Search results for: Kristin Petrovic

Authors: Jennifer Stephens, Nichole Parker, Kristin Petrovic

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To gain a better understanding of how students enrolled in a Bachelor of Nursing (BN) program are educated, faculty members in the BN program at Athabasca University (AU) in Alberta, Canada, developed a 3-phase comprehensive curriculum review project. Phase one of this review centered around hiring an external curriculum expert to examine and analyze the current curriculum and to propose recommendations focused on identifying gaps as well as building on strengths towards meeting changing health care trends. Phase two incorporated extensive institutional document analysis as well as qualitative and quantitative data collection in reciprocated critical reflection and has yielded insights into valuable processes, challenges, and solutions inherent to the complexities of undertaking curriculum review and analysis. Results of our phase one and two analysis generated a quality improvement (QI) template that could benefit other nursing education programs engaged in curriculum review and analysis. The key processes, lessons, and insights, as well as future project phase three plans, will be presented for iterative discussion and role modelling for other institutions undergoing, or planning, content-based curriculum review and evaluation.

Keywords: curriculum, education, nursing, nursing faculty practice, quality improvement

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Authors: Miljan B. Petrović, Dušan B. Petrović, Goran S. Nikolić

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This paper describes a method for AWGN (Additive White Gaussian Noise) variance estimation in noisy stochastic signals, referred to as Multiplicative-Noising Variance Estimation (MNVE). The aim was to develop an estimation algorithm with minimal number of assumptions on the original signal structure. The provided MATLAB simulation and results analysis of the method applied on speech signals showed more accuracy than standardized AR (autoregressive) modeling noise estimation technique. In addition, great performance was observed on very low signal-to-noise ratios, which in general represents the worst case scenario for signal denoising methods. High execution time appears to be the only disadvantage of MNVE. After close examination of all the observed features of the proposed algorithm, it was concluded it is worth of exploring and that with some further adjustments and improvements can be enviably powerful.

Keywords: noise, signal-to-noise ratio, stochastic signals, variance estimation

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Authors: B. Petrović, M. Petrović, L. Rutonjski, I. Djan, V. Ivanović

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Objective: Cardiac pacemakers are very sensitive to radiotherapy treatment from two sources: electromagnetic influence from the medical linear accelerator producing ionizing radiation- influencing electronics within the pacemaker, and the absorption of dose to the device. On the other hand, patients with cardiac pacemakers at the place of a tumor are rather rare, and single clinic hardly has experience with the management of such patients. The widely accepted international guidelines for management of radiation oncology patients recommend that these patients should be closely monitored and examined before, during and after radiotherapy treatment by cardiologist, and their device and condition followed up. The number of patients having both cancer and pacemaker, is growing every year, as both cancer incidence, as well as cardiac diseases incidence, are inevitably growing figures. Materials and methods: Female patient, age 69, was diagnozed with valvular cardiomyopathy and got implanted a pacemaker in 2005 and prosthetic mitral valve in 1993 (cancer was diagnosed in 2012). She was stable cardiologically and came to radiation therapy department with the diagnosis of right breast cancer, with the tumor in upper lateral quadrant of the right breast. Since she had all lymph nodes positive (28 in total), she had to have irradiated the supraclavicular region, as well as the breast with the tumor bed. She previously received chemotherapy, approved by the cardiologist. The patient was estimated to be with the high risk as device was within the field of irradiation, and the patient had high dependence on her pacemaker. The radiation therapy plan was conducted as 3D conformal therapy. The delineated target was breast with supraclavicular region, where the pacemaker was actually placed, with the addition of a pacemaker as organ at risk, to estimate the dose to the device and its components as recommended, and the breast. The targets received both 50 Gy in 25 fractions (where 20% of a pacemaker received 50 Gy, and 60% of a device received 40 Gy). The electrode to the heart received between 1 Gy and 50 Gy. Verification of dose planned and delivered was performed. Results: Evaluation of the patient status according to the guidelines and especially evaluation of all associated risks to the patient during treatment was done. Patient was irradiated by prescribed dose and followed up for the whole year, with no symptoms of failure of the pacemaker device during, or after treatment in follow up period. The functionality of a device was estimated to be unchanged, according to the parameters (electrode impedance and battery energy). Conclusion: Patient was closely monitored according to published guidelines during irradiation and afterwards. Pacemaker irradiated with the full dose did not show any signs of failure despite recommendations data, but in correlation with other published data.

Keywords: cardiac pacemaker, breast cancer, radiotherapy treatment planning, complications of treatment

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Authors: Marina Kljaković-Gašpić Batinjan, Tea Petrović, Frano Vučković, Irzal Hadžibegović, Barbara Radovani, Ivana Jurin, Lovorka Đerek, Eva Huljev, Alemka Markotić, Ivica Lukšić, Irena Trbojević-Akmačić, Gordan Lauc, Ivan Gudelj, Rok Čivljak

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Immunoglobulin G has essential role in defense against infectious diseases, but its role cannot be fully recognized without understanding of changes in its N-glycans attached to the Fc domain. We analyzed and compared total IgG glycome in plasma samples of patients with influenza, patients with COVID-19 and healthy controls. We found similarities in IgG glycosylation changes in COVID-19 survivors and influenza patients that could be the consequence of adequate immune response to enveloped viruses, while observed changes in deceased COVID-19 patients may indicate its deviation.

Keywords: COVID-19, glycosylation, immunoglobulin G, influenza, pneumonia, viral infection

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Authors: P. M. Ikonić, T. A. Tasić, L. S. Petrović, S. B. Škaljac, M. R. Jokanović, V. M. Tomović, B. V. Šojić, N. R. Džinić, A. M. Torbica, B. B. Ikonić

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The aim of the study was to determine how different ripening processes (traditional vs. industrial) influenced the proteolysis in traditional Serbian dry-fermented sausage Petrovská klobása. The obtained results indicated more intensive pH decline (0.7 units after 9 days) in industrially ripened products (I), what had a positive impact on drying process and proteolytic changes in these samples. Thus, moisture content in I sausages was lower at each sampling time, amounting 24.7% at the end of production period (90 days). Likewise, the process of proteolysis was more pronounced in I samples, resulting in higher contents of non-protein nitrogen (NPN) and free amino acids nitrogen (FAAN), as well as in faster and more intensive degradation of myosin (≈220 kDa), actin (≈45 kDa) and other polypeptides during processing. Consequently, the appearance and accumulation of several protein fragments were registered.

Keywords: dry-fermented sausage, Petrovská klobása, proteolysis, ripening process

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Authors: Jovana Petrović, Ivana Lončarević, Vesna Tumbas Šaponjac, Biljana Pajin, Danica Zarić

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Pomace, a by-product from fruit processing industry is the potential source of valuable bioactive. Cookies are popular, ready to eat and low price foods; therefore, enrichment of these products is of great importance. In this work, bioactive compounds extracted from cherry pomace, encapsulated in soy and whey proteins, have been incorporated in cookies, replacing 10 (SP10 and WP10) and 15% of wheat flour (SP15 and WP15). Cookie geometry (diameter (D), thickness (T) and spread ratio (D/T)), cookie weight, cookie hardness and cookie surface colour were measured. Sensory characteristics are also examined. The results show that encapsulated cherry pomace bioactives have positively influenced the cookie mass. Diameter, redness (a* value) and cookie hardness increased. Sensory evaluation of cookies, revealed that up to 15% substitution of wheat flour with WP encapsulate produced acceptable cookies similar to the control (100% wheat flour) cookies.

Keywords: cherry pomace, polyphenols, microencapsulation, cookies, physical characteristics

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Authors: Vladimir M. Tomović, Branislav V. Šojić, Predrag M. Ikonić, Ljiljana S. Petrović, Anamarija I. Mandić, Natalija R. Džinić, Snežana B. Škaljac, Tatjana A. Tasić, Marija R. Jokanović

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In this paper influence of packaging method (vacuum and modified atmosphere packaging) on lipid oxidative stability and sensory properties of odor and taste of the traditional sausage Petrovská klobása were examined. These parameters were examined during storage period (7 months). In the end of storage period, vacuum packed sausage showed better oxidative stability. Propanal content was significantly lower (P<0.05) in vacuum packed sausage compared to these values in unpacked and modified atmosphere packaging sausage. Hexanal content in vacuum packed sausage was 1.85 µg/g, in MAP sausage 2.98 µg/g and in unpacked sausage 4.94 µg/g. After 2 and 7 months of storage, sausages packed in vacuum had the highest grades for sensory properties of odor and taste.

Keywords: lipid oxidation, MAP, sensory properties, traditional sausage, vacuum

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Authors: A. Mandić, M. Sakač, A. Mišan, B. Šojić, L. Petrović, I. Lončarević, B. Pajin, I. Sedej

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Aldehydes as secondary lipid oxidation products are highly specific to the oxidative degradation of particular polyunsaturated fatty acids present in foods. Gas chromatographic analysis of those volatile compounds has been widely used for monitoring of the deterioration of food products. Developed static headspace gas chromatography method using flame ionization detector (SHS GC FID) was applied to monitor the aldehydes present in processed foods such as bakery, meat and confectionary products. Five selected aldehydes were determined in samples without any sample preparation, except grinding for bakery and meat products. SHS–GC analysis allows the separation of propanal, pentanal, hexanal, heptanal and octanal, within 15min. Aldehydes were quantified in fresh and stored samples, and the obtained range of aldehydes in crackers was 1.62±0.05-9.95±0.05mg/kg, in sausages 6.62±0.46-39.16±0.39mg/kg; and in cocoa spread cream 0.48±0.01-1.13±0.02mg/kg. Referring to the obtained results, the following can be concluded, proposed method is suitable for different types of samples, content of aldehydes varies depending on the type of a sample, and differs in fresh and stored samples of the same type.

Keywords: lipid oxidation, aldehydes, crackers, sausage, cocoa cream spread

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Authors: Shailendra Natraj, Kristin Paetzold, B. R. Katzy

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The significant role of technology in strategic business decisions has created the need for executives who understand technology and recognize profitable applications to products, services and processes. The role of CTO’s is very complex within technology-based firms, which stretches from the technology aspects to the strategic goal and vision of the firm. Often the roles of CTOs scales from as functional leaders, strategic leaders or supera- functional leaders. In most of the companies the roles are unclear and fuzzy. We in our research are trying to explore each of the orientation and link between leadership types (functional, strategic and super functional) of CTOs, responsibilities, credibility and strategic and conceptual responsibilities. Approach: We conducted a comprehensive literature review with the available databank sources. Results: From the conducted literature review we could identify that most of the research work conducted so far were mainly distributed between roles and responsibilities of CTOs. The available sources pointed were limited to roles of CTOs as functional leaders. Contribution: In our findings based on the literature review, we could identify that apart from the conducted research what so far has not been focused yet are (a) The leadership types (mainly) strategic and super-functional leaders) of CTOs, (b) the responsibilities and credibility of CTOs and (c) the strategic and conceptual responsibilities of CTOs.

Keywords: CTO, chief technology officer, strategy, technology leaders

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Authors: Kristin Murray

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The proposed paper exams prologues in 20th and 21st century American literature in order to show how Native American writer Tommy Orange’s Prologue in his 2018 novel There, Thereis different. In an interview about his 2018 novel There, There, explains he feels “a kind of burden to catch the general reader up with what really happened, because history has got it so wrong and still continue to” (Laubernds). Orange, thus, includes a “Prologue” in his novel to do this work, catching readers upon Native Americans and their history. Prologues are usually from the narrator’s voice, a character’s voice, or even from a fictionalized version of the author, but the tone of Orange’s “Prologue” is that of a non-fictional first-person essayist. Examining prologues in American literature posits Orange’s prologue outside the norm. This paper also examines other introductory sections, the preface, in particular. The research and examination reveal that Orange is adding his personal voice in the Prologue to the multiple narratorsof the novel, and his is the voice of a writer who knows that his audience comes to his novel with a plethora of misinformation. The truths he tells are horrifying and hopeful. He tells of Thanksgiving as a “land deal” and a “successful massacre,” but he also tellsreaders how urban Indians have found a sense of the land, even through concrete. Native American writers contributed and still contribute to the genre of autobiography in ways that have changed our understanding of this genre. This examination of Orange’s Prologue reveals the new and unexpected way to view this often under-examined introductory section, the prologue.

Keywords: native american literature, prologues, prefaces, 20th century american literature

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Authors: Kathleen Cooney, Jennifer Coates, Lesley Leach, Kristin Hrenchir

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The objective of this retrospective study was to determine whether intrarenal injection of pentobarbital sodium is a practicable method of euthanasia in client-owned cats. 131 Cats were anesthetized using a combination of tiletamine, zolazepam, and acepromazine given by of subcutaneous or intramuscular injection. Once an appropriate plane of anesthesia was reached, 6 ml of pentobarbital sodium was injected into either the left or right kidney. The patient’s age, sex, estimated weight, presenting condition, estimated dehydration level, palpable characteristics of the kidney pre and post injection, physical response of the cat, and time to cardiopulmonary arrest were recorded. Analysis of 131 records revealed that cats receiving an intrarenal injection of pentobarbital sodium had an average time to cardiopulmonary arrest of 1 minute. The great majority (79%) experienced cardiopulmonary arrest in less than one minute with the remainder experiencing cardiopulmonary arrest between 1 and 8 minutes of the injection. 95% of cats had no observable reaction to intrarenal injection other than cardiopulmonary arrest. In the 19% of cases where kidney swelling was not palpable upon injection, average time to cardiopulmonary arrest increased from 0.9 to 1.6 min. Conclusions and Clinical Relevance: Intrarenal injections of pentobarbital sodium are similar in effect to intravenous methods of euthanasia. Veterinarians who elect to use intrarenal injections can expect cardiopulmonary arrest to occur quickly in the majority of patients with few agonal reactions. Intrarenal injection of pentobarbital sodium in anesthetized cats has ideally suited for cases of owner observed euthanasia when obtaining intravenous access would difficult or disruptive.

Keywords: euthanasia, injection, intrarenal, pentobarbital sodium

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Authors: Ting Wang, Pierre Marle, Vera I. Slaveykova, Kristin Schirmer, Wei Liu

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Metal-based nanoparticles (NPs) are considered detrimental to aquatic organisms due to their potential accumulation. However, little is known about the mechanisms underlying these effects and their species-specificity. Here, we used stable silver (Ag) NPs (20 nm, from 10 to 500 μg/L) with a low dissolution rate (≤2.4%) to study the bioaccumulation and biological impacts in two freshwater gastropods: Lymnaea stagnalis and Planorbarius corneus. No mortality was detected during the experiments. Ag bioaccumulation showed a dose-related increase with an enhanced concentration in both species after 7d exposure. L. stagnalis displayed a higher accumulation for AgNPs than P. corneus (e.g., up to 18- and 15-fold in hepatopancreas and hemolymph, respectively), which could be due to the more active L. stagnalis having greater contact with suspended AgNPs. Furthermore, the hepatopancreas and stomach were preferred organs for bioaccumulation compared to the kidney, mantle and foot. Regarding biological responses, the hemolymph rather than hepatopancreas appeared more susceptible to oxidative stress elicited by AgNPs, as shown by significantly increasing lipid peroxidation (i.e., formation of malondialdehyde). Neurotoxicity was detected in L. stagnalis when exposed to high concentrations (500 μg/L). Comparison with impacts elicited by dissolved Ag revealed that the effects observed on AgNPs exposure were mainly attributable to NPs. These results highlighted the relationship between the physiological traits, bioaccumulation, and toxicity responses of these two species to AgNPs and demonstrated the necessity of species-specificity considerations when assessing the toxicity of NPs.

Keywords: nanotoxicity, freshwater gastropods, species-specificity, metals, physiological traits

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Authors: Michael R. Taber, Kristin Stanec

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This paper presents year-two of a longitudinal study on implementing Possibility Books into undergraduate courses to develop a student's creativity mindset: tolerating ambiguity, willingness to risk failure, curiosity, and openness to embrace possibility thinking through unexpected connections. Courses involved in this research span disciplines in the natural and social sciences and the humanities. Year one of the project developed indices from which baseline data could be analyzed. The two significant indices ( > 0.7) were "creativity mindset" and "intentional interactions." Preliminary qualitative and quantitative data analysis indicated that students found the new pedagogical intervention as a safe space to learn new strategies, recognize patterns, and define structures through innovative notetaking forms. Possibility Books in Natural Science courses were designed to develop students' conceptualization of science and math. Using Possibility Books in all disciplines provided a space for students to practice divergent thinking (i.e.,Possibilities), convergent thinking (i.e., forms that express meaning), and risk-taking (i.e., the vulnerability associated with expression). Qualitative coding of open responses on a post-survey revealed two major themes: 1) Possibility Books provided a mind space for learning about self, and 2) provided a calming opportunity to connect concepts. Quantitative analysis indicated significant correlations between focused headspace and notetaking (r = 0.555, p < 0.001), focused headspace, and connecting with others (r = 0.405, p < 0.001).

Keywords: pedagogy, science education, learning methods, creativity mindsets

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Authors: Signe Voltelen, Kristin Astrup Aas

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In the Scandinavian cities, there is a raised focus on the potential of using urban agriculture in city development, both as a tool for handling challenges provoked by climate change and to develop new, and stronger social communities. During the last couple of years, Copenhagen has experienced an increase in extreme weather resulting in dramatical floods with huge humanitarian and economic consequences. As an approach for climate adaption and mitigation the government has made a strategy for changing a significant amount of the cities hard surfaces into green and absorbing surfaces. Including urban farms and gardens. In close collaboration with the municipality, it has been possible to implement citizen-run gardens under the different concepts climate adaption and food literacy. Like other European cities, Copenhagen has a historical tradition of small-scale farming for food security inside the city, and in the outskirts of the urban area. Lately, this tradition has gotten new relevance, and new initiatives are popping up. In addition to providing local food, the urban farm becomes a semi-public, semi-private room that invites to community and integration across ethnicity, social background, and age. The direct interaction in the process of farming creates a connection between the urban and the rural and are educational for people growing up and living their whole life in the dense city. In the paper, three local example models of urban agriculture are presented, and the experiences of their potential as tools for developing social and environmental sustainable cities is examined.

Keywords: city development, climate mitigation, community building, urban agriculture, urban- rural transition, food security

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Authors: Salve Alessandria Alcantara, John Armand E. Aquino, Ma. Veronica Aranda, Nikki Francine Balde, Angeli Therese F. Cruz, Elise Danielle Garcia, Antonie Kyna Lim, Divina Gracia Lucero, Nikolai Thadeus Mappatao, Maylan N. Ocat, Jamille Dyanne L. Pajarillo, Jane Mierial A. Pesigan, Grace Kristin Viva, Jasmine Arielle C. Yap, Kathleen Michelle T. Yu, Joanna J. Orejola, Joanna V. Toralba

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Lead is a neurotoxic metallic element that is slowly accumulated in bones and tissues especially if present in products taken in a regular basis such as herbal tea supplements. Although sensitive analytical instruments are already available, the USP limit test for lead is still widely used. However, because of its serious shortcomings, Lang Lang and his colleagues developed a spectrophotometric method for determination of lead in all types of samples. This method was the one adapted in this study. The actual procedure performed was divided into three parts: digestion, extraction and analysis. For digestion, HNO3 and CH3COOH were used. Afterwards, masking agents, 0.003% and 0.001% dithizone in CHCl3 were added and used for the extraction. For the analysis, standard addition method and colorimetry were performed. This was done in triplicates under two conditions. The 1st condition, using 25µg/mL of standard, resulted to very low absorbances with an r2 of 0.551. This led to the use of a higher concentration, 1mg/mL, for condition 2. Precipitation of lead cyanide was observed and the absorbance readings were relatively higher but between 0.15-0.25, resulting to a very low r2 of 0.429. LOQ and LOD were not computed due to the limitations of the Milton-Roy Spectrophotometer. The method performed has a shorter digestion time, and used less but more accessible reagents. However, the optimum ratio of dithizone-lead complex must be observed in order to obtain reliable results while exploring other concentration of standards.

Keywords: herbal tea supplement, lead-dithizone complex, standard addition, visible spectroscopy

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Authors: Slavica P. Petrovic

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One of the key dimensions of management problems in organizations refers to the relations between stakeholders. The management problems that are characterized by conflict and coercion, in which participants do not agree on the ends and means, in which different groups, i.e., individuals, strive to – using the power they have – impose on others their favoured strategy and decisions represent the relevant research subject. Creatively managing the coercive problems in organizations, in which the sources of power can be identified, implies the emancipatory paradigm and the use of corresponding systems methodology. The main research aim is to critically reassess the theoretical foundations and methodological and methodical development of Critical Systems Heuristics (CSH) – as a valid representative of the emancipatory paradigm – in order to determine the conditions, ways, and achievements of its application in managing the coercive problems in organizations. The basic hypothesis is that CSH, as the emancipatory methodology, given its own theoretical foundations and methodological-methodical development, can be employed in a scientifically based and practically useful manner in creative addressing the coercive problems. The scientific instrumentarium corresponding to this research aim is critical systems thinking with its three key commitments to: a) Critical awareness of the strengths and weaknesses of each research instrument (theory, methodology, method, technique, model) for structuring the problem situations in organizations, b) Improvement of managing the coercive problems in organizations, and c) Pluralism – respect the different perceptions and interpretations of problem situations, and enable the combined use of research instruments. The relevant research result is that CSH – considering its theoretical foundations, methodological and methodical development – enables to reveal the normative content of the proposed or existing designs of organizational systems. Accordingly, it can be concluded that through the use of critically heuristic categories and dialectical debate between those involved and those affected by the designs, but who are not included in designing organizational systems, CSH endeavours to – in the application – support the process of improving position of all stakeholders.

Keywords: coercion and conflict in organizations, creative management, critical systems heuristics, the emancipatory systems methodology

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Authors: Kristin Drexler

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Climate change has exacerbated food and livelihood insecurity for Mayan milpa farmers in Central America. For centuries, milpa farming has been sustainable for subsistence; however, in the last 50 years, milpas have become less reliable due to accelerating climate change, resource degradation, declining markets, poverty, and other factors. Using interviews with extension leaders and milpa farmers in Belize, this qualitative study examines the capacity for increasing climate-smart agriculture (CSA) aspects of existing traditional milpa practices, specifically no-burn mulching, soil enrichment, and the use of cover plants. Applying community capitals and socio-ecological systems frameworks, this study finds four key capitals were perceived by farmers and agriculture extension leaders as barriers for increasing CSA practices: (1) human-capacity, (2) financial, (3) infrastructure, and (4) governance-justice capitals. The key barriers include a lack of CSA technology and pest management knowledge-sharing (human-capacity), unreliable roads and utility services (infrastructure), the closure of small markets and crop-buying programs in Belize (financial), and constraints on extension services and exacerbating a sense of marginalization in Maya communities (governance-justice). Recommendations are presented for government action to reduce barriers and facilitate an increase in milpa crop productivity, promote food and livelihood security, and enable climate resilience of Mayan milpa communities in Belize.

Keywords: socio-ecological systems, community capitals, climate-smart agriculture, food security, milpa, Belize

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Authors: Jovana Petrovic, Biljana Pajin, Ivana Loncarevic, Aleksandar Fistes, Antun Jozinivic, Durdica Ackar, Drago Subaric

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Recovery of food wastes and their conversion to economically viable products will play a vital role for the management strategies in the years to come. Apple pomace may be considered as wastes, but they contain considerable amounts of high value reusable materials. Apple pomace, the by-product of apple juice and cider production, is a good source of fibre, particularly insoluble one. The remaining apple pulp contains 12% dry residue, which is half dietary fibre. Another remarkable aspect is its richness in polyphenols, components with antioxidant activity. Apple pomace could be an interesting alternative source for fibre and polyphenols in extruded corn meals. The extruded corn meals with the addition of finely ground apple pomace were prepared (the ratio of corn meal: apple pomace was 85:15 and 70:30). Characterization of the extrudates in terms of determining the chemical composition and colour was performed. The color of samples was measured by MINOLTA Chroma Meter CR-400 (Minolta Co., Ltd., Osaka, Japan) using D 65 lighting, a 2º standard observer angle and an 8-mm aperture in the measuring head. The following CIELab color coordinates were determined: L* – lightness, a* – redness to greenness and b* – yellowness to blueness. Protein content decreased significantly from 7.91% to 5.19% with increase in pomace from 0% to 30%, while total fibre content increase from 3.39% to 16.62%. The apple pomace addition produced extrudates with a significantly lower L* value and significantly higher a* value. This study has been fully supported by the Provincial Secretariat for High Education and Scientific Research of the Government of Autonomous Province of Vojvodina, Republic of Serbia, project 142-451-2483/2017 and the Ministry of Science and Technological Development of the Republic of Serbia (Project no. 31014).

Keywords: apple pomace, chemical composition, colour, extruded corn snack products, food waste recovery

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Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić

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Radiotherapy treatment planning computers use CT data of the patient. For the computation of a treatment plan, treatment planning system must have an information on electron densities of tissues scanned by CT. This information is given by the conversion curve CT (CT number) to ED (electron density), or simply calibration curve. Every treatment planning system (TPS) has built in default CT to ED conversion curves, for the CTs of different manufacturers. However, it is always recommended to verify the CT to ED conversion curve before actual clinical use. Objective of this study was to check how the default curve already provided matches the curve actually measured on a specific CT, and how much it influences the calculation of a treatment planning computer. The examined CT scanners were from the same manufacturer, but four different scanners from three generations. The measurements of all calibration curves were done with the dedicated phantom CIRS 062M Electron Density Phantom. The phantom was scanned, and according to real HU values read at the CT console computer, CT to ED conversion curves were generated for different materials, for same tube voltage 140 kV. Another phantom, CIRS Thorax 002 LFC which represents an average human torso in proportion, density and two-dimensional structure, was used for verification. The treatment planning was done on CT slices of scanned CIRS LFC 002 phantom, for selected cases. Interest points were set in the lungs, and in the spinal cord, and doses recorded in TPS. The overall calculated treatment times for four scanners and default scanner did not differ more than 0.8%. Overall interest point dose in bone differed max 0.6% while for single fields was maximum 2.7% (lateral field). Overall interest point dose in lungs differed max 1.1% while for single fields was maximum 2.6% (lateral field). It is known that user should verify the CT to ED conversion curve, but often, developing countries are facing lack of QA equipment, and often use default data provided. We have concluded that the CT to ED curves obtained differ in certain points of a curve, generally in the region of higher densities. This influences the treatment planning result which is not significant, but definitely does make difference in the calculated dose.

Keywords: Computation of treatment plan, conversion curve, radiotherapy, electron density

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Authors: Kristin Lewis, Howard Steele, Anne Murphy, Miriam Steele, Karen Bonuck, Paul Meissner

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The present study examines data collected during the randomized control trial (RCT) of the Group Attachment-Based Intervention (GABI©), a trauma-informed, attachment-based intervention aimed at promoting healthy parent-child relationships that support child development. Families received treatment at Treatment Center and were randomly assigned to either the GABI condition or the treatment as usual condition, a parenting class called Systematic Training for Effective Parenting (STEP). Significant improvements in the parent-child relationship have been reported for families participating in GABI, but not in the STEP control group relying on Coding Interactive Behavior (CIB) as applied to 5-minute video-films of mothers and their toddlers in a free play context. This report considers five additional attachment-relevant 'clinical codes' that were also applied to the 5-minute free play sessions. Seventy-two parent-child dyads (38 in GABI and 34 in STEP) were compared to one another at intake and end-of-treatment, on these five-point dimensions: two-parent codes—the dissociation and ignoring; two child codes—simultaneous display of contradictory behavior and fear; and one parent-child code, i.e., role reversal. Overall, scores were low for these clinical codes; thus, a binary measure was computed contrasting no evidence with some evidence of each clinical code. Crosstab analyses indicate that child fear at end-of-treatment was significantly lower among children who participated in GABI (7% or 3 children) as compared to those whose mothers participated in STEP (29% or 10 children) Chi Sq= 6.57 (1), p < .01. Discussion focuses on the potential for GABI to reduce childhood fearfulness and so enhance the child's health.

Keywords: coding interactive behavior, clinical codes, group attachment based intervention, GABI, attachment, fear

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Authors: Thomas F. Ducey, Kristin M. Trippe, James A. Ippolito, Jeffrey M. Novak, Mark G. Johnson, Gilbert C. Sigua

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The Oronogo-Duenweg mining belt –approximately 20 square miles around the Joplin, Missouri area– is a designated United States Environmental Protection Agency Superfund site due to lead-contaminated soil and groundwater by former mining and smelting operations. Over almost a century of mining (from 1848 to the late 1960’s), an estimated ten million tons of cadmium, lead, and zinc containing material have been deposited on approximately 9,000 acres. Sites that have undergone remediation, in which the O, A, and B horizons have been removed along with the lead contamination, the exposed C horizon remains incalcitrant to revegetation efforts. These sites also suffer from poor soil microbial activity, as measured by soil extracellular enzymatic assays, though 16S ribosomal ribonucleic acid (rRNA) indicates that microbial diversity is equal to sites that have avoided mine-related contamination. Soil analysis reveals low soil organic carbon, along with high levels of bio-available zinc, that reflect the poor soil fertility conditions and low microbial activity. Our study looked at the use of several materials to restore and remediate these sites, with the goal of improving soil health. The following materials, and their purposes for incorporation into the study, were as follows: manure-based biochar for the binding of zinc and other heavy metals responsible for phytotoxicity, locally sourced biosolids and compost to incorporate organic carbon into the depleted soils, effective microorganisms harvested from nearby pristine sites to provide a stable community for nutrient cycling in the newly composited 'soil material'. Our results indicate that all four materials used in conjunction result in the greatest benefit to these mine-impacted soils, based on above ground biomass, microbial biomass, and soil enzymatic activities.

Keywords: locally effective microorganisms, biochar, remediation, reclamation

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Authors: Jovana Bogojeski, Dusan Cocic, Nenad Jankovic, Angelina Petrovic

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Kinetically-inert transition metal complexes, such as Rh(III) and Os(III) complexes, attract increasing attention as leading scaffolds for the development of potential pharmacological agents due to their inertness and stability. Therefore, we have designed and fully characterized a few novel rhodium(III) and osmium(III) complexes with a tridentate nitrogen−donor chelate system. For some complexes, the crystal X-ray structure analysis was performed. Reactivity of the newly synthesized complexes towards small biomolecules, such as L-methionine (L-Met), guanosine-5’-monophosphate (5’-GMP), and glutathione (GSH) has been examined. Also, the reactivity of these complexes towards the DNA/RNA (Ribonucleic acid) duplexes was investigated. Obtained results show that the newly synthesized complexes exhibit good affinity towards the studied ligands. Results also show that the complexes react faster with the RNA duplex than with the DNA and that in the DNA duplex reaction is faster with 15mer GG than with the 22mer GG. The UV-Vis (Ultraviolet-visible spectroscopy) is absorption spectroscopy, and the EB (Ethidium bromide) displacement studies were used to examine the interaction of these complexes with CT-DNA and BSA (Bovine serum albumin). All studied complex showed good interaction ability with both the DNA and BSA. Furthermore, the DFT (Density-functional theory) calculation and docking studies were performed. The impact of the metal complex on the cytotoxicity was tested by MTT assay (a colorimetric assay for assessing cell metabolic activity) on HCT-116 lines (human colon cancer cell line). In addition, all these tests were repeated in the presence of several water-soluble biologically active ionic liquids. Attained results indicate that the ionic liquids increase the activity of the investigated complexes. All obtained results in this study imply that the introduction of different spectator ligand can be used to improve the reactivity of rhodium(III) and osmium(III) complexes. Finally, these results indicate that the examined complexes show reactivity characteristics needed for potential anti-tumor agents, with possible targets being both the DNA and proteins. Every new contribution in this field is highly warranted due to the current lack of clinically used Metallo-based alternatives to cisplatin.

Keywords: biomolecules, ionic liquids, osmium(III), rhodium(III)

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Authors: Stanimira Ntermentzieva

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Gender studies in post-communist Eastern Europe emerged in the early 1990s after the collapse of the communist regime. It can be explained by a series of cultural and political factors. However, Bulgarian female composers’ contribution to Western art music has not been studied. This field shows us some aspects of the impact of globalization on gender issues. This paper outlines the female composers in the establishment of the modern Bulgarian state and society. It is dedicated to the Bulgarian award-winning female composers who studied in Western European and American universities in the 1990s. Many of them migrated to these regions as part of a great migration in which Bulgaria lost 2.3 to three million of its population and strived to modernize Bulgarian music. Nowadays, the Union of Bulgarian Composers has 262 members, but only 19 of them are women. The Grammy-awarded Penka Kouneva (b. 1967) is one of the few female composers in Hollywood. She composed and orchestrated film scores, music for video games and television. Anna-Maria Ravnopolska-Dean (b. 1960) is a Bulgarian/American harpist, arranger, composer, pedagogue and TV host. She wrote pieces for harp and chamber ensembles. Maria Panayotova (b. 1976) studied composition in the USA. Alexandra Fol (b. 1981) and Vania Angelova (b. 1954) work in Canada and are recipients of grants from the Canada Council for the Arts and the Bulgarian Ministry of Culture, among others. Afroditi Katmeridou, born in Bulgaria in 1956 by Greek parents, was the first woman who wrote electroacoustic music. One of the well-known contemporary composers is the British/Bulgarian Dobrinka Tabakova (b. 1980). She moved with her family to the United Kingdom when she was 11 and studied Composition at Guildhall School of Music and Drama in London. Her album String Paths was nominated for a Grammy award. Many female composers made a successful career in EU countries: Albena Petrovic-Vratchanska (Luxemburg), Yuliana Tochkova-Patrouilleau (France), Dariana Kumanova (Italy), Tveta Dimitrova (Austria), Ivajla Kirova (Germany), Alexandra Karastoyanova-Hermentin (Austria) and more.

Keywords: balgarian music, female composers, gender studies, western art music, migration

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Authors: Kristin Thooft

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— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

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Authors: Kristin Prentice, Carri Hand

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As the Canadian population ages and chronic health conditions continue to escalate, older adults will require various types of housing, such as long term care or retirement homes. Moving to a new home may require a change in leisure activities and social networks, which could be challenging to maintain identity and create a sense of home. Leisure has been known to help older adults maintain or increase their quality of life and life satisfaction and may help older adults in moving to new homes. Sense of home and identity within older adults' transitions to new homes are concepts that may also relate to leisure engagement. Literature is scant regarding the role of leisure in older adults moving to new homes and how the sense of home and identity inter-relate. This study aims to explore how leisure may play a role in older adults' transitioning to new homes, including how sense of home and identity inter-relate. An ethnographic approach will be used to understand the culture of older adults transitioning to new homes. This study will involve older adults who have recently relocated to a mid-sized city in Ontario, Canada. The study will focus on the older adult’s interactions with and connections to their home environment through leisure. Data collection will take place via video-conferencing and will include a narrative interview and two other interviews to discuss an activity diary of leisure engagement pre and post move and mental maps to capture spaces where participants engaged in leisure. Participants will be encouraged to share photographs of leisure engagement taken inside and outside their home to help understand the social spaces the participants refer to in their activity diaries and mental maps. Older adults attempt to adjust to their new homes by maintaining their identity, developing a sense of home through creating attachment to place, and maintaining social networks, all of which have been linked to engaging in leisure. This research will provide insight into the role of leisure in this transition process and the extent that the home and community can contribute to aiding their transition to the new home. This research will contribute to existing literature on the inter-relationships of leisure, sense of home, and identity and how they relate to older adults moving to new homes. This research also has potential for influencing policy and practice for meeting the housing needs of older adults.

Keywords: leisure, older adults, transition, identity

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Authors: Ivana Loncarevic, Biljana Pajin, Jovana Petrovic, Danica Zaric, Vesna Tumbas Saponjac, Aleksandar Fistes

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Chocolate is a food that activates pleasure centers in the human brain. In comparison to black and milk chocolate, white chocolate does not contain fat-free cocoa solids and thus lacks bioactive components. The aim of this study was to examine the sensory characteristics of enriched white chocolate with the addition of 10% of raspberry juice encapsulated in maltodextrins (denoted as encapsulate). Chocolate is primarily intended for enjoyment, and therefore, the sensory expectation is a critical factor for consumers when selecting a new type of chocolate. Consumer acceptance of chocolate depends primarily on the appearance and taste, but also very much on the mouthfeel, which mainly depends on the particle size of chocolate. Chocolate samples were evaluated by a panel of 8 trained panelists, food technologists, trained according to ISO 8586 (2012). Panelists developed the list of attributes to be used in this study: intensity of red color (light to dark); glow on the surface (mat to shiny); texture on snap (appearance of cavities or holes on the snap surface that are seen - even to gritty); hardness (hardness felt during the first bite of chocolate sample in half by incisors - soft to hard); melting (the time needed to convert solid chocolate into a liquid state – slowly to quickly); smoothness (perception of evenness of chocolate during melting - very even to very granular); fruitiness (impression of fruity taste - light fruity notes to distinct fruity notes); sweetness (organoleptic characteristic of pure substance or mixture giving sweet taste - lightly sweet to very sweet). The chocolate evaluation was carried out 24 h after sample preparation in the sensory laboratory, in partitioned booths, which were illuminated with fluorescent lights (ISO 8589, 2007). Samples were served in white plastic plates labeled with three-digit codes from a random number table. Panelist scored the perceived intensity of each attribute using a 7-point scale (1 = the least intensity and 7 = the most intensity) (ISO 4121, 2002). The addition of 10% of encapsulate had a big influence on chocolate color, where enriched chocolate got a nice reddish color. At the same time, the enriched chocolate sample had less intensity of gloss on the surface. The panelists noticed that addition of encapsulate reduced the time needed to convert solid chocolate into a liquid state, increasing its hardness. The addition of encapsulate had a significant impact on chocolate flavor. It reduced the sweetness of white chocolate and contributed to the fruity raspberry flavor.

Keywords: white chocolate, encapsulated raspberry juice, color, sensory characteristics

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Authors: Pamela R. Jackson, Andrea Hawkins-Daarud, Cassandra R. Rickertsen, Kamala Clark-Swanson, Scott A. Whitmire, Kristin R. Swanson

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Glioblastoma Multiforme (GBM), the most common primary brain tumor, often presents with hyperintensity on T2-weighted or T2-weighted fluid attenuated inversion recovery (T2/FLAIR) magnetic resonance imaging (MRI). This hyperintensity corresponds with vasogenic edema, however there are likely many infiltrating tumor cells within the hyperintensity as well. While MRIs do not directly indicate tumor cells, MRIs do reflect the microenvironmental water abnormalities caused by the presence of tumor cells and edema. The inherent heterogeneity and resulting MRI features of GBMs complicate assessing disease response. To understand how hyperintensity on T2/FLAIR MRI may correlate with edema in the extracellular space (ECS), a multi-compartmental MRI signal equation which takes into account tissue compartments and their associated volumes with input coming from a mathematical model of glioma growth that incorporates edema formation was explored. The reasonableness of two possible extracellular space schema was evaluated by varying the T2 of the edema compartment and calculating the possible resulting T2s in tumor and peripheral edema. In the mathematical model, gliomas were comprised of vasculature and three tumor cellular phenotypes: normoxic, hypoxic, and necrotic. Edema was characterized as fluid leaking from abnormal tumor vessels. Spatial maps of tumor cell density and edema for virtual tumors were simulated with different rates of proliferation and invasion and various ECS expansion schemes. These spatial maps were then passed into a multi-compartmental MRI signal model for generating simulated T2/FLAIR MR images. Individual compartments’ T2 values in the signal equation were either from literature or estimated and the T2 for edema specifically was varied over a wide range (200 ms – 9200 ms). T2 maps were calculated from simulated images. T2 values based on simulated images were evaluated for regions of interest (ROIs) in normal appearing white matter, tumor, and peripheral edema. The ROI T2 values were compared to T2 values reported in literature. The expanding scheme of extracellular space is had T2 values similar to the literature calculated values. The static scheme of extracellular space had a much lower T2 values and no matter what T2 was associated with edema, the intensities did not come close to literature values. Expanding the extracellular space is necessary to achieve simulated edema intensities commiserate with acquired MRIs.

Keywords: extracellular space, glioblastoma multiforme, magnetic resonance imaging, mathematical modeling

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Authors: Beate Englich, Linda Schlittenbauer, Christiane Pfeifer, Isabel Kratochvil, Michael Borte, Gabriele I. Stangl, Martin von Bergen, Thorsten Reemtsma, Irina Lehmann, Kristin M. Junge

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The worldwide production of endocrine disrupting compounds (EDC) has risen dramatically over the last decades, as so has the prevalence for obesity. Many EDCs are believed to contribute to this obesity epidemic, by enhancing adipogenesis or disrupting relevant metabolism. This effect is most tremendous in the early prenatal period when priming effects find a highly vulnerable time window. Therefore, we investigate the impact of parabens on childhood overweight development and adipogenesis in general. Parabens are ester of 4-hydroxy-benzoic acid and part of many cosmetic products or food packing. Therefore, ubiquitous exposure can be found in the westernized world, with exposure already starting during the sensitive prenatal period. We assessed maternal cosmetic product consumption, prenatal paraben exposure and infant BMI z-scores in the prospective German LINA cohort. In detail, maternal urinary concentrations (34 weeks of gestation) of methyl paraben (MeP), ethyl paraben (EtP), n-propyl paraben (PrP) and n-butyl paraben (BuP) were quantified using UPLC-MS/MS. Body weight and height of their children was assessed during annual clinical visits. Further, we investigated the direct influence of those parabens on adipogenesis in-vitro using a human mesenchymal stem cell (MSC) differentiation assay to mimic a prenatal exposure scenario. MSC were exposed to 0.1 – 50 µM paraben during the entire differentiation period. Differentiation outcome was monitored by impedance spectrometry, real-time PCR and triglyceride staining. We found that maternal cosmetic product consumption was highly correlated with urinary paraben concentrations at pregnancy. Further, prenatal paraben exposure was linked to higher BMI Z-scores in children. Our in-vitro analysis revealed that especially the long chained paraben BuP stimulates adipogenesis by increasing the expression of adipocyte specific genes (PPARγ, ADIPOQ, LPL, etc.) and triglyceride storage. Moreover, we found that adiponectin secretion is increased whereas leptin secretion is reduced under BuP exposure in-vitro. Further mechanistic analysis for receptor binding and activation of PPARγ and other key players in adipogenesis are currently in process. We conclude that maternal cosmetic product consumption is linked to prenatal paraben exposure of children and contributes to the development of infant overweight development by triggering key pathways of adipogenesis.

Keywords: adipogenesis, endocrine disruptors, paraben, prenatal exposure

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Authors: Ivana Loncarevic, Biljana Pajin, Jovana Petrovic, Aleksandar Fistes, Vesna Tumbas Saponjac, Danica Zaric

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Chocolate is a complex rheological system usually defined as a suspension consisting of non-fat particles dispersed in cocoa butter as a continuous fat phase. Dark chocolate possesses polyphenols as major constituents whose dietary consumption has been associated with beneficial effects. Milk chocolate is formulated with a lower percentage of cocoa bean liquor than dark chocolate and it often contains lower amounts of polyphenols, while in white chocolate the fat-free cocoa solids are left out completely. Following the current trend of development of functional foods, there is an idea to create enriched white chocolate with the addition of encapsulated bioactive compounds from berry fruits. The aim of this study was to examine the surface colour of enriched white chocolate with the addition of 6, 8, and 10% of raspberry juice encapsulated in maltodextrins, in order to preserve the stability, bioactivity, and bioavailability of the active ingredients. The surface color of samples was measured by MINOLTA Chroma Meter CR-400 (Minolta Co., Ltd., Osaka, Japan) using D 65 lighting, a 2º standard observer angle and an 8-mm aperture in the measuring head. The following CIELab color coordinates were determined: L* – lightness, a* – redness to greenness and b* – yellowness to blueness. The addition of raspberry encapsulates led to the creation of new type of enriched chocolate. Raspberry encapsulate changed the values of the lightness (L*), a* (red tone) and b* (yellow tone) measured on the surface of enriched chocolate in accordance with applied concentrations. White chocolate has significantly (p < 0.05) highest L* (74.6) and b* (20.31) values of all samples indicating the bright surface of the white chocolate, as well as a high share of a yellow tone. At the same time, white chocolate has the negative a* value (-1.00) on its surface which includes green tones. Raspberry juice encapsulate has the darkest surface with significantly (p < 0.05) lowest value of L* (42.75), where increasing of its concentration in enriched chocolates decreases their L* values. Chocolate with 6% of encapsulate has significantly (p < 0.05) highest value of L* (60.56) in relation to enriched chocolate with 8% of encapsulate (53.57), and 10% of encapsulate (51.01). a* value measured on the surface of white chocolate is negative (-1.00) tending towards green tones. Raspberry juice encapsulates increases red tone in enriched chocolates in accordance with the added amounts (23.22, 30.85, and 33.32 in enriched chocolates with 6, 8, and 10% encapsulated raspberry juice, respectively). The presence of yellow tones in enriched chocolates significantly (p < 0.05) decreases with the addition of E (with b* value 5.21), from 10.01 in enriched chocolate with a minimal amount of raspberry juice encapsulates to 8.91 in chocolate with a maximum concentration of raspberry juice encapsulate. The addition of encapsulated raspberry juice to white chocolate led to the creation of new type of enriched chocolate with attractive color. The research in this paper was conducted within the project titled ‘Development of innovative chocolate products fortified with bioactive compounds’ (Innovation Fund Project ID 50051).

Keywords: color, encapsulated raspberry juice, polyphenols, white chocolate

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Authors: Tatjana Pekmezovic, Milica Jecmenica-Lukic, Igor Petrovic, Vladimir Kostic

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Background: A group of atypical parkinsonian syndromes (APS) includes a variety of rare neurodegenerative disorders characterized by reduced life expectancy, increasing disability, and considerable impact on health-related quality of life (HRQoL). Aim: In this study we wanted to answer two questions: a) which demographic and clinical factors are main contributors of HRQoL in our cohort of patients with APS, and b) how does quality of life of these patients change over 1-year follow-up period. Patients and Methods: We conducted a prospective cohort study in hospital settings. The initial study comprised all consecutive patients who were referred to the Department of Movement Disorders, Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade (Serbia), from January 31, 2000 to July 31, 2013, with the initial diagnoses of ‘Parkinson’s disease’, ‘parkinsonism’, ‘atypical parkinsonism’ and ‘parkinsonism plus’ during the first 8 months from the appearance of first symptom(s). The patients were afterwards regularly followed in 4-6 month intervals and eventually the diagnoses were established for 46 patients fulfilling the criteria for clinically probable progressive supranuclear palsy (PSP) and 36 patients for probable multiple system atrophy (MSA). The health-related quality of life was assessed by using the SF-36 questionnaire (Serbian translation). Hierarchical multiple regression analysis was conducted to identify predictors of composite scores of SF-36. The importance of changes in quality of life scores of patients with APS between baseline and follow-up time-point were quantified using Wilcoxon Signed Ranks Test. The magnitude of any differences for the quality of life changes was calculated as an effect size (ES). Results: The final models of hierarchical regression analysis showed that apathy measured by the Apathy evaluation scale (AES) score accounted for 59% of the variance in the Physical Health Composite Score of SF-36 and 14% of the variance in the Mental Health Composite Score of SF-36 (p<0.01). The changes in HRQoL were assessed in 52 patients with APS who completed 1-year follow-up period. The analysis of magnitude for changes in HRQoL during one-year follow-up period have shown sustained medium ES (0.50-0.79) for both Physical and Mental health composite scores, total quality of life as well as for the Physical Health, Vitality, Role Emotional and Social Functioning. Conclusion: This study provides insight into new potential predictors of HRQoL and its changes over time in patients with APS. Additionally, identification of both prognostic markers of a poor HRQoL and magnitude of its changes should be considered when developing comprehensive treatment-related strategies and health care programs aimed at improving HRQoL and well-being in patients with APS.

Keywords: atypical parkinsonian syndromes, follow-up study, quality of life, APS

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