The results of this study indicate that the eight-week T-ADL training has a positive effect on upper limb functions and gross manual dexterity, and both T-ADL training and conventional OT are effective in improving ADL and QoL in chronic stroke patients.This randomized controlled study aimed to investigate the effects of 8-week task-oriented activities of daily living (T-ADL) training on upper limb functions, activities of daily living (ADL), and quality of life (QoL) in chronic stroke patients. The 33 patients were randomly assigned to the T-ADL training or conventional occupational therapy (OT) group. The respective interventions were provided for 45-min a day, five times a week for eight weeks. To compare the upper-limb function before and after the intervention, the manual function test (MFT), box and block test (BBT), and grasp power test were performed; to compare the level of ADL performance, the modified-Barthel index (MBI) was measured. To evaluate QoL, stroke-specific QoL was measured. There was a significant group-by-time interaction in the affected side MFT score and both sides of BBT scores, but no significant interaction was found in the unaffected side MFT score, ADL, and QoL. Both groups showed a significant main effect of time in their ADL and QoL after the intervention ( Recently, with the prolongation of mean human life expectancy, problems related to population aging and the incidence of adult vascular diseases have increased. Moreover, the incidence of stroke as a type of vascular disease in younger adults has increased owing to various factors ,2,3. TheNotably, only 10% of post-stroke patients show complete recovery, 30% die, and 60% suffer from chronic dysfunction ,8. TheseA task-oriented approach is an activity-centered approach that involves the repeated training of a task focusing on functional performance toward the effective completion of the task, whereby the exercise training effects are increased through the environment, task analysis, feedback, and repeated training . FunctioRecent research has investigated the effects of depression, rehabilitation motivation, and ADL on the QoL of stroke patients . Other rThis randomized controlled trial was conducted in accordance with the Consolidated Standards of Reporting Trial (CONSORT) recommendations and retrospectively registered on cris.org (KCT0007830). The study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Gachon University Institutional Review Board (1044396-202112-HR-241-01). All participants signed an informed consent form before the start of the study.Thirty-eight chronic stroke patients were assessed for eligibility in the current study. Among these, four did not meet the inclusion criteria, and one did not participate; thus, 33 patients were included in the study. The inclusion criteria of the study participants were as follows: Hemiplegia due to stroke six months after onset. The following types of patients were excluded: patients with cognitive impairment or dementia with a Korean version of the Mini-Mental State Examination score of 23 or lower who were unable to understand instructions or inability to understand oral instruction due to language disorders or other reasons, and patients with severe contracture due to orthopedic disease of the shoulder, elbow, and wrist joints. Thirty-three patients were randomly assigned to the T-ADL training group and the control group, with 15 patients assigned to each group using simple randomization methods that were independently conducted. Concealed allocation was performed using a computer-generated randomized table of numbers before data collection. All participants in both groups underwent a manual function test (MFT), box and block test (BBT), handgrip strength test, Korean version of the modified Barthel index (K-MBI), and stroke-specific QoL (SS-QoL) evaluation for baseline assessment. Both groups underwent their respective interventions for 45 min daily, five times weekly, for eight weeks . Then, all assessments were done after the 8 weeks after the intervention.n = 4), grasp (n = 2), and hand activities (n = 2). It is easily applicable as an objective test for the recovery of upper-limb functions and ADL at the level of practice. Notably, this simple and easy test allows for the testing of upper limb function in stroke patients within only 10 min . S. Sp < 0.= 0.004) D. Stroke is a neurological disease that often causes chronic disability and permanently alters the patient’s life. Therapeutic application in stroke patients should include activities with set goals and treatments for the improvement of upper-limb functions to comprehensively address the various psychological and social problems that patients encounter in the performance environment as well as the factors related to QoL . TherefoThis study found that the T-ADL training was effective in improving upper extremity function and gross manual dexterity in chronic stroke patients, with the T-ADL training group showing significantly greater increasing in MFT and BBT score compared to conventional OT group. In a recent systematic review , a progrUnlike the lower extremity, where functional movement is possible only through the use of both limbs upon an ADL, the activities related to the upper extremity mostly allow performance even through the use of a single limb, so that the use of the affected limb is frequently avoided despite residual functions to delay recovery . In a siA significant improvement in ADL was found in both groups, but only the T-ADL training group improved more than the MCID of the MBI. ADL can be divided into basic ADL, which covers everyday activities for consistent personal daily living and self-management, and IADL, which reflects the techniques to support home and community-based daily living, such as financial management, meal preparation, dishwashing, shopping, and transportation, and to mediate interactions with the complex environment . The T-AThe findings of this study suggest that the T-ADL training program led the patients in the respective groups to show greater significant improvements in upper extremity function and gross manual dexterity. Furthermore, the affected and unaffected sides showed significantly improved upper-limb functions, which implies the importance of training focused on various ADL in not only the life at the hospital but also the discharge and return home of stroke patients. The strength of this study was that T-ADL was composed of task-oriented activities and it was performed by themselves based one the instructions of the therapist, which emphasizing active intervention. Despite this strength, the current study had several limitations. The sample size was small, as only those with fair cognitive abilities were selected. Thus, it is difficult to generalize the results of the T-ADL training program to all stroke patients because of the lack of varied subjects. In the future, studies should recruit a larger number of subjects and assess the performance at each stage of the program to allow generalization of T-ADL training. Further studies should be conducted on a larger number of stroke patients regarding more varied ADL as part of the rehabilitation program.The results of this study indicate that the eight-week T-ADL training have a positive effect on upper limb functions and gross manual dexterity. Thus, the T-ADL training might be a feasible intervention for improving upper limb functions for both affected and non-affected side in chronic stroke patients. However, a further study with a larger sample size needs to confirm what was achieved in the present study.


N = 167), as well as the impact of a tailored nail-trimming demonstration on clients' confidence trimming pets' nails. Ninety-two percent of the sample reported experiencing at least one barrier to maintaining their pet's grooming  and nearly half (46%) experienced three or more barriers to providing grooming. Ninety-one percent endorsed that at least one supply/support  would be beneficial in maintaining their pet's grooming needs at home and more than half reported that three or more supplies/services would be beneficial. Differences in the prevalence of specific barriers to grooming were found across income groups, service locations, and service settings. Clients who received nail-trimming demonstrations, on average, reported statistically significant increases in confidence trimming nails following their appointment. We discuss the implications of these findings for improving animal welfare and veterinary professionals' capacity for preventing grooming-related omissions of care and increasing communities' capacity to support pet owners' access to essential pet care supplies and supports. Future research is needed to determine (a) how and for whom grooming demonstrations and subsidized services are most effective, (b) whether an increase in pet owner confidence following nail trimming demonstrations is associated with maintaining nail trimming at home over time, and (c) whether providing clients with supplies and supports is an effective way of preventing and/or ameliorating future grooming-related omissions of care and hygiene-related health concerns observed by veterinarians, animal control professionals, shelter staff, and law enforcement.Grooming is an important aspect of basic hygiene care for most companion animals. The consequences of not receiving routine grooming care can pose significant risks to animals' health and wellbeing. The current study examined barriers and facilitators of maintaining pets' grooming needs among clients of a subsidized grooming service program in New York City ( Grooming is an important aspect of basic hygiene care for most companion animals and can include activities such as bathing, trimming nails, cleaning ears, and brushing or clipping hair. Grooming may also include flea and tick baths and dips that provide prevention and treatment of parasites. The potential health consequences of inadequate grooming are diverse and can range in severity. For example, the consequences of matted hair can range from skin irritation and discomfort to constricted blood flow and lymphatic drainage, resulting in soft tissue death and bone injury . Nails tStudies examining pet caregivers' grooming practices are limited. An important step in preventing grooming-related omissions of care is to understand the reasons that caregivers may not provide adequate grooming . A 2020 The American Society for the Prevention of Cruelty to Animals (ASPCA) recently reported on the scope of grooming-related concerns among animals served by ASPCA programs in New York City. Specifically, McDonald et al.  retrospeThe current study, which seeks to advance knowledge in this area by reporting on data collected as part of a pilot study of a subsidized grooming services program in New York City, has four aims. Our first aim was to better understand how dog and cat owners served by the ASPCA's grooming services program view the role of grooming in relation to maintaining their pet's health and their confidence performing basic components of pet grooming . Although this aim was primarily exploratory, we anticipated that pet owners would be least confident trimming their pet's nails. Our second aim was to identify factors that may serve as barriers to pet owners' ability to provide basic grooming care. We hypothesized that dog and cat owners served by the program would, on average, experience multiple barriers to grooming-related care, including finances, transportation, physical ability, time, pets' behavior, and proximity to grooming services and supply stores. In addition, we anticipated that income would be the most prevalent barrier to grooming pets. Our third aim was to identify what supplies and supports are needed for dog and cat owners to maintain their pet's grooming needs at home. We hypothesized that most pet owners would benefit from varied supplies and support services based on their unique needs, including basic grooming supplies  and behavioral support services for pets. Our final aim was to test whether nail trimming demonstrations provided through the program significantly improved pet owners' confidence cutting their pet's nails. We hypothesized that, on average, pet owners' confidence trimming nails would increase following the demonstration.The ASPCA's Community Engagement (CE) team works with New York City residents who lack access to vital veterinary care, services, and supplies for their pets. Often, these pet owners are referred to the team by the New York City Police Department (NYPD) following a response to animal welfare/cruelty complaints, as cases deemed more appropriate for supportive services than criminal justice system involvement. The CE team provides families with resources to help them create and sustain a safe and healthy environment for their pet(s). The team also accepts client referrals from social service and other allied agencies and conducts outreach throughout the community to increase awareness and access to the ASPCA's veterinary and spay/neuter services. A grooming program is provided at the ASPCA's stationary Community Veterinary Clinics (CVCs) located in the Bronx and Brooklyn, in addition to mobile grooming events throughout the city. Program staff engage in targeted service promotion by distributing flyers locally, partnering with agencies such as the NYPD's Community Affairs Unit, and relying on word-of-mouth to reach prospective clients.Typically, grooming services address basic needs such as nail trimming and sanitary cuts (shave of the belly and rear area of the dog to keep this area more sanitary), which can be done quickly and efficiently. Full-service medical grooming  is also available at CVC locations. Nail trimming demonstrations were provided by the groomer using the participant's own pet during which the groomer performed basic aspects of nail trimming  and provided verbal instructions. Client eligibility includes residency of the borough in which the services are taking place and that clients report $50,000 or less in total household income. Pet owners do not need to be an existing ASPCA client to get an appointment, and the pet does not need to be vaccinated . The type of appointment a client receives  is determined through a face-to-face or phone conversation with the pet owner, who is asked by program staff to describe their pet's grooming needs and behavior. Occasionally, a photograph of the pet is shared to determine the extent of the grooming services needed and the appropriate length of time. The client's residence and the pet's grooming needs determine at which service location (Bronx or Brooklyn) and service setting (CVC or mobile event) they will receive services. Proof of address or income is not required.Study procedures were approved by Advarra IRB (Pro00058852). All clients, regardless of grooming service type, were offered the opportunity to participate in a survey at the CVCs or a mobile event. Eligibility for receiving services was determined prior to completing the study survey. ASPCA staff emphasized that participation was entirely voluntary and would not impact the services or quality of care provided. Clients who chose to participate in the study were able to choose whether they wanted to complete a Spanish- or English-language version of the survey. We partnered with a professional translation company (Language Line) to translate the English version of the survey to Spanish. In addition, bilingual staff who work within the CE program offered feedback on the survey translation and adjusted phrasing to ensure the appropriateness of the survey for local Spanish-speaking clients in New York City.3.After a client consented to participate, program staff explained the purpose of the survey, made efforts to ensure privacy and confidentiality of the survey responses, and offered clarification or assistance in completing the survey as needed. For clients receiving services at the CVCs, the survey consisted of two parts: a pre-groom survey (12 questions) and a post-groom survey (six questions). The pre-groom survey was given to the pet owner during the appointment check-in process and assessed four content areas: pet and owner demographics; the pet owner's view of the role of grooming in relation to maintaining their pet's health; the owner's confidence performing basic grooming tasks; and barriers they experience to grooming pets. After the grooming service was completed, the post-service survey was provided to the owner. The post-survey included two content areas: confidence level as it pertained to nail trimming (for nail trim demonstration appointments only) and supplies and supports that would help with maintaining grooming at home. Participants completed the survey on paper and/or using an iPad, depending on their preference, resources, and/or staff availability. To promote confidentiality and comfort, all questions were optional, participants were assigned a unique identifier, and completed surveys  could be placed directly in a locked ballot box following completion. Procedures for participants recruited at mobile grooming events were modified due to the fast-paced nature of these events, as it was not possible to administer a post-groom survey. For this reason, all participants at mobile events received one survey that included the same set and order of questions as the CVC surveys, except for survey items about post-appointment confidence, which was not assessed. Survey questions are provided in One hundred sixty-seven clients whose pet(s) received grooming services between December 21, 2021, and April 22, 2022, participated in the study. Nineteen clients (11%) received appointments for two or more pets. Clients who received services for multiple pets at the same appointment completed one survey. For clients who received services for multiple pets at the same appointment, one pet was randomly selected for inclusion in our analysis of pet demographic characteristics. Clients with multiple pets served at different times completed surveys at each appointment; however, we only used the first survey completed by the client in our analysis. Participants predominately identified as women (67%), Black or African American (45%), and reported a total household income under $25 K (63%). Ninety-two percent of participants were the primary caregiver of the pet served. Pets receiving services were predominately dogs (90%), between the age of 6 months and 7 years (60%), and of mixed breed (38%). Additional demographic characteristics of the participants and their pets are provided in via two questions: (1) Pet grooming includes activities like bathing your pet, trimming their nails, and brushing or trimming their hair. Has your pet ever been groomed by a professional before? and (2) Have you or a member of your family ever tried to groom your pet at home? If yes, what did you do? Please check all that apply. Response options included: Bathe, trim nails, brush/comb hair, trim/cut hair, and “I have never tried to groom my pet at home.” Pet owners' view on the importance of pet grooming was assessed via one question measured on a 5-point scale . Specifically, the question read, “How important do you feel regular grooming  is in keeping your pet healthy?Participants' prior efforts to groom their pet were assessed via four questions using a 10-point rating scale . Specifically, we assessed confidence bathing, trimming nails, brushing/combing hair, and trimming/cutting hair. The prompt read, “On a scale of 1 to 10, how confident are you in doing the following grooming activities for your pet at home?”Participants' confidence performing basic grooming activities was measured via the following question: “Below are some reasons people can't groom their pets. Which of the following are true for you? Please check all that apply.” The list of response options included 21 barriers . The total number of barriers experienced was calculated by creating a sum score comprised of each item and could range from zero to 21.Barriers to grooming were assessed iers see , inclusiWhat supplies or supports would help you continue grooming your pet at home? Please check all that apply.” Nine response options were provided . Income was assessed via one question: “What is your approximate annual household income?” Seven response options were provided reflecting $25 K increments, up to >$150,000. Participants could also choose “prefer not to answer.” Service setting  was identified by program staff by matching the participants' appointment date with the grooming program's service schedule.Gender was assessed p < 0.05), we conducted post-hoc analyses of the standardized adjusted residuals for each cell in each contingency table to interpret the significant difference , and service setting (mobile event vs. CVCs)]. All test assumptions were checked prior to proceeding with analysis. When the chi-square test was not suitable , a Fisher's exact test was used. When a statistically significant chi-square test was found (fference . CriticaSD = ± 3.34). Similarly, the average confidence score for brushing hair was eight on a 10-point scale (SD = 3.10). Lower ratings were found for cutting nails, with an average score of three (SD = ± 2.90). Owners of medium- and long-haired breeds (n = 46) rated their confidence cutting hair as four on average (SD = ± 3.44); short-haired breeds were excluded from analysis due to the lack of relevance of this item to maintaining their pet's health. Exploratory independent samples t-tests were conducted to examine if pets' coat length was associated with owners' confidence performing basic grooming activities. No significant differences were found between owners of short-hair and medium- to long-haired breeds when comparing confidence bathing, brushing, and cutting nails  was very important (68%) or important (21%) in relation to efforts to keep their pet healthy. Eighty-three percent of the sample reported having attempted at least some form of grooming at home. Among those who had groomed pets at home, 70% had bathed their pet, 56% had brushed their pet, 40% had cut their pet's hair, and 20% had cut their pet's nails. Sixty-four percent of participants indicated their pet had been to a professional groomer, 31% had not, and 3% were unsure. Only 5% of the sample indicated their pet had not been groomed at home or by a professional groomer; 56% of these animals were 5 months of age or younger. On average, participants rated their confidence bathing their pet as seven on a 10-point scale  compared to 44% of participants with total household incomes between $25,001 and $50K . No other significant associations were found between individual barriers to grooming and income. Results of an independent sample t-test indicated that participants who reported a total household income under $25K experienced significantly more barriers to grooming pets on average (Mean ± SD = 4.04 ± 3.29) compared to people with a total household income in the $25,001–50K range (Mean ± SD = 2.81 ± 2.15), .Exploratory chi-square analyses were conducted to examine associations between total household income categories and each barrier to grooming pets. Results indicated that individuals making < $25K were more likely than expected to report that they did not have enough money to pay for grooming, p = 0.02). No other significant associations were found between service location and individual barriers to grooming. Results of an independent sample t-test indicated no significant difference in the mean number of barriers to grooming reported when comparing residents of the Bronx and Brooklyn, .We also examined whether the barriers participants faced to grooming and total number of barriers differed across the service setting (brick-and-mortar CVCs vs. mobile). Three significant associations were found when examining the relationship between service setting and barriers to grooming. Results of a chi-square test of association indicated that pet owners who received grooming services at a CVC setting were more likely than expected to endorse that they did not have money for grooming supplies. Thirty-three percent of pet owners served at these settings endorsed this barrier , compared to 17% of people serviced through mobile grooming settings , Endorsement rates for each type of supply/support needed are listed in t-test indicated there was not a significant difference in the total number of supplies/supports needed when comparing participants who reported a total household income under $25K and those who had a total household income in the $25,001–50K range. Chi-square tests of association were used to examine associations between service location and each type of support/service needed; associations between service setting and each support/service were also examined. No significant associations were found. In addition, results of an independent sample t-test indicated that the mean level of supports/services needed did not differ across service location  and service setting .Exploratory chi-square analyses were conducted to examine associations between household income categories and each supply/support needed. No significant associations were found. Similarly, results of an independent samples SD = ± 2.12) pre-appointment and five out of 10 (SD = ± 2.91) on the post-appointment survey. Results of a paired-sample t-test indicated a statistically significant increase in clients' confidence trimming nails following the nail trimming demonstration, t(34) = −2.61, p = 0.003. The range of change in confidence from pre-demonstration to post-demonstration was −4 to 8, with 68% of participants indicating higher scores post-demonstration, 22% demonstrating no change, and 10% reporting lower levels of confidence post-demonstration. Exploratory analyses were conducted to examine potential demographic differences across these groups; we found no significant associations with pet or pet owner characteristics and/or service location or setting.Thirty-five clients received tailored nail trimming demonstrations from CE's Grooming Specialist and completed surveys at pre- and post-demonstration. On average, clients rated their confidence trimming their pet's nails as three on a 10-point scale  pet owners who were served by the grooming program and chose to participate in the survey had groomed their pets at home and/or had brought their pet to a professional groomer previously. In addition, a majority of participants indicated that they felt grooming was important or very important in maintaining their pet's overall health. Few animals served by the program had not received some form of grooming-related care in their lifetime and most pets who had not been groomed were < 5 months of age. Vaccine and wellness visits for young animals are important times to educate pet owners regarding their animals' needs as they grow, and it is essential that pets' grooming needs are part of the client-DVM dialogue in the same way vaccine and other preventative care is seen as part of the preventative care package. Furthermore, these early visits are an opportunity to strengthen owner-veterinarian relationships and support owner-pet attachment. Prior studies indicate that these relationships increase owner compliance with veterinary recommendations and overall care of the pet . Thus, iMost pet owners in the current study 89%) endorsed that grooming is important or very important to their pet's health. Our findings mirror results of Rohlf et al.'s online survey of Australian dog owners which identified that ~79% of owners groomed their dog regularly and most (83%) agreed that grooming was necessary (75%) and good for a dog's health (77%)  and supplies have typically been omitted from these conversations , 11. GivAmong barriers to grooming pets at home, fear of hurting the pet was endorsed by 45% of the sample, indicating a potential need for resources such as hands-on training, video tutorials, and text- and image-based guides that can provide long-term aid to the owner. Animal welfare organizations and veterinary professionals can address this need by providing educational resources that are readily available online and at their brick-and-mortar locations, as well as empowering staff to proactively talk to clients about grooming their pets and field any questions and concerns, particularly from new pet owners. The combination of verbal discussions with written support materials has been demonstrated in other topic areas  to be an effective way to promote owner comprehension and retention of care information . For exaSharing knowledge about alternative methods and tools for trimming nails  and making these resources available may also be helpful. Further, it may be worthwhile for veterinary practices, animal welfare programs, and humane law enforcement officers to develop an overall grooming/health guide for dogs and cats that incorporates nail care tips along with guidance on grooming activities , supply recommendations, and suggested YouTube, Instagram or TikTok videos to view; such a guide could be made available and reviewed with the client during service appointments. Veterinary practices could include these resources in new pet packages that are commonly provided to clients during initial wellness visits. In addition, shelters and rescues could provide such resources to residents in their community and at the time of adoption, with an option for pet owners to opt in to receiving reminders  about their pet's grooming needs and/or integrate questions about pet grooming into post-adoption surveys. When creating resources such as a grooming guide, it is essential to ensure these resources are available in languages and formats that are accessible to pet owners from diverse backgrounds. These resources may be particularly beneficial for individuals adopting medium and long-haired breeds. Although owners of those breeds did not report more concerns or barriers in the current study, prior research shows that these dogs and cats may be particularly vulnerable to grooming-related omissions of care , 4. OtheAnimal welfare organizations, veterinary clinics, and humane law enforcement professionals could also work collaboratively with community members to develop a system to share community resources. “Libraries of Things” have become increasingly popular in recent years and offer individuals and non-profit agencies no- or low-cost access to an inventory of tools to complete various projects. For example, “tool libraries” (which often stock and lend out various tools for home improvement) are common and many argue that they cut waste, save money, and contribute to community sustainability by lowering economic barriers to home improvement – 172. ItIn the current study, we found that the total number of barriers to grooming differed by income groups and service setting, with pet owners making under $25K and receiving services in a CVC setting facing more barriers to grooming. Regarding income, those with income under $25K were more likely to report that they did not have enough money to pay for grooming. Indeed, 86% of people who endorsed this barrier had incomes below $25K. This suggests that, if faced with limited resources, grooming programs in these areas could consider prioritizing program eligibility to families making under $25K. In addition, those who received services at the CVC setting experienced more barriers to grooming on average and were more likely than expected to endorse not having money for grooming supplies, not having someone to help groom their pet, and being afraid they would hurt their pet. Income, location (borough), and service setting were not statistically significantly associated in the current study; therefore, more research is needed to understand why CVC clients appear to be more at risk for not having help with grooming, not being able to afford supplies, being fearful of harming their pet, and experiencing more barriers to grooming pets. This finding may stem from the fact that sedated grooming can only take place where veterinarian observation can be provided, which was available at the CVCs but not mobile settings. Sedated grooming is required when the pet's behavioral, physical and/or haircoat condition would interfere with regular grooming because it would be unsafe for the pet or persons or cause undue stress or pain for the pet to be groomed without sedation. For this reason, pets seen at CVCs may have had relatively more severe grooming needs that were influenced by the greater number of barriers to grooming experienced by their owners. Future research is needed to explore these hypotheses.An interesting and unexpected finding is that some residents of Brooklyn  reported not having any place to bathe their pets whereas no residents of the Bronx reported this barrier. It is unclear whether this can be attributed to random variation or to some meaningful difference between boroughs—and if the latter, what the nature of that difference might be. Further, not having a place to bathe one's pet could mean anything from not having a suitable sink/tub, to not wanting or being allowed to use the sink/tub for bathing the pet, to not having housing, among other interpretations. Future research should continue to examine the extent to which clients report this as a barrier and more directly assess the underlying reasons, with the aim of informing potential solutions. This finding also relates to the planned acquisition of a pet. Not only should potential pet owners consider factors related to the animal when identifying a pet that is a good match—environmental factors should be considered as well to support humane and compassionate care.via direct services to focus on provision of nail trimming services and demonstrations, since owners may be able to maintain other aspects of grooming on their own when equipped with appropriate supplies and supports . Since nail-trimming may be one of the most stressful steps when grooming a pet, habituation, or desensitization, to this process at an early age is a key reason for pet owners to perform nail-trimming without hurting the animal or themselves. Our findings indicate that nail trimming demonstrations may be a cost-effective way to provide longer-term, sustainable support to pet owners who will ultimately need to provide this basic level of care throughout the pet's years of life. Results of this study help clarify that dedicated time and staff that provide nail trimming demonstrations may be a worthwhile investment with important implications for preventing grooming-related omissions of care. It would be helpful for future research to explore whether an increase in pet owners' confidence following a nail trimming demonstration is associated with their ability to maintain nail-trimming at home and/or their confidence when performing the task independently at home. Although our study suggests that brief nail trimming demonstrations are successful in achieving statistically significant increases in pet owners' perceived confidence trimming nails, on average, participants rated their post-appointment confidence at the mid-point (“5”) on our scale, indicating the need for further support and skill-building. In addition, it is important to highlight that nearly a third of participants who received nail-trimming demonstrations did not report increased confidence following the service (with some reporting lower levels of confidence). More research is needed to understand how, why, and for whom these demonstrations are/are not effective and how they can be improved to serve all clients effectively and efficiently. In addition, it may be beneficial to test whether this type of intervention can be effectively scaled up to provide demonstrations to small or large groups via in-person methods and/or via virtual platforms . Integrating assessments of animal stress and welfare may also be beneficial to establish interventions that employ best methods for promoting animal welfare while being maximally beneficial to pet owners  was endorsed most frequently in our sample, a notable 30% indicated that behavioral support services would assist them in maintaining their pet's grooming at home. Behavior concerns can be a barrier to maintaining grooming because some pets may become fearful, anxious, and/or stressed during grooming related tasks and, consequently, may exhibit aggressive and potentially dangerous behaviors (to self and person) , 20. It ive Care , Fear FrAlthough our study has many strengths and addresses a notable gap in the literature, there are several limitations that warrant consideration. First, this study used cross-sectional convenience sampling, which impacts the generalizability of our results. Improving access to grooming services, facilitating access to grooming supplies, and improving caregivers' knowledge of their pets' grooming needs are all likely to improve the welfare of a significant number of companion animals. However, it is important to consider that all participants in the current study were clients of subsidized grooming services. Future research is needed to understand barriers to grooming and supplies/supports needed in other subgroups of pet owners . Another limitation concerns the fast-paced nature of the grooming services, which prevented us from tracking how many clients declined participation in the study or determining how they may differ from those who consented to taking the survey. People who chose to participate in the study may have held more positive views of pet grooming and/or may have been motivated to participate based on their strong need for grooming-related resources. Future studies would do well to employ probability sampling in order to increase generalizability of results. It may be advantageous to randomly assign participants to a “demonstration-only” vs. “demonstration plus resource guide” group, or other combinations of interventions and resources to identify what service or combination of services and supports is most effective in assisting pet owners with maintaining grooming at home. Relatedly, although we made notable efforts to ensure confidentiality of survey responses, social desirability response bias may have contributed to participants choosing a higher rating of their confidence following the nail trimming demonstration.It is also important to note that the grooming program did not accept cats at mobile grooming events for the first few months of the program, thus potentially impacting the representation of felines in the study. Furthermore, the coat length of dogs and cats who received grooming services was not explicitly assessed. Thus, cats were omitted from our analysis of medium- and long-hair breeds since breed was not assessed, and we were only able to include dogs in our analysis if their owner endorsed one breed type and we could confidently assume they had medium- to long-hair [which omitted dogs whose owner selected “mixed breed” from consideration and those of breed origins with multiple coat types ]. Future research would benefit from examining cats and dogs separately, to identify whether there are similar and/or unique barriers to grooming across species or different supports and services needed to maintain grooming at home. Similarly, understanding differences across dog breed size would be beneficial, particularly in relation to travel and behavioral challenges. Future studies would also benefit from asking participants who had multiple pets receiving services at the same time to provide unique responses for each pet, which was not possible in the current study due to staff capacity.Another limitation pertains to the readability, relevance, and comprehensiveness of survey items in relation to our sample. Although this study employed several processes and procedures to ensure the survey was easily understood and implemented, qualitative research with clients served by the program, and other members of the community, would help ensure that all barriers and supports relevant to grooming are assessed in future research and that the language used to describe barriers and supports is clear and easily understood. It is also possible that some aspects of the Spanish-language survey may not have been appropriate for all Spanish-speaking clients due to linguistic variations across cultures and countries of origin. For example, one client selected “other” supply/support was needed to maintain their pet's grooming and wrote, “Es aggresivo para cortar al pelo” (He is aggressive for hair-cutting) but did not select that behavioral support for the pet or someone to help would assist them in maintaining their pet's grooming. This may be because the client did not view behavioral training as a means to reduce aggressive behavior and/or that our terminology was confusing or lacked cultural or linguistic relevance. Relatedly, the Bronx and Brooklyn are culturally, racially, and ethnically diverse areas, with a notable proportion of residents who speak languages other than English and Spanish. Thus, results of this study are not inclusive of these minority language speakers .Due to the nature of grooming appointments and staff capacity, we were also unable to examine how long it had been since the pets served by the program had been groomed and how often participants provided basic forms of pet grooming. Thus, our study is also limited by not knowing the context and frequency of participants' pet grooming activities, and our methodology does not allow us to delineate differences in attitudes toward grooming and barriers/supports needed among pet owners who are regularly able to meet their pet's grooming needs vs. those who are not. Understanding barriers associated with chronic or long-term inability to meet a pet's grooming needs would be helpful in preventing serious animal welfare issues involving grooming-related omissions of care. It would also be beneficial for future studies to ask about participants' perception of how often pets require grooming. Another limitation concerns our inability to examine differences in barriers to grooming in relation to pet owner age. Although our survey inquired about participants' age, a notable proportion listed their pet's age instead of their own, causing us to exclude age data from analyses. Older adult pet owners may face more barriers to grooming pets due to a greater likelihood of mobility issues and/or disabilities and may benefit from approaches tailored to those barriers , 23. We The current study examined factors and services that operate as barriers and facilitators of pet grooming among clients served by a subsidized grooming service program in New York City. Study results suggest that income and cost of services/supplies serve as primary barriers to grooming pets, along with several other factors including fear of hurting the pet, transportation, and pets' behavioral issues. Our findings suggest that a brief, tailored nail trimming demonstration may be an effective service that animal welfare organizations, veterinary clinics, and humane law enforcement can provide to increase pet owners' confidence in performing this grooming task at home. However, our findings also suggest that a one-time grooming service and/or demonstration is just one aspect of a spectrum of services needed to prevent grooming-related omissions of care. It is important that low- and no-cost grooming programs that focus on underserved communities ensure that clients also have supports/supplies needed to continue to maintain grooming at home and that stakeholders in animal welfare  work collaboratively with community members to reduce barriers to pet owners' access to these services. Further examination and identification of factors  that contribute to lasting impacts of nail trimming demonstrations and other grooming services on pet owners' maintenance of pet grooming may help identify specific methods and subsets of clients who benefit the most from these services. We recommend several directions for future research, including longitudinal research to understand the impact of subsidized grooming services and supply provision on pet owners' ability to maintain their pet's grooming needs over time.The raw data supporting the conclusions of this article may be made available by the authors upon request.This study was approved by Advarra IRB Pro00058852. The participants provided written informed consent to participate in this study.SM, CD, and JS: conceptualization and methodology. SM and AM: analysis. SM, JS, LK, LN, MG, and CD: writing, review, and editing. All authors contributed to the article and approved the submitted version.This study was funded and conducted by the ASPCA.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


We discovered an interactive effect of age and air pollution on hearing impairment, but a healthy diet did not. The findings suggested that exposure to PM10, NOX and NO2 was linked to hearing impairment in British adults, whereas PM2.5 and PM2.5 absorbance did not show similar associations. These may help researchers focus more on the impact of air pollution on hearing impairment and provide a basis for developing effective prevention strategies.The link between hearing impairment and air pollution has not been established, and the moderating effect of a healthy diet has never been investigated before. The purpose of this study was to investigate the association between air pollution and hearing impairment in British adults aged 37–73 years, and whether the association was modified by a healthy diet. We performed a cross-sectional population-based study with 158,811 participants who provided data from United Kingdom Biobank. A multivariate logistic regression model was used to investigate the link between air pollution and hearing impairment. Subgroup and effect modification analyses were carried out according to healthy diet scores, gender, and age. In the fully adjusted model, we found that exposure to PM Hearing impairment is one of the most common age-related chronic health problems . The rat2.5: particulate matter ≤ 2.5 μm in diameter) and nitrogen dioxide (NO2) had a substantially increased risk of sudden sensorineural hearing loss (SSNHL). Another study  was not associated with SSNHL. Similarly, another study  in England, Scotland, and Wales  was defined as the signal-to-noise ratio of correctly understanding half of the presented speech. The SRT ranged from −12 to +8 dB, with a lower score representing better performance. Based on the cutoff point established by The speech-in-noise hearing test  of the United Kingdom Biobank provided participants with 15 groups of English monosyllabic numbers to evaluate the listening thresholds  at different sound levels.r = 0.77) (via the internet (The DTT shows a very good correlation with the pure tone hearing test ( = 0.77) , so it c = 0.77) . There ainternet . The mosinternet , so the internet .3 a part of the BioShaRE-EU Environmental Determinants of Health Project.4 The Land Use Regression model was applied to assess air pollution in 2010 by modeling at each residential address of the participants, which was developed as part of the European Study of Cohorts for Air Pollution Effects.5 The Land Use Regression model used to calculate the spatial distribution of air pollutants was based on geographic predictors such as traffic, land use, and topography in the geographical information system. In this study, the air pollutants assessed were PM2.5, PM10, PM2.5 absorbance, NOX, and NO2, of which all were annual average concentrations in μg/m3. More details about the air pollution data used in the United Kingdom Biobank are available elsewhere.6The air pollution data recorded in the United Kingdom Biobank were from the Small Area Health Statistics Unit,7 A questionnaire8 containing the usual dietary intake was completed by United Kingdom Biobank participants during the baseline assessment. The intake of fruits (fresh fruit intake and dried fruit intake), vegetables , fish (oily fish intake and non-oily fish intake), processed meat and unprocessed red meat  from the United Kingdom Biobank food intake questionnaire was used to calculate the health diet scores , national vocational qualification (NVQ), higher national certificate (HNC), or equivalent; A levels or AS levels (including the higher school certificate), or equivalent; O levels (including the school certificate), general certificate of secondary educations (GCSEs), or equivalent; certificate of secondary educations (CSEs), or equivalent; college or university degree; and other professional qualification. Employment status was divided into seven categories: retired; unable to work because of sickness or disability; looking after home and/or family; unemployed; in paid employment or self-employed; student (full-time or part-time); or doing unpaid or voluntary work. Smoking status  was divit scores : fruit it test. The classification variables are represented as percentages (%) and the rate was compared by χ2 test. The link between air pollution and hearing impairment was investigated using a multivariate logistic regression model with and without adjusting for other variables. Model 1 was unadjusted, Model 2 was adjusted for age and gender, and Model 3 was further adjusted for race, educational level, employment, smoking status and alcohol consumption frequency, BMI, physical activity, glycosylated hemoglobin, total cholesterol, and vascular diseases . Moreover, we evaluated the association between subgroups stratified by healthy diet scores , gender  and age . The Wald test was used to test interactions among subgroups. P < 0.05 (two-sided test) was considered statistically significant.All analyses were performed using R version 4.0.2. The data are summarized descriptively. Continuous variables are represented as mean (standard deviation) and comparison between the two groups was performed by independent sample n = 86,516), 91.7% were white , with the mean (standard deviation) age of 56.68 (8.15) years. The distribution of baseline characteristics and air pollution in the two groups is shown in P < 0.05). In comparison to the group of people with normal hearing, the subjects in the hearing impairment group were older on average, non-whites. In addition, they were more likely to be obese and to have cardiovascular problems. Furthermore, the hearing impairment group was exposed to higher mean annual concentrations of air pollutants than the normal hearing group  with hearing impairment and 139,930 (88.1%) with normal hearing, 54.5% were female (ng group .P < 0.001) . After adjusting for age and gender, Model 2 showed that air pollutants were still significantly associated with hearing impairment (P < 0.001), and all OR values were larger than Model 1 . Except for PM2.5 and PM2.5 absorbance, which showed no significant associations with hearing impairment , we observed that the associations between the other pollutants and hearing impairment remained in Model 3 after further adjusting for other confounders on the basis of Model 2 , even though the estimates were lower than those in Models 1 and 2.10, PM2.5 absorbance, NOX, and NO2 were associated with hearing impairment in participants up to and including 50 years of age . In participants aged 51 to 60 years and above 60, there was no connection between air pollution and hearing impairment. Additionally, there was a statistically significant interaction between age and air pollution with hearing impairment (P < 0.05). Further, after stratifying by gender  using United Kingdom Biobank data. We found that exposure to PM10, NOX, and NO2 was linked to hearing impairment after adjusting for confounding factors, while PM2.5 and PM2.5 absorbance showed no similar correlations. Furthermore, there was no modification of these associations by a healthy diet. Regarding age, interaction effects were observed.In this cross-sectional study, we investigated the association between hearing impairment and air pollution  were at higher risk of developing sensorineural hearing loss than those exposed to the low level. The results of 2 . Likewise, 2 (14 days) . Consistent with previous studies, NO2 was associated with hearing impairment in our study. Moreover, NOX, a term that contains several nitrogen compounds but is mainly composed of nitrogen oxide and NO2, showed an association with hearing impairment.The relationship between air pollution and hearing impairment has not been fully established yet. Several studies indicated that exposure to NO10 and hearing impairment but not PM2.5. Conversely, previous studies  to reduce their potential impact. However, our research also had some limitations. Above all, the cross-sectional design of this study was inadequate to account for the cause and effect between air pollution and hearing impairment, and further longitudinal studies are needed. Second, the sample of participants in United Kingdom Biobank was suggested to be unrepresentative of the general population because of the bias toward recruiting participants who were generally healthier and had a higher socioeconomic status . Hence, 10, NOX, and NO2 was associated with hearing impairment in British adults, while PM2.5 and PM2.5 absorbance did not show similar correlations. Our findings may help researchers pay more attention to the impact of air pollution on hearing impairment and provide a basis for developing effective prevention strategies.In conclusion, we found that exposure to PMwww.ukbiobank.ac.uk) upon application.The data supporting the results of this study can be found in the website of UK Biobank (The study involving human participants was carried out with the ethical approval obtained by United Kingdom Biobank from the National Health Service National Research Ethics Service.YS, YT, and LY conceived the overall project and developed the methods as well as procedures throughout the study. DL and LY managed the data collection and data entry and carried out data verification and statistical analyses. LY drafted the first version of the manuscript. All authors oversaw statistical analysis, involved in the interpretation of the results, reviewed, and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Opuntia of cactus pear and highly concentrated in the edible fruits of O. ficus indica, L. whose bioactivity has been overlooked until recently. This review summarizes studies conducted so far in vitro and in vivo, most of which have been performed in our laboratory. The chemical and physicochemical characteristics of Indicaxanthin are reflected in the molecule’s reducing properties and antioxidant effects and help explain its ability to interact with membranes, modulate redox-regulated cellular pathways, and possibly bind to protein molecules. Measurement of bioavailability in volunteers has been key to exploring its bioactivity; amounts consistent with dietary intake, or plasma concentration after dietary consumption of cactus pear fruit, have been used in experimental setups mimicking physiological or pathophysiological conditions, in cells and in animals, finally suggesting pharmacological potential and relevance of Indicaxanthin as a nutraceutical. In reporting experimental results, this review also aimed to raise questions and seek insights for further basic research and health promotion applications.Phytochemicals from plant foods are considered essential to human health. Known for their role in the adaptation of plants to their environment, these compounds can induce adaptive responses in cells, many of which are directed at maintaining the redox tone. Indicaxanthin is a long-known betalain pigment found in the genus  As secondary plant metabolites, phytochemicals are synthetized in response to environmental adverse conditions, or other exogenous stressors promoting an increase of reactive oxygen species (ROS), and then a change of the redox status of the plant. These molecules, which are added to the powerful antioxidant machine that includes enzymes, redox proteins, and low molecular weight molecules such as antioxidant vitamins, contribute greatly to the maintenance of the plant redox homeostasis ,2,3. In In a complementary, but distinct way, the ability of the organism to cope with and exploit the potential of phytochemicals may fall under the concept of Adaptive Homeostasis . Accordimax = 540 nm), whereas its condensation with amino acids, or the corresponding amines, leads to betaxanthins (λmax = 480 nm) [Betalain pigments are water-soluble, cationized, nitrogen-containing molecules the colours of which range from the yellow betaxanthins to the violet-red betacyanins. Specifically, the conjugation of betalamic acid with cyclo-dopa, or its glucosyl derivatives, leads to the synthesis of betacyanins (λ 480 nm)   leading to activation of stress-related genes could occur during Rivina humilis berry development, as a result of abiotic stress and to cope with it.Two of these pigments, red Betanin (betanidin 5-O-β-glucoside) and yellow Indicaxanthin (proline betaxanthin), characterize the fruits of cactus pear an basin . Like than basin . Betalaian basin , which san basin . In lineaxanthin ,19, showaxanthin . Numerouaxanthin . RegulatRivina humilis, L.; Myrtillocactus geometrizans), has long been neglected, although it was the first betaxanthin whose structure was identified. Extraction from natural sources as well as synthetic methodologies to obtain Indicaxanthin in solution have been reported since 1972 [Among food-relevant betalains, redox chemistry, bioactivity and effects of Betanin, have long been studied , since tnce 1972 ; see Allnce 1972 . Most ofCaenorhabditis elegans [Indicaxanthin possesses reducing properties. Antiradical and antioxidant activity emerged in solution and in cells under certain conditions ,28,29,30 elegans ,48 showe elegans , cancer  elegans , obesity elegans  and neur elegans , proposeThe bioavailability of Indicaxanthin from the cactus pear fruit in volunteers was measured for the first time in our lab . In addi+), evaluated as 1.76 TE [Betalains are considered cationized antioxidants . It is a 1.76 TE , and 4 T 1.76 TE . Values  1.76 TE  and 6 TE 1.76 TE  were rep 1.76 TE .Voltammetric potential data provided further insights on the reducing/antioxidant properties of Indicaxanthin, prompting studies on the bioactivity of the phytochemical in solution, cells and whole organism. Two characteristic peaks at 611 mV and 895 mV emerged from the differential pulse voltammogram , suggestBesides the positive charge in proximity of the N1 nitrogen, Indicaxanthin possesses a number of ionizable carboxyl groups . Computa3 M−1, 37 °C), but not shorter dimiristoyl-phosphatidyl choline (DMPC) phospholipid bilayers. Indicaxanthin partitions at the interface between the hydrophilic head groups of DPPC bilayer and the hydrophobic core , an ideal solubilization site for molecules sharing hydrophilic and lipophilic moieties as well. At this level the active cyclic amine group of Indicaxanthin is in a position to eventually react with aqueous peroxyl radicals adsorbed onto the vesicular surface [6 Ms−1), actual pro-oxidant effects were not observed until an Indicaxanthin:PUFA molar ratio of 1:500.These measurements show that Indicaxanthin occurs as a bis-anion in a large range of pH, including physiological pH and the pH gradient at the intestine during digestion (pH 6.0–7.4) ,62. The  surface  as well  surface . Indeed, surface . It dese surface ,70,71,72 surface  . Ex vivo experiments  showed aC. elegans [Data obtained with biomimetic membranes ,63,64 pr elegans ,48 and,  elegans .The discovery of biological targets for Indicaxanthin may provide indication on how the molecule can affect cellular processes. Interactions of Indicaxanthin with one phosphodiesterase (PDE) isoform were first hypothesized by studies that investigated the mechanism of action of its inhibitory effects on mouse ileal contractility ,45 Sect. More reThrough modulating the activity of key enzymes and receptors, Indicaxanthin could influence the course of many physiological and pathophysiological processes. As reported in the following sections, Indicaxanthin can indeed influence inflammatory pathways, counteract cancer development, and appears as a potential natural neuro-modulating agent. To what extent direct interactions with specific proteins are involved in the observed effects cannot be decided before assays with purified enzymes and factors are performed, to assess if the ideal kinetics can approach the conditions in cells and tissues. At any instance, the in silico evidences may prompt further studies to test Indicaxanthin as a potential lead molecule for the prevention or the treatment of various disorders.Direct interactions of Indicaxanthin with enzyme proteins emerged from test-tube experiments. Gomez-Marques et al.  showed tMyrtillocactus geometrizans [Indicaxanthin has been shown to have higher bioavailability than most phytochemicals ,86, incletrizans , possiblR inserts. Molecular mass and physico-chemical characteristics , at pH 6.0, in a concentration-dependent mode, without involvement of H+-dependent carriers, nor efflux transporters [−7 cm s−1) at pH 6.5 [Kinetics of the trans-epithelial transport of Indicaxanthin accross intestinal cells were investigated in differentiated Caco-2 cell monolayers by the aid of Transwellsporters . Other st pH 6.5 . Overallt pH 6.5 . Other pt pH 6.5 . Differet pH 6.5 .Noticeably, the dietary Indicaxanthin may have a direct action at the intestine, where its concentrations can be quite higher than in blood. Since Indicaxanthin does not appear to be modified by intestinal enzymes , experimIn vitro evidence to date in cells and tissues does not provide a unified picture of the molecular mechanisms mediating the action of Indicaxanthin; rather different mechanisms have emerged in relation to different stimuli and conditions in both healthy and transformed cells. Many of the activities appear to be geared toward restoring cellular redox homeostasis, correcting dysfunction generated by oxidative stress, and modulating signaling pathways that control vital processes in healthy cells ; other aPhytochemicals are recognized as valuable in maintaining cellular redox homeostasis. To what extent is the redox chemistry of Indicaxanthin involved in its effects on cells?Data so far show that Indicaxanthin is stable and does not interfere with the physiological redox state of healthy cells, in the absence of pro-oxidant stimuli. This was observed with various cell lines incubated with amounts in a fairly wide range of concentrations, including postprandial blood levels (5–10 μM) up to more than one order of magnitude in excess, for time intervals from 6 h to 72 h ,41,42,44Incorporated ex vivo in human red blood cells, both normal or from thalassemia patients, after incubation of plasma with concentrations of nutritional interest (1–10 μM), Indicaxanthin prevented the oxidation of membrane lipids promoted by the stable organic oxidant cumene hydroperoxide (CumOOH), and delayed the oxidative hemolysis, being totally consumed ,29. IndiIn contrast, Indicaxanthin at 100 μM acted as a pro-oxidant in an experimental set-up in which murine macrophages were exposed to the bacterial lipopolysaccharide (LPS) . In thisThe unconventional anti-inflammatory effect of Indicaxanthin generated through HNE can fall in the frame of the ability of oxidants to modulate cell signaling, and indicate that beneficial effects may be expected from, and in fact are often due to pro-oxidant activities of natural compounds . In thisCollectively, these findings indicate that Indicaxanthin may act as an antioxidant at concentrations as low as 10 μM, when cells are exposed to certain oxidizing agents. On the other hand, they also clearly highlight the pro-oxidant capacity of high amounts in a lipoperoxide-rich cellular environment. The question that arises is whether in addition to organic oxy-radicals Indicaxanthin scavenges reactive species (ROS/RNS) that are formed when agonists initiate redox-dependent signaling in cells.Several studies showed that, other than its direct peroxyl radical-scavenging action, Indicaxanthin can prevent the increase of ROS/RNS and changes to the redox balance in various cell lines, when pre- or co-incubated with various agents under simulated patho-physiological conditions ,35,38,39Activation/deactivation and/or up-regulation of tissue-specific membrane-bound NADPH oxidases (NOXes) are a general strategy to modify the redox tone of the cells. This is used as a means to convey information and elicit responses in both normal and transformed cells ,104,105.Activation of the colonic NOX-1 , with pr2O2, while EPR measurements carried out in parallel provided evidence that Indicaxanthin did not possess direct radical scavenging capacity against superoxide [In other studies , 5–80 μMperoxide , in accoperoxide .Human monocyte/macrophage THP-1 cells underwent oxidative stress-dependent apoptosis when exposed to 7-Ketocholesterol (7-KC) . This hiThe models presented in the studies above ,33,59 reOxysterols affect cell processes through biophysical mechanisms and alterations of membrane properties ,118,119.Studies in human red blood cells suggest that a joint action of Indicaxanthin and oxysterols can provide anti-oxidative protection by interfering with the activity of ROS-generating enzymes, i.e., RBC-NOX and RBC-NOS. Early results indicated that a mixture of oxysterols enclosing the toxic 7-KC and cholestan-3beta, 5alpha, 6beta-triol (Triol), caused phosphatidyl-serine externalization and cell shrinkage, defined as eryptosis , when inOther studies show that Indicaxanthin can prevent agent-induced changes to the cell redox homeostasis and activation of oxidant/redox signals capable of inducing (i) inflammation in human umbilical vein endothelial cells (HUVEC) ,40 and  and the cytokine TNF-α are considered critical inflammatory agents that can activate the endothelial NOX and generate high level of ROS ,128,129.1-42) or its Aβ25-35 or Aβ35-25 fragments, considered key players in the onset and progression of AD [Indicaxanthin can cross the blood–brain barrier (BBB) . On thison of AD ,134, OECon of AD ,136. Theon of AD ,141,142.2•−and ROS production, and over-expression of total TG-2. It also modulated the conformational transition and subcellular distribution of the enzyme, with increased nuclear TG-2L over cytosolic TG-2S isoform. In doing so, Indicaxanthin promoted the anti-apoptotic (decrease of caspase-3) and cell regenerating (decrease of Vimentin and increase of Nestin and cyclin-D1) effects of the enzyme. Indicaxanthin alone at 100 μM did not change the level of superoxide nor total ROS, nor other activities modified by the exposure to Aβ alone [Under the conditions reported in this study , Aβ causAβ alone .2•− production, under the oxidizing conditions in the OECs. This supports the idea that a pro-oxidant behavior of Indicaxathin may not simply result from the abundance and redox capacity of the phytochemical  underlying the activity of Indicaxanthin in OECs remains an interesting question to answer. The complexity of the model, that involves Aβ interactions with OECs membranes and relevant signalling pathways, may offer various points for discussion and further research. Oxidative stress and fine regulation by cytosolic calcium ions are both crucial factors linking Aβ to over-expression, conformational activation and intracellular distribution of TG-2 ,141,142.al cells ,144, andal cells ,33. In aal cells ,146,147 The findings reported through An experimental approach using a mouse ileum preparation showed that, as a component of an aqueous extract of the cactus pear fruit, Indicaxanthin exerted antispasmodic effects on intestinal motility . It is iOn a mechanistic perspective, the myorelaxant effect was independent of neurotransmitter release and ascribed to direct action of Indicaxanthin on the smooth muscle cell, in particular the inhibition of a phosphodiesterase isoform . This caBecause cancer is seen as a disorder related to oxidative stress, phytochemicals with antioxidative capacity and a supposedly favourable side effect profile, have been the subject of research to prevent, counteract and treat this disease ,157. CheCancer cells establish and maintain a very different redox tone from that of healthy cells. A sustained imbalance in cell redox homeostasis, caused by elevation of ROS production via mitochondrial dysfunction and NOXes activity ,158, and50 of 115 μM [Added to proliferating Caco-2 colon adenocarcinoma cells, Indicaxanthin caused a concentration-dependent growth arrest with apoptosis at 48 h, and ICf 115 μM . The antf 115 μM . Somewhaf 115 μM , which if 115 μM . Lipid cf 115 μM ,170, it INK4a gene inducing demethylation of its promoter region [INK4a Indicaxanthin induced demethylation in the promoters of other onco-suppressor genes , but left others unchanged . The basal methylation seemed to be determinant, being the promoters with the highest methylation levels  unaffected [Aberrant methylation patterns, i.e., global DNA hypo-methylation contributing to chromosomal instability, but site-specific CpG promoter island hyper-methylation with silencing of tumour suppressor genes, characterize tumor cells, and have been extensively investigated in colorectal cancer . The stur region ,46 thus r region ,173,174.INK4a gene [Molecular mechanistic explanations have been attempted. The methylation status of DNA results from the cross-talk between the activity of well characterized methylating enzymes (DNMT), DNMT1, DNMT3A, DNMT3B, and of less known proteins working to transform (TET family enzymes) and remove  the methyl groups ,176. IndK4a gene ,46. UltiK4a gene . IntraceK4a gene ,59, as aK4a gene ; direct K4a gene .50 concentration or at twice the concentration [Epigenetic modifications, potentially reversible, occur early in the process of carcinogenesis, thus representing a target of choice to prevent malignant transformation in cancers with long precancerous stages such as colorectal cancer. Activity at this level may reveal chemopreventive compounds. Phytochemicals in the diet, which can be taken continuously throughout life, can act as natural controllers in a process at the confluence of redox biology and gene-environment interactions. Importantly, Indicaxanthin selectively acted at the level of modified regulatory mechanisms in the transformed cells and did not affect the viability of non-malignant colon cells, either at the ICntration . Considentration ,87,178, Investigation in melanoma cells  providedIt may be worth noting that NF-κB is subjected to several controls and activating mechanisms  finely t50 149.55 μM) or CDDP (IC50 23.91 μM) alone [Apart from individual inhibitory effects on cancer cell growth, phytochemicals may exert synergistic effects with other phytochemicals or anticancer drugs . Recent M) alone . RemarkaM) alone  providedM) alone , which wElucidating the mechanism of action of Indicaxanthin in this model, on the one hand would add new knowledge about the potential of the molecule against cancer, but also shed light on the interactions with CDDP, which may serve as a rationale for therapeutic strategies. Apart the formation of adducts with nuclear DNA, the impact of CDDP with mitochondria and mitochondrial genome, followed by ROS generation, has emerged as a cause of cytotoxicity in tumor cells ,188,189,2 μM (IC50 around 150 μM); on the other hand, nontoxic amounts of the phytochemical (2–10 μM) potentiated the antiproliferative activity of CDDP up to threefold. These findings may suggest distinct activities and possibly molecular mechanisms that complement each other.The importance of elevated production of ROS in the apoptotic action of the combination Indicaxanthin/CDDP was highlighted by the inhibition (over 60%) observed in the presence of NAC , howeverAnticancer prodrugs, including phytochemicals, can be activated under high level of oxidants , and becAn activity at the membrane of cancer cells may be considered to explore whether non-cytotoxic Indicaxanthin may facilitate transport/permeation of CDDP. The latter involves interactions of cisplatin with membrane lipids and changes in membrane phase behavior , which cThe absence of toxicity of elevated amounts of Indicaxanthin observed in various studies ,44,197 sCaenorhabditis elegans is considered suitable for biomedical research, particularly to study mechanisms underlying the aging processes and test the health-promoting and anti-aging potential of molecules. Its relevance in these studies comes from its genome that possesses homologs of about two-thirds of all human disease genes [As a pluricellular model organism, the nematode se genes ,204. In se genes ,48.hsp-16.2:GFP) strain, in a range of concentrations from 10 to 100 μM, Indicaxanthin dose-dependently prevented the juglone-induced, oxidative stress-dependent expression of a green fluorescent protein (GFP), up-regulated by a promoter binding a small 16 kDa heat shock proteins (HSP). The anti-oxidative activity of Indicaxanthin was the highest compared to the natural betanin and synthetic indoline-betacyanin and phenylethylamine-betaxanthin. In addition, wild-type N2 strain nematodes showed increased lifespan and mean survival after being grown for 48 h in liquid culture supplemented with Indicaxanthin, which occurred without accumulation of the phytochemical in the worm [Supplied to the TJ375  or toxic (400 μM) amount of pro-oxidant juglone.Indicaxanthin is chemically stable in healthy cells in the absence of a suitable stimulus, over a wide range of concentration . Pro-oxisumption . By virtsumption  and a gosumption , was alssumption . Differesumption . The persumption . EvaluatC. elegans longevity and could also be investigated as a site of action of Indicaxanthin.Other ways through which Indicaxanthin might influence longevity could be explored. Physico-chemical characteristics allow activities of Indicaxanthin at various levels, including cell membranes and cytosol, with diverse modes of action including direct binding to proteins  and moduThe ability of Indicaxanthin to prevent alteration of the endocellular redox state in normal cells submitted to oxidant stress, and modulate signaling pathways in normal, as well as in transformed cells, suggests it could be a promising candidate to exert therapeutic actions. Recent studies with murine models provide evidence that the molecule can exert pharmacological activities in a range of conditions characterized by acute inflammatory patterns or attributable to chronic inflammation-based processes ,230, incOpuntia ficus indica fruits [Acute inflammation is the patho-physiological adaptive response to noxious stimuli from bacteria, viruses, toxins, infection, and tissue injury, with the aim of eliminating pathogens and promoting tissue repair and recovery. The carrageenin pleurisy is a reproducible model of acute inflammation, widely considered a gold standard to evaluate anti-inflammatory drugs . Orally a fruits , every 8a fruits . It redua fruits ,233. Thea fruits . When coa fruits , these dSolid evidence links cancer and inflammation . In partIn light of the resistance of melanoma to current therapeutic approaches, the promising chemopreventive potential of Indicaxanthin against this deadly cancer warrants further investigation; in particular, combination therapy studies may open new opportunities.Obesity and related dysmetabolic conditions, peaking in the metabolic syndrome is a serious health problem worldwide ,242. BecWhile Western-style eating habits are considered the main culprits in promoting obesity, dietary patterns, foods, and individual bioactive components, including phytochemicals, are now being evaluated to prevent, counteract, or treat obesity-associated disorders. Beneficial effects of Indicaxanthin have recently been observed in a mouse model of high-fat diet (HFD)-induced obesity , where tCollectively these findings show that, while reducing food intake, body weight and fat mass, Indicaxanthin specifically affects glucose metabolism and corrects IR in a mouse model of metabolic syndrome. Anti-inflammatory activity, inhibition of RONS production and NF-κB/JNK activation in adipose tissue and liver emerge as the main mechanisms by which the phytochemical counteracts obesity and IR. Further studies are necessary to clarify the potential of this nutraceutical as an additive to prevent and treat obesity-related IR in humans and to consider Indicaxanthin as a novel, therapeutic agent for obesity-related disorders. In this context, the observed anoressigenic effect could be an indication to search for additional activities of Indicaxanthin, namely secretion and/or peripheral or brain receptor systems of hormones controlling food intake . The facProbably one of the most interesting aspects of Indicaxanthin bioactivity is its ability to cross the blood–brain barrier and interact with brain cells, exerting neuroprotective effects. As reported in a couple of studies in rats, this occurred after a single administration of 2 μmol/kg body weight, a nutritionally relevant amount corresponding to a dietary consumption of cactus pear fruits in humans ,37. CrosOnce crossed the BBB, Indicaxanthin distributes in rat brain areas and remains unmodified at levels comparable or even greater than those shown by other phytochemicals . IntriguElectrophysiological recordings in rats, applying microiontophoretic techniques, show that Indicaxanthin modulates the bioelectric activity of neurons, suggesting that the phytochemical could influence neuronal plasticity ,37. IndeLife-long utilization of natural compounds to preserve synaptic plasticity would help prevention of age-related neurological dysfunctions. In this context, dietary Indicaxanthin may be considered to exert beneficial effects by reducing neuronal excitability and act as a functional brake in the context of excitatory circuits, under physiological conditions. Further studies aimed at improving and controlling neuronal delivering could be a premise to envisage this phytochemical as a lead compound for therapeutical perspectives in the field of neurological pathologies, such as neurodegenerative conditions or complex cognitive brain processes, where a dysfunction of neuronal excitability plays a crucial role.The effects of Indicaxanthin in various animal set-ups modeling pathological circumstances, or focusing physiological conditions, are summarized in This review paper focuses on the bioactivity of Indicaxanthin, a dietary highly bioavailable betalainic phytochemical with nutraceutical potential. Evidence accumulated so far in healthy, transformed cells and whole organisms suggests health-promoting activities, particularly in counteracting inflammation and regulating mechanisms that control cell growth. The pleiotropic actions of this molecule in vitro and in vivo appear the result of various mechanisms of action and molecular activities. Its redox chemistry and reducing power explain the antioxidant and pro-oxidant activity; the amphiphilicity is essential to enable its activity at cell membranes, including modulation of NOX enzymes, but also the interactions with soluble proteins, so as to justify the molecule’s observed ability to counteract epigenetic modifications, inhibit ileal contractility and inflammation-associated carcinogenesis, or modulate neural bioelectric activity. Many in silico studies suggest that binding with proteins might be an avenue to be explored further with appropriate biological settings. Many observations still require explanation and deserve other studies. New research on the molecular mechanisms related to cell signaling pathways and modulation of gene expression, including suppression of NF-κB oxidative signaling and vitagen activation, could advance our understanding of the possible benefits of Indicaxanthin in maintaining redox homeostasis in normal cells and/or restoring redox homeostasis when a challenge exceeds the capacity of endogenous defense systems. Since Indicaxanthin has shown no deleterious effects in cells and animals, clinical studies could be planned to find useful effective doses for the application of this phytochemical in human health, nutrition, and pharmacology.


BackgroundIn this study, we aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic-induced social restrictions, including face masks, on patients with hearing problems.MethodologyThis cross-sectional survey study was conducted in an ENT tertiary care center. After signing the consent form, we invited study subjects with hearing disabilities who were using unilateral or bilateral hearing aids to participate in filling out the study survey. The study questionnaire was completed by 80 subjects. The questionnaire included various questions about the respondent’s demographics, hearing aids, and communication with a face mask during COVID-19 restrictions. All statistical analyses were performed using SPSS version 19 .ResultsOverall, 40% of the study sample agreed that understanding people wearing face masks is harder because their speech is muffled, whereas 10% disagreed, and 50% were neutral. While 41.3% agreed that understanding is harder because they cannot see their mouth moving, 23.8% disagreed, and 35% were neutral. More than half of the study sample (55%) agreed that they are worried about how they will communicate with others if wearing face masks becomes more common. However, 50% of the participants thought that they can still hear people when they speak to them from a safe distance. Of note, 71.3% of subjects disagreed about tinnitus being worse since the lockdown.ConclusionsThe widespread use of face masks had a significant impact on the daily communication and interactions of people with hearing impairments. More research is needed to find creative ways to help these patients improve their daily communication and social interactions. Coronavirus disease 2019 (COVID-19) is a devastating infectious disease that originally started in Wuhan and rapidly affected the entire world afterward. COVID-19 has led to drastic changes in people’s lives, work, and physical and mental health [Face coverings in public spaces make speech sound more reduced and somehow difficult as people cannot see the lip movement or facial expressions needed for understanding and communication . While uThe possible negative effects of face masks on social communication and interactions have been reported in the literature. For instance, Trecca et al. investigated the impact of wearing face masks by medical staff on patients with hearing disabilities attending a hospital visit. Of note, mild-to-severe problems were reported in most subjects 86.4%); the major face mask problems were the inability to read lip movement (n = 33), followed by the attenuated sound due to the mask (n = 26) .4%; the .According to the published literature, we hypothesized that face coverings could affect communication and interaction, especially among people suffering from hearing loss. Thus, we conducted this survey-based study among subjects with hearing problems who wear hearing aids. The survey contained several questions that aimed to elucidate the communication and social interaction problems during the COVID-19 pandemic when people wear face masks.Study subjectsThis survey-based, cross-sectional study was conducted in our tertiary hospital after obtaining the Institutional Review Board (IRB) approval . We invited a total of 120 subjects with hearing disabilities, for which they were wearing unilateral or bilateral hearing aids, to participate in the study and fill out the study survey. There were no limitations regarding age, gender, ethnicity, or any other specific characteristic. The respondents did not receive any kind of incentive for their participation and completion of the survey.Data collection and questionnaireStudy subjects were invited online to obtain their consent to participate by filling out the study survey. There were no potential risks associated with this study. The participants were asked to fill out a Google Forms questionnaire, no identifying information was obtained from the participants, and all responses were recorded anonymously. Only the authors of this research had access to the data. The survey contained several questions such as the demographics of the respondent, hearing aids, and communication through a face mask during COVID-19 restrictions. This survey was previously utilized in a similar cross-sectional study in Scotland . The queStatistical analysisAll statistical analyses were performed using SPSS version 19 . Descriptive statistics were used to outline the characteristics of respondents using frequencies and percentages for categorical variables. We used the chi-square test to determine the significant difference in variables among the subgroups. P-values below 0.05 were considered statistically significant.A total of 80 participants completely responded to our structured questionnaire. The majority of respondents 52.7%) were in the age group of 18 to 29 years old, followed by respondents older than 60 years (16.3%). The male gender predominated in the sample (62.5%). Unilateral hearing aids were used by 43 (53.8%) participants, while bilateral hearing aids were used by 37 (46.3%) participants. Regarding the duration of wearing hearing aids, the majority of the participants used them for more than eight hours per day (66.3%). However, only 13.75% and 12.5% used hearing aids from one to four and four to eight hours per day, respectively  of the sample agreed that understanding people wearing face masks is harder because they cannot see their mouth moving; eight participants were in the better hearing subgroup (33.3%), and 25 participants were in the worse hearing subgroup (44.6%), with a marginally significant difference (p = 0.047). More than half of the responders (n = 41) agreed that healthcare workers should be supplied with clear (transparent) face masks; most of them were participants with worse hearing (n = 31), with no significant difference between both subgroups (p = 0.178). However, 48.8% (n = 39) of our sample disagreed that wearing a face mask makes it hard to use hearing aids. Of these, 28 were in the worst hearing subgroup, and 11 were in the better hearing subgroup, with no significant difference between the two groups (p = 0.86).Regarding behavior concerns, more than half of the sample (55%) agreed that they were worried about how they will communicate with others if wearing face masks becomes more common; 55.4% and 54.2% of the worse and better hearing subgroups, respectively, contributed to this agreement. Moreover, no significant difference was noted between the two groups (p = 0.3). Nevertheless, 50% of participants thought they can still hear people when they speak to them from a safe distance, and no significant difference was found between the better and worse hearing subgroups (p = 0.067). A total of 54 (67.5%) participants reported their agreement about not being obliged to attend social gatherings where they will not hear well; more than two-thirds of participants in the worse hearing group contributed to this agreement  compared with half of the participants with better hearing , with no significant difference between both groups (p = 0.162). Moreover, with an approximate similar percentage of both total agreement  and disagreement , participants reported their anxieties about going to public places with the possibility of having to speak to people wearing face masks or from a distance. However, the majority of participants with better hearing disagreed  compared with the majority of participants with worse hearing who agreed , and a marginally significant difference was noted between groups (p = 0.049). On the other hand, a total of 11 (45.8%) participants with better hearing reported that they use video calls more often now than before the lockdown began, while a total of 23 (41.1%) participants with worse hearing reported their disagreement. However, no significant difference was noted (p = 0.08).Regarding participants’ increased worries about hearing aids stopping working or not being able to get batteries, 52 (65%) participants agreed on this concern; of those, 69.6% (n = 39) of the participants with worse hearing compared with 54.2% n = 13) in the better hearing group, with a significant difference (p = 0.006). Moreover, 60% (p = 0.066) and 66.3% (p = 0.627) of the participants reported their disagreement about wearing hearing aids less than usual before the lockdown or thinking about hearing loss more often than usual before the pandemic, respectively, with no significant difference between both groups  disagreed about tinnitus being worse since the lockdown began, with no significant difference p = 0.247) between both groups (Table 47 betweeThe spread of the COVID-19 pandemic worldwide has urged local public health authorities to mandate the use of face masks to curb the transmission of the virus. The widespread use of face coverings has impacted communication, especially among people with hearing problems. The findings of this survey-based report elucidate the effect of face covering and COVID-19 restrictions on people’s communication and behavior. Using face masks impacts daily communication in several ways due to the diminished acoustic power of sound and the lack of lip movement and facial expressions, as has been reported in numerous studies -10. AccoOur study has some limitations. First is the small sample of enrolled subjects; the low response rate and small sample size may be attributed to the fact that we used an online survey. It is true that not everyone has access to social media and the internet. This is probably going to comprise some of the most susceptible individuals to communication problems because of face masks. Further research should investigate if this group of patients has special needs that have not been reported in our survey. Another limitation is that our survey did not include questions regarding different types of face masks or coverings. While the use of face masks is becoming more prevalent across Saudi Arabia, it is possible that several types of face coverings will emerge. Thus, it is recommended that future studies consider the impact of different types of face masks on communication and interactions among people with hearing problems. Upcoming studies are recommended to further check if the widespread use of face masks impacts communication or decreases anxiety and embarrassment. Another factor to be considered in future research is looking for additional solutions to enhance patient communication, such as transparent face coverings, face shields, and other novel solutions.The COVID-19 pandemic has led to a lot of problems for people with hearing problems. Face masking and social distancing affect how people communicate, which is already considered difficult among these patients. Face masks not only impact communication among people with hearing loss but may also increase their worries, anxiety, and loneliness. The results of our survey represent a call to policymakers and specialized manufacturers to produce communication-friendly face masks for healthcare workers to enhance their communication and address their patients’ needs. With the problems caused by the COVID-19 pandemic, more research is needed to find ways to help people with hearing problems communicate better and have a better quality of life.