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Articles 2971 - 3000 of 4193
Full-Text Articles in Medicine and Health Sciences
The Reproductive Ecology Of Plethodontid Salamanders In The South Carolina Inner Coastal Plain, Heather Rena Oswald
The Reproductive Ecology Of Plethodontid Salamanders In The South Carolina Inner Coastal Plain, Heather Rena Oswald
Theses and Dissertations
Nest- site selection is a critical process in the life history of amphibians, directly influencing offspring survival and parental fitness. When and where an amphibian chooses to nest is strongly influenced by a range of environmental cues. We monitored plethodontid salamander breeding behavior in seepage wetlands in the South Carolina inner Coastal Plain. Seepage wetlands are ideal for monitoring semiaquatic salamander breeding, because they provide habitat for both larval and adult salamanders while having relatively predictable, constant water temperatures and presence year round. We observed the breeding phenology of three sympatric salamanders (Eurycea cirrigera, Desmognathus auriculatus, and Pseudotriton ruber) in …
Geographical Proximity To Health Facilities And Breast Cancer Morbidity And Mortality Among Women In South Carolina's Best Chance Network, Leepao Khang
Theses and Dissertations
Death rates for breast cancer have steadily decreased in women due to early detection, such as mammography, and improved treatments. Despite the benefit of mammography, many women are not up-to-date on screening and do not receive timely follow-up after abnormal mammogram finding. Breast cancer is a major contributor to morbidity and mortality among women in South Carolina. To reduce the disproportionate burden of breast cancer and cervical cancer among women in South Carolina, the South Carolina Best Chance Network (BCN) was established to provide service delivery and ensures timely and complete diagnostic follow-up and treatment initiation for underserved women.
The …
Association Between Breastfeeding And Infant Growth: A Probable Reverse Causality, Shraddha Vyas
Association Between Breastfeeding And Infant Growth: A Probable Reverse Causality, Shraddha Vyas
Theses and Dissertations
Background: Much conflicting results exist in the association between breastfeeding and infant growth. One of these confusions is related to the temporal sequence between breastfeeding practice and infant growth.
Objective: This study aimed at examining the association and investigating a possible reverse causality between breastfeeding and infant growth.
Method: Infant Feeding Practices Survey II, a national longitudinal database with repeated measurements, following women prenatally and until one year postpartum (N=2914) was used. Mixed linear model assessed the impact of breastfeeding from the 2nd, 4th, 6th and 9th months on infant growth at the 3rd, 5th, 7th and 12th months, respectively. …
Understanding Online And Offline Sex Seeking Behavior Among Young Men Who Have Sex With Men: Implications For Hiv/Aids Interventions, Winston Eromosele Abara
Understanding Online And Offline Sex Seeking Behavior Among Young Men Who Have Sex With Men: Implications For Hiv/Aids Interventions, Winston Eromosele Abara
Theses and Dissertations
Men who have sex with men (MSM), especially in the southeastern US are disproportionately impacted by the HIV/AIDS epidemic. Young MSM and African American MSM are particularly burdened accounting for a greater proportion of HIV/AIDS diagnoses. Factors such as risky sexual behavior, perception of sexual risk, ignorance about HIV sero-status, internalized homonegativity/homophobia (IH), stigma, and alcohol and illegal drug use have been advanced as reasons for this disproportionate burden. HIV/AIDS prevention efforts aimed at stemming the epidemic among MSM have focused on locations where MSM meet other men for sex such as parks, beaches, bathhouses, adult book stores, clubs, and …
Smokers' Neurological Responses To Imagery From Cigarette Package Warning Labels, Johann Fridrik Fridriksson
Smokers' Neurological Responses To Imagery From Cigarette Package Warning Labels, Johann Fridrik Fridriksson
Theses and Dissertations
Tobacco use is the leading cause of preventable death in the United States. The Family Smoking Prevention and Tobacco Control Act was signed into law in 2009 and gave the U.S. Food and Drug Administration (FDA) the authority to implement pictorial health warning labels (HWLs) on cigarette packages. Multiple studies investigating self-reported affective, cognitive and behavioral impacts of HWLs suggest that the most effective warnings include imagery that depicts physical damage to the body due to smoking. However, self-report methods of assessment used in these studies may be biased. Far less is known about how HWLs directly modulate brain activity. …
Exploring African American And White 18-19 Year Old Males' Communication Experiences With Their Parents And Partners About Sex And Contraception, Charlotte Toole Galloway
Exploring African American And White 18-19 Year Old Males' Communication Experiences With Their Parents And Partners About Sex And Contraception, Charlotte Toole Galloway
Theses and Dissertations
Background: Increasing parent-child and partner communication about sex and contraception have been identified as protective factors that are amenable to change by teen pregnancy prevention programs.
Purpose and Methods: From June through July 2012, a total of six focus groups (N=30) were conducted with African American and White 18-19 year old males to retrospectively explore their communication experiences with parents and partners about sex and contraception, and their attitudes and beliefs about sex, pregnancy, and contraception.
Results: Most participants felt that parent-child sexual risk communication would be more effective when parents had a history of open communication and a good …
Investigating Developmental Patterns Of Symptom And Impairment Change Among Youth With Adhd, Subthreshold Adhdand Youth Without Adhd, Lorie Love Geryk
Investigating Developmental Patterns Of Symptom And Impairment Change Among Youth With Adhd, Subthreshold Adhdand Youth Without Adhd, Lorie Love Geryk
Theses and Dissertations
Introduction. Despite a substantial prevalence of subthreshold Attention-Deficit/Hyperactivity Disorder (ADHD) and research indicating that many youth with this disorder have impaired functioning and negative outcomes, few studies have considered patterns of symptom and functioning change for youth with probable ADHD, subthreshold ADHD and youth without ADHD transitioning from childhood to adolescence. Additionally, we are not aware of any studies examining predictors of impairment severity among youth with subthreshold ADHD, and few studies have examined predictors of treatment utilization and patterns of symptom and functioning change based on medication status for youth with subthreshold ADHD compared to youth with ADHD. Methods. …
The Use Of Ultrasound As An Adjunct To X-Ray For The Localization And Removal Of Soft Tissue Foreign Bodies In An Urgent Care Setting, Stacy Lane Merritt
The Use Of Ultrasound As An Adjunct To X-Ray For The Localization And Removal Of Soft Tissue Foreign Bodies In An Urgent Care Setting, Stacy Lane Merritt
Theses and Dissertations
Embedded soft tissue foreign bodies are common complaints of patients presenting to rural urgent care centers. The removal of soft tissue foreign bodies present challenges for the healthcare provider when objects are radiolucent and cannot be identified on readily available diagnostic imaging modalities such as plain radiographs (X-rays). Ultrasound has been introduced in the literature as a useful adjunct to X-rays for the localization and removal of soft tissue foreign bodies. The purpose of this research utilization project was to report the use of bedside ultrasound by healthcare providers as an adjunct to X-ray for the localization and removal of …
A Qualitative Study Of An Urban Community Garden: Creating Healthier Neighborhood Environments, Lauren Workman
A Qualitative Study Of An Urban Community Garden: Creating Healthier Neighborhood Environments, Lauren Workman
Theses and Dissertations
Neighborhoods influence population level health; the places where people live, work, and grow are an essential setting for health promotion interventions. In efforts to create healthier neighborhood environments, there is a movement to better understand neighborhood social characteristics. The neighborhood social environment potentially includes social relationships (including trust and cohesion), networks, norms, and the resources that may be generated from relationships. In addition, more work is needed to learn about how people may become engaged in neighborhood initiatives. Community gardens are a 1) potential strategy to promote health at community and individual levels 2) mechanism to involve community members in …
Foot Assessment In The Dialysis Unit, Karen Robertson
Foot Assessment In The Dialysis Unit, Karen Robertson
Theses and Dissertations
ABSTRACT In 2010 the number of patients requiring renal replacement therapy in the United States increased by 1% to 593,086. This number was comprised of 593,086 in center hemodialysis patients, 179,361 functioning kidney transplants, and 29,773 peritoneal dialysis patients.
A principal difficulty in the end stage renal disease (ESRD) population is lower extremity amputation from vascular complications and nonhealing wounds. The incidence of nontraumatic lower extremity amputation among the end stage renal disease population in the United States is ten times higher when compared to the general public. Mortality rates for ESRD patients following amputation are elevated with less than …
The Effect Of Cancer Cachexia Severity And Eccentric Muscle Contractions On Selected Myofiber Metabolic Properties In Mouse Skeletal Muscle, Joshua Earl Mangum
The Effect Of Cancer Cachexia Severity And Eccentric Muscle Contractions On Selected Myofiber Metabolic Properties In Mouse Skeletal Muscle, Joshua Earl Mangum
Theses and Dissertations
Cancer cachexia is a complex syndrome that induces skeletal muscle wasting and dysregulation of skeletal muscle metabolism. Alterations in area of myofibers and myofiber metabolic properties can significantly impact the function of skeletal muscle. The purpose of this study was to examine the effect of cachexia severity and resistance exercise training on frequency and area of selected myofiber metabolic characteristics during cachexia-induced myofiber atrophy. Male ApcMin/+ (Min) mice were studied during the progression of cachexia (16-20 weeks of age) and stratified into groups based on the severity of cachexia. For the second study, male Min mice performed resistance exercise (RE) …
Bmi At Diagnosis And Its Association With Markers Of Hiv Disease Progression And Cardiovascular Disease Risk., Kelly Deshon Johnson
Bmi At Diagnosis And Its Association With Markers Of Hiv Disease Progression And Cardiovascular Disease Risk., Kelly Deshon Johnson
Theses and Dissertations
Highly active antiretroviral treatment (HAART) has transformed the state of human immunodeficiency virus (HIV) from acute to chronic. As a result, the long-term effect of HAART has caused weight gain among HIV-infected individuals, leading to an increased prevalence of overweight and obesity. Increased Body Mass Index (BMI) has been associated with adverse health outcomes in non-HIV and HIV populations, yet among HIV-infected individuals, a higher BMI at diagnosis offers a slower progression from HIV to AIDS. Pre-HAART, studies reported that obese HIV-infected individuals have higher increases in CD4 count over time. However post-HAART, some report that overweight HIV-infected individuals with …
Development Of Proteomic Characterization And Speciation Techniques Utilizing Tryptic Peptides With Maldi-Tof Ms And Lc-Esi Ms-Ms, Jennifer Marie Kooken
Development Of Proteomic Characterization And Speciation Techniques Utilizing Tryptic Peptides With Maldi-Tof Ms And Lc-Esi Ms-Ms, Jennifer Marie Kooken
Theses and Dissertations
The characterization of microbes which can be opportunists and pathogens (e.g., methicillin resistant Staphylococcus aureus (MRSA)) is important in understanding and potentially treating diseases caused by various bacterial species. Common genera found in the human skin micro-biome include Micrococcus and Staphylococcus, but there only a limited number of tests to differentiate these genera and/or species. My research reflects methods development from distinguishing one closely related genera from another and then expanded to species identification. Tryptic peptides were analyzed by MALDI TOF MS and the mass profiles compared with those of a reference strain in both genus and species identification. Aconitate …
Effects Of Dna Damage And Cdk Inhibitors On The Nucleoli, Vineet Garg
Effects Of Dna Damage And Cdk Inhibitors On The Nucleoli, Vineet Garg
Theses and Dissertations
The nucleolus is the primary site of ribogenesis and consists of three compartments, namely, fibrillar center (FC), dense fibrillar component (DFC) and granular component (GC). Recent studies have observed a novel structure distinct from these three compartments which forms in the nucleolus upon DNA damage called Intranucleolar body (INoB). Previous studies in our laboratory have found INoBs forming in HT1080 fibrosarcoma cell lines after ectopic overexpression of damage-inducible cell cycle inhibitor p21. This INoB formation has been observed to be decreased by Senexin A which is an inhibitor of transcription regulating kinases CDK8/CDK19.
Here we show that INoB formation correlates …
The Relationship Between Electronic Health Record Implementation And Outcomes Of Care For Three Cardiovascular Procedures, Deshia Ann Leonhirth
The Relationship Between Electronic Health Record Implementation And Outcomes Of Care For Three Cardiovascular Procedures, Deshia Ann Leonhirth
Theses and Dissertations
Background. The U.S. healthcare movement to improve quality and patient outcomes has prompted investigations into tools that can assist in these aims. Electronic health records (EHRs) are one tool proposed by the Institute of Medicine (IOM). The objective of this original dissertation research was to examine the relationship between electronic health record functionalities and two outcomes of care as proxies for quality: risk-adjusted mortality for abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) and log estimated cost-per-discharge. Methods. This study used 2009-2010 hospital inpatient administrative discharge data from the Nationwide Inpatient Sample (NIS), …
Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma
Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma
Theses and Dissertations
An increasing number of studies examined the association between neighborhood characteristics and birth outcomes. However, the results can be difficult to compare because of the variety of indicators used to characterize the neighborhood. As an important neighborhood characteristic, the food environment is associated with residents' nutrition status, diet quality, and related health outcomes. In addition, the food environment has been found to influence women's diet quality during pregnancy, which is a key factor in predicting birth outcomes. However to date, studies on food environment and birth outcomes are extremely limited.
This study examined the association between food environment (evaluated by …
Characterization Of The Role Of Fro6 In Metal Homeostasis In Arabidopsis Thaliana, Margo Ellen Maynes
Characterization Of The Role Of Fro6 In Metal Homeostasis In Arabidopsis Thaliana, Margo Ellen Maynes
Theses and Dissertations
Iron deficiency is the most common human nutritional disorder in the world today, affecting approximately 2 billon people worldwide, almost a third of the world's population. For most of the world's population, plant foods serve as the major source of dietary iron. One approach that may contribute towards the solution of iron deficiency is the development of crop plants that contain higher levels of bioavailable iron. This project focuses on FRO6, a ferric chelate reductase in Arabidopsis thaliana that is thought to reduce apoplastic iron for transport across the plasma membrane in leaf cells. We hypothesize therefore that FRO6 controls …
Environmental Pre-Conditioning Of Bacterial Populations And Communities To Extreme Acidity, Gabriel Joseph Swenson
Environmental Pre-Conditioning Of Bacterial Populations And Communities To Extreme Acidity, Gabriel Joseph Swenson
Theses and Dissertations
The ability of opportunistic enteric pathogens to cause disease is effected by their ability to survive the variable and lethal acidity of the mammalian host gastrointestinal milieu. In many of these pathogens, survival is conferred by an acid stress response (ASR). ASR is elicited when bacterial cells are pre-conditioned in sub-lethal acidity (pH 4-6) which induces rapid biochemical and physiological modifications and facilitates survival when extreme acidity (pH 1-3) is encountered. In Vibrio cholerae, the causative agent of the diarrheal disease Cholera, ASR was initially investigated in an effort to determine how this ubiquitous aquatic bacterium is capable of causing …
The Role Of Reactive Oxygen Species In Cell Death Induced By Thymidylate Synthase Inhibitors, Ufuk Ozer
The Role Of Reactive Oxygen Species In Cell Death Induced By Thymidylate Synthase Inhibitors, Ufuk Ozer
Theses and Dissertations
Thymidylate synthase (TS) catalyzes the reductive transfer of a methyl group from N5,N10-methylenetetrahydrofolate (CH2-THF) to dUMP, forming dTMP and dihydrofolate (DHF). It is generally accepted that inhibition of the enzyme leads to a deficiency of dTMP, followed by genome damage and programmed cell death. As such, TS has long been viewed as an important target of anti-neoplastic agents, such as 5-fluorouracil (5-FU) and raltitrexed (RTX), which lead to inhibition of the enzyme. Oxidative stress is well-recognized as having a central role in cellular response to a number of DNA damaging agents, and may be a proximate cause of …
The Role Of Host-Tumor Interactions In Liver Metastasis Of Colorectal Cancer, Yu Zhang
The Role Of Host-Tumor Interactions In Liver Metastasis Of Colorectal Cancer, Yu Zhang
Theses and Dissertations
Colon cancer is the third most frequent cancer and the second leading cause of cancer deaths in the United States. Liver metastasis is the major cause of death in colon cancer. Successful metastases depend on productive collaborations between tumor cells and host-derived cells in the tumor microenvironment, target organ environments, and cells in the hematopoietic compartment.
To identify the host-tumor interactions promoting liver metastasis and their molecular and cellular mediators, an orthotopic mouse model of liver metastasis of colon cancer was established that recapitulates all stages of tumor growth and metastasis. A highly metastatic mouse carcinoma cell line CT26-FL3 was …
Prevention Of Skin Breakdown In The Pediatric Intensive Care Unit, Lydia H. Palmer
Prevention Of Skin Breakdown In The Pediatric Intensive Care Unit, Lydia H. Palmer
Theses and Dissertations
Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin …
K+ Channels And Beta3 Adrenergic Receptors As New Pharmacological Targets For Overactive Bladder Treatment, Serge Amani Yao Afeli
K+ Channels And Beta3 Adrenergic Receptors As New Pharmacological Targets For Overactive Bladder Treatment, Serge Amani Yao Afeli
Theses and Dissertations
Overactive bladder (OAB) is a pathophysiological condition which is characterized by the urinary bladder's failure to achieve proper storage of urine. OAB has a tremendous impact on the patient's quality of life by disturbing his sleep, work, and sexual activity. About 17% of Americans are affected with this disease and most patients experience symptoms of urgency, frequent urination, and abnormally elevated detrusor smooth muscle (DSM) contractility. Despite, numerous attempts to treat the disorder in the past with antimuscarinics and now with beta3 adrenergic receptors (beta3-AR agonists), OAB still remains a serious public health issue because the long term efficacy of …
The Anti-Angiogenic Effects Of Sparstolonin B, Henry Rhodes Bateman
The Anti-Angiogenic Effects Of Sparstolonin B, Henry Rhodes Bateman
Theses and Dissertations
Sparstolonin B (SsnB) is a novel bioreactive compound isolated from Sparganium stoloniferum, an herb historically used in Traditional Chinese Medicine as an anti-tumor agent. SsnB has demonstrated anti-inflammatory properties, inhibiting Toll-like receptor mediated inflammation in isolated macrophages and in mice. Angiogenesis, the process of new capillary formation from existing blood vessels, is dysregulated in many pathological disorders, including atherosclerosis, diabetic retinopathy, and tumor growth. The goal of the project was to investigate the anti-angiogenic effects of SsnB.
The first part of the project utilized in vitro functional assays to study how SsnB affected endothelial cells. SsnB inhibited endothelial cell tube …
Mass Spectrometry And Tandem Mass Spectrometry Characterization Of Protein Patterns, Protein Markers And Whole Proteomes For Pathogenic Bacteria, Jennifer Intelicato-Young
Mass Spectrometry And Tandem Mass Spectrometry Characterization Of Protein Patterns, Protein Markers And Whole Proteomes For Pathogenic Bacteria, Jennifer Intelicato-Young
Theses and Dissertations
There have been many recent reviews published on MALDI-TOF MS (matrix assisted laser desorption/ionization time-of-flight) MS (mass spectrometry) for identification of bacteria particularly with relevance to clinical microbiology. MALDI-TOF MS is now a mature technique for bacterial identification with great promise. The purpose of this review is to put into perspective MALDI-TOF MS and other widely used mass spectrometry methods for characterization of proteins. MALDI-TOF MS is used for rapid determination of a mass pattern of proteins for bacterial characterization; these proteins
are generally not identified. Alternatively, after gel separation, MALDI TOF-TOF MSMS (tandem mass spectrometry) or on-line LC-ESI MS-MS …
High Fat Diet Induced Obesity In A Mouse Model For Colorectal Cancer, Kennerly Clinton Patrick
High Fat Diet Induced Obesity In A Mouse Model For Colorectal Cancer, Kennerly Clinton Patrick
Theses and Dissertations
Obesity is widely correlated with the incidence of colorectal cancer (CRC). The exact mechanisms that link obesity to CRC risk have not yet been fully established, and only a limited number of animal models are available to study pathways involved in obesity-related colon carcinogenesis. The objective of this study was to determine the influence of HFD-induced obesity on AOM/DSS-mediated colorectal tumorigenesis, tumor proliferation, and symptom severity. Male C57BL/6 mice were fed a novel high fat diet, designed to mimic the standard American diet (12 % saturated fat & 28 % unsaturated fat), at 4 weeks of age until 16 weeks …
A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton
A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton
Theses and Dissertations
The often toxic work environment in which nurses practice contributes to decreased well-being, job dissatisfaction, and poor retention rates, while negatively impacting quality and patient safety. Most leadership programs and resources target nurses in formal leadership positions and are exclusive of the bedside nurse. The purpose of this research utilization project was to determine immediate and short-term outcomes of an educational leadership workshop for nurses, including intent to change the work environment and subsequent action to change the work environment. The goal was to develop, deliver, and evaluate an evidence-based educational intervention to empower nurses at all levels of care …
A Novel Approach To The Design Of Selective Inhibitors For Cell Cycle Cyclin Dependent Kinases, Tracy Perkins
A Novel Approach To The Design Of Selective Inhibitors For Cell Cycle Cyclin Dependent Kinases, Tracy Perkins
Theses and Dissertations
CDK2/cyclin A and CDK4/cyclin D1 are proven targets for cancer drug discovery. The development of novel CDK inhibitors, with high selectivity, are being investigated by targeting the cyclin binding groove (CBG) located on the cyclin, the regulatory subunit of CDK. The CBG is a shallow area that is involved in signaling and the inhibition of cell cycle CDKs via endogenous tumor suppressors. Currently, non-peptidic inhibitors are being developed based on the recognition amino acid sequence, HAKRRLIF, of the C-terminal peptide sequence of the CDK inhibitor p21WAF1. Computational design and the utilization of non-natural amino acids are being proposed to identify …
Differential Effects Of The Great Recession On Minority Populations, Samuel Towne
Differential Effects Of The Great Recession On Minority Populations, Samuel Towne
Theses and Dissertations
Times of severe economic flux may burdend individuals at differing levels. The Great Recession affected individuals differently by racial group. Vulnerable individuals who may already be burdened by economic strains and health disparities may benefit from state policies that work to improve the health and health care access of individuals. Medicaid Generosity for parents or childless adults is associated with differences in individuals' health status and reporting forgone medical care. Individuals in states that have higher levels of Medicaid eligibility defined as eligibility in relation to the percent of the Federal Poverty Level report lower levels of poor or fair …
Trophic Response To Polycyclic Aromatic Hydrocarbons And Copper In Tidal Flats Of North Inlet, South Carolina, Leslie Lynn Muggelberg
Trophic Response To Polycyclic Aromatic Hydrocarbons And Copper In Tidal Flats Of North Inlet, South Carolina, Leslie Lynn Muggelberg
Theses and Dissertations
The trophic link between benthic microalgae (BMA) and fiddler crabs is critical for the ecosystem functioning of estuaries and alterations in this linkage by anthropogenic activities could have cascading impacts on food webs and biogeochemical cycling in these sensitive habitats. Singular and interactive effects of two common pollutants in aquatic ecosystems, polycyclic aromatic hydrocarbons (PAHs) and copper (Cu), were investigated by exposing field collected sediment communities to the contaminants and measuring changes in BMA biomass and community composition in a bioassay design. The consequential impacts on the food web were then explored by examining the effects of PAHs and copper …
An Assessment Of Injury Presentation To Determine Elder Abuse Prevalence In South Carolina, Brittani L. Harmon
An Assessment Of Injury Presentation To Determine Elder Abuse Prevalence In South Carolina, Brittani L. Harmon
Theses and Dissertations
As the number of individuals age 60 years of age and older continues to rise in the United States, the care and safety of this population will be a growing issue. There are many contributing factors and reasons why elder abuse occurs. Elder abuse is an emerging issue; however there is limited research and understanding in the area. There are barriers to the detection and prevention of the issue. Emergency department staff is essential to the identification and detection of possible abuse, and it is important that these providers understand the risk factors and physical manifestations of abuse and neglect …