Kinematic characteristics of elbow joint range of motion in elite Chinese freestyle swimmers with elbow pain during dry-land simulations of swimming strokes.

The aim of this study was to obtain quantitative data on elbow joint ROM in elite freestyle swimmers with EP in China. Of the 50 elite freestyle swimmers recruited, 41 completed all measurements during dry-land swimming stroke simulations. Elbow joint angle, velocity, and acceleration were measured using inertial measurement units. The RMSE/D was calculated to determine the elbow joint ROM deviation. Joint angle (3.33 ∘-42.96 ∘), angular velocity (-364.15 to 245.69 ∘/s), and angular acceleration (-7051.80 to 1465.35 ∘/s2) were significantly different between the critical pain and healthy. The probability distributions of joint angle (15.47 ∘ ±14.54 ∘), angular velocity (2.41 ∘ ±111.06 ∘/s), and angular acceleration (1.93 ± 2222.6 ∘/s2) in the slight pain group were significantly different betweenhealthy and critical pain. The RMSE/D distributions of angular velocity (28.3%) and acceleration (21.48%) in the critical pain deviated from the healthy. The peak value-RMSE/D matrix model obtained proved that elbow ROM significantly differed between the elite freestyle swimmers with EP and the healthy. Angular velocity and acceleration indicate the weakness and negative influence of kinematics on patients with EP. Thus, Potential solutions are to constantly optimise freestyle swimming techniques and strengthen the arm muscles.

Effects of isometric training and R.I.C.E. treatment on the arm muscle performance of swimmers with elbow pain.

The effects of IT and R.I.C.E. treatment on arm muscle performance in overhead athletes with elbow pain (EP) have been partially validated. However, there is a lack of research evidence regarding the efficacy of these two methods on arm muscle performance among swimmers with EP. The aim of this study was to investigate the trends and differences in the effects of IT and R.I.C.E. treatment on arm muscle performance among swimmers with EP. The main outcomes were the time effects and group effects of interventions on muscle voluntary contraction (MVC). Sixty elite freestyle swimmers from Tianjin, China, voluntarily participated in the study and completed a 10-week intervention program. Swimmers with EP in the IT group showed a positive trend in MVC, with an approximately 2% increase, whereas the MVC of subjects in the R.I.C.E. treatment group and control group decreased by approximately 4% and 5%, respectively. In comparison, the effects of the IT intervention on the MVC of the triceps and brachioradialis muscles in swimmers with EP were significant (p = 0.042 < 0.05, p = 0.027 < 0.05). The mean MVC value of the IT group (0.60) was greater than that of the other two groups (0.51, 0.50). IT has a beneficial impact on the MVC performance of the triceps and brachioradialis muscles in swimmers with EP. It is recommended that professionals consider incorporating IT into regular training routines to mitigate the risk of EP issues. Future research should examine the effectiveness of both interventions on hand-grip strength and completion time in 50-m freestyle swim drills in order for swimmers with EP to return to this sport.

Effects of Family-Professional Partnerships in Adapted Physical Education on the Fundamental Motor Skills, Adaptive Behaviors, and Physical Activity Levels of Children with Autism Spectrum Disorder and on Parent Satisfaction.

PURPOSE: This study aimed to explore the effect of family-professional partnerships in adapted physical education on the fundamental motor skills, physical activity levels, and adaptive behaviors of children with autism spectrum disorder (ASD) and on parental satisfaction. METHODS: A randomized controlled trial design was used, with pre-and post-intervention evaluations. Participants (n = 40), including children with ASD and their parents, were divided into three groups: (a) a family-school group (FSG-A, n = 14), (b) a school group (SG-B, n = 13), and (c) a control group (CG-C, n = 13). RESULTS: After 12 weeks of intervention, the within-group comparison revealed that the FSG-A performed better than the SG-B and CG-C for all variables. The among-group comparison further revealed that the FSG-A had greater fundamental motor skill scores than the SG-B (p = 0.021) and CG-C (p < 0.001), had greater adaptive behavior and family-professional partnership scores than the SG-B and CG-C (p < 0.001 for all), and had higher physical activity levels than the SG-B (p < 0.05) and CG-C (p < 0.001). CONCLUSION: This study underscores the significance of robust family-professional partnerships in exercise interventions for children with ASD.

Distribution and Prevalence of Elbow Pain (EP) in Elite Swimmers in Tianjin, China-A Regional Epidemiological Study.

Elbow pain (EP) in overhead sports is a common phenomenon. Swimming is classified as an overhead sport, but a lack of attention regarding EP in swimming has created a gap in the knowledge around elite freestyle swimming in Tianjin, China. The purpose of this study was to identify the distribution and prevalence of EP among elite freestyle swimmers in Tianjin, China. The methodology involved a total of 311 qualified participants who volunteered to undertake all measurements. The main findings showed that 183 of the elite freestyle swimmers in this study had EP (accounting for 58.84% of the total 311 participants), with 147 in slight pain and 36 in critical pain. The characteristics of a heavier body weight, taller height, longer left/right forearm length, and longer weekly average training hours serve as contributing factors to the occurrence of EP issues. Gender, age, weekly average training hours, and left/right forearm length are the primary factors correlating with and influencing the assessment scores. In conclusion, swimmers with longer weekly training hours, older ages, heavier bodyweight, and longer forearm lengths should receive greater attention in relation to EP. Regular assessments at a high frequency serve as a means to identify the risk of EP.

Effects of Tele-Pilates and Tele-Yoga on Biochemicals, Physical, and Psychological Parameters of Females with Multiple Sclerosis.

BACKGROUND: People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the serum levels of prolactin and cortisol and selected physical and psychological factors. METHODS: Forty-five females with relapsing remitting multiple sclerosis, based on age (18-65), expanded disability status scale (0-5.5), and body mass index (20-32), were randomly assigned to tele-Pilates, tele-yoga, or control groups (n = 15). Serum blood samples and validated questionnaires were collected before and after interventions. RESULTS: Following online interventions, there was a significant increase in the serum levels of prolactin (p = 0.004) and a significant decrease in cortisol (p = 0.04) in the time × group interaction factors. In addition, significant improvements were observed in depression (p = 0.001), physical activity levels (p < 0.001), QoL (p ≤ 0.001), and the speed of walking (p < 0.001). CONCLUSION: Our findings suggest that tele-yoga and tele-Pilates training could be introduced as patient-friendly, non-pharmacological, add-on therapeutic methods for increasing prolactin and decreasing cortisol serum levels and achieving clinically relevant improvements in depression, walking speed, physical activity level, and QoL in female MS patients.

Effects of tele-exercise training on physical and mental health and quality of life in multiple sclerosis: Do the effects differ by modality and clinical disease course?

INTRODUCTION: Tele-exercise training has improved mental and physical health and quality of life (QOL) in people with multiple sclerosis (PwMS), but there is little known about the comparability of effects across modalities and clinical disease courses. OBJECTIVE: To evaluate the effect of tele-Pilates and tele-yoga training on physical and mental factors and QOL in PwMS, with a focus on two phenotype classifications - relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). METHODS: Eighty-two persons with RRMS (n = 48) and SPMS (n = 34) were randomly assigned into tele-Pilates (n = 29), tele-yoga (n = 26), or control (n = 27). The tele-exercis training was conducted three times per week for eight weeks. RESULTS: Significant time × group interactions were observed for QoL (p = 0.01), physical activity levels (p < 0.001), mental health (p = 0.05), and a decline in depression (p = 0.002) following tele-Pilates and tele-yoga. The corresponding subfactors, including pain, energy, emotional well-being, and role limitation due to emotional and physical problems, have shown significant improvements after interventions compared with control (all p < 0.05). The effects of exercise over control did not depend on MS phenotype (all p > 0.05). DISCUSSION: Tele-yoga and tele-Pilates exercises improved QoL and mental and physical health in PwMS, and the benefits were similar across both MS phenotypes. These findings highlight the potential of implementing tele-yoga and tele-Pilates as non-pharmacological mind-body symptomatic treatments for individuals with both RRMS and SPMS.

Global Trends in Physical-Activity Research of Autism: Bibliometric Analysis Based on the Web of Science Database (1980-2021).

The World Health Organization has identified nervous system diseases as one of the biggest public health problems, including autism spectrum disorder (ASD). Considering the extensive benefits of physical activity (PA), the literature on the PA research of ASD has increased each year, but there is a lack of bibliometric analyses in this field. To investigate the research achievements worldwide, this paper adopts bibliometrics to analyze the trend in the academic literature on the PA research of ASD published from 1980 to 2021. The documents were retrieved from the Web of Science database, and the search strategy was to combine the keywords related to "physical activity" and "autism spectrum disorder" by using the Boolean operator tools "OR" and "AND" in the title. A total of 359 English documents were retrieved. Microsoft Excel, Data Wrapper, VOSviewer, and Biblioshiny were used for the visual analysis. We found that the number of published documents increased the fastest from 2017 to 2021, which may be due to the promulgation of the Global Action Plan for Physical Activity 2018-2030 and the influence of COVID-19 on the world. The United States and the University of California systems are in the leading position in this field. Cooperation among countries with different levels of development will help to jointly promote the PA research progress on ASD. The focus themes include "individual effect", "social support" and "activity dose". The analysis of the frontier topic points out that researchers are paying increasing attention to how to improve the health and physical fitness of this group through PA. This research clearly puts forward a comprehensive overview, theme focus, and future trends in this field, which may be helpful to guide future research.

A Bibliometric and Visual Analysis of Exercise Intervention Publications for Alzheimer's Disease (1998-2021).

Alzheimer's disease (AD) is the most common cause of dementia worldwide, posing a considerable economic burden to patients and society as a whole. Exercise has been confirmed as a non-drug intervention method in the related literature on AD. However, at present, there are still few bibliometric studies on AD exercise research. In order to fill the gap, this paper aims to intuitively analyze the growth in AD exercise literature published from 1998 to 2021 using bibliometrics, providing historical insights for scientific research circles. The main source of literature retrieval is the Web of Science database. Using the Boolean operator tools "OR" and "AND" combined with keywords related to "exercise" and "Alzheimer's disease", we conducted a title search and obtained 247 documents. Using Microsoft Excel, Datawrapper, and Biblioshiny, this study carried out a bibliometric analysis of countries, institutions, categories, journals, documents, authors, and keyword plus terms. The study found that the number of papers published from 2016 to 2021 had the greatest increase, which may have been influenced by the Global Dementia Report 2015 and COVID-19. Interdisciplinary cooperation and the research results published in high-scoring journals actively promoted research and development in the AD exercise field. The United States and the University of Minnesota system play a central role in this field. In future, it will be necessary to explore the effectiveness and feasibility of multi-mode interventions on an active lifestyle, including exercise, in different groups and environments worldwide. This study may provide a direction and path for future research by showing the global overview, theme evolution, and future trends of research results in the AD exercise field.

Analysis of Research Trends on Elbow Pain in Overhead Sports: A Bibliometric Study Based on Web of Science Database and VOSviewer.

The publications on elbow pain (EP) in overhead sports are increasing. The results of previous studies mostly focus on the influence of EP in the ball game and throwing sports. Thus, a bibliometric analysis of these publications may show the direction of hot topics and future research trends. The purpose of this study is to identify the research trends on EP in overhead sports. For the methods, the first step is to use the main keywords of 'Elbow pain' and 'Overhead sport' merging auxiliary vocabulary to reach the relevant global publications between 1970 and 2022 in the Web of Science (WoS) database. The literature data set is imported into EndNote literature manager software to remove duplication. Secondly, the duplication-reduced articles are imported to an Excel sheet according to the inclusion and exclusion criteria of this study. In the third step, VOSviewer software is applied as the main analysis tool in extracting data for analysis from the articles. Then, the main research results for three aspects are obtained by VOSviewer software which extracted and analyzed the parameters of author name, article title, publication journal, keywords, organization, publication country/region, and the sum of times cited from 455 qualified papers. The study found that the United States of America made the most outstanding contribution to this theme study. The research on EP in overhead sports in China requires more attention from scholars. EP in swimming is a new research direction worthy of attention. In conclusion, the research results prove the growth trend of EP in overhead sports. The EP problem not only exists in the ball game and throwing sports but also swimming. Sport commercialization and the involvement of related professional sports organizations determine the degree of EP's attention in a specific sport and the development of solutions. The development of a region or country also affects the depth and scope of EP study. Clinical research development and in-depth exploration are one of the bases to solve EP problems. Non-clinical action is beneficial to EP patients, but it still needs to be explored and studied.

Cytokine Profile in Patients with Multiple Sclerosis Following Exercise: A Systematic Review of Randomized Clinical Trials.

Multiple sclerosis (MS) is one of the most prevalent causes of nontraumatic neurological impairment in young adults. This review aims to determine the impact of exercise on cytokine and adipokine profile levels as inflammatory markers in MS patients across various exercise paradigms. We used specific keywords in PubMed, Web of Science, The Cochrane Library, and Scopus to find randomized clinical trials addressing the effects of physical activity and exercise training on inflammatory markers levels in MS patients. The majority of the research showed no considerable changes in IL-6 levels, while three studies reported declining levels after the intervention. Approximately half of the trials observed a change in TNF-α and IL-10 levels after exercise interventions, while the other half showed no meaningful changes. Other markers such as IL-17, IL-4, IL-12, adipokines, and BDNF showed fluctuations in levels. We found no universal agreement on the effects of different exercise training protocols on the serum level of inflammatory markers in patients with MS. More research is needed to fully identify the effects of exercise on cytokines in MS patients.

Gait analysis of national athletes after anterior cruciate ligament reconstruction following three stages of rehabilitation program: Symmetrical perspective.

This study aimed to objectively evaluate changes in gait kinematics, kinetics and symmetry among anterior cruciate ligament (ACL) reconstructed athletes during rehabilitation. Twenty-two national athletes with ACL reconstruction and 15 healthy athletes were recruited for the study. Gait data were collected between the weeks 4-5, 8-9, and 12-13 post-operation using three-dimensional motion analysis system. Five separate components, including knee range of motion (ROM), vertical ground reaction force (VGRF), their symmetries and knee extension moment were evaluated. One way and repeated measure multivariate analysis of variance (MANOVA) were used to analyze the knee ROMs. The VGRF and extension moment were tested using repeated measure ANOVA and independent sample t-test. Findings indicated significant alterations in all measured components between patients' Test 1 and control group. Repeated measure analysis revealed significant effect for time in components of knee angular and VGRF (P<0.001), their symmetry index (P=0.03) and knee extension moment (P=0.045). Univariate outcomes demonstrated significant improvement in the injured limb's stance and swing (P<0.001), and single-stance (P=0.005) ROMs over time. Symmetry indexes of stance and swing ROM, and VGRF reduced significantly by 26.3% (P=0.001), 17.9% (P<0.001), and 31.9% (P=0.03) respectively. After three months, symmetry indexes of single-stance ROM and VGRF along with operated knee extension moment were the only variables which showed significant differences with control group. The rehabilitation program allowed national athletes to restore the operated limb's gait parameters except knee extension moment by 12-13 weeks post-reconstruction; however, more time is required to normalize single-stance ROM and VGRF asymmetries.

Association between levels of sports participation and oral injuries among combat athletes / Associação entre níveis de participação no esporte e lesões orais em atletas de combate / Asociación entre niveles de participación en el deporte y lesiones orales en atletas de combate

ABSTRACT Introduction Oral injuries are common traumas in combat sports due to the aggressive nature of both offense and defense. Sports mouth guards are made to reduce the risk of traumatic face and jaw injuries and concussions during sports activities. Objective The objective of this study was to determine the prevalence of oral injuries in combat sports and to examine the association between participation levels and percentage of injury occurrence. Methods One hundred and eight participants (mean age: 22.42 ± 2.162 years) who were involved in sparring events were recruited. Data were collected using a questionnaire consisting of 22 questions about the demographic profile of the athletes, their injury experience and type of injuries sustained, awareness and use of mouth guards in sports activities. Descriptive analysis, Chi-square test, and one-way analysis of variance (ANOVA) were applied for data analysis. Results Almost 77% of participants had experienced oral injuries during sports activities and nearly 90% were aware that oral injuries can be reduced by using mouth guards. In addition, 52.7% of participants complained that the mouth guard is not comfortable to use during sports activities. Findings revealed a significant moderate association between levels of participation and number of oral injuries ( p = 0.013). One-way ANOVA showed a significant mean difference in the rate of oral injury for the four levels of participation groups F (3, 104) = 6.21, p = 0.011. Post-hoc comparisons using the Bonferroni test indicated a significant mean difference between university-state levels ( p = 0.033) and university-national levels ( p = 0.028). Conclusion This study revealed that higher levels of participation in sports have a higher risk of injury. It was also found that the discomfort of using a mouth guard can be reduced if the coaches make the athletes wear proper mouth guards that follow the recommended specifications. Level of evidence IIIb; Case control study.

RESUMO Introdução As lesões orais são traumas comuns nos esportes de combate, devido à natureza agressiva tanto do ataque quanto da defesa. Os protetores bucais esportivos são feitos para diminuir o risco de lesões traumáticas na face e na mandíbula; e também de concussão durante as atividades esportivas. Objetivo Este estudo teve como objetivo determinar a prevalência de lesões orais em esportes de combate e examinar a associação entre níveis de participação e a porcentagem de ocorrência de lesões. Métodos Foram recrutados cento e oito participantes (média de idade: 22,42 ± 2,162 anos) envolvidos em eventos de combate. Os dados foram coletados por meio de um questionário composto por 22 perguntas sobre o perfil demográfico dos atletas, sua experiência com lesões e tipo de lesões sofridas, conhecimento e uso de protetores bucais em atividades esportivas. A análise descritiva, o teste do qui-quadrado e a análise de variância (ANOVA) foram aplicados para análise dos dados. Resultados Quase 77% dos participantes sofreram lesões orais durante atividades esportivas e quase 90% estavam cientes de que as lesões orais podem ser reduzidas com o uso de protetores bucais. Além disso, 52,7% dos participantes reclamaram que o protetor bucal não é confortável para uso durante as atividades esportivas. Os achados revelaram associação moderada significativa entre níveis de participação e número de lesões orais (p = 0,013). A ANOVA unilateral mostrou uma diferença média significativa na taxa de lesão oral nos quatro níveis dos grupos de participação F (3, 104) = 6,21, p = 0,011. As comparações post-hoc usando o teste de Bonferroni indicaram diferença média significativa entre os níveis universitário-estadual (p = 0,033) e os níveis universitário-nacional (p = 0,028). Conclusão Este estudo revelou que níveis mais altos de participação no esporte representam maior risco de lesões. Verificou-se também que a sensação de desconforto ao usar protetor bucal pode ser reduzida se os treinadores fizerem com que os atletas usem protetores bucais adequados, que sigam as especificações recomendadas. Nível de evidência IIIb; Estudo Caso-Controle .

RESUMEN Introducción Las lesiones orales son traumas comunes en los deportes de combate, debido a la naturaleza agresiva tanto del ataque como de la defensa. Los protectores bucales deportivos son hechos para disminuir el riesgo de lesiones traumáticas en el rostro y en la mandíbula; y también de concusión en las actividades deportivas. Objetivo Este estudio tuvo como objetivo determinar la prevalencia de lesiones orales en deportes de combate y examinar la asociación entre los niveles de participación y el porcentaje de ocurrencia de lesiones. Métodos Fueron reclutados ciento ocho participantes (promedio de edad: 22,42 ± 2,162 años) involucrados en eventos de combate. Los datos fueron colectados a través de un cuestionario compuesto por 22 preguntas sobre el perfil demográfico de los atletas, su experiencia con lesiones y tipo de lesiones sufridas, conocimiento y uso de protectores bucales en actividades deportivas. El análisis descriptivo, el test de chi-cuadrado y el análisis de varianza (ANOVA) fueron aplicados para el análisis de los datos. Resultados Casi 77% de los participantes sufrió lesiones orales durante las actividades deportivas y casi 90% tenía conocimiento de que las lesiones orales pueden ser reducidas con el uso de protectores bucales. Además, 51,7% de los participantes reclamaron que el protector bucal no es confortable para uso durante las actividades deportivas. Los hallazgos revelaron asociación moderada significativa entre niveles de participación y número de lesiones orales (p = 0,013). El ANOVA unidireccional mostró una diferencia promedio significativa en la tasa de lesión oral en los cuatro niveles de grupos de participación F (3,104) = 6,21, p = 0,011. Las comparaciones post hoc usando el test de Bonferroni indicaron una diferencia promedio significativa entre los niveles universitario-estatal (p = 0,033) y los niveles universitario-nacional (p = 0,028). Conclusión Este estudio reveló que niveles más altos de participación en el deporte representan mayor riesgo de lesiones. Se verificó también que la sensación de incomodidad al usar protectores bucales adecuados puede reducirse si los entrenadores hacen con que los atletas usen protectores bucales adecuados, que sigan las especificaciones recomendadas. Nivel de evidencia IIIb; Estudio Caso-Control.

Association between metabolic syndrome and coronary heart disease in patients on hemodialysis.

BACKGROUND: The metabolic syndrome (MeS) is a common risk factor for coronary heart disease (CHD) in the general population. OBJECTIVES: We examined the association between MeS and its risk in terms of CHD in patients on hemodialysis (HD). PATIENTS AND METHODS: This study was conducted on 300 patients on HD in six HD centers during March 2012. Patients were divided in two groups regarding presence of MeS. The rate of CHD were evaluated in each group and compared with each other. RESULTS: A total of 300 patients on HD, 173 males and 127 females with mean age of 61.7 ± 14.2, were enrolled in the study. Prevalence of MeS was 50.3%; hypertension, 83.7%; diabetes mellitus, 52%; high triglyceride level, 34%, low HDL cholesterol, 48.3%; and abdominal obesity, 41.3%. During the study, the CHD was more frequent in patients with MeS (27.8%) than was in those without MeS (14.1%) (P = 0.004). In addition, stroke happened more frequently in the MeS group than in those without MeS (30.5% vs. 17.4%; P = 0.008). The mean number of criteria for MeS was not significantly associated with mortality causes (CHD, 2.7 ± 1.3; stroke, 2.8 ± 0.9; other causes, 2.9 ± 1.3 P = 0.78). However, hypertension (89.3%) and diabetes mellitus (53.8%) were associated with increased risk for mortality. In the group of MeS, CHD were not significantly associated with serum albumin, calcium, phosphate, blood urea nitrogen, creatinine, ferritin, C-reactive protein, and KT/V; but there was significant association with white blood cells count (P < 0.0002). CONCLUSIONS: These findings suggested MeS might be an important risk factor for CHD, but not for mortality due to CHD in patients on HD.

Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: A randomised clinical trial.

BACKGROUND AND STUDY AIMS: Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori (HP). Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance (CrCl) and eradication of HP infection with new sequential and standard triple therapeutic regimens. PATIENTS AND METHODS: A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20mg omeprazole bid, 1000mg amoxicillin bid and 500mg clarithromycin bid and a new sequential regimen with 20mg omeprazole bid and 1000mg amoxicillin bid both for 14 days, 500mg ciprofloxacin bid for the first 7 days and 200mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30mgdl(-1). RESULTS: One hundred and sixty two out of 180 HP-positive patients (54.3% male, 51.6±12.1 years) completed treatment in the four groups and were studied. According to renal function they were classified into group A (n=39), haemodialysis (HD) patients; group B (n=37), CrCl <30mgdl(-1) without HD; group C (n=36), CrCl between 30 and 60mgdl(-1); and group D (n=50), control subjects with CrCl >90mgdl(-1). HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. CONCLUSION: HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported.