Medicine and Health Sciences Commons^™

Fluoride Varnish May Improve White Spot Lesions, Gary L. Stafford

School of Dentistry Faculty Research and Publications

Design

A randomised, parallel-group, controlled clinical trial.

Intervention

The test group had fluoride varnish applied onto the tooth surfaces with WSLs using a miniature cotton swab or brush and advised not to brush for four hours. The control group had saline solution applied.

Outcome measure

Status of the WSLs were assessed using a DIAGNOdent pen (KaVo, Biberach, Germany).

Results

Of the 110 participants recruited, 14 dropped out between the debonding and the six-month recall visit. There were statistically significant differences between the mean DIAGNOdent readings of the two groups at the three-month (P

Conclusions

A greater decrease in DIAGNOdent pen …

The Effect Of Acceptance Training On Psychological And Physical Health Outcomes In Elders With Chronic Conditions, Patricia Mcdonald, Jaclene Zauszniewski, Abir K. Bekhet, Laura Dehelian, Diana L. Morris

College of Nursing Faculty Research and Publications

This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of …

Prehabilitation Before Total Knee Arthroplasty Increases Strength And Function In Older Adults With Severe Osteoarthritis, Ann M. Swank, Joseph B. Kachelman, Wendy Bibeau, Peter M. Quesada, John Nyland, Arthur Malkani, Robert V. Topp

College of Nursing Faculty Research and Publications

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least …

Perceptions Of Professional Practice And Work Environment Of New Graduates In A Nurse Residency Program, Marilyn Meyer Bratt, Holly M. Felzer

College of Nursing Faculty Research and Publications

New nurses continue to face challenging work environments and high expectations for professional competence as they enter practice. Nurse residency programs are gaining prominence as a mechanism to ease new graduates’ transition to practice. This study examined new graduates’ perceptions of their professional practice competence and work environment throughout a yearlong nurse residency program. Employing a repeated measures design, data were collected at baseline, at 6 months, and at 12 months. Results showed that job satisfaction was significantly lowest at 6 months and highest at 12 months. Job stress was found to be lowest at 12 months and organizational commitment …

A Comparison Of Adult- And Peer-Mediated Intervention For Autism: A Case Study, Maura Jones Moyle

Speech Pathology and Audiology Faculty Research and Publications

This study examined the response of a young child with autism to two play-based intervention conditions: adult-mediated and peer-mediated. The client was five years old, demonstrated moderate-to-severe autism, and exhibited developmental functioning between the 14 to 34 month level. The peer-mediated condition, based on a modified Integrated Play Group approach, utilized a typically developing peer who was three years of age. The study utilized an ABAB alternating treatment design to compare the impact of the adult- and peer-mediated interventions. Results from the current study suggest that the adult-mediated intervention resulted in increased engagement and more sophisticated social-communicative behaviors than the …

Folic Acid Supplementation Improves Vascular Function In Professional Dancers With Endothelial Dysfunction, Anne Z. Hoch, Paula Papanek, Aniko Szabo, Michael E. Widlansky, David D. Gutterman

Exercise Science Faculty Research and Publications

Objective

To determine if folic acid supplementation improves vascular function (brachial artery flow-mediated dilation [FMD]) in professional dancers with known endothelial dysfunction.

Design

Prospective cross-sectional study.

Setting

Academic institution in the Midwestern United States.

Subjects

Twenty-two professional ballet dancers volunteered for this study.

Main Outcome Measures

Subjects completed a 3-day food record to determine caloric and micronutrient intake. Menstrual status was determined by interview and questionnaire. Endothelial function was determined as flow-induced vasodilation measured by high-frequency ultrasound of the brachial artery. A change in brachial diameter of

Results

Sixty-four percent of dancers (n = 14) had abnormal brachial artery FMD …

Challenge With Care: Reflections On Teaching Excellence, Stacee M. Lerret, Marilyn Frenn

College of Nursing Faculty Research and Publications

A number of faculty have had no formal preparation to teach. Because little nursing research has focused on teaching excellence in recent years, when both nursing practice and approaches to teaching and learning have changed remarkably, this analysis integrates present perspectives and the research foundation for teaching nursing. A constant comparative method incorporating 27 doctoral student reflections and analysis of literature from 1960 to present resulted in four major categories: know and honor students, enthused, knowledgeable, and student centered. Linking the major categories, an Excellent Teacher Circle of Distinction emerged, described as “with enthusiasm and compassion the teacher engages the …

Improving Communication Between Doctors And Parents After Newborn Screening, Michael Farrell, Stephanie Christopher, Audrey Tluczek, Karen Kennedy-Parker, Alison La Pean, Kerry Eskra, Jenelle Collins, Gary Hoffman, Julie Panepinto, Philip M. Farrell

College of Professional Studies Faculty Research and Publications

Background: Newborn screening (NBS) enables early treatment, and some consider it a natural vehicle for genetic screening. Bioethicists argue for caution since families of infants with carrier status can develop psychosocial complications. This paper describes the methods and feasibility of Wisconsin’s statewide project for quality improvement of communication and psychosocial outcomes after NBS.

Methods: When NBS identifies carrier status for cystic fibrosis or sickle cell, we contact primary care providers (PCPs), answer questions, and invite them to rehearse informing the parents. Three months later, we telephone the parents, assess knowledge and psychosocial outcomes, provide counseling, and assist with self-referral to …

Peak Triceps Surae Muscle Activity Is Not Specific To Knee Flexion Angles During Mvic, Kim Hébert-Losier, Anthony G. Schneiders, José A. García, S John Sullivan, Guy G. Simoneau

Physical Therapy Faculty Research and Publications

There is limited research on peak activity of the separate triceps surae muscles in select knee flexion (KF) positions during a maximum voluntary isometric contraction (MVIC) used to normalize EMG signals. The aim of this study was to determine how frequent peak activity occurred during an MVIC for soleus (SOL), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in select KF positions, and if these peaks were recorded in similar KF positions. Forty-eight healthy individuals performed unilateral plantar-flexion MVIC in standing with 0°KF and 45°KF, and in sitting with 90°KF. Surface EMG of SOL, GM, and GL were collected and processed …

Biomechanical Effects Of Mobile Computer Location In A Vehicle Cab, Kyle Saginus, Richard W. Marklin, Patricia Seeley, Guy G. Simoneau, Stephen H. Freier

Physical Therapy Faculty Research and Publications

Objective: The objective of this research is to determine the best location to place a conventional mobile computer supported by a commercially available mount in a light truck cab.

Background: U.S. and Canadian electric utility companies are in the process of integrating mobile computers into their fleet vehicle cabs. There are no publications on the effect of mobile computer location in a vehicle cab on biomechanical loading, performance, and subjective assessment.

Method: The authors tested four locations of mobile computers in a light truck cab in a laboratory study to determine how location affected muscle activity of the lower back …

What Can Parents Do To Reduce Youth Obesity? An Initial Study With A Diverse Sample, Marilyn Frenn, Amy Heinrich, Claire Schmidt Dohmen, Jessica E. Pruszynski

College of Nursing Faculty Research and Publications

The body mass index (BMI) of diverse, low-income fifth grade students (n = 36) was regressed on physical activity (Child Adolescent Activity Log), percentage dietary fat (Food Habits Questionnaire), and the Food/Activity Parenting Practices Questionnaire. The model explained 50% of the variance in student BMI, adjusted R² = .50, F (4, 19) = 6.84, p = .001. Students accurately perceived their weight status. Students' perception of parenting strategies, along with dietary fat, was significantly associated with their BMI. Parent's (n = 14) BMI, not the child's, was associated with the strategies they used. Three parents tested an …

Women’S Perceptions Of Caesarean Birth: A Roy International Study, Jacqueline Fawcett, Cynthia Aber, Susan Haussler, Marianne Weiss, Sheila Taylor Myers, Jaye L. Hall, V. Lynn Waters, Charlette King, Marja-Terttu Tarkka, Anja Rantanen, Paivi Astedt-Kurki, Jennifer Newton, Virginia Silva

College of Nursing Faculty Research and Publications

The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women’s perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the …

Glutamatergic Plasticity In Medial Prefrontal Cortex And Ventral Tegmental Area Following Extended-Access Cocaine Self-Administration, Behnam Ghasemzadeh, Preethi Vasudevan, Chad Giles, Anthony Purgianto, Chad Seubert, John R. Mantsch

Biomedical Sciences Faculty Research and Publications

Glutamate signaling in prefrontal cortex and ventral tegmental area plays an important role in the molecular and behavioral plasticity associated with addiction to drugs of abuse. The current study investigated the expression and postsynaptic density redistribution of glutamate receptors and synaptic scaffolding proteins in dorsomedial and ventromedial prefrontal cortex and ventral tegmental area after cocaine self-administration. After 14 days of extended-access (6 h/day) cocaine self-administration, rats were exposed to one of three withdrawal regimen for 10 days. Animals either stayed in home cages (Home), returned to self-administration boxes with the levers withdrawn (Box), or underwent extinction training (Extinction). Extinction training …

A Single Phenylalanine Residue In The Main Intracellular Loop Of Α1 Γ-Aminobutyric Acid Type A And Glycine Receptors Influences Their Sensitivity To Propofol, Gustavo Moraga-Cid, Gonzalo E. Yevenes, Günther Schmalzing, Robert W. Peoples, Luis G. Aguayo

Biomedical Sciences Faculty Research and Publications

Background: The intravenous anesthetic propofol acts as a positive allosteric modulator of glycine (GlyRs) and γ-aminobutyric acid type A (GABA_ARs) receptors. Although the role of transmembrane residues is recognized, little is known about the involvement of other regions in the modulatory effects of propofol. Therefore, the influence of the large intracellular loop in propofol sensitivity of both receptors was explored. Methods: The large intracellular loop of α₁ GlyRs and α₁β₂ GABA_ARs was screened using alanine replacement. Sensitivity to propofol was studied using patch-clamp recording in HEK293 cells transiently transfected with …

Association Between Caries, Obesity And Insulin Resistance In Mexican Adolescents, Juan Pablo Loyola-Rodgriguez, Carlos Villa-Chavez, Nuria Patiño-Marin, Celia Aradillas-Garcia, Cesar Gonzalez, Esperanza De La Cruz-Mendoza

School of Dentistry Faculty Research and Publications

Aim: To determine the association among dental caries, obesity and insulin resistance in Mexican adolescents. Methods: Body Mass Index, obesity (OB) blood pressure, insulin level, insulin resistance (IR), triglycerides level, serum HDL-cholesterol (cHDL), DMFT index and salivary flow were measured. Results: Anthropometric measures showed a significant statistical difference (p < 0.05). Insulin level was 8.98 for healthy subjects, whereas for OB-IR group was 25.35, there was a statistical significant difference (p < 0.05). Triglycerides level was 88.50 for healthy subjects and 169.40 mg/dL for OB-IR; cHDL was 52.88 for healthy and 41.82 mg/dL for OB-IR group, both showed a statistically significant difference (p < 0.05). Salivary flow was 4.30 for healthy and for OB-IR group was 5.48 ml/min showed a significant statistical difference (p < 0.05). DMFT index was 3.02 for healthy and for OB-IR adolescents was 4.78, showed a significant statistical difference (p < 0.05). The caries component of DMFT index was 1.84 for healthy and was 3.52 for OB-IR adolescents, showed a significant statistical difference (p < 0.05). According to the multivariate analysis, DMFT (OR=3.10; IC95%=0.20-1.02, p=0.042) and decay (OR=3.30; IC95%=0.19-1.0, p=0.011) were associated with subjects with OB-IR. Conclusion: OB-IR Mexican adolescents showed a positive association with DMFT.

Autism Spectrum Disorder: Parenting Stress, Family Functioning And Health-Related Quality Of Life, Norah L. Johnson, Marilyn Frenn, Suzanne Feetham, Pippa Simpson

College of Nursing Faculty Research and Publications

The prevalence of Autism Spectrum Disorder (ASD) is 1 in 110 persons in the U.S. Both parents of children with ASD are under stress that may impact their health-related quality of life (HRQL) (physical and mental health). The purpose of the current study was to explore the relationship of parenting stress, support from family functioning and the HRQL (physical and mental health) of both parents. Female (n = 64) and male (n = 64) parents of children with ASD completed Web-based surveys examining parenting stress, family functioning, and physical and mental health. Results of a Wilcoxon signed-ranks test showed that …

Testing The Integrated Theory Of Health Behaviour Change For Postpartum Weight Management, Polly Ryan, Marianne Weiss, Nicole Traxel, Michael J. Brondino

College of Nursing Faculty Research and Publications

Aim.  This is a report of a correlational study to test the Integrated Theory of Health Behaviour Change within the context of postpartum weight self‐management including the impact of race/ethnicity and weight classification.

Background.  Women experiencing childbirth face increasing challenges to manage their weight postpartum. Little is known about women’s weight self‐management during the complex physiological and psychosocial transition of the postpartum period.

Methods.  Data were collected during the birth hospitalization and 4 months postbirth during 2005 and 2006. A quota sample of 250 postpartum women using two strata, race/ethnicity and prepregnant weight classification, were enrolled; 179 women completed the …

Tailoring A Treatment Fidelity Framework For An Intensive Care Unit Clinical Trial, Linda L. Chlan, Jill L. Guttormson, Kay Savik

College of Nursing Faculty Research and Publications

Background:

Treatment fidelity (TF) refers to methodological strategies and practices used to monitor and enhance the reliability and validity of behavioral interventions. Treatment fidelity monitoring enhances internal and external validity and is needed for study replication and generalizability.

Objectives:

The aim of this study was to describe the implementation, monitoring, and impact of TF in an intensive-care-unit-based clinical trial testing music for anxiety self-management with mechanically ventilated patients.

Method:

Development of the criteria was based on the Five-Component Treatment Fidelity Framework from the Treatment Fidelity Workgroup. Descriptive statistics were used to evaluate adherence rates to the key TF criteria and …

Utilizing Induced Voxel Correlation In Fmri Analysis, Daniel B. Rowe, Andrew S. Nencka

Mathematics, Statistics and Computer Science Faculty Research and Publications

No abstract provided.

Augmented Cocaine Seeking In Response To Stress Or Crf Delivered Into The Ventral Tegmental Area Following Long-Access Self-Administration Is Mediated By Crf Receptor Type 1 But Not Crf Receptor Type 2, Jordan M. Blacktop, Chad Seubert, David A. Baker, Nathan Ferda, Geng Lee, Evan N. Graf, John R. Mantsch

Biomedical Sciences Faculty Research and Publications

Stressful events are determinants of relapse in recovering cocaine addicts. Excessive cocaine use may increase susceptibility to stressor-induced relapse through alterations in brain corticotropin-releasing factor (CRF) regulation of neurocircuitry involved in drug seeking. We previously reported that the reinstatement of cocaine seeking by a stressor (footshock) is CRF dependent and is augmented in rats that self-administered cocaine under long-access (LgA; 6 h daily) conditions for 14 d when compared with rats provided shorter daily cocaine access [short access (ShA) rats; 2 h daily]. Further, we have demonstrated that reinstatement in response to intracerebroventricular CRF administration is heightened in LgA rats. …

Comparison Of The Effects Of Ice And 3.5% Menthol Gel On Blood Flow And Muscle Strength Of The Lower Arm, Robert V. Topp, Lee J. Winchester, Amber M. Mink, Jeremiah S. Kaufmann, Dean E. Jacks

College of Nursing Faculty Research and Publications

Context: Soft-tissue injuries are commonly treated with ice or menthol gels. Few studies have compared the effects of these treatments on blood flow and muscle strength. Objective: To compare blood flow and muscle strength in the forearm after an application of ice or menthol gel or no treatment. Design: Repeated measures design in which blood-flow and muscle-strength data were collected from subjects under 3 treatment conditions. Setting: Exercise physiology laboratory. Participants: 17 healthy adults with no impediment to the blood flow or strength in their right arm, recruited through word of mouth. Intervention: Three …

Lubricin Immunohistochemical Expression In Human Temporomandibular Joint Disc With Internal Derangement, Rosalia Leonardi, Luis Eduardo Almeida, Carla Loreto

School of Dentistry Faculty Research and Publications

Lubricin is a chondroprotective, mucinous glycoprotein which contribute to joint lubrication, especially to boundary lubrication and maintains joint integrity. The present investigation aimed to study the immunolocalization of lubricin in TMJ discs from patients affected by anterior disc displacement with reduction (ADDwR) ADDwoR. Eighteen TMJ displaced disc affected by ADDwoR were processed immunohistochemically, with a polyclonal anti‐lubricin antibody, used at 1:50 working dilution. The percentage of lubricin immunopositive cells (extent score = ES) and the extent of lubricin staining of the disc extracellular matrix (ECM), were evaluated. Each sample was scored for histopathological changes. Percentage of immunostained surface disc cells …

Natural And Synthetic Corticosteroids Inhibit Uptake2-Mediated Transport In Cns Neurons, Jonathan E. Hill, Khadijah Makky, Lalita Shrestha, Cecilia J. Hillard, Paul J. Gasser

Biomedical Sciences Faculty Research and Publications

In addition to exerting actions via mineralocorticoid and glucocorticoid receptors, corticosteroids also act by inhibiting uptake₂, a high-capacity monoamine transport system originally described in peripheral tissues. Recent studies have demonstrated that uptake₂ transporters are expressed in the brain and play roles in monoamine clearance, suggesting that they mediate some corticosteroid effects on physiological and behavioral processes. However, the sensitivity of brain uptake₂ to many natural and synthetic corticosteroids has not been characterized. Cultured rat cerebellar granule neurons (CGNs) were previously shown to exhibit corticosterone-sensitive accumulation of the uptake₂ substrate1-methyl-4-phenylpyridinium (MPP⁺). We examined the …

Serotonin Mediated Changes In Corticotropin Releasing Factor Mrna Expression And Feeding Behavior Isolated To The Hypothalamic Paraventricular Nuclei, Joanne P. Boisvert, Tyler J. Boschuetz, Jon M. Resch, Christopher R. Mueller, Sujean Choi

Biomedical Sciences Faculty Research and Publications

Fenfluramine reduces hunger and promotes body weight loss by increasing central serotonin (5-HT) signaling. More recently, neuropeptides have been linked to the regulation of feeding behavior, metabolism and body weight. To examine possible interactions between 5-HT and neuropeptides in appetite control, fenfluramine (200 nmol/0.5 μl/side) was administered directly into the hypothalamic paraventricular nuclei (PVN) of male rats. Bilateral fenfluramine produced significant hypophagia and increased expression of PVN corticotropin releasing factor (CRF) mRNA and neuropeptide Y (NPY) mRNA in the arcuate nucleus within the first hour after drug administration. Fenfluramine's effects on feeding behavior and mRNA expression were blocked by PVN …

Oral Administration Of Levo-Tetrahydropalmatine Attenuates Reinstatement Of Extinguished Cocaine Seeking By Cocaine, Stress Or Drug-Associated Cues In Rats, Yazmin Figueroa-Guzman, Christopher R. Mueller, Oliver Vranjkovic, Samantha Wisniewski, Zheng Yang, Shi-Jiang Li, Colin Bohr, Evan N. Graf, David A. Baker, John R. Mantsch

Biomedical Sciences Faculty Research and Publications

Cocaine addiction is characterized by a persistently heightened susceptibility to drug relapse. For this reason, the identification of medications that prevent drug relapse is a critical goal of drug abuse research. Drug re-exposure, the onset of stressful life events, and exposure to cues previously associated with drug use have been identified as determinants of relapse in humans and have been found to reinstate extinguished cocaine seeking in rats. This study examined the effects of acute oral (gavage) administration of levo-tetrahydropalmatine (l-THP), a tetrahydroprotoberberine isoquinoline with a pharmacological profile that includes antagonism of D1, D2 and D3 dopamine receptors, …

Galvanic Corrosion Between Various Combinations Of Orthodontic Brackets And Archwires, Arash Bakhtari, T. Gerard Bradley, William K. Lobb, David W. Berzins

School of Dentistry Faculty Research and Publications

Introduction: The purpose of this study was to compare galvanic currents generated by different combinations of commonly used brackets and archwires.

Methods: As-received stainless steel, nickel-titanium, and betatitanium wires were coupled to stainless steel and titanium brackets in an artificial saliva medium. The galvanic current and amount of charge transferred for each pair were monitored with a zero resistance ammeter for 10 hours.

Results: Two-way analysis of variance (ANOVA) showed a significant difference in charge and galvanic currents when factored for type of bracket (P\0.001), but no significant difference between them when factored by type of wire (P .0.05). Specifically, …

Speaking Rate Effects On Normal Aspects Of Articulation: Outcomes And Issues, Jeffrey J. Berry

Speech Pathology and Audiology Faculty Research and Publications

The articulatory effects of speaking rate have been a point of focus for a substantial literature in speech science. The normal aspects of speaking rate variation have influenced theories and models of speech production and perception in the literature pertaining to both normal and disordered speech. While the body of literature pertaining to the articulatory effects of speaking rate change is reasonably large, few speaker-general outcomes have emerged. The purpose of this paper is to review outcomes of the existing literature and address problems related to the study of speaking rate that may be germane to the recurring theme that …

Speech-Language Pathologists Collaborating With Head Start To Improve Children’S Early Language And Literacy Skills: Efficacy And Intensity Effects, Maura Jones Moyle, Sue Berman

Speech Pathology and Audiology Faculty Research and Publications

The current study examined the efficacy of a speech-language pathologist–designed and implemented emergent literacy program for Head Start preschoolers and the influence of intensity of intervention on children’s gains. Results indicated that children who participated in the intervention program exhibited greater gains than the control group on oral language, phonological awareness, and alphabet/print knowledge. Children who received a higher dosage of intervention made greater gains on vocabulary and oral language compared to the lower intensity group. Speech-language pathologists may be valuable collaborators in promoting emergent literacy skills in at-risk children.

Implementation Of A Virtual Journal Club In A Clinical Nursing Setting, Jill Berger, Heather K. Hardin, Robert V. Topp

College of Nursing Faculty Research and Publications

Healthcare practice is increasingly focused on delivering care that is based on published research evidence. Staff development nurses can institute journal clubs to teach nursing staff critical appraisal of research articles and ways to translate research findings into clinical practice. Unfortunately, attending meetings regularly is often a challenge for nurses, and relatively few have the knowledge and expertise to adequately critique research articles. One way to bridge the limitations of accessibility and limited research expertise of journal club members is to establish a virtual journal club. This article describes one hospital's experience with developing a virtual journal club.

Insulin-Like Growth Factor 1 And Transforming Growth Factor-Β Stimulate Cystine/Glutamate Exchange Activity In Dental Pulp Cells, Katherine Pauly, Kymberly Fritz, Alyssa Furey, Doug Lobner

Biomedical Sciences Faculty Research and Publications

Introduction

The growth factors insulin-like growth factor (IGF-1) and transforming growth factor-β (TGF-β) are protective to dental pulp cells in culture against the toxicity of the composite materials Durafill VS and Flow Line (Henry Schein Inc, New York, NY). Because the toxicity of these materials is mediated by oxidative stress, it seemed possible that the protective effects of IGF-1 and TGF-β were through the enhancement of an endogenous antioxidant mechanism.

Methods

We used cultured dental pulp cells to determine the mechanism of the protective effects of IGF-1 and TGF-β, focusing on the glutathione system and the role of cystine/glutamate exchange …