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Endocrinology, Diabetes, and Metabolism

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Full-Text Articles in Medicine and Health Sciences

Dietary Intake And Continuous Blood Glucose Measurement In Nurses Working Either 12-Hour Day Shifts Or Night Shifts, Rachel Carlson, Teresa Rangel, Lindsey Miller, Sushana Sudhi Mar 2024

Dietary Intake And Continuous Blood Glucose Measurement In Nurses Working Either 12-Hour Day Shifts Or Night Shifts, Rachel Carlson, Teresa Rangel, Lindsey Miller, Sushana Sudhi

Providence Nursing Research Conference 2023 – Present

Background:

Night shift work is essential in the hospital yet shift work among nurses is linked to negative outcomes such as chronic fatigue and cardiometabolic illnesses. Furthermore, nurses working night shift are more likely to have aberrant glucose levels, defined as greater than 140 mg/dl. Currently, it is unclear whether nurses working night shift eat differently than those working day shift which may explain aberrant glucose levels.

Purpose:

To determine whether night shift nurses have altered glucose levels and dietary intake compared to day shift nurses.

Methods/Approach:

Nurses regularly working full time 12-hour night shifts (n=12) or full time …


Clinical Practice Panel: Diabetes Mellitus Management In A Medical-Surgical Unit, Jane Tajonera Sep 2023

Clinical Practice Panel: Diabetes Mellitus Management In A Medical-Surgical Unit, Jane Tajonera

2023 South Division Nursing Research Conference

No abstract provided.


Identifying Systemic Errors In Refilling Insulin To Prevent Another Hospitalization: An Rca, John Butler, Mikayla Button, Jared Fincher, Rakin Solaiman, Michael Woodfin Apr 2023

Identifying Systemic Errors In Refilling Insulin To Prevent Another Hospitalization: An Rca, John Butler, Mikayla Button, Jared Fincher, Rakin Solaiman, Michael Woodfin

View All Graduate Medical Education Content

No abstract provided.


Improving Metabolic Monitoring During Transfers Of Care For Psychiatric Patients Discharged From The Inpatient Psychiatric Residency Service On An Antipsychotic Medication – Part 2, Allison Cohen, Anisha Boetel Apr 2023

Improving Metabolic Monitoring During Transfers Of Care For Psychiatric Patients Discharged From The Inpatient Psychiatric Residency Service On An Antipsychotic Medication – Part 2, Allison Cohen, Anisha Boetel

View All Graduate Medical Education Content

No abstract provided.


Factors Impacting Adherence To Antidiabetic Medications And Health Outcomes In Diabetes Mellitus Patients In Medicare Populations, Kelli Hoang, Kelly Simpson, Danny Wallenslager Jan 2023

Factors Impacting Adherence To Antidiabetic Medications And Health Outcomes In Diabetes Mellitus Patients In Medicare Populations, Kelli Hoang, Kelly Simpson, Danny Wallenslager

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2023

No abstract provided.


Analysis Of Egfr Vs Crcl To Monitor For Renal Dose Adjustments Within Central Refill, Briana Thompson, Angela Koerner Jan 2023

Analysis Of Egfr Vs Crcl To Monitor For Renal Dose Adjustments Within Central Refill, Briana Thompson, Angela Koerner

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2023

No abstract provided.


Severe To Very Severe Hypertriglyceridemia Management, Lauren Johnston, Rachel K. Bennings Jun 2022

Severe To Very Severe Hypertriglyceridemia Management, Lauren Johnston, Rachel K. Bennings

2022 Providence Nurse Research Conference

Background: HTG-induced acute pancreatitis (HTG-IAP) is the third most common cause of pancreatitis, accounting for approximately 14% of cases. Knowing best care practices and having protocols to care for this patient population is imperative. Nurses working on the frontline of care noticed an increase in patients with HTG-IAP being admitted to their critical care unit, thus looking for an answer to how to best care for them became crucial. Nurses sought to find an answer to what evidence-based care delivery to this patient population is available in peer-reviewed literature.

Purpose/aims: Investigators sought to answer the question, “In adults (>18 …


Immune Checkpoint Inhibitor Induced Type 1 Diabetes Mellitus: A Pembrolizumab Case Study, Michael R. Dirks Jr. May 2022

Immune Checkpoint Inhibitor Induced Type 1 Diabetes Mellitus: A Pembrolizumab Case Study, Michael R. Dirks Jr.

Milwaukie Family Medicine 2022

No abstract provided.


Pocus Evaluation In Acute Kidney Injury, Vanessa Hoytfox, Brittney Ward, Kang X Zhang Jan 2022

Pocus Evaluation In Acute Kidney Injury, Vanessa Hoytfox, Brittney Ward, Kang X Zhang

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium


Trust But Verify: Ethical Considerations Of Potential Misdiagnoses And Incorrect Patient Diagnoses, Eric Grisham Jan 2022

Trust But Verify: Ethical Considerations Of Potential Misdiagnoses And Incorrect Patient Diagnoses, Eric Grisham

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium


The Impact Of A Medicare Public Health Emergency Policy Change For Continuous Glucose Monitors On Utilization And Total Cost Of Care For Diabetes, Momoka Abe, Katie Norton, Jenifer Smith Jan 2022

The Impact Of A Medicare Public Health Emergency Policy Change For Continuous Glucose Monitors On Utilization And Total Cost Of Care For Diabetes, Momoka Abe, Katie Norton, Jenifer Smith

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

Home glucose monitoring was revolutionized in 1999 when the U.S. Food and Drug Administration (FDA) approved the first professional continuous glucose monitor (CGM). With the advancements in technology, newer CGMs are available for personal use and have greatly impacted the way diabetes is managed. Although there are data regarding the benefits of CGMs in lowering hemoglobin A1c, data is currently lacking regarding whether the use of CGM affects the number of hospitalization/emergency department visits as well as the effect on cost of care. In addition, while CGMs have been traditionally used in patients with type 1 diabetes due to their …


Esophageal Necrosis As An Unexpected Complication Of Diabetic Ketoacidosis, Hayden Smith, Tricia James May 2021

Esophageal Necrosis As An Unexpected Complication Of Diabetic Ketoacidosis, Hayden Smith, Tricia James

Providence Portland Medical Center Internal Medicine 2021

No abstract provided.


Cardio-Renal-Metabolic Care Models: Toward Achieving Effective Interdisciplinary Care., Janani Rangaswami, Katherine Tuttle, Muthiah Vaduganathan Nov 2020

Cardio-Renal-Metabolic Care Models: Toward Achieving Effective Interdisciplinary Care., Janani Rangaswami, Katherine Tuttle, Muthiah Vaduganathan

Articles, Abstracts, and Reports

No abstract provided.


Acute Hyperkalemia: A Novel Strategy To Prevent Insulin Induced Hypoglycemia, Brandon Wu, Eric Harvey Sep 2020

Acute Hyperkalemia: A Novel Strategy To Prevent Insulin Induced Hypoglycemia, Brandon Wu, Eric Harvey

View All

No abstract provided.


Gestational Diabetes Prevention, Shelly Johnson Sep 2020

Gestational Diabetes Prevention, Shelly Johnson

View All

No abstract provided.


Exploring The Effect Of Inpatient Diabetes Education On Readmission Rates, Cynthia Chun Sep 2020

Exploring The Effect Of Inpatient Diabetes Education On Readmission Rates, Cynthia Chun

View All

No abstract provided.


Supervised Exercise Intervention And Overall Activity In Ckd., Mindy M Pike, Aseel Alsouqi, Samuel A E Headley, Katherine Tuttle, Elizabeth Elspeth Evans, Charles M Milch, Kelsey Anne Moody, Michael Germain, Thomas G Stewart, Loren Lipworth, Jonathan Himmelfarb, T Alp Ikizler, Cassianne Robinson-Cohen Aug 2020

Supervised Exercise Intervention And Overall Activity In Ckd., Mindy M Pike, Aseel Alsouqi, Samuel A E Headley, Katherine Tuttle, Elizabeth Elspeth Evans, Charles M Milch, Kelsey Anne Moody, Michael Germain, Thomas G Stewart, Loren Lipworth, Jonathan Himmelfarb, T Alp Ikizler, Cassianne Robinson-Cohen

Articles, Abstracts, and Reports

Introduction: Patients are often instructed to engage in multiple weekly sessions of exercise to increase physical activity. We aimed to determine whether assignment to a supervised exercise regimen increases overall weekly activity in individuals with chronic kidney disease (CKD).

Methods: We performed a secondary analysis of a pilot randomized 2 × 2 factorial design trial examining the effects of diet and exercise (10%-15% reduction in caloric intake, 3 supervised exercise sessions/wk, combined diet restriction/exercise, and control). Activity was measured as counts detected by accelerometer. Counts data were collected on all days for which an accelerometer was worn at baseline, month …


Diabetes Education With A Teaching Kitchen Intervention Can Improve Hemoglobin A1c For Type 2 Diabetics Compared To Traditional Diabetes Education, Jill Christensen, Heidi Davis, Charlotte Navarre, Hsin-Fang Li, Kathy Schwab, Richard O'Neil, Justin Ferley Apr 2020

Diabetes Education With A Teaching Kitchen Intervention Can Improve Hemoglobin A1c For Type 2 Diabetics Compared To Traditional Diabetes Education, Jill Christensen, Heidi Davis, Charlotte Navarre, Hsin-Fang Li, Kathy Schwab, Richard O'Neil, Justin Ferley

Milwaukie Family Medicine 2020

Authors
Jill Christensen MD MPH Providence Milwaukie Hospital
Heidi Davis MSW Providence Milwaukie Hospital
Charlotte Navarre RN Providence Milwaukie Hospital
Hsin-Fang Li PHD Providence Medical Data Research Center
Kathy Schwab MPH RDN Providence Health Education
Richard O’Neil MBA Providence Planning Analyst

Title Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education

Purpose The Providence Milwaukie Community Teaching Kitchen offers health-focused, budget friendly cooking classes for patients. In 2019, we piloted diabetes education classes with an added hands-on culinary session. This study compares the change in hemoglobin A1c for patients …


Memote For Standardized Genome-Scale Metabolic Model Testing., Christian Lieven, Moritz E Beber, Brett G Olivier, Frank T Bergmann, Meric Ataman, Parizad Babaei, Jennifer A Bartell, Lars M Blank, Siddharth Chauhan, Kevin Correia, Christian Diener, Andreas Dräger, Birgitta E Ebert, Janaka N Edirisinghe, José P Faria, Adam M Feist, Georgios Fengos, Ronan M T Fleming, Beatriz García-Jiménez, Vassily Hatzimanikatis, Wout Van Helvoirt, Christopher S Henry, Henning Hermjakob, Markus J Herrgård, Ali Kaafarani, Hyun Uk Kim, Zachary King, Steffen Klamt, Edda Klipp, Jasper J Koehorst, Matthias König, Meiyappan Lakshmanan, Dong-Yup Lee, Sang Yup Lee, Sunjae Lee, Nathan E Lewis, Filipe Liu, Hongwu Ma, Daniel Machado, Radhakrishnan Mahadevan, Paulo Maia, Adil Mardinoglu, Gregory L Medlock, Jonathan M Monk, Jens Nielsen, Lars Keld Nielsen, Juan Nogales, Intawat Nookaew, Bernhard O Palsson, Jason A Papin, Kiran R Patil, Mark Poolman, Nathan D Price, Osbaldo Resendis-Antonio, Anne Richelle, Isabel Rocha, Benjamín J Sánchez, Peter J Schaap, Rahuman S Malik Sheriff, Saeed Shoaie, Nikolaus Sonnenschein, Bas Teusink, Paulo Vilaça, Jon Olav Vik, Judith A H Wodke, Joana C Xavier, Qianqian Yuan, Maksim Zakhartsev, Cheng Zhang Mar 2020

Memote For Standardized Genome-Scale Metabolic Model Testing., Christian Lieven, Moritz E Beber, Brett G Olivier, Frank T Bergmann, Meric Ataman, Parizad Babaei, Jennifer A Bartell, Lars M Blank, Siddharth Chauhan, Kevin Correia, Christian Diener, Andreas Dräger, Birgitta E Ebert, Janaka N Edirisinghe, José P Faria, Adam M Feist, Georgios Fengos, Ronan M T Fleming, Beatriz García-Jiménez, Vassily Hatzimanikatis, Wout Van Helvoirt, Christopher S Henry, Henning Hermjakob, Markus J Herrgård, Ali Kaafarani, Hyun Uk Kim, Zachary King, Steffen Klamt, Edda Klipp, Jasper J Koehorst, Matthias König, Meiyappan Lakshmanan, Dong-Yup Lee, Sang Yup Lee, Sunjae Lee, Nathan E Lewis, Filipe Liu, Hongwu Ma, Daniel Machado, Radhakrishnan Mahadevan, Paulo Maia, Adil Mardinoglu, Gregory L Medlock, Jonathan M Monk, Jens Nielsen, Lars Keld Nielsen, Juan Nogales, Intawat Nookaew, Bernhard O Palsson, Jason A Papin, Kiran R Patil, Mark Poolman, Nathan D Price, Osbaldo Resendis-Antonio, Anne Richelle, Isabel Rocha, Benjamín J Sánchez, Peter J Schaap, Rahuman S Malik Sheriff, Saeed Shoaie, Nikolaus Sonnenschein, Bas Teusink, Paulo Vilaça, Jon Olav Vik, Judith A H Wodke, Joana C Xavier, Qianqian Yuan, Maksim Zakhartsev, Cheng Zhang

Articles, Abstracts, and Reports

No abstract provided.


Epigenetic Reprogramming At Estrogen-Receptor Binding Sites Alters 3d Chromatin Landscape In Endocrine-Resistant Breast Cancer., Joanna Achinger-Kawecka, Fatima Valdes-Mora, Phuc-Loi Luu, Katherine A Giles, C Elizabeth Caldon, Wenjia Qu, Shalima Nair, Sebastian Soto, Warwick J Locke, Nicole S Yeo-Teh, Cathryn M Gould, Qian Du, Grady C Smith, Irene R Ramos, Kristine F Fernandez, Dave S B Hoon, Julia M W Gee, Clare Stirzaker, Susan J Clark Jan 2020

Epigenetic Reprogramming At Estrogen-Receptor Binding Sites Alters 3d Chromatin Landscape In Endocrine-Resistant Breast Cancer., Joanna Achinger-Kawecka, Fatima Valdes-Mora, Phuc-Loi Luu, Katherine A Giles, C Elizabeth Caldon, Wenjia Qu, Shalima Nair, Sebastian Soto, Warwick J Locke, Nicole S Yeo-Teh, Cathryn M Gould, Qian Du, Grady C Smith, Irene R Ramos, Kristine F Fernandez, Dave S B Hoon, Julia M W Gee, Clare Stirzaker, Susan J Clark

Articles, Abstracts, and Reports

Endocrine therapy resistance frequently develops in estrogen receptor positive (ER+) breast cancer, but the underlying molecular mechanisms are largely unknown. Here, we show that 3-dimensional (3D) chromatin interactions both within and between topologically associating domains (TADs) frequently change in ER+ endocrine-resistant breast cancer cells and that the differential interactions are enriched for resistance-associated genetic variants at CTCF-bound anchors. Ectopic chromatin interactions are preferentially enriched at active enhancers and promoters and ER binding sites, and are associated with altered expression of ER-regulated genes, consistent with dynamic remodelling of ER pathways accompanying the development of endocrine resistance. We observe that loss of …


Recent Advances In The Understanding And Management Of Primary Hyperparathyroidism., Melanie Goldfarb, Frederick R Singer Jan 2020

Recent Advances In The Understanding And Management Of Primary Hyperparathyroidism., Melanie Goldfarb, Frederick R Singer

Articles, Abstracts, and Reports

Primary hyperparathyroidism is a hormonal disorder whose prevalence is approximately 1-2% in the United States of America. The disease has become more recognizable to clinicians in an earlier phase and, at present, patients can be diagnosed with "classic", "normocalcemic", "normohormonal", or "mild, asymptomatic" primary hyperparathyroidism. Surgery, with a focused parathyroidectomy when possible, or a four-gland exploration, is the only way to cure the disease. Cure is determined by use of intra-operative parathyroid hormone monitoring with long-term cure rates ranging from 90-95%. Newer adjuncts to surgery include CT or PET imaging and near-infrared immunofluorescence. This article highlights updates in parathyroid disease …


Demonstration Of Reciprocal Diurnal Variation In Human Serum T3 And Rt3 Concentration Demonstrated By Mass Spectrometric Analysis And Establishment Of Thyroid Hormone Reference Intervals., Qian Sun, Lívia Avallone, Brian Stolze, Katherine A Araque, Yesim Özarda, Jacqueline Jonklaas, Toral Parikh, Kerry Welsh, Likhona Masika, Steven J Soldin Jan 2020

Demonstration Of Reciprocal Diurnal Variation In Human Serum T3 And Rt3 Concentration Demonstrated By Mass Spectrometric Analysis And Establishment Of Thyroid Hormone Reference Intervals., Qian Sun, Lívia Avallone, Brian Stolze, Katherine A Araque, Yesim Özarda, Jacqueline Jonklaas, Toral Parikh, Kerry Welsh, Likhona Masika, Steven J Soldin

Articles, Abstracts, and Reports

Background: There has been a wide range of reference intervals proposed in previous literature for thyroid hormones due to large between-assay variability of immunoassays, as well as lack of correction for collection time. We provided the diurnal reference intervals for five thyroid hormones, namely total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), and reverse T3 (rT3), measured in serum samples of healthy participants using a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method.

Methods: Couplet serum samples (a.m. and p.m.) were collected from 110 healthy females and 49 healthy males. Healthy volunteers were recruited from four participating centers …


Progressive Shifts In The Gut Microbiome Reflect Prediabetes And Diabetes Development In A Treatment-Naive Mexican Cohort., Christian Diener, María De Lourdes Reyes-Escogido, Lilia M Jimenez-Ceja, Mariana Matus, Claudia M Gomez-Navarro, Nathaniel D Chu, Vivian Zhong, M Elizabeth Tejero, Eric Alm, Osbaldo Resendis-Antonio, Rodolfo Guardado-Mendoza Jan 2020

Progressive Shifts In The Gut Microbiome Reflect Prediabetes And Diabetes Development In A Treatment-Naive Mexican Cohort., Christian Diener, María De Lourdes Reyes-Escogido, Lilia M Jimenez-Ceja, Mariana Matus, Claudia M Gomez-Navarro, Nathaniel D Chu, Vivian Zhong, M Elizabeth Tejero, Eric Alm, Osbaldo Resendis-Antonio, Rodolfo Guardado-Mendoza

Articles, Abstracts, and Reports

Type 2 diabetes (T2D) is a global epidemic that affects more than 8% of the world's population and is a leading cause of death in Mexico. Diet and lifestyle are known to contribute to the onset of T2D. However, the role of the gut microbiome in T2D progression remains uncertain. Associations between microbiome composition and diabetes are confounded by medication use, diet, and obesity. Here we present data on a treatment-naive cohort of 405 Mexican individuals across varying stages of T2D severity. Associations between gut bacteria and more than 200 clinical variables revealed a defined set of bacterial genera that …


Increase Postpartum Gestational Diabetes Screening, Kari Ayala, Angela Bonin, Rachael Baker, Susan Chin, Brian Drake, Joseph Kaempf, Christina Malango, Judy Marvin, Shelly Johnson Dec 2019

Increase Postpartum Gestational Diabetes Screening, Kari Ayala, Angela Bonin, Rachael Baker, Susan Chin, Brian Drake, Joseph Kaempf, Christina Malango, Judy Marvin, Shelly Johnson

Articles, Abstracts, and Reports

Introduction:

Diabetic women did not get follow up screening after delivery. Nurses are finding a way to screen more women.


Antepartum Screening Alignment, Shelly Johnson, Silvia Moreno-Aguilar, Joanna Sullivan, Dennis Tan Dec 2019

Antepartum Screening Alignment, Shelly Johnson, Silvia Moreno-Aguilar, Joanna Sullivan, Dennis Tan

Articles, Abstracts, and Reports

No abstract provided.


Diabetes Prevention, Shelly Johnson, Miles Hassell, Heidi Davis, Caroline Garrett, Joseph Kaempf Dec 2019

Diabetes Prevention, Shelly Johnson, Miles Hassell, Heidi Davis, Caroline Garrett, Joseph Kaempf

Articles, Abstracts, and Reports

Introduction:

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. If not treated properly, medicine is recommended = A2GDM. Both are preventable.


Long-Term Safety And Efficacy Of Subcutaneous Pasireotide In Patients With Cushing's Disease: Interim Results From A Long-Term Real-World Evidence Study., Luca Manetti, Timo Deutschbein, Jochen Schopohl, Kevin C J Yuen, Michael Roughton, Ulrike Kriemler-Krahn, Libuse Tauchmanova, Ricardo Maamari, Carla Giordano Oct 2019

Long-Term Safety And Efficacy Of Subcutaneous Pasireotide In Patients With Cushing's Disease: Interim Results From A Long-Term Real-World Evidence Study., Luca Manetti, Timo Deutschbein, Jochen Schopohl, Kevin C J Yuen, Michael Roughton, Ulrike Kriemler-Krahn, Libuse Tauchmanova, Ricardo Maamari, Carla Giordano

Articles, Abstracts, and Reports

PURPOSE: Clinical trials have demonstrated the favorable efficacy/safety profile of pasireotide in patients with Cushing's disease (CD). We report interim long-term results of an ongoing real-world evidence study of subcutaneous pasireotide in patients with CD.

METHODS: Adults with CD receiving pasireotide, initiated before (prior-use) or at study entry (new-use), were monitored for ≤ 3 years during a multicenter observational study ( http://clinicaltrials.gov identifier NCT02310269). Primary objective was to assess long-term safety of pasireotide alone or with other CD therapies.

RESULTS: At the time of this interim analysis, 127 patients had received pasireotide (new-use, n = 31; prior-use, n = 96). …


Extracellular Vesicle Encapsulated Micrornas In Patients With Type 2 Diabetes Are Affected By Metformin Treatment., Vikas Ghai, Taek-Kyun Kim, Alton Etheridge, Trine Nielsen, Torben Hansen, Oluf Pedersen, David Galas, Kai Wang May 2019

Extracellular Vesicle Encapsulated Micrornas In Patients With Type 2 Diabetes Are Affected By Metformin Treatment., Vikas Ghai, Taek-Kyun Kim, Alton Etheridge, Trine Nielsen, Torben Hansen, Oluf Pedersen, David Galas, Kai Wang

Articles, Abstracts, and Reports

Recently, microRNAs (miRNAs) in circulating extracellular vesicles (EVs), have emerged as a source of potential biomarkers for various pathophysiological conditions, including metabolic disorders such as diabetes. Type 2 diabetes mellitus (T2DM), is the most prevalent form of diabetes in the USA, with 30 million diagnosed patients. Identifying miRNA biomarkers that can be used to assess response to glucose lowering treatments would be useful. Using patient plasma samples from a subset of the Danish Metagenomics of the Human Intestinal Tract (MetaHIT) cohort, we characterized miRNAs from whole plasma, plasma-derived EVs, and EV-depleted plasma by small RNA-sequencing to identify T2DM associated miRNAs. …


Erratum. Sodium-Glucose Cotransporter 2 Inhibition And Diabetic Kidney Disease. Diabetes 2019;68:248-257., Radica Alicic, Joshua J Neumiller, Emily J Cox, Brad P Dieter, Katherine Tuttle May 2019

Erratum. Sodium-Glucose Cotransporter 2 Inhibition And Diabetic Kidney Disease. Diabetes 2019;68:248-257., Radica Alicic, Joshua J Neumiller, Emily J Cox, Brad P Dieter, Katherine Tuttle

Articles, Abstracts, and Reports

No abstract provided.


Sodium Glucose Co-Transporters Inhibition And Diabetic Kidney Disease, Radica Alicic Apr 2019

Sodium Glucose Co-Transporters Inhibition And Diabetic Kidney Disease, Radica Alicic

Books, Presentations, Posters, Etc.

No abstract provided.