Diseases Commons^™

Trunk Kinematics Using Musculoskeletal Modeling During Range Of Motion Tasks, Maryam Moeini, Ruth M. Higgins, Hunter Bennett, Stacie Ringleb

College of Health Sciences Posters

A spine model can be used to predict post-spinal fusion motion needed to perform physical activities in individuals with scoliosis. Full body lumbar spine (FBLS) model (Raabi et al., 2016) allows for modeling lumbar spine and pelvis movement and was validated for jogging. However, like other existing adult spine models, FBLS model does not allow for a motion providing thoracic and spine. Purpose: To adapt the FBLS model for simulating thoracic, lumbar and pelvis motion during trunk rotation in all 3 planes of motion. Methods: Since T12-L1 in FBLS model is designed as a dependent joint (axial rotation analogous to …

“It’S Pretty Hard To Make Friends Over A Zoom Meeting Room”: Understanding The Recreational Experiences Of Youth With Type 1 Diabetes During Covid-19, Ryan Malpaya, Rowan Williams

Undergraduate Research Symposium

Youth with diabetes frequently have limited access to traditional camps because of the need for accessible medical staff (Hill, E., 2019). COVID-19 has made it even more difficult for youth with type 1 diabetes to participate in any youth development programs due to the pandemic restrictions. During the pandemic, it is unknown if youth with T1D are able to engage in any recreational activities that may teach them resilience and independence in managing their medical condition. The purpose of this study was to see how youth with T1D cope in an altered recreation environment as a result of COVID-19

Using …

Predictive Modeling And Estimation Of The Doubling Time Of Confirmed Cases Of Covid-19 In Niger, Ibrahim Sidi Zakari, Hadiza Galadima

Community & Environmental Health Faculty Publications

Modeling is increasingly used to assess scenarios and make projections on the future course of new coronavirus disease. This allows for better planning of care as well as a relaxation or tightening of the restrictive measures decreed by the government and the health authorities. The data analyzed in this study covers the period from March 19 to June 05, 2020 and allowed predictions of new cases of COVID-19 based on a growth model with a growth rate that changes linearly over time. In addition, we calculated and predicted the doubling time of the number of positive cases in each region …

The Relationship Between Insurance And Health Outcomes Of Diabetes Mellitus Patients In Maryland: A Retrospective Archival Study, Soo-Hoon Lee, Samuel L. Brown, Andrew A. Bennett

Management Faculty Publications

Background

Past studies examining the health outcomes of diabetes mellitus (DM) patients found that social determinants of health disparities were associated with variabilities in health outcomes. However, improving access to healthcare, such as health insurance, should mitigate negative health outcomes. The aim of the study was to explore the association between four types of health insurance, namely, Medicare Fee-For-Service (FFS), Medicare Managed Care (MC), Private FFS, and Private MC plans, and the health outcomes of DM patients, controlling for patients’ social determinants of health.

Methods

This is a retrospective cross-sectional archival record study to explore the relationships between types of …

Physical Activity, Dietary Patterns, And Glycemic Management Of Active Individuals With Type 1 Diabetes: An Online Survey, Sheri Colberg, Jihan Kannane, Norou Diawara

Human Movement Studies & Special Education Faculty Publications

Individuals with type 1 diabetes (T1D) are able to balance their blood glucose levels while engaging in a wide variety of physical activities and sports. However, insulin use forces them to contend with many daily training and performance challenges involved with fine-tuning medication dosing, physical activity levels, and dietary patterns to optimize their participation and performance. The aim of this study was to ascertain which variables related to the diabetes management of physically active individuals with T1D have the greatest impact on overall blood glucose levels (reported as A1C) in a real-world setting. A total of 220 individuals with T1D …

Dietary Phytoestrogens Ameliorate Hydrochloric Acid-Induced Chronic Lung Injury And Pulmonary Fibrosis In Mice, Pavel Solopov, Ruben Manuel Luciano Colunga Biancatelli, Christiana Dimitropoulou, John D. Catravas

Bioelectrics Publications

We previously reported that female mice exhibit protection against chemically induced pulmonary fibrosis and suggested a potential role of estrogen. Phytoestrogens act, at least in part, via stimulation of estrogen receptors; furthermore, compared to residents of Western countries, residents of East Asian countries consume higher amounts of phytoestrogens and exhibit lower rates of pulmonary fibrosis. Therefore, we tested the hypothesis that dietary phytoestrogens ameliorate the severity of experimentally induced pulmonary fibrosis. Male mice placed on either regular soybean diet or phytoestrogen-free diet were instilled with 0.1 N HCl to provoke pulmonary fibrosis. Thirty days later, lung mechanics were measured as …

Moderate Heat-Assisted Gene Electrotransfer For Cutaneous Delivery Of A Dna Vaccine Against Hepatitis B Virus, Chelsea Edelblute, Cathryn Mangiamele, Richard Heller

Bioelectrics Publications

An estimated 350 million people are living with chronic Hepatitis B virus (HBV) worldwide. Preventative HBV vaccination in infants has reduced the disease burden; however, insufficient immunization programs and access obstacles leave vulnerable populations at risk for infection in endemic regions. Gene electrotransfer (GET) using a noninvasive multielectrode array (MEA) provides an alternative platform for DNA vaccination in the skin. DNA vaccines are nonlive and nonreplicating and temperature stable unlike their counterparts. In addition, their simple engineering allows them to be manufactured quickly at a low cost. In the current work, we present the combination of GET and moderate heating …

Short-Range Forecasting Of Covid-19 During Early Onset At County, Health District, And State Geographic Levels Using Seven Methods: Comparative Forecasting Study, Christopher Lynch, Ross Gore

VMASC Publications

BACKGROUND:

Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels.

OBJECTIVE:

COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes …

Microbiomes Of Blood-Feeding Arthropods: Genes Coding For Essential Nutrients And Relation To Vector Fitness And Pathogenic Infections. A Review, Daniel E. Sonenshine, Philip E. Stewart

Biological Sciences Faculty Publications

Blood-feeding arthropods support a diverse array of symbiotic microbes, some of which facilitate host growth and development whereas others are detrimental to vector-borne pathogens. We found a common core constituency among the microbiota of 16 different arthropod blood-sucking disease vectors, including Bacillaceae, Rickettsiaceae, Anaplasmataceae, Sphingomonadaceae, Enterobacteriaceae, Pseudomonadaceae, Moraxellaceae and Staphylococcaceae. By comparing 21 genomes of common bacterial symbionts in blood-feeding vectors versus non-blooding insects, we found that certain enteric bacteria benefit their hosts by upregulating numerous genes coding for essential nutrients. Bacteria of blood-sucking vectors expressed significantly more genes (p < 0.001) coding for these essential nutrients than those of non-blooding insects. Moreover, compared to endosymbionts, the genomes of enteric bacteria also contained significantly more genes (p < 0.001) that code for the synthesis of essential amino acids and proteins that detoxify reactive oxygen species. In contrast, microbes in non-blood-feeding insects expressed few gene families coding for these nutrient categories. We also discuss specific midgut bacteria essential for the normal development of pathogens (e.g., Leishmania) versus …

Sex-Related Differences In Murine Models Of Chemically Induced Pulmonary Fibrosis, Pavel Solopov, Ruben Manuel Luciano Colunga Biancatelli, Christiana Dimitropoulou, John D. Catravas

Bioelectrics Publications

We developed two models of chemically induced chronic lung injury and pulmonary fibrosis in mice (intratracheally administered hydrochloric acid (HCl) and intratracheally administered nitrogen mustard (NM)) and investigated male-female differences. Female mice exhibited higher 30-day survival and less weight loss than male mice. Thirty days after the instillation of either HCl or NM, bronchoalveolar lavage fluid displayed a persistent, mild inflammatory response, but with higher white blood cell numbers and total protein content in males vs. females. Furthermore, females exhibited less collagen deposition, milder pulmonary fibrosis, and lower Ashcroft scores. After instillation of either HCl or NM, all animals displayed …

Occupational Health Practices Among Dental Care Professionals Before And During The Covid-19 Pandemic, Sean Banaee, Denise M. Claiborne, Muge Akpinar-Elci

Community & Environmental Health Faculty Publications

BACKGROUND: The COVID-19 pandemic has posed a substantial burden on dental care professionals. While dentistry is known as one of the most exposed and high-risk professions, dental care professionals are indeed at even greater risk.

OBJECTIVE: The aim of this study was to assess knowledge, attitudes, occupational health practices, personal protective equipment usage, and mental stressors during COVID-19 pandemic among dental care professionals.

METHODS: A cross-sectional study was conducted among dental care professionals who were subscribers to a dental hygiene journal using a self-administered online survey (n = 1047 respondents). Cross-tabulations were performed to determine differences in the responses to …

Trends And Opportunities In Tick-Borne Disease Geography, Catherine A. Lippi, Sadie J. Ryan, Alexis L. White, Holly D. Gaff, Colin J. Carlson

Biological Sciences Faculty Publications

Tick-borne diseases are a growing problem in many parts of the world, and their surveillance and control touch on challenging issues in medical entomology, agricultural health, veterinary medicine, and biosecurity. Spatial approaches can be used to synthesize the data generated by integrative One Health surveillance systems, and help stakeholders, managers, and medical geographers understand the current and future distribution of risk. Here, we performed a systematic review of over 8,000 studies and identified a total of 303 scientific publications that map tick-borne diseases using data on vectors, pathogens, and hosts (including wildlife, livestock, and human cases). We find that the …

Tetraspanins As Potential Therapeutic Candidates For Targeting Flaviviruses, Waqas Ahmed, Girish Neelakanta, Hameeda Sultana

Biological Sciences Faculty Publications

Tetraspanin family of proteins participates in numerous fundamental signaling pathways involved in viral transmission, virus-specific immunity, and virus-mediated vesicular trafficking. Studies in the identification of novel therapeutic candidates and strategies to target West Nile virus, dengue and Zika viruses are highly warranted due to the failure in development of vaccines. Recent evidences have shown that the widely distributed tetraspanin proteins may provide a platform for the development of novel therapeutic approaches. In this review, we discuss the diversified and important functions of tetraspanins in exosome/extracellular vesicle biology, virus-host interactions, virus-mediated vesicular trafficking, modulation of immune mechanism(s), and their possible role(s) …

The Effects Of The Traditional Scaling Technique Versus A Modified Scaling Technique On Muscle Activity And Pinch Force Generation: A Pilot Study, Jessica R. Suedbeck, Cortney Armitano-Lago

Dental Hygiene Faculty Publications

Purpose: Dental hygienists perform precision instrumentation tasks repetitively throughout the workday, placing them at increased risk for developing a musculoskeletal disorder. The purpose of this pilot study was to determine differences in muscle activity and pinch force generation between the traditional scaling technique and a modified scaling technique.

Methods: A convenience sample of dental hygienists (n=12) acted as their own controls in this counterbalance-designed pilot study. Muscle activity and pinch forces were assessed while participants performed traditional and modified scaling techniques with designated instruments on artificial calculus applied to the lower left quadrant of a typodont, for a period of …

Application Of One-, Three-, And Seven-Day Forecasts During Early Onset On The Covid-19 Epidemic Dataset Using Moving Average, Autoregressive, Autoregressive Moving Average, Autoregressive Integrated Moving Average, And Naïve Forecasting Methods, Christopher J. Lynch, Ross Gore

VMASC Publications

The coronavirus disease 2019 (COVID-19) spread rapidly across the world since its appearance in December 2019. This data set creates one-, three-, and seven-day forecasts of the COVID-19 pandemic's cumulative case counts at the county, health district, and state geographic levels for the state of Virginia. Forecasts are created over the first 46 days of reported COVID-19 cases using the cumulative case count data provided by The New York Times as of April 22, 2020. From this historical data, one-, three-, seven, and all-days prior to the forecast start date are used to generate the forecasts. Forecasts are created using: …

Deep Neural Network Analysis Of Pathology Images With Integrated Molecular Data For Enhanced Glioma Classification And Grading, Linmin Pei, Karra A. Jones, Zeina A. Shboul, James Y. Chen, Khan M. Iftekharuddin

Electrical & Computer Engineering Faculty Publications

Gliomas are primary brain tumors that originate from glial cells. Classification and grading of these tumors is critical to prognosis and treatment planning. The current criteria for glioma classification in central nervous system (CNS) was introduced by World Health Organization (WHO) in 2016. This criteria for glioma classification requires the integration of histology with genomics. In 2017, the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) was established to provide up-to-date recommendations for CNS tumor classification, which in turn the WHO is expected to adopt in its upcoming edition. In this work, we propose a novel …

Complete Genome Sequence Of Rickettsia Parkeri Strain Black Gap, Sandor E. Karpathy, Christopher D. Paddock, Stephanie L. Grizzard, Dhwani Batra, Lori A. Rowe, David T. Gauthier

Biological Sciences Faculty Publications

A unique genotype of Rickettsia parkeri, designated R. parkeri strain Black Gap, has thus far been associated exclusively with the North American tick, Dermacentor parumapertus. The compete genome consists of a single circular chromosome with 1,329,522 bp and a G+C content of 32.5%.

Tick Ecdysteroid Hormone, Global Microbiota/Rickettsia Signaling In The Ovary Versus Carcass During Vitellogenesis In Part-Fed (Virgin) American Dog Ticks, Dermacentor Variabilis, Loganathan Ponnusamy, Haley Sutton, Robert D. Mitchell Iii, Daniel E. Sonenshine, Charles S. Apperson, Richard Michael Roe

Biological Sciences Faculty Publications

The transovarial transmission of tick-borne bacterial pathogens is an important mechanism for their maintenance in natural populations and transmission, causing disease in humans and animals. The mechanism for this transmission and the possible role of tick hormones facilitating this process have never been studied. Injections of physiological levels of the tick hormone, 20-hydroxyecdysone (20E), into part-fed (virgin) adult females of the American dog tick, Dermacentor variabilis, attached to the host caused a reduction in density of Rickettsia montanensis in the carcass and an increase in the ovaries compared to buffer-injected controls. This injection initiates yolk protein synthesis and uptake …

Adaptive Physics-Based Non-Rigid Registration For Immersive Image-Guided Neuronavigation Systems, Fotis Drakopoulos, Christos Tsolakis, Angelos Angelopoulos, Yixun Liu, Chengjun Yao, Kyriaki Rafailia Kavazidi, Nikolaos Foroglou, Andrey Fedorov, Sarah Frisken, Ron Kikinis, Alexandra Golby, Nikos Chrisochoides

Computer Science Faculty Publications

Objective: In image-guided neurosurgery, co-registered preoperative anatomical, functional, and diffusion tensor imaging can be used to facilitate a safe resection of brain tumors in eloquent areas of the brain. However, the brain deforms during surgery, particularly in the presence of tumor resection. Non-Rigid Registration (NRR) of the preoperative image data can be used to create a registered image that captures the deformation in the intraoperative image while maintaining the quality of the preoperative image. Using clinical data, this paper reports the results of a comparison of the accuracy and performance among several non-rigid registration methods for handling brain deformation. A …

Predictors Of Biologic Use And Satisfaction Among Patients With Psoriasis: An Analysis And Geographic Visualization Of The 2016 And 2017 National Psoriasis Foundation Annual Surveys, Clinton W. Enos, Hadiza I. Galadima, Arjun Saini, Stacie Bell, Michael Siegel, Abby S. Van Voorhees

Community & Environmental Health Faculty Publications

Background: There are an increasing number of biologic therapies approved for the treatment of psoriasis. Previous reports have identified undertreatment as a concern in the United States. Undertreatment has been associated with decreased patient satisfaction and increased morbidity.

Objectives: Assess biologic use and satisfaction among respondents to the 2016 and 2017 National Psoriasis Foundation (NPF) Annual Surveys.

Methods: Retrospective data analysis of the 2016 and 2017 NPF Annual Survey responses from individuals with psoriasis. ArcGIS Pro software was utilized to generate maps and perform an optimized hot spot analysis of moderate-to-severe psoriasis and biologic use.

Results: …

Workshop #1: Vulnerable Populations & Planning Considerations For The 2020 Hurricane Season: After Action Report (Aar), Converge Nsf Working Group, Joshua G. Behr, Wie Yusuf, Jennifer Marshall, Elizabeth Dunn

Presentations, Lectures, Posters, Reports

This workshop shed light on the challenges and importance of adapting current hurricane season planning. Coexisting with COVID-19 will pose even more challenges for hurricane season responses. Suggested adaptations include identifying further shelter spaces to reduce the numbers of evacuees per building (for required social distancing), create isolation spaces to protect populations vulnerable to COVID-19, and quarantine those who are symptomatic. Some strategies being considered include modifying existing shelters (e.g. schools, by using classrooms) and using hotels, dormitories, and other large vacant spaces (e.g., stores and convention centers).

Along with identifying new shelter options comes modifying procedures for screening, triage, …

Quercetin And Vitamin C: An Experimental, Synergistic Therapy For The Prevention And Treatment Of Sars-Cov-2 Related Disease (Covid-19), Ruben Manuel Luciano Colunga Biancatelli, Max Berrill, John D. Catravas, Paul Ellis Marik

Bioelectrics Publications

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) represents an emergent global threat which is straining worldwide healthcare capacity. As of May 27th, the disease caused by SARS-CoV-2 (COVID-19) has resulted in more than 340,000 deaths worldwide, with 100,000 deaths in the US alone. It is imperative to study and develop pharmacological treatments suitable for the prevention and treatment of COVID-19. Ascorbic acid is a crucial vitamin necessary for the correct functioning of the immune system. It plays a role in stress response and has shown promising results when administered to the critically ill. Quercetin is a well-known flavonoid whose antiviral properties …

Tactics Against Scheming Diseases, Brian Martin

The Journal of Sociotechnical Critique

Achieving good health can be thought of as a struggle against opponents—disease and unhealthy practices—that are imagined to be active agents, in a type of thought experiment. These opponents of health, to reduce outrage about their activities, draw on a standard set of tactics: cover-up of the threat, devaluation of victims, reinterpretation of what is happening, use of official processes to give an illusion of safety, and intimidation. To promote good health, each of these tactics can be countered, by exposure of the problem, validation of victims, reframing of what is happening, mobilisation of support, and resistance. Three case studies …

Novel Method Of Supplementing Current Depression Treatments: Using Autonomous Sensory Meridian Response-Centered Therapy To Improve Constipation-Associated Comorbidity Of Depression, Shivam Patel

Virginias Collegiate Honors Council Conference

One-third of individuals struggling with constipation also suffer chronically from comorbid depression, but the evidently shared etiology has remained relatively ambiguous. This proposed study aims to analyze the role of Autonomous Sensory Meridian Response (ASMR), a newly recorded neural phenomenon that causes relaxing “tingles” from unique “triggers” in a subset of individuals, in altering serotonin (5-HT) levels within the ENS to aid with both depression and constipation. In depressed individuals, reduced 5-HT has been clinically accepted as a key symptom and is frequently treated with ineffective SSRIs. Prospective alternative methods of non-invasive treatment, such as ASMR, would not only aid …

Canine Cognitive Dysfunction (Ccd), Alzheimer’S Disease (Ad), And Β-Amyloid Accumulation: Using Ccd As A Reference For The Development Of Ad Treatments And Therapies, Isabel Gibbs

Virginias Collegiate Honors Council Conference

I researched the similarities and differences between Canine Cognitive Dysfunction (CCD)—a disease with symptoms and progression pattern that parallels Alzheimer’s Disease (AD)—and AD. I studied how β-amyloid accumulates in various brain regions—such as the prefrontal, occipital, entorhinal and parietal cortices—in canines to determine how β-amyloid accumulation is associated with the development of behaviors signifying cognitive decline observed in CCD and AD—such as changes in the sleep-wake cycle, social interaction, housetraining, and general orientation—in order to understand how neuroscientists may be able to derive new understandings from a canine model with CCD, and apply them to humans with AD to develop …

Antidepressants Versus Music Therapy: Which Treatment Is Better For Treating Depression In Parkinson's Disease?, Emaan Dawood

Virginias Collegiate Honors Council Conference

Music and medicine are merging to treat depression in Parkinson’s disease (PD). Antidepressants, the current standard, demonstrate mixed effects in clinical trials, warranting other treatment options. Here, I compare music therapy to antidepressants in the treatment of depression in PD via literature review. Studies of depressed PD patients undergoing music therapy and/or antidepressants were reviewed with attention to variables including depression (on a patient-reported outcome) that were measured pre- and post- therapy. In the music studies, improvements were seen in depression. Methodological inconsistencies across these studies, a paucity of studies, and small sample sizes, however, necessitate more research to reach …

Strategies For Safe And Effective Treatment Of Patients With Alzheimer Disease, Jafar Alabdullah, Ahmed Almuntashiri

Community & Environmental Health Faculty Publications

Alzheimer disease is a progressive neurodegenerative disorder that causes cognition impairment and memory loss, affecting activities in daily living. In the United States, an estimated 4.5 million people have AD and this figure is expected to reach 14 million by 2050. Because patients with AD experience a deterioration of their mental functions, patients need more help with their activities of daily living, including oral hygiene, as their AD progresses. Studies have found that individuals with AD often experience poor oral health. As advanced age is a risk factor for AD and the number of older adults in the US continues …

Exposure To Household Secondhand Smoke Among Adolescents In Kuwait: Results From Two School-Based Cross-Sectional Studies, Ali H. Ziyab, Mohammad Almari, Abdullah Al-Taiar

Community & Environmental Health Faculty Publications

INTRODUCTION: Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level.

METHODS: Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11-14 years) and high (n=1959; aged 14-19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance …

Synthesis, Characterization, Dna Binding, Topoisomerase Inhibition, And Apoptosis Induction Studies Of A Novel Cobalt(Iii) Complex With A Thiosemicarbazone Ligand, Stephen J. Beebe, Michael J. Celestine, Jimmie L. Bullock, Shayna Sandhaus, Jessa Faye Arca, Donald M. Cropek, Tekettay A. Ludvig, Sydney R. Foster, Jasmine S. Clark, Floyd A. Beckford, Criszcele M. Tano, Elizabeth A. Tonsel-White, Raj K. Gurung, Courtney E. Stankavich, Yuk-Ching Tse-Dinh, William L. Jarrett, Alvin A. Holder

Bioelectrics Publications

In this study, 9-anthraldehyde-N(4)-methylthiosemicarbazone (MeATSC) 1 and [Co(phen)₂(O₂CO)]Cl·6H₂O 2 (where phen = 1,10-phenanthroline) were synthesized. [Co(phen)₂(O₂CO)]Cl·6H₂O 2 was used to produce anhydrous [Co(phen)₂(H₂O)₂(NO₃)₃ 3. Subsequently, anhydrous [Co(phen)₂(H₂O)₂] (NO₃)₃ 3 was reacted with MeATSC 1 to produce [Co(phen)₂(MeATSC)](NO₃)₃·1.5H₂O·C₂ H₅OH 4. The ligand, MeATSC 1 and all complexes were characterized by elemental analysis, FT IR, UV–visible, and multinuclear NMR …

Electrochemical Detection Of Neurotransmitters, Saikat Banerjee, Stephanie Mccracken, Md Faruk Hossain, Gymama Slaughter

Bioelectrics Publications

Neurotransmitters are important chemical messengers in the nervous system that play a crucial role in physiological and physical health. Abnormal levels of neurotransmitters have been correlated with physical, psychotic, and neurodegenerative diseases such as Alzheimer's, Parkinson's, dementia, addiction, depression, and schizophrenia. Although multiple neurotechnological approaches have been reported in the literature, the detection and monitoring of neurotransmitters in the brain remains a challenge and continues to garner significant attention. Neurotechnology that provides high-throughput, as well as fast and specific quantification of target analytes in the brain, without negatively impacting the implanted region is highly desired for the monitoring of the …