A review on electrocoagulation process for the removal of emerging contaminants: theory, fundamentals, and applications.

Electrocoagulation (EC) is an excellent and promising technology in wastewater treatment, as it combines the benefits of coagulation, flotation, and electrochemistry. During the last decade, extensive researches have focused on removal of emerging contaminants by using electrocoagualtion, due to its several advantages like compactness, cost-effectiveness, efficiency, low sludge production, and eco-friendness. Emerging contaminants (ECs) are micropollutants found in trace amounts that discharging into conventional wastewater treatment (WWT) plants entering surface waters and imposing a high threat to human and aquatic life. Various studies reveal that about 90% of emerging contaminants are disposed unscientifically into water bodies, creating problems to public health and environment. The studies on removal of emerging contaminants from wastewater are by global researchers are critically reviewed. The core findings proved that still more research required into optimization of parameters, system design, and economic feasibility to explore the potential of EC combined systems. This review has introduced an innovative collection of current knowledge on electro-coagulation for the removal of emerging contaminants.

Spray-dried alginate-coated Pickering emulsion stabilized by chitosan for improved oxidative stability and in vitro release profile.

The commercial application of liquid-state Pickering emulsions in food systems remains a major challenge. In this study, we developed a spray-dried Pickering emulsion powder using chitosan as a Pickering emulsifier and alginate as a coating material. The functionality of the powder was evaluated in terms of its oxidative stability, pH-responsiveness, mucoadhesivity, and lipid digestibility. The Pickering emulsion powder was oxidatively more stable than the conventional emulsion powder stabilized by gum Arabic. The powder exhibited pH-responsiveness, whereby it remained intact in acidic pH, but dissolved to release the emulsion in 'Pickering form' at near-neutral pH. The Pickering emulsion powder was also mucoadhesive and could be digested by lipase in a controlled manner. These findings suggested that the multi-functional Pickering emulsion powder could be a potential delivery system for applications in the food industry.

Techno-economical optimization using Box-Behnken (BB) design for chemical oxygen demand and chloride reduction from hospital wastewater by electro-coagulation.

The study examines the optimum condition of an electro-coagulation (EC) unit for treatment of hospital wastewater (HWW) using iron (Fe) electrodes. The impact of factors such as pH, current, and electrolysis time on COD, chloride, and anode dissolution was investigated. For this purpose, Box-Behnken (BB) design based on the response surface methodology (RSM) was used to design and analyze the results. The predicted value of chemical oxygen demand (COD) and chloride removal at optimum conditions (pH: 7.41, current: 2.64 A and electrolysis time: 41.31 min) were 92.81% and 71.23%, respectively. At same optimum conditions, the value of energy and electrode consumption per kg of COD was 0.06376 kWh/kg COD and 1.362 kg/kg COD, respectively. High value of R2 (i.e., R2  > 99%) for all three responses (Y1 , Y2 , and Y3 ) obtained from ANOVA confirms that the proposed model is valid, accurate, and acceptable. The kinetic study shows linear relationship and follows pseudo-first-order kinetics. Pareto graph shows that the percentage impact of current factor on COD and chloride removal was maximum, that is, 54.984% and 66.79%, respectively. Lastly, the total cost of EC treatment was calculated in terms of COD removal and was found to be 55.47 â‚¹/kg COD. PRACTITIONER POINTS: Using Fe electrode results in 92.81% COD and 71.23% Chloride removal, respectively. High value of R2  > 99% for all three responses from ANOVA confirms the proposed model is valid. Pareto analysis shows current factor has maximum percentage impact on pollutant removal. Kinetic study shows linear relationship and follows pseudo-first-order kinetics.

Remedial Technologies for Aniline and Aniline Derivatives Elimination from Wastewater.

BACKGROUND: Aniline and its derivatives are widely used as intermediate chemicals in the pharmaceutical and dye industries and are present in their wastewaters. These chemicals are of concern due to their potential detrimental effects on public health and aquatic species in the environment. OBJECTIVES: Various available remedial technologies presented in the literature were investigated to determine the most suitable technology for the elimination of aniline and aniline derivatives from waste streams. METHODS: The related literature was collected electronically from ScienceDirect, Google Scholar, the International Agency for Research on Cancer (IARC), ResearchGate and Wiley Online Library for systematic review. The search terms included 'aniline', 'aniline degradation', 'advanced oxidation processes (AOPs)', 'aniline derivatives' and 'Fenton's reagent'. DISCUSSION: Aniline and its derivatives are a serious issue in the effluents of dye and pharmaceutical industries, but a number of efficient treatment methods using biological, physical and AOPs have been presented in the literature. CONCLUSIONS: Comparison of the available technologies showed that AOPs were the most cost effective and efficient technologies for eliminating aniline and its derivatives from wastewater. COMPETING INTERESTS: The authors declare no competing financial interests.

Comparative study on decentralized treatment technologies for sewage and graywater reuse - a review.

Currently, reservoirs, lakes, rivers etc. are being overloaded by the demand for fresh water, due to rapid industrialization and population explosion, and also the effluents from industries and domestic wastewater are continuously polluting these resources. To address this issue, several decentralized wastewater treatment system (DWTS) have been installed all over the globe to reuse and recycle wastewater/graywater for non-potable uses such as fire protection, toilet-flushing, and landscape irrigation. In this review, a comparison between different DWTS was carried out to evaluate their performance, merits and limitations. Hybrid technologies like the electrically enhanced biomass concentrator reactor and integration of physical/ biological methods with bio-electrochemical systems such as microbial fuel cells were found to be the most promising methods for near complete removal of pollutants from wastewater and also the issue of membrane fouling was reduced to a good extent.

Clinico-radiological characteristics and not laboratory markers are useful in diagnosing diabetic myonecrosis in Asian Indian patients with type 2 diabetes mellitus: A 10-year experience from South India.

INTRODUCTION: Diabetic myonecrosis or muscle infarction is an unusual complication of Type 2 Diabetes, usually associated with longstanding disease. It commonly presents as an acute non-traumatic palpable swelling of the affected muscle with predilection for the quadriceps and thigh muscles, often accompanied by retinopathy and nephropathy. METHODOLOGY: A retrospective review of the medical records of patients admitted with diabetic myonecrosis under the Department of Endocrinology, Christian Medical College Vellore over a period of ten years(2006-2015) was done. Data pertaining to clinical, biochemical and radiological characteristics were obtained and treatment modalities and outcomes were recorded. RESULTS AND ANALYSIS: A total of n = 4 patients with diabetic myonecrosis and completed clinical data were included in the study. In our present series, the mean age at presentation was 45.5 years (±7.3 years), the mean duration of the diabetes was 9.0 years (±2.5 years)with an equal distribution of male and female subjects. The mean HbA1c (9.5 ± 0.6%) was suggestive of poor glycemic control at presentation with all (100%) the patients in our series having concomitant one or more microvascular complications. While laboratory parameters of elevated CPK or LDH were mostly normal, the findings of T1 hyperintense and T2 hypointense heterogenous lower limb lesions were present in all the subjects (n = 4). Conservative management with bed rest, analgesics and good glycemic control were effective in good clinical improvement over a period of 1-2 months. CONCLUSIONS: Our series of diabetic myonecrosis in Indian patients with Type 2 diabetes mellitus, elucidates the varied clinical presentations, with MRI findings rather than laboratory markers being the mainstay of diagnosis.

Primary pyomyositis in North India: a clinical, microbiological, and outcome study

BACKGROUND/AIMS: Pyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis. METHODS: This study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent. RESULTS: Sixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality. CONCLUSIONS: Primary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.

Variations of treatment in selected proximal femur fractures among surgeons with different surgical experience--A survey at an international AO course.

INTRODUCTION: Different modalities of treatment for hip fractures have been discussed in the literature; however, practice may vary between centres. A survey was conducted on participants at an international AO course to assess the current management of pertrochanteric fractures (AO/OTA 31-A2) and displaced, non-impacted, subcapital fractures (AO/OTA 31-B3) in a 35-year-old patient and an 85-year-old patient. METHODS: Surgeons taking part in an international orthopaedic course were invited to participate in a survey and were divided into two groups: inexperienced (one-to-three years since qualification) and experienced (four or more years). A survey was conducted to assess the management modalities used for pertrochanteric fractures (AO/OTA 31-A2) and displaced, non-impacted, subcapital fractures (AO/OTA 31-B3) in a 35-year-old patient and an 85-year-old patient. RESULTS: Fifty-two surgeons participated: 18 were inexperienced and 34 were experienced. The method of operative fixation for the pertrochanteric fracture was gamma-nailing for 95% of the surgeons in the inexperienced group; in the experienced group, 56% opted for gamma-nailing and 38% for dynamic hip screw (DHS). For the displaced subcapital fracture in a 35-year-old, screw fixation was the dominant treatment option for both groups. For the displaced subcapital fracture in an 85-year-old, most of the surgeons in both groups preferred hemiarthroplasty: 59% in the inexperienced group chose cemented bipolar hemiarthroplasty and 12% uncemented, whereas 56% of the experienced group suggested cemented bipolar hemiarthroplasty and 25% uncemented. DISCUSSION: This survey shows that a variety of methods are used to treat femoral neck fractures. A prospective randomised trial has shown the DHS to be the implant of choice for pertrochanteric fractures; however, this was not considered an option in the inexperienced group of surgeons and was the treatment of choice in only 13 out of 34 experienced surgeons. There is a general consensus for femoral head-conserving surgery in young patients with displaced subcapital fractures. Replacement arthroplasty was considered in the 85-year-old with a subcapital fracture. In the inexperienced group, 10 of 17 surgeons would cement the prosthesis, as would 27 of 36 in the experienced group.

Past, present and perspectives of Manipur traditional medicine: A major health care system available for rural population in the North-East India.

BACKGROUND: Traditional health care practices are still being followed extensively in Manipur, North-East India. This is the major or the only medical facility available in some rural areas of Manipur. Cross cultural ethno-pharmacological survey was conducted to document traditional health care practices by Maiba-Maibi (male-female traditional health care practitioners of Manipur). MATERIALS AND METHODS: All together 59 traditional practitioners belonging to 12 ethnic communities in nine districts of the Manipur state were interviewed. A predesigned questionnaire was used for interviews, which included queries for type of ailments treating, symptoms, bioresources used, method of preparation, dosage forms, formulation, unit doses. The entire interviews were done in the residence of respective Maiba-Maibi, their patient handing and preparation of medicinal formulations were documented in written and audio-visual format. RESULTS: The survey recorded traditional knowledge on 949 formulations used for 66 human ailments. Five hundred forty six plant products, 42 animal products and 22 organic/inorganic materials were found to be used in these 949 formulations. Five plant species - Zingiber officinale (Zingiberaceae), Cocos nucifera (Arecaceae), Oroxylum indicum (Bignonaceae), Curcuma longa (Zingiberaceae) and Allium sativum (Liliaceae) used by maximum number of Maiba and Maibi in maximum number of formulations. RECOMMENDATION: This particular method of documentation keeps traditional knowledge alive. The WHO estimated perspective of traditional medicine across the world. These observations support therapeutic worth of Manipur Traditional medicines (MTM). Having generated a large database in course of this survey, next focus targeted for the scientific justification of MTM with an aim to develop commercially viable products.

Isolation, characterization, and evaluation of bacterial root and nodule endophytes from chickpea cultivated in Northern India.

Endophytic bacteria from roots (12 isolates) and nodules (76 isolates) of chickpea legume grown under CCS Haryana Agricultural University farm were isolated. Among the endophytic bacteria, 50% from roots and 93.4% from nodules were Gram positive spore formers. Large number of endophytes from roots and nodules solubilized phosphate and produced ammonia. Isolate CRE3, and CNE215, were most efficient P solubilizers and. CRE12 and CNE76 being most efficient ammonia producer. Interestingly, few endophytic bacteria produced organic acid. Further selected 62 isolates were used to determine molecular diversity by RFLP of PCR amplified 16S rDNA. Endophytes from roots formed five separate clusters and nodule endophytes formed 13 clusters. Isolate CNE215 from nodules and CRE1 from roots possessed multiple beneficial traits and belonged two different clusters. These two isolates were identified after amplification and sequencing of 16S rRNA gene. Isolate CNE215 showed more than 98% similarity with partial sequence of 16S rRNA gene of Bacillus subtilis, whereas CRE1 showed more than 98% similarity with Bacillus licheniformis. Efficacy of these two strains was evaluated under field conditions and an increase up to 22.5% in grain yield over uninoculated control was observed with B. subtilis strain CNE215, whereas all the recommended biofertilizers were able to record an increase upto 14.4%.

Studies on salinization in Haryana soils on free-living nitrogen-fixing bacterial populations and their activity.

A total of 26 soil samples from saline soils of Haryana were collected. Based on their electrical conductivity (EC) values, which varied from 1.04 to 21.00 dS m(-1), the soils were categorized into non-saline soils (EC 0-2 dS m(-1)), weakly saline soils (EC 2-4 dS m(-1)), saline soils (EC 4-8 dS m(-1)), strongly saline soils (EC 8-16 dS m(-1)), and very strongly saline soils (EC >16 dS m(-1)). The pH values of these soil samples ranged from 6.03 to 8.62, while organic C, total N, and available P were in the range of 0.06-0.94%, 0.07-0.15%, and 0.11-0.29 µg g(-1) soil, respectively. As a measure of the impact of salinity on free-living N(2) fixers and their activity, the total bacterial populations on four media (Jensen's nitrogen-free medium, malate medium, Burk's medium, and soil extract agar medium) decreased from 6.12 to 3.70 log CFU g(-1) soil with increasing salinity level. PCR amplification of the nifH region of the DNA from 234 selected morphotypes from all the media showed the presence of nifH in 71 isolates. Out of these, 37% of the isolates were obtained using Jensen's medium; 35, 28, and 21% of the isolates were obtained using soil extract medium, Burk's medium, and malate medium, respectively. The majority of the free-living N(2) fixers (67%) were Gram negative. Apart from the acetylene reduction assay (ARA) activity in these isolates, other beneficial traits like ammonia excretion and indole acetic acid (IAA) production were also present. A decreasing trend in the activities was observed with increasing salinity levels. Isolates JN6, BP8, and MJ4 showed the highest ARA activity, ammonia excretion, and IAA production. The performance of isolates like BNC2 with good ARA activity, ammonia excretion, and IAA production and isolated from a very strongly saline soil should be further evaluated under high-saline conditions.

The challenging aspects and successful anaesthetic management in a case of situs inversus totalis.

Situs inversus totalis is a rare condition with a predicted incidence of one in 10,000 among the general population, the aetiologic factors for which are still not completely understood. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult due to distorted anatomy and transposition of thoraco abdominal viscera but equally challenging is the anaesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for open cholecystectomy. The present case report lays an emphasis on the potential difficulties during anaesthetic management and its various implications.

Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine.

BACKGROUND AND CONTEXT: Different adjuvants been tried out for neuraxial anesthesia in emergency caesarean section so that the dose of the local anesthetic can be reduced and hypotension thereby prevented. AIMS AND OBJECTIVES: The present study was carried out in patients presenting for emergency lower segment caesarean section (LSCS) to establish the dose of intrathecal clonidine that would allow reduction of the dose of local anesthetic (thereby reducing the incidence and magnitude of hypotension) while at the same time providing clinically relevant prolongation of spinal anesthesia without significant side effects. MATERIALS AND METHODS: This randomized clinical study was carried out in our institution among 100 pregnant females who underwent emergency caesarean section. The participants were divided randomly into four groups: A, B, C, and D, each comprising 25 parturients. Subarachnoid block was performed using a 26G Quincke needle, with 12 mg of hyperbaric bupivacaine (LA) in group A, 9 mg of LA + 30 µg of clonidine in group B, LA + 37.5 µg of clonidine in group C, and LA + 45 µg of clonidine in group D. The solution was uniformly made up to 2.2 mL with normal saline in all the groups. Onset of analgesia at T(10) level, sensory and motor blockade levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative block characteristics, and adverse events were looked for and recorded. Statistical analysis was carried out with SPSS(®) version 10.0 for Windows(®), using the ANOVA test with post hoc significance, the Chi-square test, and the Mann-Whitney U test. P<.05 was considered significant and P<.0001 as highly significant. RESULTS: One hundred patients were enrolled for this study. The four groups were comparable with regard to demographic data and neonatal Apgar scores. Onset and establishment of sensory and motor analgesia was significantly shorter in groups C and D, while hypotension (and the use of vasopressors) was significantly higher in groups A and D. Perioperative shivering, nausea, and vomiting were significantly higher in groups A and D, while incidence of dry mouth was significantly higher in group D. CONCLUSIONS: The addition of 45 µg, 37.5 µg, and 30 µg of clonidine to hyperbaric bupivacaine results in more prolonged complete and effective analgesia, allowing reduction of up to 18% of the total dose of hyperbaric bupivacaine. From the results of this study, 37.5 µg of clonidine seems to be the optimal dose.

Treatment failure with disease-modifying antirheumatic drugs in rheumatoid arthritis patients

<p><b>INTRODUCTION</b>Rheumatoid arthritis (RA) patients taking disease-modifying antirheumatic drugs (DMARDs) may experience treatment failure due to adverse effects or a lack of efficacy/resistance. The purpose of this study was to evaluate the prescription patterns, the incidence and reasons for failure, and the time to treatment failure of DMARDs in RA patients.</p><p><b>METHODS</b>The medical records of patients visiting the Rheumatology Clinic were scrutinised retrospectively in order to extract the relevant data, including demographics, clinical and laboratory investigations and drug usage, for analysis.</p><p><b>RESULTS</b>More than 60% of the 474 eligible patients were started on a combination of DMARDs. Hydroxychloroquine (HCQ) (79.7%) and methotrexate (MTX) (55.6%) were the most common DMARDs prescribed initially. There was a significant difference in survival times among the various treatment groups (p ≤ 0.001). Adverse effect was the main reason for treatment failure of sulfasalazine (SSZ) (88.9%) and MTX (75%), while addition or substitution DMARDs was more common for those taking HCQ (72.2%). Adverse event was reported as the most significant predictor of treatment failure. The most commonly reported adverse effects were bone marrow suppression and hepatotoxicity.</p><p><b>CONCLUSION</b>A combination of DMARDs was used to initiate therapy in more than 60% of RA patients, with HCQ and MTX being prescribed most frequently. Adverse effects accounted mainly for treatment failures with MTX and SSZ, while lack of efficacy was responsible for major treatment failures with HCQ.</p>

Establishment of Azotobacter on plant roots: chemotactic response, development and analysis of root exudates of cotton (Gossypium hirsutum L.) and wheat (Triticum aestivum L.).

Biofertilizers contribute in N(2) fixation, P solubilization, phytohormone production and thus enhance plant growth. Beneficial plant-microbe interactions and the stability and effectiveness of biofertilizer depend upon the establishment of bacterial strains in the rhizosphere of the plant. This interaction depends upon many factors, one of them being plant exudates. Root exudates are composed of small organic molecules like carbonic acids, amino acids or sugars etc., which are released into the soil and bacteria can be attracted towards these exudates due to chemotaxis. The chemotactic behaviour of Azotobacter strains was studied using cotton (Desi HD 123 and American H 1098) and wheat (WH 711) seedlings and the root exudates of these two plants were chemically characterized. Analysis of the root exudates revealed the presence of sugars and simple polysaccharides (glucose), amino acids (glutamate, lysine) and organic acids (citric acid, succinic acid, maleic acid, malonic acid). Differences between cotton cultivars in root exudates were observed which influenced chemotactic response in Azotobacter. These results indicate colonization with rhizobacteria which implies that optimal symbionts, on the sides of both plant cultivar and bioinoculant bacteria can lead to better plant growth under cultivation conditions.

Cosmetic dermatitis - current perspectives.

BACKGROUND: Increasing use of cosmetics by modern society has contributed alarming to an rise in the incidence of cosmetic dermatitis (CD). The causative agents are skin, hair, nail and eye cosmetics. Reported cases of cosmetic dermatitis represent only the tip of the iceberg, as most patients who experience an adverse reaction to cosmetics do not consult a physician but discontinue using the suspected items. METHODS: A comprehensive history followed by adequate clinical examination and patch test is important to diagnose reaction to cosmetics. In addition other tests like Repeated Open Application Test (ROAT), usage test, elimination test and safety test are important, as many cosmetics and their ingredients are either weak allergens or irritants. RESULTS: A wide variety of adverse reactions to cosmetics are seen which are of both irritant and allergic type. Pattern of CD varies in different parts of the world depending upon the type and frequency of different cosmetics used. Reactions are more commonly seen in females of younger age and the face is the most common site. CONCLUSIONS: Though prevention is better than cure, but cosmetics have definitely infiltrated into our life style. We cannot prevent use of cosmetics but can only limit their use by educating their users and helping them in judicious selection of the required cosmetics.

Health care needs of foreign-born Asian Americans: an overview.

Asian Americans are one of the fastest growing groups in the United States. A majority of them are foreign born, which makes their health-related situation very complex. Many still have the diseases they brought with them from their native lands. In addition, they acquire new diseases attributed to the changes in their living conditions and lifestyle. They are vulnerable to the physical effects of acculturation-related stress as well. The health care needs of these new Americans are not being adequately met. This article describes the barriers to their ability to use health care services and analyzes the reasons for the health care system's inability to respond to their needs. Finally, it urges social work to contribute to the system's responsiveness and suggests approaches to social work intervention with and on behalf of Asian Americans.

Functional assessment of the right ventricle with gated myocardial perfusion SPECT.

BACKGROUND: The evaluation of right ventricular function can provide valuable information in a variety of cardiac and noncardiac conditions. Functional assessment of the right ventricle is difficult because of its anatomy and geometry. The authors describe a method for assessing right ventricular function using gated myocardial perfusion SPECT. METHODS: In 20 patients, right and left ventricular ejection fractions (RVEF, LVEF) were determined using gated blood-pool scintigraphy (GBPS) and gated myocardial perfusion SPECT (GSPECT). To avoid contamination with right atrial activity, the two-frame method was adopted for gated blood-pool data when RVEF was measured. In nine patients with normal right ventricles, an index of wall thickening for the right ventricle was derived from the peak systolic and diastolic counts in the free wall. RESULTS: Linear correlation between the two methods adopted for calculation of LVEF and RVEF was good. Bland-Altman analysis revealed good agreement between the two methods with no specific bias. The mean LVEF was 47.9 +/- 12% (GBPS) and 47.3 +/- 12.4 (GSPECT). The mean RVEF was 43.2 +/- 9.6% (GBPS) and 44.2 +/- 8.5% (GSPECT). In both cases, the values were not significantly different. The mean wall motion index was 35%. There was no correlation between the wall thickness index and ejection fraction, but the index was greater in patients with a normal right ventricle compared with those with reduced RVEF. CONCLUSIONS: Gated SPECT offers an alternative to GBPS for the functional assessment of the right ventricle. Using GSPECT will allow the simultaneous assessment of both the right and left ventricles.

Caregivers of Alzheimer's Disease Patients.

Based on an extensive review of the literature, this paper describes the major changes in the patient's behavior at the various stages of Alzheimer's disease and looks at the problems generally involved in caring from different perspectives. It also discusses factors that may explain the uniqueness of each caregiving situation and highlights the approaches to helping the caregiving families effectively.