Medicine and Health Sciences Commons^™

Professional Counseling's Alignment With The Core Competencies For Interprofessional Collaborative Practice, Kaprea F. Johnson, Miranda Mj Parries

Counseling & Human Services Faculty Publications

Previous findings show that there is a misconception of the counseling profession and a lack of awareness of their role in interprofessional collaboration; which may lead to underutilization of counselors for team based care. As an example, in 2009 six professional health related associations developed core competencies for interprofessional collaborative practice and counseling associations were not involved in the development. This manuscript introduces the profession of counseling to others in medical health professions in hopes that similarities will bridge the gap between knowledge and future collaborative practice. The manuscript shows how the profession aligns with the core competencies for interprofessional …

Walking-Induced Fatigue Leads To Increased Risk In Older Adults, S. Morrison, S. R. Colberg, H. K. Parson, S. Neumann, R. Handel, E. J. Vinik, J. Paulson, A. I. Vinik

Rehabilitation Sciences Faculty Publications

Background- For older adults, falls are a serious health problem, with more than 30% of people older than 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person's balance, walking ability, and overall falls risk is affected by performing activities of daily living such as walking.

Objective- This study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait, and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into 5 equal groups …

Handoffs, Safety Culture, And Practices: Evidence From The Hospital Survey On Patient Safety Culture, Soo-Hoon Lee, Phillip H. Phan, Todd Dorman, Sallie J. Weaver, Peter J. Pronovost

Management Faculty Publications

Background: The context of the study is the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (HSOPSC). The purpose of the study is to analyze how different elements of patient safety culture are associated with clinical handoffs and perceptions of patient safety.

Methods: The study was performed with hierarchical multiple linear regression on data from the 2010 Survey. We examine the statistical relationships between perceptions of handoffs and transitions practices, patient safety culture, and patient safety. We statistically controlled for the systematic effects of hospital size, type, ownership, and staffing levels on perceptions of patient safety. …

Sport Commitment And Purchase Intentions Of Intercollegiate Boxing Coaches And Participants, Lamar Reams

Human Movement Studies & Special Education Faculty Publications

The current study analyzed the sport commitment and purchase intentions of club level intercollegiate boxers and coaches. Participants at United States Intercollegiate Boxing Association ( USIBA) member institutions ( N = 155) completed an online survey answering questions regarding their sport commitment and future equipment purchase intentions. Multivariate analysis discovered significant sport commitment differences among boxers and coaches, Wilk's Lambda =.838, F ( 7, 125) = 3.46, p

Examining Consumer Perceptions Of Demand-Based Ticket Pricing In Sport, Stephen L. Shapiro, Joris Drayer, Brendan Dwyer

Human Movement Studies & Special Education Faculty Publications

Dynamic ticket pricing (DTP), a new revenue management (RM) strategy in sport, has grown in popularity in response to the demand-based ticket resale market. Previous research has examined the relationship between the primary and secondary ticket market and determinants of price in a DTP environment. However, research has not focused on consumer perceptions of DTP or resale prices. The purpose of this study was to examine consumer perceptions of demand-based pricing over time, to assess the influence of attitudes on perceived value and purchase intentions. Results indicated that time, team performance expectations, fairness perceptions, seat location, and ticket market influenced …

Examining The Role Of Price Fairness In Sport Consumer Ticket Purchase Decisions, Stephen L. Shapiro, Brendan Dwyer, Joris Drayer

Human Movement Studies & Special Education Faculty Publications

Ticket pricing in professional sports is transitioning from a cost-based to demand-based approach. It has been argued that consumer perceptions of fairness regarding demand-based ticket pricing could influence purchase decisions. Perceptions of unfair pricing practices can lead to dissatisfaction and negatively affect purchase behavior. However, familiarity with demand-based pricing strategies could mitigate perceptions that real-time price fluctuations are unfair to the consumer. Guided by transaction utility theory, the current study examined the relationship between various ticket offers, consumer perceptions of fairness, familiarity, and intentions to purchase professional sports tickets. The findings support previous theory suggesting perceptions of fairness and purchase …

Assessment Of Mass Fatality Preparedness And Response Content In Dental Hygiene Education, Ann M. Bruhn, Tara L. Newcomb, Manasi Sheth-Chandra

Dental Hygiene Faculty Publications

When mass fatality incidents (MFIs) occur, they can quickly overwhelm local, state, and government agencies, resources, and personnel. It is important to have a rapid and effective response with skilled, multidisciplinary victim identification teams since specific skill sets are necessary to participate in mass fatality preparedness and response. The aims of this study were to determine the extent of formal education related to mass fatality preparedness and response training in U.S. dental hygiene programs and to assess program directors' perceptions of the need for such training. A 23-item cross-sectional survey was emailed to 319 U.S. dental hygiene programs in 2015. …

Bisphenol-A And Sleep Adequacy Among Adults In The National Health And Nutrition Examination Surveys, Hind A. Beydoun, May A. Beydoun, Hueiwang Anna Jeng, Alan B. Zonderman, Shaker M. Eid

Community & Environmental Health Faculty Publications

Study Objectives: To evaluate bisphenol-A (BPA) level and its relationship to sleep adequacy in a nationally representative sample of U.S. adults.
Methods: A population-based cross-sectional study was conducted using 2005-2010 National Health and Nutrition Examination Survey whereby data were collected using in-person interviews, physical examination and laboratory testing. BPA level was measured in urine samples and analyzed as loge-transformed variable and in quartiles (< 0.9 ng/mL; 0.9 to < 1.9 ng/mL; 1.9 to < 3.7 ng/mL; 3.7+ ng/mL). Sleep adequacy was operationalized with three questions: "How much sleep do you usually get at night on weekdays or workdays?", "Have you ever told a doctor or other health professionals that you have trouble sleeping?" and "Have you ever been told by a doctor or other health professional that you have a sleep disorder?" Sleep duration was further categorized as (< 6 h, ≥ 6 h); (< 7 h, 7-8 h, > 8 h); (< 5 h, 5-6 h, 7-8 h, ≥ 9 h). Linear, binary, and ordinal logistic regression models were constructed.
Results: Loge-transformed BPA level was inversely related to sleep duration defined, in hours, as a continuous variable, a dichotomous variable (≥ 6, < 6), or an ordinal variable (≥ 9, 7-8, 5-6, < 5), after adjustment for confounders. Help-seeking behavior for sleep problems and diagnosis with sleep disorders were not significantly associated with loge-transformed BPA level in fully adjusted models.
Conclusions: Loge-transformed BPA level may be associated with fewer hours of …

Effect Of Twisted Fiber Anisotropy In Cardiac Tissue On Ablation With Pulsed Electric Fields, Fei Xie, Christian W. Zemlin

Bioelectrics Publications

Background: Ablation of cardiac tissue with pulsed electric fields is a promising alternative to current thermal ablation methods, and it critically depends on the electric field distribution in the heart.

Methods: We developed a model that incorporates the twisted anisotropy of cardiac tissue and computed the electric field distribution in the tissue. We also performed experiments in rabbit ventricles to validate our model. We find that the model agrees well with the experimentally determined ablation volume if we assume that all tissue that is exposed to a field greater than 3 kV/cm is ablated. In our numerical analysis, we considered …

A Latent Profile Analysis Of Drinking Patterns Among Nonstudent Emerging Adults, Cathy Lau-Barraco, Abby L. Braitman, Amy L. Stamates, Ashley N. Linden-Carmichael

Psychology Faculty Publications

Research indicates that nonstudent emerging adults, as compared to their college-attending peers, are at higher risk for experiencing alcohol-related problems, including alcohol use disorders. The present study sought to extend the limited research on nonstudent drinking by (1) identifying sub-groups of nonstudent drinkers based on their drinking patterns and (2) determining the extent to which social-cognitive between-person factors related to drinking (i.e., social expectancies, perceived drinking norms, social drinking motivations) distinguish these sub-groups. Participants were 195 (65.1% men) nonstudent emerging adult heavy episodic drinkers recruited from the community. Mean age was 21.88 (SD = 2.08) years and 45.4% were unemployed. …

Analysis Of Ca²⁺ Mobilization Of Nanosecond Pulses In Cells, Iurii Semenov

Bioelectrics Publications

Exposure to nanosecond electric pulses (nsEPs) evokes transient rise of cytosolic free Ca²⁺ concentration ([Ca²⁺]i) in the cells. We quantified the external Ca²⁺ uptake, intracellular Ca²⁺ release and uncover interplay of these processes for CHO-K1 cells upon exposure to single 60 ns pulse in the range of amplitudes from 0 to 30 kV/cm. NsEPs are distinguished by the ability to electroporate intracellular membranes. We studied how duration of nsEPs is related to efficiency of intracellular membranes electroporation comparing ability of single 300-, 60- and 10 ns pulses to recruit Ca²⁺ from endoplasmic reticulum (ER) in respect to the uptake of …

Hydrocortisone, Vitamin C And Thiamine For The Treatment Of Severe Sepsis And Septic Shock: A Retrospective Before-After Study, Paul E. Marik, Vikramjit Khangoora, Racquel Rivera, Michael H. Hooper, John Catravas

Bioelectrics Publications

BACKGROUND: The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries.

METHODS: In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a 7-month period (treatment group) compared to a control group treated in our ICU during the preceding 7 months. The primary outcome was hospital survival. A propensity score was generated to adjust the primary outcome.

FINDINGS: There were 47 patients in both treatment and control groups with no …

The Protective Role Of Mlcp-Mediated Erm Dephosphorylation In Endotoxin-Induced Lung Injury In Vitro And In Vivo, Anita Kovacs-Kasa, Boris A. Gorshkov, Kyung-Mi Kim, Sanjiv Kumar, Stephen M. Black, David J. Fulton, Christiana Dimitropoulou, John D. Catravas, Alexander D. Verin

Bioelectrics Publications

The goal of this study was to investigate the role of MLC phosphatase (MLCP) in a LPS model of acute lung injury (ALI). We demonstrate that ectopic expression of a constitutively-active (C/A) MLCP regulatory subunit (MYPT1) attenuates the ability of LPS to increase endothelial (EC) permeability. Down-regulation of MYPT1 exacerbates LPS-induced expression of ICAM1 suggesting an anti-inflammatory role of MLCP. To determine whether MLCP contributes to LPS-induced ALI in vivo, we utilized a nanoparticle DNA delivery method to specifically target lung EC. Expression of a C/A MYPT1 reduced LPS-induced lung inflammation and vascular permeability. Further, increased expression of the …

Activation Of Dna Pattern Recognition Receptors After Plasmid Electrotransfer In Melanoma Cells And Tumors, Loree Heller, Masa Bosnjak, Katarina Znidar, Maja Cemazar

Bioelectrics Publications

(First sentence) In vivo electroporation or electrotransfer, the application of controlled electric pulses, enhances delivery of plasmid DNA to a wide variety of healthy tissues as well as tumor types.

A Dielectric Rod Antenna For Picosecond Pulse Stimulation Of Neurological Tissue, Ross A. Petrella, Karl H. Schoenbach, Shu Xiao

Bioelectrics Publications

A dielectrically loaded wideband rod antenna has been studied as a pulse delivery system to subcutaneous tissues. Simulation results applying 100-ps electrical pulse show that it allows us to generate a critical electric field for biological effects, such as brain stimulation, in the range of several centimeters. In order to reach the critical electric field for biological effects, which is similar to 20 kV/cm, at a depth of 2 cm, the input voltage needs to be 175 kV. The electric field spot size in the brain at this position is similar to 1 cm(2). Experimental studies in free space with …

A Novel Copper (Ii) Complex Identified As A Potent Drug Against Colorectal And Breast Cancer Cells And As A Poison Inhibitor For Human Topoisomerase Iiᶐ, Shayna Sandhaus, Rosella Taylor, Tiffany Edwards, Alexis Huddleston, Stephen J. Beebe, Alvin A. Holder

Bioelectrics Publications

A novel complex, [Cu(acetylethTSC)Cl]Cl · 0.25C₂H₅OH 1 (where acetylethTSC = (E)-N-ethyl-2-[1-(thiazol-2-yl)ethylidene]hydrazinecarbothioamide), was shown to have anti-proliferative activity against various colon and aggressive breast cancer cell lines. In vitro studies showed that complex 1 acted as a poison inhibitor of human topoisomerase IIᶐ which may account for the observed anti-cancer effects.

An Alignment-Free "Metapeptide" Strategy For Metaproteomic Characterization Of Microbiome Samples Using Shotgun Metagenomic Sequencing, Damon H. May, Emma Timmins-Schiffman, Molly P. Mikan, H. Rodger Harvey, Elhanan Borenstein, Brook L. Nunn, William S. Noble

OES Faculty Publications

In principle, tandem mass spectrometry can be used to detect and quantify the peptides present in a microbiome sample, enabling functional and taxonomic insight into microbiome metabolic activity. However, the phylogenetic diversity constituting a particular microbiome is often unknown, and many of the organisms present may not have assembled genomes. In ocean microbiome samples, with particularly diverse and uncultured bacterial communities, it is difficult to construct protein databases that contain the bulk of the peptides in the sample without losing detection sensitivity due to the overwhelming number of candidate peptides for each tandem mass spectrum. We describe a method for …

An In Vitro Study On The Effect Of Synthesized Tin (Iv) Complexes On Glioblastoma, Colorectal, And Skin Cancer Cell Lines, Jennie L. Williams, Lesley C. Lewis-Alleyne, Melinda Solomon, Long Nguyen, Robert Johnson, Jennifer Vital, Ping Ji, John Durant, Camille Cooper, Patrice Cagle, Patrick Martin, Don Vanderveer, William L. Jarrett, Alvin A. Holder

Chemistry & Biochemistry Faculty Publications

((E)-2-(2-hydroxybenzylideneamino)phenolato-2,2-diphenyl-6-aza-1,3-dioxa-2-stanna-[d,h]dibenzocyclononene, [Sn(Ph₂SB)] (compound 1, where Ph₂SB=(E)-2-(2-hydroxybenzylideneamino)phenolato Schiff base) and two novel compounds, [[SnPh2(F-azoSB)] (compound 2, where F-azoSB=4-((E)-(4-fluorophenyl)diazenyl)-2-((E)-(2-hydroxyphenylimino)methyl)phenolato Schiff base), [[SnPh2(sulf-azoSB)]0.125CHCl₃ (compound 3, where sulfamerazineazosalSB=4-((E)-(4-hydroxy-3-((E)-(2-hydroxyphenylimino)methyl)phenyl)diazenyl)-N-(4-methylpyrimidin-2-yl) benzenesulfonamide Schiff base), and the control compound, cisplatin (compound 4) were analysed to comparatively determine their effect on cancer cell growth. Anti-cancer properties of compounds 1-4 were examined using glioblastoma (U-1242 MG), colorectal (HT-29 and HCT-116), and skin (A431) human cancer cell lines. With regards to human glioblastoma cells, compounds 1 and 3 demonstrated anti-proliferative capacity in the cell line tested. Specifically, compounds 1 and 3 inhibited cell proliferation by 50% at …

Vanadium Toxicological Potential Versus Its Pharmacological Activity: New Developments And Research, Agnieszka Ścibior, Juan Llopis, Alvin A. Holder, Mario Altamirano-Lozano

Chemistry & Biochemistry Faculty Publications

Scibior, A., Llopis, J., Holder, A. A., & Altamirano-Lozano, M. (2016). Vanadium toxicological potential versus its pharmacological activity: New developments and research. Oxidative Medicine and Cellular Longevity, 2016, 1-2. doi: 10.1155/2016/7612347

I'M Still Standing, But I'M Not Standing Still, Janice E. Hawkins

Ellmer School of Nursing Faculty Publications

(First paragraph) When I made the decision to return to school for a PhD, I anticipated hard work, challenges, and a demanding schedule. Two years into my part-time program, I proudly informed readers of Reflections on Nursing Leadership that I was still standing and happy with my decision (Hawkins, 2014). Two years later, I'm not quite done.

Zika Virus- Emergence, Evolution, Pathology, Diagnosis, And Control: Current Global Scenario And Future Perspectives- A Comprehensive Review, Raj K. Singh, Kuldeep Dhama, Yashpal S. Malik, Muthannan A. Ramakrishnan, Kumaragurubaran Karthik, Sunil K. Joshi

Bioelectrics Publications

This review converses the Zika virus which has attained global concern due to its rapid pandemic potential and impact on humans. Though Zika virus was first isolated in 1947, till the recent large-scale outbreak which occurred in Micronesia, in 2007, the virus was placed into the innocuous pathogen category. The World Health Organization on 1 February 2016 declared it as a Public Health Emergency of International Concern.' Of the note, American as well as Pacific Island strains/isolates is relatively closer to Asian lineage strains. The African and American strains share more than 87.5% and 95% homologies with Asian strains/isolates, respectively. …

Depressive Symptoms And Alcohol-Related Problems Among College Students: A Moderated-Mediated Model Of Mindfulness And Drinking To Cope, Adrian J. Bravo, Matthew R. Pearson, Leah E. Stevens, James M. Henson

Psychology Faculty Publications

Objective: In college student samples, the association between depressive symptoms and alcohol-related problems has been found to be mediated by drinking-to-cope motives. Mindfulness-based interventions suggest that mindfulness may attenuate the conditioned response of using substances in response to negative emotional states, and trait mindfulness has been shown to be a protective factor associated with experiencing fewer alcohol-related problems. In the present study, we examined trait mindfulness as a moderator of the indirect associations of depressive symptoms on alcohol-related problems via drinking-to-cope motives. Method: Participants were undergraduate students at a large, southeastern university in the United States who drank at least …

Spatio-Temporal Progression Of Cortical Activity Related To Continuous Overt And Covert Speech Production In A Reading Task, Jonathan S. Brumberg, Dean J. Krusienski, Shreya Chakrabarti, Aysegul Gunduz, Peter Brunner, Anthony L. Ritaccio, Gerwin Schalk

Electrical & Computer Engineering Faculty Publications

How the human brain plans, executes, and monitors continuous and fluent speech has remained largely elusive. For example, previous research has defined the cortical locations most important for different aspects of speech function, but has not yet yielded a definition of the temporal progression of involvement of those locations as speech progresses either overtly or covertly. In this paper, we uncovered the spatio-temporal evolution of neuronal population-level activity related to continuous overt speech, and identified those locations that shared activity characteristics across overt and covert speech. Specifically, we asked subjects to repeat continuous sentences aloud or silently while we recorded …

Mitochondrial Function Assessed By 31p Mrs And Bold Mri In Non-Obese Type 2 Diabetic Rats, Yuchi Liu, Xunbai Mei, Jielei Li, Nicola Lai, Xin Yu

Electrical & Computer Engineering Faculty Publications

The study aims to characterize age-associated changes in skeletal muscle bioenergetics by evaluating the response to ischemia-reperfusion in the skeletal muscle of the Goto-Kakizaki (GK) rats, a rat model of non-obese type 2 diabetes (T2D). ³¹P magnetic resonance spectroscopy (MRS) and blood oxygen level-dependent (BOLD) MRI was performed on the hindlimb of young (12 weeks) and adult (20 weeks) GK and Wistar (control) rats. ³¹P-MRS and BOLD-MRI data were acquired continuously during an ischemia and reperfusion protocol to quantify changes in phosphate metabolites and muscle oxygenation. The time constant of phosphocreatine recovery, an index of mitochondrial oxidative capacity, …

Physical Activity For Adults With Visual Impairments: Impact Of Socio-Demographic Factors, Justin A. Haegele, Xihe Zhu, Jihyun Lee, Lauren J. Lieberman

Human Movement Studies & Special Education Faculty Publications

Little is known about what factors influence physical activity participation for adult-aged individuals with visual impairments. Therefore, the purpose of this study was to explore the impact of socio-demographic factors on the physical activity participation of adults with visual impairments. The international physical activity questionnaire-short form and a socio-demographic factor questionnaire were distributed to individuals with visual impairments. A total of 176 adults (M_age = 47.04, 52.8% female) completed the questionnaires. Physical activity and socio-demographic variables were analyzed descriptively and relationships were explored using correlation analysis and multiple regression analysis. On average, participants reported 413.79 minutes of moderate-to-vigorous physical …

Physical Activity/Exercise And Diabetes: A Position Statement Of The American Diabetes Association, Sheri R. Colberg, Ronald J. Sigal, Jane E. Yardley, Michael C. Riddell, David W. Dunstan, Paddy C. Dempsey

Human Movement Studies & Special Education Faculty Publications

The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes and prediabetes. Recommendations and precautions vary depending on individual characteristics and health status. In this Position Statement, we provide a clinically oriented review and evidence-based recommendations regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes.

Physical activity includes all movement that increases energy use, whereas exercise is planned, structured physical activity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and …

Physical Activity And Situational Interest In Mobile Technology Integrated Physical Education: A Preliminary Study, Xihe Zhu, Loren A. Dragon

Human Movement Studies & Special Education Faculty Publications

Background: Mobile technology permeates every aspect of student lives. The question is whether mobile technology integration can produce desirable effects in the gymnasium.

Objective: This preliminary study aimed to investigate the effects of mobile technology integration on student situational interest and physical activity fluctuation in physical education lessons.

Methods: Sixth grade students (N = 53) were randomly placed into either an experiment group by class that utilized mobile technology-integrated resources (iPad and applications), or a comparison group that did not utilize technology. Both groups received five identical physical education lessons. Student physical activity was tracked with accelerometers, and they completed …

Wake Me When It's Over- Bacterial Toxin-Antitoxin Proteins And Induced Dormancy, Nathan P. Coussens, Dayle A. Daines

Biological Sciences Faculty Publications

Toxin-antitoxin systems are encoded by bacteria and archaea to enable an immediate response to environmental stresses, including antibiotics and the host immune response. During normal conditions, the antitoxin components prevent toxins from interfering with metabolism and arresting growth; however, toxin activation enables microbes to remain dormant through unfavorable conditions that might continue over millions of years. Intense investigations have revealed a multitude of mechanisms for both regulation and activation of toxin-antitoxin systems, which are abundant in pathogenic microorganisms. This minireview provides an overview of the current knowledge regarding type II toxin-antitoxin systems along with their clinical and environmental implications.

Rnd3 As A Novel Target To Ameliorate Microvascular Leakage, Jerome W. Breslin, Dayle A. Daines, Travis M. Doggett, Kristine H. Kurtz, Flavia M. Souza-Smith, Xun E. Zhang, Mack H. Wu, Sarah Y. Yuan

Biological Sciences Faculty Publications

Background -Microvascular leakage of plasma proteins is a hallmark of inflammation that leads to tissue dysfunction. There are no current therapeutic strategies to reduce microvascular permeability. The purpose of this study was to identify the role of Rnd3, an atypical Rho family GTPase, in the control of endothelial barrier integrity. The potential therapeutic benefit of Rnd3 protein delivery to ameliorate microvascular leakage was also investigated.

Methods and Results-Using immunofluorescence microscopy, Rnd3 was observed primarily in cytoplasmic areas around the nuclei of human umbilical vein endothelial cells. Permeability to fluorescein isothiocyanate-albumin and transendothelial electrical resistance of human umbilical vein …

Radio-Frequency Plasma Polymerized Biodegradable Carrier For In Vivo Release Of Cis-Platinum, Sudhir Bhatt, Fatemeh Valamanesh, Jerome Pulpytel, Rea Lo Dico, Aliby Baiyukha, Iman Al-Dybiat, Marc Pocard, Farzaneh Arefi-Khonsari, Massoud Mirshahi

Bioelectrics Publications

A low pressure plasma process based on plasma deposition has been used to develop a drug delivery strategy. In this study, a drug delivery system based on different layers of plasma co-polymerized Poly ε-caprolactone-Polyethylene glycol (PCL-PEG) co-polymers was deposited on biocompatible substrates. Cis-platinum (118 μgm/cm²) was used as an anti-cancer drug and incorporated for local delivery of the chemotherapeutic agent. The co-polymer layers and their interaction with cancer cells were analyzed by scanning electron microscopy. Our study showed that the plasma-PCL-PEG coated cellophane membranes, in which the drug, was included did not modify the flexibility and appearance of …