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1

Figueiredo, Sabrina. "Nordic Walking: a new training for frail elderly." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86946.

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The elderly are the fastest growing proportion of the world population. Additional increase in longevity, brought about by improved medical technology, will impact significantly on the health care system as, with advancing age comes a variety of acute and chronic health conditions. No matter how fit, advancing age leads to reduction in mobility and physical function, and these changes, affect quality of gait and the capacity for functional and safe ambulation. With the frail elderly, gait impairments are often severe and impact on health and quality of life. Given that improving walking capaci
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2

Ellmers, Susan E. "Drug handling in fit & frail elderly people." Thesis, University of Bath, 1991. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.292811.

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3

Zochling, Jane Margaret. "The Epidemiology of Osteoporosis in the Frail Institutionalized Elderly." University of Sydney. Department of Rheumatology, 2004. http://hdl.handle.net/2123/637.

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As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particula
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4

Zochling, Jane Margaret. "The Epidemiology of Osteoporosis in the Frail Institutionalized Elderly." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/637.

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As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particula
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5

Faxén, Irving Gerd. "Nutritional status and cognitive function in frail elderly subjects /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-004-4/.

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6

Barry, David C. "Preferences of frail elders regarding ideal living environments /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9988647.

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7

McNamee, Paul. "The resource implications of care for frail older people." Thesis, University of Newcastle Upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270586.

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8

Wang, Miranda, and 王慕恩. "Nutritional interventions among community-dwelling frail elderly : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193851.

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Background: The worldwide ageing demographic trend has resulted in a growing number of frail elderly who are in the last stages of autonomous living. Oral nutritional interventions for the frail elderly address the body’s natural weight loss, sometimes reversing weight loss, though the literature is not of one accord. No review of nutritional interventions has been conducted for community-dwelling frail elderly, who are most likely to benefit from these interventions and delay adverse outcomes. Objective: (i) This systematic review analyzes results from randomized controlled trials of oral
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9

Lammes, Eva. "Nutrition, energy metabolism and body composition in the frail elderly /." Stockholm, 2007. http://diss.kib.ki.se/2006/91-7357-058-3/.

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10

張學泰 and Xuetai Zhang. "Community-based care for the frail elderly in urban China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31243903.

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11

Zhang, Xuetai. "Community-based care for the frail elderly in urban China /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B24873457.

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12

Splinter, Audrey Patricia. "An investigation into how elderly persons perceive elder Abuse." Thesis, University of the Western Cape, 2009. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_6309_1276805303.

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<p>The international concern about human rights, gender equality, domestic violence and the increase in the aging populations has brought elder abuse into the public focus. Elder abuse is a complex, multi-faceted health, social, criminal justice, international public health and human rights issue. The widely divergent and varying definitions is a controversial problem to understanding elder abuse. The elderly have been excluded from national gender-based programs on domestic violence and the abuse of women and children. In South Africa victims of elder abuse are often physically and or cogniti
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13

Cronin, Donna Leilani. "Effects of functional and resistive exercise training on physical function and perceived self-efficacy and well-being in frail elderly adults." Access restricted to users with UT Austin EID Full text (PDF) from UMI/Dissertation Abstracts International, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3036587.

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14

Grenier, Amanda. "Diverse older women : narratives negotiating frailty." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82884.

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This study explores women's narratives from within and outside of the frail/non-frail binary of public home care services. It focuses on the stories that are commonly told about older women's needs and bodies and the regulatory potential of these accounts. Considering power, language, diversity and change, this study focuses on the way that twelve diverse older women at various social locations (e.g., ability, age, culture, ethnicity, 'race', sexual orientation, and socio-economic status) understand, make meaning, and negotiate the concept of frailty in relation to their everyday lives.
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15

Rydwik, Elisabeth. "Effects of physical training on physical performance in frail elderly people /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-310-8/.

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16

Romell, Eleanor, and Kevin Broxe. "The Impact of Nutrition on the Frail Elderly - A Literature Study." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-386058.

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ABSTRACT Background: The population of elderly people is an expanding group with an average life expectancy far exceeding that of only several decades ago. This increased number of older adults is a direct result of improved medical improvements, but it has also created a group vulnerable to the decline of bodily functions, diminished physical strength and poor quality of life. They are susceptible to poor nutrition and frailty that can lead to ill health and poor quality of life that ultimately imposes a strain on the health care system and its resources. It is key that effective intervention
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17

Ödlund, Olin Ann. "Nutritional and functional effects of energy-dense food in the frail elderly /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-080-X/.

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18

Liu, Qiaoming. "Social support for the frail elderly at two kinds of retirement communities." PDXScholar, 1990. https://pdxscholar.library.pdx.edu/open_access_etds/4098.

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As few studies focus explicitly on social support for residents by residents in retirement communities which have staff, this thesis is designed to explore the nature of informal social support among residents at planned, non-subsidized retirement care facilities: the types, the amount, the impact, the limitation and the appropriateness of such support. Our focus is to explore whether different organization of a retirement community affects social support among residents, so we compare two retirement care facilities. One provides single-level care for its residents and the other provides multi
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19

Wong, Irene. "Difficulties & rewards for caregivers who take care of frail elders during the end-of-life period /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36783316.

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20

Mak, Suk-kwan Lorensa. "An exploratory study of the influence of Chinese values on the caregiving of Frail elderly /." Hong Kong : University of Hong Kong, 1994. http://sunzi.lib.hku.hk/hkuto/record.jsp?B1399167X.

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21

Sävenstedt, Stefan. "Telecare of frail elderly : reflections and experiences among health personnel and family members." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-339.

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Telecare has been an approach to care that, internationally, has experienced a generally rapid development during the last ten years. There are many examples of successful pilot projects where ICT applications have been used in the care of elderly: for improved remote consultation with health professionals, to improve the communication and support of the elderly person’s social network, and as intelligent sensors intended to improve the safety of the elderly person. Despite these successes, implementation has been slow. This research project was set up to provide additional knowledge on some o
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22

Dumughn, Ishbel. "Mental health, marital intimacy and support in elderly caregivers of physically frail partners." Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/26467.

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The impact of caregiving and the role of psychosocial resources are examined in elderly spouses of the physically frail. Despite evidence from the literature, the strain of caring for older people with physical illnesses is less well recognised that that of caring for dementia sufferers. Similarly, although marriage is the prime location of care, the impact on the marital relationship is little studied. In this study elderly spouse caregivers were interviewed before and after their partner's attendance at a day hospital. Questionnaires were used to assess stressors, mood, general mental health
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23

Sävenstedt, Stefan. "Telecare of frail elderly : reflections and experiences among health personnel and family members /." Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-339.

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24

Meyer, Rhonda D. (Rhonda Dawn). "Effects of Strength on Selected Psychomotor Performances of Healthy and Frail Elderly Females." Thesis, University of North Texas, 1993. https://digital.library.unt.edu/ark:/67531/metadc500976/.

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The purpose of this study was to compare muscle strength and psychomotor performance measures in healthy (n = 18) and frail (n = 21) groups of elderly women utilizing movements requiring various amounts of strength and ballistic action. Subjects were community-dwelling females ranging in age from 66-92 years. Evaluations of functional assessment of motor skills and grip strength occurred. Psychomotor performance was measured through production of aiming movements on a Digitizing Tablet. RT, MT, and movement kinematics (e.g., peak velocity, deceleration, movement adjustments) were evaluated. Di
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25

Wissendorff, Ekdahl Anne. "Frail and Elderly Hospital Patients : The Challenge of Participation in Medical Decision Making." Doctoral thesis, Linköpings universitet, Hälsa, Aktivitet, Vård (HAV), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-81408.

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Background: In research, patient participation in medical decision-making has been shown to be associated with higher patient satisfaction and improvement of treatment outcomes. But when it comes to patient participation when being old and frail there are pitfalls and the research in this area is sparse. The aim of this thesis is to explore participation in medical decision making of the frail elderly patient in hospital from the perspectives of patients themselves and the health care staff. In this thesis frail, elderly patients is defined as individuals 75 years old or older, who during the
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26

Troyer, Richard. "Attributions of Responsibility Among Caregivers of the Frail Elderly: Predicting Formal Service Use." TopSCHOLAR®, 1989. https://digitalcommons.wku.edu/theses/2920.

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A review of the research on family caregivers of the frail elderly indicates that although caregivers often experience high levels of burden, they make only minimal use of available professional, or formal, services. A theoretical model of helping and coping proposed by Brickman, Rabinowitz, Karuza, Coates, Cohn, and Kidder (1982) suggests that attributions of responsibility for causing and for solving problems define four distinct attributional styles, each determining how people will respond to outside help. The current study of 40 family caregivers attempted to validate an attribution instr
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27

Schindler, Doris. "Intergenerational Programming: A Confluence of Interests Between the Frail Elderly and Urban Youth." PDXScholar, 1992. https://pdxscholar.library.pdx.edu/open_access_etds/1387.

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Two groups of urban residents present ongoing problems, the frail elderly and disadvantaged youth who are approaching transition from school to the work force. Many of the disadvantaged youth are at risk because of family background, inadequate education, and lack of work experience. Many of the frail elderly are unable to care for themselves because of debility, chronic illness, or functional impairments (Eustis, 1974). The United States is experiencing an unprecedented increase in the numbers of persons over 65 years of age and it is expected that between 1980 and 2000 there will be a 67 per
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28

Silva, Taís Regina da. "Síndrome da Fragilidade em idosos hospitalizados." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/152936.

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Submitted by Taís Regina da Silva null (tais.rsilva71@gmail.com) on 2018-03-07T10:40:03Z No. of bitstreams: 1 Dissertacao Mestrado - fev 2018 - Tais Regina da Silva (5).pdf: 1774137 bytes, checksum: bc90c39167e23317082e573c843da5ab (MD5)<br>Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-08T19:32:27Z (GMT) No. of bitstreams: 1 silva_tr_me_bot.pdf: 1774137 bytes, checksum: bc90c39167e23317082e573c843da5ab (MD5)<br>Made available in DSpace on 2018-03-08T19:32:27Z (GMT). No. of bitstreams: 1 silva_tr_me_bot.pdf: 1774137 bytes, checksum: bc90c39167e233
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29

Lindelöf, Nina. "Effects and experiences of high-intensity functional exercise programmes among older people with physical or cognitive impairment /." Luleå : Luleå tekniska universitet/Hälsovetenskap/Sjukgymnastik, 2008. http://epubl.ltu.se/1402-1544/2008/01/.

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30

Hanusaik, Nancy Anna. "Association of measures of functional status with fat-free mass in frail elderly women." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ29708.pdf.

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31

Hanusaik, Nancy Anna. "Association of measures of functional status with fat-free mass in frail elderly women." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=27333.

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The association of functional status with fat-free mass (FFM) was examined cross-sectionally in a sample of 30 frail elderly women $(81.5 pm 7$ years) to evaluate potential outcome indicators for nutritional interventions. FFM, determined using multi-frequency bioelectrical impedance analysis, was lower in this frail group than in previous reports for "younger" elderly females. All measures of muscle strength (handgrip, biceps, quadriceps) were significantly correlated with FFM $ rm (r ge 0.45, p le 0.02),$ while the measures of global function (Timed "Up & Go" Test and walking speed) as well
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32

He, Weijia, and 何維佳. "Use of proxy method for assessing swallowing-related quality of life in frail elderly." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/202377.

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Dysphagia, which refers to difficulties in swallowing, is a common clinical dysfunction with high morbidity in the ageing population. At least four validated questionnaires are available for assessing swallowing-related quality of life. These include the M. D. Anderson Dysphagia Inventory (MDADI), the Swallow Quality-of-Life Questionnaire (SWAL-QOL), the Sydney Swallowing Questionnaire (SSQ) and the Dysphagia Handicap Index (DHI). However, these questionnaires are either designed for some specific dysphagic populations or only focused on the impact of swallowing disorders at the impairment lev
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33

Owens, Margaret N. "The lived experience of daughters who care for frail, elderly parents in the parents' home." Cincinnati, Ohio : University of Cincinnati, 2004. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=ucin1084469332.

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34

Brink, F. J. "The development of a financial plan to partly cover the cost of frail care in a retirement village in George." Thesis, Port Elizabeth Technikon, 2002. http://hdl.handle.net/10948/84.

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The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research me
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35

JÃnior, Arnaldo Aires Peixoto. "AvaliaÃÃo de marcadores inflamatÃrios, da modulaÃÃo do sistema nervoso autonÃmico e de suas associaÃÃes na fragilidade de idosos." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12065.

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nÃo hÃ<br>IntroduÃÃo: Sarcopenia, estado inflamaÃÃo crÃnica e diminuiÃÃo da modulaÃÃo autonÃmica cardÃaca sÃo frequentemente descritos em idosos frÃgeis. No entanto, o papel da inflamaÃÃo e diminuiÃÃo da modulaÃÃo autonÃmica em perda de massa muscular associada ao envelhecimento deve ser esclarecido. Objetivo: identificar, em idosos frÃgeis e robustos residentes na comunidade, correlaÃÃes entre alteraÃÃes autonÃmicas, nÃveis sÃricos de marcadores bioquÃmicos de inflamaÃÃo e diminuiÃÃo da forÃa e do desempenho muscular. Resultados: 98 voluntÃrios frÃgeis e robustos com idade de 60 anos ou mais
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36

Khursigara, Zareen. "Factors regulating resting energy expenditure and thermic effect of food in elderly women." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84046.

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Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response.<br>Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and c
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37

Fitzsimons, Claire Frances. "Oxygen uptake kinetics at the onset of exercise and cardiorespiratory fitness in frail elderly people." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/24572.

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Methods: VO<sub>2</sub> and walking speed were measured during 3 minutes of comfortable self-paced walking in young (Y) (N=17, median age 23 (20-29) years) and healthy elderly (HE) (N=15; median age 80 (76-87) years) volunteers and groups of patients recovering from a hip fracture (HF) (N=8; median age 81 (72-91) years) or stroke (ST) (N=66; median age 74 (49-87) years). Results: <i>Feasibility. </i>On 214/277 study visits individuals completed 3 walks of 3 minutes (77%). Participants maintained a constant walking speed of moderate intensity and achieved steady state VO<sub>2 ­</sub>conditions
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38

Ardenghi, Diego Macgadi. "Exploring the views of relatives of frail elderly patients about the UBC geriatric dentistry program." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/48373.

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Elderly residents of long-term care facilities (LTC) have difficulty accessing dental services. Aiming to improve access for this population, the Geriatric Dental Program (GDP) was established by the UBC Faculty of Dentistry in 2002. Within the GDP, elderly LTC residents receive fee-for-service dental treatment. The objective of this research is to explore whether having access to the GDP services had an impact on the life of the patients’ relatives (family members). This research hopes to better understand how quality of health in relation to dental health extends to relatives who are respons
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39

Lemieux, Ann L. "The experience of adult sons and daughters of hospitalized frail elderly parents : a qualitative study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/mq23378.pdf.

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40

Mak, Suk-kwan Lorensa, and 麥淑筠. "An exploratory study of the influence of Chinese values on the caregiving of Frail elderly." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1994. http://hub.hku.hk/bib/B31249899.

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41

Subki, Manal. "Assessment of the nutritional status of frail elderly persons participating in geriatric day hospital rehabilitation program." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33847.

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We assessed the nutritional status and physical function of 121 women (79.4 +/- 6.6 y, 26.8 +/- 5.6 kg/m2) and 61 men (78.6 +/- 8.3 y, 26.6 +/- 4.7 kg/m2) participating in the Geriatric Day Hospital. According to a composite index of malnutrition, 19% of them were found malnourished whereas the Mini-Nutritional Assessment, a validated nutritional screening tool, found that 56% of the elderly were malnourished or at risk for malnutrition. Malnourished persons, as determined by the composite index, had a lower lean body mass (LBM) by bioelectrical impedance analysis compared with the well-nouris
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42

Chan, Lung-fai, and 陳龍輝. "Mental health of Chinese spousal caregivers of frail elderly: the role of the traditional Chinese familyvalues." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B38482034.

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43

Fernandes, Alan Lins. "Efeitos da suplementação de proteína de soja versus proteína do soro do leite em idosos com pré-fragilidade e fragilidade submetidos a um programa de treinamento de força." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/39/39132/tde-30012018-110203/.

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A fragilidade cursa com importante alterações biológicas, dentre as quais destacam-se uma considerável perda de massa, força e função muscular. O consumo de proteínas aliado ao treinamento de força, parece atuar como uma estratégia promissora para atenuar alguns danos morfofuncionais decorrentes do envelhecimento. Portanto, a presente tese tem como objetivo central investigar os efeitos de diferentes fontes de suplementação de proteínas (Soja versus whey) combinadas ao treinamento de força sobre a massa e força muscular em idosos com pré-fragilidade e fragilidade. Esta tese faz parte de um gra
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44

Stadnyk, Karen J. "Testing the measurement properties of the Short Form-36 Health Survey in a frail elderly patient population." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq24924.pdf.

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45

Fossum, Tracy-Lynn A. "Reasons for choosing community versus institutional long-term care for frail elderly people living with their spouses." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ52899.pdf.

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46

Chan, Lung-fai. "Mental health of Chinese spousal caregivers of frail elderly : the role of the traditional Chinese family values /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38165727.

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47

Hui, Yee-ki, and 許綺琪. "Gender differences in psychological wellbeing of spousal carers for frail elderly in Hong Kong: a secondary dataanalysis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B45167898.

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48

Silva, Vanessa Abreu da 1980. "Desfechos da síndrome da fragilidade : um estudo longitudinal com idosos em atendimento ambulatorial." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/283899.

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Orientador: Maria José D'Elboux<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem<br>Made available in DSpace on 2018-08-27T08:50:00Z (GMT). No. of bitstreams: 1 Silva_VanessaAbreuda_D.pdf: 2181192 bytes, checksum: f2b09456b1f7e48f3b035d252adb01da (MD5) Previous issue date: 2014<br>Resumo: Este estudo teve como objetivo analisar os desfechos e fatores associados à síndrome da fragilidade de idosos atendidos em serviço de geriatria de um hospital escola. Trata-se de um estudo quantitativo, comparativo e com delineamento longitudinal, integrante da pesquisa maior
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49

Gray, Roberta. "Constructions of frailty in a senior housing facility /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/8259.

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50

Vogler, Constance. "Reducing fall risk in older people discharged from hospital: a randomised controlled trial comparing (i) seated lower limb resistance training, (ii) functional weight-bearing exercises and (iii) social visits." Thesis, The University of Sydney, 2007. https://hdl.handle.net/2123/28062.

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Abstract:
Whilst exercise therapy has been found in trials to reduce fall rates in older people, not all exercise interventions have been found to be equally effective in preventing falls or reducing fall risk factors. Older people who have recently been discharged from hospital are at an increased risk of falling, but they are a population that has not been well studied in interventional trials. This study aimed to investigate the effects of different types of exercise therapy on fall risk factors in older people recently discharged from hospital, using a randomised controlled trial. It also a
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