Search results for: Vestibular disorder
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 132

Search results for: Vestibular disorder

42 In vitro and in vivo Assessment of Cholinesterase Inhibitory Activity of the Bark Extracts of Pterocarpus santalinus L. for the Treatment of Alzheimer’s Disease

Authors: K. Biswas, U. H. Armin, S. M. J. Prodhan, J. A. Prithul, S. Sarker, F. Afrin

Abstract:

Alzheimer’s disease (AD) (a progressive neurodegenerative disorder) is mostly predominant cause of dementia in the elderly. Prolonging the function of acetylcholine by inhibiting both acetylcholinesterase and butyrylcholinesterase is most effective treatment therapy of AD. Traditionally Pterocarpus santalinus L. is widely known for its medicinal use. In this study, in vitro acetylcholinesterase inhibitory activity was investigated and methanolic extract of the plant showed significant activity. To confirm this activity (in vivo), learning and memory enhancing effects were tested in mice. For the test, memory impairment was induced by scopolamine (cholinergic muscarinic receptor antagonist). Anti-amnesic effect of the extract was investigated by the passive avoidance task in mice. The study also includes brain acetylcholinesterase activity. Results proved that scopolamine induced cognitive dysfunction was significantly decreased by administration of the extract solution, in the passive avoidance task and inhibited brain acetylcholinesterase activity. These results suggest that bark extract of Pterocarpus santalinus can be better option for further studies on AD via their acetylcholinesterase inhibitory actions.

Keywords: Pterocarpus santalinus, cholinesterase inhibitor, passive avoidance, Alzheimer’s disease.

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41 Architecture and Students with Autism: Exploring Strategies for Their Inclusion in Society Mainstream

Authors: Safaa Mahmoud Issa

Abstract:

Architecture, as an art and science of designing, has always been the medium to create environments that fulfill their users’ needs. It could create an inclusive environment that would not isolate any individual regardless of his /her disabilities. It could help, hopefully, in setting the strategies that provide a supportive, educational environment that would allow the inclusion of students with autism. Architects could help in the battle against this neuro-developmental disorder by providing the accommodating environment, at home and at school, in order to prevent institutionalizing these children. Through a theoretical approach and a review of literature, this study will explore and analyze best practices in autism-friendly, supportive, teaching environments. Additionally, it would provide the range of measures, and set the strategies to deal with the students with autism sensory peculiarities, and that, in order to allow them to concentrate in the school environment, and be able to succeed, and to be integrated as an important addition to society and the social mainstream. Architects should take into consideration the general guidelines for an autism-friendly built environment, and apply them to specific buildings systems. And that, as certain design elements have great effect on children’s behavior, by appropriating architecture to provide inclusive accommodating environments, the basis for equalization of opportunities is set allowing these individuals a better, normal, non-institutional life, as the discussion presented in this study would reveal.

Keywords: Architecture, inclusion, students with autism, mainstream society.

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40 Dynamics of Marital Status and Information Search through Consumer Generated Media: An Exploratory Study

Authors: Shivakumar Krishnamurti, Ruchi Agarwal

Abstract:

The study examines the influence of marital status on consumers of products and services using blogs as a source of information. A pre-designed questionnaire was used to collect the primary data from the respondents (experiences). Data were collected from one hundred and eighty seven respondents residing in and around the Emirates of Sharjah and Dubai of the United Arab Emirates. The collected data was analyzed with the help of statistical tools such as averages, percentages, factor analysis, Student’s t-test and Structural Equation Modelling Technique. Objectives of the study are to know the reasons how married and unmarried or single consumers of products and services are motivated to use blogs as a source of information, to know whether the consumers of products and services irrespective of their marital status share their views and experiences with other bloggers and to know the respondents’ future intentions towards blogging. The study revealed the following: Majority of the respondents have the motivation to blog because they are willing to receive comments on what they post about services, convenience of blogs to search for information about services and products, by blogging respondents share information on the symptoms of a disease/ disorder that may be experienced by someone, helps to share information about ready to cook mix products and are keen to spend more time blogging in the future.

Keywords: Blog, consumer, information, marital status.

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39 Teaching Math to Preschool Children with Autism

Authors: Hui Fang Huang Su, Jia Borror

Abstract:

This study compared two different interventions for math instruction among preschoolers with autism spectrum disorder (ASD). The first intervention, a combination of discrete trial teaching and Strategies for Teaching Based on Autism Research (STAR), was the regular math curriculum utilized at the preschool. The second activity-based, naturalistic intervention was Project Mind, also known as Math is Not Difficult. The curricular interventions were randomly assigned to four preschool classrooms with ASD students and implemented over three months for Project MIND. Measurements gained during the same three months for the STAR intervention were used. A quasi-experimental, pre-test/post-test design was selected to compare which intervention was the most effective in increasing mathematical knowledge and skills among preschoolers with ASD. Standardized pre and post-test instruments included the Bracken Basic Concept Scale-3 Receptive, the Applied Problems and Calculation subtests of the Woodcock-Johnson IV Tests of Achievement, and the TEMA 3: Test of Early Mathematics Ability – Third Edition. The STAR assessment is typically administered to all preschoolers at the study site three times per year, and those results were used in this study. We anticipated that the implementation of these two approaches would lead to improvement in the mathematical knowledge and skills of children with ASD. Still, it is essential to see whether a behavioral or naturalistic teaching approach leads to more significant results.

Keywords: Autism, mathematics, preschool, special education.

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38 Biological Diagnosis and Physiopathology of von Willebrand-s Disease in a Part of the Algerian Population in the East and the South

Authors: H. Djaara, M. Yahia, H. Bousselsela, N Khelif, A. Zidani, S. Benbia.

Abstract:

Von Willebrand-s disease is the most common inherited bleeding disorder in humans, it caused by qualitative abnormalities of the von Willebrand factor (vWF). Our objective is to determine the prevalence of this disease at part of the Algerian population in the East and the South by a biological diagnosis based on specific biological tests (automated platelet count, the bleeding time (TS), the time of cephalin + activator (TCA), measure of the prothrombin rate (TP), vWF rate and factor VIII rate, Molecular electrophoresis of vWF multimers in agarose gel in the presence of SDS). Four patients of type III or severe Willebrand-s disease were found on 200 suspect cases. All cases are showed a deficit in vWF rate (< 5%), and factor VIII (P<0, 0001), and lengthening very significantly high of the TCA (P<0, 0001) and of the bleeding time (P<0,0001), with a normal blood platelet rate (P=0,7433) and a normal prothrombin rate (P=0,5808), an absence of all the multimers of vWF in plasma patients. The severe Willebrand-s disease is not only one pathology of primary haemostasis, but it can be accompanied by coagulation-s anomaly due to deficit in factor VIII. At this studied population, von Willebrand-s disease is less frequent (2%) than other hemorrhagic syndromes identified by the differential diagnosis like the thrombocytopenia (36%).

Keywords: Von Willebrand's disease, differential diagnosis, von Willebrand factor, factor VIII, biological diagnosis, thrombocytopenia.

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37 Armed Groups and Intra State Conflict: A Study on the Egyptian Case

Authors: Ghzlan Mahmoud Abdel Aziz

Abstract:

This case study aims to identify the intrastate conflicts between the nation state and armed groups. Nowadays, most wars weaken states against armed groups. Thus, it is very important to negotiate with such groups in order to reinforce the law for the protection of victims. These armed groups are the cause of conflicts and they are related with many of humanitarian issues that result out of conflicts. In this age of rivalry; terrorists, insurgents, or transnational criminal parties have surfaced to the top as a reaction to these armed groups in an effort to set up a new world order. Moreover, the intra state conflicts became increasingly treacherous than the interstate conflicts, particularly when nation state systems deal with armed groups which try to influence the state. The unexpected upraising of the Arab Spring during 2011 in parts of the Middle East and North Africa formed various patterns of conflicts. The events of the Arab Spring resulted in current and long term change across the region. Significant modifications in the level, strength and period of armed conflict around the world have been made. Egypt was in the center of these events. It has fought back the armed groups under the name of terrorism and spread common disorder and violence among civilians. On this note, this study focuses on the problem of the transformation in the methods of organized violence within one state rather than between two state or more and analyzes the objectives, strategies, and internal composition of armed groups and the environments that foster them, with a focus on the Egyptian case.

Keywords: Armed groups, conflicts, Egyptian armed forces, intrastate conflicts.

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36 Two Cases of VACTERL Association in Pregnancy with Lymphocyte Therapy

Authors: Seyed Mazyar Mortazavi, Masod Memari, Hasan Ali Ahmadi, Zhaleh Abed

Abstract:

VACTERL association is a rare disorder with various congenital malformations. The aetiology remains unknown. Combination of at least three congenital anomalies of the following criteria is required for diagnosis: vertebral defects, anal atresia, cardiac anomalies, tracheo-esophageal fistula, renal anomalies, and limb defects. The first case was 1-day old male neonate with multiple congenital anomalies was bore from 28 years old mother. The mother had history of pregnancy with lymphocyte therapy. His anomalies included: defects in thoracic and lumbar vertebral, anal atresia, bilateral hydronephrosis, atrial septal defect, and lower limb abnormality. Other anomalies were cryptorchidism and nasal canal narrowing. The second case was born with 32 weeks gestational age from mother with history of pregnancy with lymphocyte therapy. He had thoracic vertebral defect, cardiac anomalies and renal defect. diagnosis based on clinical finding is VACTERL association. Early diagnosis is very important to investigation and treatment of other coexistence anomalies. VACTERL association in mothers with history of pregnancy with lymphocyte therapy has suggested possibly of relationship between VACTERL association and this method of pregnancy.

Keywords: Anal atresia, tracheo-esophageal fistula, atrial septal defect, lymphocyte therapy.

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35 ZBTB17 Gene rs10927875 Polymorphism in Slovak Patients with Dilated Cardiomyopathy

Authors: I. Boroňová, J. Bernasovská, J. Kmec, E. Petrejčíková

Abstract:

Dilated cardiomyopathy (DCM) is a severe cardiovascular disorder characterized by progressive systolic dysfunction due to cardiac chamber dilatation and inefficient myocardial contractility often leading to chronic heart failure. Recently, a genome-wide association studies (GWASs) on DCM indicate that the ZBTB17 gene rs10927875 single nucleotide polymorphism is associated with DCM. The aim of the study was to identify the distribution of ZBTB17 gene rs10927875 polymorphism in 50 Slovak patients with DCM and 80 healthy control subjects using the Custom Taqman®SNP Genotyping assays. Risk factors detected at baseline in each group included age, sex, body mass index, smoking status, diabetes and blood pressure. The mean age of patients with DCM was 52.9±6.3 years; the mean age of individuals in control group was 50.3±8.9 years. The distribution of investigated genotypes of rs10927875 polymorphism within ZBTB17 gene in the cohort of Slovak patients with DCM was as follows: CC (38.8%), CT (55.1%), TT (6.1%), in controls: CC (43.8%), CT (51.2%), TT (5.0%). The risk allele T was more common among the patients with dilated cardiomyopathy than in normal controls (33.7% versus 30.6%). The differences in genotype or allele frequencies of ZBTB17 gene rs10927875 polymorphism were not statistically significant (p=0.6908; p=0.6098). The results of this study suggest that ZBTB17 gene rs10927875 polymorphism may be a risk factor for susceptibility to DCM in Slovak patients with DCM. Studies of numerous files and additional functional investigations are needed to fully understand the roles of genetic associations.

Keywords: Dilated cardiomyopathy, SNP polymorphism, ZBTB17 gene.

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34 Anti-Diabetic Effect of Bryophyllum pinnatum Leaves

Authors: E. F. Aransiola, M.O. Daramola, E. O. Iwalewa, A. M. Seluwa, O. O. Olufowobi

Abstract:

Diabetes is a chronic metabolic disorder that affects the quality of life in terms of physical health, social and psychological well-being. In spite of the enormous progress in the treatment of diabetes using existing commercial drugs, such as, insulin and oral hypoglycemic agents, the quest and search for new drugs is imperative due to several limitations of the commercial drugs. In addition, the existing diabetic drugs are expensive and unaffordable by the rural populace in the developing countries. The present study demonstrates the anti-diabetic property of aqueous extract of Bryophyllum pinnatum (BP) leaves using diabetic rats (albino rats) as models. At the same time, the anti-diabetic effect of the aqueous extract was compared to that of a sample containing a mixture of the extract and a commercial diabetic medicine, glibenclamide. A specified dosage of aqueous extract of Bryophyllum pinnatum (BP) leaves was administered on the experimental diabetic rats, and their BGL was measured and recorded. The results showed a significant drop in the BGL of the diabetic rats to a value close to normal blood glucose level within 120 minutes when only aqueous extract from BP leaves was used. When a sample containing a mixture of the aqueous extract and glibenclamide was administered, a further drop in BGL was observed. Therefore, the results reveal that aqueous extract of Bryophyllum pinnatum leaves have significant anti-diabetic properties, and that the performance of the existing drugs (glibenclamide) could be enhanced with the use of the aqueous extract.

Keywords: Anti-diabetics, Bryophyllum pinnatum, Blood glucose level, albino rats.

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33 Neurological Manifestations in Patients with HIV Infection in the Era of Combined Antiretroviral Therapy

Authors: Sharan Badiger, Prema T. Akkasaligar, Deepak Kadeli, M. Vishok

Abstract:

Neurological disorders are the most debilitating of manifestations seen in patients infected with HIV. The clinical profile of neurological manifestations in HIV patients has undergone a shift in recent years with opportunistic infections being controlled with combination anti-retroviral therapy and the advent of drugs which have higher central nervous system penetrability. The aim of this paper is to study the clinical, investigation profile and various neurological disorders in HIV patients on anti‐retroviral therapy. Fifty HIV patients with neurological manifestations were studied. A complete neurological examination including neurocognitive functioning using Montreal Cognitive Assessment and HIV Dementia scale were assessed. Apart from relevant investigations, CD4 count, cerebrovascular fluid analysis, computed tomography (CT) and magnetic resonance imaging (MRI) of brain were done whenever required. Neurocognitive disorders formed the largest group with 42% suffering from HIV associated Neurocognitive Disorders. Among them, asymptomatic neurocognitive impairment was seen in 28%; mild neurocognitive disorder in 12%, and 2% had HIV‐associated dementia. Opportunistic infections of the nervous system accounted for 32%, with meningitis being the most common. Four patients had space occupying lesions of central nervous system; four tuberculomas, and one toxoplasmosis. With the advent of highly active retroviral therapy, HIV patients have longer life spans with suppression of viral load leading to decrease in opportunistic infections of the nervous system. Neurocognitive disorders are now the most common neurological dysfunction seen and thus neurocognitive assessment must be done in all patients with HIV.

Keywords: Anti retroviral therapy, cognitive dysfunction, dementia, neurological manifestations, opportunistic infections.

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32 A Linear Regression Model for Estimating Anxiety Index Using Wide Area Frontal Lobe Brain Blood Volume

Authors: Takashi Kaburagi, Masashi Takenaka, Yosuke Kurihara, Takashi Matsumoto

Abstract:

Major depressive disorder (MDD) is one of the most common mental illnesses today. It is believed to be caused by a combination of several factors, including stress. Stress can be quantitatively evaluated using the State-Trait Anxiety Inventory (STAI), one of the best indices to evaluate anxiety. Although STAI scores are widely used in applications ranging from clinical diagnosis to basic research, the scores are calculated based on a self-reported questionnaire. An objective evaluation is required because the subject may intentionally change his/her answers if multiple tests are carried out. In this article, we present a modified index called the “multi-channel Laterality Index at Rest (mc-LIR)” by recording the brain activity from a wider area of the frontal lobe using multi-channel functional near-infrared spectroscopy (fNIRS). The presented index aims to measure multiple positions near the Fpz defined by the international 10-20 system positioning. Using 24 subjects, the dependencies on the number of measuring points used to calculate the mc-LIR and its correlation coefficients with the STAI scores are reported. Furthermore, a simple linear regression was performed to estimate the STAI scores from mc-LIR. The cross-validation error is also reported. The experimental results show that using multiple positions near the Fpz will improve the correlation coefficients and estimation than those using only two positions.

Keywords: Stress, functional near-infrared spectroscopy, frontal lobe, state-trait anxiety inventory score.

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31 Clinical Signs of Neonatal Calves in Experimental Colisepticemia

Authors: Samad Lotfollahzadeh

Abstract:

Escherichia coli (E. coli) is the most isolated bacteria from blood circulation of septicemic calves. Given the prevalence of septicemia in animals and its economic importance in veterinary practice, better understanding of changes in clinical signs following disease, may contribute to early detection of disorder. The present study has been carried out to detect changes of clinical signs in induced sepsis in calves with E. coli. Colisepticemia has been induced in 10 twenty-day old healthy Holstein- Frisian calves with intravenous injection of 1.5 X 109 colony forming units (cfu) of O111:H8 strain of E. coli. Clinical signs including rectal temperature, heart rate, respiratory rate, shock, appetite, sucking reflex, feces consistency, general behavior, dehydration and standing ability were recorded in experimental calves during 24 hours after induction of colisepticemia. Blood culture was also carried out from calves four times during experiment. ANOVA with repeated measure is used to see changes of calves’ clinical signs to experimental colisepticemia, and values of P≤ 0.05 was considered statistically significant. Mean values of rectal temperature and heart rate as well as median values of respiratory rate, appetite, suckling reflex, standing ability and feces consistency of experimental calves increased significantly during study (P<0.05). In the present study median value of shock score was not significantly increased in experimental calves (P> 0.05). The results of present study showed that total score of clinical signs in calves with experimental colisepticemia increased significantly, although score of some clinical signs such as shock did not change significantly.

Keywords: Calves, Clinical signs scoring, E. coli O111:H8, Experimental colisepticemia,

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30 Using the Minnesota Multiphasic Personality Inventory-2 and Mini Mental State Examination-2 in Cognitive Behavioral Therapy: Case Studies

Authors: Cornelia-Eugenia Munteanu

Abstract:

From a psychological perspective, psychopathology is the area of clinical psychology that has at its core psychological assessment and psychotherapy. In day-to-day clinical practice, psychodiagnosis and psychotherapy are used independently, according to their intended purpose and their specific methods of application. The paper explores how the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Mini Mental State Examination-2 (MMSE-2) psychological tools contribute to enhancing the effectiveness of cognitive behavioral psychotherapy (CBT). This combined approach, psychotherapy in conjunction with assessment of personality and cognitive functions, is illustrated by two cases, a severe depressive episode with psychotic symptoms and a mixed anxiety-depressive disorder. The order in which CBT, MMPI-2, and MMSE-2 were used in the diagnostic and therapeutic process was determined by the particularities of each case. In the first case, the sequence started with psychotherapy, followed by the administration of blue form MMSE-2, MMPI-2, and red form MMSE-2. In the second case, the cognitive screening with blue form MMSE-2 led to a personality assessment using MMPI-2, followed by red form MMSE-2; reapplication of the MMPI-2 due to the invalidation of the first profile, and finally, psychotherapy. The MMPI-2 protocols gathered useful information that directed the steps of therapeutic intervention: a detailed symptom picture of potentially self-destructive thoughts and behaviors otherwise undetected during the interview. The memory loss and poor concentration were confirmed by MMSE-2 cognitive screening. This combined approach, psychotherapy with psychological assessment, aligns with the trend of adaptation of the psychological services to the everyday life of contemporary man and paves the way for deepening and developing the field.

Keywords: Assessment, cognitive behavioral psychotherapy, MMPI-2, MMSE-2, psychopathology.

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29 Role of Inflammatory Markers in Arthritic Rats Treated with Ethanolic Bark Extract of Albizia procera

Authors: M. Sangeetha, D. Chamundeeswari, C. Saravanababu, C. Rose, V. Gopal

Abstract:

Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disorder affecting the synovial joints and typically producing symmetrical arthritis that leads to joint destruction, which is responsible for the deformity and disability. Despite improvements in the treatment of RA over the past decade, there still is a need for new therapeutic agents that are efficacious, less expensive, and free of severe adverse reactions. The present study aimed to investigate role of inflammatory markers in arthritic rats treated with ethanolic bark extract of Albizia procera. The protective effect of ethanolic bark extract of Albizia procera against complete Freund’s adjuvant (CFA) induced arthritis in rats. Arthritis was induced by an intradermal injection of 0.1 ml FCA in the foot pad of left hind limb of rats. ETBE (100 and 200 mg/kg b.wt./p.o) and the reference drug diclofenac (25 mg/kg b.wt./p.o) were administered to arthritic rats. Paw volume was measured for all the animals before inducing arthritis and thereafter once in seven days by using plethysmometer for 42 days. Gene expression of inflammatory markers such as IL-1β and IL-10 were investigated in paw tissues. Up regulation of IL-1β and Down regulation IL-10 were observed in CFA injected rats when compared to normal rats. ETBE attenuated these alterations dose dependently when compared to the vehicle treated rats. These results provide insights into the mechanism of anti-arthritic activity, and unravel potential therapeutic use of Albizia procera in arthritis.

Keywords: CFA-Complete Freund’s adjuvant, ETBE, Ethanolic Bark Extract, IL- Interleukins, RA-Rheumatoid Arthritis.

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28 Early Depression Detection for Young Adults with a Psychiatric and AI Interdisciplinary Multimodal Framework

Authors: Raymond Xu, Ashley Hua, Andrew Wang, Yuru Lin

Abstract:

During COVID-19, the depression rate has increased dramatically. Young adults are most vulnerable to the mental health effects of the pandemic. Lower-income families have a higher ratio to be diagnosed with depression than the general population, but less access to clinics. This research aims to achieve early depression detection at low cost, large scale, and high accuracy with an interdisciplinary approach by incorporating clinical practices defined by American Psychiatric Association (APA) as well as multimodal AI framework. The proposed approach detected the nine depression symptoms with Natural Language Processing sentiment analysis and a symptom-based Lexicon uniquely designed for young adults. The experiments were conducted on the multimedia survey results from adolescents and young adults and unbiased Twitter communications. The result was further aggregated with the facial emotional cues analyzed by the Convolutional Neural Network on the multimedia survey videos. Five experiments each conducted on 10k data entries reached consistent results with an average accuracy of 88.31%, higher than the existing natural language analysis models. This approach can reach 300+ million daily active Twitter users and is highly accessible by low-income populations to promote early depression detection to raise awareness in adolescents and young adults and reveal complementary cues to assist clinical depression diagnosis.

Keywords: Artificial intelligence, depression detection, facial emotion recognition, natural language processing, mental disorder.

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27 Predictors of Social Participation of Children with Cerebral Palsy in Primary Schools in Czech Republic

Authors: Marija Zulić, Vanda Hájková, Nina Brkić-Jovanović, Linda Rathousová, Sanja Tomić

Abstract:

Cerebral palsy is primarily reflected in the disorder of the development of movement and posture, which may be accompanied by sensory disturbances, disturbances of perception, cognition and communication, behavioural disorders and epilepsy. According to current inclusive attitudes towards people with disabilities implies that full social participation of children with cerebral palsy means inclusion in all activities in family, peer, school and leisure environments in the same scope and to the same extent as is the case with the children of proper development and without physical difficulties. Due to the fact that it has been established that the quality of children's participation in primary school is directly related to their social inclusion in future life, the aim of the paper is to identify predictors of social participation, respectively, and in particular, factors that could to improve the quality of social participation of children with cerebral palsy, in the primary school environment in Czech Republic. The study includes children with cerebral palsy (n = 75) in the Czech Republic, aged between six and 12 years who attend mainstream or special primary schools to the sixth grade. The main instrument used was the first and third part of the School function assessment questionnaire. It will also take into account the type of damage assessed according to a scale the Gross motor function classification system, five–level classification system for cerebral palsy. The research results will provide detailed insight into the degree of social participation of children with cerebral palsy and the factors that would be a potential cause of their levels of participation, in regular and special primary schools, in different socioeconomic environments in Czech Republic.

Keywords: Cerebral palsy, social participation, Czech Republic, school function assessment.

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26 The Latency-Amplitude Binomial of Waves Resulting from the Application of Evoked Potentials for the Diagnosis of Dyscalculia

Authors: Maria Isabel Garcia-Planas, Maria Victoria Garcia-Camba

Abstract:

Recent advances in cognitive neuroscience have allowed a step forward in perceiving the processes involved in learning from the point of view of acquiring new information or the modification of existing mental content. The evoked potentials technique reveals how basic brain processes interact to achieve adequate and flexible behaviours. The objective of this work, using evoked potentials, is to study if it is possible to distinguish if a patient suffers a specific type of learning disorder to decide the possible therapies to follow. The methodology used in this work is to analyze the dynamics of different brain areas during a cognitive activity to find the relationships between the other areas analyzed to understand the functioning of neural networks better. Also, the latest advances in neuroscience have revealed the exis-tence of different brain activity in the learning process that can be highlighted through the use of non-invasive, innocuous, low-cost and easy-access techniques such as, among others, the evoked potentials that can help to detect early possible neurodevelopmental difficulties for their subsequent assessment and therapy. From the study of the amplitudes and latencies of the evoked potentials, it is possible to detect brain alterations in the learning process, specifically in dyscalculia, to achieve specific corrective measures for the application of personalized psycho-pedagogical plans that allow obtaining an optimal integral development of the affected people.

Keywords: dyscalculia, neurodevelopment, evoked potentials, learning disabilities, neural networks

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25 Addressing Global Trauma: Somatic Interventions in PTSD Treatment and Clinician Burnout Prevention

Authors: Nina Kaufmans

Abstract:

Traditional treatments for post-traumatic stress disorder (PTSD) that rely primarily on oral narratives are partially insufficient to prevent PTSD symptoms from recurrence. As a result of the global COVID-19 pandemic, war conflicts, and economic crises, a rising proportion of users of mental health services express somatically based distress in addition to their existing mental health symptoms. Furthermore, the rapid increase in demand for mental health services has resulted in substantial burnout among mental health professionals, which may further impact the quality of services provided and the sustainability of professional life-work balance. This article examines the implications of current developments and challenges in mental health services demand and subsequent responses, as well as the effects of those responses on mental health professionals. The article examines the neurobiological mechanisms underlying traumatic experiences, then discusses the premises for "bottom-up," or somatically oriented, psychotherapy approaches, and concludes with suggestions for clinical skills and interventions to be used by practitioners who work with clients diagnosed with PTSD. In addition, we examine how somatically based psychotherapy interventions performed in sessions might reduce clinician burnout and improve their well-being. We examine how incorporating somatically based therapies into counseling will boost the efficacy of mental health recovery and maintain remission while providing mental health practitioners with chances for self-care.

Keywords: Somatic psychotherapy interventions, trauma counseling, preventing and treating burnout, adults with PTSD, bottom-up skills, the effectiveness of trauma treatment.

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24 Mutation Analysis of the ATP7B Gene in 43 Vietnamese Wilson’s Disease Patients

Authors: Huong M. T. Nguyen, Hoa A. P. Nguyen, Mai P. T. Nguyen, Ngoc D. Ngo, Van T. Ta, Hai T. Le, Chi V. Phan

Abstract:

Wilson’s disease (WD) is an autosomal recessive disorder of the copper metabolism, which is caused by a mutation in the copper-transporting P-type ATPase (ATP7B). The mechanism of this disease is the failure of hepatic excretion of copper to bile, and leads to copper deposits in the liver and other organs. The ATP7B gene is located on the long arm of chromosome 13 (13q14.3). This study aimed to investigate the gene mutation in the Vietnamese patients with WD, and make a presymptomatic diagnosis for their familial members. Forty-three WD patients and their 65 siblings were identified as having ATP7B gene mutations. Genomic DNA was extracted from peripheral blood samples; 21 exons and exon-intron boundaries of the ATP7B gene were analyzed by direct sequencing. We recognized four mutations ([R723=; H724Tfs*34], V1042Cfs*79, D1027H, and IVS6+3A>G) in the sum of 20 detectable mutations, accounting for 87.2% of the total. Mutation S105* was determined to have a high rate (32.6%) in this study. The hotspot regions of ATP7B were found at exons 2, 16, and 8, and intron 14, in 39.6 %, 11.6 %, 9.3%, and 7 % of patients, respectively. Among nine homozygote/compound heterozygote siblings of the patients with WD, three individuals were determined as asymptomatic by screening mutations of the probands. They would begin treatment after diagnosis. In conclusion, 20 different mutations were detected in 43 WD patients. Of this number, four novel mutations were explored, including [R723=; H724Tfs*34], V1042Cfs*79, D1027H, and IVS6+3A>G. The mutation S105* is the most prevalent and has been considered as a biomarker that can be used in a rapid detection assay for diagnosis of WD patients. Exons 2, 8, and 16, and intron 14 should be screened initially for WD patients in Vietnam. Based on risk profile for WD, genetic testing for presymptomatic patients is also useful in diagnosis and treatment.

Keywords: ATP7B gene, mutation detection, presymptomatic diagnosis, Vietnamese Wilson’s disease.

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23 An Educational Application of Online Games for Learning Difficulties

Authors: M. Margoudi, Z. Smyrnaiou

Abstract:

The current paper presents the results of a conducted case study. During the past few years the number of children diagnosed with Learning Difficulties has drastically augmented and especially the cases of ADHD (Attention Deficit Hyperactivity Disorder). One of the core characteristics of ADHD is a deficit in working memory functions. The review of the literature indicates a plethora of educational software that aim at training and enhancing the working memory. Nevertheless, in the current paper, the possibility of using for the same purpose free, online games will be explored. Another issue of interest is the potential effect of the working memory training to the core symptoms of ADHD. In order to explore the abovementioned research questions, three digital tests are employed, all of which are developed on the E-slate platform by the author, in order to check the levels of ADHD’s symptoms and to be used as diagnostic tools, both in the beginning and in the end of the case study. The tools used during the main intervention of the research are free online games for the training of working memory. The research and the data analysis focus on the following axes: a) the presence and the possible change in two of the core symptoms of ADHD, attention and impulsivity and b) a possible change in the general cognitive abilities of the individual. The case study was conducted with the participation of a thirteen year-old, female student, diagnosed with ADHD, during after-school hours. The results of the study indicate positive changes both in the levels of attention and impulsivity. Therefore, we conclude that the training of working memory through the use of free, online games has a positive impact on the characteristics of ADHD. Finally, concerning the second research question, the change in general cognitive abilities, no significant changes were noted.

Keywords: ADHD, attention, impulsivity, online games.

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22 The Application of a Neural Network in the Reworking of Accu-Chek to Wrist Bands to Monitor Blood Glucose in the Human Body

Authors: J. K Adedeji, O. H Olowomofe, C. O Alo, S.T Ijatuyi

Abstract:

The issue of high blood sugar level, the effects of which might end up as diabetes mellitus, is now becoming a rampant cardiovascular disorder in our community. In recent times, a lack of awareness among most people makes this disease a silent killer. The situation calls for urgency, hence the need to design a device that serves as a monitoring tool such as a wrist watch to give an alert of the danger a head of time to those living with high blood glucose, as well as to introduce a mechanism for checks and balances. The neural network architecture assumed 8-15-10 configuration with eight neurons at the input stage including a bias, 15 neurons at the hidden layer at the processing stage, and 10 neurons at the output stage indicating likely symptoms cases. The inputs are formed using the exclusive OR (XOR), with the expectation of getting an XOR output as the threshold value for diabetic symptom cases. The neural algorithm is coded in Java language with 1000 epoch runs to bring the errors into the barest minimum. The internal circuitry of the device comprises the compatible hardware requirement that matches the nature of each of the input neurons. The light emitting diodes (LED) of red, green, and yellow colors are used as the output for the neural network to show pattern recognition for severe cases, pre-hypertensive cases and normal without the traces of diabetes mellitus. The research concluded that neural network is an efficient Accu-Chek design tool for the proper monitoring of high glucose levels than the conventional methods of carrying out blood test.

Keywords: Accu-Chek, diabetes, neural network, pattern recognition.

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21 Vancomycin and Rifaximin Combination Therapy for Diarrhoea Predominant Irritable Bowel Syndrome: An Observational Study

Authors: P. Murphy, D. Vasic, A. W. Gunaratne, T. Tugonon, M. Ison, C. Pagonis, E. T. Sitchon, A. Le Busque, T. J. Borody

Abstract:

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by an alteration in bowel movements. There are three different types of IBS: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) and IBS with mixed bowel habit (IBS-M). Antimicrobials are increasingly being used as treatment for all types of IBS. Due to this increased use and subsequent success, the gut microbiome as a factor in the etiology of IBS is becoming more apparent. Accepted standard treatment has focused on IBS-C and involves either vancomycin or rifaximin. Here, we report on a cohort of 18 patients treated with both vancomycin and rifaximin for IBS-D. These patients’ records were reviewed retrospectively. In this cohort, patients were aged between 24-74 years (mean 44 years) and nine were female. At baseline all patients had diarrhea, four with mucus and one with blood. Other reported symptoms include abdominal pain (n = 11) bloating (n = 9), flatulence (n = 7), fatigue (n = 4) and nausea (n = 3). Patient’s treatments were personalized according to their symptom severity and tolerability and were treated with a combination of rifaximin (500-3000 mg/d) and vancomycin (500 mg-1500 mg/d) for an ongoing period. Follow-ups were conducted between 2-32 weeks. Of all patients, 89% reported improvement of at least 1 symptom, one reported no change and one patient’s symptoms got worse. The success of this combination treatment could be due to the different mechanisms of action undertaken by each medication. Vancomycin works by inhibiting the cell wall of the bacteria and rifaximin by inhibiting protein synthesis. This success in treatment validates the idea that IBS-D may be driven by a bacterial infection of the gastrointestinal microbiome. As IBS-D presents similarly to Clostridium difficile and symptom improvement can occur with the same treatment as Clostridium difficile of rifaximin and vancomycin, there is reason to suggest that the infectious agent could be an unidentified strain of Clostridium. Although these results offer some validity to the theory, more research is required.

Keywords: Clostridium difficile infection, diarrhea predominant irritable bowel syndrome, microbiome, vancomycin/rifaximin combination.

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20 Building an Arithmetic Model to Assess Visual Consistency in Townscape

Authors: Dheyaa Hussein, Peter Armstrong

Abstract:

The phenomenon of visual disorder is prominent in contemporary townscapes. This paper provides a theoretical framework for the assessment of visual consistency in townscape in order to achieve more favourable outcomes for users. In this paper, visual consistency refers to the amount of similarity between adjacent components of townscape. The paper investigates parameters which relate to visual consistency in townscape, explores the relationships between them and highlights their significance. The paper uses arithmetic methods from outside the domain of urban design to enable the establishment of an objective approach of assessment which considers subjective indicators including users’ preferences. These methods involve the standard of deviation, colour distance and the distance between points. The paper identifies urban space as a key representative of the visual parameters of townscape. It focuses on its two components, geometry and colour in the evaluation of the visual consistency of townscape. Accordingly, this article proposes four measurements. The first quantifies the number of vertices, which are points in the three-dimensional space that are connected, by lines, to represent the appearance of elements. The second evaluates the visual surroundings of urban space through assessing the location of their vertices. The last two measurements calculate the visual similarity in both vertices and colour in townscape by the calculation of their variation using methods including standard of deviation and colour difference. The proposed quantitative assessment is based on users’ preferences towards these measurements. The paper offers a theoretical basis for a practical tool which can alter the current understanding of architectural form and its application in urban space. This tool is currently under development. The proposed method underpins expert subjective assessment and permits the establishment of a unified framework which adds to creativity by the achievement of a higher level of consistency and satisfaction among the citizens of evolving townscapes.

Keywords: Townscape, Urban Design, Visual Assessment, Visual Consistency.

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19 Implicit Responses for Assessment of Autism Based on Natural Behaviors Obtained Inside Immersive Virtual Environment

Authors: E. Olmos-Raya, A. Cascales Martínez, N. Minto de Sousa, M. Alcañiz Raya

Abstract:

The late detection and subjectivity of the assessment of Autism Spectrum Disorder (ASD) imposed a difficulty for the children’s clinical and familiar environment. The results showed in this paper, are part of a research project about the assessment and training of social skills in children with ASD, whose overall goal is the use of virtual environments together with physiological measures in order to find a new model of objective ASD assessment based on implicit brain processes measures. In particular, this work tries to contribute by studying the differences and changes in the Skin Conductance Response (SCR) and Eye Tracking (ET) between a typical development group (TD group) and an ASD group (ASD group) after several combined stimuli using a low cost Immersive Virtual Environment (IVE). Subjects were exposed to a virtual environment that showed natural scenes that stimulated visual, auditory and olfactory perceptual system. By exposing them to the IVE, subjects showed natural behaviors while measuring SCR and ET. This study compared measures of subjects diagnosed with ASD (N = 18) with a control group of subjects with typical development (N=10) when exposed to three different conditions: only visual (V), visual and auditory (VA) and visual, auditory and olfactory (VAO) stimulation. Correlations between SCR and ET measures were also correlated with the Autism Diagnostic Observation Schedule (ADOS) test. SCR measures showed significant differences among the experimental condition between groups. The ASD group presented higher level of SCR while we did not find significant differences between groups regarding DF. We found high significant correlations among all the experimental conditions in SCR measures and the subscale of ADOS test of imagination and symbolic thinking. Regarding the correlation between ET measures and ADOS test, the results showed significant relationship between VA condition and communication scores.

Keywords: Autism, electrodermal activity, eye tracking, immersive virtual environment, virtual reality.

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18 Emotion Regulation: An Exploratory Cross-Sectional Study on the Change and Grow Therapeutic Model

Authors: Eduardo da Silva, Tânia Caetano, Jessica B. Lopes

Abstract:

Emotion dysregulation has been linked to psychopathology in general and, in particular, to substance abuse and other addiction-related disorders, such as eating disorders, impulsive disorder, and gambling. It has been proposed that a lessening of the difficulties in emotion regulation can have a significant positive impact on the treatment of these disorders. The present study explores the association between the progress in the Change & Grow® therapeutic model (5 stages of treatment), and the decrease in the difficulties related to emotion regulation. The Change & Grow® model has five stages of treatment according to the model’s five principles (Truth, Acceptance, Gratitude, Love and Responsibility) and incorporates different therapeutic approaches such as positive psychology, cognitive and behavioral therapy and third generation therapies. The main objective is to understand the impact of the presented therapeutic model on difficulties in emotion regulation in patients with addiction-related disorders. The exploratory study has a cross-sectional design. Participants were 44 (15 women and 29 men) Portuguese patients in the residential Villa Ramadas International Treatment Centre. The instrument used was the Portuguese version of the Difficulties in Emotion Regulation Scale (DERS), which measures six dimensions of emotion regulation (Strategies, Non-acceptance, Awareness, Impulse, Goals, and Clarity). The mean rank scores for both the DERS total score and the Impulse subscale showed statistically significant differences according to Stage of Treatment/Principles. Furthermore, Stage of Treatment/Principles held a negative correlation with the scores of the Non-acceptance and Impulse subscales, as well as the DERS total score. The results indicate that the Change & Grow® model seems to have an impact in lessening the patient’s difficulties in emotion regulation. The Impulse dimension suffered the greater impact, which supports the well-known relevance of impulse control, or related difficulties, in addiction-related disorders.

Keywords: Addiction, Change & Grow®, emotion regulation, psychopathology.

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17 Hypolipidemic and Antioxidant Effects of Black Tea Extract and Quercetin in Atherosclerotic Rats

Authors: Wahyu Widowati, Hana Ratnawati, Tjandrawati Mozefis, Dwiyati Pujimulyani, Yelliantty Yelliantty

Abstract:

Background: Atherosclerosis is the main cause of cardiovascular disease (CVD) with complex and multifactorial process including atherogenic lipoprotein, oxidized low density lipoprotein (LDL), endothelial dysfunction, plaque stability, vascular inflammation, thrombotic and fibrinolytic disorder, exercises and genetic factor Epidemiological studies have shown tea consumption inversely associated with the development and progression of atherosclerosis. The research objectives: to elucidate hypolipidemic, antioxidant effects, as well as ability to improve coronary artery’s histopathologyof black tea extract (BTE) and quercetin in atherosclerotic rats. Methods: The antioxidant activity was determined by using Superoxide Dismutase activity (SOD) of serum and lipid peroxidation product (Malondialdehyde) of plasma and lipid profile including cholesterol total, LDL, triglyceride (TG), High Density Lipoprotein (HDL) of atherosclerotic rats. Inducing atherosclerotic, rats were given cholesterol and cholic acid in feed during ten weeks until rats indicated atherosclerotic symptom with narrowed artery and foamy cells in the artery’s wall. After rats suffered atherosclerotic, the high cholesterol feed and cholic acid were stopped and rats were given BTE 450; 300; 150 mg/kg body weight (BW) daily, quercetin 15; 10; 5 mg/kg BW daily, compared to rats were given vitamin E 60 mg/kg/BW; simvastatin 2.7 mg/kg BW, probucol 30 mg/kg BW daily for 21 days (first treatment) and 42 days (second treatment), negative control (normal feed), positive control (atherosclerotic rats). Results: BTE and quercetin could lower cholesterol total, triglyceride, LDL MDA and increase HDL, SOD were comparable with simvastatin, probucol both for 21 days and 42 days treatment, as well to improve coronary arteries histopathology. Conclusions: BTE andquercetin have hypolipidemic and antioxidant effects, as well as improve coronary arteries histopathology in atherosclerotic rats.

Keywords: Black tea, quercetin, atherosclerosis, antioxidant, hypolipidemic, cardiovascular disease.

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16 Food for Thought: Preparing the Brain to Eat New Foods through “Messy” Play

Authors: L. Bernabeo, T. Loftus

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Many children often experience phases of picky eating, food aversions and/or avoidance. For families with children who have special needs, these experiences are often exacerbated, which can lead to feelings that negatively impact a caregiver’s relationship with their child. Within the scope of speech language pathology practice, knowledge of both emotional and feeding development is key. This paper will explore the significance of “messy play” within typical feeding development, and the challenges that may arise if a child does not have the opportunity to engage in this type of exploratory play. This paper will consider several contributing factors that can result in a “picky eater.” Further, research has shown that individuals with special needs, including autism, possess a neurological makeup that differs from that of a typical individual. Because autism is a disorder of relating and communicating due to differences in the limbic system, an individual with special needs may respond to a typical feeding experience as if it is a traumatic event. As a result, broadening one’s dietary repertoire may seem to be an insurmountable challenge. This paper suggests that introducing new foods through exploratory play can help broaden and strengthen diets, as well as improve the feeding experience, of individuals with autism. The DIRFloortimeⓇ methodology stresses the importance of following a child's lead. Within this developmental model, there is a special focus on a person’s individual differences, including the unique way they process the world around them, as well as the significance of therapy occurring within the context of a strong and motivating relationship. Using this child-centered approach, we can support our children in expanding their diets, while simultaneously building upon their cognitive and creative development through playful and respectful interactions that include exposure to foods that differ in color, texture, and smell. Further, this paper explores the importance of exploration, self-feeding and messy play on brain development, both in the context of typically developing individuals and those with disordered development.

Keywords: Autism, development, exploration, feeding, play.

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15 Analysis of Metallothionein Gene MT1A (rs11076161) and MT2A (rs10636) Polymorphisms as a Molecular Marker in Type 2 Diabetes Mellitus among Malay Population

Authors: Norsakinah Mohammad Osman, Ali Etemad, Patimah Ismail

Abstract:

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder that characterized by the presence of high glucose in blood that cause from insulin resistance and insufficiency due to deterioration β-cell Langerhans functions. T2DM is commonly caused by the combination of inherited genetic variations as well as our own lifestyle. Metallothionein (MT) is a known cysteine-rich protein responsible in helping zinc homeostasis which is important in insulin signaling and secretion as well as protection our body from reactive oxygen species (ROS). MT scavenged ROS and free radicals in our body happen to be one of the reasons of T2DM and its complications. The objective of this study was to investigate the association of MT1A and MT2A polymorphisms between T2DM and control subjects among Malay populations. This study involved 150 T2DM and 120 Healthy individuals of Malay ethnic with mixed genders. The genomic DNA was extracted from buccal cells and amplified for MT1A and MT2A loci; the 347bp and 238bp banding patterns were respectively produced by mean of the Polymerase Chain Reaction (PCR). The PCR products were digested with Mlucl and Tsp451 restriction enzymes respectively and producing fragments lengths of (158/189/347bp) and (103/135/238bp) respectively. The ANOVA test was conducted and it shown that there was a significant difference between diabetic and control subjects for age, BMI, WHR, SBP, FPG, HBA1C, LDL, TG, TC and family history with (P<0.05). While the HDL, CVD risk ratio and DBP does not show any significant difference with (P>0.05). The genotype frequency for AA, AG and GG of MT1A polymorphisms was 72.7%, 22.7% and 4.7% in cases and 15%, 55% and 30% in control respectively. As for MT2A, genotype frequency of GG, GC and CC was 42.7%, 27.3% and 30% in case and 5%, 40% and 55% for control respectively. Both polymorphisms show significant difference between two investigated groups with (P=0.000). The Post hoc test was conducted and shows a significant difference between the genotypes within each polymorphism (P=0. 000). The MT1A and MT2A polymorphisms were believed to be the reliable molecular markers to distinguish the T2DM subjects from healthy individuals in Malay populations.

Keywords: Type 2 Diabetes Mellitus (T2DM), Metallothionein (MT), MT1A (rs11076161), MT2A (rs10636), Malay, Genetic Polymorphism.

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14 Understanding Help Seeking among Black Women with Clinically Significant Posttraumatic Stress Symptoms

Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

Abstract:

Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: Culture, help-seeking, integrated care, PTSD.

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13 Association between ADHD Medication, Cannabis, and Nicotine Use, Mental Distress, and Other Psychoactive Substances

Authors: Nicole Scott, Emily Dwyer, Cara Patrissy, Samantha Bonventre, Lina Begdache

Abstract:

Across North America, the use and abuse of Attention Deficit Hyperactivity Disorder (ADHD) medication, cannabis, nicotine, and other psychoactive substances across college campuses have become an increasingly prevalent problem. Students frequently use these substances to aid their studying or deal with their mental health issues. However, it is still unknown what psychoactive substances are likely to be abused when college students illicitly use ADHD medication. In addition, it is not clear which psychoactive substance is associated with mental distress. Thus, the purpose of this study is to fill these gaps by assessing the use of different psychoactive substances when illicit ADHD medication is used; and how this association relates to mental stress. A total of 702 undergraduate students from different college campuses in the US completed an anonymous survey distributed online. Data were self-reported on demographics, the use of ADHD medications, cannabis, nicotine, other psychoactive drugs, and mental distress, and feelings and opinions on the use of illicit study drugs were all included in the survey. Mental distress was assessed using the Kessler Psychological Distress 6 Scale. Data were analyzed in SPSS, Version 25.0, using Pearson’s Correlation Coefficient. Our results show use of ADHD medication, cannabis use (non-frequent and very frequent), and nicotine use (non-frequent and very frequent); there were both statistically significant positive and negative correlations to specific psychoactive substances and their corresponding frequencies. Along the same lines, ADHD medication, cannabis use (non-frequent and very frequent), and nicotine use (non-frequent and very frequent) had statistically significant positive and negative correlations to specific mental distress experiences. As these findings are combined, a vicious loop can initiate a cycle where individuals who abuse psychoactive substances may or may not be inclined to use other psychoactive substances. This may later inhibit brain functions in those main areas of the brain stem, amygdala, and prefrontal cortex where this vicious cycle may or may not impact their mental distress. Addressing the impact of study drug abuse and its potential to be associated with further substance abuse may provide an educational framework and support proactive approaches to promote awareness among college students.

Keywords: Stimulant, depressant, nicotine, ADHD medication, psychoactive substances, mental health, illicit, ecstasy, adrenochrome.

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