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Introduction: Ireland has the one of the lowest urologist per population ratios in Europe1 Out-patient department (OPD) visits are time consuming, costly and frequently patients cannot be reviewed in the intended timeframe2 With the COVID-19 crisis innovative virtual models of care are essential Methods: Patients for OPD review were assessed by a Consultant in a “virtual” clinic using electronic records (letters, imaging, blood results) and chart review if required Patients were either discharged, discharged for GP testing with specified re-referral criteria, phone/letter follow up by a LUTS clinical nurse specialist, investigated and reviewed by phone/letter, or returned for face-to-face consultation Results: 400 patients were assessed The majority were seen previously by SHO or junior registrar 160 (40%) patients were discharged directly via letter and advice 121 (30%) required further imaging and could be contacted by phone with the results 79 (20%) could be contacted by the LUTS clinical nurse specialist for phone/written review 40 (10%) necessitated face-to-face OPD review for clinical assessment or investigation review In 47 patients there was insufficient information available in the electronic platforms, thus requiring formal chart review Overall, 360 patients could be managed via “virtual” means The potential out-patient cost savings were estimated at €27,000 Conclusion: With this COVID-19 pandemic, innovative models of care are necessitated Introduction of a “virtual” OPD clinic allows reliable review of patients with reduced face-to-face follow-up attendances Further study of staff training and patient satisfaction is required

A decision support system, SBN-Watch, was developed to demonstrate the influence of crop rotation and the choice of sugar beets (Beta vulgaris) varieties on the sugar beet cyst nematode Heterodera schachtii Schmidt (SBN) population and sugar beets yield. The database in SBN-Watch consists of a varietal unit with five sugar beet varieties representing the three categories “Standard,” “Tolerant” and “semi-tolerant.” Data of minimal yield (m), tolerance limit (T), and population dynamic parameters were obtained from published commercial field trials conducted in Sweden and Denmark in 2011. Additionally, a sanitation intercrop unit with different resistant classes of white mustard (Sinapsis arvensis) and oil seed radish (Raphanus sativus) was included. The relationship between initial population (Pi) and sugar yield as well as SBN final population in soil (Pf) was calculated by two Seinhorst equations. Few data inputs are required to be entered by the user in SBN-Watch, mainly the initial population (Pi), expected sugar price and exchange rate of € to SEK. The calculated reproduction factor (Rf) values using SBN-Watch corresponded well with varietal characteristics, where the standard variety Mixer had the highest (Rf) values. The influence of the initial SBN population on the calculated sugar yield (tonnes ha(−1)) was generally small at Pi < 2.

The prognosis of liver cirrhosis depends on the presence of its major complications as well as on other factors such as hypersplenism with thrombocytopenia. Partial splenic embolization is an effective interventional procedure performed in liver cirrhosis complicated with portal hypertension to improve the low platelet count. This technique represents an efficient alternative to splenectomy, which has major drawbacks and is associated with a high morbidity. We report a series of patients with liver cirrhosis and portal hypertension who presented with severe thrombocytopenia and were treated with partial splenic embolization eventually having a favourable outcome.

Four Ag(I), Cd(II) and Cu(II) complexes, [Ag2L2](ClO4)2 (1), [CdL(NO3)2] (2), [Cd2L2Cl4] (3) and [Cu2L2(ClO4)3](ClO4) (4), derived from the new Schiff base ligand (N1E,N2E)-N1,N2-bis(1-(pyrazin-2-yl)ethylidene)ethane-1,2 diamine (L) have been synthesized and crystallographically characterized. The crystal structural features of 1–4 show that 1 is a ligand-supported dinuclear silver complex, 2 is a mononuclear eight-coordinate complex, 3 is a dinuclear hepta coordinate species and 4, interestingly, discloses two distinctly crystallographically independent groups of mononuclear [Cu(ClO4)2L] and a 1D [Cu(ClO4)L](ClO4) unit in one asymmetric group. Furthermore, π⋯π stacking and/or hydrogen bonding interactions seem to be effective in stabilizing these crystal structures. The antioxidant activities of L and complexes 1–4 have also been studied.

Objective:The aim of the study was to assess the particularities and the comorbidities in hypertensive very elderly patients.Design and method:We performed a retrospective study on 119 patients admitted to a Clinical Emergency Hospital between July 2014 and December 2018.Results:Pacients in the stud

Strawberry (Fragaria x ananasa) is grown for its excellent food and nutritional value in many parts of the world. The main objective of this study was to optimize an efficient, reliable and economical protocol for In vitro propagation of strawberry plants. The effect of BAP (6-Benzyl amino purine) alone or combined with (Gibberellic acid, Kinetin, IBA) and the effects of TDZ (Thidiazuron) on shoot proliferation of strawberry (Fragaria x ananasa) has been evaluated. It has been noticed that 2.0 mgl-1 BAP combination with 0.25 mgl-1 IBA able to generate the maximum number of shoots / explants (6.375) with high shoot length ( 0.675 cm) and high leaves number /explants (19.0). On the other hand, presence of 1.5 mgl-1 of TDZ in the nutrient medium increased the shoot number/explants to (7.335) as compared to BAP treatments. The proliferated shoots were subjected to full strength MS media supplemented with 0.75 mgl-1 IAA give the optimal ratio of rooting. Survived rooted plantlets were acclimatized gradually and successfully transferred under greenhouse conditions for hardening.

Normal.dotm 0 0 1 323 1843 OSU Medical Center 15 3 2263 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0pc .45pc 0pc .45pc; mso-para-margin:0pc; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Zinc and copper are beneficial to health, growth and development, and also for the prevention of cardiovascular disease (CVD) with regards to improved dietary habits as a preliminary step in CVD prevention. This study was conducted among 2-18-year old children with high family risk of premature CVD in comparison to controls. Material and Methods: One hundred randomly selected children whose parents had premature myocardial infarction were included in the study. The controls were 100 individuals randomly selected from the case group's neighbors and matched for age, sex and socioeconomic status. A four-day food record questionnaire was used to assess zinc and copper intakes, and their serum levels were determined using Flame-Atomic Absorption Spectrophotometry. The data were analyzed by SPSS/Windows V6 software, using the Student's t and Mantel-Hanzel tests. Significance of differences was considered at P 0.05). Zinc deficiency was more prevalent among the case in boys than their controls (58% vs.18%, P=0.04). This difference was not significant in girls (44% vs. 40%). The daily intake and serum level of copper were not significantly different between the case and control groups. No case of copper deficiency was found. The mean systolic blood pressure was not significantly different between the zinc-deficient and zinc-sufficient subjects. Although the mean diastolic blood pressure of the former was higher than the latter, there was no statistically significant difference. About 23.7% of all studied sample had mild-to-moderate degrees of failure to thrive, with significantly lower daily intake and serum zinc level than other subjects (5.41±1.06 mg, 82.09±12.74 µg/dL vs. 6.89±2.14 mg, 99.25±27.15 µg/dL, respectively, P

In examining the presence of indole-3-acetic acid (IAA) in supernatants of pink-pigmented facultativemethylotrophic (PPFMs) bacterial cultures, three out of the 16 isolates tested showed a positive reaction ina colorimetric assay. The presence was further unambiguously con?rmed by high-performance liquidchromatography in combination with NMR. The IAA production was signi?cantly stimulated byL-tryptophan. These results prove that PPFM bacteria are able to produce the plant hormone IAA.

The upper digestive hemorrhage is one of the main causes of mortality from liver cirrhosis (CH). The measurement of the hepatic venous pressure gradient (HVPG) by angiographic way can be used for the determination of the risk of hemorrhage. The aim of this study is to verify the influence of the HVPG measurement upon the survival in patients with CH and upper digestive hemorrhage. A retrospective pilot study on 33 patients with upper digestive hemorrhage divided into two groups according to the therapeutic attitude followed, was carried out. One group was classically treated, with variceal band ligation, non-elective beta-blockers and in emergency Octreotide. The other group was treated depending on the value of HVPG. From the moment of the first episode of digestive hemorrhage, the survival period was in average of 8.1 months for the patients with viral etiology and for those with alcoholic etiology it was of 19.7 months. In patients treated after HVPG measurement, the average survival period was of 34.2 months and in patients “classically” treated, the average survival period was of 15.5 months (significant difference). In conclusion, the measurement of HVPG allowed the selection of a high-risk group of patients. This permitted the making of a therapeutical decision with a significant prolongation of life in these patients.

Two new species of Heliotropium L. (Boraginaceae, subfam. Heliotropioideae), growing in sandy loam soils in Jizan, south-west Saudi Arabia, Heliotropium chaudharyanum Al-Turki, Omer & A. Ghafoor andHeliotropium jizanense Al-Turki, Omer & A. Ghafoor, are described and illustrated. The relationships of the new species within the small-flowered Heliotropium europaeum L. species group are discussed. Notes on distribution and habitat are provided, together with a map.

The genus Atriplex L. is revised from Saudi Arabia. In all 10 species are reported, out of which seven are native (Atriplex coriacea, A. dimorphostegia, A. farinosa, A glauca, A. halimus, A. leucoclada and A. tatarica), and three are introduced and cultivated/naturalised (A. canescens, A. semibaccata and A. suberecta). The study has introduced the presences of following new taxa: Atriplex dimorphostegia f. collenettea Al-Turki, Omer & A. Ghafoor f. nova, and Atriplex leucoclada var. mandavillea Al-Turki, Omer & A.Ghafoor var. nova. Status and history of genera segregated from Atriplex has been discussed. A key for identification of taxa recognized and their descriptions are given; notes on nomenclature, variation pattern, ecology, distribution maps, local names and uses are provided. A list of introduced and cultivated species is appended. Eine Synopsis der Gattung Atriplex L. in Saudi Arabien Die Gattung Atriplex L. wird fur Saudi Arabien einer Revision unterzogen. Von den insgesamt zehn untersuchten Arten sind sieben einheimisch (Atriplex coriacea, A. dimorphostegia, A. farinosa, A. glauca, A. halimus, A. leucocladia und A. tatarica) und drei Arten sind eingeschleppte und kultivierte/eingeburgerte (A. canescen, A. semibaccata und A. suberecta). Die Studie listet als neue Taxa auf: Atriplex dimorphostegia f. collenettea Al-Turki, Omer & A.Ghafoor f. nova und Atriplex leucoclada var. mandavillea Al-Turki, Omer & A.Ghafoor var. nova. Status und Geschichte der von Atriplex abgetrennten Gattungen werden diskutiert. Bestimmungsschlussel der erfassten Taxa und ihre Beschreibungen sind beigefugt; Anmerkungen zu Nomenklatur, Variationsbreite, Okologie, Verbreitungskarten, Lokalnamen und Verwendungszweck erganzen die Beschreibungen. Abschliesend folgt eine Liste der eingeschleppten und kultivierten Arten.

We tested the hypothesis that pregnancy might increase diabetes-associated nitric oxide (NO) production and renal hyperfiltration. Two weeks following i.v. streptozotocin (40 mg/kg), mean arterial pressure (MAP) was not modified by diabetes; glomerular filtration rate (GFR), renal plasma flow (RPF) and filtration fraction (FF) were higher in pregnant than in virgin controls and increased by diabetes to a greater extent in pregnant than in virgin rats. Urinary volume (UV), creatinine, albumin and sodium (UNaV) were significantly increased by diabetes. Diabetes led to an increase in renal, cardiac, aortic and uterine but not in placental NO synthase activities. Infusion of NG-nitro-l-arginine (l-NA) caused a dose-dependent reduction in GFR, RPF, plasma NO2-/NO3-, UV and UNaV; in general, diabetes increased these effects to a greater extent in pregnant than in virgin rats. l-NA increased MAP in all groups of rats but did not alter FF. Diabetes did not alter responses of thoracic aorta rings to vasoconstrictor effects of phenylephrine and the vasorelaxant effects of sodium nitroprusside but increased endothelium-dependent relaxant effects of acetylcholine. In general the effects of diabetes of 7 days duration were similar to those described above for diabetes of 14 days duration. These data suggest that diabetes-associated renal hyperfiltration and NO production are augmented by pregnancy.

Using renal glomeruli and papillae from virgin, pregnant (15- to 17-day), and postpartum (day 2) rats, we investigated whether the decrease in the renal effects of atrial natriuretic factor (ANF) during pregnancy is caused by a downregulation of ANF receptors. Pregnancy decreased the maximal binding of 125I-labeled ANF to guanylyl cyclase (GC)-linked ANF-GC receptors in glomeruli and papillae and increased the binding to clearance receptors (ANF-C) in glomeruli; ANF-C receptors were not detected in the papillae Ribonuclease protection assay detected mRNAs for all the three receptors in the papillae; pregnancy decreased GC-A and ANF-C but not GC-B-receptor mRNAs. Western blots revealed a decrease in GC-A receptors in the papillae of pregnant rats; GC-B-receptor protein was barely detectable. Effects of ANF on guanosine 3', 5'-cyclic monophosphate (cGMP) production by the glomeruli and papillae were decreased during pregnancy and returned to virgin levels during postpartum. It is concluded that a decrease in the renal effects of ANF during pregnancy is caused by a downregulation of renal ANF GC-A receptors and receptor-coupled cGMP production.

The influence of pregnancy on renal responses to atrial natriuretic factor (ANF) was determined in urethane-anesthetized Sprague-Dawley rats. Infusions of ANF caused a significantly greater increase in urinary excretion of fluid, sodium, and potassium in virgin than in pregnant (13-15 days and 21 days) rats. Guanosine 3',5'-cyclic monophosphate (cGMP) excretion, mean arterial pressure, plasma immunoreactive ANF, and glomerular filtration rate (GFR) following ANF infusions were not different in virgin and gravid rats, although increments in GFR over basal were greater in virgin than in gravid animals. Renal responses to ANF normalized during postpartum and were attenuated by progesterone treatment of virgin rats. Natriuretic effects of infusions of ANF plus ANF-(4-23) (a ligand for clearance receptors) or of ANF plus thiorphan (an endopeptidase inhibitor) in virgin and pregnant rats did not differ; ANF-(4--23) and thiorphan alone caused greater natriuresis in pregnant than in virgin rats. Effects of ANF on cGMP production by collecting duct cells isolated from virgin and pregnant rats did not differ. We concluded that the attenuation in the renal effects of ANF during pregnancy might be mediated by progesterone by an increase in the intrarenal metabolism of ANF and might reflect physiological adjustment to facilitate fluid/electrolyte expansion.

This study was done to determine if a decrease in the aldosterone-suppressant effect of atrial natriuretic factor (ANF) by progesterone and an increase by estrogen was caused by modulation of adrenal zona glomerulosa ANF receptors. Freshly dispersed glomerulosa cells from virgin, 13-15 day pregnant, ovariectomized (OVX) estradiol-17 beta-treated and OVX progesterone-treated rats were used. Competitive displacement of specifically bound [125I]ANF1-28 with unlabelled ANF1-28 yielded concentrations of guanylate cyclase-linked ANF-R1 plus ANF-R2 (clearance) receptors and the displacement with unlabelled ANF4-23 yielded ANF-R2 receptors; the difference between the two was treated as the concentration of ANF-R1 receptors. Pregnancy and progesterone decreased and estrogen increased the number of glomerulosa ANF-R1 receptors. ANF produced a significantly greater suppression of potassium-induced aldosterone secretion in cells from OVX estradiol-treated rats than in cells from OVX progesterone-treated animals. These data suggest that the inhibition of the aldosterone-suppressant activity of ANF by progesterone is the result of a downregulation of ANF-R1 receptors.

Assisted reproductive technology has helped many childless couples. It has also raised questions about how appropriate the technology might be in different situations. How we understand parenthood is crucial in taking a stand on such scientific intervention. It is suggested that physicians should decide on offering artificial insemination, surrogacy and in-vitro fertilisation only after considering if the child will have good parents and if there will be legal complications from the use of the technology.

In the title complex, [Ni(NO3)2(C14H16N6O2)]·H2O, the Ni(II) atom, lying on a twofold rotation axis, is coordinated by a tetra-dentate 3,3'-{(1E,1'E)-1,1'-[ethane-1,2-diylbis(azan-1-yl-1-yl-idene)]bis-(ethan-1-yl-1-yl-idene)}di-pyrazine 1-oxide ligand and two mutually trans monodentate nitrate anions in a distorted o-cta-hedral geometry. The lattice water mol-ecule is located on a twofold rotation axis. The complex mol-ecules are linked by the water mol-ecules through O-H⋯O hydrogen bonds into a chain along [001]. Further C-H⋯O hydrogen bonds lead to the formation of a three-dimensional network.

We describe a patient with a stroke in the territory of the right middle cerebral artery in whom the initial manifestation was unilateral pulsatile headache and positive visual symptoms. Doppler echography and cerebral angiography demonstrated dissection of the cervical internal carotid artery. Extracranial internal carotid artery dissection may present in a similar way to the migraine-stroke syndrome. Appropriate imaging investigations are essential in order not to overlook the diagnosis.

We explored the effects on health of both household asset inequality and political armed conflict in Sudan. Using the 2010 Sudan household survey, we evaluated the role of both household asset distribution (measured by the Gini coefficient) and armed conflict status at the state level. We measured associations with six health-related outcomes: life expectancy, infant mortality, height-for-age (stunting), adequacy of food consumption, teenage birth rates and vaccination coverage for young children. For each of six measures of health in Sudan, outcomes were significantly worse in the states with more unequal asset distribution, with correlation coefficients ranging between -0.56 (stunting) and -0.80 (life expectancy). Conflict status predicted worse outcomes. Wealth redistribution in the more unequal states, as well as a political resolution of conflict, may improve population health.

This work was designed with the purpose of determining whether the presence of allelic imbalances (AI) such as microsatellite instability (MSI) and loss of heterozygosity (LOH) in chromosomes 2, 11, 13, and 17 in primary breast cancer could be used as prognostic indicators of patient survival. The DNA from breast cancers removed from 29 patients who were followed-up for up to five years was analyzed for MSI and LOH using a panel of 24 markers located at chromosome 2 (TPO, D2S131, D2S144, D2S171, D2S177, D2S119, D2S123, D2S147 and D2S136), chromosome 11 (C-RAS, Int-2, D11S940, D11S912), chromosome 13 (D13S289, D13S260, D13S267, D13S218, D13S263, D13S155, and D13S162), and chromosome 17 (D17S513, TP53, D17S855, and D17S785). The frequency of AI in the markers studied ranged from 30-55%, being highest for D11S912, D2S171, TP53 and D17S855. Univariate analysis showed association between overall survival rate and AI in 9 out of the 24 markers tested. Five of them were located at the area of the mismatch repair gene (MMR)-2 gene, two at 11p, one at 13q and one at 17p. Using multivariate analysis, it was observed that only pathological and clinical stage (defined as stage II or not) and AI at D2S171, D11S912, or D17STP53 generated significant predictive models for survival.

The main objective of this study was to find out if the reported changes in the aldosterone-suppressant activity of atrial natriuretic peptide (ANP) during different hormonal states in rats are due to a modulation of ANP receptors. In zona glomerulosa cells, ribonuclease protection assay detected mRNAs for guanylate cyclase (GC)-coupled ANP GC-A and GC-B receptors, and for ANP C receptors, which are not coupled to GC. Western analysis using polyclonal anti-GC-A and anti-GC-B receptor antibodies revealed the presence of GC-A but not GC-B receptor proteins in zona glomerulosa cells. Pregnancy (days 7, 16 and 21), oestradiol-17 beta and progesterone decreased mRNAs for all the three ANP receptors in zona glomerulosa cells. Pregnancy decreased GC-A receptor proteins in zona glomerulosa cells, but these recovered to virgin values on day 2 postpartum. ANP receptor mRNAs in zona glomerulosa cells increased by postpartum day 2, but did not reach the values found in virgin rats. Zona fasciculata mainly contained GC-A receptor mRNA. It is concluded that ANP receptors in rat adrenal zona glomerulosa are modulated by pregnancy, oestrogen and progesterone; a decrease in ANP GC-A receptors during pregnancy might explain the accompanying decrease in the aldosterone-suppressant effects of ANP.

We investigated if the refractoriness to the tocolytic effects of atrial natriuretic factor (ANF) during rat pregnancy is due to a downregulation of one or both guanylyl cyclase (GC)-coupled GC-A and GC-B ANF receptors; lungs were used as controls. Uteri and lungs of virgin, pregnant ( days 7, 16, and 21), and day 2postpartum rats expressed mRNAs for GC-A and GC-B as well as GC-uncoupled ANF-C receptors. GC-B receptor protein was more abundant than GC-A in uteri; the reverse was the case in lungs. Pregnancy decreased uterine mRNAs and proteins for GC-A and GC-B receptors as well as the effects of ANF and C-type natriuretic peptide (CNP) on uterine GC activity; lung ANF receptors and effects of ANF and CNP on lung GC activity were not modulated by pregnancy. It is concluded that pregnancy induces organ-specific modulation of ANF receptors and a downregulation of ANF-GC receptors would minimize interference with uterine motility during pregnancy.

In the title compound, C19H15N3O, the benzimidazole ring system makes dihedral angles of 44.36 (7) and 75.67 (7)° with the pyridine and benzene rings, respectively. In the crystal, phenolic O-H⋯N hydrogen bonds to benzimidazole N-atom acceptors give rise to a chain extending along [011].

The present studies were done to determine if the attenuation of the natriuretic and diuretic effects of atrial natriuretic factor (ANF) during rat pregnancy was caused by an increase in its metabolism. It was found that the plasma half-life (min), plasma clearance (ml.kg-1.min-1), and volume of distribution (ml/kg) of ANF were, respectively, 2.5 +/- 4, 115 +/- 19, and 371 +/- 44 in pentobarbital-anesthetized virgin rats (n = 6) and not different from the corresponding values of 3.1 +/- 0.5, 124 +/- 26, and 526 +/- 120 in 20-day gravid animals (n = 6). Rates of metabolism of ANF (pmol.min-1.microgram protein-1) by renal cortical membranes from virgin (n = 5) and gravid (n = 5) rats were, respectively, 45 +/- 0.6 and 45 +/- 0.5; likewise, cortical membrane neutral endopeptidase activities in virgin and 20-day gravid rats (n = 7) did not differ. It is concluded that the attenuation of the renal effects of ANF during pregnancy is not caused by changes in its systemic or renal metabolism but might be due to a decrease in guanylate cyclase-linked renal ANF receptors and/or receptor-mediated effects.

We recently reported that the hormonal status of female rats modified atrial natriuretic factor (ANF) receptors and the aldosterone-suppressant activity of ANF in adrenal glomerulosa cells; here we investigated if this was also true for adrenal fasciculata cells. Adrenal fasciculata cells from animals in different hormonal states contained guanylate cyclase linked ANF-R1 receptors but not ANF-R2 (clearance) receptors. The concentration of ANF-R1 receptors in cells from intact virgin rats was insignificantly higher than in cells from 13- to 15-day pregnant rats and significantly higher than in cells from ovariectomized (OVX), OVX β-estradiol-treated, and OVX progesterone-treated rats. Under none of the hormonal states did ANF suppress adrenocorticotropic hormone (ACTH) stimulated corticosterone secretion. Data suggest that the interactions between ANF and ACTH on mineralocorticoid and glucocorticoid synthesis markedly differ.Key words: atrial natriuretic factor receptors, corticosterone, estrogen, progesterone, pregnancy.

Paraplegia caused by intrathecal chemotherapy has no known pathognomonic features and is a diagnosis of exclusion.The authors reported the clinical and neuroimaging findings in one patient with this syndrome.The patient had severe paraplegia with urinary retention and impaired pain and touch sensation below T-10 with sparing of proprioception and vibration sense. Magnetic resonance imaging (MRI) scan showed diminished intensity throughout the central cervical spinal cord. Post-gadopentetate dimeglumine enhancement was scattered throughout the cervical spinal cord and in two areas of the dorsal spinal cord. Axial views of the cervical spinal cord showed that this enhancement was limited to the lateral columns.The MRI in myelopathy due to intrathecal chemotherapy may show a unique pattern of postgadopentetate dimeglumine enhancement limited to the lateral columns of the spinal cord. However, two recently encountered patients with the same syndrome did not show similar changes.