Exercise Science Commons^™

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

Radial And Carotid Arterial Pulse Signals For Assessing Cardiovascular Function At Rest And During Post-Exercise Recovery In A Heart Transplant Patient: A Case Study, Md Mahfuzur Rahman, Mamun Hasan, Jennifer F. May, John M. Herre, Leryn Reynolds, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

Aim: This study investigates the feasibility of using radial and carotid arterial pulse signals to assess cardiovascular (CV) function at rest and during post-exercise recovery in a heart transplant (HTx) patient. Method: Two micro-fabricated tactile sensors were used to simultaneously acquire arterial pulse signals at the radial artery (RA) and carotid artery (CA). Measurements were taken at rest and at multiple time points post-exercise on three subjects: an HTx patient, a percutaneous coronary intervention (PCI; coronary stent) patient and a healthy control. An SDOF-TF-based time-frequency analysis algorithm was applied to extract a comprehensive set of CV parameters, including heart rate …

Independent Animal Chiropractic Practice: An Evidence-Based Argument For Autonomy Beyond Veterinary Supervision, Montana Adams

Undergraduate Honors Theses

Animal chiropractic is a growing form of conservative care used to improve mobility, reduce pain, and support neuromusculoskeletal function in animals. Despite evidence suggesting it is both effective and low risk, access remains limited due to inconsistent state regulations. Many jurisdictions require chiropractors to obtain veterinary supervision, referral, or licensure, even when they have completed specialized training and certification in animal chiropractic. This paper evaluates the effectiveness and safety of animal chiropractic while analyzing the impact of current regulatory policies. Research indicates that chiropractic care can improve mobility and reduce spinal conditions in animals when performed by trained professionals. However, …

Pain And Pace: Investigating Gait Velocity In Individuals With Cancer, Melaina E. Taylor

2026 Honors Symposium

Background: Cancer remains the second leading cause of death worldwide, with incidence rates continuing to rise. Pain, a hallmark symptom of many cancers, is caused by both the progression of disease and treatments. Gait, the way in which someone walks, is now dubbed the “6th vital sign” for its strong relationship with functional status, longevity, and survival. Specifically, gait velocity is a key metric for gait, with previous studies in cancer free adults showing increased pain associated with a decreased gait velocity. The relationship between gait velocity and pain has not yet been explored in individuals with cancer. Purpose: The …

Biomechanical Effects Of Exercise-Based Interventions In Chronic Nonspecific Low Back Pain: A Systematic Review And Meta-Analysis, Lara De Vecchi Machado

Theses and Dissertations--Kinesiology and Health Promotion

Chronic nonspecific low back pain (CNLBP) is the leading cause of years lived with disability worldwide and represents a complex, multifactorial, and heterogeneous condition. It is characterized by substantial interindividual variability in muscle activation patterns, lumbo-pelvic coordination, and movement strategies. Although exercise is widely recommended as a first-line intervention and its clinical benefits are well established, the biomechanical mechanisms underlying functional improvement remain fragmented in the literature and are rarely synthesized quantitatively.

This dissertation conducted a systematic review with meta-analysis to investigate the biomechanical effects of exercise-based interventions in individuals with CNLBP. A total of 39 studies were included and …

Ultrasound-Derived Liver Composition And Metabolic Flexibility Under Exercise Stress, Rhodes Van Houten

All Master's Theses

Metabolic Associated Fatty Liver Disease (MAFLD) is characterized by abnormal liver fat accumulation in conjunction with metabolic syndromes. MAFLD affects 33% of individuals worldwide, though little is known about how increased liver fat impacts physiological responses to exercise. This study aimed to analyze the relationship between liver composition and metabolic flexibility during a graded exercise test.  Body composition was analyzed via dual-energy X-ray absorptiometry. Liver ultrasound was evaluated for echogenicity, where elevated mean gray volume (MGV) indicates abnormal liver tissue. Rates of fat (FATox) and carbohydrate (CHOox) oxidation (g/min), respiratory exchange ratio (RER), and blood lactate concentrations ([LA^-], …

The Sequence (S) Index As A Marker Of Diminished Step-To-Step Transition Efficiency In Older Adults, Elham Alijanpour, Ashwini Kulkarni, Peter G. Adamczyk, Daniel M. Russell

Rehabilitation Sciences Faculty Publications

Introduction: Age-related declines in walking efficiency are often attributed to musculoskeletal and neuromuscular changes, yet the mechanisms underlying these inefficiencies remain poorly understood. One key contributor is the step-to-step transition (STST), during which the center of mass (CoM) is redirected between limbs. The Sequence (S) index quantifies the temporal overlap between push-off and collision forces during STST, with higher values indicating greater mechanical energy loss. This study investigated whether aging affects STST efficiency, as quantified by the S index, and examined the timing and impulse characteristics underlying observed differences.

Methods: Thirteen young and eleven older healthy adults walked at five …

Radial And Carotid Arterial Pulse Signals For Assessing Cardiovascular Function At Rest And During Post-Exercise Recovery In A Heart Transplant Patient: A Case Study, Md Mahfuzur Rahman, Mamun Hasan, Jennifer F. May, John M. Herre, Leryn Reynolds, Zhili Hao

Mechanical & Aerospace Engineering Faculty Publications

Aim: This study investigates the feasibility of using radial and carotid arterial pulse signals to assess cardiovascular (CV) function at rest and during post-exercise recovery in a heart transplant (HTx) patient. Method: Two micro-fabricated tactile sensors were used to simultaneously acquire arterial pulse signals at the radial artery (RA) and carotid artery (CA). Measurements were taken at rest and at multiple time points post-exercise on three subjects: an HTx patient, a percutaneous coronary intervention (PCI; coronary stent) patient and a healthy control. An SDOF-TF-based time-frequency analysis algorithm was applied to extract a comprehensive set of CV parameters, including heart rate …

Neighborhood Socioeconomic Deprivation And Physical Activity Associate With Extracellular Vesicle Size And Cargo In A Community-Based Cohort Of Women, Yvonne Baumer, Elizabeth M. Aquino Peterson, Matthew R. Bavuso, Noel Miller, Cristhian A. Gutierrez-Huerta, Nithya P. Vijayakumar, Sam J. Neally, Kaveri Curlin, Valerie M. Mitchell, Billy S. Collins, Neelam R. Redekar, Subrata Paul, Anca D. Dobrian, Tiffany M. Powell-Wiley

Department of Biomedical and Translational Sciences Faculty Publications

African American (AA) women face disproportionate cardiovascular disease (CVD) risk due to adverse social determinants of health (SDoH), including lower socioeconomic status (SES). Physical activity (PA) and plasma extracellular vesicles (EVs) modulate CVD risk, but their relationships with SDoH remain unclear. This study examines associations between SDoH, PA, and plasma EVs in a Washington, DC-based cohort of at-risk AA women. Participants (N = 24, Age: 57 ± 12, BMI: 35 ± 6, ASCVD: 9 ± 5) joined the Step It Up Community-Engaged, Digital Health Physical Activity Intervention pilot study. EVs were isolated from fasting plasma samples. Multivariable regression, adjusted for …

Velocity Based Training In Athletic Development, Ross Martin Sangalang

Graduate Student Theses, Dissertations, & Professional Papers

The foundation of high-level sport performance is the ability to produce and express force rapidly across the task-specific temporal demands of sport. Traditional percentage-based prescription methods have long been used to develop hypertrophy, maximal strength, and power; however, fixed %1RM prescriptions fail to account for daily undulations in athlete readiness, accumulated fatigue, and changes in neuromuscular capacity. Velocity based training (VBT) offers a practical framework to regulate training through measurement of concentric velocity, allowing coaches to more accurately prescribe loads, stringently monitor repetition quality, and precisely regulate fatigue. This review discusses the neuromuscular qualities underpinning success in athletic endeavors, limitations …

An Exploratory Analysis Of The Role Of Sex In Load Carriage, Rachel E. Perez, Dustin R. Slivka, Brent C. Ruby

Graduate Student Theses, Dissertations, & Professional Papers

Axially loaded weight may impose a metabolic demand equivalent to that of fat mass (FM) during load carriage. Males (M) typically have a lower body fat percentage than females (F), resulting in metabolic demand differences during load carriage that may be mitigated by accounting for FM in pack loads. PURPOSE: To determine whether normalizing pack load to FM equalizes metabolic cost across sexes during load carriage. METHODS: Twenty-eight participants (14M, 23 ± 5 y, 1.81 ± 0.07 m, 78.7 ± 10.0 kg, 12.7 ± 5.4% body fat, VO₂peak 4.18 ± 0.54 L·min^-1; 14F, 22 ± 4 …

Predicting Tilt In Esports: A Psychophysiological Approach To Understanding Player Emotional Regulation, Nathan Rhea

University of the Pacific Theses and Dissertations

Emotional regulation and stress management are important to both casual and competitive esports players. When players become dysregulated, they experience a phenomenon known as “tilt” within the gaming community, where they often lose control of their emotions and their performance declines. This study aimed to investigate whether a psychophysiological variable in heart rate variability could predict tilt in college-age esports players. Additionally, the relationship between heart rate variability and emotions predicted by the Tiltometer system with gameplay performance and winning or losing was tested.

This study used a quantitative correlational research design. Participants for this study were college-age players (N=23) …

Association Between A Lifestyle Medicine Score And Stroke In U.S. Adults With Hyperglycemia: 2007- 2010 Nhanes, Swarnima Naithani

UNF Graduate Theses and Dissertations

The relationship between glycemic control and cardiovascular disease (CVD) is well- established, however, lifestyle modifications to prevent CVD warrant further investigation. Purpose: This study aimed to evaluate the relationship between adherence to the six lifestyle medicine pillars promoted by the American College of Lifestyle Medicine and stroke in U.S. adults with hyperglycemia. A lifestyle medicine composite score (LMS) was developed to quantify adherence with the hypothesis that a higher LMS (greater adherence to lifestyle recommendations) correlates with lower odds of stroke in adults with hyperglycemia. Methods: The study sample (n=2,079) included adult (≥ 40 years of age) participants in the …

Gastrointestinal Symptoms Associated With Sodium Bicarbonate Supplementation Protocols: A Systematic Review, Ian P. Winter, Paul Sarac, Patrick B. Wilson

Exercise Science Faculty Publications

Sodium bicarbonate positively impacts performance, but its associated gastrointestinal symptoms (GIS) may limit use. This systematic review synthesized literature that has evaluated GIS with sodium bicarbonate supplementation. Literature searches were performed from February 2024-March 2026. Eligible studies provided ≥ 5 g of sodium bicarbonate within a 24-h period or, if a multi-day protocol, at least one day involving ≥ 5 g. Included studies had a placebo group/condition or a comparison group/condition that created a contrast related to delivery method, form, or dose. In total, 101 investigations were summarized in six categories: acute single dosing (n = 35); acute spread dosing …

Healthcare Provider Perspectives On A Clinical Decision Tool To Support Individualized Exercise Prescriptions And Discussions For Breast Cancer Survivors, Jinani Jayasekera, Oliver W. A. Wilson, Kaitlyn M. Wojcik, Eleanor M. Kerr, Rachelle Brick, David Berrigan, Jennifer Yeong-Shin Sheng, Takeo Fujii, Kathleen Thomas, Henri K. Parson, Padma Sheila Rajagopal, Richard L. Street Jr.

Department of Medicine Faculty Publications

Purpose: We evaluated healthcare providers' current knowledge, practices, and perspectives on a novel clinical decision tool (beta-version) to facilitate individualized exercise prescriptions and discussions in clinical settings.

Methods: We recruited healthcare providers who had treated or provided care to breast cancer survivors aged >= 35-years in the past 12 months. The participants were presented with a tool to provide individualized exercise recommendations considering women's individual, clinical, and contextual characteristics. Validated and reliable pre-existing instruments were used to survey providers' current knowledge, practices regarding exercise discussions, and perspectives on the beta-version (paper-draft) of the novel tool.

Results: The sample consisted of …

The Epidemiology Of Catastrophic Head And Neck Injuries In High School And College Non-Football Sports: A 4-Decade Review, Courtney M. Meyer, Kristen L. Kucera, Samantha E. Scarneo-Miller, Zachary K. Winkelmann, Susan W. Yeargin

Rehabilitation Sciences Faculty Publications

Background:

Catastrophic head and neck injuries (CHNIs) in sport are rare but can have disabling or fatal outcomes. Prior studies have focused on football, equipment-laden sports, or different injury severities, not CHNI in nonfootball sports.

Purpose:

To describe the epidemiology of CHNI across levels (high school vs collegiate) in nonfootball sports and evaluate differences in injury rates (IRs) by sport, sex, and decade.

Study Design

Descriptive epidemiological study.

Methods:

This study utilized 40 academic years (1982-1983 to 2021-2022) of surveillance data from the National Center for Catastrophic Sports Injury Research. Descriptive statistics summarized athlete, event, and injury characteristics. IRs were …

The Effects Of Physical Activity Timing And Adherence To Physical Activity Guidelines On Sleep In Children With Adhd, Xiao Liang, Mengping Zhao, Li Su, Justin A. Haegele, Richard H. Xu, Jingjing Li, Andy Choi-Yeung Tse, Shirley X. Li

Human Movement Studies & Special Education Faculty Publications

Regular physical activity (PA) has been shown to benefit sleep. However, the effects of PA timing and adherence to the WHO's recommended 60-min moderate-to-vigorous physical activity (MVPA) guideline on sleep are unclear, especially for children with ADHD who often experience sleep problems. This study examined whether timing of MVPA influenced objectively measured sleep, including sleep latency (SL), sleep efficiency (SE), total sleep time (TST), and wake after sleep onset (WASO), among children with ADHD. This cross-sectional study involved 253 children with ADHD (Mage = 8.60 ± 1.31 years, 81% boys). MVPA timing was categorized as more than 8 h before …

Organized Sports-Based Interventions And Motor Outcomes In Children Diagnosed With Autism Spectrum Disorder: A Systematic Review, Kailash Ram, Maeren Hill, Caitlyn Stewart, Kaitlin P. Hardy Md, Sonia Khurana

Rehabilitation Sciences Faculty Publications

Aim

To evaluate the effectiveness of organized sports-based interventions on motor outcomes in children with autism spectrum disorder (ASD).

Method

Four databases were searched from inception to November 2025 for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) reporting motor outcomes of organized sports-based interventions in children with ASD. Risk of bias was evaluated using ROB-2 (Cochrane Risk of Bias Tool, Version Two) for RCTs and ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) for NRCTs.

Results

Eleven studies (six RCTs, five NRCTs) were included and categorized as martial arts (n = 5), aquatic training (n = …

Cv: Catherine Bohlin (Exercise Science), Catherine Bohlin

Rehabilitation and Health Sciences Department Faculty Curricula Vitae

No abstract provided.

Cv: Catherine Bohlin (Exercise Science), Catherine Bohlin

Health Sciences Department Curricula Vitae

No abstract provided.

Knee Injury Prevention Program In An Early Pubertal Female Athlete During A Recreational Softball Season, Doug W. Dendy, Toby Brooks, C Roger James, Micah Lierly

Topics in Exercise Science and Kinesiology

Topics in Exercise Science and Kinesiology Volume 6: Issue 1, Article 12, 2025. This case study was intended to analyze the impact of a knee injury prevention program (KIPP) for a young female athlete in a short recreational softball season. It was hypothesized that initiating a KIPP early within a recreational sports season would positively alter lower extremity biomechanics, subsequently reducing the risk of knee injuries during and after skeletal development. During a recreational softball season, a 13-year-old female athlete completed a preliminary biomechanical test, the drop vertical jump battery (DVJB_pre), underwent a 7-week in-season KIPP, then was …

Effects Of Ghost Energy Drink On Muscle Strength, Psychomotor Vigilance, And Mood., Jason M. Curtis, Jose J. Rojas, Flavia F. Pereira, Cassandra Evans, Elizabeth Espocito, Alyana Andal Andal, Gavin Poulshock, Hena Thakkar, Taila De Castro, Alexandra Jimenez, Antonio Cristanti, Antonella V. Schwarz, Juan Carlos Santana, Jose Antonio

Journal for Sports Neuroscience

Abstract

Background: This study aimed to evaluate the effects of a commercially available energy drink (Ghost®) compared to a caffeine-matched control on measures of mental and physical performance.

Methods: In a randomized, double-blind design, 62 participants were assigned to receive either the energy drink (Ghost®) or a caffeine-matched control (200 mg caffeine). Assessments were conducted at baseline and approximately 45 minutes post-ingestion, including the Psychomotor Vigilance Test (PVT), CNS Tap Test, handgrip strength, and the Profile of Mood States (POMS).

Results: Participant demographics are presented in Table 1. No significant between-group differences were observed for any performance measures. Both groups …

Host-Intrinsic Factors Determine Anti-Tumor Efficacy Of Exercise In Pancreatic Ductal Adenocarcinoma, Sumedha Pareek

Dissertations and Theses (Open Access)

Pancreatic Ductal Adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths with a low 5-year relative survival rate of approximately 13.3% for all stages combined. We have previously shown that exercise can improve quality of life and enhance functional capacity among patients with PDAC. Exercise induces a variety of changes in the tumor microenvironment with beneficial effects in several tumor types. However, our understanding of the clinical effects of exercise and the mechanisms that mediate anti-tumor effects are limited in pancreatic cancer.

In this project, using C57BL/6 mice from Taconic Biosciences (Tac) and Jackson Laboratories (Jax), we established a …

Investigating The Cardiovascular And Autonomic Responses To Energy Drink Consumption: The Role Of Energy And Calorie Content, Sophia Schmidt

Honors Theses

Energy drinks (EDs) are among the most consumed functional beverages, often marketed to enhance focus, alertness, and physical performance. Despite their popularity, the combined cardiovascular and autonomic effects of caffeine and sugar during exercise remain poorly understood. The purpose of this study was to examine the acute cardiovascular, metabolic, and autonomic responses to sugar-sweetened (ED-S), non-nutritive sweetened (ED-NNS), and placebo beverages during submaximal cycling in healthy young males.

Nine male participants (age 22.2 ± 2.4 yrs; BMI 26.2 ± 2.9 kg/m²) completed three experimental visits in a randomized, repeated-measures design. Each visit involved ingestion of one drink (ED-S, ED-NNS, or …

Single Vs. Whole Muscle Group Assessments: Does The Specific Muscle Influence Its Association With Performance?, Carina M. Velasquez, Kealey J. Wohlgemuth, Mckenzie M. Hare, Kathryn E. Southall, Jacob A. Mota

Topics in Exercise Science and Kinesiology

Topics in Exercise Science and Kinesiology Volume 6: Issue 1, Article 11, 2025. Biometric Muscle size and echo intensity are thought to influence muscle function. Unfortunately, previous works often will examine a single muscle from a group of agonists as a metric of whole muscle performance. This approach may not always be the most appropriate to assess performance outcomes. The purpose of the study was to 1) quantify the association of muscle size and echo intensity with vertical jump performance (VJ), 2) Compare the associations between individual and whole muscle group size and echo intensity, 3) determine whether single or …

Differences In Dieting Behavior In Athletic Trainers, Emily Madrak, Ki L. Cole, Bridget M. Miller, Jennifer L. Volberding

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: Athletic trainers (ATs) have a foundational knowledge in many facets of health, including optimization of wellness. Though ATs may be actively trying to improve their own health, societal pressure can have a large impact on behavior. The purpose of this study was to identify differences between gender and years-certified in diet patterns in ATs. Methods: A cross-sectional survey was distributed to 2500 National Athletic Training Association members, It included a demographics section and five-item researcher-created questions regarding diet. Chi-square tests of independence were used to determine the relationship. Results: Significance was determined for gender and question 2, “Have …

Comparing Lower Extremity Kinematics Using Trazer And Inertial Motion Capture Systems, Gabriella Juoza-Clark Spt, Joellen Carter Spt, Nikki Stam Spt, Kevin Robinson Pt, Dsc, Ocs

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: This study assessed the validity of a non-immersive body motion tracking system (TRAZER) as an alternative to using Inertial Measurement Units (IMU)-based motion capture (MyoMotion) for lower extremity kinematic analysis. Methods: Twenty healthy participants (10 females, 10 males) with a mean age of 24.03 years (range: 20-33 years) and a mean BMI of 25.15 kg/m² (range: 18.45-32.23 kg/m²) performed double and single-leg squats. Data Analysis: Kinematic data from TRAZER and MyoMotion IMUs were compared using a mixed two-way ANOVA. Results: No significant differences were observed in knee flexion data across all movements (p > 0.05) and knee abduction during the …

Parameters Of Suspension Training On Core Performance: A Critically Appraised Topic, Sara Stiltner, Andrea Cripps

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Clinical Scenario: The core is a functional unit connecting the upper and lower extremities consisting of abdominal, back, and hip musculature. A highly functional core is essential within the kinetic chain and aids in injury prevention and rehabilitation. Traditional means of core stability training are performed on a stable surface. An emerging mode of core training is suspension training (ST), which utilizes a movement paired with instability to challenge the core stabilizers and increase motor unit recruitment.The purpose of suspension training is to increase muscle activation in core stabilizer’s, while mimicking functional movements.It was the purpose of this research to …

The Impact Of Athletic Retirement On Anxiety In Elite Athletes, A Critically Appraised Topic, Jordan Gorham, Emily Madrak

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Though there is growing interest in athletic mental health, this interest appears to diminish significantly once an athlete enters athletic retirement. The abrupt transition can precipitate mental health struggles, exacerbated by the lack of adequate preparation for lifestyle after retirement and the attachment of athletic identity to their sport. Consequently, these circumstances may increase symptoms associated with poor mental health, with a specific focus on anxiety. As the athlete retires and moves into different stages of life, research notes that athletes with stronger athletic identities have poorer mental health than those who had weaker athletic identity^. While the scrutiny …

Comparing Position Specific Gps Normative Data In Professional Female Club Soccer, Andy Seraphin, Christi Edson, Cory Price, Barrett Jones, Amanda Jagielo, Justin Mullner

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Objective: To establish normative ranges in common performance tests for professional women’s club soccer. Setting:1^st division professional women’s soccer club in the United States

Participants: Twenty-eight healthy professional women’s soccer players (Age: 27.8 ± 5.1 years; Body Mass: 66.2 ± 6.7 kg). Main Outcome Measures: Season GPS data was analyzed and metrics included minutes, total distance, high speed running, total accelerations, total decelerations, and maximum speed. Statistical analysis was performed to determine differences between positions. Results: Statistically significant differences were found across all metrics in comparison to overall mean. Differences in each metric may be due to a …