Medicine and Health Sciences Commons^™

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Seborrheic Dermatitis, Christian J. Scheufele, Christopher M. Wong, Daniel A. Nguyen Do, Pharmd, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Seborrheic dermatitis is a common dermatologic disease affecting patients of all ages, ethnicities, and skin pigmentations. The rash often affects the scalp, ears, and central face. The underlying skin pigmentation of the individual may affect how this disease presents. We present several cases of seborrheic dermatitis in individuals of varying ages, genders, and skin pigmentations.

Opioid-Related Emergency Department Visits Before And During Covid-19: Association With Community-Level Factors, Timothy F. Page, Weiwei Chen, François Sainfort, Julie A. Jacko

HCA Healthcare Journal of Medicine

Background

The purpose of the study was to investigate the relationship between community-level variables and emergency department (ED) visit rates before and during COVID-19. The focus was on opioid-related ED visits. Despite large declines in overall ED visits during COVID-19, opioid-related visits increased. While visits for avoidable conditions decreased, the opposite was true for opioid-related visits.

Methods

We combined data from Florida EDs with community-level variables from the 2020 American Community Survey. The outcome measures of the study were quarterly ZIP code tabulation-area-level ED visit rates for opioid-related ED visits as well as visit rates for all other causes. Associations …

Drivers Of Being Unhoused And The Prevalence Of Health Conditions Among Unhoused Individuals In Asheville, Nc, Andrea K. Yontz, Amber Beane, Tessa Frank, Amy Upham, Dustin V. Patil, Dan Pizzo, Steve Buie, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background

During the COVID-19 pandemic, there was an increase in the number of unhoused individuals in Asheville, North Carolina resulting in more tent encampments.

Understanding the physical, mental, and socially determined health characteristics associated with being unhoused can help guide stakeholders with policy development, healthcare program planning, and funding decisions to support unhoused individuals.

Methods

In this study, we used an observational cross-section methodology. Using a convenience sample approach, we interviewed 101 participants who were receiving services from 2 emergency hotel shelters, a day center, and a resource center. Data were analyzed using descriptive statistics, and open-ended responses were collected …

Evaluation Of The Efficacy Of Remdesivir For The Treatment Of Coronavirus Disease 2019, Alexandra Flannery, Anastasia Knecht, Koravangala Sundaresh

HCA Healthcare Journal of Medicine

Background

Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, SARS-CoV-2, has accounted for more than 1 000 000 deaths in the United States alone. In May 2020, the Food and Drug Administration issued an Emergency Use Authorization to allow the investigational use of intravenous remdesivir for the treatment of suspected or confirmed COVID-19 in hospitalized children and adults. Several other agents, such as hydroxychloroquine, dexamethasone, and tocilizumab have been investigated as potential treatment options; however, dexamethasone is currently the only agent that has been proven to reduce mortality in patients who require supplemental oxygen. The purpose of this study …

Prophylactic Mesh Reinforcement For Non-Midline Incisions: A Systematic Review, Rainna Coelho, Oluwatunmininu Anwoju, Ali Siddiqui, Andrew Youssef, Oscar A. Olavarria, Nalia H. Dhanani, Karla Bernardi, Zuhair Ali, Mike Liang

HCA Healthcare Journal of Medicine

Background

Many abdominal-pelvic surgeries utilize incisions not along the linea alba, such as transverse, laparoscopic, ostomy reversal, or ostomy formation incisions. The prevalence of ventral incisional hernias (VIH) at these sites and the efficacy of prophylactic mesh in preventing VIH remains unclear.

Methods

PubMed, Embase, Scopus, and Cochrane databases were systematically reviewed from inception to September 2022. We included published randomized controlled trials (RCTs) that compared prophylactic mesh reinforcement versus no mesh. The primary outcome was the incidence of VIH at postoperative follow-up equal to or greater than 24 months. Secondary outcomes included surgical site infection (SSI) and surgical site …

A Combination Of Generated Hydrogen Sulfide And Nitric Oxide Activity Has A Potentiated Protectant Effect Against Cisplatin Induced Nephrotoxicity, Faria Khurshid, Javeid Iqbal, Fiaz Ud Din Ahmad, Arslan Hussain Lodhi, Abdul Malik, Suhail Akhtar, Azmat Ali Khan, Marvi Imam Bux, Mohammed Younis

Biomedical Sciences Faculty Publications

Aim: Hydrogen sulfide and nitricoxide possess cytoprotective activity and in vivo, they are generated from exogenous sodium hydrosulfide and L-arginine respectively. Cisplatin is a major chemotherapeutic agent used to treat cancer and has a high incidence of nephrotoxicity as a side effect. The study aim was to explore the effects of NaHS and L-arginine or their combination on cisplatin induced nephrotoxicity in rats. Methods: Wistar Kyoto rats were given a single intraperitoneal dose of cisplatin (5 mg/kg) followed either by NaHS (56 μmol/kg, i. p.), L-arginine (1.25 g/L in drinking water) or their combination daily for 28-days. Post-mortem plasma, urine …

How And Why Foster Care Impacts Maltreated Youths' School Performance, Mallory Constantine

Lincy Institute Events

Youth mistreated within the foster care system are more likely to miss school as compared to non-maltreated peers. A single report of child maltreatment has a rapid and negative effect on school attendance and causes serious, long-term effects on school performance. A report of maltreatment substantiated by the department of family and child services removes a youth from a foster home and places the child in an alternative setting. These disruptions in foster care often result in additional problems with school behavior, achievement, and attendance. This lecture will explore how disruptions in foster care affect school behavior and performance and …

Final Scholarly Project: Development Of Evidenced-Based Practice Guidelines For Female Patients Undergoing Anesthesia For Breast Cancer Surgery, Alexa High

Doctor of Nursing Practice Scholarly Projects

In the United States, the rate at which cancer is diagnosed is on the rise. In women, breast cancer is the second most common cancer diagnosis, following skin cancer, with approximately one in eight women developing breast cancer in their lifetime. When a patient receives a breast cancer diagnosis, the oncologic team will discuss the most suitable treatment plan for the patient, this often includes chemotherapy, radiation therapy, and surgery. Within the last few decades, research has shown that there may be a correlation between anesthetic medications and breast cancer metastasis. This project aims to create an evidence-based anesthesia guideline …

“We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Bj Cunningham

Communication Sciences and Disorders Publications

Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers’ perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers’ perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.

We Were The Best People To Do The Job”: Caregivers’ Reported Outcomes Of A Virtual Caregiver-Delivered Program For Autistic Preschoolers, Lauren Denusik, Danielle Glista, Michelle Servais, Jodi Friesen, Janis Oram, Bj Cunningham

PRECISe Preschool Speech and Language Publications

Background and aims: Caregiver-delivered programs are a recommended best practice to support young autistic children. While research has extensively explored children's outcomes quantitatively, minimal qualitative research has been conducted to understand caregivers' perspectives of program outcomes for themselves and their children. Hearing directly from caregivers is an important step in ensuring these programs are meeting the needs of those who use them. This study explored caregivers' perceived outcomes following one virtual caregiver-delivered program, The Hanen Centre's More Than Words® (MTW) program.

Methods: This study was a secondary analysis of data from individual interviews conducted with 21 caregivers who had …

Ensuring Equitable Application Of Interventions To Vulnerable Subpopulations In The Kentucky Consortium For Accountable Health Communities (Kc-Ahc), Jing Li, Jessica M. Clouser, Akosua Adu, Aiko Weverka, Nikita Vundi, Terry D. Stratton, Mark V. Williams

Journal of Appalachian Health

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women.

Methods: Twenty-eight primary …

Bmp4 And Grem1 Are Targets Of Shh Signaling And Downstream Regulators Of Collagen In The Penis, Jiangping Deng, Timothy Searl, Samuel Ohlander, Danuta Dynda, Daniel A Harrington, Kevin T Mcvary, Carol A Podlasek

Faculty, Staff and Student Publications

Background: Cavernous nerve (CN) injury, caused by prostatectomy and diabetes, initiates a remodeling process (smooth muscle apoptosis and increased collagen) in the corpora cavernosa of the penis of patients and animal models that is an underlying cause of erectile dysfunction (ED), and the Sonic hedgehog (SHH) pathway plays an essential role in the response of the penis to denervation, as collagen increases with SHH inhibition and decreases with SHH treatment.

Aim: We examined if part of the mechanism of how SHH prevents penile remodeling and increased collagen with CN injury involves bone morphogenetic protein 4 (BMP4) and gremlin1 (GREM1) and …

Trilogies: Lessons From 50 Years Facilitating Community-Based Health Assessments And Planning In Appalachia, Bruce Behringer

Journal of Appalachian Health

Involvement of community and organizational groups is fundamental to most public ventures. Most social, health, economic, and educational improvements in Appalachia have been characterized by successfully integrating community input and finding ways to encourage organizational change and collaboration.

Managing group process and related facilitation skills are fundamental competencies for public health professionals and others guiding change efforts. Groups from communities and organizations can get stalled in their deliberations; a facilitator frequently must think quickly to diagnose the situation and propose alternative approaches. Creative and flexible approaches, learned through practice experiences, can blend with theories and frameworks learned in academic preparation …

Maternal Age And Inadequate Prenatal Care In West Virginia: A Project Watch Study, Madelin Gardner, Amna Umer, Brian Hendricks, Toni Marie Rudisill, Candice Lefeber, Collin John, Christa Lilly

Journal of Appalachian Health

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and infant. Teen age and advanced maternal age (AMA) are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC.

Purpose: This study sought to determine the potential association between maternal age (in groups, aged 20–24, 25–29, 30–34, 35–39, and >40) and inadequate PNC (visits).

Methods: West Virginia (WV) Project WATCH population-level data (May 2018–March 2022) were used for this study. Multiple logistic regressions were performed on inadequate PNC (less than 10 visits) with maternal age …

Telehealth Utilization In Clinical Trials: Facilitators, Barriers, And Future Directions, Michael Carpenter

MUSC Theses and Dissertations

Purpose: Telehealth implementation in clinical trials is not as well developed as compared to telehealth utilization in other areas of medical care. The focus of this project will explore the factors that foster and hinder the effective use of telehealth in clinical trials and how these insights can inform future strategies and policies.

Method: The project synthesizes empirical research and theoretical literature on the integration of telehealth into clinical trial. The research utilizes an online survey via REDCap to gauge the level of acceptance, perceived effectiveness, and potential barriers to the implementation of telehealth in clinical research.

Results: The responses …

Using The Confusion Assessment Method For The Intensive Care Unit (Cam-Icu) To Decrease Length Of Stay: A Scoping Review, Brooke D. Ward Bsn, Rn, Dnp Agacnp Student, Martina Little Bsn, Rn, Dnp Agacnp Student, Tracy Mcclinton Dnp, Agacnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium.

Methods

A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of …

A Developmental Exploration Of The Role Of Catp-6 Gene In Model Organism C. Elegans Relating To Parkinson’S Disease, Kaiser Kate Weafer

Undergraduate Theses

Parkinson’s disease (PD) is considered a common and complex neurogenerative disease characterized by the complete loss of dopaminergic neurons located in the substantia nigra pars compacta. With the incomplete understanding of this neurological disorder, Caenorhabditis elegans (C. elegans), a microscopic nematode, could serve as a model organism of study due to specific gene analogs, relating to PD, present in both C. elegans and humans. The gene of interest for this project is catp-6 in C. elegans an ortholog of the human ATP132A gene. Mutations in the ATP132A gene correlate with an abnormal form of early onset PD called Kufor-Rakeb Syndrome, …

Modelling The Combined Use Of Long-Lasting Insecticidal Nets And Insecticides Zooprophylaxis Against The Resilience Of Anopheles Arabiensis For Effective Malaria Control, Watson Levens

Tanzania Journal of Science

Malaria is a significant public health concern, especially in tropical regions. It remains endemic in many areas where malaria mosquitoes are prevalent. This study investigates the viability of insecticide zooprophylaxis (IZ) in conjunction with Long Lasting Insecticidal Nets (LLINs) as a strategic approach to combat malaria transmission, particularly in regions dominated by zoophagic vectors. Through the presentation and analysis of a mathematical model that integrates IZ and LLINs for the control of Anopheles arabiensis (An. arabiensis), the research underscores IZ's role in reducing zoophagic vector populations and enhancing malaria control efforts. Notably, the study reveals that achieving comprehensive coverage of …

Modeling The Transmission Dynamics Of Tuberculosis In Humans, Farida Kisinda, Joshua A. Mwasunda, Mbwiga S. Aloni

Tanzania Journal of Science

Tuberculosis (TB) is a major threat to human health particularly in most of developing countries. In this article, we formulate and analyze a deterministic model for the transmission dynamics of pulmonary and extra-pulmonary tuberculosis. The next generation method is employed to find the basic reproduction number which helps to determine whether TB clears or persists in the human population. Global stability of model equilibria is done through Lyapunov functions whereas the normalized forward sensitivity index method is adopted to determine parameters that drive tuberculosis. Analysis shows that both TB free and endemic equilibria exist. The TB free equilibrium is globally …

Prevalence And Predictors Of Cesarean Delivery In A Tertiary Hospital In Taraba State, Nigeria, Olateju Alao Bamigbala, Ayodeji Oluwatobi Ojetunde, Maza Tanko

Tanzania Journal of Science

A cesarean section (CS) is a surgical technique in which a baby is delivered through an abdomen and uterine incision following fetal viability. It is imperative to identify the factors that influence the use of CS to reduce the needless use of this life-saving procedure and increase its availability for those who need it most. Therefore, this study assesses the prevalence and predictors of cesarean delivery in a tertiary hospital in Taraba state, Nigeria. Information of pregnant women who came for delivery to Federal Medical Center, Jalingo, Taraba state Nigeria from August 2021 to August 2023 was collected. Binary Logistic …

The Organization Of Irrational Beliefs In Academic Burnout, Diniy Hidayatur Rahman, Yuliati Hotifah, Irene Maya Simon, Ariya Kuha, A Fathorrazi

Jurnal Kajian Bimbingan dan Konseling

From the Rational-Emotive Behavior Therapy (REBT) perspective, irrational beliefs are posited as the primary catalysts for a myriad of problems, including academic burnout. This study aims to examine the theoretical model of irrational beliefs organization in academic burnout. The hypothesized model delineates the following pathways: (1) from demandingness (DEM) to academic burnout (BURN) via catastrophizing (CAT); (2) from demandingness (DEM) to academic burnout (BURN) via low frustration tolerance (LFT); and (3) from demandingness (DEM) to academic burnout (BURN) via self-depreciation (DEP). To achieve the aim, the study employed a causal relationship design. 424 subjects obtained by stratified random sampling participated …

Goal Commitment As Mediator Of Relationship Between Emotional Intelligence And Career Decision Difficulties Among Vocational High School Students, Thalia Zamira, Puji Lestari Suharso

Jurnal Kajian Bimbingan dan Konseling

Vocational high school students were provided with a curriculum designed to facilitate their transition into the workforce. Elicitation studies have indicated that vocational high school students experience difficulties in making career decisions. The internship program is designed to enhance students' emotional intelligence and goal commitment, thereby preventing career decision-making difficulties. This research aims to investigate the mediating effect of goal commitment in the relationship between emotional intelligence and career decision-making difficulties. This quantitative correlational research was conducted in a vocational high school in Bogor with a total of 173 participants using a self-report questionnaire of CDDQ, TEIQue-SF, and HWK Scale. …

Cultural Intelligence Profile Of Junior High School Counsellors And Its Implication On Multicultural Counseling, M Ramli, Nur Mega Aris Saputra, Ulfah Muhayani

Jurnal Kajian Bimbingan dan Konseling

The diversity of ethnicities, religions, and races that exist in Indonesia contribute to the country's characterization as a nation with a multitude of cultures. In the context of the relationship between counselor and counselee, cultural diversity is a significant concern. The comprehension, awareness, and work behavior of the counselee's cultural diversity is indicative of the counselor's cultural intelligence. The concept of cultural intelligence is a crucial aspect that counselors must consider when providing multicultural counseling services. The objectives of this research are to determine the description of counselors' cultural intelligence and its application in multicultural counseling. The research employed a …

Navigating Diverse Career Paths: Students’ Perception On Career Counseling Need In Islamic Universities, Faizah Binti Awad, Muh. Shaleh, Anita Rezki, Arlita Aristianingsih Jufra, Horst Tonn-Meller

Jurnal Kajian Bimbingan dan Konseling

This research aims to explore the needs of career counseling services for students in different majors in Islamic universities, and identify how these services can be tailored to meet their unique needs. A mixed-methods approach was used to collect and analyze data from undergraduate students in diverse majors at an Islamic university in Kendari. The study found that students in certain majors require more specific counseling, such as information on job market trends and technical skills development. Additionally, the study suggests that career counseling services can be tailored to meet the specific needs of students in diverse majors by providing …

Current Update Of Clinical Therapeutic Strategies For Colon-Targeted Delivery Systems, Risa Widiani Batubara, Fadlina Chany Saputri, Raditya Iswandana

Pharmaceutical Sciences and Research

Oral colon-targeted drug delivery systems represent a significant advancement offering both systemic and local therapeutic effects for a range of intestinal diseases, including irritable bowel syndrome, inflammatory bowel disease, colonic bacterial infections, and colorectal cancer. These systems facilitate the delivery of both small molecules and macromolecular compounds such as peptides, proteins, antibodies, oligonucleotides, RNA, and probiotics. This review provides an up-to-date exploration of the critical factors crucial for the effective design and development of drug delivery systems targeting the colon. The chosen strategy takes into account various aspects of colon physiology that influences the profile of drug release, absorption, dissolution, …

Transdermal Delivery Of Ketoprofen For Osteoarthritis Treatment And Management: A Literature Review On Current Progression, Dwi Asih Ramadhani, Yahdiana Harahap, Erny Sagita, Kartika Citra Dewi Permata Sari, Rr. Kirana Andranilla, Jessica Trisina, Gabriella Frederika Punu, Delly Ramadon

Pharmaceutical Sciences and Research

Arthritis, a diverse spectrum of joint disorders, is characterized by chronic pain and inflammation. Osteoarthritis (OA), the most prevalent form, leads to disabling pain, functional limitations, and reduced mobility. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for managing OA pain, with ketoprofen recognized as one of the effective options. However, oral administration of ketoprofen may cause gastrointestinal irritation. Addressing this issue, Transdermal Drug Delivery Systems (TDDS) emerge as a promising alternative route of administration. TDDS facilitates delivery of various drugs through the skin without undergoing first-pass metabolism. Recent studies have centered on enhancing ketoprofen’s transdermal delivery, particularly focusing on different …

Using An American Sign Language Video Intervention To Improve Advance Care Planning Engagement Among Deaf Adults, Colleen Ann Manning Dnp, Aprn, Fnp-C

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement (QI) project was intended to increase ACP engagement by 25% from baseline by implementing an ASL video intervention. The project was conducted at a Deaf community organization in Houston, Texas.

BACKGROUND Literacy and language barriers negatively impact access to healthcare and health information among the Deaf population. ASL video interventions aimed at improving health equity are supported in the literature.

METHODOLOGY The Plan-Do-Study-Act (PDSA) quality improvement methodology was used to create a video for the Deaf community about ACP using ASL and captioning. The PREPARE™ ACP Engagement Survey measured changes in ACP behavior due to a …

Decorin Suppresses Tumor Lymphangiogenesis: A Mechanism To Curtail Cancer Progression, Dipon K. Mondal, Christopher Xie, Gabriel J. Pascal, Simone Buraschi, Renato V. Iozzo

Kimmel Cancer Center Faculty Papers

The complex interplay between malignant cells and the cellular and molecular components of the tumor stroma is a key aspect of cancer growth and development. These tumor-host interactions are often affected by soluble bioactive molecules such as proteoglycans. Decorin, an archetypical small leucine-rich proteoglycan primarily expressed by stromal cells, affects cancer growth in its soluble form by interacting with several receptor tyrosine kinases (RTK). Overall, decorin leads to a context-dependent and protracted cessation of oncogenic RTK activity by attenuating their ability to drive a prosurvival program and to sustain a proangiogenic network. Through an unbiased transcriptomic analysis using deep RNAseq, …

The Efficacy Of High-Fidelity Simulation On Knowledge And Performance In Undergraduate Nursing Students: An Umbrella Review Of Systematic Reviews And Meta-Analysis, Celeste Marie Alfes

Faculty Scholarship

Objectives: This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students. Design: Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results. Data sources: Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies. Review methods: The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). …

Phase I Trial Of Single-Photon Emission Computed Tomography-Guided Liver-Directed Radiotherapy For Patients With Low Functional Liver Volume, Enoch Chang, Franklin C L Wong, Beth A Chasen, William D Erwin, Prajnan Das, Emma B Holliday, Albert C Koong, Ethan B Ludmir, Bruce D Minsky, Sonal S Noticewala, Grace L Smith, Cullen M Taniguchi, Maria J Rodriguez, Sam Beddar, Rachael M Martin-Paulpeter, Joshua S Niedzielski, Gabriel O Sawakuchi, Emil Schueler, Luis A Perles, Lianchun Xiao, Janio Szklaruk, Peter C Park, Arvind N Dasari, Ahmed O Kaseb, Bryan K Kee, Sunyoung S Lee, Michael J Overman, Jason A Willis, Robert A Wolff, Ching-Wei D Tzeng, Jean-Nicolas Vauthey, Eugene J Koay

Faculty, Staff and Student Publications

BACKGROUND: Traditional constraints specify that 700 cc of liver should be spared a hepatotoxic dose when delivering liver-directed radiotherapy to reduce the risk of inducing liver failure. We investigated the role of single-photon emission computed tomography (SPECT) to identify and preferentially avoid functional liver during liver-directed radiation treatment planning in patients with preserved liver function but limited functional liver volume after receiving prior hepatotoxic chemotherapy or surgical resection.

METHODS: This phase I trial with a 3 + 3 design evaluated the safety of liver-directed radiotherapy using escalating functional liver radiation dose constraints in patients with liver metastases. Dose-limiting toxicities were …