Medicine and Health Sciences Commons^™

A Framework For Real-Time Covid-19 Media Classification, Sentiment And Opinion Mining, Information Extraction, And Trends Analysis (Issue 17, 8 July 2020), Hadeel El-Kassabi, M Adel Serhani, Khaled Khalil

Covid19 Newsletters

No abstract provided.

The Membrane Protein Ankh Is Crucial For Bone Mechanical Performance By Mediating Cellular Export Of Citrate And Atp., Flora Szeri, Stefan Lundkvist, Sylvia Donnelly, Udo F H Engelke, Kyu Rhee, Charlene J Williams, John P Sundberg, Ron A Wevers, Ryan E Tomlinson, Robert S Jansen, Koen Van De Wetering

Faculty Research 2020

The membrane protein ANKH was known to prevent pathological mineralization of joints and was thought to export pyrophosphate (PPi) from cells. This did not explain, however, the presence of ANKH in tissues, such as brain, blood vessels and muscle. We now report that in cultured cells ANKH exports ATP, rather than PPi, and, unexpectedly, also citrate as a prominent metabolite. The extracellular ATP is rapidly converted into PPi, explaining the role of ANKH in preventing ankylosis. Mice lacking functional Ank (Ankank/ank mice) had plasma citrate concentrations that were 65% lower than those detected in wild type control animals. Consequently, citrate …

Optimizing The Effectiveness Of Peripheral Intravenous Catheters, Carrie Kollar

Dissertations

Problem Hospitalized adult patients require more than one short peripheral catheter (SPC) to complete the prescribed intravenous (IV) therapy due to catheter failure and the practice of resiting. The purpose of this quality improvement initiative was to increase the rate of SPCs remaining in situ for the entire duration of the IV therapy for hospitalized adult patients.

Methods Application of an engineered securement device (ESD), an educational program pertaining to modifiable risk factors, and changing the practice to removal upon clinical indication were methods utilized to reduce the number of SPC insertions and catheter failures. This study was conducted at …

2020-07-08_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

Compassion Fatigue And The Emergency Department, Alexandra Myers

Dissertations

Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response^© (RTR). RTR^© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of …

Free L-Glutamate-Induced Modulation In Oxidative And Neurochemical Profile Contributes To Enhancement In Locomotor And Memory Performance In Male Rats, Saiqa Tabassum, Saara Ahmad, Syeda Madiha, Sidrah Shahzad, Zehra Batool, Sadia Sadir, Saida Haider

Department of Biological & Biomedical Sciences

Glutamate (Glu), the key excitatory neurotransmitter in the central nervous system, is considered essential for brain functioning and has a vital role in learning and memory formation. Earlier it was considered as a harmful agent but later found to be useful for many body functions. However, studies regarding the effects of free L-Glu administration on CNS function are limited. Therefore, current experiment is aimed to monitor the neurobiological effects of free L-Glu in male rats. L-Glu was orally administered to rats for 5-weeks and changes in behavioral performance were monitored. Thereafter, brain and hippocampus were collected for oxidative and neurochemical …

Pathophysiology Of Hyperkalemia Presenting As Brugada Pattern On Electrocardiogram (Ecg), Benjamin Doty, Elaine Kim, Jeremiah T. Phelps, Peter Akpunonu

Emergency Medicine Faculty Publications

BACKGROUND Brugada phenocopies (BrP) are clinical and electrocardiographic (ECG) entities elicited by reversible medical conditions speculated to have pathogenesis rooted in ion current imbalances or conduction delays within the myocardial wall. During an inciting pathologic condition, it produces ECG patterns identical to those of congenitally-acquired Brugada syndrome and subsequently returns to normal ECG patterns upon resolution of the medical condition. This case report describes a 26-year-old man presenting to the Emergency Department (ED) for suspected heroin overdose with a rare ECG consistent with BrP secondary to acute hyperkalemia.

CASE REPORT A 26-year-old man with a history of substance abuse and …

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 …

Meta-Analysis Examining Overall Survival In Patients With Pancreatic Cancer Treated With Second-Line 5-Fluorouracil And Oxaliplatin-Based Therapy After Failing First-Line Gemcitabine-Containing Therapy: Effect Of Performance Status And Comparison With Other Regimens, Zev Wainberg, Kynan Feeney, Myung Ah Lee, Andrés Muñoz, Antonio Cubillo Gracián, Sara Lonardi, Baek Yeol Ryoo, Annie Hung, Yong Lin, Johanna Bendell, J. Randolph Hecht

Research outputs 2014 to 2021

© 2020 The Author(s).

Background:

Pancreatic cancer has a poor prognosis and few choices of therapy. For patients with adequate performance status, FOLFIRINOX or gemcitabine plus nab-paclitaxel are preferred first-line treatment. 5-Fluorouracil (5-FU)-based therapy (e.g. FOLFIRI, OFF, or FOLFOX) are often used in patients who previously received gemcitabine-based regimens. A systematic review was conducted of the safety and efficacy of FOLFOX for metastatic pancreatic cancer following prior gemcitabine-based therapy. A Bayesian fixed-effect meta-analysis with adjustment of patient performance status (PS) was conducted to evaluate overall survival (OS) and compare outcomes with nanoliposomal irinotecan combination therapy.

Methods:

PubMed.gov, FDA.gov, ClinicalTrials.gov, congress …

An Improved Method For Spectroscopic Quality Classification, Elizabeth G. Mayer

Mathematics & Statistics ETDs

Spectral quality classification is a vital step in data cleaning before the

analysis of magnetic resonance spectroscopy (MRS) data can be done. This

analysis compares five methods of quality classification; three of these are

legacy methods, Maudsley et al. (2006), Zhang et al. (2018), and

Bustillo et al. (2020), and two newly created methods that used a random forests

classifier (RFC) to inform their classifications. We found that the random forest

classifier was the most accurate at predicting spectra quality (balanced

accuracy for RF of 88% vs legacy of 70%, 72%, or 72%). A

Random-Forests-Informed Filtering method (RFIFM) for quality …

A Counterpoint Paper: Comments On The Electrocardiographic Part Of The 2018 Fourth Universal Definition Of Myocardial Infarction Endorsed By The International Society Of Electrocardiology And The International Society For Holter And Noninvasive Electrocardiology, Yochai Birnbaum, Miguel Fiol, Kjell Nikus, Javier Garcia Niebla, Ljuba Bacharova, Sergio Dubner, Wojciech Zareba, Peter W Macfarlane, Antonio Luiz Ribeiro, Iwona Cygankiewicz, Antoni Bayes De Luna

Faculty, Staff and Students Publications

The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG …

Consensus Guidelines For Digital Scholarship In Academic Promotion., Abbas Husain, Zachary Repanshek, Manpreet Singh, Felix Ankel, Jennifer Beck-Esmay, Daniel Cabrera, Teresa M Chan, Robert Cooney, Michael Gisondi, Michael Gottlieb, Jay Khadpe, Jennifer Repanshek, Jessica Mason, Dimitrios Papanagnou, Jeff Riddell, N Seth Trueger, Fareen Zaver, Emily Brumfield

Department of Emergency Medicine Faculty Papers

INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.

METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.

RESULTS: We …

Facts About Mold: A Consumer Focus, Cheri Marcham

Publications

The U.S. Centers for Disease Control and Prevention, the Institute of Medicine of the U.S. National Academy of Sciences, the American Academy of Allergy Asthma and Immunology, Health Canada, and the World Health Organization all agree that living or working in a building with mold-damaged building materials results in an increased risk of respiratory diseases such as asthma.

The American Industrial Hygiene Association (AIHA) has worked to translate the advice from these public health and medical authorities into state-of-the-art inspection and sampling protocols. These protocols are captured in AIHA’s second edition of the Recognition, Evaluation and Control of Indoor Mold …

Facts About Mold: An Aiha Perspective For Ieq Investigators, Physicians, And Engineers, Cheri Marcham

Publications

The U.S. Centers for Disease Control and Prevention (CDC), the Institute of Medicine of the U.S. National Academy of Sciences, the American Academy of Allergy, Asthma & Immunology (AAAAI), Health Canada, and the World Health Organization all agree that living or working in a building with mold-damaged building materials results in increased risk of respiratory diseases such as asthma.

The American Industrial Hygiene Association (AIHA) has worked to translate the advice from these public health and medical authorities into state-of-the-art inspection and sampling protocols. These protocols are captured in AIHA’s Recognition, Evaluation and Control of Indoor Mold publication, also known …

Edwardsiella Ictaluri Is Capable Of Persisting In Channel Catfish By Evading Host T Cell And Cell Death Responses, Elizabeth Watts Griggs

LSU Doctoral Dissertations

Edwardsiella ictaluri is a gram-negative bacterium of the family Enterobacteriaceae that infects and causes enteric septicemia (ESC) of channel catfish (Ictalurus punctatus), a fatal disease costing the catfish industry millions of dollars in losses each year. Edwardsiella. ictaluri is capable of replicating in catfish head-kidney-derived-macrophages (HKDM), and like many other gram-negative bacteria, E. ictaluri encodes a Type III Secretion System (T3SS) that is required for virulence and intracellular replication. In the case of E. ictaluri, the T3SS translocates effectors from the Edwardsiella containing vacuole (ECV) through the bacterial cell wall and the vacuolar membrane directly to the …

Neuromotor Control Of The Hand During Smartphone Manipulation, Prasanna Kumar Acharya

LSU Doctoral Dissertations

The primary focus of this dissertation was to understand the motor control strategy used by our neuromuscular system for the multi-layered motor tasks involved during smartphone manipulation. To understand this control strategy, we recorded the kinematics and multi-muscle activation pattern of the right limb during smartphone manipulation, including grasping with/out tapping, movement conditions (MCOND), and arm heights.

In the first study (chapter 2), we examined the neuromuscular control strategy of the upper limb during grasping with/out tapping executed with a smartphone by evaluating muscle-activation patterns of the upper limb during different movement conditions (MCOND). There was a change in muscle …

Acute Effusive Pericarditis: A Late Complication Of Covid-19., Kelli Fox, Jessica A Prokup, Kyle Butson, Kim Jordan

Heart and Vascular Articles

As the COVID-19 pandemic evolves, the medical community continues to discover novel clinical manifestations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Often, extrapulmonary manifestations occur simultaneously with pulmonary disease. However, there is a paucity of literature describing the cardiac manifestations of COVID-19 in the absence of pulmonary findings. We report a rare case of acute pericarditis presenting with pericardial effusion and cardiac tamponade in a 43-year-old man diagnosed with COVID-19. This case emphasizes the importance of continued investigation regarding diagnosis and treatment of COVID-19 and its related symptoms.

The Role Of Parent Self-Regulation In Youth Type 1 Diabetes Management., Katherine W Bauer, Marisa E Hilliard, Dana K. Albright Phd, Sharon L Lo, Emily M. Fredericks, Alison L Miller

Health Services and Informatics Research

PURPOSE OF REVIEW: Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management.

RECENT FINDINGS: Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support …

The Influence Of Instructor Mental Illness Disclosure On The Perceptions Of Mental Illness, Classroom Climate, Teacher Credibility, Homophily, And Social Attraction, Kirsten L. Bridgemen

Theses and Dissertations

This study uses the lens of Communication Privacy Management theory to analyze the impact an instructor’s depth of disclosure of their mental illness can have on mental illness stigmatization, classroom climate, as well as teacher credibility, homophily, and social attraction. Participants responded to a series of quantitative-based questions regarding a hypothetical syllabus with varied levels of a teacher disclosing their mental illness. Results indicated that none of the investigated dependent variables were negatively affected by the hypothetical instructor’s disclosure, and mental illness stigmatization was lessened. Implications, limitations, and areas for future research are discussed.

A Prospective Study To Validate The Functional Assessment Of Cancer Therapy (Fact) For Epidermal Growth Factor Receptor Inhibitor (Egfri)-Induced Dermatologic Toxicities Fact-Egfri 18 Questionnaire: Swog S1013, Siu Fun Wong, Joseph M. Unger, James L. Wade Iii, Lynne I. Wagner, Mario E. Lacouture, Keisha C. Humphries, Anna Moseley, Kathryn Arnold, Mario R. Velasco Jr., Justin D. Floyd, Benjamin T. Esparaz, Afsaneh Barzi, Heinz-Josef Lenz, Marianna Koczywas, Shaker Dakhil, Gary V. Burton, Michael J. Fisch, N. Lynn Henry, Dawn L. Hershman, Carol M. Moinpour

Pharmacy Faculty Articles and Research

Background

Papulopustular rash is a common class effect of epidermal growth factor receptor inhibitors (EGFRI) that can affect patients’ health-related quality of life and cause disruptions to treatment. SWOG S1013 (NCT01416688) is a multi-center study designed to validate the Functional Assessment of Cancer Therapy EGFRI 18 (FACT-EGFRI 18) using 7-items from the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 to assess EGFRI-induced skin-related toxicities and their impact on functional status.

Methods

Patients with a diagnosis of colorectal or lung cancer to receive EGFRI therapies for at least 6 weeks were enrolled. Patient self-assessments using …

An Applied Ecology Of Fear Framework: Linking Theory To Conservation Practice, Kaitlyn M. Gaynor, Michael J. Cherry, Sophie L. Gilbert, Michael T. Kohl, Courtney L. Larson, Thomas M. Newsome, Laura R. Prugh, Justin P. Suraci, Julie K. Young, Justine A. Smith

United States Department of Agriculture Wildlife Services: Staff Publications

Research on the ecology of fear has highlighted the importance of perceived risk from predators and humans in shaping animal behavior and physiology, with potential demographic and ecosystem-wide consequences. Despite recent conceptual advances and potential management implications of the ecology of fear, theory and conservation practices have rarely been linked. Many challenges in animal conservation may be alleviated by actively harnessing or compensating for risk perception and risk avoidance behavior in wild animal populations. Integration of the ecology of fear into conservation and management practice can contribute to the recovery of threatened populations, human–wildlife conflict mitigation, invasive species management, maintenance …

2020 July 7 - Medical Student Education Committee Minutes, Medical Student Education Committee, East Tennessee State University

Medical Student Education Committee Minutes

No abstract provided.

2020-07-07_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …

2020-07-07_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

2020-07-07_Michiganoverview_Covidlongtermcare, Michigan Department Of Health & Human Services

Michigan COVID-19 Long Term Care Data

The COVID Long Term Care Facilities page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173-526911--,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by long-term care facilities into EMResource. Data is updated on an ongoing basis.

The data below represents a cumulative total of confirmed COVID-19 resident cases, cumulative total of suspected and confirmed resident deaths, cumulative total of confirmed COVID-19 staff cases, and cumulative total of suspected and confirmed staff deaths reported by SNFs in Michigan since January 1, 2020. Case numbers are provisional and may change as facilities correct …

2020-07-07_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of care (POC) tests, look for current infection. Serology (antibody) tests are used to look for the possibility of previous infection.
Source: Michigan Disease Surveillance System (MDSS) and Vital Records

The website contained the tables …

2020-07-07_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

The webpage was obtained from Michigan's Coronavirus Cumulative Data page, under the link Data About Places. Data is self-reported by hospitals daily to the EM Resource System per MDHHS Director Robert Gordon's Emergency Order.

Contains the tables Statewide Available Bed Tracking for COVID-19, COVID-19 Metrics, Statewide Available PPE Tracking for COVID-19 (Statewide Available PPE and Bed Tracking), as well as the tables PPE Days On Hand and Patient Census.

Inflammatory Pathway Analytes Predicting Rapid Cognitive Decline In Mci Stage Of Alzheimer’S Disease, Jagan A. Pillai, Gurkan Bebek, Lynn M. Bekris, Aaron Bonner-Jackson, Stephen M. Rao, Mark R. Chance, James B. Leverenz

Faculty Scholarship

Objective: To determine the inflammatory analytes that predict clinical progression and evaluate their performance against biomarkers of neurodegeneration. Methods: A longitudinal study of MCI-AD patients in a Discovery cohort over 15 months, with replication in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort over 36 months. Fifty-three inflammatory analytes were measured in the CSF and plasma with a RBM multiplex analyte platform. Inflammatory analytes that predict clinical progression on Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) and Mini Mental State Exam scores were assessed in multivariate regression models. To provide context, key analyte results in ADNI were compared against biomarkers …

A Mechanistic Model And Therapeutic Interventions For Covid-19 Involving A Ras-Mediated Bradykinin Storm, Michael R. Garvin, Christiane Alvarez, J. Izaak Miller, Erica T. Prates, Angelica M. Walker, B. Kirtley Amos, Alan E. Mast, Amy Justice, Bruce Aronow, Daniel Jacobson

Horticulture Graduate Research

Neither the disease mechanism nor treatments for COVID-19 are currently known. Here, we present a novel molecular mechanism for COVID-19 that provides therapeutic intervention points that can be addressed with existing FDA-approved pharmaceuticals. The entry point for the virus is ACE2, which is a component of the counteracting hypotensive axis of RAS. Bradykinin is a potent part of the vasopressor system that induces hypotension and vasodilation and is degraded by ACE and enhanced by the angiotensin1-9 produced by ACE2. Here, we perform a new analysis on gene expression data from cells in bronchoalveolar lavage fluid (BALF) from COVID-19 patients that …

Metformin Enhances Autophagy And Normalizes Mitochondrial Function To Alleviate Aging-Associated Inflammation, Leena P. Bharath, Madhur Agrawal, Grace Mccambridge, Dequina A. Nicholas, Hatice Hasturk, Jing Liu, Lao Jiang, Rui Liu, Zhenheng Guo, Jude T. Deeney, Caroline M. Apovian, Jennifer Snyder-Cappione, Gregory S. Hawk, Rebecca M. Fleeman, Riley M. F. Pihl, Katherine Thompson, Anna C. Belkina, Licong Cui, Elizabeth A. Proctor, Philip A. Kern, Barbara S. Nikolajczyk

Clinical and Translational Science Faculty Publications

Age is a non-modifiable risk factor for the inflammation that underlies age-associated diseases; thus, anti-inflammaging drugs hold promise for increasing health span. Cytokine profiling and bioinformatic analyses showed that Th17 cytokine production differentiates CD4+ T cells from lean, normoglycemic older and younger subjects, and mimics a diabetes-associated Th17 profile. T cells from older compared to younger subjects also had defects in autophagy and mitochondrial bioenergetics that associate with redox imbalance. Metformin ameliorated the Th17 inflammaging profile by increasing autophagy and improving mitochondrial bioenergetics. By contrast, autophagy-targeting siRNA disrupted redox balance in T cells from young subjects and activated the Th17 …