Search results for: dialectical behaviour therapy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3844

Search results for: dialectical behaviour therapy

1174 Lipidomic Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer

Authors: Patricia O. Carvalho, Marcia C. F. Messias, Salvador Sanchez Vinces, Caroline F. A. Gatinoni, Vitor P. Iordanu, Carlos A. R. Martinez

Abstract:

Lipidomics methods are widely used in the identification and validation of disease-specific biomarkers and therapy response evaluation. The present study aimed to identify a panel of potential lipid biomarkers to evaluate response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma (RAC). Liquid chromatography–mass spectrometry (LC-MS)-based untargeted lipidomic was used to profile human serum samples from patients with clinical stage T2 or T3 resectable RAC, after and before chemoradiotherapy treatment. A total of 28 blood plasma samples were collected from 14 patients with RAC who recruited at the São Francisco University Hospital (HUSF/USF). The study was approved by the ethics committee (CAAE 14958819.8.0000.5514). Univariate and multivariate statistical analyses were applied to explore dysregulated metabolic pathways using untargeted lipidic profiling and data mining approaches. A total of 36 statistically significant altered lipids were identified and the subsequent partial least-squares discriminant analysis model was both cross validated (R2, Q2) and permutated. Lisophosphatidyl-choline (LPC) plasmalogens containing palmitoleic and oleic acids, with high variable importance in projection score, showed a tendency to be lower after completion of chemoradiotherapy. Chemoradiotherapy seems to change plasmanyl-phospholipids levels, indicating that these lipids play an important role in the RAC pathogenesis.

Keywords: lipidomics, neoadjuvant chemoradiotherapy, plasmalogens, rectal adenocarcinoma

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1173 Ellagic Acid Enhanced Apoptotic Radiosensitivity via G1 Cell Cycle Arrest and γ-H2AX Foci Formation in HeLa Cells in vitro

Authors: V. R. Ahire, A. Kumar, B. N. Pandey, K. P. Mishra, G. R. Kulkarni

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Radiation therapy is an effective vital strategy used globally in the treatment of cervical cancer. However, radiation efficacy principally depends on the radiosensitivity of the tumor, and not all patient exhibit significant response to irradiation. A radiosensitive tumor is easier to cure than a radioresistant tumor which later advances to local recurrence and metastasis. Herbal polyphenols are gaining attention for exhibiting radiosensitization through various signaling. Current work focuses to study the radiosensitization effect of ellagic acid (EA), on HeLa cells. EA intermediated radiosensitization of HeLa cells was due to the induction γ-H2AX foci formation, G1 phase cell cycle arrest, and loss of reproductive potential, growth inhibition, drop in the mitochondrial membrane potential and protein expression studies that eventually induced apoptosis. Irradiation of HeLa in presence of EA (10 μM) to doses of 2 and 4 Gy γ-radiation produced marked tumor cytotoxicity. EA also demonstrated radio-protective effect on normal cell, NIH3T3 and aided recovery from the radiation damage. Our results advocate EA to be an effective adjuvant for improving cancer radiotherapy as it displays striking tumor cytotoxicity and reduced normal cell damage instigated by irradiation.

Keywords: apoptotic radiosensitivity, ellagic acid, mitochondrial potential, cell-cycle arrest

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1172 Experimental and Numerical Evaluation of a Shaft Failure Behaviour Using Three-Point Bending Test

Authors: Bernd Engel, Sara Salman Hassan Al-Maeeni

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A substantial amount of natural resources are nowadays consumed at a growing rate, as humans all over the world used materials obtained from the Earth. Machinery manufacturing industry is one of the major resource consumers on a global scale. Even though the incessant finding out of the new material, metals, and resources, it is urgent for the industry to develop methods to use the Earth's resources intelligently and more sustainable than before. Re-engineering of machine tools regarding design and failure analysis is an approach whereby out-of-date machines are upgraded and returned to useful life. To ensure the reliable future performance of the used machine components, it is essential to investigate the machine component failure through the material, design, and surface examinations. This paper presents an experimental approach aimed at inspecting the shaft of the rotary draw bending machine as a case to study. The testing methodology, which is based on the principle of the three-point bending test, allows assessing the shaft elastic behavior under loading. Furthermore, the shaft elastic characteristics include the maximum linear deflection, and maximum bending stress was determined by using an analytical approach and finite element (FE) analysis approach. In the end, the results were compared with the ones obtained by the experimental approach. In conclusion, it is seen that the measured bending deflection and bending stress were well close to the permissible design value. Therefore, the shaft can work in the second life cycle. However, based on previous surface tests conducted, the shaft needs surface treatments include re-carburizing and refining processes to ensure the reliable surface performance.

Keywords: deflection, FE analysis, shaft, stress, three-point bending

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1171 Patient’s Knowledge and Use of Sublingual Glyceryl Trinitrate Therapy in Taiping Hospital, Malaysia

Authors: Wan Azuati Wan Omar, Selva Rani John Jasudass, Siti Rohaiza Md. Saad

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Introduction & objective: The objectives of this study were to assess patient’s knowledge of appropriate sublingual glyceryl trinitrate (GTN) use as well as to investigate how patients commonly store and carry their sublingual GTN tablets. Methodology: This was a cross-sectional survey, using a validated researcher-administered questionnaire. The study involved cardiac patients receiving sublingual GTN attending the outpatient and inpatient departments of Taiping Hospital, a non-academic public care hospital. The minimum calculated sample size was 92, but 100 patients were conveniently sampled. Respondents were interviewed on 3 areas, including demographic data, knowledge and use of sublingual GTN. Eight items were used to calculate each subject’s knowledge score and six items were used to calculate use score. Results: Of the 96 patients who consented to participate, majority (96.9%) were well aware of the indication of sublingual GTN. With regards to the mechanism of action of sublingual GTN, 73 (76%) patients did not know how the medication works. Majority of the patients (66.7%) knew about the proper storage of the tablet. In relation to the maximum number of sublingual GTN tablets that can be taken during each angina episode, 36.5% did not know that up to 3 tablets of sublingual GTN can be taken during each episode of angina. Fifty four (56.2%) patients were not aware that they need to replace sublingual GTN every 8 weeks after receiving the tablets. Majority (69.8%) of the patients demonstrated lack of knowledge with regards to the use of sublingual GTN as prevention of chest pain. Conclusion: Overall, patients’ knowledge regarding the self administration of sublingual GTN is still inadequate. The findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use, storage and drug stability.

Keywords: glyceryl trinitrate, knowledge, adherence, patient education

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1170 Effect of Shape and Size of Concrete Specimen and Strength of Concrete Mixture in the Absence and Presence of Fiber

Authors: Sultan Husein Bayqra, Ali Mardani Aghabaglou, Zia Ahmad Faqiri, Hassane Amidou Ouedraogo

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In this study, the effect of shape and size of the concrete specimen on the compressive and splitting tensile strength of the concrete mixtures in the absence and presence of steel fiber was investigated. For this aim, ten different concrete mixtures having w/c ratio of 0.3, 0.4, 0.5, 0.6 and 0.7 with and without fiber were prepared. In the mixtures containing steel fibers having aspect ratio (L/D) of 64 were used by 1% of the total mixture volume. In all concrete mixtures, CEM I 42,5R type Portland cement and crushed Lime-stone aggregates having different aggregate size fractions were used. The combined aggregate was obtained by mixing %40 0-5 mm, %30 5-12 mm and %30 12-22 mm aggregate size fraction. The slump values of concrete mixtures were kept constant as 17 ± 2 cm. To provide the desired slump value, a polycarboxylate ether-based high range water reducing admixture was used. In order to investigate the effect of size and shape of concrete specimen on strength properties 10 cm, 15 cm cubic specimens and 10×20 cm, 15×30 cm cylindrical specimens were prepared for each mixture. The specimens were cured under standard conditions until testing days. The 7- and 28-day compressive and splitting tensile strengths of mixtures were determined. The results obtained from the experimental study showed that the strength ratio between the cylinder and the cube specimens increased with the increase of the strength of the concrete. Regardless of the fiber utilization and specimen shape, strength values of concrete mixtures were increased by decreasing specimen size. However, the mentioned behaviour was not observed for the case that the mixtures having high W/C ratio and containing fiber. The compressive strength of cube specimens containing fiber was less affected by the size of the specimen compared to that of cube specimens containing no fibers.

Keywords: compressive strength, splitting tensile strength, fiber reinforced concrete, size effect, shape effect

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1169 Modelling of Pipe Jacked Twin Tunnels in a Very Soft Clay

Authors: Hojjat Mohammadi, Randall Divito, Gary J. E. Kramer

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Tunnelling and pipe jacking in very soft soils (fat clays), even with an Earth Pressure Balance tunnel boring machine (EPBM), can cause large ground displacements. In this study, the short-term and long-term ground and tunnel response is predicted for twin, pipe-jacked EPBM 3 meter diameter tunnels with a narrow pillar width. Initial modelling indicated complete closure of the annulus gap at the tail shield onto the centrifugally cast, glass-fiber-reinforced, polymer mortar jacking pipe (FRP). Numerical modelling was employed to simulate the excavation and support installation sequence, examine the ground response during excavation, confirm the adequacy of the pillar width and check the structural adequacy of the installed pipe. In the numerical models, Mohr-Coulomb constitutive model with the effect of unloading was adopted for the fat clays, while for the bedrock layer, the generalized Hoek-Brown was employed. The numerical models considered explicit excavation sequences and different levels of ground convergence prior to support installation. The well-studied excavation sequences made the analysis possible for this study on a very soft clay, otherwise, obtaining the convergency in the numerical analysis would be impossible. The predicted results indicate that the ground displacements around the tunnel and its effect on the pipe would be acceptable despite predictions of large zones of plastic behaviour around the tunnels and within the entire pillar between them due to excavation-induced ground movements.

Keywords: finite element modeling (FEM), pipe-jacked tunneling, very soft clay, EPBM

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1168 Beyond Informality: Relocation from a Traditional Village 'Mit Oqbah' to Masaken El-Barageel and the Role of ‘Urf in Governing Built Environment, Egypt

Authors: Sarah Eldefrawi, Maike Didero

Abstract:

In Egypt, residents’ urban interventions (colloquially named A’hali’s interventions) are always tackled by government, scholars, and media as an encroachment (taeadiyat), chaotic (a’shwa’i) or informal (gheir mokanan) practices. This paper argues that those interventions cannot be simply described as an encroachment on public space or chaotic behaviour. We claim here that they are relevant to traditional governing methods (‘Urf) that were governing Arab cities for many decades. Through an in-depth field study conducted in a real estate public housing project in the city of Giza called 'Masaken El-Barageel', we traced the urban transformations demonstrated in private and public spaces. To understand those transformations, we used wide-range of qualitative research methods such as semi-guided and informal interviews, observations and mapping of the built environment and the newly added interventions. This study was as well strengthened through the contributions of the author in studying nine sectors emerging by Ahali in six districts in Great Cairo. The results of this study indicate that a culturally and socially sensitive framework has to be related to the individual actions toward the spatial and social structures as well as to culturally transmitted views and meanings connected with 'Urf'. The study could trace three crucial principals in ‘urf that influenced these interventions; the eliminating of harm (Al-Marafiq wa Man’ al-Darar), the appropriation of space (Haqq el-Intefa’) and public interest (maslaha a’ma). Our findings open the discussion for the (il) legitimate of a’hali governing methods in contemporary cities.

Keywords: Urf, urban governance, public space, public housing, encroachments, chaotic, Egyptian cities

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1167 Clinical Signs of River Blindness and the Efficacy of Ivermectin Therapy in Idogun, Ondo State-Nigeria

Authors: Afolabi O.J, Simon-Oke I.A., Oniya M.O., Okaka C.E.

Abstract:

River blindness is a skin, and an eye disease caused by Onchocerca volvulus and vectored by a female hematophagous blackfly. The study aims to evaluate the distribution of the clinical signs of river blindness and the efficacy of ivermectin in the treatment of river blindness in Idogun. Observational studies in epidemiology that involve the use of a structured questionnaire to obtain useful epidemiological information from the respondents, physical assessment via palpation from head to ankle was used to assess clinical signs from the respondents and skin snip test was used to evaluate the prevalence of the disease. The efficacy of the drug was evaluated and expressed in percentages. One hundred and ninety-two (192) out of the 384 respondents examined, showed various signs of river blindness. However, it was only 108 (28.1%) respondents with the clinical signs that demonstrated Onchocerca volvulus microfilariae in their skin snips. The clinical signs observed among the respondents include skin depigmentation such as dermatitis, leopard skin, papules, pruritus and self-inflicted injury, while ocular symptoms include cataract, ocular lesion and partial blindness. Among these clinical signs, papules, and pruritus were the most dominant in the community. The prevalence of the clinical signs was observed to vary significantly among the age groups and gender (P<0.05). The efficacy of the drug after 6 and 12 months of treatments shows that the drug is more effective at age groups 10-50 years than the age groups 51-90 years. Ivermectin is observed to be efficacious in the treatment of the disease. However, to achieve eradication of the disease, the drug may be administered at 0.15mg/kg twice a year.

Keywords: riverblindness, clinical signs, ivermectin, Idogun

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1166 Evaluation of Postural Stability in Patients with Flat Feet: A Controlled Trial

Authors: Ghada Mohamed Rashad, Doaa Ayoub Elimy, Mohamed Hussein Elgendy, Ahmed Mohamed Fathi Elshiwi, Mahmoud Ghazy

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Background: Flat feet cause changes in foot mobility, foot posture, and load distribution under the foot which influences dynamic balance, that is essential in activities of daily living and for optimal performance in sports activity. Purpose: To investigate the effect of flat feet on dynamic balance including overall stability index (OAI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI). Study Design: The design of the study was an experimental design. Subjects: Forty subjects from both sexes were selected from the Faculty of Physical Therapy, Cairo University, their mean age (23.55 ± 1.74 ) years, divided into two groups, group A (8 males and 12 females) with flat feet, and group B (9 males and 11 females) with normal feet. Methods: The Navicular Drop Test was used to determine if the feet were pronated and Biodex Balance System was used to assess dynamic balance at level 8 and level 4 for both groups. Results: There was no significant difference in dynamic balance including (OSI, APSI and MLSI) of the Biodex at stability level (8) (most stable) (p = 0.56). While there was a significant difference between both groups in all dependent variables at stability level (4) (less stable level) (p = 0.0001). Conclusion: It may be concluded that flat feet have an effect on dynamic balance and there is balance affection in subjects with flat feet.

Keywords: flat feet, dynamic balance, postural stability, types of flat feet, eversion strength

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1165 Visual Speech Perception of Arabic Emphatics

Authors: Maha Saliba Foster

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Speech perception has been recognized as a bi-sensory process involving the auditory and visual channels. Compared to the auditory modality, the contribution of the visual signal to speech perception is not very well understood. Studying how the visual modality affects speech recognition can have pedagogical implications in second language learning, as well as clinical application in speech therapy. The current investigation explores the potential effect of speech visual cues on the perception of Arabic emphatics (AEs). The corpus consists of 36 minimal pairs each containing two contrasting consonants, an AE versus a non-emphatic (NE). Movies of four Lebanese speakers were edited to allow perceivers to have partial view of facial regions: lips only, lips-cheeks, lips-chin, lips-cheeks-chin, lips-cheeks-chin-neck. In the absence of any auditory information and relying solely on visual speech, perceivers were above chance at correctly identifying AEs or NEs across vowel contexts; moreover, the models were able to predict the probability of perceivers’ accuracy in identifying some of the COIs produced by certain speakers; additionally, results showed an overlap between the measurements selected by the computer and those selected by human perceivers. The lack of significant face effect on the perception of AEs seems to point to the lips, present in all of the videos, as the most important and often sufficient facial feature for emphasis recognition. Future investigations will aim at refining the analyses of visual cues used by perceivers by using Principal Component Analysis and including time evolution of facial feature measurements.

Keywords: Arabic emphatics, machine learning, speech perception, visual speech perception

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1164 Crossing Multi-Source Climate Data to Estimate the Effects of Climate Change on Evapotranspiration Data: Application to the French Central Region

Authors: Bensaid A., Mostephaoui T., Nedjai R.

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Climatic factors are the subject of considerable research, both methodologically and instrumentally. Under the effect of climate change, the approach to climate parameters with precision remains one of the main objectives of the scientific community. This is from the perspective of assessing climate change and its repercussions on humans and the environment. However, many regions of the world suffer from a severe lack of reliable instruments that can make up for this deficit. Alternatively, the use of empirical methods becomes the only way to assess certain parameters that can act as climate indicators. Several scientific methods are used for the evaluation of evapotranspiration which leads to its evaluation either directly at the level of the climatic stations or by empirical methods. All these methods make a point approach and, in no case, allow the spatial variation of this parameter. We, therefore, propose in this paper the use of three sources of information (network of weather stations of Meteo France, World Databases, and Moodis satellite images) to evaluate spatial evapotranspiration (ETP) using the Turc method. This first step will reflect the degree of relevance of the indirect (satellite) methods and their generalization to sites without stations. The spatial variation representation of this parameter using the geographical information system (GIS) accounts for the heterogeneity of the behaviour of this parameter. This heterogeneity is due to the influence of site morphological factors and will make it possible to appreciate the role of certain topographic and hydrological parameters. A phase of predicting the evolution over the medium and long term of evapotranspiration under the effect of climate change by the application of the Intergovernmental Panel on Climate Change (IPCC) scenarios gives a realistic overview as to the contribution of aquatic systems to the scale of the region.

Keywords: climate change, ETP, MODIS, GIEC scenarios

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1163 Statistical Modelling of Maximum Temperature in Rwanda Using Extreme Value Analysis

Authors: Emmanuel Iyamuremye, Edouard Singirankabo, Alexis Habineza, Yunvirusaba Nelson

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Temperature is one of the most important climatic factors for crop production. However, severe temperatures cause drought, feverish and cold spells that have various consequences for human life, agriculture, and the environment in general. It is necessary to provide reliable information related to the incidents and the probability of such extreme events occurring. In the 21st century, the world faces a huge number of threats, especially from climate change, due to global warming and environmental degradation. The rise in temperature has a direct effect on the decrease in rainfall. This has an impact on crop growth and development, which in turn decreases crop yield and quality. Countries that are heavily dependent on agriculture use to suffer a lot and need to take preventive steps to overcome these challenges. The main objective of this study is to model the statistical behaviour of extreme maximum temperature values in Rwanda. To achieve such an objective, the daily temperature data spanned the period from January 2000 to December 2017 recorded at nine weather stations collected from the Rwanda Meteorological Agency were used. The two methods, namely the block maxima (BM) method and the Peaks Over Threshold (POT), were applied to model and analyse extreme temperature. Model parameters were estimated, while the extreme temperature return periods and confidence intervals were predicted. The model fit suggests Gumbel and Beta distributions to be the most appropriate models for the annual maximum of daily temperature. The results show that the temperature will continue to increase, as shown by estimated return levels.

Keywords: climate change, global warming, extreme value theory, rwanda, temperature, generalised extreme value distribution, generalised pareto distribution

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1162 Cultural Psychology in Sports: How Understanding Culture May Help Sports Psychologists Augment Athletic Performance

Authors: Upasana Ranjib

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Sports psychology, as a niche area, has, since the last two decades, found for itself a space within the outer peripheries of the discipline of traditional psychology. It has aimed to understand the many variables that push athletes to enhance their performances. While sociological aspects have been duly represented in academia, little has been written about the role of culture in shaping the psyche of athletes. The impact that cultures of different communities and societies have towards specifics like gender, castes, religion and race and how that helps evolve an individual has not been fully addressed. In the case of Sport, culture has made itself felt in the form of stereotypes, traditional outlooks towards sects and its implication on the engagement with sports. Culture is an environment that an individual imbibes. It is what shapes him, physically as well as mentally. Their nurture and nature both stem from it and depend on it. To realize the linkages between their nurture, nature and sports efficiency, cultural studies must collaborate in scholarship with psychology and practical sports. Cultural sports psychology would allow sports psychologists, coaches and even athletes themselves to understand the behavioural variations that affect their performance. The variations in the performance of athletes from different cultures and countries could be attributed to their socio-political, economic and environmental differences. These cultural influences shape and impact the athlete's behaviour and might lead as a gateway to understanding their skill sets and internal motivational factors. With that knowledge in mind, this paper aims to understand and reflect on how, in the present times of heavy sporting competition, shifting cultural equations and changing world dynamics, it is mandatory to infuse Cultural Studies with Sports Psychology to understand how Sports Psychologists can help and augment the performances of athletes.

Keywords: sporting performance, Asian sports, sports psychology, cultural psychology, society

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1161 Effect of a Mindfulness Application on Graduate Nursing Student’s Stress and Anxiety

Authors: Susan K. Steele-Moses, Aimee Badeaux

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Background Literature: Nurse anesthesia education placed high demands on students both personally and professionally. High levels of anxiety affect student’s mental, emotional, and physical well-being, which impacts their student success. Whereas more research has focused on the health and well-being of graduate students, far less has focused specifically on nurse anesthesia students (SNRAs), who may experience higher levels of anxiety due to the rigor of their academic program. Current literature describes stressors experienced by SRNAs that cause anxiety and affect their performance, including personal, academic, clinical, interpersonal, emotional, and financial. Sample: DNP-NA 2025 and DNP-NA 2024 cohorts (N = 36). Eighteen (66.7%) students participated in the study. Instrumentation: The DASS-21 was used to measure stress (7 items; α = .87) and anxiety (7 items; α = .74) from the participants. Intervention: The mind-shift meditation app, based on cognitive behavioral therapy, is being used daily before clinical and exams to decrease nurse anesthesia students’ stress and anxiety over time. Results: At baseline, the students exhibited a moderate level of stress, but their anxiety levels were low. The range of scores was 4-21 (out of 28) for stress (M = 12.88; SD = 5.40) and 0-16 (out of 28) for anxiety (M = 6.81; SD = 5.04). Both stress and anxiety were normally distributed [SW = .242 (stress); SW = .210 (anxiety)] without any outliers. There was a significant difference between their stress and anxiety levels (t = 5.55; p < .001) at baseline. Stress and anxiety will be measured over time, with the change analyzed using repeated measures ANOVA. Implications for Practice: The use of purposeful mindfulness meditation has been shown to decrease stress and anxiety in nursing students.

Keywords: mindfulness, meditation, graduate nursing education, nursing education

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1160 Effects of Progressive Resistive Exercise on Isometric Strength of Shoulder Extensor and Abductor Muscles in Adult Hemiplegic

Authors: S. Abbasi, M. R. Hadian, M. Abdolvahab, M. Jalili, S. H. Jalaei

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Background: Rehabilitation treatments have significant role in reducing the disabilities of Cerebro Vascular Accident (CVA). Due to great role of upper limb in the function of individuals particularly in Activity of Daily Living and the effect of stability of shoulder girdle on hand function, the aim of this study was to study the effects of Progressive Resistive Exercise on shoulder extensor and abductor muscles isometric strengths in adult hemiplegic. Methods: 17 adult hemiplegics patients (50-70 yrs., mean 60/52, SD7/22); with RT side dominancy and 6 months after stroke, participated in this study. All procedures were approved by ethical committee of TUMS and written consents were also taken. Patients were familiarized with the procedure and shoulder extensor and abductor muscles isometric strengths were measured by dynamometer. Results: according to result to our study, shoulder extensor and abductor muscles isometric strengths showed Significant differences between mean scores of pre and post intervention (P<0/05). Progressive Resistive Exercise improved 34% shoulder extensor muscles isometric strength and 27% shoulder abductor muscle isometric strength. Conclusion: Results of our research showed that progressive resistive exercise approach is a useful method for increasing the isometric strength of shoulder extensor and abductor muscles. Therefore, it might be concluded that improvement of strength of shoulder muscles could result in stability in shoulder girdle and consequently might effect on hand function in hemiplegic patients.

Keywords: shoulder extensor muscles isometric strength, shoulder abductor muscles isometric strength, hemiplegic, physical therapy

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1159 Risk Tolerance in Youth With Emerging Mood Disorders

Authors: Ange Weinrabe, James Tran, Ian B. Hickie

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Risk-taking behaviour is common during youth. In the time between adolescence and early adulthood, young people (aged 15-25 years) are more vulnerable to mood disorders, such as anxiety and depression. What impact does an emerging mood disorder have on decision-making in youth at critical decision points in their lives? In this article, we explore the impact of risk and ambiguity on youth decision-making in a clinical setting using a well-known economic experiment. At two time points, separated by six to eight weeks, we measured risky and ambiguous choices concurrently with findings from three psychological questionnaires, the 10-item Kessler Psychological Distress Scale (K10), the 17-item Quick Inventory of Depressive Symptomatology Adolescent Version (QIDS-A17), and the 12-item Somatic and Psychological Health Report (SPHERE-12), for young help seekers aged 16-25 (n=30, mean age 19.22 years, 19 males). When first arriving for care, we found that 50% (n=15) of participants experienced severe anxiety (K10 ≥ 30) and were severely depressed (QIDS-A17 ≥ 16). In Session 2, taking attrition rates into account (n=5), we found that 44% (n=11) remained severe across the full battery of questionnaires. When applying multiple regression analyses of the pooled sample of observations (N=55), across both sessions, we found that participants who rated severely anxious avoided making risky decisions. We suggest there is some statistically significant (although weak) (p=0.09) relation between risk and severe anxiety scores as measured by K10. Our findings may support working with novel tools with which to evaluate youth experiencing an emerging mood disorder and their cognitive capacities influencing decision-making.

Keywords: anxiety, decision-making, risk, adolescence

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1158 The Relationship between Self-Care Behaviour and Quality of Life Among Heart Failure Patients in Jakarta, Indonesia

Authors: Shedy Maharani Nariswari, Prima Agustia Nova, I. Made Kariasa

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Background. Heart Failure (HF) is a chronic and progressive condition associated with significant morbidity, mortality, health care expenditures, and a high readmission rate over the years. Self‐care is essential to manage chronic heart failure in the long term, and it is related to better outcomes and can enhance the quality of life. Objective. The aims of this study were to describe the relationship between self-care behavior and quality of life among heart failure patients in East Jakarta, Indonesia. Methods. This study used a correlational-descriptive design with a cross-sectional study, the sampling method used purposive sampling method. Self-care was measured using Self-care Heart Failure Index version 6.2, and quality of life was measured using The Minnesota Living with Heart Failure. Pearson correlation and Spearman-rho correlations are used to analyze the data. Results. We recruited 103 patients with HF in both outpatient and inpatient ward: mean age 59.26 ± 11.643 years, 63.1% male. Patients with higher levels of education were associated with higher self-care maintenance (p= 0.007). The patient's average quality of life is quite high, with a score of 72,07 ± 16,89. There were a significant relationship among self-care maintenance (r=0,305, p=0,001), self-care management (r=0,330, p=0,001), and self-care confidence (r=0,335, p=0,001) towards the quality of life. Most participants have inadequate self-care maintenance, self-care management, and self-care confidence (score < 70), while the score of quality of life is categorized as poor. Conclusion. The self-care behaviors were limited among patients living with HF in Indonesia yet was associated with better quality of life. It is necessary to promote health related to knowledge and adherence to self-care behavior so that it can improve the quality of life of heart failure patients. This study can be used as a reference to promote self-care among patients with heart failure, it can help to enhance their quality of life.

Keywords: heart failure, self-care maintenance, self-care management, self-care confidence, quality of life

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1157 Challenges That People with Autism and Caregivers Face in Public Environments

Authors: Andrei Pomana, Graham Brewer

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Autism is a lifelong developmental disorder that affects verbal and non-verbal communication, behaviour and sensory processing. As a result, people on the autism spectrum have a difficult time when confronted with environments that have high levels of sensory stimulation. This is often compounded by the inability to properly communicate their wants and needs to caregivers. The capacity for people with autism to integrate depends on their ability to at least tolerate highly stimulating public environments for short periods of time. The overall challenges that people on the spectrum and their caregivers face need to be established in order to properly create and assess methods to mitigate the effects of high stimulus public spaces. The paper aims to identify the challenges that people on the autism spectrum and their caregivers face in typical public environments. Nine experienced autism therapists have participated in a semi-structured interview regarding the challenges that people with autism and their caregivers face in public environments. The qualitative data shows that the unpredictability of events and the high sensory stimulation present in public environments, especially auditory, are the two biggest contributors to the difficulties that people on the spectrum face. If the stimuli are not removed in a short period of time, uncontrollable behaviours or 'meltdowns' can occur, which leave the person incapacitated and unable to respond to any outside input. Possible solutions to increase integration in public spaces for people with autism revolve around removing unwanted sensory stimulus, creating personalized barriers for certain stimuli, equipping people with autism with better tools to communicate their needs or to orient themselves to a safe location and providing a predictable pattern of events that would prepare individuals for tasks ahead of time.

Keywords: autism, built environment, meltdown, public environment, sensory processing disorders

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1156 COVID-19: The Cause or the Confounder

Authors: Praveenkumar Natarajan

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A 59-year-old male with no known co-morbidities was admitted to a private hospital for complaints of fever and cough and was diagnosed to haveCOVID-19. CT of the thorax revealed the involvement of 50% of the lungs. Screening ECG and ECHO were normal. The patient was treated with oxygen therapy and drugs and was discharged after 12 days of admission. Post-discharge, the patient remained symptom-free and continued his work. After one month, the patient developed a fever for three days, for which he took antipyretics. Subsequently, the patient developed sudden onset breathlessness, which rapidly progressed to grade 4 NYHA, and developed a cough as well. Suspecting COVID-19 reinfection, the patient visited a nearby hospital, where COVID–19 rt-PCR swabs turned out to be positive, and was referred to our hospital. On receiving, the patient had diffuse lung crepitations and a diastolic murmur in the neo-aortic area. CT thorax revealed pulmonary edema with areas of consolidation. ECHO revealed vegetation on the aortic valve with severe aortic regurgitation. Blood cultures were taken, which revealed the growth of Enterococcus faecalis. The diagnosis of infective endocarditis was made, and the patient was started on appropriate treatment. COVID–19 has effects on various systems, including the cardiovascular system. Even though infective endocarditis is common in the elderly with valvular heart disease, this patient had developed infective endocarditis in an apparently normal aortic valve. Infective endocarditis and COVID–19 can have similar presentations leading to diagnostic difficulties. COVID–19, affecting the heart valves causing valvulitis and predisposing them to the development of infective endocarditis, is also an area to be explored.

Keywords: aortic regurgitation, COVID-19, infective endocarditis, valvulitis

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1155 Estimated Human Absorbed Dose of 111 In-BPAMD as a New Bone-Seeking Spect-Imaging Agent

Authors: H. Yousefnia, S. Zolghadri

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An early diagnosis of bone metastases is very important for providing a profound decision on a subsequent therapy. A prerequisite for the clinical application of new diagnostic radiopharmaceutical is the measurement of organ radiation exposure dose from biodistribution data in animals. In this study, the dosimetric studies of a novel agent for SPECT-imaging of bone methastases, 111In-(4-{[(bis(phosphonomethyl))carbamoyl]methyl}-7,10-bis(carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid (111In-BPAMD) complex, have been estimated in human organs based on mice data. The radiolabeled complex was prepared with high radiochemical purity at the optimal conditions. Biodistribution studies of the complex were investigated in male Syrian mice at selected times after injection (2, 4, 24 and 48 h). The human absorbed dose estimation of the complex was performed based on mice data by the radiation absorbed dose assessment resource (RADAR) method. 111In-BPAMD complex was prepared with high radiochemical purity >95% (ITLC) and specific activities of 2.85 TBq/mmol. Total body effective absorbed dose for 111In-BPAMD was 0.205 mSv/MBq. This value is comparable to the other 111In clinically used complexes. The results show that the dose to critical organs the complex is well within the acceptable considered range for diagnostic nuclear medicine procedures. Generally, 111In-BPAMD has interesting characteristics and can be considered as a viable agent for SPECT-imaging of the bone metastases in the near future.

Keywords: In-111, BPAMD, absorbed dose, RADAR

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1154 Treatment Outcome of Cutaneous Leishmaniasis and Its Associated Factors among Admitted Patients in All Africa Leprosy Rehabilitation and Training Center Hospital, Ethiopia

Authors: Kebede Mairie, Getahun Belete, Mitike Abeba

Abstract:

Background: Leishmania aethiopica is a peculiar parasite causing cutaneous leishmaniasis in Ethiopia and its mainstay treatment is Sodium Stibogluconate. However, its treatment outcome in Ethiopia is not well documented. Objectives: To determine the treatment outcome of admitted cutaneous leishmaniasis patients and its associated factors in Addis Ababa, Ethiopia. Methods: A retrospective study was conducted from 1st November 2021 to 30th March 2022. Medical records of all cutaneous leishmaniasis-diagnosed and admitted patients who received parenteral sodium stibogluconate at All Africa Leprosy Rehabilitation and Training Center (ALERT) hospital, the main Leishmania treatment center in Ethiopia from July 2011 to September 2021 were reviewed. Results: A total of 827 charts of admitted cases from July 2011 to September 2021 were retrieved, but 667 (80.65%) were reviewed. Improvement in the treatment outcome was recorded in 93.36 % in the first course of SSG treatment and 96.23%, 94.62%, and 96.97% subsequently in the second, third and fourth treatment courses, respectively. Female gender and diffuse cutaneous leishmaniasis were the two predictive determinants in the treatment of cutaneous leishmaniasis. Conclusion: The study shows that parenteral sodium stibogluconate therapy treats hospitalized cutaneous leishmaniasis patients well, with female gender and diffuse cutaneous leishmaniasis having poor outcomes suggesting the need for a different approach for diffuse cutaneous leishmaniasis patients.

Keywords: cutaneous leishmaniasis, leishmania aethiopica, sodium stibogluconate, diffuse cutaneous leishmaniasis, pentostam

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1153 Resistin Mediates Tomato and Broccoli Extracts Effects on Glucose Homeostasis in High Fat Diet Induced Obesity in Rats

Authors: N. M. Aborehab, M. Helmy, N. E. Waly

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Resistin was identified as an adipocyte hormone that participates in regulation of glucose metabolism. Elevated levels of Resistin are postulated to cause insulin resistance. This may link obesity, and increased fat mass to type II diabetes and insulin resistance. We hypothesized that tomato and broccoli extract treatment regulates glucose homeostasis via modulation of resistin levels in high fat diet induced obesity rats (HFD). 63 male albino rats were divided into 8 groups as follows: control, HFD, stop fat diet (SD), Tomato 200 mg/kg (T200), Tomato 400mg/kg (T400), Broccoli 200 mg/kg (B200), Broccoli 400 mg/kg (B400), Chromax (CX). Treatment continued for 1 month. Serum levels of resistin, leptin, adiponectin, glucose and insulin were measured using ELISA, and spectrophotometry. Serum level of resistin was significantly reduced in T 200, T 400, B 200, B 400 and CX groups to: 4.13 ± 0.22 ng/ml, 1.51 ± 0.04 ng/ml, 4.13 ± 0.22 ng/ml, 2.32 ± 0.15 ng/ml and 1.37 ± 0.03 ng/ml respectively compared to HFD group and SD group (P value < 0.0001). Non-significant difference was found between T 400, B 400 and CX groups. Mean serum level of leptin was significantly reduced in T 400 (22.7 ± 0.84 Pg/ml) group compared to B 400 (41 ± 2.45 Pg/ml) and CX groups (45.7 ± 2.91 Pg/ml), P value < 0.001.The mean serum level of adiponectin was significantly increased in T 400 group (131 ± 3.84 Pg/ml) compared to CX group (112 ± 4.77 Pg/ml), P value was < 0.01. Our results demonstrate that tomato and broccoli extract treatment regulates glucose homeostasis via reduction of serum resistin and may be a useful non-pharmacological therapy for obesity. Further studies are required to assess the potential use of these extract as a treatment for type II diabetes and obesity.

Keywords: broccoli, obesity, resistin, tomato

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1152 Adult Health Outcomes of Childhood Self-Control and Social Disadvantage in the United Kingdom

Authors: Michael Daly

Abstract:

Background/Aims: The interplay of childhood self-control and early life social background in predicting adult health is currently unclear. We drew on rich data from two large nationally representative cohort studies to test whether individual differences in childhood self-control may: (i) buffer the health impact of social disadvantage, (ii) act as a mediating pathway underlying the emergence of health disparities, or (iii) compensate for the health consequences of socioeconomic disadvantage across the lifespan. Methods: We examined data from over 25,000 participants from the British Cohort Study (BCS) and the National Child Development Study (NCDS). Child self-control was teacher-rated at age 10 in the BCS and ages 7/11 in the NCDS. The Early life social disadvantage was indexed using measures of parental education, occupational prestige, and housing characteristics (i.e. housing tenure, home crowding). A range of health outcomes was examined: the presence of chronic conditions, whether illnesses were limiting, physiological dysregulation (gauged by clinical indicators), mortality, and perceptions of pain, psychological distress, and general health. Results: Childhood self-control and social disadvantage predicted each measure of adult health, with similar strength on average. An examination of mediating factors showed that adult smoking, obesity, and socioeconomic status explained the majority of these linkages. There was no systematic evidence that self-control moderated the health consequences of early social disadvantage and limited evidence that self-control acted as a key pathway from disadvantage to later health. Conclusions: Childhood self-control predicts adult health and may compensate for early life social disadvantage by shaping adult health behaviour and social status.

Keywords: personality and health, social disadvantage, health psychology, life-course development

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1151 Regulating Nanocarrier and Mononuclear Phagocyte System Interactions through Esomeprazole-Based Preconditioning Strategy

Authors: Zakia Belhadj, Bing He, Hua Zhang, Xueqing Wang, Wenbing Dai, Qiang Zhang

Abstract:

Mononuclear phagocyte system (MPS) forms an abominable obstacle hampering the tumor delivery efficiency of nanoparticles. Passively targeted nanocarriers have received clinical approval over the past 20 years. However, none of the actively targeted nanocarriers have entered clinical trials. Thus it is important to endue effective targeting ability to actively targeted approaches by overcoming biological barriers to nanoparticle drug delivery. Here, it presents that an Esomeprazole-based preconditioning strategy for regulating nanocarrier-MPS interaction to substantially prolong circulation time and enhance tumor targeting of nanoparticles. In vitro, the clinically approved proton pump inhibitor Esomeprazole “ESO” was demonstrated to reduce interactions between macrophages and subsequently injected targeted vesicles by interfering with their lysosomal trafficking. Of note, in vivo studies demonstrated that ESO pretreatment greatly decreased the liver and spleen uptake of c(RGDm7)-modified vesicles, highly enhanced their tumor accumulation, thereby provided superior therapeutic efficacy of c(RGDm7)-modified vesicles co-loaded with Doxorubicin (DOX) and Gefitinib (GE). This MPS-preconditioning strategy using ESO provides deeper insights into regulating nanoparticles interaction with the phagocytic system and enhancing their cancer cells' accessibility for anticancer therapy.

Keywords: esomeprazole (ESO), mononuclear phagocyte system (MPS), preconditioning strategy, targeted lipid vesicles

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1150 Metabolome-based Profiling of African Baobab Fruit (Adansonia Digitata L.) Using a Multiplex Approach of MS and NMR Techniques in Relation to Its Biological Activity

Authors: Marwa T. Badawy, Alaa F. Bakr, Nesrine Hegazi, Mohamed A. Farag, Ahmed Abdellatif

Abstract:

Diabetes Mellitus (DM) is a chronic disease affecting a large population worldwide. Africa is rich in native medicinal plants with myriad health benefits, though less explored towards the development of specific drug therapy as in diabetes. This study aims to determine the in vivo antidiabetic potential of the well-reported and traditionally used fruits of Baobab (Adansonia digitata L.) using STZ induced diabetic model. The in-vitro cytotoxic and antioxidant properties were examined using MTT assay on L-929 fibroblast cells and DPPH antioxidant assays, respectively. The extract showed minimal cytotoxicity with an IC50 value of 105.7 µg/mL. Histopathological and immunohistochemical investigations showed the hepatoprotective and the renoprotective effects of A. digitata fruits’ extract, implying its protective effects against diabetes complications. These findings were further supported by biochemical assays, which showed that i.p., injection of a low dose (150 mg/kg) of A. digitata twice a week lowered the fasting blood glucose levels, lipid profile, hepatic and renal markers. For a comprehensive overview of extract metabolites composition, ultrahigh performance (UHPLC) analysis coupled to high-resolution tandem mass spectrometry (HRMS/MS) in synchronization with molecular networks led to the annotation of 77 metabolites, among which 50% are reported for the first time in A. digitata fruits.

Keywords: adansonia digital, diabetes mellitus, metabolomics, streptozotocin, Sprague, dawley rats

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1149 Electrochemical/Electro-Catalytic Applications of Novel Alcohol Substituted Metallophthalocyanines

Authors: Ipek Gunay, Efe B. Orman, Metin Ozer, Bekir Salih, Ali R. Ozkaya

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Phthalocyanines with macrocyclic ring containing at least three heteroatoms have nine or more membered structures. Metal-free phthalocyanines react with metal salts to obtain chelate complexes. This is one of the most important features of metal-free phthalocyanine as ligand structure. Although phthalocyanines have very similar properties with porphyrins, they have some advantages such as lower cost, easy to prepare, and chemical and thermal stability. It’s known that Pc compounds have shown one-electron metal-and/or ligand-based reversible or quasi-reversible reduction and oxidation processes. The redox properties of phthalocyanines are critically related to the desirable properties of these compounds in their technological applications. Thus, Pc complexes have also been receiving increasing interest in the area of fuel cells due to their high electrocatalytic activity in dioxygen reduction and fuel cell applications. In this study, novel phthalocyanine complexes coordinated with Fe(II) and Co (II) to be used as catalyst were synthesized. Aiming this goal, a new nitrile ligand was synthesized starting from 4-hydroxy-3,5-dimethoxy benzyl alcohol and 4-nitrophthalonitrile in the presence of K2CO3 as catalyst. After the isolation of the new type of nitrile and metal complexes, the characterization of mentioned compounds was achieved by IR, H-NMR and UV-vis methods. In addition, the electrochemical behaviour of Pc complexes was identified by cyclic voltammetry, square wave voltammetry and in situ spectroelectrochemical measurements. Furthermore, the catalytic performances of Pc complexes for oxygen reduction were tested by dynamic voltammetry measurements, carried out by the combined system of rotating ring-disk electrode and potentiostat, in a medium similar to fuel-cell working conditions.

Keywords: phthalocyanine, electrocatalysis, electrochemistry, in-situ spectroelectrochemistry

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1148 Bedouin Dialects: Language Use and Identity Perceptions of Bedouin-Speaking University Students in North-Western Saudi Arabia and Implications for Language Vitality

Authors: Hend Albalawi

Abstract:

Amid the dynamic use of the Arabic language worldwide, Saudi Arabia employs Modern Standard Arabic (MSA) as its formal, official language, whereas other dialects of Arabic are common in informal situations. Such trends not only maintain the powerful, state-supported status of MSA but are liable to also affect the use and status of other varieties, including Bedouin dialects, and prompt code-mixing behaviour among their speakers. Exposure to MSA and English in education in Saudi Arabia may also be liable to reduce the vitality of Bedouin dialects in the country, particularly among current generations of educated Bedouin speakers. Therefore, the proposed research will involve examining the perceived vitality of Bedouin dialects in Saudi language policies prescribing MSA as the official national language of Saudi Arabia and requiring university students to complete English-language coursework in the national education system. It will also entail identifying Bedouin speakers’ attitudes towards the use of Bedouin dialects in order to assess the need, if any, to implement policies in Saudi Arabia that can enhance the use of those dialects amid the competing use of MSA and English in the country. Empirical data collected from questionnaires and semi-structured interviews that purport patterns of the everyday use of languages among Bedouin-speaking university students in Tabuk, as well as the content of language policy documents, can clarify whether policy-based pressure to use MSA and English in mainstream educational and social activities in Saudi Arabia has jeopardised the language vitality of Bedouin dialects in north-west Saudi Arabia. The findings of the research can thus ultimately contribute to the development of policies to support and enhance the use of Bedouin dialects and, in turn, their language vitality.

Keywords: attitudes, Bedouin dialects, language policy, vitality

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1147 Clinical Outcomes and Surgical Complications in Patients with Cervical Disk Degeneration

Authors: Mirzashahi Babak, Mansouri Pejman, Najafi Arvin, Farzan Mahmoud

Abstract:

Introduction: There are several surgical treatment choices for cervical spondylotic myelopathy (CSM). The aim of this study is to evaluate clinical outcomes and surgical complications in patients with cervical disk degeneration (CDD) undergoing either anterior cervical discectomy with or without fusion or cervical laminectomy and fusion. Methods: This prospective case series study included 45 consecutive patients with cervical spondylotic myelopathy between January 2010 and November 2014. There were 28 males and 17 females, with a mean age of 47 (range 37-68) years. The mean clinical follow-up was 14 months (range 3-24 months). The Neck Disability Index (NDI), visual analog scale (VAS) neck and arm pain, Short Form-36 (SF-36) were used as the functional outcome measurements. All of the complications in our patients were recorded. Results: In our study group, 26 patients underwent only one or two level anterior cervical discectomy. Ten patients underwent anterior cervical discectomy and fusion (ACDF) and nine cases underwent posterior laminectomy and fusion. We have found a statistically significant improvement between mean preoperative (29, range 19-43) and postoperative (7, range 0-12) NDI scores following surgery (P < 0.05). Also, there was a statistically significant difference between pre and post-operative VAS and SF-36 score (p < 0.05). There was a 7% overall complication rate (n = 3). The only complication in our patients was surgical site cellulitis which has been managed with oral antibiotic therapy. Conclusion: Both anterior cervical discectomy with or without fusion or posterior laminectomy and fusion are safe and efficacious treatment options for the management of CSM. The clinical outcomes seem to be fairly reproducible.

Keywords: cervical, myelopathy, discectomy, fusion, laminectomy

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1146 Culturally Responsive School Leadership in Indigenous Schools in Malaysia

Authors: Nalini Murugaiyah

Abstract:

Indigenous students require a positive school environment where meaningful learning ought to be there to minimise myriad challenges. Therefore, Orang Asli student’s school environment should be culturally responsive and equipped with student-centred activities or provide constructively designed curriculum and pedagogy. This study sought to extend the knowledge of culturally responsive school leadership practises which relevant and responsive to Orang Asli students through th lens of a theoretical framework, Culturally Responsive School Leadership. The aim of the proposed study is to examine and understand the real-world application of leadership practices that are relevant and responsive to Orang Asli students in Malaysia. This study will also include the often-voiceless voices’ of Orang Asli students, parents, and community leaders to gain a deeper understanding of the process and experience of engaging in culturally responsive school leadership. The study will explore the differences between school leaders, teachers, parents, and community leaders in relation to culturally responsive school environment, non-Orang Asli school leaders’ and teachers’ support to the needs of Orang Asli children, children’s perspectives of teachers’ practices in the classroom align with their culture; and, the demonstration of teacher’s culturally responsive behaviour in the classroom. A basic qualitative study is the proposed research design for this study, and the data is collected through semi-structured interviews and focus group interviews. This qualitative research is designed to gain in-depth knowledge about how the principal’s leadership is culturally responsive towards the school environment, which will improve the quality of education received by the Orang Asli community in Malaysia, hence reducing the drop-out rates in Orang Asli students.

Keywords: indigenous leadership, equity, inclusion, policy

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1145 Erectile Dysfunction among Bangladeshi Men with Diabetes

Authors: Shahjada Selim

Abstract:

Background: Erectile dysfunction (ED) is an important impediment to quality of life of men. ED is approximate, three times more common in diabetic than non-diabetic men, and diabetic men develop ED earlier than age-matched non-diabetic subjects. Glycemic control and other factors may contribute in developing and or deteriorating ED. Aim: The aim of the study was to determine the prevalence of ED and its risk factors in type 2 diabetic (T2DM) men in Bangladesh. Methods: During 2013-2014, 3980 diabetic men aged 30-69 years were interviewed at the out-patient departments of seven diabetic centers in Dhaka by using the validated Bengali version of the questionnaire of the International index of erectile function (IIEF) for evaluation of baseline erectile function (EF). The indexes indicate a very high correlation between the items and the questionnaire is consistently reliable. Data were analyzed with Chi-squared (χ²) test using SPSS software. P ≤ 0.05 was considered significant. Results: Out of 3790, ED was found in 2046 (53.98%) of T2DM men. The prevalence of ED was increased with age from 10.5% in men aged 30-39 years to 33.6% in those aged over 60 years (P < 0.001). In comparison with patients with reported diabetes lasting ≤ 5 years (26.4%), the prevalence of ED was less than in those with diabetes of 6-11 years (35.3%) and of 12-30 years (42.5%, P <0.001). ED increased significantly in those who had poor glycemic control. The prevalence of ED in patients with good, fair and poor glycemic control was 22.8%, 42.5% and 47.9% respectively (P = 0.004). Treatment modalities (medical nutrition therapy, oral agents, insulin, and insulin plus oral agents) had significant association with ED and its severity (P < 0.001). Conclusion: Prevalence of ED is very high among T2DM men in Bangladesh and can be reduced the burden by improving glycemic status. Glycemic control, duration of diabetes, treatment modalities, increasing age are associated with ED.

Keywords: erectile dysfunction, diabetes, men, Bangladesh

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