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Articles 121 - 150 of 427
Full-Text Articles in Virus Diseases
Comparative Analysis Of N95 Respirators Fit Testing With Commercially Available And In House Reagent, Erum Khan, Joveria Farooqi, Humaira Shafaq, Kaleem Ullah Khushik, Syed Shamim Raza, Sara Khan, Zohra Rafiq, Bushra Ahmed, Shazia Chisti, Kehkashan Imtiaz, Hasnain Zafar, Afia Zafar
Comparative Analysis Of N95 Respirators Fit Testing With Commercially Available And In House Reagent, Erum Khan, Joveria Farooqi, Humaira Shafaq, Kaleem Ullah Khushik, Syed Shamim Raza, Sara Khan, Zohra Rafiq, Bushra Ahmed, Shazia Chisti, Kehkashan Imtiaz, Hasnain Zafar, Afia Zafar
Department of Pathology and Laboratory Medicine
Background: Due to COVID-19, thousands of healthcare workers have been affected and have lost their lives in the line of duty. For the protection of healthcare workers, WHO and CDC have made standard guidelines and requirements for PPE use. N95 masks are amongst the most readily used PPE by healthcare professionals and it is highly recommended by OSHA that every make and model of N95 should go through a fit test at least once in a year.
Method: A total of 30 randomly selected healthcare professionals (who were a regular user of N95 respiratory masks) were subjected to assess in-house …
Acceptance Rates And Beliefs Toward Covid-19 Vaccination Among The General Population Of Pakistan: A Cross-Sectional Survey, Farah Yasmin, Waleed Asghar, Maryam Salma Babar, Hiba Khan, Shoaib Ahmad, Zaid Hameed, Muhammad Sohaib Asghar, Hamza Nauman, Abdullah Khan Khattak
Acceptance Rates And Beliefs Toward Covid-19 Vaccination Among The General Population Of Pakistan: A Cross-Sectional Survey, Farah Yasmin, Waleed Asghar, Maryam Salma Babar, Hiba Khan, Shoaib Ahmad, Zaid Hameed, Muhammad Sohaib Asghar, Hamza Nauman, Abdullah Khan Khattak
Medical College Documents
Developing countries like Pakistan have previously suffered from barriers to acceptance of vaccination by the public because of financial and belief barriers. This study aims to explore these beliefs and highlight concerns regarding vaccine hesitancy in the general population of Pakistan since they are a hindrance to an effective coronavirus disease-19 (COVID-19) immunization in the country. A cross-sectional study was performed involving 1,778 participants from all four provinces of Pakistan. Results from the study showed more than half of the participants to be unsure of the safety (50%) and efficacy (51%) of the vaccine, whereas 42% were concerned about the …
Coronavirus Update 9-2-21, The Coronavirus Planning Team
Coronavirus Update 9-2-21, The Coronavirus Planning Team
University Briefings & Virtual Events
We continue to have students, faculty and staff express concerns about members of the community who are either not wearing their masks indoors or are wearing them incorrectly. The graphic below illustrates the correct and incorrect ways to wear a mask.
Global Respiratory Syncytial Virus-Related Infant Community Deaths, Natalie I. Mazur, Yvette N. Löwensteyn, Joukje E. Willemsen, Christopher J. Gill, Leah Forman, Lawrence M. Mwananyanda, Dianna M. Blau, Robert F. Breiman, Shabir A. Madhi, Abdul Momin Kazi
Global Respiratory Syncytial Virus-Related Infant Community Deaths, Natalie I. Mazur, Yvette N. Löwensteyn, Joukje E. Willemsen, Christopher J. Gill, Leah Forman, Lawrence M. Mwananyanda, Dianna M. Blau, Robert F. Breiman, Shabir A. Madhi, Abdul Momin Kazi
Department of Paediatrics and Child Health
Background: Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized.
Methods: The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed …
Challenges Of Assessing Community Mortality Due To Respiratory Viruses In Children Aged Less Than 5 Years, Mauricio T. Caballero, Ashish Satav, Christopher J. Gill, Saad B. Omer, Rachel C. Pieciak, Abdul Momin Kazi, Eric Af Simões, Fernando P. Polack
Challenges Of Assessing Community Mortality Due To Respiratory Viruses In Children Aged Less Than 5 Years, Mauricio T. Caballero, Ashish Satav, Christopher J. Gill, Saad B. Omer, Rachel C. Pieciak, Abdul Momin Kazi, Eric Af Simões, Fernando P. Polack
Department of Paediatrics and Child Health
Background: Estimating the real impact of respiratory syncytial virus (RSV) disease is key for the development of vaccines and treatments. Ascertaining the burden of community mortality due to RSV is challenging due to the lack of primary data. Therefore, conducting observational studies to determine the factors associated with community mortality due to the virus in developing countries is important.
Objective: Our aim in this study was to describe the obstacles, gaps, and challenges that investigators face in low-income, vulnerable regions in 4 developing countries on 3 continents.
Results: The main obstacles and challenges of ascertaining community mortality due to RSV …
Rabbit Control: Rhdv1 K5, Department Of Primary Industries And Regional Development, Western Australia
Rabbit Control: Rhdv1 K5, Department Of Primary Industries And Regional Development, Western Australia
Biosecurity factsheets
The national release of the Korean strain of rabbit haemorrhagic disease virus, RHDV1 K5, took place during the first week of March 2017. It was the first time in 20 years a new rabbit biocontrol agent had been released into Australia, and was part of a 20-year national biocontrol plan for rabbits. More than 600 release sites were selected, including 110 sites in Western Australia (WA).
RHDV1 K5 is a naturally occurring Korean variant of the rabbit haemorrhagic disease virus (RHDV). Its release was expected to boost management and help slow the increase in rabbit numbers. RHDV1 K5 does not …
Interpreting Covid-19 Deaths Among Nursing Home Residents In The Us: The Changing Role Of Facility Quality Over Time, Debasree Das Gupta, Uma Kelekar, Sidney C. Turner, Anupam A. Sule, Taya G. Jerman
Interpreting Covid-19 Deaths Among Nursing Home Residents In The Us: The Changing Role Of Facility Quality Over Time, Debasree Das Gupta, Uma Kelekar, Sidney C. Turner, Anupam A. Sule, Taya G. Jerman
Kinesiology and Health Science Faculty Publications
A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that …
Voices From A Prison Pandemic: Lives Lost From Covid-19 At Lakeland Correctional, Kimberly Thomas
Voices From A Prison Pandemic: Lives Lost From Covid-19 At Lakeland Correctional, Kimberly Thomas
Articles
Coronavirus tore through jails and prisons like wildfire. In some states, more than half of the people incarcerated there tested positive for COVID-19; nearly 400,000 people in prison across the United States have tested positive. For people in prison, COVID-19 brought the loss of close friends, solitary confinement, loss of connection with family and programming, lack of information, and fear of contracting the virus. It has also reminded those who are incarcerated of the one-dimensional way in which people in prison are perceived. As stated by one collaborator, Cory Souders, "[s]o many men and women who come to prison are …
Obesity, Race, And Covid-19 Mortality: Results From A Large Cohort Early In The Pandemic, Eric K. Shaw, Anyul Ferez-Pinzon, Micah Mabe, Mike Flynn, Christopher K. Senkowski
Obesity, Race, And Covid-19 Mortality: Results From A Large Cohort Early In The Pandemic, Eric K. Shaw, Anyul Ferez-Pinzon, Micah Mabe, Mike Flynn, Christopher K. Senkowski
HCA Healthcare Journal of Medicine
Background
Obesity has increased progressively in the United States and is a known risk factor for several diseases such as type 2 diabetes, coronary artery disease, stroke and hypertension. Amid the current pandemic, concerns have been raised about obesity as a risk factor for COVID-19 positive patients. The primary goal of this study was to explore the association between obesity and hospital mortality in COVID-19 patients. Our secondary objective was to explore the relationship between obesity and race on hospital mortality in COVID-19 patients.
Methods
This was a cross-sectional, retrospective analysis using data from 186 hospitals from across the United …
Coronavirus Update 8-31-21, The Coronavirus Planning Team
Coronavirus Update 8-31-21, The Coronavirus Planning Team
University Briefings & Virtual Events
Wear a Mask Indoors! As you know, we are requiring that everyone wear a mask when indoors, except in their dorm rooms with only roommates present or alone in offices for faculty and staff. Unfortunately, we have observed a significant number of students who are not adhering to this mandate. To be compliant, you need to be wearing a mask that completely covers your nose and mouth.
Covid-19 Newsletter (Vol. 87), Center For Disaster Medicine, New York Medical College
Covid-19 Newsletter (Vol. 87), Center For Disaster Medicine, New York Medical College
COVID-19 Newsletter
No abstract provided.
Higher Entropy Observed In Sars-Cov-2 Genomes From The First Covid-19 Wave In Pakistan, Najia Karim Ghanchi, Asghar Nasir, Kiran I. Masood, Syed Hani Abidi, Syed Faisal Mahmood, Akber Kanji, Safina Abdul Razzak, Waqasuddin Khan, Saba Shahid, Maliha Yameen, Ali Raza, Javaria Ashraf, Zeeshan Ansar Ahmed, Mohammad Buksh Dharejo, Nazneen Islam, Zahra Hasan, Rumina Hasan
Higher Entropy Observed In Sars-Cov-2 Genomes From The First Covid-19 Wave In Pakistan, Najia Karim Ghanchi, Asghar Nasir, Kiran I. Masood, Syed Hani Abidi, Syed Faisal Mahmood, Akber Kanji, Safina Abdul Razzak, Waqasuddin Khan, Saba Shahid, Maliha Yameen, Ali Raza, Javaria Ashraf, Zeeshan Ansar Ahmed, Mohammad Buksh Dharejo, Nazneen Islam, Zahra Hasan, Rumina Hasan
Department of Pathology and Laboratory Medicine
Background: We investigated the genome diversity of SARS-CoV-2 associated with the early COVID-19 period to investigate evolution of the virus in Pakistan.
Materials and methods: We studied ninety SARS-CoV-2 strains isolated between March and October 2020. Whole genome sequences from our laboratory and available genomes were used to investigate phylogeny, genetic variantion and mutation rates of SARS-CoV-2 strains in Pakistan. Site specific entropy analysis compared mutation rates between strains isolated before and after June 2020.
Results: In March, strains belonging to L, S, V and GH clades were observed but by October, only L and GH strains were present. The …
Knowledge And Awareness Of Dental Specialists, General Dentists And Dental Assistants Regarding Sars‑Cov‑2, Hafsa Qabool, Rashna Hoshang Sukhia, Mubassar Fida
Knowledge And Awareness Of Dental Specialists, General Dentists And Dental Assistants Regarding Sars‑Cov‑2, Hafsa Qabool, Rashna Hoshang Sukhia, Mubassar Fida
Section of Dental-Oral Maxillofacial Surgery
Background: Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has had drastic effects among healthcare professionals.
Objectives: This study aimed to assess knowledge and awareness among dental specialists, general dentists and dental assistants regarding standard patient care guidelines for minimizing the spread of the infection.
Material and methods: A survey-based cross-sectional study was conducted on a sample of 84 participants. The participants were divided into groups of dental specialists, general dentists and dental assistants. A modified version of a validated questionnaire was used to evaluate knowledge and awareness regarding SARS‑CoV‑2 as per the Centers for Disease Control and Prevention (CDC) guidelines. …
Factors That Influence Perception Of Hiv Risk And Willingness To Use Pre-Exposure Prophylaxis In People Who Inject Drugs, Daria Egorova, Anny Fenton, Kinna Thakarar
Factors That Influence Perception Of Hiv Risk And Willingness To Use Pre-Exposure Prophylaxis In People Who Inject Drugs, Daria Egorova, Anny Fenton, Kinna Thakarar
Journal of Maine Medical Center
Introduction: Sexual and injection behaviors increase the risk of HIV transmission in people who inject drugs (PWID). We aimed to determine the prevalence of sexual and drug behaviors that increase HIV risk in PWID hospitalized for infections related to injection drug use in Maine. We also examined factors that influenced their perception of HIV risk and willingness to take pre-exposure prophylaxis (PrEP).
Methods: We surveyed 101 PWID with infections related to injection drug use who were hospitalized at 4 hospitals in Maine. T-tests assessed differences in means of bacterial infection risk scores and willingness to take PrEP based on different …
Comparative Trends In Ischemic Heart Disease Admissions, Presentation And Outcomes Due To The Covid-19 Pandemic: First Insights From A Tertiary Medical Center In Pakistan, Ali Aahil Noorali, Humza Thobani, Shiraz Hashmi, Sara Iqbal, Asma A H. Merchant, Mian Arsam Haroon, Sardar Shahmir Babar Chauhan, Saad Mallick, Nida Zahid, Yasir Khan, Osman Faheem, Saulat Fatimi
Comparative Trends In Ischemic Heart Disease Admissions, Presentation And Outcomes Due To The Covid-19 Pandemic: First Insights From A Tertiary Medical Center In Pakistan, Ali Aahil Noorali, Humza Thobani, Shiraz Hashmi, Sara Iqbal, Asma A H. Merchant, Mian Arsam Haroon, Sardar Shahmir Babar Chauhan, Saad Mallick, Nida Zahid, Yasir Khan, Osman Faheem, Saulat Fatimi
Department of Medicine
Introduction: COVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic.
Methods: We conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (>18 years) …
Coronavirus Update 8-27-21, The Coronavirus Planning Team
Coronavirus Update 8-27-21, The Coronavirus Planning Team
University Briefings & Virtual Events
We want to say welcome to the Class of 2025 who have been moving in yesterday and today. We just have a few quick reminders for you as we get ready for the start of the fall semester.
Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam
Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam
Centre of Excellence in Women and Child Health
Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan's response to COVID-19 has been under scrutiny for its granularity, reach and impact.
Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.
Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.
Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case …
Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam
Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam
Department of Paediatrics and Child Health
Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan's response to COVID-19 has been under scrutiny for its granularity, reach and impact.
Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.
Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.
Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case …
Disparities In Covid-19 Rates Among Various Demographics And Lack Of Racial Representation In Medical Texts, Diangelo Gonzalez
Disparities In Covid-19 Rates Among Various Demographics And Lack Of Racial Representation In Medical Texts, Diangelo Gonzalez
Celebration of Learning
The 2019 novel coronavirus (COVID-19) outbreak, which originated in Wuhan, China in December of 2019, has impacted nations all over the globe. Given the health disparities which existed within the United States prior to the COVID-19 pandemic, this pandemic continued to pose a significant challenge to the health of the public. The aims of this research study were twofold: (1) to analyze the incidence rates of COVID-19 among different racial and ethnic groups within the United States and (2) to describe the occurrence of diversity within medical texts. Overall, the COVID-19 pandemic exacerbated health disparities within the United States. Understanding …
Why Should People Use Face Masks In The Time Of Covid? The Jri Position, Jose Bordon, Alex Glynn, Forest W. Arnold
Why Should People Use Face Masks In The Time Of Covid? The Jri Position, Jose Bordon, Alex Glynn, Forest W. Arnold
The University of Louisville Journal of Respiratory Infections
No abstract provided.
Coronavirus Update 8-24-21, The Coronavirus Planning Team
Coronavirus Update 8-24-21, The Coronavirus Planning Team
University Briefings & Virtual Events
Today we want to focus on the procedures and protocols you follow if you have COVID symptoms or if you test positive for COVID. The CampusClear app can also help you with this, so please make sure that you are checking in with the app each morning before you head outside.
Covid-19 Newsletter (Vol. 86), Center For Disaster Medicine, New York Medical College
Covid-19 Newsletter (Vol. 86), Center For Disaster Medicine, New York Medical College
COVID-19 Newsletter
No abstract provided.
No Difference In Clinical Outcomes For African American And White Patients Hospitalized With Sars-Cov-2 Pneumonia In Louisville, Kentucky, Julio A. Ramirez, Stephen P. Furmanek, Thomas Chandler, Stephen S. Hanson, Dawn Balcom, Subathra Marimuthu, Sathya Krishnasamy, Jose Bordon, Rodrigo Cavallazzi, Amr Aboelnasr, Mahder A. Tella, William A. Mattingly, Ashley M. Wilde, Daisy Sangroula, Demetra Antimisiaris, Donghoon Chung, Guillermo Cabral, Gabino R Fernandez-Botran, Jiapeng Huang, Martin Gnoni, Ozan Akca, Paul Schulz, Phillip F. Bressoud, Priya Krishnan, Sally Suliman, William P. Mckinney, Bryan Moffett, Leslie A Wolf, Mark Burns, Alex Glynn, Ruth Carrico, Forest W. Arnold
No Difference In Clinical Outcomes For African American And White Patients Hospitalized With Sars-Cov-2 Pneumonia In Louisville, Kentucky, Julio A. Ramirez, Stephen P. Furmanek, Thomas Chandler, Stephen S. Hanson, Dawn Balcom, Subathra Marimuthu, Sathya Krishnasamy, Jose Bordon, Rodrigo Cavallazzi, Amr Aboelnasr, Mahder A. Tella, William A. Mattingly, Ashley M. Wilde, Daisy Sangroula, Demetra Antimisiaris, Donghoon Chung, Guillermo Cabral, Gabino R Fernandez-Botran, Jiapeng Huang, Martin Gnoni, Ozan Akca, Paul Schulz, Phillip F. Bressoud, Priya Krishnan, Sally Suliman, William P. Mckinney, Bryan Moffett, Leslie A Wolf, Mark Burns, Alex Glynn, Ruth Carrico, Forest W. Arnold
The University of Louisville Journal of Respiratory Infections
Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky.
Methods: This was a retrospective cohort study of hospitalized patients with SARS-CoV-2 CAP at eight hospitals in Louisville, Kentucky. Severity of CAP at time of hospitalization …
Coronavirus Update 8-20-21, The Coronavirus Planning Team
Coronavirus Update 8-20-21, The Coronavirus Planning Team
University Briefings & Virtual Events
Thanks to all of you who joined our town hall meeting for students and parents last night. We hope your questions were answered. Because of the impending storm (see below), we have moved the faculty and staff town hall to Tuesday at 3:30.
Equine Influenza Virus And Vaccines, Fatai S. Oladunni, Saheed Oluwasina Oseni, Luis Martinez-Sobrido, Thomas M. Chambers
Equine Influenza Virus And Vaccines, Fatai S. Oladunni, Saheed Oluwasina Oseni, Luis Martinez-Sobrido, Thomas M. Chambers
Veterinary Science Faculty Publications
Equine influenza virus (EIV) is a constantly evolving viral pathogen that is responsible for yearly outbreaks of respiratory disease in horses termed equine influenza (EI). There is currently no evidence of circulation of the original H7N7 strain of EIV worldwide; however, the EIV H3N8 strain, which was first isolated in the early 1960s, remains a major threat to most of the world’s horse populations. It can also infect dogs. The ability of EIV to constantly accumulate mutations in its antibody-binding sites enables it to evade host protective immunity, making it a successful viral pathogen. Clinical and virological protection against EIV …
The Current, Scott K. Heysell
Coronavirus Update 8-17-21, The Coronavirus Planning Team
Coronavirus Update 8-17-21, The Coronavirus Planning Team
University Briefings & Virtual Events
We are looking forward to meeting with you in the coming days to answer your questions about protocols for fall.
Covid-19 Newsletter (Vol. 85), Center For Disaster Medicine, New York Medical College
Covid-19 Newsletter (Vol. 85), Center For Disaster Medicine, New York Medical College
COVID-19 Newsletter
No abstract provided.
Discrepancy Between Pcr Based Sars-Cov-2 Tests Suggests The Need To Re-Evaluate Diagnostic Assays, Zain Mushtaq, Sadia Shakoor, Akber Kanji, Najma Shaheen, Asghar Nasir, Zeeshan Ansar Ahmed, Imran Ahmed, Syed Faisal Mahmood, Rumina Hasan, Zahra Hasan
Discrepancy Between Pcr Based Sars-Cov-2 Tests Suggests The Need To Re-Evaluate Diagnostic Assays, Zain Mushtaq, Sadia Shakoor, Akber Kanji, Najma Shaheen, Asghar Nasir, Zeeshan Ansar Ahmed, Imran Ahmed, Syed Faisal Mahmood, Rumina Hasan, Zahra Hasan
Section of Internal Medicine
Objective: We investigated the discrepancy between clinical and PCR-based diagnosis of COVID-19. We compared results of ten patients with mild to severe COVID-19. Respiratory samples from all cases were tested on the Roche SARS-CoV-2 (Cobas) assay, Filmarray RP2.1 (bioMereiux) and TaqPath™ COVID19 (Thermofisher) PCR assays.
Results: Laboratory records of ten patients with mild to severe COVID-19 were examined. Initially, respiratory samples from the patients were tested as negative on the SARS-CoV-2 Roche® assay. Further investigation using the BIOFIRE® Filmarray RP2.1 assay identified SARS-CoV-2 as the pathogen in all ten cases. To investigate possible discrepancies between PCR assays, additional testing was …
Coronavirus Update 8-13-21, The Coronavirus Planning Team
Coronavirus Update 8-13-21, The Coronavirus Planning Team
University Briefings & Virtual Events
We continue to prepare for your arrival with great excitement for the year ahead. Today is the deadline for uploading proof of your first vaccine (or single vaccine if you received Johnson & Johnson) or your request for a medical or religious exemption.