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Articles 2671 - 2700 of 2755
Full-Text Articles in Medical Specialties
Experience With Larangeal Mask Airway In Pakistani Patients, F A. Khan, M A. Afzal, R S. Kamal
Experience With Larangeal Mask Airway In Pakistani Patients, F A. Khan, M A. Afzal, R S. Kamal
Department of Anaesthesia
One hundred and thirty seven adult patients undergoing peripheral surgery were studied regarding ease of larangeal mask airway (LMA) insertion, airway maintenance during surgery and complication encountered during insertion, maintenance and in the postoperative period. In a majority (84%) of patients, the airway was positioned correctly at the first attempt, 3% patients had mild laryngospasm at insertion and in 85% a good airway was obtained. No airway related problems were encountered intraoperatively. Two percent patients had laryngospasm on removal of LMA. Postoperatively, the complaint of sore throat and uvular trauma was seen in 4% cases.
Pregnancy Induced Hypertension--Anaesthetic Considerations, N A. Zubair
Pregnancy Induced Hypertension--Anaesthetic Considerations, N A. Zubair
Department of Anaesthesia
No abstract provided.
Treatment Effects Of The Edgewise Bioprogressive Herbst Appliance, Bernard C. Chang
Treatment Effects Of The Edgewise Bioprogressive Herbst Appliance, Bernard C. Chang
Loma Linda University Electronic Theses, Dissertations & Projects
The effect of the Edgewise Bioprogressive Herbst appliance, as described by Dr. Terry Dischinger, was investigated on 24 Class II, Division 1 malocclusions. Mean pretreatment age of this sample was 11.2 months. All patients were treated by Dischinger with a Bioprogressive Herbst appliance. Lateral cephalographs taken before, after Herbst appliance therapy, and after edgewise treatment were traced, then digitized into Quick Ceph™. Measurements were computed by the computer software. The following results were found: 1) Average treatment time was 9 months. 2) An overcorrected Class I relationship was achieved. 3) Class II malocclusion was corrected by 4.5 mm skeletal alteration …
The Accuracy Of Computer Video Imaging Prediction : Just Prior To Surgical Mandibular Advancement/Genioplasty Orthognathic Cases, Jason T. Chiakowsky
The Accuracy Of Computer Video Imaging Prediction : Just Prior To Surgical Mandibular Advancement/Genioplasty Orthognathic Cases, Jason T. Chiakowsky
Loma Linda University Electronic Theses, Dissertations & Projects
The accuracy of the computer video imaging treatment prediction was investigated using Quick Ceph Image.™ Thirty one surgical mandibular advancement/genioplasty orthognathic cases were examined to determine if the soft tissue profile prediction was representative of the actual result. All patients were over the age of 18. Lateral cephalographs and slides were taken immediately pre-surgically, and six months post-surgically. The slides were duplicated into 4X6 photographs. The cephalographs were digitized and the photographs captured by video on the Quick Ceph Image software program. A line drawing and computer video image treatment prediction were generated using the actual surgical change that had …
Preventing Perinatal Transmission Of Hiv Costs And Effectiveness Of A Recommended Intervention, Robin D. Gorsky, P G. Farnham, Walter L. Straus, Blake Caldwell, D R. Holtgrave, R. J. Simonds, M F. Rogers, Mary Guinan
Preventing Perinatal Transmission Of Hiv Costs And Effectiveness Of A Recommended Intervention, Robin D. Gorsky, P G. Farnham, Walter L. Straus, Blake Caldwell, D R. Holtgrave, R. J. Simonds, M F. Rogers, Mary Guinan
School of Public Health Faculty Research
In the United States, nearly all new human immunodeficiency virus (HIV) infections in children are acquired through perinatal (mother-to-infant) transmission. Each year, approximately 7000 infants are born to HIV-infected women in the United States.1 Without intervention, an estimated 15-30% of these infants would become infected.2 In 1994, results of the AIDS Clinical Trial Group (ACTG) Protocol 076 showed that treatment of infected pregnant women and their infants with zidovudine (ZDV) reduced the rate of perinatal HIV transmission from 25% to 8%.3,4 Following these findings, the Public Health Service (PHS) issued recommendations for ZDV therapy to prevent perinatal …
Ventricular Remodeling Following Infant-Pediatric Cardiac Transplantation. Does Age At Transplantation Or Size Disparity Matter?, Girish S. Shirali, F Lombano, W L. Beeson, D A. Dyar, N F. Mulla, A Khan, J K. Johnston, R E. Chinnock, S R. Gundry, A J. Razzouk
Ventricular Remodeling Following Infant-Pediatric Cardiac Transplantation. Does Age At Transplantation Or Size Disparity Matter?, Girish S. Shirali, F Lombano, W L. Beeson, D A. Dyar, N F. Mulla, A Khan, J K. Johnston, R E. Chinnock, S R. Gundry, A J. Razzouk
Manuscripts, Articles, Book Chapters and Other Papers
Early left ventricular (LV) remodeling following pediatric cardiac transplantation has not been described. To identify patterns and determinants of change in left ventricular mass and volume posttransplant, we studied 125 consecutive children who underwent cardiac transplantation between January 1, 1989 and July 31, 1993. Two-dimensional imaging-directed M-mode echocardiograms were studied weekly until 26 weeks post-transplant. LV mass and volume (indexed to BSA1.5) were measured. LV mass index increased until 3 weeks post-transplant, and then decreased. The mean decrement in LV mass index after 8 weeks post-transplant (relative to baseline) was significantly larger in patients with donor-recipient weight ratio > 1.5 compared …
Mandibular Asymmetry In Unilateral Class Ii Malocclusion : A Cephalometric Study, Raed Z. Moussa
Mandibular Asymmetry In Unilateral Class Ii Malocclusion : A Cephalometric Study, Raed Z. Moussa
Loma Linda University Electronic Theses, Dissertations & Projects
The purpose of this study is to evaluate skeletal and dental asymmetry in unilateral class II malocclusion. A study group of 25 unilateral subdivision patients was compared to 25 class I malocclusion patients serving as the control group. Submento-vertical and frontal radiographs were used for the evaluation. Symmetry was evaluated by comparing measurements between right and left sides for both groups and matching the middle points with the midsagittal axis. Statistical paired and simple t-test were used to evaluate the difference between the two sides for both groups. The measurements showed no significant skeletal and dental asymmetries except for three …
Evaluation Of Oral Midazolam As Pre-Medication In Day Care Surgery In Adult Pakistani Patients, N Ahmed, F A. Khan
Evaluation Of Oral Midazolam As Pre-Medication In Day Care Surgery In Adult Pakistani Patients, N Ahmed, F A. Khan
Department of Anaesthesia
A placebo controlled randomized double blind study was designed to assess the suitability of oral Midazolam as a premedication in day care surgery in adult Pakistani patients. Fifty ASA I and II patients aged between 20-60 years received either Midazolam 7.5 mg or a placebo approximately one hour prior to surgery. Midazolam 7.5 mg produced significant anxiolysis and sedation (p < 0.001) in comparison to placebo after one hour of premedication. There was a significant difference (p < 0.001) in the mean heart rate and blood pressure in both groups after 1 hour of premedication with a lesser rise in blood pressure and heart rate in the Midazolam group. Psychomotor performance assessed by 'n' deletion test was impaired by Midazolam (p < 0.001) and recall of pictures revealed differences (p < 0.05) in the groups at one hour after premedication. However, at four hours after surgery there were no differences in both groups. These findings indicate that rapidly acting oral Midazolam in doses of 7.5 mg provided safe and effective premedication in terms of anxiolysis, sedation, amnesia and psychomotor performance and is suitable for day surgery.
Ai : Artificial Insemination Of Sheep, David Windsor
Ai : Artificial Insemination Of Sheep, David Windsor
Journal of the Department of Agriculture, Western Australia, Series 4
Artificial insemination (Al) is used widely in the dairy and beef industries and often performed by farmers themselves. By contrast, sheep breeders generally require assistance from vets when frozen semen is to be used. However, recent experiments with frozen semen are indicating that do-it-yourself Al may soon become a reality.
Complexity Of Fetal Movement Detection Using A Single Doppler Ultrasound Transducer, William A. Russell Jr., Curtis L. Lowery, Patrick J. Baggot, James D. Wilson, Robert Walls, Roger M. Hawk, Pam Murphy
Complexity Of Fetal Movement Detection Using A Single Doppler Ultrasound Transducer, William A. Russell Jr., Curtis L. Lowery, Patrick J. Baggot, James D. Wilson, Robert Walls, Roger M. Hawk, Pam Murphy
Journal of the Arkansas Academy of Science
The objective of this paper is to discuss the complexity of fetal movement detection encountered during development and implementation of an automated single Doppler ultrasonic transducer based instrument. The single transducer instrument was intended to better quantify the duration, velocity, and magnitude of fetal movements. A Corometrics Model 116 fetal heart rate monitor was modified, and a fetal movement detection algorithm (Russell Algorithm) was developed to detect fetal movements on one and two (data fusion) transducers. A Hewlett-Packard (HP) M-1350-A fetal monitor and the Russell Algorithm were used to detect and record fetal movements concurrently on sixty patients between the …
Interaoperative Frozen Section Consultation: An Analysis Of Accuracy In A Teaching Hospital., Farrukh Aijaz, Suhail Muzaffar, Akbar Shah Hussainy, Shahid Pervez, Sheema H. Hasan, Hizbullah Sheikh
Interaoperative Frozen Section Consultation: An Analysis Of Accuracy In A Teaching Hospital., Farrukh Aijaz, Suhail Muzaffar, Akbar Shah Hussainy, Shahid Pervez, Sheema H. Hasan, Hizbullah Sheikh
Department of Pathology and Laboratory Medicine
This Is a retrospective quality assurance study of all frozen sections done at The Aga Khan University Hospital during a six year period (1986 to 1991). There were 1,031 frozen sections out of a cumulative total of 42,985 surgical specimens (2.39%). Nine hundred and seventy-six (94.66%) were concordant. In 92(8.9%) fresh specimens were brought from other hospitals of Karachi, in 37 cases (3.58%) the diagnosis was deferred till the evaluation of permanent paraffin sections and 18 (1,74%) were discordant with 7 (0.67%) false positive and 11(1,06%) false negative. Among the discordant cases, 9 were attributed to misinterpretation, 7 due to …
The Accuracy Of Sonographic Imaging (Dolphintm Digigraph) And Standard Lateral Cephalometric Radiographs : A Comparative Study, Michael D. Teichman
The Accuracy Of Sonographic Imaging (Dolphintm Digigraph) And Standard Lateral Cephalometric Radiographs : A Comparative Study, Michael D. Teichman
Loma Linda University Electronic Theses, Dissertations & Projects
Radiation due to x-ray exposure is a concern, and the development of the Dolphin™ DigiGraph represents an attempt to limit this exposure. The purpose of this paper was to compare measurements (using Ricketts analysis) obtained from conventional radiographic cephalometric tracings with those obtained by computerized digitizing with the DigiGraph. Forty-six patients from the Loma Linda University School of Dentistry graduate orthodontic clinic were digitized, and the results were compared to the x-ray tracings of these patients. The results showed that seven of the twenty-one variables examined exhibited a statistical similarity between the two methods (DigiGraph and x-ray tracing). An examination …
The Use Of Corrected Occlusal X-Ray For Determination Of Ald : A Comparative Study, Merlin D. Ekvall
The Use Of Corrected Occlusal X-Ray For Determination Of Ald : A Comparative Study, Merlin D. Ekvall
Loma Linda University Electronic Theses, Dissertations & Projects
In this study arch length discrepancy or ALD was studied in 50 untreated patients. The measurements obtained from Hilgers' corrected occlusal x-ray using his Occlusal Paralleling Instrument or O.P.I, were compared with those derived by four conventional methods, - "Eye balling," digital caliper determination, conventional mandibular x-ray, and the Rocky Mountain Data Systems computer analysis (31 cases). When using the OPI, results give a higher negative ALD as it takes into consideration the space required to level a curve of Spee.
Measurements were made by the author and 3 faculty members using the above methods. Statistical analysis of the means …
The Effects Of Suxamethonium And Pancuronium On The Haemodynamic Response To Endotracheal Intubation, F A. Khan, R S. Kamal
The Effects Of Suxamethonium And Pancuronium On The Haemodynamic Response To Endotracheal Intubation, F A. Khan, R S. Kamal
Department of Anaesthesia
The pharmacological effects of suxamethonium and pancuronium on the cardiovascular system may vary and therefore alter the haemodynamic response to intubation. The arterial blood pressure, the heart rate and the rate pressure product were measured as parameters of haemodynamic change in forty adult ASA. I and II patients undergoing laryngoscopy and endotracheal intubation in a randomised controlled study. The patients were induced with either thiopentone/suxamethonium (Group A) or thiopentone/pancuronium (Group B). There was no significant difference between the groups on comparison of systolic and diastolic blood pressure changes. Pancuronium, however, caused a significantly higher rise in the heart rate after …
Quantitative Respirator Fit Testing: Probed Facepiece Versus Probed Cartridge, Sonya Melissa Seward
Quantitative Respirator Fit Testing: Probed Facepiece Versus Probed Cartridge, Sonya Melissa Seward
Community & Environmental Health Theses & Dissertations
This study was performed to determine if there is a quantifiable difference between quantitative fit testing using a probed facepiece and a probed cartridge. Four subjects were tested on four different respirators. The respirators used were MSA & 3M full and half face respirator. Each subject performed each method five times per respirator. The results indicated no correlation between the two fit testing methods overall. However, a moderate correlation was found between the MSA respirators and the two methods. This study found many variables which influence fit testing. These include the type of respirator used (brand and facepiece), the probe …
Factors That Influence Prepared Childbirth Couples' Use Of Epidural Anesthesia For Labor And Delivery, Terri S. Chambers
Factors That Influence Prepared Childbirth Couples' Use Of Epidural Anesthesia For Labor And Delivery, Terri S. Chambers
Community & Environmental Health Theses & Dissertations
The purpose of this study was to identify factors that influence a Prepared Childbirth couple's decision to utilize epidural anesthesia for labor and delivery. Review of the literature indicated a high correlation between epidural use for uncomplicated labors and deliveries and a high incidence of maternal complications and low neonatal neurological and behavioral scores.
A sample of twenty-nine couples was used in this prospective, non-experimental field study for the research. Data were collected utilizing two developed demographic and factual event tools, Rotter's Internal-External Locus of Control Tool and Spanier's Dyadic Marital Adjustment Tool.
Three hypotheses were developed and data were …
Predictive Value Of Radiographic Analysis Of Menton, Hyoid Bone, And The Third Cervical Vertebra Angle, Kalfred G.S. Chun
Predictive Value Of Radiographic Analysis Of Menton, Hyoid Bone, And The Third Cervical Vertebra Angle, Kalfred G.S. Chun
Loma Linda University Electronic Theses, Dissertations & Projects
The purpose of this study is to determine if the hyoid bone could be used as a reliable and stable reference landmark. Previous researchers have used cranial landmarks to determine the hyoid bone position. The results of these studies have shown a large variability in hyoid position. To determine the hyoid bone position, an analysis called the hyoid triangle was used. The hyoid triangle is formed by joining the cephalometric points retrognathion (the most inferior posterior point on the mandibular symphysis), hyoidale (the most superior anterior point on the body of the hyoid bone), and C3 (the most anterior inferior …
A Comparison Of Enamel Detachments After Debonding Between Unitek's "Dynalok" Bracket And A Foil-Mesh Bracket: A Scanning Electron Microscope Study, Robert E. Meister
A Comparison Of Enamel Detachments After Debonding Between Unitek's "Dynalok" Bracket And A Foil-Mesh Bracket: A Scanning Electron Microscope Study, Robert E. Meister
Loma Linda University Electronic Theses, Dissertations & Projects
The intent of this paper was to: 1. Evaluate the mode of adhesive failure when debonding both flexible and rigid base orthodontic brackets. 2. Evaluate the bracket bases for enamel detachments. 3. Measure the enamel detachments.
After preforming shear test on flexible and rigid base orthodontic brackets mounted to extracted human teeth it was determined that failure occurred at the enamel/adhesive interface 30% of the time, at the bracket/adhesive interface 10% of the time and a combination of these 60% of the time for both groups.
Five brackets from each group were evaluated for enamel detachments using energy dispersive x-ray …
Mandibular Repositioning With Frankel Appliance Therapy, Clark E. Schneekluth
Mandibular Repositioning With Frankel Appliance Therapy, Clark E. Schneekluth
Loma Linda University Electronic Theses, Dissertations & Projects
A sample of twelve Frankel appliance (FR-2) treated patients, in the mixed dentition stage, were selectively chosen by an orthodontist based on the Class II correction and evaluated from before treatment and end of treatment laminagraphic and lateral cephalometric radiographs. The average treatment period was 22 months (1 yr. 10 mos.). The average pre-treatment age was 9.5 years with a range from 8 to 11 years old, while the average post-treatment age was 11.3 years with a range of 10 to 13 years.
Frankel appliance therapy was the only form of mechanics used in this study.
The before treatment lateral …
A Correlation Study Of Facial Soft Tissue Proportions (Golden Sections) And Cephalometric Measurements Of Golden Sections And The Eleven Factor Analysis, Russell Andrew Sutliff
A Correlation Study Of Facial Soft Tissue Proportions (Golden Sections) And Cephalometric Measurements Of Golden Sections And The Eleven Factor Analysis, Russell Andrew Sutliff
Loma Linda University Electronic Theses, Dissertations & Projects
Frontal photographs on a total of one hundred and three individuals who had been treated by Dr. Ricketts, and had been involved in a prior study at Rocky Mountain Data Systems, were evaluated for facial proportions according to Ricketts application of Pythagoras' golden section. Seven facial proportions were analyzed from 1:1 retention phase frontal photographs. Forty individuals, made up of twenty-two females and eighteen males, 12.2 to 21.0 years of age, were selected and divided into two groups of twenty each, according to their soft tissue facial proportions. A range of acceptability for the facial proportions was derived. Proportions within …
J.T.: A Case Of Mitral Valve Prolapse, F. Matthew Mihelic
J.T.: A Case Of Mitral Valve Prolapse, F. Matthew Mihelic
Faculty Publications
No abstract provided.
The Coronary Distribution Zone : Mathematical Modelling Of The Left Ventricular Epicardial Surface For Area Calculation, Three-Dimensional Rotaton And Display, S. Matts E. Sjölander
The Coronary Distribution Zone : Mathematical Modelling Of The Left Ventricular Epicardial Surface For Area Calculation, Three-Dimensional Rotaton And Display, S. Matts E. Sjölander
Loma Linda University Electronic Theses, Dissertations & Projects
A computer model of the left ventricular (LV) epicardial surface was developed from Jang’s truncated ellipsoidal model, which has a minor to major axis ratio of 6:10. The model was applied in calculating the area of a segment of the myocardium, jeopardized by an impending occlusion of its associated artery. The endangered segment of the LV muscle was also visualized in different projections by rotations in three space and graphical displays simulating the three dimensions.
The area formula for the surface of the ideal model , a truncated prolate spheroid, was derived and used in producing maps for manual calculations …
A Comparative Analysis Of Intrusion Of Incisor Teeth Achieved In Adults And Children According To Facial Type, Ronald L. Otto
A Comparative Analysis Of Intrusion Of Incisor Teeth Achieved In Adults And Children According To Facial Type, Ronald L. Otto
Loma Linda University Electronic Theses, Dissertations & Projects
A comparison of incisor intrusion achieved in deep bite adults and children was made. Facial type was also examined for affect upon intrusion achieved. Fifty-five cases treated with Bioprogressive mechanics were studied cephalometrically, including twenty-four adults and thirty-one children. Neither age nor facial type was found to be statistically related to the amount of incisor intrusion achieved in this sample. A method of measuring intrusion at the root apices was devised which was felt to give a more accurate indication of actual bodily intrusion. More external root changes during treatment were observed for adults than for growing children. Wide latitude …
Xeroradiography & Conventional Radiography : Comparative Imaging Of The Temporomandibular Joint, Nelson R. Gatov
Xeroradiography & Conventional Radiography : Comparative Imaging Of The Temporomandibular Joint, Nelson R. Gatov
Loma Linda University Electronic Theses, Dissertations & Projects
An investigation was conducted to evaluate the application of Xeroradiography for imaging the Temporomandibular Joint using the Updegrave and Weinberg positioning boards and to compare these images to those obtained by conventional radiography using the same positioning boards.
A cadaver head in which three spherical radiopaque implants had been placed was used in this study. A General Electric Model 1000 (Dental Unit) was the source of radiation. The conventional radiographs were produced on Dupont Cronex 2DC film and processed by a Phillips 810 automatic processed by a Xerox "125 System".
MAGNIFICATION
A comparison of the implant sphere diameters and the …
Cephalometric Objectives For The Maxillary Central Incisor, John Mickey Damerell
Cephalometric Objectives For The Maxillary Central Incisor, John Mickey Damerell
Loma Linda University Electronic Theses, Dissertations & Projects
A cephalometric study was conducted to determine the ideal inclination of the maxillary central incisor for various facial patterns. Selected measurements were made on lateral headplate tracings of three samples: ideal, random and Class III malocclusions. Statistical analysis of data included means, standard deviations, simple correlations and stepwise regressions.
The Frankfort plane was found to be the most reliable reference plane when measuring the inclination of the maxillary central incisor. The maxillary central incisor inclination was found to be dependent upon the lower incisor position and inclination, chin position and the anterior cranial base inclination. A formula was produced to …
Maine Mental Health Annual Review And Progress Report 1977, Department Of Mental Health And Corrections
Maine Mental Health Annual Review And Progress Report 1977, Department Of Mental Health And Corrections
Maine Collection
Maine Mental Health Annual Review and Progress Report 1977
State of Maine., Department of Mental Health and Corrections, Augusta, Maine, 1977.
George A. Zitnay, Commissioner
Contents: Preface / Administrative Part / Services and Facilities Part
Growth Augmentation With Activators, John R. Sibley
Growth Augmentation With Activators, John R. Sibley
Loma Linda University Electronic Theses, Dissertations & Projects
This research was performed to determine if bony changes could be effected by activator treatment and how stable this treatment is.
From a sample of twenty-seven cases with before activator treatment cephalometric radiographs. Rocky Mountain Data Systems provided growth projections, with and without edgewise treatment, for the period of time each patient was in treatment. These forecasts were compared to the post-treatment cephalograms to analyze the orthopedic effects of activator treatment with normal growth and with edgewise therapy.
Nine of the twenty-seven case treated sample responded to recall for post-treatment cephalograms and were analyzed for relapse.
It was apparent that …
A Cephalometric Study Of Post-Retention Relapse In Mandibular Expansion Of Cuspids And Molars, Randall J. Schuler
A Cephalometric Study Of Post-Retention Relapse In Mandibular Expansion Of Cuspids And Molars, Randall J. Schuler
Loma Linda University Electronic Theses, Dissertations & Projects
The purpose of this research was to determine if the advancements of cephalometrics and the capacity of the computer to quantify skeletal relationships could help the orthodontist recognize those cases where arch length could be gained through buccal expansion with little risk of relapse. To determine the stability of orthodontic treatment changes, the mandibular arches of 72 patients were studied. The cases were treated by Drs. Bench and Ricketts and were selected on the basis that each case must include three complete sets of frontal and lateral headplates, before and after treatment, and a minimum of two years out of …
Clinical Experience With Radioisotopic Powered Cardiac Pacemakers, Nicholas P. D. Smyth, Tomas Hernandez, Alvin Johnson
Clinical Experience With Radioisotopic Powered Cardiac Pacemakers, Nicholas P. D. Smyth, Tomas Hernandez, Alvin Johnson
Henry Ford Hospital Medical Journal
Significant increase in the useful lifetime of the implantable cardiac pacemaker has been made possible by the development of a radioisotope power source. This paper reports experience with two models, the AEC-ARCO Nu-5 (fixed rate) and the Medtronic Model 9000 (ventricular inhibited demand). Five of the former models were implanted in 1973, and six of the latter more recently. Both types of units have functioned well.
A Cephalometric Study Of Mandibulo-Facial Disostosis In Monozygotic Twins Using Computerized Methods, Lyn M. Lamberton
A Cephalometric Study Of Mandibulo-Facial Disostosis In Monozygotic Twins Using Computerized Methods, Lyn M. Lamberton
Loma Linda University Electronic Theses, Dissertations & Projects
An investigation using computerized cephalometrics has been conducted to consider the cephalometric factors responsible for the characteristic appearance evident in individuals afflicted with Mandibulo-Facial Dysostosis. A pair of Negro monozygotic affected twins were studied using the other 10 non-affected members of the family as a control to minimize the environmental and hereditary factors. The Rocky Mountain Data System was utilized to analyze the lateral and frontal cephalometric radiographs of each individual using Ricketts Analysis and the data were subjected to statistical tests to determine the factors contributory to the syndrome. Age and size were considered and adjustments were made to …