Earticle

본 연구는 노인을 대상으로 인지기능에 관한 교육과 함께 주의, 기억, 실행기능, 기억책략 등을 다루는 인지과제 를 수행하는 인지훈련을 실시하여 훈련 이전의 인지기능 수준은 어떤 개인적 특성과 관련이 있는지, 주관적 인지감퇴는 실제적인 인지감퇴를 반영하는지, 인지훈련의 효과는 어떤 개인 특성과 관련이 있는지를 알아보기 위해 수행되었다. 연구 참가자는 건강한 노인 20명으로 14회기의 인지훈련을 주 1회, 회기당 2시간씩 진행하였으며 사전 및 사후로 검사 를 실시하였다. 연구 결과, 인지기능은 연령과 자아존중감, 성격 특질 중 외향성과 개방성이 관련이 있는 것으로 나타났 으며, 주관적인 인지감퇴는 객관적인 인지기능보다는 우울, 불안, 성격, 자기효능감, 자아존중감, 주관적 연령과의 상관 이 유의하였다. 또한 인지훈련을 통해 전반적인 인지기능을 측정하는 정신상태, 기억, 전두엽기능 검사 점수가 향상되었 으며 인지훈련의 효과는 연령, 주관적 인지감퇴, 불안, 자기효능감, 자아존중감, 주관적 연령, 성격과 관련이 있는 것으 로 나타났다. 이러한 결과는 어떤 특성의 노인이 인지노화에 취약한지 알려주며, 인지훈련의 효과를 높이기 위해 교육 참가자의 특성을 고려해야 한다는 것을 시사한다.

The present study investigated the related variables of cognitive function, subjective cognitive decline and cognitive training effects. The cognitive training was composed of mete-cognitive education and cognitive task performing. Twenty older adults attended for 14 weeks and were tested before and after the training. Results show that their cognitive level was related with age, self-esteem and personality traits. And subjective cognitive decline was related depression, anxiety, personality traits, self-efficacy, self-esteem and subjective age, but it does not reflect objective cognitive impairments. Their cognitive test scores were enhanced after training in MMSE, memory and executive function, and enhanced scores were related with age, subjective cognitive decline, anxiety, self-efficacy, self-esteem, subjective age and personality traits. Findings suggest one’s personality and psychological state need to be considered for the effects of cognitive training.

Objective : We investigated the efficacy of an artificial intelligence computerized cognitive training program using motion capture to identify changes in cognition, depression, and quality of life in older adults with mild cognitive impairment. Methods : A total of seven older adults (experimental group = 4, control group = 3) participated in this study. During the COVID-19 period from October to December 2021, we used a program, “MOOVE Brain”, that we had developed. The experimental group performed the program 30 minutes 3×/week for 1 month. We analyzed patients scores from the Korean version of the Mini-Mental State Examination-2, the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet for Daily Life Evaluation, the short form Geriatric Depression Scale, and Geriatric Quality of Life Scale. Results : We observed positive changes in the mean scores of the Stroop Color Test (attention), Stroop Color/Word Test (executive function), SGDS-K (depression), and GQOL (QoL). However, these changes did not reach statistical significance for each variable. Conclusion : The study results from "MOOVE Brain" can help address cognitive and psychosocial issues in isolated patients with MCI during the COVID-19 pandemic or those unable to access in-person medical services.

Purpose: The purpose of this study was to evaluate the impact of differences in computer-aided cognitive rehabilitation aimed at stroke patients on cognitive function and daily life. Methods: The study subjects were Gwangju, Jeonnam including the attention group (group I), memory group (group II), and visual perception group (group III), who were randomly placed in each of a 10 by one problem solving group (group IV). The PSSCogRehab was applied to all subjects who underwent eight weeks once a week after 20 minutes in each group by strengthening mediation 10 minutes 30 minutes total, with a five minute break in the middle. Results: Cognitive function and activities of daily living is security and inter-group differences before intervention, and post-test results in the memory training group II, the intervention group I, III, IV and more on cognitive function and activities of daily living compared to it was effective. Conclusion: The results of computer-aided cognitive rehabilitation measuring cognitive function and ADL in patients with stroke in accordance with the group I, III, and IV group cognitive function and activities of daily living compared to IV showed that it was more effective.

Purpose: This study was conducted to identify the effect of a multicomponent cognitive stimulation program (MCSP) on the improvement of older people's cognitive abilities. It also aimed to determine whether the effectiveness of the MCSP is related to age. Methods: A one-group pretest-posttest design was used. The program was conducted once a week for 10 weeks. The Korean-Montreal Cognitive Assessment (K-MoCA) was used to measure cognitive functions before and after the MCSP. Participants included 37 people aged over 65 years with normal cognitive functions and living in I city. A paired t-test was used to compare K-MoCA scores before and after the MCSP, and a two-way analysis of variance was performed to confirm whether there is an interaction between the MCSP and age. Results: It was found that the MCSP had a significant effect on improving cognitive functions (t = ?5.15, p < .001). Regarding the subdomains, visuospatial/executive ability, recall, naming, and language ability showed significant effects; however, abstractive ability?which was not a focus of the program?showed no significant effect. There were differences in visuospatial/executive functions, language skills, and memory between the 65-79 years age group and the aged over 80 group. Further, regarding the relationship between the MCSP and age, it was found that their interaction was significant only with regard to visuospatial/executive ability. Conclusion: The MCSP helps to improve the cognitive functions of the elderly; however, its effect differs between the young-old group and the old-old group. Therefore, age should be considered when developing MCSPs.

Objective: This study aimed to investigate the effects of a multicomponent exercise program on cognitive function, balance, and psychological factors in older adults with mild cognitive impairment (MCI). Design: Nonequivalent control group pretest-posttest design. Methods: Thirty-four older adults with MCI participated in this study. Participants were assigned to either the experimental (n=17) or control (n=17) groups using a convenience allocation method. The control group participated in a general program at a senior welfare center, whereas the experimental group participated in a general and multicomponent exercise program.All interventions were conducted thrice weekly for 60 min per session over 6 weeks. The effects were assessed before and after the intervention using the Mini-Mental State Examination-Korean version (MMSE-K), Berg Balance Scale (BBS), Timed Up and Go (TUG), EuroQol-5 Dimension (EQ-5D), and Geriatric Depression Scale-Korean version (GDS-K). Between-group differences before and after the intervention were analyzed using an independent t-test, and within-group differences were examined using a paired t-test. Results: Both groups showed significant improvements in MMSE-K, TUG, and EQ-5D scores after the intervention (p<0.05). In addition, the experimental group showed significant improvements in the MMSE-K, BBS, TUG, EQ-5D, and GDS-K scores compared to the control group (p<0.05). Conclusions: A multicomponent exercise program can effectively improve cognitive function, balance, and psychological factors in older adults with MCI.

Objective: This study was conducted to verify the effectiveness of a cognitive rehabilitation program consisting of physical exercises and mental activities for patients with chronic stroke with mild cognitive impairment (MCI). We aimed to investigate how this cognitive rehabilitation program affects patients' cognitive ability, depression, and sleep quality. Design: One group pretest-posttest design Methods: The study was conductedon 12 patients who participated in thecognitive rehabilitation complex exercise program for 16 weeks. The Korean version of the Montreal Cognitive Assessment (MoCA-K), Hamilton Depression Rating Scale (K-HDRS), and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the measured variables before and after study participation. The cognitive rehabilitation complex exercise program included 30 minutes of cognitive exercise and 30 minutes of Brill Exercise. The Wilcoxon signed-rank test was used to compare the variables before and after program participation. Cronbach's ɑ was used to assess the reliability of the test variables. Results: The post-program assessment showed a statistically significant increase in the MoCA-K score, which measures cognitive function (Z=-2.628, P=0.009). For depression ratings, there was a statistically significant decrease in the K-HDRS score (Z=-2.041, P=0.041). For sleep quality, although there was a numerical increase in the PSQI score, the difference was not statistically significant (Z=-0.702, P=0.483). The reliability test confirmed that all the individual test variables exhibited high reliability (cognitive function, 0.859; depression, 0.872; sleep, 0.822). Conclusions: We found that cognitive rehabilitation program used in this study had a positive effect on the cognitive function and depression in patients with chronic stroke with MCI.

PURPOSE: The purpose of this study was to examine the effects of dual-task training with cognitive tasks on cognitive functions and β-amyloid levels in the elderly with mild dementia. METHODS: The subjects were 36 elderly inpatients diagnosed with mild dementia at S Hospital located in Gyeongsangbuk-do, South Korea. The patients were randomly divided into a dual-task training group (DTG; n = 18) or a single-task training group (STG; n = 18). DTG performed dual-task training with cognitive tasks while STG performed only exercise tasks. These groups performed their respective exercises during a 30-minute session occurring three times a week over an 8-week period. MMSE-K and GDS were used to measure the subjects' cognitive function. To assess the subjects' dementia-related factors, their β-amyloid levels were measured by blood analysis. RESULTS: The results of the experiment were as follows: DTG showed statistically significant differences between their MMSE-K scores and β-amyloid levels before and after training (p < .05), whereas they exhibited no statistically significant differences in their GDS scores. MMSE-K scores and β-amyloid levels were significantly different between DTG and STG after training. CONCLUSION: The present study's overall results indicate that dual-task training with cognitive tasks is more effective than single-task training in improving cognitive functions and β-amyloid levels in the elderly with mild dementia. In other words, regular dual-task training can be considered as effective in improving cognitive function and dementia-related factors in the elderly with mild dementia and thus may be suggested as an effective exercise method for the treatment and early prevention of dementia.

The purpose of this study was to find out the effects of electroencephalograph (EEG) power and coherence on cognitive function in normal elderly, non-demented elderly with mild cognitive impairment, and demented elderly during working cognition tasks. Forty elderly women (19 demented elderly, 10 non-demented elderly with mild cognitive impairment, 11 norma1 elderly) participated in this study, All subjects performed working cognition tasks with Raven's CPM while EEG signal was recorded, EEGs were measured continuously at rest and during the working cognition task. EEG power and coherence was computed over 21 channels: right and left frontal, central, parietal, temporal and occipital region. We found that there were more correct answers among normal elderly women than in other groups Owing the working cognition task, ${\Theta}$ wave at Fp1, Fp2 and F8, a wave at Fp2, ${\beta}$ wave at Fp1, Fp2. F4 and F8 of the frontal region was increased significantly in the demented elderly group. On the other hand. ${\Theta}$ wave at Fp1, Fp2 and F7, ${\beta}$ wave at Fp1, Fp2, F3 and F7 of the frontal region was increased significantly in the group of non-demented elderly with mild cognitive impairment. In contrast. in the normal elderly group, all of the ${\Theta}$ wave and ${\beta}$ wave at Fp1, Fp2, F3, F4, F7 and F8 of the frontal region (except ${\beta}$ wave at F3) was increased significantly, These results suggest that the nerves in prefrontal and right hemisphere regions were most active in the demented elderly group during problem solving, and the nerves in the prefrontal and left hemisphere lobe were most active in the group of non-demented elderly with mild cognitive impairment. In contrast, me majority of nerves in the frontal region were active in the normal elderly group.

The aim of this pilot study was to investigate the effects of computerized cognitive rehabilitation on patients after they had each experienced an acute stroke and evaluate the association between rehabilitation satisfaction and age. Eighteen patients who had each experienced an acute stroke participated in the study. They were assigned to two groups: the experimental group (n = 12) and control group (n = 6). Interventions were performed with each group for 30 minutes per day, five times per week, for four weeks. The experimental group engaged in computerized cognitive rehabilitation, and the control group participated in traditional cognitive rehabilitation. In addition, both groups engaged in traditional cognitive rehabilitation for four weeks according to an established schedule. The Lowenstein Occupational Therapy Cognitive Assessment test (LOTCA) was performed to measure cognitive function. The Visual Analog Satisfaction Scale (VASS) was used to measure satisfaction with cognitive rehabilitation?specifically, overall satisfaction, therapeutic effects, interest, and intention to reuse. After the interventions, total cognitive function scores for both groups were significantly improved compared to scores before the interventions. However, the experimental group showed significant improvement in more sub-items of cognitive function compared to the control group. There was no significant difference in satisfaction between the two groups after the interventions. In the experimental group, overall satisfaction and interest in computerized cognitive rehabilitation were significantly lower among elderly participants when compared to middle-aged participants. Computerized cognitive rehabilitation may have a positive effect on cognitive function improvement. However, computerized cognitive rehabilitation programs must be developed to meet the specific characteristics and needs of elderly stroke patients.

Owing to the need to establish a cooperative-intelligent transport system (C-ITS) environment in the transportation sector locally and abroad, various research and development efforts such as high-tech road infrastructure, connection technology between road components, and traffic information systems are currently underway. However, the current central control center-oriented information collection and provision service structure and the insufficient road infrastructure limit the realization of the C-ITS, which requires a diversity of traffic information, real-time data, advanced traffic safety management, and transportation convenience services. In this study, a network construction method based on the existing received signal strength indicator (RSSI) selected as a comparison target, and the experimental target and the proposed intelligent edge network compared and analyzed. The result of the analysis showed that the data transmission rate in the intelligent edge network was 97.48%, the data transmission time was 215 ms, and the recovery time of network failure was 49,983 ms.

Purpose The aim of this study was to explore perceived cognitive function and its related factors in breast cancer patients that had received or were receiving adjuvant chemotherapy after surgery. Methods A cross-sectional and correlational design was used in this study. A total of 118 women who had undergone or were undergoing adjuvant chemotherapy after breast cancer surgery recruited from a convenience sample from a university hospital in Korea were included in the study. The attentional function index was used to measure perceived cognitive function while the linear analogue self-assessment scale was used to measure mood disturbance. Hierarchical multiple regression analyses were done to determine possible predictors of perceived cognitive function in patients with breast cancer. Results Perceived cognitive function and mood disturbance had a mean score of 66.22 (SD= 13.43) and 159.78 (SD= 81.40), respectively. Mood disturbance was a statistically significant predictor of cognitive function in patients with breast cancer. Conclusions Breast cancer patients with mood disturbance may experience decrements in perceived cognitive function. Nurses should be aware of mood changes and its influence on perceived cognitive function in breast cancer patients.

Previous studies have reported that decreased cognitive ability has been consistently associated with significant declines in performance of one or both tasks under a dual-task walking condition. This study examined the relationship between specific cognitive abilities and the dual-task costs (DTCs) of spatio-temporal gait parameters in stroke patients. The spatio-temporal gait parameters were measured among 30 stroke patients while walking with and without a cognitive task (Stroop Word-Color Task) at the study participant's preferred walking speed. Cognitive abilities were measured using Computerized Neuropsychological Testing. Pearson's correlation coefficients (r) were calculated to quantify the associations between the neuropsychological measures and the DTCs in the spatio-temporal gait parameters. Moderate to strong correlations were found between the Auditory Continuous Performance test (ACPT) and the DTCs of the Single Support Time of Non-paretic (r=.37), the Trail Making A (TMA) test and the DTCs of Velocity (r=.71), TMA test and the DTCs of the Step Length of Paretic (r=.37), TMA test and the DTCs of the Step Length Non-paretic (r=.36), the Trail Making B (TMB) test and the DTCs of Velocity (r=.70), the Stroop Word-Color test and the DTCs of Velocity (r=-.40), Visual-span Backward (V-span B) test and the DTCs of Velocity (r=-.41), V-span B test and the DTCs of the Double Support Time of Non-paretic (r=.38), Digit-span Forward test and the DTCs of the Step Time of Non-paretic (r=-.39), and Digit-span Backward test and the DTCs of the Single Support Time of Paretic (r=.36). Especially TMA test and TMB test were found to be more strongly correlated to the DTCs of gait velocity than the other correlations. Understanding these cognitive features will provide guidance for identifying dual- task walking ability.

The Purpose of this study was to investigate correlations between the Mini-Mental State Examination (MMSE) and the Functional Independence Measure (FIM) in strokes. The data collected retrospectively from fifty-five stroke rehabilitation patients. The MMSE and FIM at the time of admission and discharge were obtained from patients' medical records. Firstly, Pearson correlation coefficients of the MMSE score at the time of admission revealed $0.286{\sim}0.747$ with FIM at the time of discharge (p<0.05). Also, the change of MMSE score significantly correlated with the change of total FIM scores in strokes (r=0.409, p<0.05). Because the MMSE scores at the time of admission and FIM at the time of discharge are correlated, the MMSE scores can be used to predict the FIM at the time of discharge and establish a rehabilitation program.

Purpose: This study examined the effects of cognitive function, health literacy, and social support influence the risk of self-care non-adherence among older adults with chronic kidney disease. Methods: A cross-sectional survey was conducted using structured questionnaires. The study included 105 older adults (≥65 years) in the pre-dialysis stage, all of whom were receiving regular follow-up at a nephrology outpatient clinic in Jeonju, Jeollabuk-do, Korea. Data were collected through one-on-one interviews from April to May 2024 and analyzed using SPSS version 26.0. Predictive factors were assessed using hierarchical multiple regression analysis. Results: The risk of self-care non-adherence was significantly correlated with cognitive impairment (r=.61, p<.001), lower social support from healthcare providers (r= ?.36, p<.001), and reduced healthliteracy (r=?.42, p<.001). Multiple regression analysis indicated that decreased physical activity (β=.25, p=.002), greater cognitive impairment (β=.29, p<.001), and lower support from healthcare providers (β=?.26, p=.008) were significant predictors of increased risk of self-care non-adherence. The model explained 46% of the variance in the risk of self-care non-adherence. In contrast, family support and health literacy were not significant predictors. Conclusion: To reduce the risk of self-care non-adherence in older adults with chronic kidney disease, routine cognitive screening and tailored education for those with cognitive impairment should be implemented in outpatient care. Promoting physical activity and strengthening support from healthcare providers are also key strategies to improve adherence in this population.

Purpose: This study aimed to identify factors influencing the health-related quality of life of elderly men in partial medically underserved rural areas. Methods: The subjects included 182 elderly men aged 65 or older living in the jurisdictions of the Health Care Centers in G, I, and J Myeon, which were medically underserved rural areas in Gongju City, South Korea. Data were collected on October 31 to November 1, 2020, and were analyzed with descriptive statistics, t-test, ANOVA, Scheffe test, Pearson’s correlation coefficient, and hierarchical linear regression. Results: The subjects’ scored mean 24.20±3.29 points out of 30 in cognitive functions and mean 17.08±9.40 out of 60 in social support. The influential factors included three chronic diseases (β=-.50, p<.001), two chronic diseases (β=-.30, p<.001), one chronic disease (β=-.21, p<.001); fair subjective health status (β=.24, p<.001); good subjective health status (β=.25, p<.001); cognitive functions (β=.17, p=.004); aged 80 or older (β=-.16, p=.006); and brushing teeth three times per day or more (β=.14, p=.009) with an explanatory power of 53.8%. Conclusion: It is necessary to develop chronic disease management and cognitive function enhancement programs to identify factors influencing the health-related quality of life of elderly men in partial medically underserved rural areas and thus improve their health-related quality of life.

Purpose: This study was to identify changes in cognitive function and fatigue following chemotherapy in patients with stomach or colorectal cancer. Methods: Of the participants, 67 underwent adjuvant chemotherapy, while 66 healthy participants made up the comparison group. Three assessment tools were used: 1) the Korean Mini-Mental State Examination; 2) Everyday Cognition; 3) Functional Assessment of Chronic Illness Therapy-Fatigue. The questionnaires were administered in three stages, before chemotherapy, towards the end of chemotherapy, and 6 months after the final chemotherapy session. Data were analyzed using descriptive statistics and repeated measures analysis of variance (RM ANOVA). Results: At the post-chemotherapy stage, 38.8% of the patients who underwent adjuvant chemotherapy complained of subjective cognitive impairment and reported greater difficulty in the cognitive domains of attention and concentration, memory, and executive function. RM ANOVA revealed a significant decline in cognitive function after chemotherapy. However, improvement was observed six months after the completion of chemotherapy (F=42.68, p< .001). Cancer-related fatigue also showed similar patterns as observed in the case of cognitive function (F=44.76, p< .001). Conclusion: Chemotherapy was associated with increased cognitive decline and fatigue in cancer patients with cancer. Nursing intervention programs need to be developed to counteract cognitive decline and fatigue in patients undergoing chemotherapy.

Purpose: This study aimed to identify factors affecting cognitive function in stomach cancer patients. Methods: This was a cross-sectional study designed to obtain data from stomach cancer patients. The Global Assessment of Recent Stress, Hospital Anxiety-Depression Scale, Distress Thermometer, Korean version of the Montreal Cognitive Assessment, and electronic medical records were used to assess stress, anxiety, depression, psychological distress, and cognitive function, respectively. Results: Among 182 total participants, there were statistically significant differences in sex between the group of patients who received chemotherapy and those who did not (χ2=5.32, p=.029). There were statistically significant differences in stress and cognitive function between the two groups. The factors affecting cognitive function in stomach cancer patients included distress, stress, anxiety, and depression. Conclusion: Cognitive function should be examined with consideration of the psychological distress, stress, anxiety, and depression in patients with stomach cancer. Moreover, an improved program to manage cognitive function is needed, which includes mediation between psychological and physiological factors including stress, anxiety, and cognitive level.

Objective To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke.Methods A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase.Results Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002?1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002?1.016; p=0.017).Conclusion Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.

This study examined whether subjective age (SA) protects against the adverse effects of low social activity on cognitive func tion in older people. Data from the National Survey of Older Koreans collected during the COVID-19 pandemic were ana lyzed to test this hypothesis. Among the 10,097 older adults aged 65 and older, 9,878 who met the inclusion criteria were se lected. Participants were classified into “older SA” (n=6,437) and “youthful SA” (n=3,441). The results demonstrated that low social activities decreased cognitive function (B= .55, t= 6.20, p< .001), and this effect was more pronounced in the older SA group (B=.82, t=11.55, p<.001), suggesting that the older SA group is more vulnerable to limited social activities. During the COVID-19 pandemic, the reduced social activity of older adults negatively affected their cognitive function. However, these results suggest that maintaining a youthful mind can protect older adults against the adverse effects of limited social ac tivity on cognitive function.

Purpose: The purpose of this study is to examine the cognitive function in the elderly and to identify the influencing factors. Methods: The design of this study was descriptive research design. A total of 139 elderly people (aged 65 years and over) visiting the electroencephalogram (EEG) center in Seoul, Korea were evaluated. Data were assessed by self-administered questionnaires and CNS Vital Signs (CNSVS). Data were analyzed using SPSS Statistics 23.0 for Windows. Results: There were significant differences in the Korean Mini-Mental State Examination (K-MMSE), executive functions and reasoning according to education level. K-MMSE, visual memory and executive functions were different depending on the jobs. Age was highly correlated with cognitive function. In addition, stepwise multiple regression analyses showed that the factor significantly associated with reaction time and visual memory was depression. Depression and Trait-Anxiety had significant impacts on executive functions and K-MMSE. Conclusion: CNSVS enabled the accurate and objective measurement of cognitive function. Therefore, this study provides useful data to improve cognitive function of the community-dwelling elderly. The results suggested that there is need for comprehensive interventional programs that manage cognitive impairment.