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Usp8 Promotes Smoothened Signaling By Preventing Its Ubiquitination And Changing Its Subcellular Localization, Ruohan Xia, Hongge Jia, Junkai Fan, Yajuan Liu, Jianhang Jia Jan 2012

Usp8 Promotes Smoothened Signaling By Preventing Its Ubiquitination And Changing Its Subcellular Localization, Ruohan Xia, Hongge Jia, Junkai Fan, Yajuan Liu, Jianhang Jia

Molecular and Cellular Biochemistry Faculty Publications

The seven transmembrane protein Smoothened (Smo) is a critical component of the Hedgehog (Hh) signaling pathway and is regulated by phosphorylation, dimerization, and cell-surface accumulation upon Hh stimulation. However, it is not clear how Hh regulates Smo accumulation on the cell surface or how Hh regulates the intracellular trafficking of Smo. In addition, little is known about whether ubiquitination is involved in Smo regulation. In this study, we demonstrate that Smo is multi-monoubiquitinated and that Smo ubiquitination is inhibited by Hh and by phosphorylation. Using an in vivo RNAi screen, we identified ubiquitin-specific protease 8 (USP8) as a deubiquitinase that …


Conformational Altered P53 As An Early Marker Of Oxidative Stress In Alzheimer's Disease, Laura Buizza, Giovanna Cenini, Cristina Lanni, Giulia Ferrari-Toninelli, Chiara Prandelli, Stefano Govoni, Erica Buoso, Marco Racchi, Maria Barcikowska, Maria Styczynska, Aleksandra Szybinska, D. Allan Butterfield, Maurizio Memo, Daniela Uberti Jan 2012

Conformational Altered P53 As An Early Marker Of Oxidative Stress In Alzheimer's Disease, Laura Buizza, Giovanna Cenini, Cristina Lanni, Giulia Ferrari-Toninelli, Chiara Prandelli, Stefano Govoni, Erica Buoso, Marco Racchi, Maria Barcikowska, Maria Styczynska, Aleksandra Szybinska, D. Allan Butterfield, Maurizio Memo, Daniela Uberti

Sanders-Brown Center on Aging Faculty Publications

In order to study oxidative stress in peripheral cells of Alzheimer's disease (AD) patients, immortalized lymphocytes derived from two peculiar cohorts of patients, referring to early onset AD (EOSAD) and subjects harboured AD related mutation (ADmut), were used. Oxidative stress was evaluated measuring i) the typical oxidative markers, such as HNE Michel adducts, 3 Nitro-Tyrosine residues and protein carbonyl on protein extracts, ii) and the antioxidant capacity, following the enzymatic kinetic of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GRD). We found that the signs of oxidative stress, measured as oxidative marker levels, were evident only in ADmut …


Hiv-1 Tat Triggers Nuclear Localization Of Zo-1 Via Rho Signaling And Camp Response Element-Binding Protein Activation, Yu Zhong, Bei Zhang, Sung Yong Eum, Michal Toborek Jan 2012

Hiv-1 Tat Triggers Nuclear Localization Of Zo-1 Via Rho Signaling And Camp Response Element-Binding Protein Activation, Yu Zhong, Bei Zhang, Sung Yong Eum, Michal Toborek

Neurosurgery Faculty Publications

The human immunodeficiency virus (HIV)-specific protein trans-activator of transcription (Tat) can contribute to the dysfunction of brain endothelial cells and HIV trafficking into the brain by disrupting tight junction (TJ) integrity at the blood–brain barrier (BBB) level. Specific TJ proteins, such as zonula occludens (ZO) proteins, localize not only at the cell–cell borders but are also present in the nuclei. The objective of the present study was to evaluate the mechanisms and significance of Tat-induced nuclear localization of ZO-1. Treatment of a brain endothelial cell line (hCMEC/D3 cells) with Tat resulted in a decrease in total levels of ZO-1 but …


Child Food Security And The Food Stamp Program: What A Difference A Month Makes, Yiran Li, Bradford Mills, George Davis, Elton Mykerezi Jan 2012

Child Food Security And The Food Stamp Program: What A Difference A Month Makes, Yiran Li, Bradford Mills, George Davis, Elton Mykerezi

University of Kentucky Center for Poverty Research Discussion Paper Series

Most Americans believe that children should not have either persistent concerns about the quality and quantity of food to eat or lack of actual access to food due to low household resources. However, in 2007, approximately 3.3 million households (8.3 percent of households with children) had food insecure children who did not have consistent access to adequate and safe foods (Nord and Golla, 2009). This implies less than complete coverage of children by the food-assistance safety net.

The United States’s Supplemental Nutrition Assistance Program (SNAP), historically and commonly known as the Food Stamp Program (FSP), is a federal-assistance program designed …


Low Income Preschoolers' Non-Parental Care Experiences And Household Food Insecurity, Colleen Heflin, Irma Arteaga, Sara Gable Jan 2012

Low Income Preschoolers' Non-Parental Care Experiences And Household Food Insecurity, Colleen Heflin, Irma Arteaga, Sara Gable

University of Kentucky Center for Poverty Research Discussion Paper Series

Rates of food insecurity in households with children have significantly increased over the past decade. The majority of children, including those at risk for food insecurity, participate in some form of non-parental child care during the preschool years. To evaluate the relationship between the two phenomenon, this study investigates the effects of child care arrangements on food insecurity in households with children. To address the selection bias problem that arises from the fact that enrollment in different types of child care is not a random process, this study uses propensity scores techniques. The authors compare outcomes across five child care …


Food Store Environment Modifies Intervention Effect On Fruit And Vegetable Intake Among Low-Income Women In North Carolina, Alison A. Gustafson, Joseph Sharkey, Carmen D. Samuel-Hodge, Jessica C. Jones-Smith, Jianwen Cai, Alice S. Ammerman Jan 2012

Food Store Environment Modifies Intervention Effect On Fruit And Vegetable Intake Among Low-Income Women In North Carolina, Alison A. Gustafson, Joseph Sharkey, Carmen D. Samuel-Hodge, Jessica C. Jones-Smith, Jianwen Cai, Alice S. Ammerman

Dietetics and Human Nutrition Faculty Publications

Background. The aim of the study is to determine how the food store environment modifies the effects of an intervention on diet among low-income women. Study Design. A 16-week face-to-face behavioral weight loss intervention was delivered among low income midlife women. Methods. The retail food environment for all women was characterized by (1) the number and type of food stores within census tracts; (2) availability of healthy foods in stores where participants shop; (3) an aggregate score of self-reported availability of healthy foods in neighborhood and food stores. Statistical Analyses. Multivariable linear regression was used to …


Atrazine Exposure In Public Drinking Water And Preterm Birth, Jessica L. Rinsky, Claudia Hopenhayn, Vijay Golla, Steven R. Browning, Heather M. Bush Jan 2012

Atrazine Exposure In Public Drinking Water And Preterm Birth, Jessica L. Rinsky, Claudia Hopenhayn, Vijay Golla, Steven R. Browning, Heather M. Bush

Epidemiology and Environmental Health Faculty Publications

Objectives

Approximately 13% of all births occur prior to 37 weeks gestation in the U.S. Some established risk factors exist for preterm birth, but the etiology remains largely unknown. Recent studies have suggested an association with environmental exposures. We examined the relationship between preterm birth and exposure to a commonly used herbicide, atrazine, in drinking water.

Methods

We reviewed Kentucky birth certificate data for 2004–2006 to collect duration of pregnancy and other individual-level covariates. We assessed existing data sources for atrazine levels in public drinking water for the years 2000–2008, classifying maternal county of residence into three atrazine exposure groups. …


Role Of Community Health Workers In Improving Diabetes Outcomes, Janet Kegley, Helen Collett, Ralph Fugate Jan 2012

Role Of Community Health Workers In Improving Diabetes Outcomes, Janet Kegley, Helen Collett, Ralph Fugate

Center of Excellence in Rural Health Presentations

Objective Examine the effectiveness of using community health workers (CHWs) to support nurse-led diabetes self-management education (DSME) with medically underserved clients.

Methods A pretest-posttest group design was used. A sample of 640 was non-randomly drawn from eastern Kentucky Homeplace division clients who reported that they had been told by a health professional they have type-2 diabetes. The sample size for was reduced to 489 because of a decrease in project funding. Inclusion criteria for the study were Kentucky Homeplace clients 18-65+ years of age who reported they had been told by a provider they have diabetes. Clients meeting inclusion criteria …


Youth And Adult Perceptions Of Their Relationships Within Community-Based Youth Programs, Kenneth R. Jones, Daniel F. Perkins Jan 2012

Youth And Adult Perceptions Of Their Relationships Within Community-Based Youth Programs, Kenneth R. Jones, Daniel F. Perkins

Community & Leadership Development Faculty Publications

This study examined perceptions and experiences of youth and adults engaged in various types of community-based youth-adult relationships. Involvement and interaction rating scales were completed by 108 participants involved in community groups from 12 communities in 10 states. The rating scale measured three constructs: youth involvement, adult involvement, and youth- adult interaction. Significant gender differences in participants’ perceptions were found on all three constructs, with females being more positive. Rural participants were found to be significantly more positive than urban participants on the construct of youth involvement. Finally, significant differences were found between all participants within categories of the youth-adult …


Cooperative Cluster Formation, Dna Bending And Base-Flipping By O6-Alkylguanine-Dna Alkyltransferase, Ingrid Tessmer, Manana Melikishvili, Michael G. Fried Jan 2012

Cooperative Cluster Formation, Dna Bending And Base-Flipping By O6-Alkylguanine-Dna Alkyltransferase, Ingrid Tessmer, Manana Melikishvili, Michael G. Fried

Center for Structural Biology Faculty Publications

O6-Alkylguanine-DNA alkyltransferase (AGT) repairs mutagenic O6-alkylguanine and O4-alkylthymine adducts in DNA, protecting the genome and also contributing to the resistance of tumors to chemotherapeutic alkylating agents. AGT binds DNA cooperatively, and cooperative interactions are likely to be important in lesion search and repair. We examined morphologies of complexes on long, unmodified DNAs, using analytical ultracentrifugation and atomic force microscopy. AGT formed clusters of ≤11 proteins. Longer clusters, predicted by the McGhee–von Hippel model, were not seen even at high [protein]. Interestingly, torsional stress due to DNA unwinding has the potential to limit cluster size …


Families With Hungry Children And The Transition From Preschool To Kindergarten, Colleen Heflin, Irma Arteaga, Sara Gable Jan 2012

Families With Hungry Children And The Transition From Preschool To Kindergarten, Colleen Heflin, Irma Arteaga, Sara Gable

University of Kentucky Center for Poverty Research Discussion Paper Series

This paper exploits a source of variation in the eligibility for federal nutrition programs to identify the program effects on food insecurity. Children are eligible for the WIC program until the day before they turn 61 months old. The result is an age discontinuity in program participation at the 61-month cutoff. Using the Early Childhood Longitudinal Study Birth-cohort dataset, we find strong evidence of a sizeable increase in household food insecurity at the 61- month cutoff. Our findings are robust to different model specifications, datasets, and various bandwidth choices using various non-parametric estimations.


From Service Provision To Function Based Performance - Perspectives On Public Health Systems From The Usa And Israel, F. Douglas Scutchfield, Ehud Miron, Richard Ingram Jan 2012

From Service Provision To Function Based Performance - Perspectives On Public Health Systems From The Usa And Israel, F. Douglas Scutchfield, Ehud Miron, Richard Ingram

Preventive Medicine and Environmental Health Faculty Publications

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.

The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions …


Three Studies To Investigate Biopsychosocial Influences On Marital Conflict, Claire Kimberly Jan 2012

Three Studies To Investigate Biopsychosocial Influences On Marital Conflict, Claire Kimberly

Theses and Dissertations--Family Sciences

Research is beginning to find a positive and significant relationship between marriage and health. Even though the current literature shows that separation and divorce have strong negative consequences for the mental and physical health of both spouses (Dush & Amato, 2005), the answer to why and how this occurs has yet to be solved.

A comprehensive perspective that could greatly benefit the analysis of this connection is the use of social neuroscientific methods in a biopsychosocial model. By including biological factors, social elements, and psychological variables in analyzing marriages, researchers would be able to further understand both the intra- and …


New Models For The Compensation Of Natural Resources Damage, Michael Faure, Jing Liu Jan 2012

New Models For The Compensation Of Natural Resources Damage, Michael Faure, Jing Liu

Kentucky Journal of Equine, Agriculture, & Natural Resources Law

No abstract provided.


Effects Of Self-Directed Physiological Monitoring On Therapists Anxiety, Melissa D. Dalton Jan 2012

Effects Of Self-Directed Physiological Monitoring On Therapists Anxiety, Melissa D. Dalton

Theses and Dissertations--Family Sciences

This mixed-method study investigated the effects of self-directed physiological monitoring on therapists anxiety. Ten therapists participated in a10-week physiological monitoring training sessions while monitoring respiratory sinus arrhythmia (RSA) and heart rate variability (HRV). The participants completed the state-trait anxiety inventory questionnaire after having a first, sixth, or tenth therapy session with a client. This was designed to monitor their state anxiety while working with clients. A series of paired sampled t-tests was conducted to assess changes in HRV, RSA, trait anxiety, and state anxiety. One significant result was found: the RSA of the therapist increased significantly. Correlations existed between …


Polymorph Formation Of Tolfenamic Acid: An Investigation Of Pre-Nucleation Association, Alessandra Mattei Jan 2012

Polymorph Formation Of Tolfenamic Acid: An Investigation Of Pre-Nucleation Association, Alessandra Mattei

Theses and Dissertations--Pharmacy

The majority of pharmaceutical products are formulated as solids in the crystalline state. With the potential to exist in different crystalline modifications or polymorphs, each solid form bears its own physical and chemical properties, influencing directly bioavailability and manufacturability of the final dosage form. In view of the importance of crystalline form selection in the drug development process, it is imperative for pharmaceutical scientists to work arduously on various aspects of polymorphism, ranging from fundamental understanding of the phenomenon at the molecular level to practical utilization of a specific crystalline form. One common feature of organic crystals is the existence …


Minority Stress And Physical Health In Lesbians, Gays, And Bisexuals: The Mediating Role Of Coping Self-Efficacy, Fowler Nicholas Denton Jan 2012

Minority Stress And Physical Health In Lesbians, Gays, And Bisexuals: The Mediating Role Of Coping Self-Efficacy, Fowler Nicholas Denton

Theses and Dissertations--Educational, School, and Counseling Psychology

Mental health issues have been the primary focus of much of the health research concerning lesbian, gay, and bisexual (LGB) individuals over the previous decade. Studies have demonstrated that LGB individuals experience psychological distress due to prejudice and discrimination (Lewis, Derlega, Berndt, Morris, & Rose, 2002; Meyer, Schwartz, & Frost, 2008; Rostosky, Riggle, Horne, & Miller, 2009). Health researchers have not given the physical health of LGB individuals the same level of attention (Dibble, Eliason, & Christiansen, 2007). The Gay and Lesbian Medical Association (GLMA; 2001) asserted that little was known about LGB physical health disparities and called for more …


Factors Influencing Women’S Psychological Well-Being Within A Positive Functioning Framework, Krista Moe Jan 2012

Factors Influencing Women’S Psychological Well-Being Within A Positive Functioning Framework, Krista Moe

Theses and Dissertations--Educational, School, and Counseling Psychology

Women suffer a high prevalence rate of several mental disorders. National U.S. data (N = 9,282) shows that 23.4% of women meet the criteria for an anxiety disorder, 8.6% for depression, and 11.6% for a mood disorder (Kessler et al., 2005). Compared to men, women are two times more likely to be depressed (Lewinsohn, Rhode, Seeley, & Baldwin, 2001) and two to three times more likely to suffer from anxiety disorders such as panic disorders, phobias, obsessive compulsive disorders, and Posttraumatic Stress (Kessler et al., 2005). Due to experiencing a high number of mental disorders, women’s psychological well-being (PWB) …


Privatization And Performance In The Implementation Of Temporary Assistance To Needy Families, Adam Michael Butz Jan 2012

Privatization And Performance In The Implementation Of Temporary Assistance To Needy Families, Adam Michael Butz

Theses and Dissertations--Political Science

In response to the passage of the Personal Responsibility Work Opportunity Reconciliation Act (PRWORA) and its lead cash assistance program Temporary Assistance to Needy Families (TANF), states have taken unique and divergent approaches to welfare policy implementation. One popular approach to workfare delivery, known as privatization, involves contracting with non-profit and for-profit entities operating within the private sector. The General Accounting Office reports that nearly every state is privatizing TANF services to some degree through third-party contracts, but very little is understood about why variation in contracting exists and the ramifications for the program outcomes of welfare recipients. This dissertation …


Creed Vs. Deed: Secession, Legitimacy, And The Use Of Child Soldiers, Trace C. Lasley Jan 2012

Creed Vs. Deed: Secession, Legitimacy, And The Use Of Child Soldiers, Trace C. Lasley

Theses and Dissertations--Political Science

The use of child soldiers has troubled human rights activists, policy-makers, and local communities for decades. Although rebellions around the world routinely use children in their activities, many do not. Despite its overwhelming importance for conflict resolution, the topic of child soldiers remains understudied. My research blends classic rational choice and constructivist themes to develop an explanation for when child soldiers will be used, and when they will be avoided.

The likelihood of child recruitment is influenced by the value of international opinion; this is determined by the groups' long-term goals. Secessionist rebellions desire to have their own state. However, …


Lesion-Specific Dna-Binding And Repair Activities Of Human O⁶-Alkylguanine Dna Alkyltransferase, Manana Melikishvili, Michael G. Fried Jan 2012

Lesion-Specific Dna-Binding And Repair Activities Of Human O⁶-Alkylguanine Dna Alkyltransferase, Manana Melikishvili, Michael G. Fried

Center for Structural Biology Faculty Publications

Binding experiments with alkyl-transfer-active and -inactive mutants of human O6-alkylguanine DNA alkyltransferase (AGT) show that it forms an O6-methylguanine (6mG)-specific complex on duplex DNA that is distinct from non-specific assemblies previously studied. Specific complexes with duplex DNA have a 2:1 stoichiometry that is formed without accumulation of a 1:1 intermediate. This establishes a role for cooperative interactions in lesion binding. Similar specific complexes could not be detected with single-stranded DNA. The small difference between specific and non-specific binding affinities strongly limits the roles that specific binding can play in the lesion search process. Alkyl-transfer kinetics with …


Glimpses Of Ecstasy: The Public Shaping Of Personal History In Carlos Bulosan's America Is In The Heart, Nicholas A. Henson Jan 2012

Glimpses Of Ecstasy: The Public Shaping Of Personal History In Carlos Bulosan's America Is In The Heart, Nicholas A. Henson

disClosure: A Journal of Social Theory

No abstract provided.


Dismemberment In The Chicana/O Body Politic: Fragmenting NationNess And Form In Oscar Zeta Acosta's The Revolt Of The Cockroach People, And Alejandro Morales's The Rag Doll Plagues, Danizete Martinez Jan 2012

Dismemberment In The Chicana/O Body Politic: Fragmenting NationNess And Form In Oscar Zeta Acosta's The Revolt Of The Cockroach People, And Alejandro Morales's The Rag Doll Plagues, Danizete Martinez

disClosure: A Journal of Social Theory

No abstract provided.


Global Kentucky (Winter 2012), University Of Kentucky International Center Jan 2012

Global Kentucky (Winter 2012), University Of Kentucky International Center

Global Kentucky

No abstract provided.


Regulation Of Platelet Exoctosis And Its Role In Diseases, Rania A. Al Hawas Jan 2012

Regulation Of Platelet Exoctosis And Its Role In Diseases, Rania A. Al Hawas

Theses and Dissertations--Health and Clinical Sciences

In addition to their role in hemostasis, platelets appear to contribute to vascular inflammatory diseases. Platelets achieve this through the secretion of various prothrombotic and pro-inflammatory molecules. Platelet secretion is mediated by integral membrane proteins called Soluble NSF Attachment protein REceptors (SNAREs). SNAREs come from both granule/vesicle membranes (v-SNAREs) and target membranes (t-SNAREs) to form a trans-bilayer complex that promotes membrane fusion and subsequent granule cargo release. The work described in this dissertation dissects various, yet related aspects of platelet secretion in both physiological relevant and pathological circumstances.

Atherosclerosis is a leading cause of death in the westernized countries and …


Governance In Large Nonprofit Health Systems: Current Profile And Emerging Patterns, Lawrence Prybil, Samuel Levey, Rex Killian, David Fardo, Richard Chait, David R. Bardach, William Roach Jan 2012

Governance In Large Nonprofit Health Systems: Current Profile And Emerging Patterns, Lawrence Prybil, Samuel Levey, Rex Killian, David Fardo, Richard Chait, David R. Bardach, William Roach

Health Management and Policy Faculty Book Gallery

From the foreword:

Nonprofit healthcare organizations are not exempt from good governance. In fact, more today than ever, the hospitals and health care systems of this country must have the discipline and commitment to organize their governance structures and practices to provide forward-thinking leadership and stand up to scrutiny from any type of evaluation and review. As we move from “sick care” organizations to “health care” organizations with accountability for the health of the population of our communities from birth to end-of-life, the role of governance becomes even more critical.

Fourteen of the largest and most notable health care systems …


Economic Modeling & Optimization Of A Region Specific Multi-Feedstock Biorefinery Supply Chain, William H. Faulkner Jan 2012

Economic Modeling & Optimization Of A Region Specific Multi-Feedstock Biorefinery Supply Chain, William H. Faulkner

Theses and Dissertations--Manufacturing Systems Engineering

The objective of this thesis is to include strategic and tactical level decisions into the biorefinery supply chain design for a specific region while comparing multiple conversion technologies and biomass feedstocks. The allocation of biomass feedstocks, products, and the respective supply chain configuration locations are determined while ensuring the regions monthly biomass availability and product market demand constraints are met. This research considers all actions required to bring the bio-based products to market from harvesting, storing, and processing the biomass to market distribution. Two different conversion technologies are chosen for comparison: one advanced conversion technology and one conventional technology. Potential …


Sexually Transmitted Diseases (Stds), Donald E. Greydanus, Jane Seyler, Hatim A. Omar Jan 2012

Sexually Transmitted Diseases (Stds), Donald E. Greydanus, Jane Seyler, Hatim A. Omar

Pediatrics Faculty Publications

High rates of unprotected sexual behavior in adolescents result in millions of cases of STDs in the world. This chapter reviews factors inducing high STD rates, specific STDs, and their management based on 2010 U.S. Centers for Disease Control and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures.


Microstructural And Mineralogical Transformation Of Hydraulically Disposed Fly Ash—Implications To The Environment, Jabulani S. Mahlaba, Elsabe P. Kearsley, Richard A. Kruger Jan 2012

Microstructural And Mineralogical Transformation Of Hydraulically Disposed Fly Ash—Implications To The Environment, Jabulani S. Mahlaba, Elsabe P. Kearsley, Richard A. Kruger

Coal Combustion and Gasification Products Journal Archive

Increasing amounts of coal are combusted annually to meet the ever-increasing energy demands. The inevitable by-products include fly ash and saline effluents, which require acceptable disposal. The aim of this article is to compare the effect of hydraulic disposal with dry ash dumping. The results indicate that the former carries more environmental benefits based on the physical, chemical, and mineralogical aspects that were investigated.


Changes To The Equine Hindgut Microflora In Response To Antibiotic Challenge, Brittany E. Harlow Jan 2012

Changes To The Equine Hindgut Microflora In Response To Antibiotic Challenge, Brittany E. Harlow

Theses and Dissertations--Animal and Food Sciences

Antibiotics are important to equine medicine, but can cause detrimental side-effects including reduced feed intake, allergic reactions, and diarrhea. Antibiotic-associated diarrhea (AAD) is attributed to disruption of the hindgut microflora, permitting proliferation of pathogenic microbes. The objectives were to evaluate the effects of antibiotics on beneficial fecal bacteria, AAD-associated pathogens, microbial species richness and fermentation. Horses were assigned to treatment groups: control (no antibiotics, n=6), trimethoprim-sulfadiazine (oral, n=6), or sodium ceftiofur (IM, n=6). Fecal samples were taken during adaptation (3 wk), antibiotic challenge (1 wk), and withdrawal (1 wk). Fecal cellulolytics decreased by >99% during challenge and did not recover …