01/2014 journal articles
UNDERNUTRITION AND RISK OF MULTIDRUG-RESISTANT INFECTIONS IN THE ELDERLY
R. Billon, J.-L. Fanon, P. Thomas
J Aging Res Clin Practice 2014;3(1):3-6Show summaryHide summary
Objectives: To appraise the risk of having a multi resistant bacteria infection attributable to poor nutritional status in the elderly. Design: Using a statement from a case-control study in an acute geriatric medical service, knowing the overall risk of infection in the studied population, it is possible from the likelihood ratio, frequency of malnourished infected by MRB, divided by frequency in malnourished infected with sensitive organisms, to calculate a probability which is a post-test assessment of this risk. Two groups of patients had a documented infection, one with both an albumin less than 25g and pre albumin levels less than 0.15g and another where values were greater than or equal to 35g and 0.15g. Setting: The geriatrics short care unit in Fort de France, Martinique, France. Participants: Patients over 75 years, hospitalized in the short care unit and who had an acute infection with a positive sample (urine, blood .. ) Measurements: The frequency of malnourished patients is increased when infected with multi-resistant Bacteria, as shown with post test probability calculation. Results: In a population averaging 85 years old, the malnourished group had almost a double risk of infection , 26.92% ( 95% CI : 22.73-30.38 ) against 13.95% ( 95% CI : 7.01-25.85) in the other group. The fraction attributable to undernutrition was 48%. Conclusion: Nearly half of the resistance can be attributed to malnutrition with a fraction attributable to exposure to 48%. It's still possible that other factors not taken into account in this presentation partly explain this difference. The case-control statement type can also be biased and finally we relied only on the rate of albumin and pre-albumin to classify patients. But it is still unlikely that the observed result is due to chance.
R. Billon ; J.-L. Fanon ; P. Thomas (2014): UNDERNUTRITION AND RISK OF MULTIDRUG-RESISTANT INFECTIONS IN THE ELDERLY . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.1
DISTRIBUTION OF THE BIOELECTRICAL IMPEDANCE VECTOR IN BRAZILIAN FREE-LIVING ELDERLY SUBJECTS
K. Pfrimer, A.V.B. Margutti, I.A. Leme, J.S. Camelo Jr, J.C. Moriguti, N.K.C. Lima, J.S. Marchini, E. Ferriolli
J Aging Res Clin Practice 2014;3(1):7-13Show summaryHide summary
Objectives: The calculation of body composition using bioelectrical impedance analysis is limited in the elderly because most equations have been found to be inadequate. Bioelectrical impedance vector analysis (BIVA) is a new method that is used for the routine monitoring of the variation in body fluids and nutritional status. The aim of the present study was to determine bivariate tolerance intervals of the whole-body impedance vector and to describe phase angle (PA) values for healthy urban-living elderly aged 60-70 years. Design: This descriptive cross-sectional study. Setting: Ribeirão Preto, São Paulo, Brazil. Participants: Healthy free living elderly. Measurements: General and anthropometric data and bioelectrical impedance data (800µA–50kHz) were obtained. Bivariate vector analysis was conducted with resistance-reactance (RXc) graph method. The BIVA software was used to construct the graphs. Results: Ninety-eight elderly persons (59.1% females) who were healthy, independent and aged 60 to 70 years old were studied. We constructed standard RXc-score graph and RXc-tolerance ellipses (50, 75 and 95%) that can be used in any analyses. Mean PA was 5.47 (SD 0.67)° for men and 5.0 (SD 0.59)° for women. Different ellipses were defined for men and women because there are differences in the body composition according to gender. Conclusion: The graphs differ from those previously reported in the literature, due to ethnic differences in body composition. BIVA and PA allow nutritional assessment and eliminate the prediction errors of conventional impedance formulas.
K. Pfrimer ; A.V.B. Margutti ; I.A. Leme ; J.S. Camelo Jr ; J.C. Moriguti ; N.K.C. Lima ; J.S. Marchini ; E. Ferriolli (2014): DISTRIBUTION OF THE BIOELECTRICAL IMPEDANCE VECTOR IN BRAZILIAN FREE-LIVING ELDERLY SUBJECTS . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.2
VALIDATION OF FOUR FREQUENTLY USED GLUCOSE METRES AND SELECTION OF FREESTYLE FREEDOM LITE FOR EXAMINING THE EFFECTS OF ANIMATED CONVERSATION AND PROBLEM SOLVING ON BLOOD GLUCOSE CONCENTRATIONS FOLLOWING A STANDARDISED CARBOHYDRATE LOADING
B. Phillips, S. Ali, M. Chopra
J Aging Res Clin Practice 2014;3(1):14-18Show summaryHide summary
Objectives: Benefits of physical activity on maintenance of blood glucose within an acceptable range are well documented. This study explores the possible beneficial effect of animated conversation and mental activities on blood glucose levels following dietary carbohydrate loading. Design and Participants: Blood glucose changes were examined in 18 non-diabetic individuals following the consumption of two doughnuts providing ~48g of carbohydrate. The participants acted as their own controls and were studied twice. On the first occasion they maintained quiet/passive behaviour, on the second they conversed and participated in structured mental activities e.g. reading and solving puzzles. Measurements: Using the Freestyle Freedom Lite glucose metre, baseline, then post-fasting blood glucose concentrations were evaluated every 30 minutes over a 2 hour period after the consumption of doughnuts. Results: ANOVA repeated measures analysis of the results showed that time (P<0.001), activity (P<0.01) and time*activity interaction (P<0.05) all had a significant effect on the blood glucose levels. Compared with active intervention, the mean blood glucose levels during quiet/passive behaviour period remained ~30-40% higher and this difference was most significant at 30 minutes (1.40 vs 0.87 mmol/L, P<0.05)) and 60 minutes (1.53 vs 0.91mmol/L, P<0.01) measurements. Conclusion: The results of this preliminary study indicate that simple non-exercise related activities involving mental activity and conversation have a significant influence on reducing blood glucose levels. This may be of value when individuals are unable to engage in regular exercise due to personal and environmental constraints.
B. Phillips ; S. Ali ; M. Chopra (2014): VALIDATION OF FOUR FREQUENTLY USED GLUCOSE METRES AND SELECTION OF FREESTYLE FREEDOM LITE FOR EXAMINING THE EFFECTS OF ANIMATED CONVERSATION AND PROBLEM SOLVING ON BLOOD GLUCOSE CONCENTRATIONS FOLLOWING A STANDARDISED CARBOHYDRATE LOADING. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.3
INFLUENCE OF CHEMOSENSORY IMPAIRMENT ON INTAKE AND LIKING OF A FUNCTIONAL DRINK IN UNDERNOURISHED INSTITUTIONALIZED ELDERLY PEOPLE
C. Arganini, L.M. Donini, M. Peparaio, F. Sinesio
J Aging Res Clin Practice 2014;3(1):19-23Show summaryHide summary
Background: Age-related chemosensory impairments (i.e., reduction of taste and smell acuity) affect a large proportion of the population older than 65 years. These conditions can affect overall health, quality of life and influence food appreciation and intake. The knowledge about the relation between chemosensory perception and hedonic food liking in older people might facilitate the development of effective strategies aiming to improve their nutritional wellbeing. Objectives: The key objective of this study is to test the influence of a sensory compensatory strategy on liking and intake of a functional red fruit drink in undernourished nursing home elderly people. Design: The research consisted of three main phases. In the first step the enrolled subjects were classified on the basis of their taste and olfaction sensitivity; in the second step the sensory compensatory strategy, aiming to counteract age-associated sensory losses and increase product pleasantness, was identified; the last step consisted of 14 days of exposure to each drink variant (standard and enhanced) to observe the effects of sensory modifications on liking and intake. Setting: “Villa delle Querce” Clinical Rehabilitation Institute of Nemi (Rome- Italy). Participants: 76 elderly people (64-97 years). Results: Overall the prevalence of measured chemosensory impairments in this sample of institutionalized older adults was very high (81%). The sensory modification strategy did influence significantly neither the intake nor liking in the elderly people. Consistent with the findings of previous studies (3, 6, 24, 25) no significant correlation was found between sensory capabilities and hedonic responses. Conclusion: These findings highlight that, in accordance to other studies (2, 3, 6-8), the role of sensory compensatory strategies in increasing products appreciation and intake of institutionalized elderly people have been overestimated.
C. Arganini ; L.M. Donini ; M. Peparaio ; F. Sinesio (2014): INFLUENCE OF CHEMOSENSORY IMPAIRMENT ON INTAKE AND LIKING OF A FUNCTIONAL DRINK IN UNDERNOURISHED INSTITUTIONALIZED ELDERLY PEOPLE . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.4
THE INTAKE OF SOYBEANS AND SOYBEAN PRODUCTS IS MOST EFFECTIVE FOR THE PREVENTION OF VASCULAR AGING IN THE JAPANESE MIDDLE-AGED AND ELDERLY
M. Kaneko, T. Kaneko, M. Yamate, T. Matsushita, K. Ohishi, S. Tsutie
J Aging Res Clin Practice 2014;3(1):24-27Show summaryHide summary
Background: Vascular aging is the main pathogenic factor for heart and cerebrovascular disease. It is a critical challenge to prevent vascular aging in the rapidly aging Japanese society. Objective: This study was carried out to examine the impact of dietary habits on the progression of vascular aging in middle-aged and elderly Japanese individuals. Participants: Subjects were 16 healthy males and females aged 63 to 72 years who gave consent to participate in the present study. Measurements: Vascular aging was evaluated by the second derivative of the fingertip photoplethysmogram, and the subjects were divided into two groups: Group I (vascular age was older than actual age) and Group II (vascular age was younger than actual age). Subjects took photos of all food dishes consumed for 7 days to investigate their dietary habits. We collected information of types of foods and the amounts from the photos, and entered this information into a Food Frequency Questionnaire based on Food Group (FFQg) to analyze the data. Results: Group II showed significantly greater (p < 0.05) intakes of polyunsaturated fatty acids (Group I, 10.3 ± 1.9 g/day; Group II, 13.2 ± 2.0 g/day), n-3 fatty acids (Group I, 2.3 ± 0.4 g/day; Group II, 2.7 ± 0.3 g/day), and n-6 fatty acids (Group I, 7.9 ± 1.6 g/day; Group II, 10.5 ± 1.9 g/day). Despite no significant difference in the intake of seafood (Group I, 95.4 ± 33.7 g/day; Group II, 98.8 ± 29.5 g/day) containing large amounts of n-3 fatty acids, Group II showed a significantly greater (p < 0.05) intake of soybeans and processed soybean products (90.9 ± 32.7 g/day) than Group I (52.9 ± 24.8 g/day). Conclusion: Intake of soybeans and processed soybean products was considered most effective in preventing the progression of vascular aging in the middle-aged and elderly subjects who participated in this study.
M. Kaneko ; T. Kaneko ; M. Yamate ; T. Matsushita ; K. Ohishi ; S. Tsutie (2014): THE INTAKE OF SOYBEANS AND SOYBEAN PRODUCTS IS MOST EFFECTIVE FOR THE PREVENTION OF VASCULAR AGING IN THE JAPANESE MIDDLE-AGED AND ELDERLY. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.5
INFLUENCE OF STRENGTH TRAINING ON DISTRIBUTION OF TRUNK AND APPENDICULAR MUSCLE MASS
T. Abe, J.P. Loenneke, K. Kojima, R.S. Thiebaud, C.A. Fahs, O. Sekiguchi
J Aging Res Clin Practice 2014;3(1):28-30Show summaryHide summary
Strength training can increase skeletal muscle mass (SM), however, the hypertrophic responses between trunk and limb muscles may differ. This may be problematic because dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass (aLM) does not include trunk SM. Thus, the purpose was to compare trunk and limb SM (measured by magnetic resonance imaging) between weightlifters (WL) and moderately active men (CON). With the exception of lower-leg SM, WL had greater total and segmental SM than CON. Relative SM, such as trunk to total SM ratio, was greater in WL than in CON. Because trunk SM includes the shoulder and hip joints muscles, we reanalyzed major individual muscles of only three subjects (two in CON group and one in WL group). Although WL had greater trunk SM, the DXA-determined aLM does contain these muscles. Thus, these results suggest that the DXA may be used to track SM adaptations to chronic strength training.
T. Abe ; J.P. Loenneke ; K. Kojima ; R.S. Thiebaud ; C.A. Fahs ; O. Sekiguchi (2014): INFLUENCE OF STRENGTH TRAINING ON DISTRIBUTION OF TRUNK AND APPENDICULAR MUSCLE MASS. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.6
THE INTAKE OF FIBER MESOCARP PASSIONFRUIT (PASSIFLORA EDULIS) LOWERS LEVELS OF TRIGLYCERIDE AND CHOLESTEROL DECREASING PRINCIPALLY INSULIN AND LEPTIN
E.M. Corrêa, L. Medina, J. Barros-Monteiro, N.O. Valle, R. Sales, A. Magalães, F.C.A. Souza, T.B. Carvalho, J.R. Lemos, E.F. Lira, E.S. Lima, D.M.L. Galeno, L. Morales, C. Ortiz, R.P. Carvalho
J Aging Res Clin Practice 2014;3(1):31-35Show summaryHide summary
Background: Diabetes mellitus (DM) is a major risk factor for coronary artery disease, renal failure, retinopathy, and neuropathy. Over the last years, there has been an increasing demand in folk medicine for natural sources that could help in the treatment of chronic diseases, including diabetes. The rind of passion fruit (Passiflora edulis f. Flavicarpa) is traditionally used as a functional food due to its high concentration of soluble and insoluble fiber. Objective: The aim of this study was to determine the effect of high-fiber diet albedo of passion fruit on the metabolic and biochemical profile in diabetic rats induced by alloxan (2%). Design: The passion fruit mesocarp fiber was dried in an oven with circulating air at 60°C and pulverized. We used 32 adult male rats, divided into 4 groups: Wistar group 1 control (GC), Wistar group 2, 15% fiber (GF15), Wistar group 3, 30% fiber (GF30), Wistar group 4, fiber disolved in water (GFH2O). The ratio of passion fruit was prepared according to the AIN 93M guidelines, varying only the source of dietary fiber. The corresponding diet for each group was offered to the animals for 60 days. Results: There was a statically significant decrease in plasma glucose for GFH2O, GF15%, and GF30% groups with 27.0%, 37.4%, and 40.2%, respectively. Conclusion: The use of mesocarp fiber of passion fruit at concentrations of 15% and 30% are an important dietary supplement for the treatment of DM due to its potential hypoglycemic effect, and its ability to reduce triglycerides and VLDL-cholesterol levels with a principal reduction of insulin and leptin.
E.M. Corrêa ; L. Medina ; J. Barros-Monteiro ; N.O. Valle ; R. Sales ; A. Magalães ; F.C.A. Souza ; T.B. Carvalho ; J.R. Lemos ; E.F. Lira ; E.S. Lima ; D.M.L. Galeno ; L. Morales ; C. Ortiz ; R.P. Carvalho (2014): THE INTAKE OF FIBER MESOCARP PASSIONFRUIT (PASSIFLORA EDULIS) LOWERS LEVELS OF TRIGLYCERIDE AND CHOLESTEROL DECREASING PRINCIPALLY INSULIN AND LEPTIN. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.7
MARRIAGE AND ATTACHMENT IN ALZHEIMER’S DISEASE: A LITERATURE REVIEW
P. Velotti, R. Castellano, M. Canevelli, G. Bruno
J Aging Res Clin Practice 2014;3(1):36-40Show summaryHide summary
This article presents an overview of the role of attachment in the couple’ relationship in presence of a partner with Alzheimer’s Disease. The diagnosis of Alzheimer Disease has profound repercussions on the individual and family system. The first objective of this report is to discuss literature on the association between Alzheimer Disease and couple’s relationship, through the lens of attachment perspective. The usefulness of attachment framework is proposed for a deeper understanding of couple functioning in presence of AD. The methodology used was a systematic search on electronic databases for published literature. A detailed search of the databases was conducted for articles published between January 1st 1993 and October 10th 2013: MEDLINE (via Pub Med), PsycINFO and PsycARTICLES (via EBSCO). It is shown that promising studies from the attachment perspective can be useful for the understanding of marital relationship in presence of AD. Finally, the interlacement among attachment, caregiving and sexuality systems in the couple managing this diagnosis is proposed.
P. Velotti ; R. Castellano ; M. Canevelli ; G. Bruno (2014): MARRIAGE AND ATTACHMENT IN ALZHEIMER’S DISEASE: A LITERATURE REVIEW . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.8
NUTRITIONAL CHALLENGES FOR THE FAMILY CAREGIVER AND PERSON WITH DEMENTIA DYAD
E. Beattie, J. McCrow, C. Dyce, E. Fielding, E. Isenring
J Aging Res Clin Practice 2014;3(1):41-46Show summaryHide summary
Background: The majority of people with dementia live at home until quite late in the disease trajectory, supported by family caregivers who typically take increasing responsibility for providing nutrition. Caregiving is highly stressful and thus both dyad partners are at risk of nutritional issues. Objective: This study evaluated the nutritional status of both dyad members and the associations between these. Design: Descriptive, correlational. Setting: Community. Participants: 26 dyads of persons with dementia and caregivers. Measurements: The nutritional status of each dyad member was evaluated at home using a comprehensive battery of measures including the Mini-Nutritional Assessment, Corrected Arm Muscle Area and a 3-day food diary. Stage of dementia and functional eating capacity was measured for the person with dementia. Caregivers completed a brief burden scale. Result: Of those with dementia (n = 26), a large proportion had nutritional issues (one was malnourished and another 16 were at risk). Six of the caregivers were at risk of malnutrition. In addition, fifteen of the people with dementia did not meet their recommended daily energy requirements. A moderate and significant positive correlation between functional eating skills and nutritional status (MNA score) among participants with dementia was found (r = .523, n = 26, p = .006). Conclusion: These findings suggest that a dyadic perspective on nutritional status provides important insights into risk in this vulnerable group. Specifically, monitoring of the functional eating independence skills of the person with dementia is critical, along with assisting caregivers to be aware of their own eating patterns and intake.
E. Beattie ; J. McCrow ; C. Dyce ; E. Fielding ; E. Isenring (2014): NUTRITIONAL CHALLENGES FOR THE FAMILY CAREGIVER AND PERSON WITH DEMENTIA DYAD . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.9
WATER-BASED EXERCISE FOLLOWING STROKE: A RANDOMISED CONTROLLED PILOT STUDY
M.E.L. van den Berg, M. Crotty
J Aging Res Clin Practice 2014;3(1):47-50Show summaryHide summary
Background: Decline in mobility is commonly observed following stroke. Reducing the impact of stroke is key to the maintainance of functional independence. Objectives: To determine the acceptability and adherence of a water-based exercise program post-stroke. Design: A single-blind randomised controlled pilot study with masked outcome assessment. Setting: Rehabilitation Unit, Adelaide, South Australia. Participants: 22 community-dwelling older people e living with strokes (6 months-3 years post-stroke). Intervention: Subjects were randomized to either: a six-week water-based intervention group (WG), thrice-weekly; a six-week gym-based intervention group (GG), thrice-weekly; or a six-week chronic disease self-management course (CG), once-weekly. Measurements: Assessments took place at baseline, post-intervention and at 3 months follow-up. Primary outcome measures was the 6-minute walk test. Secondary outcomes were measures of balance, body composition, cognition, ADL, goal attainment, quality of life, sleep and fatigue. Results: Recruitment was difficult with only 20% of those approached meeting entry criteria and consenting. A larger increase in walking speed and reduced use of walking aids post-intervention was observed in the WG, however, differences between groups were not significant. No between-group differences were found for any secondary outcomes. The average attendance rate was 90% (n=6). Conclusion: Subjects tolerated the moderate to high intensity water-based exercise program and adherance was good. Although we can not draw firm conclusions due to study completion failure the results suggest that a relatively short program of water-based exercise in stroke survivors is safe and feasible and can improve functional mobility. Hydrotherapy can be delivered with minimal supervision and a well powered trial is needed to assess the effects in chronic stroke patients
M.E.L. van den Berg ; M. Crotty (2014): WATER-BASED EXERCISE FOLLOWING STROKE: A RANDOMISED CONTROLLED PILOT STUDY. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.10
ANTI-OXIDATIVE POTENTIALS FROM SIX THAI COMMON MEDICINAL AND EDIBLE PLANTS
N. Luplertlop, T. Kitisin
J Aging Res Clin Practice 2014;3(1):51-55Show summaryHide summary
Repetitive and long term exposure of solar UV irradiation can cause skin aging and induced wrinkling skin. These remarkable sequences are involving in accumulation of reactive oxygemspecies (ROS), induction of pro-inflammatory cytokines, and degradation of skin extreacellular matrix (ECM). Moreover, repetitive photo-aging by solar UV damaged together with chronological aging could cause significant changes in skin morphology. As the cosmetic market increasing, the high demands usage of synthetic anti-oxidative compounds consequently exhibited long term adverse effects to consumers. Thus, the attempt to find a natural plant extracts with anti-oxidative power can be used as a good candidate for anti-aging formulation. The present of this review mainly aimed to provide alternative plants information as a candidate to use their reported active ingredients, which exhibited possible potential on skin aging prevention. The review on these medicinal and edible plants with their constituents was described to highlight the potentials of the plants which may help to maximize the beneficial of anti-skin aging therapy.
N. Luplertlop ; T. Kitisin (2014): ANTI-OXIDATIVE POTENTIALS FROM SIX THAI COMMON MEDICINAL AND EDIBLE PLANTS . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.11
THE EFFECT OF ELEVATP™ ON WHOLE BLOOD ATP LEVELS: A SINGLE DOSE, CROSSOVER CLINICAL STUDY
T. Reyes-Izquierdo, C. Shu, R. Argumedo, B. Nemzer, Z. Pietrzkowski
J Aging Res Clin Practice 2014;3(1):56-60Show summaryHide summary
Purpose: elevATP™, a supplement containing plant-derived inorganic microelements and apple polyphenols, was previously shown to increase endogenous whole blood ATP levels in healthy human subjects. In this report, we tested the supplement in a larger cohort and assessed the effect of the supplement in muscle. Methods: Twenty healthy, fasted, and resting adult human subjects participated in this acute, placebo-controlled, single-dose crossover clinical study. Oral placebo was administered on the first day of testing followed by a single, 150 mg dose of elevATP™ on the second day. Blood was collected immediately prior to treatment, 60 and 120 minutes after ingestion. Whole blood ATP, plasma ATP, hemoglobin, blood lactate, and blood glucose levels were collected. A muscle biopsy was performed on one resting study subject before, and 60 and 120 minutes after, a single dose of elevATP™. Results: elevATP™ increased whole blood levels of ATP by 40% after 60 minutes (p<0.0001) and by 28% after 120 min (p=0.0009) versus baseline, pre-supplementation levels. ATP plasma levels did not increase after elevATP™ administration under these experimental conditions. Intramuscular ATP levels from biopsy of one patient increased significantly at 60 and 120 minutes after ingestion of elevATP™ and reached higher levels than ATP measured in whole blood. Conclusions: These results indicate that elevATP™ increases intracellular ATP in blood cells, confirming results from a previous study, and suggest that it may increase ATP in muscle tissue. Further clinical testing is needed to confirm tissue- and organ-specific changes in ATP levels following ingestion of elevATP™.
T. Reyes-Izquierdo ; C. Shu ; R. Argumedo ; B. Nemzer ; Z. Pietrzkowski (2014): THE EFFECT OF ELEVATP™ ON WHOLE BLOOD ATP LEVELS: A SINGLE DOSE, CROSSOVER CLINICAL STUDY . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2014.12