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Articles 31 - 60 of 124
Full-Text Articles in Medicine and Health Sciences
Use Of Complete Decongestive Therapy And A Task-Oriented Approach In Treating Secondary Lymphedema And Improving Ambulation In A Patient Following A Stroke: A Case Report, Snezhana Rudakova
Use Of Complete Decongestive Therapy And A Task-Oriented Approach In Treating Secondary Lymphedema And Improving Ambulation In A Patient Following A Stroke: A Case Report, Snezhana Rudakova
Case Report Papers
Background and Purpose: Ninety percent of stroke survivors have some functional disability with mobility and paralysis of the extremities being a major impairment. A paralysis of the extremities can result in an ineffective muscle pumping action, which can lead to the development of lymphedema, further increasing difficulty with ambulation post stroke. The purpose of this case is to report the use of complete decongestive therapy for the treatment of lymphedema as part of a comprehensive treatment program consisting of a task-oriented approach to improve walking ability in a stroke survivor. Case Description: The patient was a 53 year old female …
The Role Of Physical Therapy In The Treatment And Discharge Of An Elderly Homeless Patient With Fractures Of The T12-L1 Vertebrae: A Case Report, Matthew Kraft
Case Report Papers
Background and Purpose: On any given day there are over 600,000 homeless persons in the United States. Many homeless people sustain injuries directly resultant of their living situations and are treated at local hospitals. Following medical stabilization, many times hospitals encounter difficulties with discharging homeless patients. This case report examines the role of Physical Therapy in one such case in the context of direct patient care and collaboration with the interdisciplinary team for safe patient discharge. Case Description: The patient was a 77 year old homeless male who sustained compression fractures to his T12 and L1 vertebrae after falling from …
Evaluation And Treatment Of A Patient Diagnosed With Adhesive Capsulitis Classified As A Derangement Using The Mckenzie Method: A Case Report, Ashley Bowser
Case Report Papers
Background/Purpose: The McKenzie Method of mechanical diagnosis and therapy (MDT) is supported in the literature as a valid and reliable approach to spine injuries. It can also be applied to the peripheral joints, but has not been explored through research to the same extent. This method sub-classifies an injury based on tissue response to mechanical loading and repeated motion testing with repeated motions identified during testing used to guide treatment. The purpose of this report is to demonstrate the assessment, intervention, and clinical outcomes of a patient classified as having a shoulder derangement using MDT methodology. Case Description: The patient …
Management Of A Patient Lumbar Spinal Stenosis And Carotid Aneurysm Using Therapeutic Exercise, Education, And Manual Therapy: A Case Report, Nicholas Adriance
Management Of A Patient Lumbar Spinal Stenosis And Carotid Aneurysm Using Therapeutic Exercise, Education, And Manual Therapy: A Case Report, Nicholas Adriance
Case Report Papers
Background and Purpose: Lumbar Spinal Stenosis (LSS) is a clinical syndrome involving a narrowing of the space for the neural and vascular structures to pass. The purpose of this case report describes physical therapy management of a patient with chronic low back due to lumbar spinal stenosis with associated lumbar radiculopathy, status post carotid aneurysm. Case Description: The Patient was a 60-year-old female with a 20-year history of intermittent back pain and works as a crossing guard. The patient had radiographic evidence of multi level lumbar disc disease with central stenosis and foraminal narrowing most pronounced at L4-L5 and disc …
Strength And Balance Exercises To Improve Functional Outcomes And Mobility For A Patient With Parkinson’S Disease And Co-Morbidities: A Case Report, Nicholas Lasarso
Strength And Balance Exercises To Improve Functional Outcomes And Mobility For A Patient With Parkinson’S Disease And Co-Morbidities: A Case Report, Nicholas Lasarso
Case Report Papers
Background and Purpose: Parkinson’s disease (PD) is a movement disorder that can lead to declines in function and falls. As a common age-related neurological diagnosis, PD is most often accompanied by other co-morbidities. The purpose of this case report is to document the physical therapy management of a patient presenting with PD and other co-morbidities. This case report looks at the outcomes of strength and balance exercises on the patient’s impairments, mobility and overall function. Case Description: The 69 year-old male patient presented with a history of PD, Lyme disease, osteoarthritis, peripheral neuropathy (PN) and exposure to Agent Orange. He …
Use Of Therapeutic Exercise, Functional Endurance, And Gait Re-Training In A Deconditioned Patient With Acute Respiratory Failure: A Case Report, Ellen Forslund
Use Of Therapeutic Exercise, Functional Endurance, And Gait Re-Training In A Deconditioned Patient With Acute Respiratory Failure: A Case Report, Ellen Forslund
Case Report Papers
Background and Purpose: The human body requires oxygen-rich blood to work efficiently. Respiratory failure occurs due to a lack of oxygen passing from the lungs into the bloodstream or if the lungs cannot remove carbon dioxide from the blood. The purpose of this case report was to describe the therapeutic exercise, functional endurance and gait training for an individual following acute respiratory failure (ARF) and (1) document the practicability of this therapeutic approach in an intensive inpatient rehabilitation setting, (2) record the outcomes that occurred for the patient, and (3) discuss the possibility for further research regarding a similar physical …
Using The Selective Functional Movement Assessment And Regional Interdependence Theory To Guide Treatment Of An Athlete With Back Pain: A Case Report, Gabriella Goshtigian
Using The Selective Functional Movement Assessment And Regional Interdependence Theory To Guide Treatment Of An Athlete With Back Pain: A Case Report, Gabriella Goshtigian
Case Report Papers
Background: Despite the multidirectional quality of human movement, common measurement procedures used in physical therapy examination are often uni-planar and lack the functional complexities involved in daily activities. Currently, there is no widely accepted, validated standard to assess movement quality. The Selective Functional Movement Assessment (SFMA) is one possible system to objectively assess complex functional movements. This case report illustrates the application of the SFMA in the management of a patient with non-specific low back pain (LBP). Case Description: An adolescent male athlete with non-specific LBP was evaluated using the SFMA. It was determined that the patient had mobility limitations …
Balance And Gait Training To Reduce Fall Risk In A Patient With Bilateral Foot And Hand Deformities Secondary To Rheumatoid Arthritis: A Case Report, Kirsten Bombardier
Balance And Gait Training To Reduce Fall Risk In A Patient With Bilateral Foot And Hand Deformities Secondary To Rheumatoid Arthritis: A Case Report, Kirsten Bombardier
Case Report Papers
Background and Purpose – Falls are the leading cause of death from injury in persons greater than 65 years of age. The risk of suffering a fall increases with age, but falls are not an unavoidable aspect of the aging process. By maximizing an individual’s balance, gait and strength, their risk for future falls can be decreased. The purpose of this case report is to provide an overview of the physical therapy (PT) plan of care for a patient at high risk for falls. Case Description - The patient was an 84 year old female who suffered a fall likely …
Neuromuscular Electrical Stimulation And Quadriceps Strength Following Patellar Fracture And Open Reduction Internal Fixation Surgery: A Case Report, Chelsea Hussey
Case Report Papers
Background and Purpose: Patellar fractures followed by open reduction internal fixation (ORIF) surgery can cause numerous impairments which can negatively impact a person’s ability to participate in normal daily activities. Quadriceps weakness is common following this type of injury and surgery, and the literature reflects varying opinions as to what is the best method for regaining strength. Previous studies have examined the use of neuromuscular electrical stimulation (NMES) in conjunction with traditional exercises on quadriceps strength following surgeries such as a total knee arthroplasty (TKA), but there is limited research involving patients status post (s/p) ORIF following a comminuted patellar …
Vestibular Rehabilitation And Cervical Postural Re-Education In A Young Athlete Who Presented With Post-Concussion Syndrome: A Case Report, Cristen Schmidt
Vestibular Rehabilitation And Cervical Postural Re-Education In A Young Athlete Who Presented With Post-Concussion Syndrome: A Case Report, Cristen Schmidt
Case Report Papers
Background and Purpose: Current literature on Post-Concussion Syndrome (PCS) rehabilitation is limited. Current literature is focused on individuals experiencing military blast traumatic brain injuries and the management of these injuries. Thus, the purpose of this case report is to describe and implement PT management and outcomes for the young athlete presenting with PCS following a concussion. Case Description: The patient was a 14 year old male who presented to the outpatient clinic with significant impairments secondary to diagnosis of PCS. Impairments that the patient presented with were activity intolerance, increased muscle tone, headaches, and dizziness. The patient underwent manual therapy …
Use Of Core Stabilization Exercise And Medical Exercise Therapy In The Treatment Of A Patient With Chronic Post Partum Low Back Pain: A Case Report, Zachary Chaloner
Use Of Core Stabilization Exercise And Medical Exercise Therapy In The Treatment Of A Patient With Chronic Post Partum Low Back Pain: A Case Report, Zachary Chaloner
Case Report Papers
Background and Purpose: Low back pain and lumbar hyper-mobility are common during and after pregnancy. Postpartum low back laxity can contribute to LBP and can become chronic if not addressed. Core stabilization exercises (CSE) have been shown to improve function and reduce pain in patients with nonspecific chronic low back pain due to lumbar instability. Additionally, Medical Exercise Therapy (MET) has shown good outcomes in reducing pain in patients with LBP but has not been thoroughly investigated in the treatment of chronic post partum LBP. There is limited research reporting the use of a combined treatment protocol utilizing CSE and …
Body Weight Supported Treadmill Training And Overground Gait Training In The In-Patient Setting For An Individual With Chronic Stroke: A Case Report, Stephanie Bordignon
Body Weight Supported Treadmill Training And Overground Gait Training In The In-Patient Setting For An Individual With Chronic Stroke: A Case Report, Stephanie Bordignon
Case Report Papers
Background and Purpose: The use of body weight supported treadmill training (BWSTT) and overground gait training (GT) has been shown to improve bilateral coordination and gait symmetry for patients experiencing chronic stroke. Evidence to support BWSTT rather than overground GT for use following chronic stroke is mixed and does not include representation for the young stroke population. The purpose of this case report is to describe the outcomes of gait speed, efficiency of gait, and fall risk in an individual following a chronic stroke managed with intense BWSTT and overground GT. Description: 43 year old male was managed with BWSTT …
Treatment Of A Patient With Thoracolumbar Scoliosis Utilizing A Regional Interdependence Approach Including Components Of The Schroth Method: A Case Report, Samantha Fisk
Case Report Papers
Background and Purpose: Spinal deformity is a challenging spinal disorder in adults. A scoliotic curve of >10 degrees exists in up to 12% of the population and while surgery is the definitive measure, there is limited evidence to guide non-surgical treatment. This case investigated traditional physical therapy (PT) treatment utilizing a Regional Interdependence Approach (RIA) and components of the Schroth method for a patient with chronic low back pain (CLBP). Case Description: A 66 year old male presented with CLBP, worst upon rising in the AM with (6/10 NPRS). Imaging demonstrated thoracolumbar dextroscoliosis, bilateral foraminal narrowing and associated spondylolisthesis of …
A Task Oriented Approach For A Patient With Chronic Effects Of Stroke: A Case Report, Sarah Richardson
A Task Oriented Approach For A Patient With Chronic Effects Of Stroke: A Case Report, Sarah Richardson
Case Report Papers
Background and Purpose: Stroke is the leading cause of serious long-term disability for American adults. Most stroke survivors receive physical therapy (PT), and task-oriented rehabilitation is one novel approach known to benefit stroke survivors. The purpose of this case report is to illustrate the outcomes of a task-oriented approach to PT interventions on a patient >12 months post stroke. The unique aims were to 1) outline possible benefits in function from repetitive task-oriented training techniques and 2) document outcomes of a patient who had received PT services >12 months post stroke. Case Description: The patient was an 82 year-old female …
The Effects Of Specific Training On Balance And Ambulation In A Patient With Stage Iv Glioblastoma: A Case Report, Matt Denning
The Effects Of Specific Training On Balance And Ambulation In A Patient With Stage Iv Glioblastoma: A Case Report, Matt Denning
Case Report Posters
Glioblastoma is a malignant brain tumor, often found in the cerebellum. From 2005-2009 there were 109,605 incidences of malignant brain tumors reported in the united states. Specific incidence rates for malignant brain tumors ranged from 5.8 to 11.70 per 100,000 adults 20 years or older. Stage IV is the most rapidly growing and invasive glioblastoma and most common adult neoplasm usually affecting people in the 5th or 6th decade of life. Treatment of glioblastoma frequently involves surgery to excise the tumor followed by radiation therapy. Similar to the growing malignancy these treatments often cause further progressive and even rapid neurological …
The Use Of Aquatic Therapy In Rehabilitation For A Patient Following Complicated Reverse Total Shoulder Arthroplasty: A Case Report, Alyssa Grigware
The Use Of Aquatic Therapy In Rehabilitation For A Patient Following Complicated Reverse Total Shoulder Arthroplasty: A Case Report, Alyssa Grigware
Case Report Posters
According to the Aquatic Physical Therapy Section of the American Physical Therapy Association, aquatic physical therapy is the evidence-based and skilled practice of physical therapy in an aquatic environment by a physical therapist, and includes interventions designed to improve or maintain: function, aerobic capacity/endurance conditioning, balance, coordination and agility, body mechanics and postural stabilization, flexibility, gait and locomotion, relaxation, muscle strength, power, and endurance. Reverse Total Shoulder Arthroplasty (rTSA) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff damage, among other complex circumstances. A typical protocol will progress from joint protection, …
Use Of The Lower Extremity Functional Scale (Lefs) In A Patient After A First Metatarsophalangeal Joint Implant: A Case Report, Courtney Brinckman
Use Of The Lower Extremity Functional Scale (Lefs) In A Patient After A First Metatarsophalangeal Joint Implant: A Case Report, Courtney Brinckman
Case Report Posters
First metatarsolphalangeal (MTP) total joint implants are uncommon; however, hemi implants have increased in popularity. The. HemiCAP® (Franklin, MA) implant resurfaces the metatarsal head while leaving the distal phalanx intact. While early results of the HemiCAP(®) implant surgery have been promising, physical therapy outcome measures such as the LEFS have not been extensively studied in this population. The Lower Extremity Functional Scale (LEFS) is a sensitive and reliable outcome measure that has commonly been used in patients with hip and knee dysfunction. While the LEFS has been used for a broad spectrum of lower-extremity pathologies, there is a paucity of …
Restoring Functional Mobility In A Patient With Delayed Onset Of Physical Rehabilitation Following A Hemorrhagic Stroke: A Case Report, Bettie Kruger, G. Noel Squires
Restoring Functional Mobility In A Patient With Delayed Onset Of Physical Rehabilitation Following A Hemorrhagic Stroke: A Case Report, Bettie Kruger, G. Noel Squires
Case Report Posters
Typical rehabilitation post-stroke is initiated as soon as the patient is medically stable. The most dramatic neurological recovery occurs within the first three to six months following medical stabilization. It has been suggested in the literature that early and frequent out of bed activity within the first 24 hours following stroke onset will enhance motor recovery. The patient in this case report was sedentary for three months following the onset of stroke and was non-ambulatory at the time of admission to sub-acute physical therapy. The purpose of this case report is to describe the rehabilitative course, motor recovery, and functional …
Functional Skill Training And Group Therapy Treatment Following A Total Hip Arthroplasty In The Acute Care Setting: A Case Report, Heidi Johnson
Functional Skill Training And Group Therapy Treatment Following A Total Hip Arthroplasty In The Acute Care Setting: A Case Report, Heidi Johnson
Case Report Posters
Osteoarthritis (OA) is a very common degenerative condition, often developed during middle and older ages, especially in those with more active lifestyles. Although OA can occur in any joint throughout the body, it most often develops in weight-bearing joints, such as the hip. In 2011 more than 28 million people in the United States were estimated to have OA. OA can lead to pain, stiffness, decreased range of motion, decreased strength, and in turn an overall decline in functional ability. Total hip arthroplasty (THA) is becoming more widely utilized as a means for gaining mobility and independence when a person’s …
The Clinical Decision Making And Outcomes Of A Patient With C7, C8 Radiculopathy And Contralateral Upper Quarter Lateral Epicondylitis: A Case Report, Courtney Naimi
Case Report Posters
Preliminary diagnosis and management strategies exist for both cervical radiculopathy (CR) and lateral epicondylis, however little literature exists describing the clinical decision making and management in the presence of both conditons simultaneously. Management of (CR) (right side) can include neural mobilizations, manual therapy, and exercises. Management of lateral epicondylis (left side) can include eccentric tendinopathy management and manual therapy. The purpose of this case report is to discuss the diagnosis and management for a patient presenting simultaneously with right C7, C8 cervical radiculopathy and contralateral lateral epicondylis.
Effect Of The Pep Program On Biomechanical Risk Factors In Male Collegiate Lacrosse Athletes, Sebastian Stoltzfus, Casey Cottle, Chad Lyons, Michael A. Lawrence
Effect Of The Pep Program On Biomechanical Risk Factors In Male Collegiate Lacrosse Athletes, Sebastian Stoltzfus, Casey Cottle, Chad Lyons, Michael A. Lawrence
PEP Program Investigation With Men's Lacrosse Team
Research poster stemming from IPEC mini-grant funded student project Effect of The Prevent Injury Enhance Performance Program on Biomechanical Risk Factors and Performance Variables in Male Collegiate Lacrosse Athletes. Background: Landing and cutting maneuvers are common mechanisms for noncontact anterior cruciate ligament (ACL) injury. Men’s lacrosse is a high risk sport for ACL injury. The Prevent Injury Enhance Performance (PEP) program has been shown to decrease injury rates in women’s soccer but has not been studied in men’s lacrosse. Purpose: Determine if collegiate men’s lacrosse athletes land and cut in ways that put them at risk of ACL tear …
The Use Of Lasers For Direct Pulp Capping, Takashi Komabayashi, Arata Ebihara, Akira Aoki
The Use Of Lasers For Direct Pulp Capping, Takashi Komabayashi, Arata Ebihara, Akira Aoki
Dental Medicine Faculty Publications
Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems …
Application Of A Balance Training Program In A Patient With Charcot Marie Tooth Disease: A Case Report, Eduardo Pena
Application Of A Balance Training Program In A Patient With Charcot Marie Tooth Disease: A Case Report, Eduardo Pena
Case Report Posters
Charcot Marie Tooth Disease (CMT) is the most common progressive inherited neurological disease. Proteins in the myelin sheath of both motor and sensory nerves become damaged, resulting in muscle atrophy and reduced sensation. Patients experience difficulty with gait, balance, and independence with ADLs. The RUSK Modified Romberg Program (MRP) is a balance program used for patients with neurological pathologies. There is minimal research on the effectiveness of the RUSK MRP in patients with CMT. The purpose of this case report was to determine the effectiveness of the RUSK MRP in order to improve balance and reduce risk of falls in …
A Task Oriented Approach For A Patient With Chronic Effects Of Stroke: A Case Report, Sarah Richardson, Amy J. Litterini
A Task Oriented Approach For A Patient With Chronic Effects Of Stroke: A Case Report, Sarah Richardson, Amy J. Litterini
Case Report Posters
Stroke is the leading cause of serious long-term disability for American adults. Most stroke survivors receive physical therapy (PT) and task-oriented rehabilitation is one novel approach. This technique, which shifts the focus from the impairment level to activity level, is known to benefit stroke survivors. However, the benefits for long-term survivors of stroke are not yet well established. PT professionals would benefit from learning about innovative interventions to improve functional mobility for long-term stroke survivors. The rationale for this report was to document the outcomes of a task-oriented approach to rehabilitation on the late effects of stroke. The unique aims …
The Role Of Physical Therapy In The Treatment And Discharge Of An Elderly Homeless Patient With Fractures Of The T12-L1 Vertebrae: A Case Report, Matthew Kraft
Case Report Posters
More than 600,000 are homeless in the USA. Homeless people have higher rates of premature mortality than the rest of the population, especially from unintentional injuries, and have an increased prevalence of mental disorders. Hospitals often encounter difficulty with discharge when homeless patients are medically stable enough to be transferred to a lower level of care. Hospitals risk potential legal action and poor portrayal by the media if a homeless patient claims he/she was discharged improperly.
Gait Training, Strength Training, And Pain Management Of A 26 Year Old Female Recovering From A Multiple Sclerosis Exacerbation: A Case Report, Ellen Cox
Case Report Posters
Multiple Sclerosis (MS) is an autoimmune disorder where it is thought that the body attacks the myelin sheath covering nerve fibers and disrupts communication in the central nervous system. Presentations are varied with symptoms ranging from loss of vision, poor balance and coordination, tremors, fatigue, pain, and problems with memory and concentration. MS is classified into four types in order of severity: relapsing- remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Evidence links stressful events to increased risk for exacerbations. Treatment of MS can be variable due to the multiple presentations and progressions of disease. Currently little information is available regarding the most …
Rehabilitation And Cancer Survivorship, Matthew Denning, Samantha Fisk, Alyssa Grigware, Mary Leopold, Erika Lopez, Margaret Masiak, Sebastian Stoltzfus, Ashley Tomaswick
Rehabilitation And Cancer Survivorship, Matthew Denning, Samantha Fisk, Alyssa Grigware, Mary Leopold, Erika Lopez, Margaret Masiak, Sebastian Stoltzfus, Ashley Tomaswick
Disease Prevention and Health Promotion Resources
Presentation given at Central Maine Medical Center on December 4, 2015, to build awareness of the role of rehabilitation services in cancer survivor management and discuss strategies to address existing needs. This presentation was based on a project undertaken to determine which physical distress screening tools are most appropriate to trigger a wellness or rehabilitation referral when it is warranted for a survivor. The use of effective screening tools will assist in directing cancer survivors, who experience physical and emotional burdens caused by the disease and subsequent treatment, to access services that will continue to improve their overall quality of …
A Review Of Screening Processes For Physical Distress And Appropriate Outcome Measures For Outpatient Rehabilitation Referral In Cancer Survivorship, Ashley Tomaswick, Sebastian Stoltzfus, Margaret Masiak, Erika Lopez, Mary Leopold, Alyssa Grigware, Samantha Fisk, Matthew Denning
A Review Of Screening Processes For Physical Distress And Appropriate Outcome Measures For Outpatient Rehabilitation Referral In Cancer Survivorship, Ashley Tomaswick, Sebastian Stoltzfus, Margaret Masiak, Erika Lopez, Mary Leopold, Alyssa Grigware, Samantha Fisk, Matthew Denning
Disease Prevention and Health Promotion Papers
The goal of this project is to determine which physical distress screening tools are most appropriate to trigger a wellness or rehabilitation referral when it is warranted for a survivor. The use of effective screening tools will assist in directing cancer survivors, who experience physical and emotional burdens caused by the disease and subsequent treatment, to access services that will continue to improve their overall quality of life upon completion of cancer treatment or in a setting of ongoing palliative care. These measures should focus on functional mobility, balance, fatigue, and distress. Additionally, there are many common tests used to …
Use Of Manual Therapy And Sport Specific Re-Training In An Adolescent Elite Sprinter With Bilateral Pedicle Stress Fractures: A Case Report, Erika Lopez
Case Report Posters
Bilateral pedicle stress fractures are extremely rare, with few cases reported in the literature. The pedicle is known to be the second weakest point of the vertebra, has a short moment arm from the vertebral body, and can resist a large amount of cyclic shear forces. The main causes of lumbar pedicle stress fractures are shear stress and twisting stressors, followed by sudden hyperflexion or hyperextension of the spine. There have been several reports describing pedicle stress fracture in adolescent athletes. However, in those reports the fracture was usually associated with contralateral spondylolysis, and isolated pedicle fractures are rarely found. …
Strength And Balance Exercises To Improve Functional Outcomes And Mobility For A Patient With Parkinson’S Disease And Co-Morbidities: A Case Report, Nicholas Lasarso
Strength And Balance Exercises To Improve Functional Outcomes And Mobility For A Patient With Parkinson’S Disease And Co-Morbidities: A Case Report, Nicholas Lasarso
Case Report Posters
Parkinson’s disease is the second most common age-related neurodegenerative disorder after Alzheimer’s disease. Cardinal features include rigidity, bradykinesia, tremor and postural instability. There is a lack of literature pertaining to the physical therapy management of patients with Parkinson’s Disease and other co-morbidities. The purpose of this case report was to illustrate the physical therapy management of a patient with Parkinson’s disease and other co-morbidities.