behavioral change of China in East Asia and what role has China played to promote regionalism in East Asia since Open Door Policy of Deng Xiaoping. To understand these two phenomena, this study applies the international relations theory of Uneven and Combined Development (U&CD). The central finding of this study is that ‘whip of external necessity’ posed by the Western dominance during the Chinese ‘century of ignominy’ resulted in a Maoist regime in China in 1948 which was hostile to its neighbors due to ideological tensions. Maoist regime in China could not solve the challenges posed by the ‘international’; therefore after Mao’s death, a new economic approach was introduced in China to deal with the challenges postured by the ‘international’. Due to Deng Xiaoping’s 'Open Door Policy' era, China used its ‘privilege of historic backwardness’ and witnessed unprecedented economic growth. As the societies are multiple and exist in real time, therefore interaction among societies is pertinent. Export oriented domestic policy pushed China to concentrate less on class struggle and improve its relations with its neighbors in East Asia. As China soon become a global hub of trade after market oriented reforms, therefore friendly relations with the states of East Asia was pertinent. This study will investigate Chinese role in regionalism in East Asia in three area: Chinese role in promoting regionalism in East Asia, China’s role in economic integration in East Asia and China’s role in combatting terrorism in East Asia. This study will be divided in two section. The first section will deal with the transformation in Chinese behavior in East Asia in post Maoist era, and the second section will analyze China’s role in East Asia by looking at Chinese role in institutional mechanism, economic integration and combatting terrorism in East Asia.Keywords: East Asia, regionalism, institutionlism, economic integration
Procedia PDF Downloads 3764508 The Effect of Reminiscence Therapy with Ethernet-Based Videos on Cognition and Apathy in Elderly with Mild Dementia
Authors: Ayse Inel Manav, Nuray Simsek
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The number of people with dementia and the problems that are experienced by these people are increasing along with aging world population. This study was carried out to assess the effects of reminiscence therapy using internet videos on the cognitive condition and apathy levels of elderly people who had mild dementia and lived in nursing homes. This randomly controlled experimental study was conducted between 25 May-25 August 2016 in the nursing home, elderly care and rehabilitation centers in Adana and Seyhan, Turkey. A total of 32 individuals participated in this study, 16 in the experimental group and 16 in the control group. Data were collected using a personal information form developed on the basis of the published literature, the Standardized Mini Mental Test (SMMT) and the Apathy Rating Scale (ARS). The Clinical Research Ethics Committee's approval, written institutional permission, and the written consent of the participants were obtained before data collection. The individuals in the experimental group received reminiscence therapy using internet videos for 60 minutes one day a week for three months. During the same period, 25-30 minutes of unstructured interviews on subjects unrelated to reminiscence were carried out with individuals in the control group. The SMMT and ARS were administered before the applications in the experimental group and at the end of the third month. The collected data were analyzed using descriptive statistics (means, standard deviations, and frequencies) as well as Student's t-test, the Mann-Whitney U-test, and Wilcoxon's signed ranks test. In this study, the total SMMT post-test scores of the experimental group were higher than those of the control group (p = 0.001; p < 0.01). There was a difference between experimental and control groups' total SMMT post-test scores (p = 0.001; p < 0.01). The experimental group's ARS total post-test scores were higher than those of the control group (p = 0.001; p < 0.01). This study found that group reminiscence therapy using internet videos improved the cognitive functions and apathy levels of elderly individuals with mild dementia.Keywords: apaty, cognitive testing, dementia, elderly, reminisence threapy
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