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In this work we develop a novel algorithm for reconstructing the genomes of ancestral individuals, given genotype or sequence data from contemporary individuals and an extended pedigree of family relationships. A pedigree with complete genomes for every individual enables the study of allele frequency dynamics and haplotype diversity across generations, including deviations from neutrality such as transmission distortion. When studying heritable diseases, ancestral haplotypes can be used to augment genome-wide association studies and track disease inheritance patterns. The building blocks of our reconstruction algorithm are segments of Identity-By-Descent (IBD) shared between two or more genotyped individuals. The method alternates between identifying a source for each IBD segment and assembling IBD segments placed within each ancestral individual. Unlike previous approaches, our method is able to accommodate complex pedigree structures with hundreds of individuals genotyped at millions of SNPs. We apply our method to an Old Order Amish pedigree from Lancaster, Pennsylvania, whose founders came to North America from Europe during the early 18th century. The pedigree includes 1338 individuals from the past 12 generations, 394 with genotype data. The motivation for reconstruction is to understand the genetic basis of diseases segregating in the family through tracking haplotype transmission over time. Using our algorithm thread, we are able to reconstruct an average of 224 ancestral individuals per chromosome. For these ancestral individuals, on average we reconstruct 79% of their haplotypes. We also identify a region on chromosome 16 that is difficult to reconstruct-we find that this region harbors a short Amish-specific copy number variation and the gene HYDIN. thread was developed for endogamous populations, but can be applied to any extensive pedigree with the recent generations genotyped. We anticipate that this type of practical ancestral reconstruction will become more common and necessary to understand rare and complex heritable diseases in extended families.
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Variaciones en el Número de Copia de ADN , Estudio de Asociación del Genoma Completo/métodos , Haplotipos , Dinámica Poblacional , Algoritmos , Animales , Mapeo Cromosómico/métodos , Simulación por Computador , Frecuencia de los Genes , Ligamiento Genético , Genotipo , Humanos , Desequilibrio de Ligamiento , Modelos Genéticos , Linaje , Polimorfismo de Nucleótido Simple , Programas Informáticos , Secuenciación Completa del GenomaAsunto(s)
Examen Ginecologíco , Trabajo de Parto , Embarazo , Femenino , Humanos , Parto , Parto ObstétricoRESUMEN
Motivational Interviewing provides the opportunity to health professionals to have an effective strategy to increase the level of readiness to change health behaviors. Along with the Transtheoretical Model (Stages of Change Model) compose the theoretical base of intervention in psychiatry settings. OBJECTIVE: This study was aimed to change nutritious behavior of psychiatric patients using a specific Model of Change and Counseling implementing a health education program. METHODOLOGY: A quasi-experimental design was adopted on a random sample of 60 psychiatric patients at Military Hospital of Athens. Patients were divided into two groups as follows; (a) Intervention Group (four sessions of counseling and encouraging motivation for modification of their nutritious habits), and (b) Control Group (simple information sessions about the principles of healthy alimentation). RESULTS: The mean age of Intervention Group (IG) was 43.9 ± 9.5 and Control Group (CG) 46.1 ± 9.1, ranging from 40 to 55 years old. Also, 26.7% of the participants were female, 23.3% were married and, 10% divorced. Our analyses showed that IG patients were significantly loss weight post-intervention compared to CG patients. Specifically, IG patients were significantly moderated the intake of starchy foods in every meal (p < 0.001) and the intake of fruits and vegetables (p < 0.001). Similarly, IG patients were moderated the intake of low fat dairy foods while they changed the full fat dairy foods with low fat (p < 0.001). Also important, IG patients showed significant enhance (80%) regarding drugs compliance, suggesting that 34% of the CG patients often forgot to take their medication. Finally, IG patients reported a positive attitude towards moderating unhealthy nutritious behaviors (p = 0.032). CONCLUSIONS: Our results confirms that health educational and promotional Interventions may change behavior of psychiatric patients and thus may positively influence their nutritious habits.
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Consejo , Dieta Saludable , Conductas Relacionadas con la Salud , Promoción de la Salud/métodos , Adulto , Femenino , Frutas , Hábitos , Educación en Salud , Humanos , Masculino , Persona de Mediana Edad , Motivación , VerdurasRESUMEN
Geriatric depression is more common in nursing homes and social support is a mechanism that mitigates the stressors of life factors and simultaneously promotes wellness and health. The purpose of the study was to assess the levels of depression and social support among elderly in nursing homes. During the period February 2016-March 2016 170 elderly residents in nursing homes completed the Geriatric Depression Scale-15 (GDS-15) and the Multidimensional Scale of Perceived Social Support (MSPSS). Statistical analysis was conducted with IBM SPSS Statistics 23. 37, 1% of the sample had depressive symptoms. Depression is statistically correlated with age and it is affected by the years of education (p = 0.003), the number of the children (p = 0.006), whether the elderly person is bedridden or not (p < 0.001), the frequency of visits by family members (p < 0.001) and whether the elderly performs activities outside the nursing home (0.001). Higher GDS score had those who were illiterate (6.41), those with one or no children (6.82 and 6.59 respectively), the bedridden (6.70), people without visits from relatives (7.69) and without activities outside (5.64). Also, social support is affected by the family status (p < 0.001), the number of children (p < 0.001), the frequency of visits by relatives (p < 0.001) and whether the elderly performs activities outside the foundation (p < 0.008). Higher MSPSS score had those who were married (61.60), those who had four children (63.50), people who accept visits from relatives every day (64.58) and people who do activities outside the institution (58.07). The appearance of this increased rate of depression symptoms in this elderly population leads to the need for more aid social support.
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Depresión/psicología , Evaluación Geriátrica/métodos , Casas de Salud , Apoyo Social , Anciano , Anciano de 80 o más Años , Depresión/diagnóstico , Escolaridad , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Masculino , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Spiritual health is one of the important aspects of health status that is often neglected. AIM: the present study aims to evaluate spiritual wellbeing in end stage renal disease patients undergoing hemodialysis and its relation to sociodemographic and clinical variables. METHODS: A convenience sample of 183 individuals undergoing hemodialysis was recruited. Measurements were conducted with the following instruments: (a) a sheet containing demographic data and clinical information such as duration of dialysis e.t.c (b) Facit Spiritual Wellbeing Scale (Facit-Sp12). Statistical analysis was contacted with SPSS v.22. Descriptive statistics were initially generated for sample characteristics. Parametric and no-parametric statistics were used for searching the relations between the variables. P values <0.05 were defined as reflecting the acceptable level of statistical significance. RESULTS: From the total of the 183 participants of the study the 69.9% were male and 30.1% female. The age range was from 26 to 88 years old, with mean 61.39 ± 14.11. The subscale "peace" is associated to gender (t = 2.150, p = 0.033), educational level (F = 2.698, p = 0.047) and duration of dialysis (F = 2.969, p = 0.033) and religious beliefs (t = -2.059, p = 0.041). The subscale "faith" is associated to gender (t = -3.428, p = 0.001), age (p = 0.006), number of children (F = 4.347, p = 0.014). Moreover, the subscale "meaning" is associated to age (p = 0.001). Finally its worth to be mentioned that comorbidity is associated to subscales "meaning" (t = -2.071, p = 0.040), "peace" (t = -2.377, p = 0.018) and the overall spiritual wellbeing (t = -1.988, p = 0.048). CONCLUSIONS: Social, demographic factors as well as clinical variables such duration of dialysis and comorbidities are affecting spiritual wellbeing in end stage renal disease.
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Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Diálisis Renal , Espiritualismo , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
The aim of this study was to investigate the use of alcohol in health professionals during the economic crisis in Greece. The sample included 579 health professionals. Despite the fact that alcohol consumption was low and women held more negative views on the effectiveness of its use compared to men, they consumed more than men both in quantity (mean 1.57 vs 1.46, p=0.291) and in frequency (mean 1.98 vs 1.73, p=0.132). Employees with a higher level of education expressed more opposition to the use of alcohol than those with a basic level of education (93.5% vs 66.7%, p=0.004). There was a significant positive correlation between the amount of alcohol consumed after a stressful event and the frequency with which this amount of alcohol consumption occurred in workers.
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Consumo de Bebidas Alcohólicas/epidemiología , Recesión Económica , Personal de Salud/estadística & datos numéricos , Adulto , Femenino , Grecia/epidemiología , Personal de Salud/psicología , Humanos , Masculino , Persona de Mediana Edad , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The total fertility rate is influenced over an extended period of time by shifts in population socioeconomic characteristics and attitudes and values. However, it may be impacted by macroeconomic trends in the short term, although these effects are likely to be minimal when fertility is low. With the objective of forecasting monthly deliveries, this study concentrates on the analysis of registered births in Scotland. Through this approach, we examine the significance of precisely forecasting fertility trends, which can subsequently aid in the anticipation of demand in diverse sectors by allowing policymakers to anticipate changes in population dynamics and customize policies to tackle emerging demographic challenges. Consequently, this has implications for fiscal stability, national economic accounts and the environment. In conducting our analysis, we incorporated non-linear machine learning methods alongside traditional statistical approaches to forecast monthly births in an out-of-sample exercise that occurs one step in advance. The outcomes underscore the efficacy of machine learning in generating precise predictions within this particular domain. In sum, this research will comprehensively demonstrate a cutting-edge model of machine learning that utilizes several attributes to assist in clinical decision-making, predict potential complications during pregnancy and choose the appropriate delivery method, as well as help in medical diagnosis and treatment.
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Tasa de Natalidad , Predicción , Aprendizaje Automático , Escocia , Humanos , Predicción/métodos , Tasa de Natalidad/tendencias , Femenino , Algoritmos , EmbarazoRESUMEN
Background: Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep, leading to neurological and cardiovascular adverse effects. Objective: The present study aimed to explore seasonal compliance with Continuous Positive Airway Pressure (CPAP) therapy among OSA patients in Greece. Methods: Data from 954 OSA patients using CPAP devices were collected during summer and winter months. Factors evaluated included the Apnea-Hypopnea Index (AHI), mask type, mask leaks, and hours of CPAP device usage. Results: The majority of patients were male (78.2%) and aged 60 years or above (58.5%). Most patients had been using CPAP for over 2 years (82.8%), with auto CPAP devices and nasal or pillow masks being most common. Compliance was observed in 57.7% of patients, while 22.1% were non-compliant. A significant number of patients (8.2% and 12%) were compliant only in summer or winter, respectively. Compliance was influenced by duration of CPAP use, BMI up to 25, and the use of nasal/pillow masks. Higher compliance was associated with lower summer severity and both low and severe winter severity. Logistic regression analysis confirmed these findings. Conclusion: The findings suggest that utilizing CPAP device data can provide actionable insights on seasonal compliance among OSA patients. Summer compliance is lower, and the use of nasal/pillow masks and auto CPAP devices is recommended for improved compliance.
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Background: Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients. Objective: The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece. Methods: Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage. Results: The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence. Conclusion: CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.
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INTRODUCTION: Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure to treat coronary artery occlusion. The quality of life (QoL) is a way to measure the impact of illness and additionally its treatments to traditional measures of clinical outcomes. PURPOSE: The aim of the present study was to explore the levels of QoL pre-PCI, 6 and 12 months after PCI, as well as the factors associated with the QoL pre-PCI. METHODS: In the present study, 100 patients undergoing PCI were enrolled. Data were collected through the completion of the SF-36 Health Survey (SF-36), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS: Patients had moderate levels of QoL at baseline, with a median general health score of 45 (IQR: 30-65). A gradual statistically significant increase in scores was observed in all subcategories of the patients' QoL at 6 and 12 months after PCI (p < 0.001). A greater increase in scores was observed in physical functioning, physical role, emotional role and social functionality. In terms of the pre-PCI phase, it was found that physical functionality was statistically significantly associated with educational level (p = 0.005), occupation (p = 0.026) and whether the patients had children (p = 0.041). The physical and emotional role was significantly associated with gender (p = 0.046 and p = 0.040) and educational level (p = 0.030 and p = 0.001). Energy-fatigue was significantly associated with gender (p = 0.001), age (p = 0.028), marital status (p = 0.001), educational level (p = 0.001), whether the patients had children (p= 0.012) and other diseases (p = 0.001). Emotional well-being was significantly associated with family history of coronary artery disease (p = 0.011) and the frequency of physical exercise (p = 0.001). Social functioning was significantly associated with gender (p = 0.033), marital status (p = 0.034) and educational level (p = 0.002). Pain was not found to be significantly associated with patients' demographics. General health was significantly associated with gender (p = 0.003), age (p = 0.043), educational level (p = 0.001), other diseases (p = 0.005) and the frequency of physical exercise (p = 0.001). CONCLUSION: Information about the QoL of PCI and its determinants is important to define an effective and comprehensive care plan.
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Introduction: Hospitalization is a stressful event for both patients and relatives. The aim of the study was to explorefactors affecting state and trait anxiety of relatives of hospitalized patients. Methods: In this cross-sectional study, was enrolled a convenience sample of 222 relatives of hospitalized patients in a public hospital in Athens, Greece. Data were collected by the completion of State-Trait Anxiety Inventory (STAI) which also included participants' characteristics. Data were analyzed using SPSS version 25, while the statistical significance level was P < 0.05. Results: Of the 222 relatives, 72 were men and 150 women. The average state and trait anxiety score was 45.6 and 42, respectively, within the possible range of scores (20-80) thus indicating moderate levels of anxiety. Moreover, state and trait anxiety was statistically significantly associated with gender, degree of information of patient's health, whether they had readjusted family responsibilities, whether they had financial worries, whether they experienced uncertainty about future and finally whether they were anxious about their ability to respond to patients care. Conclusion: Factors associated with relatives' anxiety were gender, information regarding patient's health, family responsibilities, financial worries, uncertainty and anxiety to respond to patients' care. These factors need to be evaluated when planning psychological intervention to alleviate this emotional burden.
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Population genetics relies heavily on simulated data for validation, inference and intuition. In particular, since the evolutionary 'ground truth' for real data is always limited, simulated data are crucial for training supervised machine learning methods. Simulation software can accurately model evolutionary processes but requires many hand-selected input parameters. As a result, simulated data often fail to mirror the properties of real genetic data, which limits the scope of methods that rely on it. Here, we develop a novel approach to estimating parameters in population genetic models that automatically adapts to data from any population. Our method, pg-gan, is based on a generative adversarial network that gradually learns to generate realistic synthetic data. We demonstrate that our method is able to recover input parameters in a simulated isolation-with-migration model. We then apply our method to human data from the 1000 Genomes Project and show that we can accurately recapitulate the features of real data.
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Programas Informáticos , Simulación por Computador , Demografía , HumanosRESUMEN
The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.
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Amputación Traumática/psicología , Ansiedad/diagnóstico , Cuidadores/psicología , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Factores de Edad , Ansiedad/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Modelos Lineales , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Centros de Atención TerciariaRESUMEN
The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence-based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.
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Depresión Posparto/enfermería , Madres/psicología , Relaciones Enfermero-Paciente , Enfermeros de Salud Comunitaria/organización & administración , Atención Perinatal/métodos , Adulto , Enfermería en Salud Comunitaria/métodos , Chipre , Manejo de la Enfermedad , Femenino , Visita Domiciliaria/estadística & datos numéricos , HumanosRESUMEN
Background: Patients with mental health problems are in high risk to develop addiction, since smoking incidence is three times higher than that of the general population. The aim of the study was to investigate the factors affecting mental health patients' smoking habits. Methods: The sample of study were 356 patients out of 403 initially approached, with 142 hospitalized in hospital facilities and 214 in community settings. The «Smoking in psychiatric hospitals" and General Health Questionnaire (GHQ-28) questionnaires were used. A principal component analysis was performed using the correlation coefficients of the various variables and an orthogonal varimax rotation, in order to interpret the seven factors emerging. Among the variables the most important factors appeared to be the type of healthcare facility, legal status, depression and age. Results: The type of healthcare facility was correlated to demographic characteristics, clinical features, psychopathology and functionality, but also to the attitudes and behaviors related to smoking. More specifically, the in-hospital patients were heavier smokers, about 90% of the patients said they would consider quitting smoking. The various variables had only a small effect on the intention to quit smoking. The comparison of the coefficients of determination of each variable, showed that age had the strongest effect (R2=0.152), while the GHQ D subscale (severe depression) had the least significant effect (R2=0.023). From all (7) factors, it appears that hospitalization was positively correlated with factor 5 and negatively with the factors 2, 3 and 6, legal status (commitment order) negatively with factors 1 and 4, while depression (or consuming antidepressants) positively factor 4 and negatively to factors 1 and 3. Finally, age was the only variable that is associated with the agent 7. Conclusions: Patients are permissive to staff's smoking in the healthcare facility and may resist attempts to restrict it. It is important that these conclusions are taken into account in any systematic attempt to limit smoking within mental health settings.
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Background: University students worldwide seem to have increased rates of smoking, alcohol abuse, binge drinking episodes and harmful consumption trends, raising a serious public health issue. The aim of the present study was to investigate university students' smoking habits and exposure to secondary smoke amid a financial crisis. Methods: The present descriptive, correlational analysis was conducted at the University of Peloponnese. Results: The average age of the sample (n=203) was 24.9 years (±7.6 years) with 36.0% of the participants (n=73) being postgraduate students. Some 51.2% (n=104) of the participants said they didn't smoke and 46.3% (n=94, p=0.003) reported no secondary smoke exposure during the past week at home. The majority of the remainder initiated smoking at age 16-17 (48.5%, n=48), and 64.6% (n=42) said the financial crisis did not lead them to change their smoking habits. Conclusions: The majority of students support smoking ban laws in enclosed public spaces, but also their replies highlighted poor implementation on behalf of the state and the authorities. The financial crisis did not appear to have affected student smoking habits.
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Background: Breast cancer is the most frequent type of cancer among women worldwide, especially in developed countries. To be diagnosed with breast cancer and undergo cancer treatment can be a very stressful event. It is estimated that one-third of cancer patients are dealing with psychological problems, such as anxiety and depression and resilience is a way of coping and overcome life stressors such cancer diagnosis. Purpose: The purpose of this study was to examine resilience in women diagnosed with breast cancer and its association with depression and anxiety. Methods: A cross-sectional study was conducted, 144 women diagnosed with breast cancer answered a questionnaire consisted of four parts: Sociodemographic data, the Patient Health Questionnaire Two-Item Depression Scale, the Generalized Anxiety Disorder Questionnaire and the Connor-Davidson Resilience Scale 25. Results: The majority of the sample belongs to age group 51- 60 years, with the mean age of 53.5 SD±11.7 years. The 59.5% of patients were residents of an urban area, 56.8% were married and 36.5% has 2 children. The mean value of CD-RISC25 was 65.3 SD±17.9, meaning a moderate resilience of cancer patients. The 54.5% of respondents indicated a depressed mood. The anxiety severity measured with the GAD-2, where the mean was 2.1 and 46.8% of patients suffered from high anxiety. Conclusions: According to our results, resilience can negative influence depressive symptomatology. Moreover, lower levels of depression can lead to fewer anxiety symptoms.
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INTRODUCTION: Smoking rates amongst people with a mental health disorder are significantly higher than in the general population and there is growing evidence to show a strong association between smoking and mental health disorders. The aim of the present study was to investigate views and attitudes of mental patients regarding smoking. MATERIAL & METHODS: The sample is composed of 356 patients treated in the Attica Psychiatric Hospital (a.k.a. "Dafni") as well as in other Units affiliated with the Hospital. The 'Smoking in psychiatric hospitals-a survey of patients' views' questionnaire was used in the form of semi-structured interviews. The PASW 18 (SPSS Inc.) package was used for the statistical analysis and statistical significance was set to p= 0.05. RESULTS: Overall, 40% of the participants were in-patients, the rest being treated in other settings, the average length of hospital stay was 4.4 years, and the most common diagnosis (61.5.%) was schizophrenia (F20, according to ICD-10), while almost all of the participants (97.5%) were smokers. Most patients (58.8%) said they had had a hard time trying to quit smoking although they had sufficient information and encouragement (≈90%); they also reported that watching the staff smoking did not affect them inasmuch as watching other patients smoking (41 % vs 54.8%). 75.5% of the patients felt that they had no particular difficulty to quit smoking. Men smoked significantly more cigarettes per day compared to females (36.70 vs 30.82, p=0.002). There were no significant differences among males and females regarding previous attempts to quit smoking. Information gathered from such studies should be taken into account when designing systematic smoking management plans in mental institutions. CONCLUSION: Although almost all mental patients smoke, they seem to be receptive to quitting smoking, since two thirds of them have already tried to quit, but one-third of the patients find smoking a little or not at all dangerous.