Noninvasive Mechanical Ventilation And Neuropsychiatric Disorders

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Noninvasive Mechanical Ventilation and Neuropsychiatric Disorders

Author : Antonio M. Esquinas
Publisher : Springer Nature
ISBN 13 : 3031279689
Total Pages : 390 pages
Book Rating : 4.0/5 (312 download)

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Book Synopsis Noninvasive Mechanical Ventilation and Neuropsychiatric Disorders by : Antonio M. Esquinas

Download or read book Noninvasive Mechanical Ventilation and Neuropsychiatric Disorders written by Antonio M. Esquinas and published by Springer Nature. This book was released on 2023-06-12 with total page 390 pages. Available in PDF, EPUB and Kindle. Book excerpt: In different sections of this book the relationships between the patterns of psychological response in acute and chronic respiratory failure, as well as the epidemiology of neuropsychiatric disorders in ventilator management, are collected and analyzed. Main concepts such as “vulnerability to stress”, critical illness-psychological stress and susceptibility that may develop during NIV support, as well as the diagnosis of neuropsychiatric disorders in respiratory failure are also summarized. A section is devoted to the most frequent indications of NIV, also including a special use of NIV in pandemic and high-risk infections, as well as in several other conditions such as acute and chronic respiratory failures and neurological disorders. A summary of practical approaches for treatment and prevention in neurologic and psychiatric disorders during noninvasive mechanical ventilation, as well as the perspective in terms of outcomes, quality-of-life, palliative care is also given. The book is intended for all those healthcare professionals treating patients suffering from neurological or psychiatric disorders and who develop acute or chronic respiratory failure. Neurologists, psychiatrists, pulmonary critical care professionals, geriatricians, internists and psychologists will find in the book a valuable guide for their everyday clinical practice.

Upper Airway Disorders and Noninvasive Mechanical Ventilation

Author : Antonio M. Esquinas
Publisher : Springer Nature
ISBN 13 : 3031324870
Total Pages : 379 pages
Book Rating : 4.0/5 (313 download)

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Book Synopsis Upper Airway Disorders and Noninvasive Mechanical Ventilation by : Antonio M. Esquinas

Download or read book Upper Airway Disorders and Noninvasive Mechanical Ventilation written by Antonio M. Esquinas and published by Springer Nature. This book was released on 2023-09-26 with total page 379 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book analyses the basic rationale of noninvasive respiratory management in upper airways medical and perioperative disorders and key interactions and clinical implications. It offers key diagnostic tools to detect early and late failure of upper airway disorders whit a noninvasive approach. Furthermore, all medical and post-operative clinical indications of acute and chronic diseases in upper airway respiratory disorders and outcomes are summarized. The book can be considered unique from various perspectives: from the physiological and practical point of view as well as from the side of the therapeutic approach. As a matter of fact, from the physiological perspective, noninvasive mechanical ventilation has been shown to have several beneficial effects on the elasticity, musculature, and resistance of the upper and lower airways. Then, in the book the relationships between noninvasive respiratory management options and upper airway disorders in medical and postoperative conditions are also considered. Finally, the book provides information and analysis of the interaction of upper airways in the interaction of noninvasive mechanical ventilation management, which are the determining factors in the response in various clinical settings. Considering the growing evidence of the role of upper airways disorders in influencing the outcomes of noninvasive mechanical ventilation, in this book is presented a unique multidisciplinary approach to better understand the role of upper airways in noninvasive mechanical ventilation. The volume – richly illustrated – offers an exhaustive analysis of the role of the upper airways in patients who require treatment with noninvasive mechanical ventilation and can be considered a scientific reference for several specialists such as intensivists and anesthesiologists, pneumologists-sleep medicine professionals as well as otorhinolaryngologists.

Noninvasive Mechanical Ventilation

Author : ANTONIO ESQUINAS
Publisher : Springer Science & Business Media
ISBN 13 : 3642113656
Total Pages : 388 pages
Book Rating : 4.6/5 (421 download)

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Book Synopsis Noninvasive Mechanical Ventilation by : ANTONIO ESQUINAS

Download or read book Noninvasive Mechanical Ventilation written by ANTONIO ESQUINAS and published by Springer Science & Business Media. This book was released on 2010-08-12 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt: Noninvasive mechanical ventilation is an effective technique for the management of patients with acute or chronic respiratory failure. This comprehensive and up-to-date book explores all aspects of the subject. The opening sections are devoted to theory and equipment, with detailed attention to the use of full-face masks or helmets, the range of available ventilators, and patient-ventilator interactions. Clinical applications are then considered in depth in a series of chapters that address the use of noninvasive mechanical ventilation in chronic settings and in critical care, both within and outside of intensive care units. Due attention is also paid to weaning from conventional mechanical ventilation, potential complications, intraoperative applications, and staff training. The closing chapters examine uses of noninvasive mechanical ventilation in neonatal and pediatric care. This book, written by internationally recognized experts, will be an invaluable guide for both clinicians and researchers.

Noninvasive Ventilation Outside Intensive Care Unit

Author : Antonio M. Esquinas
Publisher : Springer Nature
ISBN 13 : 3031377966
Total Pages : 445 pages
Book Rating : 4.0/5 (313 download)

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Book Synopsis Noninvasive Ventilation Outside Intensive Care Unit by : Antonio M. Esquinas

Download or read book Noninvasive Ventilation Outside Intensive Care Unit written by Antonio M. Esquinas and published by Springer Nature. This book was released on 2023-12-28 with total page 445 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book aims to highlight the importance of the development of health conditions and demand for the application of noninvasive mechanical ventilation (NIMV) outside the intensive care units (ICUs); the diversification of possible scenarios outside the ICUs; the need to establish references that consolidate this phenomenon and the healthcare organizations models. In the last decades the extension of the use of NIMV outside of the ICUs has led to the generation of protocols and to the creation of new in-hospital care models. In this field, the main determining factors are a better knowledge of technique, technological advancement, better monitoring capacity, the creation of multidisciplinary teams adequately trained in their application, and social and health events that have overloaded ICUs. All these elements have promoted the creation of these NIMV units outside ICUs. This new reality entails the need for clarification of concepts, recommendations, and analysis of how to plan NIMV. Although the literature that clearly determine the indications and aids on the use of NIMV is considerable, this volume, pointing out the diversity of different healthcare models to define how to organize NIMV outside the ICUs, shed a light and bring a clear benefit to the scientific community involved. The book is structured in eleven main sections analyzing the epidemiology and trends for NIMV healthcare models and determining factors for these models outside ICUs. The originality of the work, its clear clinical-practical impact and the multidisciplinary approach given by all healthcare professionals involved (intensivists, pneumologists, internal medicine and emergency medicine specialists, geriatricians, chest respiratory therapists, etc.) is very relevant for the thoroughness of the book.

Sleep and Neuropsychiatric Disorders

Author : Ravi Gupta
Publisher : Springer Nature
ISBN 13 : 9811601232
Total Pages : 833 pages
Book Rating : 4.8/5 (116 download)

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Book Synopsis Sleep and Neuropsychiatric Disorders by : Ravi Gupta

Download or read book Sleep and Neuropsychiatric Disorders written by Ravi Gupta and published by Springer Nature. This book was released on 2022-02-01 with total page 833 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book explores the intricate links between sleep and neuropsychiatric diseases. In clinical settings, understanding the development, treatment, and management of neuropsychiatric diseases poses a substantial challenge. Neuropsychiatric disorders place a significant cost on society, affecting the health of people affected, care providers, and the general community. Sleep and neuropsychiatric disease are inextricably linked. Sleep disorders are widespread in these populations and are frequently overlooked in neurology and psychiatry. The book offers readers up-to-date information on different facets of the bidirectional connections between sleep and neuropsychiatric diseases. Following the initial fundamental science part, a unique series of chapters concentrate on the behavioural manifestations of sleep problems, a hitherto unexplored field. Additional chapters include patient evaluation techniques as well as public health implications of sleep disorders. The individual chapters cover all main mental and neurological diseases where a change in sleep is evident, and recent concepts in pathogenesis, presentation, evaluation, and treatment. Neuropsychotropic drugs must be seen as a double-edged sword when it comes to sleep and sleep disorders. Overall, this book is an excellent resource for learning about neuropsychiatric diseases and how they affect sleep while simultaneously being impacted by sleep.

Noninvasive Mechanical Ventilation

Author : Antonio M. Esquinas
Publisher : Springer
ISBN 13 : 3319216538
Total Pages : 851 pages
Book Rating : 4.3/5 (192 download)

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Book Synopsis Noninvasive Mechanical Ventilation by : Antonio M. Esquinas

Download or read book Noninvasive Mechanical Ventilation written by Antonio M. Esquinas and published by Springer. This book was released on 2015-11-24 with total page 851 pages. Available in PDF, EPUB and Kindle. Book excerpt: The new edition presents updates regarding new clinical applications of noninvasive mechanical ventilation and discusses recent technical advances in this field. The opening sections are devoted to theory , equipment, with new chapters on clinical applications in emergency medicine, critical care and sleep medicine, with detailed attention to current studies on NIV-CPAP, innovative clinical implications of NIV-CPAP devices. Due attention is also paid to new ventilation modes and the development of synchronization and patient ventilator interaction results. The closing chapters examine clinical indication. Written by internationally recognized experts in the field, this book will be an invaluable guide for both clinicians and researchers.

Respiratory Care in Non Invasive Mechanical Ventilatory Support

Author : Antonio M. Esquinas
Publisher : Nova Science Publishers
ISBN 13 : 9781536199024
Total Pages : 635 pages
Book Rating : 4.1/5 (99 download)

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Book Synopsis Respiratory Care in Non Invasive Mechanical Ventilatory Support by : Antonio M. Esquinas

Download or read book Respiratory Care in Non Invasive Mechanical Ventilatory Support written by Antonio M. Esquinas and published by Nova Science Publishers. This book was released on 2021 with total page 635 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Non-invasive ventilation refers to the use of breathing support administered through a face mask, nasal mask, or helmet. This form of ventilatory support is useful in the treatment of respiratory illnesses including SARS, MERS, PH1N1, and COVID-19. Consisting of 63 chapters, this book provides a detailed, holistic overview of the principles and practice of non-invasive mechanical ventilatory support"--

Case Reports in Aging Psychiatry

Author : Vincenza Frisardi
Publisher : Frontiers Media SA
ISBN 13 : 2832543863
Total Pages : 54 pages
Book Rating : 4.8/5 (325 download)

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Book Synopsis Case Reports in Aging Psychiatry by : Vincenza Frisardi

Download or read book Case Reports in Aging Psychiatry written by Vincenza Frisardi and published by Frontiers Media SA. This book was released on 2024-02-08 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt: Frontiers in Psychiatry is proud to present our Case Reports series. Our case reports aim to highlight unique cases of patients that present with an unexpected/unusual diagnosis, treatment outcome, or clinical course. Case reports provide insight into the differential diagnosis, decision-making, and clinical management of unusual cases and are a valuable educational tool.

Handbook of Emergency Room Protocols

Author : S Arulrhaj
Publisher : Jaypee Brothers Medical Publishers
ISBN 13 : 9356961468
Total Pages : 183 pages
Book Rating : 4.3/5 (569 download)

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Book Synopsis Handbook of Emergency Room Protocols by : S Arulrhaj

Download or read book Handbook of Emergency Room Protocols written by S Arulrhaj and published by Jaypee Brothers Medical Publishers. This book was released on 2023-01-24 with total page 183 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a systemic approach to the diagnosis and management of medical emergencies. Divided into 16 sections, each chapter covers a different system of the body. Poisoning, trauma, anaesthesia, and paediatric emergencies also have dedicated chapters. Each topic begins with ‘key points’ before guiding the reader step by step through clinical presentation, history taking, physical examination, diagnostic methods, medical decision-making, and treatment plans. Drug dosages are also clearly explained. Algorithms are provided to assist clinicians in reaching an accurate diagnosis and a selection of images and figures further enhance learning.

Neurological and Neurosurgical Emergencies

Author : Indu Kapoor
Publisher : Elsevier
ISBN 13 : 044315662X
Total Pages : 552 pages
Book Rating : 4.4/5 (431 download)

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Book Synopsis Neurological and Neurosurgical Emergencies by : Indu Kapoor

Download or read book Neurological and Neurosurgical Emergencies written by Indu Kapoor and published by Elsevier. This book was released on 2024-04-20 with total page 552 pages. Available in PDF, EPUB and Kindle. Book excerpt: Neurological and Neurosurgical Emergencies addresses emergencies in all fields of neuroscience, including disciplines like Neurology, Neurosurgery, Neuroanaesthesia, and Neuroradiology. This volume covers neurosurgical emergencies, like hydrocephalus, brain edema, intracranial bleed, intracranial hematoma, infection, and trauma, alongside neurovascular emergencies like acute ischemic stroke, non-traumatic, aneurysmal subarachnoid hemorrhage, carotid cavernous fistula, and arteriovenous malformation. In addition, the book discusses common emergencies in neurology, including status epilepticus, refractory epilepsy, super-refractory epilepsy, and neuromuscular disorders. Beginning with neurological examination of patients through to anesthetic management of various emergencies, this book features clear images that accompany each emergency with learner-friendly features such as flow-charts, figures, text boxes, and algorithms. This book provides insights into all possible aspects of emergency management and the anesthetic management of such patients. - Covers all neurological and neurosurgical emergencies during the perioperative period - Offers practical approaches in the treatment and management of such patients in operation theatre, neuroradiological suites, and intensive care units - Discusses practical and evidence-based concepts of neuroanaesthesia - Details the latest guidelines in patient management

Post-Operative Neuropsychiatric Disorder

Author : Chun Yang
Publisher : Frontiers Media SA
ISBN 13 : 2832545912
Total Pages : 140 pages
Book Rating : 4.8/5 (325 download)

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Book Synopsis Post-Operative Neuropsychiatric Disorder by : Chun Yang

Download or read book Post-Operative Neuropsychiatric Disorder written by Chun Yang and published by Frontiers Media SA. This book was released on 2024-03-08 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: Post-operative neuropsychiatric disorder (POND) is a series of neuropsychiatric symptoms strongly linked to the triggering factors, anesthesia, and surgery exposure. The clinical manifestations mainly include delirium, cognitive dysfunction, and affective disorders after surgeries. POND is the most frequent postoperative complication in elderly patients, especially those undergoing major surgery, such as cardiac and hip surgeries. It has been well recognized that oxidative stress, abnormal changes in neurotransmitters and synapses, as well as Aβ deposition, and phosphorylation of tau protein are probably involved in the mechanisms of POND. Although studies on the POND are in full swing, underlying pathogenesis is still ambiguous because of conflicting results and controversial evidence. Currently, patients with POND still fail to receive effective treatments, although clinical studies in this field have focused on these potential therapeutic targets in the last decades. Most importantly, more than 320 million people are scheduled to undergo surgeries every year globally, it is, therefore, an urgent need to develop and provide effective therapeutic strategies for patients with POND.

COVID-19: The neurorehabilitation perspective

Author : Thomas Platz
Publisher : Frontiers Media SA
ISBN 13 : 2832524737
Total Pages : 240 pages
Book Rating : 4.8/5 (325 download)

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Book Synopsis COVID-19: The neurorehabilitation perspective by : Thomas Platz

Download or read book COVID-19: The neurorehabilitation perspective written by Thomas Platz and published by Frontiers Media SA. This book was released on 2023-06-02 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response (volume I.B)

Author : Zisis Kozlakidis
Publisher : Frontiers Media SA
ISBN 13 : 2832522300
Total Pages : 1127 pages
Book Rating : 4.8/5 (325 download)

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Book Synopsis Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response (volume I.B) by : Zisis Kozlakidis

Download or read book Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response (volume I.B) written by Zisis Kozlakidis and published by Frontiers Media SA. This book was released on 2023-04-25 with total page 1127 pages. Available in PDF, EPUB and Kindle. Book excerpt: Volume I.B An outbreak of a respiratory disease first reported in Wuhan, China in December 2019 and the causative agent was discovered in January 2020 to be a novel betacoronovirus of the same subgenus as SARS-CoV and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease 2019 (COVID-19) has rapidly disseminated worldwide, with clinical manifestations ranging from mild respiratory symptoms to severe pneumonia and a fatality rate estimated around 2%. Person to person transmission is occurring both in the community and healthcare settings. The World Health Organization (WHO) has recently declared the COVID-19 epidemic a public health emergency of international concern. The ongoing outbreak presents many clinical and public health management challenges due to limited understanding of viral pathogenesis, risk factors for infection, natural history of disease including clinical presentation and outcomes, prognostic factors for severe illness, period of infectivity, modes and extent of virus inter-human transmission, as well as effective preventive measures and public health response and containment interventions. There are no antiviral treatment nor vaccine available but fast track research and development efforts including clinical therapeutic trials are ongoing across the world. Managing this serious epidemic requires the appropriate deployment of limited human resources across all cadres of health care and public health staff, including clinical, laboratory, managerial and epidemiological data analysis and risk assessment experts. It presents challenges around public communication and messaging around risk, with the potential for misinformation and disinformation. Therefore, integrated operational research and intervention, learning from experiences across different fields and settings should contribute towards better understanding and managing COVID-19. This Research Topic aims to highlight interdisciplinary research approaches deployed during the COVID-19 epidemic, addressing knowledge gaps and generating evidence for its improved management and control. It will incorporate critical, theoretically informed and empirically grounded original research contributions using diverse approaches, experimental, observational and intervention studies, conceptual framing, expert opinions and reviews from across the world. The Research Topic proposes a multi-dimensional approach to improving the management of COVID-19 with scientific contributions from all areas of virology, immunology, clinical microbiology, epidemiology, therapeutics, communications as well as infection prevention and public health risk assessment and management studies.

Nocturnal Non-Invasive Ventilation

Author : Robert C. Basner
Publisher : Springer
ISBN 13 : 1489976248
Total Pages : 274 pages
Book Rating : 4.4/5 (899 download)

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Book Synopsis Nocturnal Non-Invasive Ventilation by : Robert C. Basner

Download or read book Nocturnal Non-Invasive Ventilation written by Robert C. Basner and published by Springer. This book was released on 2015-09-30 with total page 274 pages. Available in PDF, EPUB and Kindle. Book excerpt: This comprehensive resource brings together the most current theories, evidence and best practice parameters for the use of nocturnal non-invasive ventilation (nNIV). Chapters focus on the application of acute and chronic nNIV in patients with cardio-respiratory disorders over a range of major medical settings. Updates on past and recent research in this field are highlighted. Authored by leading clinicians and investigators, Nocturnal Non-Invasive Ventilation provides practical and cutting-edge knowledge to physicians, researchers and allied health professionals on the front lines of treating cardio-respiratory and sleep disorders.

Neonatal Intensive Care Nursing (RNC-NIC®) Certification Review

Author : Kathryn Kovar Moore, MSN, ARNP, NNP-BC, BSN, BS, RN, RNC-NIC
Publisher : Springer Publishing Company
ISBN 13 : 0826187374
Total Pages : 472 pages
Book Rating : 4.8/5 (261 download)

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Book Synopsis Neonatal Intensive Care Nursing (RNC-NIC®) Certification Review by : Kathryn Kovar Moore, MSN, ARNP, NNP-BC, BSN, BS, RN, RNC-NIC

Download or read book Neonatal Intensive Care Nursing (RNC-NIC®) Certification Review written by Kathryn Kovar Moore, MSN, ARNP, NNP-BC, BSN, BS, RN, RNC-NIC and published by Springer Publishing Company. This book was released on 2024-11-15 with total page 472 pages. Available in PDF, EPUB and Kindle. Book excerpt: Neonatal Intensive Care Nursing (RNC-NIC®) Certification Review is designed to help you prepare for the NCC certification exam. This comprehensive study aid is organized according to the latest exam blueprint and presents the information in a clear, concise format. Clinical pearls, key points, test-taking tips, and glossary terms are highlighted throughout the text, and case studies are featured online. Each chapter covers everything you need to know to pass the exam and includes end-of-chapter questions to check your knowledge. The review concludes with a full-length practice test to get you ready for exam day. With 350 practice questions, detailed review content and answer rationales, this study aid empowers you with the tools and materials to study your way and the confidence to pass the first time, guaranteed! Know that you're ready. Know that you'll pass with Springer Publishing Exam Prep. Key Features Reflects the latest NCC exam blueprint Provides a comprehensive yet concise review of essential knowledge for the exam Features clinical pearls and key terms Highlights key points and test-taking strategies Case studies included online Includes end-of-chapter Q&A and a full practice test with detailed rationales Boosts your confidence with a 100% pass guarantee For 70 years, it has been our greatest privilege to prepare busy nurses like you for professional certification and career success. Congratulations on qualifying to sit for the exam. Now let's get you ready to pass! RNC-NIC® is a registered service mark of National Certification Corporation (NCC). NCC does not sponsor or endorse this resource, nor does it have a proprietary relationship with Springer Publishing.

Robotics and Automation in Healthcare

Author : R. Thanigaivelan
Publisher : CRC Press
ISBN 13 : 1040004032
Total Pages : 315 pages
Book Rating : 4.0/5 (4 download)

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Book Synopsis Robotics and Automation in Healthcare by : R. Thanigaivelan

Download or read book Robotics and Automation in Healthcare written by R. Thanigaivelan and published by CRC Press. This book was released on 2024-07-26 with total page 315 pages. Available in PDF, EPUB and Kindle. Book excerpt: The recent pandemic has forced researchers to adapt technologies such as robotics and AI in the healthcare field. This book, Robotics and Automation in Healthcare: Advanced Applications, explores these new technologies by focusing on important issues related to the employment of robotics and automation in healthcare, such as in medical diagnosis, treatment, and surgery. The volume reviews wireless charging of implantable pacemakers, considers smart bot design for library building of medical colleges, and discusses strain distribution in biomechanical systems. Other topics included in the book are medical imaging, drone technology, 3D printing, and image processing techniques. The application and importance of actuators in medical devices, especially during surgery, is discussed, as are wearable devices for pre-identification of seizure development. The volume also looks at a decision support system for detection of suitable robots and early detection of diseases with the support of image processing techniques. The application of nano-robots in healthcare is also explored. Providing advanced information and insight into robotics, wearable devices, and applications of image processing in healthcare field, this volume will be helpful to those in communications and electronics engineering as well as those at the forefront of smart technology in healthcare.

Oxford Textbook of Palliative Care for Children

Author : Ann Goldman
Publisher : Oxford University Press, USA
ISBN 13 : 0198526539
Total Pages : 680 pages
Book Rating : 4.1/5 (985 download)

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Book Synopsis Oxford Textbook of Palliative Care for Children by : Ann Goldman

Download or read book Oxford Textbook of Palliative Care for Children written by Ann Goldman and published by Oxford University Press, USA. This book was released on 2006 with total page 680 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is the first authoritative, systematic and comprehensive text to define the increasingly important and evolving specialty of paediatric palliative care. It explores both the clinical aspects and the multidimensional and holistic nature of care for the dying child, based on theknowledge that all human experience has a physical, emotional, psychological and spiritual impact. The book covers ways of providing support in all of these areas both for the child, families, and carers, recognising the importance of teamwork and taking an evidence-based approach. The Oxford Textbook of Palliative Care for Children is about the care of children for whom cure of their underlying disease is not possible. It encompasses the physical management of symptoms such as pain and nausea, as well as social issues such as accessing appropriate education and funding,emotional issues such as techniques for communication, and spiritual issues such as feelings of guilt and isolation. The book suggests that if we are to maintain the quality of life for a child it is essential to recognise all these dimensions and try to address them. This can only be done by recognising the skills of a wide range of professionals and working together in ways that are not always intuitive to anyone discipline. It explores the multidimensional and holistic nature of care for the dying child. Those working in paediatric palliative care recognise that all human experience has emotional, psychological and spiritual impact as well as physical, and this book attempts to find ways of providingsupport in all these.