The effect of thoracic manipulation on pulmonary function in swimmers / Efecto de la manipulación torácica en la función pulmonar de nadadores / Efeito da manipulação torácica na função pulmonar em nadadores

Objective: Spinal manipulation has been used to improve respiratory function in healthy individuals. However, it has been observed that there are no studies in the context of sports activities. The objective of this study was to analyse the effect of thoracic spinal manipulation on forced vital capacity, forced expiratory volume in one second and maximal voluntary ventilation in swimmers.Method: A randomized controlled crossover study consisting of 21 swimmers, divided into two groups (Intervention vs Control), aged 16 – 24y, where forced vital capacity, forced expiratory volume in one second and maximal voluntary ventilation were measured in five evaluation moments: at baseline and, 1 minute, 10 minutes, 20 minutes and 30 minutes following the thoracic spinal manipulation procedures.Results: ANOVA tests showed no statistically significant differences for forced vital capacity (p = 0.35) and forced expiratory volume in one second (p = 0.25) among the five evaluation moments. With the maximal voluntary ventilation there was a statistically significant (p = 0.02) reduction, observed between baseline (86.00 litres) and at 10 minutes (79.29 litres) and 30 minutes (76.24 litres). No significant differences were observed between the results of intervention and control groups.Conclusions: In the current study no significant differences were observed in pulmonary function after thoracic spinal manipulation. Future research efforts should examine the effects of different manual therapy techniques and treatment protocols. (AU)

Objetivo: La manipulación espinal se ha utilizado para mejorar la función respiratoria en individuos sanos. Sin embargo, se ha observado que no hay estudios en el contexto de las actividades deportivas. El objetivo de este estudio fue analizar el efecto de la manipulación de la columna torácica en la capacidad vital forzada, el volumen espiratorio forzado en el primer segundo y la ventilación voluntaria máxima en nadadores.Método: Un estudio cruzado controlado aleatorio que consta de 21 nadadores, divididos en dos grupos (Intervención vs Control), de 16 a 24 años, donde se midieron la capacidad vital forzada, el volumen espiratorio forzado en el primer segundo y la ventilación voluntaria máxima en cinco momentos de evaluación: al inicio y, 1 minuto, 10 minutos, 20 minutos y 30 minutos después de los procedimientos de la manipulación de la columna torácica.Resultados: Las pruebas ANOVA no mostraron diferencias estadísticamente significativas para la capacidad vital forzada (p = 0.35) y el volumen espiratorio forzado en el primer segundo (p = 0.25) entre los cinco momentos de evaluación. Con la ventilación voluntaria máxima hubo una reducción estadísticamente significativa (p = 0.02), observada entre lo inicio (86.00 litros) y a los 10 minutos (79.29 litros) y 30 minutos (76.24 litros). No se observaron diferencias significativas entre los resultados de los grupos de intervención y control.Conclusiones: En el presente estudio, no se observaron diferencias significativas en la función pulmonar después de la manipulación de la columna torácica. Futuros estudios de investigación deberían examinar los efectos de diferentes técnicas de terapia manual y protocolos de tratamiento. (AU)

Objetivo: A manipulação da coluna vertebral tem sido utilizada para melhorar a função respiratória em indivíduos saudáveis. No entanto, observou-se que não existem estudos no contexto de atividades desportivas. O objetivo deste estudo foi analisar o efeito da manipulação da coluna torácica na capacidade vital forçada, volume expiratório forçado no primeiro segundo e ventilação voluntária máxima em nadadores.Método: Estudo aleatorizado controlado cruzado composto por 21 nadadores, divididos em dois grupos (Intervenção vs Controlo), com idades entre 16 e 24 anos, onde a capacidade vital forçada, volume expiratório forçado no primeiro segundo e ventilação voluntária máxima foram medidos em cinco momentos de avaliação: no início e, 1 minuto, 10 minutos, 20 minutos e 30 minutos após os procedimentos da manipulação da coluna torácica.Resultados: Os testes ANOVA não mostraram diferenças estatisticamente significativas para a capacidade vital forçada (p = 0.35) e volume expiratório forçado no primeiro segundo (p = 0.25) entre os cinco momentos da avaliação. Com a ventilação voluntária máxima houve uma redução estatisticamente significante (p = 0.02), observada entre o início (86.00 litros) e as medições aos 10 minutos (79.29 litros) e 30 minutos (76.24 litros). Não foram observadas diferenças significativas entre os resultados dos grupos intervenção e controlo.Conclusões: No presente estudo, não foram observadas diferenças significativas na função pulmonar após a manipulação da coluna torácica. Futuras pesquisas devem examinar os efeitos de diferentes técnicas de terapia manual e protocolos de tratamento. (AU)

Persistence of phylogeographic footprints helps to understand cryptic diversity detected in two marine amphipods widespread in the Mediterranean basin.

Amphipods of the genus Gammarus are a vital component of macrozoobenthic communities in European inland and coastal, marine and brackish waters of the Mediterranean and the Black Sea. Exceptional levels of cryptic diversity have been revealed for several widespread freshwater Gammarus species in Europe. No comprehensive assessment has yet been made for brackishwater counterparts, such as Gammarus aequicauda and G. insensibilis, which are among the most widely dispersed members of the so-called "G. locusta group" in the Mediterranean and in the Black Sea. Here we probe the diversity of these morphospecies examining the partitioning of mtDNA and nDNA across multiple populations along their distribution range and discuss it within the regional paleogeographic framework. We gathered molecular data from a collection of 166 individuals of G. aequicauda and G. insensibilis from 47 locations along their distribution range in the Mediterranean including the Black Sea. They were amplified for both mitochondrial COI and 16S rRNA as well as the nuclear 28S rRNA. All five MOTU delimitation methods (ABGD, BIN, bPTP, GMYC single and multiple threshold models) applied revealed deep divergence between Black Sea and Mediterranean populations in both G. aequicauda and G. insensibilis. There were eight distinct MOTUs delimited for G. aequicauda (6-18% K2P) and 4 MOTUs for G. insensibilis (4-14% K2P). No sympatric MOTUs were detected throughout their distribution range. Multimarker time-calibrated phylogeny indicated that divergence of both G. aequicauda and G. insensibilis species complexes started already in the late Oligocene/early Miocene with the split between clades inhabiting eastern and western part of the Mediterranean occurring in both species at the similar time. Our results indicate a high cryptic diversity within Mediterranean brackishwater Gammarus, similar to that observed for freshwater counterparts. Moreover, the phylogenetic history combined with the current geographic distribution indicate that the evolution of both studied Gammarus morphogroups has been strongly connected with the geological events in the Mediterranean Basin and it reflect the turbulent history of the area.

Effect of preparation and processing conditions on UV absorbing properties of hydroxyapatite-Fe2O3 sunscreen.

The development of innovative, safe and non-photocatalytic sunscreens is urgently needed, as it is essential to have sunscreen filters offering appropriate UV protection without damaging the environment and/or generating free radicals when in contact with the skin. Hydroxyapatite (Ca10(PO4)6(OH)2, HAp) when substituted with iron has UV protection properties and is not photocatalytic; HAp was used to make a sunscreen filter by treating cod fish bones in an iron-containing solution, and then calcining them at 700°C. Here we present a systematic and advanced study on this material, to obtain a sunscreen with improved UV absorbing properties. Bones were treated with three different iron salts - Fe(II) chloride, Fe(II) lactate and Fe(III) nitrate - under various pH conditions. Results showed that Fe(II) chloride in basic pH led to the most effective iron inclusion. High energy ball milling or ultrasound were investigated to increase surface area and corresponding UV absorption; high energy ball milling treatment led to the best optical properties. The optimum powders were used to formulate UV protection creams, which showed Sun Protection Factor (SPF) values significantly superior to the control cream (up to 4.1). Moreover the critical wavelength (λcrit) was >370nm (388-389nm) and UVA/UVB ratios were very close to 1. With these properties these sunscreens can be classified as broad UV protectors. Results also showed that combining these powders with other sunscreens (i.e. titanium dioxide), a synergic effect between the different components was also observed. This investigation showed that HAp-based sunscreens of marine origin are a valid alternative to commercial products, safe for the health of the customers and, being non-photocatalytic, do not pose a threat to the environment.

Dydrogesterone does not reverse the cardiovascular benefits of percutaneous estradiol.

OBJECTIVE: To evaluate the influence of dydrogesterone on estimated cardiovascular risk of users of hormone replacement therapy (HRT) (with percutaneous 17ß-estradiol in monotherapy and in combination with dydrogesterone) and HRT non-users through the Framingham score tool for a period of 2 years. METHODS: Framingham scores were calculated from the medical records of patients treated for at least 2 years with 17ß-estradiol alone or in combination with dydrogesterone, along with HRT non-users, through the analysis of patient medical records, followed for at least 2 years at Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione. RESULTS: Improvements in lipid profile, glucose and blood pressure levels, which reduced the estimated cardiovascular risk, were observed in the 17ß-estradiol group. Similar changes were observed in the users of 17ß-estradiol + dydrogesterone, suggesting that this progestogen does not attenuate the effects caused by 17ß-estradiol. CONCLUSIONS: Both HRT groups showed a reduction in their Framingham score. In contrast to data from other HRT investigations on cardiovascular risk, these formulations proved to be safe, even in the first year of use.

The +3187A/G HLA-G polymorphic site is associated with polar forms and reactive reaction in leprosy.

Considering that variability in immune response genes has been associated with susceptibility to leprosy and with disease severity, leprosy presents clinicopathological variants that are highly associated with the immune response, HLA-G has a well-recognized role in the modulation of the immune response, and polymorphisms at the 3' untranslated region (UTR) of the HLA-G gene may influence HLA-G production, we studied the polymorphic sites at the 3' UTR of the HLA-G gene in leprosy and their association with disease severity. We evaluated by sequencing analysis the allele, genotype, and haplotype frequencies of the 3' UTR HLA-G polymorphic sites (14-bpINDEL/+3003C-T/+3010C-G/+3027A-C/+3035C-T/+3142C-G/+3187A-G/+3196C-G) in 146 individuals presenting reactive leprosy from a highly endemic area, and associated with bacillary load and the type of reactive leprosy. A total of 128 healthy subjects were also studied. Allele, genotype, and haplotype frequencies for the 3' UTR HLA-G polymorphisms in leprosy patients did not differ from those observed in healthy donors. The +3187A allele was responsible for protection against the development of multibacillary leprosy in a dominant model (AA + AG)/GG, OR = 0.11, P = 0.018), and the +3187A allele and +3187A-A genotype were overrepresented in type II reactive leprosy reaction. The effect of genetic factors on leprosy susceptibility may be hidden by environmental components in highly endemic areas. The HLA-G + 3187A polymorphic site, which is related to unstable mRNA production, was associated with the development of polar forms of leprosy and reactive leprosy reaction.

Differential diagnosis of active hypodermal and hematopoietic necrosis virus based on gene choice and reverse transcription coupled with PCR.

The Pacific whiteleg shrimp Litopenaeus vannamei (Penaeidae) is one of the most important cultivated species in world aquaculture. In Brazil, the northeastern states are home to the main shrimp producers. As shrimp aquaculture has expanded and intensified, diseases have progressively become one of the most serious threats to this industry. Infectious hypodermal and hematopoietic necrosis virus (IHHNV) is an enzootic viral agent in Brazilian shrimp farms. Its is usually diagnosed by histological methods. However, to detect sub-clinical or acute IHHNV infection, more refined methods based on molecular techniques have been utilized. We found that by using "universal" primers and a single-step PCR diagnostic test, it was difficult to distinguish between non-infective forms of the virus and active IHHNV. Detection of IHHNV was more accurate when we used two alternative molecular strategies, namely 1) single-step PCR amplification based on gene choice and 2) reverse transcription coupled with PCR.

Contact angle of a hemispherical bubble: an analytical approach.

We have calculated the equilibrium shape of the axially symmetric Plateau border along which a spherical bubble contacts a flat wall, by analytically integrating Laplace's equation in the presence of gravity, in the limit of small Plateau border sizes. This method has the advantage that it provides closed-form expressions for the positions and orientations of the Plateau border surfaces. Results are in very good overall agreement with those obtained from a numerical solution procedure, and are consistent with experimental data. In particular we find that the effect of gravity on Plateau border shape is relatively small for typical bubble sizes, leading to a widening of the Plateau border for sessile bubbles and to a narrowing for pendant bubbles. The contact angle of the bubble is found to depend even more weakly on gravity.

Computed tomography (CT) of the lungs of the dog using a helical CT scanner, intravenous iodine contrast medium and different CT windows.

The aim of this study was to determine the accuracy of helical computed tomography (CT) for visualizing pulmonary parenchyma and associated formations in normal dogs. CT scan was performed by using intravenous contrast medium and by applying different types of CT windows: soft tissue and lung windows, and high-resolution computed tomography of the lung. This technique allowed, especially with lung window types, a good view of the parenchyma, bronchial tree, vascular structures and pleural cavity. The selected images, with high anatomical quality and tissue contrast, may be a reference for future clinical studies of this organ. Thus, helical CT is a promising non-invasive method of diagnosing a wide variety of pulmonary diseases in dogs.

[Nutritional status recording in hospitalized patient notes]. / Menções sobre o estado nutricional nos registos clínicos de doentes hospitalizados.

The prevalence of disease-related malnutrition (DRM) is described to be of 30-60% on admission to hospital, and of 10% in the community. It has been associated with worse clinical outcomes, namely higher morbidity and mortality as well as higher frequency of health care and its associated costs. The lack of screening and monitoring of nutritional status have been said to be risk factors for the increased prevalence of DRM during hospital stay. The aims of this study were to evaluate the importance given by health care professionals to certain aspects related with nutritional status (weight, food intake) of hospital patients and to see if there were any differences between the under and non undernourished ones. A systematic sample of patients from six hospitals was collected. Pregnancy, paediatric age and critical illness were exclusion criteria as well as incapacity to fulfil nutritional risk screening protocol and length-of-stay less than 24h. Socio-demographic, anthropometric data and clinical notes (e.g. weight, food/nutrient intake) from medical records were collected and Nutritional Risk Screening 2002 protocol was applied. A total of 1152 patients were included in this study. The prevalence of nutritional risk varied between 28.5% and 47.3% while undernutrition classified by anthropometrical parameters was considerably lower (6.3% to 14.9%). Two thirds of the patients had their food intake monitored and registered in medical records but only one third were weighted. Undernourished patients had their food intake more frequently monitored but their weight was less frequently measured, than the well-nourished ones. DRM prevalence amongst hospital patients on admission is significantly high. Clinical notes regarding nutritional status is rather infrequent on medical records. This study showed that urges the need to empower health care providers of the importance of the screening and monitoring of weight and food intake, on admission and during hospital stay.

Effects of an individually ventilated cage system on the airway integrity of rats (Rattus norvegicus) in a laboratory in Brazil.

The ventilation method used in the management of laboratory rats is important in maintaining their health. Rats kept under general diluting ventilation (GDV) are exposed to high levels of pollutants present in the environment (dust, airborne bacteria, etc.) or those pollutants produced by animal metabolism and excretion inside the boxes (e.g. ammonia and carbon dioxide). These pollutants may contribute to respiratory pathologies. An alternative experimental ventilation system for laboratory animal housing using intracage ventilation technology (individually ventilated cage system, IVC) was developed. In this system, ammonia levels decreased and rats exhibited better reproductive performance and a lower incidence of pneumonia than rats maintained under GDV. Using two different levels of air speed (0.03-0.26 m/s: IVC(1); 0.27-0.80 m/s: IVC(2)), the effects of IVC were compared with GDV (control) in Wistar rats in terms of respiratory mucus properties, on the nasal epithelium (as measured by quantitative morphometry) and on the lungs (as determined by the cellular composition obtained by bronchoalveolar lavage). Mucus of the respiratory system was evaluated using the following techniques: rheology (viscoelasticity) by microrheometer, in vitro mucociliary transportability (frog palate) and contact angle (an indicator of adhesivity). Also, membrane transepithelial potential difference was measured as a biomarker of airway integrity. After bedding was changed, ammonia concentrations inside the cages on day 3 were significantly higher for GDV than for IVC(1) and IVC(2). The potential-difference values for IVC(1), IVC(2) and GDV in the epiglottis and in the trachea also showed differences. Although some significant differences were observed across the three groups in counts of some cell types, the intragroup results were highly variable among individuals and inconsistent between sexes. No significant differences in the other parameters were found across groups. These results establish that rats maintained under GDV in relatively unregulated conditions are exposed to factors that can lead to deleterious effects on the ciliated epithelium of the airways, and that these effects can be prevented by the use of IVC.

Extensor digitorum brevis manus: a raremuscle on the dorsum of the hand

The extensor digitorum brevis manus is one of the rare anatomic variations which occur on the dorsum of the hand. Only some 295 articles were found worldwide in an extensive bibliographic review carried out in 2003. This muscle was dissected bilaterally on a male corpse at the Human Anatomy Laboratory of the Morphophysiological Department of the “Faculty of Medical Sciences of Minas Gerais”. It is an elongated, small muscle, originating at the carpal bones and at the extensor retinaculum and inserting into one of the tendons of the finger’s extensor muscle. Even though it does not present an essential function in the movement of the fingers nor the hand, it can lead to pain when hypertrophied, creating the need for clinical or even surgical treatment.

Reactive phenotypes after acute and chronic NK-cell activation.

Several phenotypic changes have been shown to occur after NK-cell stimulation, involving molecules that have been proved to regulate NK-cell migration into tissues and NK-cell activation and proliferation as well as target cell recognition and killing. Here, we review the reactive phenotypes observed in vivo after acute and chronic NK-cell activation.

Cd8(+)/V beta 5.1(+) large granular lymphocyte leukemia associated with autoimmune cytopenias, rheumatoid arthritis and vascular mammary skin lesions: successful response to 2-deoxycoformycin.

We report a case of CD8(+)/V beta 5.1(+) T-cell large granular lymphocyte leukemia (T-LGL leukemia) presenting with mild lymphocytosis, severe autoimmune neutropenia, thrombocytopenia, polyarthritis and recurrent infections with a chronic disease course. Immunophenotyping showed an expansion of CD3(+)/TCR alpha beta(+)/CD8(+bright)/CD11c(+)/CD57(-)/CD56(-) large granular lymphocytes with expression of the TCR-V beta 5.1 family. Southern blot analysis revealed a clonal rearrangement of the TCR beta-chain gene. Hematopoietic growth factors, high dose intravenous immunoglobulin and corticosteroids were of limited therapeutic benefit to correct the cytopenias. During the disease course, the patient developed a severe cutaneous leg ulcer and bilateral vascular mammary skin lesions. Treatment with 2-deoxycoformycin resulted in both clinical and hematological complete responses, including the resolution of vascular skin lesions. Combined immuno-staining with relevant T-cell associated and anti-TCR-V beta monoclonal antibodies proved to be a sensitive method to assess the therapeutic effect of 2-deoxycoformicin and to evaluate the residual disease.

Evaluation of reproductive indices in rats (Rattus norvegicus) housed under an intracage ventilation system.

A cabinet with an intracage ventilation system (ICV) was developed, and rats (Rattus norvegicus) were exposed to five air-speed levels (ICV 1, 0.03 to 0.12 m/s; ICV 2, 0.13 to 0.18 m/s; ICV 3, 0.19 to 0.33 m/s; ICV 4, 0.34 to 0.51 m/s, and ICV 5, 0.52 to 0.80 m/s) to evaluate optimal rates for ventilation and to assess whether reproductive performance differed at the various air speeds. Our results showed that rats housed under ICV conditions tolerate a continuous air flow into the cage. This condition did not impair the reproductive performance in any of the groups. In fact, air-speed levels ranging from 0.19 to 0.51 m/s (ICV3 and ICV4 conditions) led to a greater number of and more uniform litters with decreased mortality rates compared with those of the control group.

Are some breast carcinomas polyclonal in origin?

This editorial comments on the important study by Going et al. published in the present issue of the Journal [1]. Using a molecular genetic assay based on the X-chromosome inactivation principle, they found that 4 out of 12 breast carcinomas examined exhibited what the authors call "clonal mosaicism" that is, two or more monoclonal samples were mosaic (polyclonal) in respect of X chromosome inactivation between separate, morphologically homogeneous tumour areas. The authors very carefully discuss potential methodological errors that could have led to this surprising finding, which seems to run counter to the almost unanimously held conviction that carcinomas are monoclonal in origin, but none of these potential errors would explain the results. As often in such situations, the authors prudently state that further studies using independent analytical techniques are necessary to find out whether a significant proportion of mammary carcinomas are indeed polyclonal. However, there already exists a substantial body of evidence from cytogenetic studies of breast cancers indicating that many of them are polyclonal. Although there is still room for interpretation and some doubt remains as to exactly which role should be ascribed to the observed clonal heterogeneity in our models of carcinogenesis, it seems obvious that more attention than before ought to be paid to this now well documented fact.

Aggressive natural-killer cell lymphoma presenting with skin lesions, breast nodule, suprarenal masses and life-threatening pericardial and pleural effusions.

We report the clinical and laboratory findings of a patient with an aggressive Epstein-Barr virus positive CD2+/CD56+ natural killer-cell lymphoma with a high mitotic activity and complex chromosomal abnormalities presenting with life-threatening pericardial and pleural effusions, disseminated skin lesions, breast nodule and large suprarenal masses. The clinical course was characterized by resistance to chemotherapy and relapsing pericardial and pleural effusions with respiratory and haemodynamic failure. Death occurred 4 months after the first manifestations of the disease as a consequence of cardiac tamponade.

Immunophenotypic characterization of normal blood CD56+lo versus CD56+hi NK-cell subsets and its impact on the understanding of their tissue distribution and functional properties.

In the present study we have compared the immunophenotypic characteristics of the CD56+lo and CD56+hi NK-cell subsets in a group of normal healthy adults. Our results show that CD56+hi NK-cells display greater light-scatter properties than CD56+lo NK-cells at the same time they have higher levels of CD25 and CD122 IL-2 chains, together with a higher reactivity for HLA-DR and CD45RO and lower levels of CD45RA, supporting that, as opposed to the majority of the CD56+lo population, CD56+hi NK-cells might correspond to a subset of activated circulating NK-lymphocytes. Higher expression of the CD2 and CD7 costimulatory molecules found for the CD56+hi NK-cells would support their greater ability to respond to various stimuli. In addition, CD56+hi NK-cells expressed higher levels of several adhesion molecules such as CD2, CD11c, CD44, CD56, and CD62L compared to CD56+lo NK-cells, supporting a particular ability of these cells to migrate from blood to tissues and/or a potential advantage to form conjugates with target cells. Interestingly, CD56+lo and CD56+hi NK-cells showed a different pattern of expression of killer receptors that might determine different activation requirements for each of these NK-cell subsets. For instance, absence or low levels of CD16 expression might explain the lower antibody-dependent cytotoxicity activity of CD56+hi NK-cells. On the other hand, the virtual absence of expression of the CD158a and NKB1 immunoglobulin-like and the greater reactivity for the CD94 lectin-like killer receptors on CD56+hi in comparison to CD56+lo NK-cells might determine different MHC-class I specificities for both NK-cell subsets, a possibility that deserves further studies to be confirmed.

Association of CD4+/CD56+/CD57+/CD8+(dim) large granular lymphocytic leukemia, splenic B-cell lymphoma with circulating villous lymphocytes, and idiopathic erythrocytosis.

In this paper we report a rare association of a splenic marginal zone B-cell lymphoma with villous lymphocytes and a T-cell large granular lymphocytic leukemia coexpressing CD4 and CD8 as well as CD56 and CD57 natural killer-associated markers in an asymptomatic patient investigated because of an occasional finding of erythrocytosis and leukocytosis in routine blood analysis. We also discuss the possible reasons for this particular association.

[Women caring for women: a study at the "Viva Maria" shelter, Porto Alegre, Rio Grande do Sul, Brazil]. / Mulheres cuidando de mulheres: um estudo sobre a Casa de Apoio Viva Maria, Porto Alegre, Rio Grande do Sul, Brasil.

This research was conducted in Porto Alegre, Rio Grande do Sul, with a sample of battered women selected from a government shelter called the "Casa Viva Maria". We analyzed data on 110 women staying at the shelter during the previous two years (January 1996-June 1998). The profile of the women was as follows: abused women were young (mean age 29 years), all had low socioeconomic status, 12% were illiterate, 21% were black, 80% reported frequent abuse by their partners, and 18% had returned to violent homes. The researchers visited 34 former lodgers from the shelter and invited them to participate in a series of evaluation workshops. A total of 118 persons, including mothers and children, attended three evaluation meetings. During this process, researchers encouraged participants to express opinions, perceptions, and feelings about their past experience in the shelter and their own concept of violence. Finally, a focal group was organized with the "Viva Maria" staff members. Female workers reported how their job had been helpful for their personal development and had helped change their own lives.