Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons

Open Access. Powered by Scholars. Published by Universities.®

Articles 1 - 23 of 23

Full-Text Articles in Medicine and Health Sciences

Feasibility Of Continuous Fever Monitoring Using Wearable Devices, Benjamin L. Smarr, Kirstin Aschbacher, Sarah M. Fisher, Anoushka Chowdhary, Stephan Dilchert, Karena Puldon, Adam Rao, Frederick M. Hecht, Ashley E. Mason Dec 2020

Feasibility Of Continuous Fever Monitoring Using Wearable Devices, Benjamin L. Smarr, Kirstin Aschbacher, Sarah M. Fisher, Anoushka Chowdhary, Stephan Dilchert, Karena Puldon, Adam Rao, Frederick M. Hecht, Ashley E. Mason

Publications and Research

Elevated core temperature constitutes an important biomarker for COVID-19 infection; however, no standards currently exist to monitor fever using wearable peripheral temperature sensors. Evidence that sensors could be used to develop fever monitoring capabilities would enable large-scale health-monitoring research and provide high-temporal resolution data on fever responses across heterogeneous populations. We launched the TemPredict study in March of 2020 to capture continuous physiological data, including peripheral temperature, from a commercially available wearable device during the novel coronavirus pandemic. We coupled these data with symptom reports and COVID-19 diagnosis data. Here we report findings from the first 50 subjects who reported …


Trypanosoma Cruzi Modulates Piwi-Interacting Rna Expression In Primary Human Cardiac Myocytes During The Early Phase Of Infection, Kayla J. Rayford, Ayorinde Cooley, Ashutosh Arun, Girish Rachakonda, Yulia Kleschenko, Fernando Villalta, Siddharth Pratap, Maria F. Lima, Pius N. Nde Dec 2020

Trypanosoma Cruzi Modulates Piwi-Interacting Rna Expression In Primary Human Cardiac Myocytes During The Early Phase Of Infection, Kayla J. Rayford, Ayorinde Cooley, Ashutosh Arun, Girish Rachakonda, Yulia Kleschenko, Fernando Villalta, Siddharth Pratap, Maria F. Lima, Pius N. Nde

Publications and Research

Trypanosoma cruzi dysregulates the gene expression profile of primary human cardiomyocytes (PHCM) during the early phase of infection through a mechanism which remains to be elucidated. The role that small non-coding RNAs (sncRNA) including PIWI-interacting RNA (piRNA) play in regulating gene expression during the early phase of infection is unknown. To understand how T. cruzi dysregulate gene expression in the heart, we challenged PHCM with T. cruzi trypomastigotes and analyzed sncRNA, especially piRNA, by RNA-sequencing. The parasite induced significant differential expression of host piRNAs, which can target and regulate the genes which are important during the early infection phase. An …


Pandemic Vibrio Cholerae Shuts Down Site-Specific Recombination To Retain An Interbacterial Defence Mechanism, Francis J. Santoriello, Lina Michel, Daniel Unterweger, Stefan Pukatzki Dec 2020

Pandemic Vibrio Cholerae Shuts Down Site-Specific Recombination To Retain An Interbacterial Defence Mechanism, Francis J. Santoriello, Lina Michel, Daniel Unterweger, Stefan Pukatzki

Publications and Research

Vibrio cholerae is an aquatic microbe that can be divided into three subtypes: harmless environmental strains, localised pathogenic strains, and pandemic strains causing global cholera outbreaks. Each type has a contact-dependent type VI secretion system (T6SS) that kills neighbouring competitors by translocating unique toxic effector proteins. Pandemic isolates possess identical effectors, indicating that T6SS effectors may affect pandemicity. Here, we show that one of the T6SS gene clusters (Aux3) exists in two states: a mobile, prophage-like element in a small subset of environmental strains, and a truncated Aux3 unique to and conserved in pandemic isolates. Environmental Aux3 can be readily …


An Investigation Into The Response Of The Us And Eu5 To The Covid-19 Disease (Convergence Of Two Pandemics: Covid-19 And Ncds), Omar Hassan Dec 2020

An Investigation Into The Response Of The Us And Eu5 To The Covid-19 Disease (Convergence Of Two Pandemics: Covid-19 And Ncds), Omar Hassan

Publications and Research

In late December 2019, a coronavirus disease (COVID-19) was identified in Wuhan China. COVID-19 was a result of the novel severe acute respiratory syndrome coronavirus 2 (SARA-CoV-2), which has resulted in a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. As of October 6, 2020, SARS-CoV-2 has affected more than 200 countries, resulting in more than 35 million identified cases with more than 1 million confirmed deaths.

This is a cross-sectional, non-interventional, observational study in patients infected with the novel coronavirus (SARS-CoV-2) or Covid-19, using John Hopkins University database JHU Coronavirus map. The data collected from …


Automatic Covid-19 Lung Infected Region Segmentation And Measurement Using Ct-Scans Images, Adel Oulefki, Sos Agaian, Thaweesak Trongtirakul, Azzeddine Kassah Laouar Nov 2020

Automatic Covid-19 Lung Infected Region Segmentation And Measurement Using Ct-Scans Images, Adel Oulefki, Sos Agaian, Thaweesak Trongtirakul, Azzeddine Kassah Laouar

Publications and Research

History shows that the infectious disease (COVID-19) can stun the world quickly, causing massive losses to health, resulting in a profound impact on the lives of billions of people, from both a safety and an economic perspective, for controlling the COVID-19 pandemic. The best strategy is to provide early intervention to stop the spread of the disease. In general, Computer Tomography (CT) is used to detect tumors in pneumonia, lungs, tuberculosis, emphysema, or other pleura (the membrane covering the lungs) diseases. Disadvantages of CT imaging system are: inferior soft tissue contrast compared to MRI as it is X-ray-based Radiation exposure. …


From Ace2 To Covid-19: A Multiorgan Endothelial Disease, Richard A. Stein, Lauren M. Young Nov 2020

From Ace2 To Covid-19: A Multiorgan Endothelial Disease, Richard A. Stein, Lauren M. Young

Publications and Research

Editorial


Gestational Diabetes Status And Dietary Intake Modify Maternal And Cord Blood Allostatic Load Markers, Chauntelle Jack-Roberts, Patricia Maples, Betul Kalkan, Kaydine Edwards, Ella Gilboa, Ikhtiyor Djuraev, Shuli Zou, Lori Hoepner, Lawrence Fordjour, Wen-Ching Lee, John Kral, Mudar Dalloul, Xinyin Jiang Oct 2020

Gestational Diabetes Status And Dietary Intake Modify Maternal And Cord Blood Allostatic Load Markers, Chauntelle Jack-Roberts, Patricia Maples, Betul Kalkan, Kaydine Edwards, Ella Gilboa, Ikhtiyor Djuraev, Shuli Zou, Lori Hoepner, Lawrence Fordjour, Wen-Ching Lee, John Kral, Mudar Dalloul, Xinyin Jiang

Publications and Research

Introduction: Allostatic load (AL) defines cardiometabolic, inflammatory, and neuroendocrine changes in the body in response to internal and external stressors. It is largely unknown whether gestational diabetes mellitus (GDM) alters maternal and fetal AL, which in turn affects GDM outcomes. Whether dietary intakes and quality can modify AL and thus influence GDM progression is also unknown.

Research: design and methods In this study, we recruited 35 GDM and 30 non-GDM women in gestational week 25–33. Fasting blood samples were collectedat enrollment, and cord venous blood samples were collected at delivery for the measurement of a series of AL biomarkers to …


A Body Shape Index Significantly Predicts Mri-Defined Abdominal Adipose Tissue Depots In Non-Obese Asian Indians With Type 2 Diabetes Mellitus, Shajith Anoop, Jesse Krakauer, Nir Krakauer, Anoop Misra Oct 2020

A Body Shape Index Significantly Predicts Mri-Defined Abdominal Adipose Tissue Depots In Non-Obese Asian Indians With Type 2 Diabetes Mellitus, Shajith Anoop, Jesse Krakauer, Nir Krakauer, Anoop Misra

Publications and Research

Introduction: We aimed to determine the correlations of volumes of subcutaneous abdominal adipose tissue (SCAT) (anterior, posterior, superficial and deep), total SCAT, intraperitoneal adipose tissue, retroperitoneal abdominal adipose tissue (RPAT), total intra-abdominal adipose tissue (IAAT), pancreatic volume, liver span, total body fat (TBF) and truncal fat mass (TFM) with anthropometric indices, viz., A Body Shape Index (ABSI), Hip Index, their Z scores and Anthropometric Risk Index in non-obese (body mass index (BMI) /m2) Asian Indians with type 2 diabetes mellitus (T2DM).

Research design and methods: Non-obese patients with T2DM (cases; n, 85) and BMI-matched, healthy subjects …


Soluble Neprilysin And Long-Term Clinical Outcomes In Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study, Ik Jun Choi, Sungmin Lim, Youngdeok Hwang, Dongjae Lee, Won Jik Lee, Kwan Yong Lee, Mi-Jeong Kim, Doo Soo Jeon Aug 2020

Soluble Neprilysin And Long-Term Clinical Outcomes In Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study, Ik Jun Choi, Sungmin Lim, Youngdeok Hwang, Dongjae Lee, Won Jik Lee, Kwan Yong Lee, Mi-Jeong Kim, Doo Soo Jeon

Publications and Research

Background: Neprilysin has an essential role in regulating fluid balance and vascular resistance, and neprilysin inhibitors have shown beneficial effects in patients with heart failure. However, the potential predictive value of neprilysin levels as a biomarker for cardiovascular risk remains unclear. The aim of this study was to assess the prognostic value of soluble neprilysin (sNEP) levels in patients with ischemic heart disease.

Methods: Neprilysin levels were measured in 694 consecutive patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). These patients were classified into two groups according to their serum levels of neprilysin and categorized into the …


Neurological Symptoms Due To Coronavirus Disease 2019, Farage Ftiha, Moshe Shalom, Henry Jradeh Jul 2020

Neurological Symptoms Due To Coronavirus Disease 2019, Farage Ftiha, Moshe Shalom, Henry Jradeh

Publications and Research

In this review, we focus on summarizing everything that is known about the neurological effects of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2). It has been shown that Coronavirus Disease 2019 (Covid-19) may result in neuromuscular disorders or damage to nerves outside of the brain and spinal cord, which may lead to weakness, numbness, and pain. Published literature has stated that SARS-COV-1 may infect the central nervous system and due to its similarities to SARS-COV-2, we suspect that SARS-COV-2 has the same potential. We conclude that Covid-19 has neurological manifestations. Further research should be done in this field to understand …


Neuroinvasion, Neurotropic, And Neuroinflammatory Events Of Sars-Cov-2: Understanding The Neurological Manifestations In Covid-19 Patients, Yassine Yachou, Abdeslem El Idrissi, Vladimir Belapasov, Said Ait Benali Jul 2020

Neuroinvasion, Neurotropic, And Neuroinflammatory Events Of Sars-Cov-2: Understanding The Neurological Manifestations In Covid-19 Patients, Yassine Yachou, Abdeslem El Idrissi, Vladimir Belapasov, Said Ait Benali

Publications and Research

Respiratory viruses are opportunistic pathogens that infect the upper respiratory tract in humans and cause severe illnesses, especially in vulnerable populations. Some viruses have neuroinvasive properties and activate the immune response in the brain.These immune events may be neuroprotective or they may cause long-term damage similar to what is seen in some neurodegenerative diseases. The new “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is one of the Respiratory viruses causing highly acute lethal pneumonia coronavirus disease 2019 (COVID-19) with clinical similarities to those reported in “Severe Acute Respiratory Syndrome Coronavirus” (SARS-CoV) and the “Middle East Respiratory SyndromeCoronavirus” (MERS-CoV) including neurological …


Thrombospondin-1 Plays An Essential Role In Yes-Associated Protein Nuclear Translocation During The Early Phase Of Trypanosoma Cruzi Infection In Heart Endothelial Cells, Ashutosh Arun, Kayla J. Rayford, Ayorinde Cooley, Girish Rachakonda, Fernando Villalta, Siddharth Pratap, Maria F. Lima, Nader Sheibani, Pius N. Nde Jul 2020

Thrombospondin-1 Plays An Essential Role In Yes-Associated Protein Nuclear Translocation During The Early Phase Of Trypanosoma Cruzi Infection In Heart Endothelial Cells, Ashutosh Arun, Kayla J. Rayford, Ayorinde Cooley, Girish Rachakonda, Fernando Villalta, Siddharth Pratap, Maria F. Lima, Nader Sheibani, Pius N. Nde

Publications and Research

The protozoan parasite Trypanosoma cruzi is the causative agent of Chagas disease. This neglected tropical disease causes severe morbidity and mortality in endemic regions. About 30% of T. cruzi infected individuals will present with cardiac complications. Invasive trypomastigotes released from infected cells can be carried in the vascular endothelial system to infect neighboring and distant cells. During the process of cellular infection, the parasite induces host cells, to increase the levels of host thrombospondin-1 (TSP-1), to facilitate the process of infection. TSP-1 plays important roles in the functioning of vascular cells, including vascular endothelial cells with important implications in cardiovascular …


Lower Practice Effects As A Marker Of Cognitive Performance And Dementia Risk: A Literature Review, Roos J. Jutten, Evan Grandoit, Nancy S. Foldi, Sietske A. M. Sikkes, Richard N. Jones, Seo-Eun Choi, Melissa L. Lamar, Diana K. N. Louden, Joanne Rich, Douglas Tommet, Paul K. Crane, Laura A. Rabin Jul 2020

Lower Practice Effects As A Marker Of Cognitive Performance And Dementia Risk: A Literature Review, Roos J. Jutten, Evan Grandoit, Nancy S. Foldi, Sietske A. M. Sikkes, Richard N. Jones, Seo-Eun Choi, Melissa L. Lamar, Diana K. N. Louden, Joanne Rich, Douglas Tommet, Paul K. Crane, Laura A. Rabin

Publications and Research

Background: Practice effects (PEs) are improvements in performance after repeated exposure to test materials, and typically viewed as a source of bias in repeated cogni- tive assessments. We aimed to determine whether characterizing PEs could also pro- vide a useful marker of early cognitive decline.

Methods: We conducted a systematic review of the literature, searching PsycInfo (Ebsco) and PubMed databases for articles studying PEs in aging and dementia pop- ulations. Articles published between 1920 and 2019 were included.

Result: We identified 259 articles, of which 27 studied PEs as markers of cognitive performance. These studies consistently showed that smaller, less-robust …


Medical Resource Use And Costs Of Treating Sickle Cell-Related Vaso-Occlusive Crisis Episodes: A Retrospective Claims Study, Nirmish Shah, Menaka Bhor, Lin Xie, Jincy Paulose, Huseyin Yuce Jun 2020

Medical Resource Use And Costs Of Treating Sickle Cell-Related Vaso-Occlusive Crisis Episodes: A Retrospective Claims Study, Nirmish Shah, Menaka Bhor, Lin Xie, Jincy Paulose, Huseyin Yuce

Publications and Research

Background: The study investigated the economic burden of vaso-occlusive crisis (VOC) among sickle cell disease (SCD) patients, through assessment of overall utilization and costs and costs per VOC episode (regarding the number of VOC episodes and health care setting, respectively).

Methods: Using the Medicaid Analytic Extracts database, the first SCD-related diagnosis claim (index claim) between June 1, 2009–December 31, 2012 was identified among eligible adults. Patients were required to have continuous medical and pharmacy benefits for 6 months pre- and 12 months post-index. Discrete VOC claims identified within a 3-day gap were combined as a single VOC episode. Annual all-cause …


A Role For Retinoids In The Treatment Of Covid-19?, Steven E. Trasino May 2020

A Role For Retinoids In The Treatment Of Covid-19?, Steven E. Trasino

Publications and Research

The 2020 global outbreak of the novel coronavirus (SARS-CoV-2 or COVID-19) is a serious threat to international health, and thus, there is an urgent need for discoverynof novel therapies or use of repurposed drugs that can make a significant impact on slowing the spread of the virus. Type 1 interferons (IFN-I) are a family cytokines of the early innate immune response to viruses that are being tested against SARSCoV- 2. However, coronaviruses similar to SARS-CoV-2 can suppress host IFN-I antiviral responses. Retinoids are a family molecules related to vitamin A that possess robust immune-modulating properties, including the ability to increase …


Twenty-Seven Questions For Writers & Journalists To Consider When Writing About Covid-19 & Hiv/Aids, Alexandra Juhasz, Pato Hebert, Theodore Kerr, Diana Cage May 2020

Twenty-Seven Questions For Writers & Journalists To Consider When Writing About Covid-19 & Hiv/Aids, Alexandra Juhasz, Pato Hebert, Theodore Kerr, Diana Cage

Publications and Research

The desire to compare COVID-19 and HIV/AIDS is understandable. The response to HIV provides an inspiring road map for how to save lives. For over four decades, starting in the early 1980s, activists, scientists, politicians and cultural producers have been working alongside one another resulting in life saving developments—and goals not yet achieved. Since the late 1990s, HIV has become a manageable chronic illness for those with access to life saving medicine, housing, food, and social support. Meanwhile, stigma, discrimination, and criminalization directed at people living with HIV continue, based on social difference, access to resources and community, and an …


In Vivo Data: Treatment With The F11r/Jam-A Peptide 4d Decreases Mortality And Reduces The Generation Of Atherosclerotic Plaques In Apoe-Deficient Mice, Anna Babinska, Cristina C. Clement, Yan Li, Joanna Wzorek, Tomasz Przygodzki, Marcin Talar, Marcin Braun, Maria Swiatkowska, Yigal H. Ehrlich, Elizabeth Kornecki, Cezary Watala, Moro O. Salifu Apr 2020

In Vivo Data: Treatment With The F11r/Jam-A Peptide 4d Decreases Mortality And Reduces The Generation Of Atherosclerotic Plaques In Apoe-Deficient Mice, Anna Babinska, Cristina C. Clement, Yan Li, Joanna Wzorek, Tomasz Przygodzki, Marcin Talar, Marcin Braun, Maria Swiatkowska, Yigal H. Ehrlich, Elizabeth Kornecki, Cezary Watala, Moro O. Salifu

Publications and Research

The data in this article focus on the F11 Receptor (F11R/JAM-A; Junctional Adhesion Molecule-A; JAM-A, F11R), a cell adhesion protein constitutively expressed on the membrane surface of circulating platelets and localized within the tight junctions of healthy endothelial cells (ECs). Previous reports have shown that F11R/JAM-A plays a critical role in the adhesion of platelets to an inflamed endothelium due to its’ pathological expression on the luminal surface of the cytokine-inflamed endothelium. Since platelet adhesion to an inflamed endothelium is an early step in the development of atherosclerotic plaque formation, and with time, resulting in heart attacks and stroke, we …


Combating Sars-Cov-2: Leveraging Microbicidal Experiences With Other Emerging/Re-Emerging Viruses, M. Khalid Ijaz, Syed A. Sattar, Joseph R. Rubino, Raymond W. Nims, Charles P. Gerba Apr 2020

Combating Sars-Cov-2: Leveraging Microbicidal Experiences With Other Emerging/Re-Emerging Viruses, M. Khalid Ijaz, Syed A. Sattar, Joseph R. Rubino, Raymond W. Nims, Charles P. Gerba

Publications and Research

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan City, China, late in December 2019 is another example of an emerging zoonotic virus that threatens public health and international travel and commerce. When such a virus emerges, there is often insufficient specific information available on mechanisms of virus dissemination from animal to human or from person to person, on the level or route of infection transmissibility or of viral release in body secretions/excretions, and on the survival of virus in aerosols or on surfaces. The effectiveness of available virucidal agents and hygiene practices as interventions for disrupting …


Managing The Threat Of Covid-19, Susan H. Davide, Anty Lam, Christine Macarelli Apr 2020

Managing The Threat Of Covid-19, Susan H. Davide, Anty Lam, Christine Macarelli

Publications and Research

Oral health professionals should remain up-to-date on Covid-19 to prevent its transmission in the dental practice.


A Real-World Analysis Of Patient Characteristics And Predictors Of Hospitalization Among Us Medicare Beneficiaries With Respiratory Syncytial Virus Infection, Veronique Wyffels, Furaha Kariburyo, Sandra Gavart, Roman Fleischhackl, Huseyin Yuce Feb 2020

A Real-World Analysis Of Patient Characteristics And Predictors Of Hospitalization Among Us Medicare Beneficiaries With Respiratory Syncytial Virus Infection, Veronique Wyffels, Furaha Kariburyo, Sandra Gavart, Roman Fleischhackl, Huseyin Yuce

Publications and Research

Introduction: Little has been published on respiratory syncytial virus (RSV) among Medicare patients at high risk (HR) of RSV complications due to age or comorbidity. Methods: Adult patients (at least 18 years of age) with at least 1 diagnostic code for RSV were identified using the 5% US Medicare database from 2011 through 2015. Patients were required to have continuous health plan enrollment for 180 days pre- and 180 days post-RSV diagnosis (baseline and follow-up periods, respectively). HR was defined as diagnosis of chronic lung disease, congestive heart failure, or weakened immune system for 180 days during the base-line period. …


Antibacterial, Antifungal, Antioxidant Activity And Polyphenol Content Of Aerial Parts And Bulbs Of Allium Schugnanicum., Saidbeg Satorov, F. Mirzoeva, Sh. Kurbonbekova, Sh. Satorov, M. Vakhidova, Vyacheslav Dushenkov Jan 2020

Antibacterial, Antifungal, Antioxidant Activity And Polyphenol Content Of Aerial Parts And Bulbs Of Allium Schugnanicum., Saidbeg Satorov, F. Mirzoeva, Sh. Kurbonbekova, Sh. Satorov, M. Vakhidova, Vyacheslav Dushenkov

Publications and Research

Objective: То study of antibacterial, antifungal and antioxidant activity, and content of polyphenols in the bulb and aerial parts of an endemic species of onion A. schugnanicum. Methods: An ethanol-based extract was prepared from fresh plants. Total polyphenolic content (Folin) and ABTS antioxidant capacity assays were used to characterized extracts. Extracts obtained from bulbs, peduncle, and seeds demonstrated antibacterial activity against the reference Staphylococcus aureus (ATCC 4929), Pseudomonas aeruginosa (ATCC 4930) and Klebsiella pneumoniae (ATCC 4927) strains, as well as against the hospital strains of the same types of bacteria, i.e. strains isolated from inpatient surgical patients. Results: The study …


Protecting Public Health, Susan H. Davide, Christine Macarelli, Anty Lam Jan 2020

Protecting Public Health, Susan H. Davide, Christine Macarelli, Anty Lam

Publications and Research

In light of declining vaccination rates, oral health professionals need to be knowledgeable about current vaccine recommendations so they can best advise their patients and support public health.


Leveraging Technology To Blend Large-Scale Epidemiologic Surveillance With Social And Behavioral Science Methods: Successes, Challenges, And Lessons Learned Implementing The Unite Longitudinal Cohort Study Of Hiv Risk Factors Among Sexual Minority Men In The United States, H. Jonathon Rendina, Ali J. Talan, Nicola F. Tavella, Jonathan Lopez Matos, Ruben H. Jimenez, S. Scott Jones, Brian Salfas, Drew Westmoreland Jan 2020

Leveraging Technology To Blend Large-Scale Epidemiologic Surveillance With Social And Behavioral Science Methods: Successes, Challenges, And Lessons Learned Implementing The Unite Longitudinal Cohort Study Of Hiv Risk Factors Among Sexual Minority Men In The United States, H. Jonathon Rendina, Ali J. Talan, Nicola F. Tavella, Jonathan Lopez Matos, Ruben H. Jimenez, S. Scott Jones, Brian Salfas, Drew Westmoreland

Publications and Research

The use of digital technologies to conduct large-scale research with limited interaction (i.e., no in-person contact) and objective endpoints (i.e., biological testing) has significant potential for the field of epidemiology, but limited research to date has been published on the successes and challenges of such approaches. We analyzed data from a cohort study of sexual minority men across the United States, collected using digital strategies during a 10-month period from 2017 to 2018. Overall, 113,874 individuals were screened, of whom 26,000 were invited to the study, 10,691 joined the study, and 7,957 completed all enrollment steps, including return of a …