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Articles 2701 - 2730 of 5384
Full-Text Articles in Medicine and Health Sciences
Effectiveness Of Visual Aids On Preventive Dental Goals, Kristin Hodgson
Effectiveness Of Visual Aids On Preventive Dental Goals, Kristin Hodgson
Theses and Dissertations
Purpose: To assess a caregiver’s oral health attitudes, habits, and behaviors pre and post intervention, and to determine whether a particular delivery-style (verbal-only or with visual supplementation) of a motivational interviewing session is more effective in improving oral health behaviors as well as improving success of a chosen preventive goal. Methods: N=140 caregivers of pediatric dental patients were given questionnaires to assess readiness to change and current preventive oral health behaviors. Oral health education was communicated in a MI style (verbal-only or with visual supplementation). One preventive oral health goal was selected to focus on. The home preventive behavior survey …
Cannabinoids Delta-9-Tetrahydrocannabinol (Thc) And Cp55,940 Ablate Specific Chemokine And Cytokine Inflammatory Response In Bv-2 Mouse Microglial Cells Activated With Hiv-1 Pro-Inflammatory Protein Tat, Rebecca Maddux
Theses and Dissertations
Despite the widespread use of Highly Active Anti-retroviral Therapy (HAART) to combat Human Immunodeficiency Virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), HIV-Associated Neurocognitive Disorders (HANDs) still remain a dire issue. HIV can enter the brain through infected monocytes and infect microglia, the resident macrophages within that compartment. Due to its pro-inflammatory properties, HIV regulatory protein Tat (Transactivating protein) may play a role in the progression of neurocognitive disorders. The aim of this project was to determine whether the select cannabinoids THC and CP55,940 could ablate the inflammatory response on BV-2 mouse microglia cells caused by Tat. Within …
Selection Of A Non-Phosphorylated Peptide Inhibitor Of Brca1’S (Brct)2 Domain, Railey White
Selection Of A Non-Phosphorylated Peptide Inhibitor Of Brca1’S (Brct)2 Domain, Railey White
Theses and Dissertations
A growing body of literature suggests Breast Cancer-Associated Protein 1 (BRCA1) is important not only as a cause, but also as a target in the quest for cancer treatment. BRCA1 deficient cells treated with radiation as well as PARP inhibitors and other chemotherapeutics demonstrate a greater sensitivity than cells with wild type BRCA1. Inhibitors of BRCA1 would take advantage of this synthetic lethality and represent a significant advance in cancer treatment as well as an understanding of the biology of DNA repair. Despite significant study of BRCA1 protein and function, it is a large protein (220 KDa) that is still …
An Analysis Of The External Environmental And Internal Organizational Factors Associated With Adoption Of The Electronic Health Record, Clemens Kruse
An Analysis Of The External Environmental And Internal Organizational Factors Associated With Adoption Of The Electronic Health Record, Clemens Kruse
Theses and Dissertations
Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple organizational theories and empirical studies. The study is conducted in two phases. The primary phase of this study identifies and evaluates the effects of external environmental and internal organizational factors on healthcare organizations to adopt the EHR. From secondary data, twelve IVs (df=19) are chosen based on existing models …
Cytotoxic Properties Of Novel Platinum Compounds, Bbr3610-Dach And Trans-4-Nbd In Tumor Cells: Cellular Effects Of 1, 2-Dach And Nbd Ligands, Vijay Menon
Theses and Dissertations
Platinum-based chemotherapeutics are used for the treatment of a wide range of cancers and a number of attempts have been made toward developing compounds with better cellular stability and similar or enhanced cytotoxicity as compared to their predecessors. The first part of the work reported here focuses on the cellular effects of the metabolically stable dinuclear platinum compound, BBR3610-DACH. Comet assay showed this compound to form interstrand crosslinks, a highly toxic DNA lesion in HCT116 cells, at equimolar concentrations to its parental compound, BBR3610. Cell cycle studies showed that BBR3610-DACH causes G1/S and G2/M cell cycle arrest with S phase …
Breastfeeding Influencing Factors In Thai Adolescent Mothers, Supannee Kanhadilok
Breastfeeding Influencing Factors In Thai Adolescent Mothers, Supannee Kanhadilok
Theses and Dissertations
Background: Breastfeeding is well established as the optimal method for ensuring healthy infant nutrition. However, many adolescents remain unaware of the role of breastfeeding. Adolescent mothers continue to have the lowest rate of breastfeeding in many countries including Thailand, with only 17% of Thai adolescent mothers continuing to breastfed at 6 months postpartum. Objective: Examine factors influencing breastfeeding behaviors in adolescent mothers, particularly those in Thailand. Methods: This dissertation project involved two research studies focusing on breastfeeding influencing factors in adolescent mothers. The first study was an integrative review of 22 articles published in 2000-2012. The findings revealed that personal …
Development And Evaluation Of The Assessment Of Opioid Taking Behaviors And Adherence Scale (Aotba) In Patients With Sickle Cell Disease, Abdulkhaliq Jassem Alsalman
Development And Evaluation Of The Assessment Of Opioid Taking Behaviors And Adherence Scale (Aotba) In Patients With Sickle Cell Disease, Abdulkhaliq Jassem Alsalman
Theses and Dissertations
The rapid growth in opioid therapy for non-cancer pain has occurred without an adequate appreciation of the consequences of this growth. Few studies provide patient-centered evidence that can be used to inform the current proposed standards for efficacious (safe and effective) opioid prescribing in non-cancer pain. Furthermore, different terms may be used interchangeably in the literature to refer to opioid-taking behaviors, resulting in imprecise or vague interpretation of existing evidence. We therefore sought to explore patterns of opioid-taking behavior and their biopsychosocial-spiritual determinants in African-American adults with sickle cell disease (SCD). Many questions surround opioid use for non-cancer pain, but …
Predictors Of Agitation In The Critically Ill, Ruth Burk
Predictors Of Agitation In The Critically Ill, Ruth Burk
Theses and Dissertations
BACKGROUND: Agitation is a common complication in the intensive care unit (ICU) manifested in behavior and actions that range from simple apprehension or anxiety to frankly combative behavior.5 Agitation is associated with significant adverse outcomes.1-3 Studies report up to 71% of ICU patients have some degree of agitation during their ICU stay and that agitation is observed 32% of the time.3;4 Potential causes of agitation in critically ill patients are numerous; however, data about factors that predict agitation are limited. OBJECTIVE: The specific aim of this study was to identify predictors of agitation on admission to the ICU as well …
Determinants Of Abuse-Related Effects Of Monoamine Releasers In Rats, Clayton T. Bauer
Determinants Of Abuse-Related Effects Of Monoamine Releasers In Rats, Clayton T. Bauer
Theses and Dissertations
Monoamine releasers constitute a class of compounds that promote release of dopamine, serotonin, and/or norepinephrine. These compounds have a range of different uses in the medical setting, including treatment of attention deficit hyperactivity disorder, narcolepsy, and obesity. A major limitation of many of these compounds (i.e. amphetamine, methamphetamine, phenmetrazine) is their propensity for abuse; however, not all monoamine releasers are abused (i.e. fenfluramine). The goal of this dissertation was to examine pharmacological determinants of abuse-related effects produced by monoamine releasers in two preclinical assays in rats: intracranial self-stimulation (ICSS) and drug discrimination. First, this work confirmed and expanded upon previous …
Reverse-Phase Ion-Pairing Ultra Performance Liquid Chromatography-Mass Spectrometry In Characterization And Fingerprinting Of Diverse Sulfated Glycosaminoglycan Mimetics, Pooja Ponnusamy
Theses and Dissertations
Heparin is a highly sulfated glycosaminoglycan with potent anticoagulant, antimetastatic, and anti-inflammatory effects. Polymeric and polyanionic nature of heparin makes dosing and side effects a nightmare for healthcare professionals. Our laboratory has proposed appropriately designed, small, highly sulfated aromatic molecules as potential mimetics of heparin. These easier-to-synthesize small molecules have been shown to possess interesting pharmacological and improved toxicological profiles. However, the detection and characterization of these highly sulfated molecules is challenging. A robust RP-IP UPLC-MS method was developed to successfully retain, resolve and quantify sulfated non-saccharide GAG mimetics without the requirement of pre- or post- column derivatization. Comparative analysis …
Effects Of Mu Opioid Receptor Agonists On Intracranial Self-Stimulation In The Absence And Presence Of “Pain” In Rats, Ahmad Altarifi
Effects Of Mu Opioid Receptor Agonists On Intracranial Self-Stimulation In The Absence And Presence Of “Pain” In Rats, Ahmad Altarifi
Theses and Dissertations
Pain is a significant health problem. Mu opioid receptor agonists are used clinically as analgesics, but their use is constrained by high abuse liability. Intracranial self-stimulation (ICSS) is a preclinical behavioral procedure that has been used to assess abuse potential of opioids, and drug-induced facilitation of ICSS is interpreted as an abuse-related effect. ICSS can also be used as a behavioral baseline to detect affective dimensions of pain. Specifically, pain-related depression of ICSS can model pain-related depression of behavior and mood, and drug-induced blockade of pain-related ICSS depression can serve as a measure of affective analgesia. This dissertation used mu …
A Comparison Of Rectangular Vs. Circular Radiographic Collimation During Simulated Endodontic Therapy, Tareq Alali
A Comparison Of Rectangular Vs. Circular Radiographic Collimation During Simulated Endodontic Therapy, Tareq Alali
Theses and Dissertations
Rectangular collimation is used in dentistry to reduce radiation by restricting the x-ray beam to approximately the size of a number 2 intraoral film (3.2X4.1 cm). However, this restricted beam size can lead to exposure errors. The aim of this study was to retrospectively evaluate the number of radiographs exposed and the presence of technical errors by the use of traditional circular or rectangular collimators during endodontic therapy on simulated teeth in manikins. A total of 1475 digital radiographs of 84 teeth exposed by 60 dental students were evaluated. Evaluation was done by a board certified endodontist, an endodontic resident, …
Accuracy Of Limited Field Cone Beam Computed Tomography In The Detection Of Buccal Cortical Plate Perforations Due To Periapical Lesions, Dan-Linh Ha
Theses and Dissertations
Pre-surgical planning for endodontic microsurgery is facilitated by the use of cone beam computed tomography (CBCT). The purpose of this study was to determine whether limited field CBCT accurately predicts buccal cortical plate perforations due to endodontic lesions. Thirty-five roots that underwent microsurgical root end resection were included in this study. Prior to the surgery, 90 voxel CBCTs were taken with a Carestream 9300. The scans were analyzed by an endodontic resident and oral radiologist to determine the presence of a perforation in the buccal plate. These findings were compared to the clinical appearance of the bone. There was a …
Microbial Evaluation Of The Calamus Heated Gutta-Percha Delivery System, Christopher Smart Dds
Microbial Evaluation Of The Calamus Heated Gutta-Percha Delivery System, Christopher Smart Dds
Theses and Dissertations
If gutta-percha cartridges are contaminated with bacteria prior to obturation then contamination of the root canal system may result. Successful treatment not only depends on bacterial elimination but also depends on prevention of recontamination. This study was motivated by the observation that endodontists frequently use single use gutta-percha cartridges on multiple patients. The goal of this study was to determine if cross contamination occurred when a single gutta-percha cartridge in the Calamus™ Flow System was used on multiple patients. An effective recovery method was established during a pilot study using Enterococcus faecalis as a sample bacterium. Microbial recovery was obtained …
The Development And Applications Of The Hint Scoring Function: Exploring Colchicine-Site Anticancer Agents And Tautomerism, Chenxiao Da
Theses and Dissertations
The overall aim of this work was to apply HINT, an empirical scoring function based on the understanding of hydrophobicity, to analyze and predict the binding affinities and biological activities of colchicine-site anticancer agents. The second, concurrent aim was to improve the scoring function by incorporating tautomerism within the modeling process. Our belief is that proper evaluation of tautomeric forms for small molecules will improve performance of virtual screening. The novel pyrrole-based compounds targeting the colchicine site were docked into the receptor using HINT as a rescoring function. Two distinct binding modes dictated by the size and shape of a …
Comparative Analysis Of Waveone And Lightspeed Lsx For The Residual Dentin Thickness Of The Bifurcated Maxillary First Premolar Buccal Root Utilizing Limited Field Cone Beam Computed Tomography, Manpreet Singh Sarao
Comparative Analysis Of Waveone And Lightspeed Lsx For The Residual Dentin Thickness Of The Bifurcated Maxillary First Premolar Buccal Root Utilizing Limited Field Cone Beam Computed Tomography, Manpreet Singh Sarao
Theses and Dissertations
The purpose of this study was to compare the thickness of dentin removed from the buccal root of bifurcated maxillary first premolars (BMFP) in the area of furcation groove after instrumentation with WaveOne and LightSpeed LSX files utilizing limited field cone beam computerized tomography. All data was analyzed using repeated-measured mixed-model ANOVA and differences were described using Tukey’s multiple comparison procedure. The thickness of dentin removed with LightSpeed LSX files (0.1 mm) was significantly less than the thickness of dentin removed with WaveOne files (0.2 mm). To conclude, LSX files remove a more predictable and consistent thickness of dentin from …
Effect Of Cannabinoids On Pain-Stimulated And Pain-Depressed Behavior In Rats, Andrew Kwilasz
Effect Of Cannabinoids On Pain-Stimulated And Pain-Depressed Behavior In Rats, Andrew Kwilasz
Theses and Dissertations
Cannabinoids produce antinociception in many preclinical models of acute and chronic pain. In contrast, cannabinoids produce inconsistent analgesia in humans, showing little or no efficacy in treating acute pain, with modest efficacy in treating chronic inflammatory pain. This discrepancy may reflect an overreliance on preclinical assays of pain-stimulated behaviors, defined as behaviors that increase in rate or intensity following delivery of a noxious stimulus. In these assays, antinociception is indicated by a reduction in pain-stimulated behaviors, and antinociception is produced either by a reduction in sensory sensitivity to the noxious stimulus (i.e. true analgesia) or by false positive motor impairment. …
The Impact Of Medicaid Reform On Dental Practice Setting, Barrett W. R. Peters
The Impact Of Medicaid Reform On Dental Practice Setting, Barrett W. R. Peters
Theses and Dissertations
Purpose: To assess the impact of dental Medicaid reform in Virginia on dental practice settings (private practice, corporate practice and safety net clinics). Methods: This retrospective cohort study of 16.2 million dental claims is from the Virginia Department of Medical Assistance Services, which included claims for providers participating in Virginia’s Medicaid program during a 10-year period (2002-2012). The dividing date for the reform was July 1, 2005. The outcome measure was mean claims per participating provider. A Poisson regression model was used to predict the mean number of claims per provider with the following predictors: reform period, practice setting, provider …
Comparison Of Oral Ketamine-Midazolam And Chloral Hydrate-Meperidine-Hydroxyzine Sedation Regimens In Pediatric Dentistry, David Merrell
Comparison Of Oral Ketamine-Midazolam And Chloral Hydrate-Meperidine-Hydroxyzine Sedation Regimens In Pediatric Dentistry, David Merrell
Theses and Dissertations
Purpose: The purpose of this study was to create an experimental design to compare the regimen of ketamine-midazolam to chloral hydrate-meperidine-hydroxyzine for moderate oral conscious sedation. Methods: Patients between 36 and 83 months of age have been randomly assigned to receive 1 of the 2 regimens. Dosages, times, and vital signs will be recorded. Procedures will be recorded on video for assessment of sedation level and behavior. Patients will be contacted to evaluate postoperative sleeping, discomfort, and amnesia. Data will be analyzed using two-group t-tests (TOST) of equivalence in means to compare the two groups across the study period. Results: …
Myelin Is Not Required For Maintenance Of The Axon Initial Segment, Anna Josephson
Myelin Is Not Required For Maintenance Of The Axon Initial Segment, Anna Josephson
Theses and Dissertations
Axonal pathology is a major contributor to impaired motor, sensory and cognitive dysfunction associated with multiple sclerosis particularly with the progressive forms of the disease. However, the early pathologic events responsible for axonal deterioration remain unclear. It is well recognized that maintaining proper axonal function is intimately related to proper establishment and maintenance of axonal domains such as the node of Ranvier and the axon initial segment (AIS). Numerous laboratories, including ours, have investigated the mechanisms that regulate node of Ranvier formation and maintenance. These studies have shown that node of Ranvier formation and maintenance require myelin contact. Interestingly, many …
Three-Dimensional Soft Tissue Changes Upon Smiling, Clayton Mcentire
Three-Dimensional Soft Tissue Changes Upon Smiling, Clayton Mcentire
Theses and Dissertations
As esthetic improvement continues to be a primary goal of orthodontic patients and practitioners, it is important to understand the soft tissue movements that occur during the transition from rest to smile. Advances in technology allow capture of 3-dimesional photographs. The purpose of this study was to quantify the soft tissue changes that occur upon smiling and to compare changes between males and females using 3-dimensional photography. Fifty-four participants had resting and smiling photographs taken with the 3dMDface camera system. The two images were registered on stable facial surfaces, landmarks were placed, and measurements were recorded. Three-dimensional changes occurred in …
Service-Learning Programs Impact On Dental Students' Confidence In Treating Pediatric Population, Bushra Bhatti
Service-Learning Programs Impact On Dental Students' Confidence In Treating Pediatric Population, Bushra Bhatti
Theses and Dissertations
Purpose: In 2011, Clinical Service-Learning (DENS 762) became a formal university-designated course required to all senior dental students at VCU School of Dentistry. The interest of this study was to measure students' experience in treating pediatric patients and to determine the effect the course had on students' self-perceived confidence in treating the pediatric population. Methods: This was an observational study of the VCU class of 2012 who were enrolled in the clinical service-learning class. Following their service-learning rotations, fourth-year dental students were surveyed about their experiences on their service-learning rotation. Out of 105 students, 76 completed the survey. Results: The …
Comparison Of Injection Discomfort And Anesthetic Duration Of Plain Polocaine Versus Epinephrine Containing Articaine And Lidocaine, Dana Doan
Theses and Dissertations
Purpose: To determine possible differences in the pain level and soft tissue anesthesia duration of plain polocaine versus epinephrine-containing articaine and lidocaine during intraoral injections. Methods: Forty-eight subjects received plain polocaine and one epinephrine-containing anesthetic. Injections were randomized according to the first injection a)left or right buccal sulcus and b)epinephrine or not. The second injections were the opposite conditions. Subjects then recorded discomfort on a VAS and the time anesthesia wore off. Result: The second injection’s pain rating was influenced by the first. This carry-over effect makes it impossible to analyze all of the data. An analysis of the first …
Principled Variance Reduction Techniques For Real Time Patient-Specific Monte Carlo Applications Within Brachytherapy And Cone-Beam Computed Tomography, Andrew Sampson
Theses and Dissertations
This dissertation describes the application of two principled variance reduction strategies to increase the efficiency for two applications within medical physics. The first, called correlated Monte Carlo (CMC) applies to patient-specific, permanent-seed brachytherapy (PSB) dose calculations. The second, called adjoint-biased forward Monte Carlo (ABFMC), is used to compute cone-beam computed tomography (CBCT) scatter projections. CMC was applied for two PSB cases: a clinical post-implant prostate, and a breast with a simulated lumpectomy cavity. CMC computes the dose difference between the highly correlated dose computing homogeneous and heterogeneous geometries. The particle transport in the heterogeneous geometry assumed a purely homogeneous environment, …
Risk Factors For Postoperative Cognitive Dysfunction In Older Adults Undergoing Major Noncardiac Surgery, Osama Shoair
Risk Factors For Postoperative Cognitive Dysfunction In Older Adults Undergoing Major Noncardiac Surgery, Osama Shoair
Theses and Dissertations
Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had …
Characterizing The Role Of Cdk2ap1 In Primary Human Fibroblasts And Human Embryonic Stem Cells, Khaled Alsayegh
Characterizing The Role Of Cdk2ap1 In Primary Human Fibroblasts And Human Embryonic Stem Cells, Khaled Alsayegh
Theses and Dissertations
Cyclin Dependent Kinase-2 Associated Protein-1 (CDK2AP1) plays an important role in cell cycle regulation, by inhibiting CDK2 and by targeting it for proteolysis. It is also known to bind the DNA polymerase alpha-primase complex and regulate the initiation step of DNA synthesis. Its overexpression has been shown to inhibit growth, reduce invasion and increase apoptosis in a number of cancer cell lines. In studies in which mouse embryonic stem cells (mESCs) with targeted deletion of the Cdk2ap1 gene were used, Cdk2ap1 was shown to be required for epigenetic silencing of Oct4 during differentiation. The goal of this thesis was to …
Microbial Dna Receptor Expression In Chronic Periodontitis, Stephanie Voth
Microbial Dna Receptor Expression In Chronic Periodontitis, Stephanie Voth
Theses and Dissertations
AIM: The aim of this study was to determine the expression of microbial nucleic acid receptors including Toll like receptor 9 “TLR-9”, DNA-dependent activator of interferon-regulatory factors “DAI” and absent in melanoma “AIM-2” in chronic periodontitis (P) versus healthy (H) tissues. METHODS: 33 chronic periodontitis (P) and 27 periodontally-healthy (H) gingival biopsies were included. The gene and protein expression for each receptor was determined using real-time quantitative PCR and immunohistochemistry. RESULTS: Our results revealed statistically significant up-regulation of TLR-9 (p<0.006) and DAI (p<0.001) gene expression in P tissues compared to H sites. We were also able to demonstrate significant correlation among three DNA receptors (p<0.05). Immunohistochemistry further confirmed the expression of DNA sensors in gingival tissues. CONCLUSION: This study highlights a possible role for nucleic acid sensing in periodontal inflammation. Further investigations will determine whether cytoplasmic receptors and their ligands can be targeted to improve clinical outcomes in periodontitis.
Pain Management And Menopausal Health Outcomes In Multiple Sclerosis, Rachel Jawahar
Pain Management And Menopausal Health Outcomes In Multiple Sclerosis, Rachel Jawahar
Theses and Dissertations
Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. …
Influence Of Facial Profile On Social Perceptions: A 3d Video Imaging Study., Lisa Babb
Influence Of Facial Profile On Social Perceptions: A 3d Video Imaging Study., Lisa Babb
Theses and Dissertations
The purpose of this study was to evaluate the influence of facial convexity on the perception of social attributes in a young adult population. Nine models were asked to pose for a 3 dimensional photograph that was then modified to represent ideal, retrognathic, and prognathic facial convexity angles. Survey evaluators were shown digital videos of models with ideal and non-ideal profiles and asked to rate their perception of the following 4 social attributes: intelligence, athleticism, popularity, and leadership ability using a visual analog scale. Results gathered from 271 evaluators showed that the model images with ideal facial convexity angles were …
Time Dependent Cone-Beam Ct Reconstruction Via A Motion Model Optimized With Forward Iterative Projection Matching, David Staub
Time Dependent Cone-Beam Ct Reconstruction Via A Motion Model Optimized With Forward Iterative Projection Matching, David Staub
Theses and Dissertations
The purpose of this work is to present the development and validation of a novel method for reconstructing time-dependent, or 4D, cone-beam CT (4DCBCT) images. 4DCBCT can have a variety of applications in the radiotherapy of moving targets, such as lung tumors, including treatment planning, dose verification, and real time treatment adaptation. However, in its current incarnation it suffers from poor reconstruction quality and limited temporal resolution that may restrict its efficacy. Our algorithm remedies these issues by deforming a previously acquired high quality reference fan-beam CT (FBCT) to match the projection data in the 4DCBCT data-set, essentially creating a …