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INTRODUCTION: Patients with paroxysmal atrial fibrillation experience low health-related quality of life which can be improved by performing yoga. The aim of this study was to evaluate gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga. METHODS: This is a secondary analysis of subgroups, investigating the yoga groups, from two randomized controlled trials (RCT 1: yoga group versus control group, RCT 2: a three-armed randomized study with yoga, control and relaxation groups). The yoga groups performed MediYoga for one hour/week over a 12-week period in both studies. Quality of life (SF-36), blood pressure and heart rate were collected at baseline and end of study. RESULTS: No differences were found between the women and men. Within the women's group, there were improvements in vitality (p = 0.011), social function (p = 0.022), mental health (p = 0.007) and Mental Components Summary (p = 0.022). There were differences within the men's group in bodily pain (p = 0.005), general health (p = 0.003), vitality (p = 0.026), social function (p = 0.005), role-emotion (p = 0.011) and Mental Components Summary (p = 0.018). Within the women's group, differences were observed in systolic blood pressure (p = 0.010) and diastolic blood pressure (p = <0.001). The men's group also showed improvement in diastolic blood pressure (p = 0.021). CONCLUSION: MediYoga improved mental health as well as diastolic blood pressure in both men and women with PAF. This study suggests that both men and women, with PAF, may benefit from complementary treatment such as yoga.Clinical Trial Gov Id: NCT01789372.

AIMS: To describe the perceptions of delay in medical care-seeking, when afflicted by an acute myocardial infarction (AMI) during the first wave of the pandemic. METHODS AND RESULTS: A qualitative descriptive study with an inductive approach. Fourteen semi-structured interviews were conducted, analysed by qualitative content analysis with a manifest approach. One category and six sub-categories emerged. The decision was reached when the health threat was perceived as critical, which made the earlier thoughts of the pandemic fade away. The risk of infection during medical visits caused fear of contracting the disease. This resulted in hesitation, neglect of symptoms, and avoidance of healthcare visits. Following recommendations from authorities and media about personal responsibility was motivated by fear, affecting the care-seeking. CONCLUSION: It appears that the COVID-19 pandemic raised the threshold for deciding to seek medical care when presenting with an AMI. The pandemic led to increased patient delay due to several reasons among which fear of contracting the disease was prominent. The emotion of fear was related to the external threat to one's own health, due to COVID-19, and not fear of symptoms related to an AMI. The media reporting the healthcare system as overloaded increased insecurity and may have had an influence on delay.

Läsåret 2019/2020 ställde svenska gymnasieskolor om till distansundervisning under perioden 18 mars-15 juni. Syftet med denna studie var att belysa hur lärarna uppfattade sin undervisning när undervisningen förändrades från klassrumsundervisning till distansundervisning. Lärarnas uppfattning av sin undervisning undersöktes kvalitativt med utgångspunkt i ett sociokulturellt perspektiv och med analysverktyget Paradigm grid for online learning. Intervjuer med fyra matematiklärare som vid studiens genomförande arbetade på gymnasieskolor i Mellansverige har redovisats. Intervjuresultaten visade att och hur lärarna upplevde att undervisningen hade påverkats. Aktivitet och samspel mellan lärare och elev samt elever emellan hade minskat under perioden för distansundervisning. Vidare framgick i ett paradigm gridperspektiv att lärarens undervisning förändrades vid övergången till distansundervisning. Undersökningen visade att undervisning och lärande blev mer lärarstyrt, exempelvis genom det sätt som uppgifter utformades och hanterades, vilket i en avslutande diskussion har problematiserats., During the school year 2019/2020, Swedish upper secondary schools switched to distance education from 18 March-15 June. The purpose of this study was to shed light on how teachers perceived their teaching when the teaching changed from classroom instruction to distance education. The teachers' perception of their teaching was examined qualitatively based on a socio-cultural perspective and with the analysis tool Paradigm grid for online learning. Interviews with four mathematics teachers who at the time of the study worked at upper secondary schools in central Sweden have been presented. The interview results demonstrated that the teachers experienced that the teaching had been affected and how it had been affected. Activity and interaction between teachers and students, as well as between students, have decreased during the period for distance education. Moreover, the paradigm grid perspective illustrated that the role of the teacher changed during the period of distance education. The study showed that teaching and learning became more teacher-controlled, such as how tasks were designed and handled, which has been problematized in the concluding discussion.

Bakgrund: Ofrivillig barnlöshet är en funktionsnedsättning och ett globalt problem som drabbar 10–15 procent av befolkningen. Kvinnors sexuella och reproduktiva hälsa ser olika ut i världen och påverkas av diskriminering och ojämställdhet. Ofrivillig barnlöshet ses i delar av världen som ett tillstånd med medicinsk orsak och i andra delar som ett stigma och får en betydelsefull roll i livet för kvinnor som är ofrivilligt barnlösa. Syfte: Syftet med denna studie var att beskriva kvinnors upplevelser av ofrivillig barnlöshet ur ett globalt perspektiv. Metod: Metoden för denna studie var en kvalitativ metasyntes med metaetnografisk analysmetod. I resultatet användes 17 artiklar som kvalitetsgranskandes. Resultat: Fem huvudkategorier med flera underkategorier identifierades. Kategorierna som skapades var Psykiska påverkan, Förändring av relationer, Stöd och sjukvårdens betydelse, Att hantera den nya livssituationen och Tankar om framtiden. Slutsats: Ofrivillig barnlöshet påverkade kvinnorna psykiskt genom sorg, skuld, ångest och upplevelse av förlorad identitet som kvinna. Ofrivillig barnlöshet påverkade kvinnors relationer och kunde leda till isolering, utanförskap och kränkningar. Kvinnor upplevde stöd från partnern viktigt, fann stöttning hos andra infertila kvinnor och saknade ett stöd från sjukvården. Livssituationen hanterades genom en religiös tro eller känslomässig hantering. Klinisk tillämpbarhet: Studien skulle kunna ge en ökad förståelse för ofrivillig barnlöshet och vara ett stöd för barnmorskan, som arbetar globalt med kvinnor och familjeplanering. Barnmorskans arbete globalt handlar även om stärka kvinnors rättigheter. En förståelse för kvinnors upplevelser av ofrivillig barnlöshet ger barnmorskan ett redskap i att stödja kvinnor i deras sexuella och reproduktiva hälsa, Background: Involuntary childlessness is a disability and a global problem affecting 10–15 percent of the population. Women's sexual and reproductive health looks different in the world and is affected by discrimination and gender inequality. Involuntary childlessness is seen in some parts of the world as a condition with medical cause and in other parts as a stigma and plays a significant role for women who are involuntarily childless. Purpose: The aim of this essay was to describe women´s experiences of involuntary childlessness from a global perspective. Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. A total of 17 articles were quality checked and used in the result. Results: Five main categories with several subcategories were identified. The categories that were created were Psychological impact, Changing relationships, Support and the importance of health care services, Managing the new life situation and Thoughts about the future. Conclusion: Involuntary childlessness affected women emotionally through grief, guilt, anxiety and lost identity. Childlessness affects women's relationships and could lead to isolation, exclusion and violations. Women perceived support from the partner important, found support from other infertile women and lacked support from the healthcare system. The life situation was handled through a religious belief or emotional handling. Clinical applicability: The study could show an increased understanding of involuntary childlessness and sustained support for the midwife, who work globally with women and family planning. The work of midwives globally is also about strengthening women's rights. An understanding of women's experiences of involuntary infertility gives the midwife a tool to support women in their sexual and reproductive health.

Bakgrund: Finansiellt beslutsfattande är en central del i den finansiella rådgivningen gentemot privatpersoner och det gemensamma branschorganet SwedSec har uppmärksammat psykologiska fallgropars roll i den finansiella rådgivningen. Den finansiella rådgivarens roll är att, bland annat, hjälpa sina kunder hantera de psykologiska fallgropar de kan råka ut för vid investeringar. Därför finns incitament att undersöka hur rådgivare i rådgivningsprocessen hanterar den eventuella förekomsten av anchoring och framing, samt hur väl de känner till dem. Syfte: Syftet med denna studie är att undersöka finansiella rådgivares kännedom kring anchoring och framing, samt hur de upplever och hanterar fenomenen som en del av rådgivningsprocessen gentemot privatpersoner med ett placerbart kapital under 2 miljoner kronor. Vidare syftar studien till att analysera hur dessa psykologiska fallgropar kan tydas i den finansiella rådgivningsprocessen. Metod: Studien har genomförts med en kvalitativ metod för att uppfylla studiens syfte. Datainsamlingen har bestått av nio semi-strukturerade djupintervjuer med SwedSeclicensierade finansiella rådgivare. Vidare har en abduktiv ansats antagits, för att kunna bidra med en intressant analys kring det studerade ämnet samt nå en slutsats. Slutsats: Studien finner att rådgivarnas kännedom är låg kring behavioral finance i allmänhet och anchoring och framing i synnerhet, även om förekomsten av de psykologiska fallgroparna uppmärksammats i studien. Trots låg kännedom har ungefär hälften av respondenterna utvecklat medvetna strategier för att hantera anchoring och framing. Hos de rådgivare som inte utvecklat medvetna strategier finner studien stöd för en omedveten hantering. Vidare kan studien inte ge stöd för att anchoring och framing utgör ett problem i rådgivningsprocessen gentemot privatpersoner med ett placerbart kapital under 2 miljoner kronor., Background: Financial decision making is a central part of the financial advisory process for individuals, and the organization SwedSec has acknowledged the role of biases in the advisory process. The role of the financial advisor is, amongst other things, to protect their customers from biases in investments. Therefore, it is of interest to examine how well the advisors manage any presence of anchoring and framing, and the advisor's knowledge of them. Aim: The purpose of this thesis is to examine the financial advisor's knowledge regarding anchoring as well as framing, and how they handle these factors as part of the advisory process towards clients with funds of no more than 2 million SEK. Furthermore, the thesis aims to analyze how these biases can take shape in the advisory process. Method: The thesis has, to fulfill its purpose, used a qualitative method. Empirical data has been gathered through nine semi-structured interviews with SwedSec-licensed financial advisors. Furthermore, the thesis has taken on an abductive approach, to contribute with an interesting analysis of the subject and to reach a conclusion. Conclusion: The thesis finds that the financial advisor's knowledge about behavioral finance in general, along with anchoring and framing in particular, is low. The thesis, however, supports these biases existence in the advisory process. Regardless of the lack of knowledge, about half of the respondents have developed aware methods to handle the biases. The thesis shows that the advisors without aware methods handle the biases unconsciously. Furthermore, the thesis cannot support that anchoring and framing constitutes a problem in the advisory process towards clients with funds under 2 million SEK.

BACKGROUND: Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension. AIM: The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation. METHODS: Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed. RESULTS: After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group (p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks. CONCLUSIONS: MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients wit

Background Some of the hantavirus species in Euro-Asia cause haemorrhagic fever with renal syndrome (HFRS) in humans. The first documented human hantavirus infection in Turkey was diagnosed in 2009. This report describes the dynamics of the first hantavirus outbreak that emerged in humans in the Western Black Sea Region of Turkey. Methods All the suspected cases of hantavirus infection were admitted to the Infectious Diseases and Clinical Microbiology Department at the Zonguldak Bulent Ecevit University Hospital in Zonguldak, Turkey. The patients were carefully interviewed, examined and evaluated using routine laboratory tests and hantavirus diagnostic tools. Hantavirus-reactive antibodies (IgM and IgG) in serum samples were detected via enzyme immune assay (EIA) and immunofluorescence assay (IFA) in the acute and convalescence stages of the disease. The presence of hantavirus ribonucleic acid (RNA) was analysed via reverse transcription polymerase chain reaction (RT-PCR) in serum and urine samples. A focus reduction neutralization test (FRNT) was performed to confirm specific hantavirus serotypes. In addition, a case-control study was conducted to identify possible risk factors for hantavirus transmission in the outbreak area. A control group was composed of asymptomatic individuals who were seronegative for hantavirus IgM and IgG and living in the outbreak area. Results A total of 55 suspected cases of hantavirus infection were admitted to the inpatient clinic between February and June of 2009. Twenty-four patients were diagnosed with acute HFRS via EIA or IFA. In 22 of the 24 infected patients, Puumala virus (PUUV) was identified as the causative hantavirus type by detecting IgM in the acute stage and an increase in the IgG level in follow-up serum samples. PUUV was also verified as the infecting agent by FRNT in two of the 24 cases. Among the 24 laboratory-confirmed HFRS cases, 21 (87.5%) were males and 3 (12.5%) were females, and the mean age was 45.92 years (s

Introduction Patients with paroxysmal atrial fibrillation often experience impaired health-related quality of life. Standard treatment is not always sufficient and changes in life-style habits are suggested as a complement. Also, studies have suggested differences in gender where women have extended side effects of rhythm medications, more symptoms and estimate lower health-related quality of life than men. Yoga has been shown to increase health-related quality of life and decrease blood pressure, heart rate and cardiac biomarkers. The overall aim of this thesis was to study the effects of MediYoga among patients with paroxysmal atrial fibrillation. In addition, to evaluate perceptions and experiences of MediYoga as well as gender differences. Methods and results Paper I: This is a randomized, controlled pilot study in which 80 patients were randomized to MediYoga, n=40, or a control group, n=40 at an University Hospital, in Stockholm, Sweden. The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, EQ-5D Visual Analogue Scale), blood pressure and heart rate were collected at baseline and at the end of study. The results showed an improvement of health-related quality of life in the yoga group. Blood pressure and heart rate also decreased in the yoga group. Paper II: In this prospective randomized study at an University Hospital, Stockholm, Sweden, with stratification in gender, 132 patients, with symptomatic PAF, were randomized to yoga (n=44), relaxation (n=44) and a control group (n=44). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, ASTA), blood pressure, heart rate as well as NT-proBNP were collected at baseline and at the end of the study. The results showed no differences in the ASTA and SF-36 between the groups. However, improvements were seen

Introduction: Patients with paroxysmal atrial fibrillation often experience impaired health-related quality of life. Standard treatment is not always sufficient and changes in life-style habits are suggested as a complement. Also, studies have suggested differences in gender where women have extended side effects of rhythm medications, more symptoms and estimate lower health-related quality of life than men. Yoga has been shown to increase health-related quality of life and decrease blood pressure, heart rate and cardiac biomarkers. The overall aim of this thesis was to study the effects of MediYoga among patients with paroxysmal atrial fibrillation. In addition, to evaluate perceptions and experiences of MediYoga as well as gender differences. Methods and results: Paper I. This is a randomized, controlled pilot study in which 80 patients were randomized to MediYoga, n=40, or a control group, n=40 at an University Hospital, in Stockholm, Sweden. The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, EQ-5D Visual Analogue Scale), blood pressure and heart rate were collected at baseline and at the end of study. The results showed an improvement of health-related quality of life in the yoga group. Blood pressure and heart rate also decreased in the yoga group. Paper II. In this prospective randomized study at an University Hospital, Stockholm, Sweden, with stratification in gender, 132 patients, with symptomatic PAF, were randomized to yoga (n=44), relaxation (n=44) and a control group (n=44). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, ASTA), blood pressure, heart rate as well as NT-proBNP were collected at baseline and at the end of the study. The results showed no differences in the ASTA and SF-36 between the groups. However, improvements were see

OBJECTIVES: We investigated the perceptions and experiences of a therapeutic yoga form, MediYoga, which is evolved from Kundaliniyoga among patients with symptomatic paroxysmal atrial fibrillation (PAF). DESIGN AND SETTING: an inductive exploratory design was chosen with individual semi-structured interviews. The study was conducted with 12 participants (7 men and 5 women, average age 63.5) at a university hospital, Sweden. Informed consent was obtained from all participants. The data were analyzed using a qualitative content analysis with an inductive method and a manifest approach. RESULTS: Three categories were found in the analysis. In the category "A time for a sense of existence and presence", the patients described an increased thoughtfulness and experiences of gaining access to an inner self. The category "A way of gaining well-being and increased consciousness" describes patients` feelings of relaxation and feeling of comfort, with components of mental and physical well-being. Furthermore, "Access to a tool to gain willpower and relieve symptoms" describes the perceptions from patients to obtained access to a tool for handling the emotions, such as fear and anxiety, as well as symptoms that they could struggling with between, and during, their episodes of atrial fibrillation. No adverse events were reported by the yoga group, during the study. CONCLUSIONS: Patients with PAF described MediYoga as an accessible tool to manage emotions and symptoms related to episodes of AF. MediYoga may also assist in enhancing body awareness, whereby physical, mental and spiritual components are integrated. MediYoga may strengthen self-management among patients with PAF.

BACKGROUND: Patients with atrial fibrillation often have an impaired quality of life (QoL). Practising yoga may decrease stress and have positive effects on mental and physical health. The aim of this study was to investigate whether yoga can improve QoL and decrease blood pressure and heart rate in patients with paroxysmal atrial fibrillation (PAF). METHODS: In this pilot study, 80 patients diagnosed with PAF were randomized to standard treatment (control group, n=40) or standard treatment in combination with yoga (yoga group, n=40) during a 12-week period. QoL, blood pressure and heart rate were evaluated at baseline and at the end of the study (12 (+2) weeks). EuroQoL-5D (EQ-5D) Visual Analogue Scale (VAS) and the two dimensions in Short-Form Health Survey (SF-36) were used to evaluate QoL. RESULTS: At baseline there was a significant difference in QoL between the groups in EQ-5D VAS- scale (p=0.02) and SF-36 mental health score (p<0.001) in which the control group had higher scores. At the end of the study, the yoga group averaged higher SF-36 mental health scores. There was a significant difference between the two groups (p=0.016), but no differences in EQ-5D VAS- scale and physiological health score was seen between the two groups. At the end of the study, the yoga group had significantly lower heart rate (p=0.024) and systolic (p=0.033) and diastolic blood pressure (p<0.001) compared to the control group. CONCLUSIONS: Yoga with light movements and deep breathing may lead to improved QoL, lower blood pressure and lower heart rate in patients with PAF compared to a control group. Yoga could be a complementary treatment method to standard therapy.

The knowledge of viral shedding patterns and viraemia in the reservoir host species is a key factorin assessing the human risk of zoonotic viruses. The shedding of hantaviruses (familyBunyaviridae) by their host rodents has widely been studied experimentally, but rarely in naturalsettings. Here we present the dynamics of Puumala hantavirus (PUUV) shedding and viraemia innaturally infected wild bank voles (Myodes glareolus). In a monthly capture–mark–recapturestudy, we analysed 18 bank voles for the presence and relative quantity of PUUV RNA in theexcreta and blood from 2 months before up to 8 months after seroconversion. The proportion ofanimals shedding PUUV RNA in saliva, urine and faeces peaked during the first month afterseroconversion, but continued throughout the study period with only a slight decline. The quantityof shed PUUV in reverse transcription quantitative PCR (RT-qPCR) positive excreta was constantover time. In blood, PUUV RNA was present for up to 7 months but both the probability of viraemiaand the virus load declined with time. Our findings contradict the current view of a decline in virusshedding after the acute phase and a short viraemic period in hantavirus infection – anassumption widely adopted in current epidemiological models. We suggest the life-long sheddingas a means of hantaviruses to survive over host population bottlenecks, and to disperse infragmented habitats where local host and/or virus populations face temporary extinctions. Ourresults indicate that the kinetics of pathogens in wild hosts may differ considerably from thoseobserved in laboratory settings.

The aim of this thesis is to examine and describe the Swedish diary novel. The examination and description is based on an inventory of diary fiction written and published in Swedish between 1825 and 2010. The novels are discussed from a narratological point-of-view in the first part of the thesis. The second part is a close reading of three novels, Fredrika Bremer’s A Diary (1843), Hjalmar Söderberg’s Doctor Glas (1905), and Eyvind Johnson’s Dreams of roses and fire (1949), written in their entirety or partly in diary form. They all thematizes the mirror effect typical of self-writing. The diary novel is discussed as a mimetic genre, that is, a type of novel that formally as well as thematically imitates a non-fiction genre. The implied model is, of course, the authentic diary, although the early epistolary novel had an important influence as well. The effect of using a well-established literary form is its ability to raise certain expectations on behalf of the reader. The basic forms of authentic diary-keeping are all associated with truthfulness, and consequently the diary form is above all connected to an allegedly truthful and honest account of reality. Diary fiction is thematically necessarily associated with the written self, and the fictive diarist is scrutinized from different viewpoints. He or she is commonly said to be, by profession or otherwise, an intellectual, who has writing as work or pastime. The diarist is also typically prone to loneliness and alienation, caused by either an inner predisposition or physical isolation (or both).

A total of 1935 migratory birds from 104 different species were captured in southeastern Sweden in 2005-2006 and tested for antibodies against West Nile virus (WNV). Overall, 46 birds (2.4%; binomial confidence limits, 1.8-3.2) were positive by blocking-ELISA, but only 2 (0.10%; binomial confidence limits, 0.0-0.4) had antibodies detectable by both blocking-ELISA and WNV neutralization test. ELISA-positive birds included long- and short-distance migrants likely exposed to WNV while wintering in or migrating through areas enzootic for WNV. Exposure to a cross-reactive Flavivirus was suspected for short-distance migrants of the Turdidae family, but no cross-neutralization with tick-borne encephalitis and Usutu viruses was observed.

Dengue virus (DENV) infection is the most common arthropod-borne viral disease in man and there are approximately 100 million infections annually. Despite the global burden of DENV infections many important questions regarding DENV pathogenesis remain unaddressed due to the lack of appropriate animal models of infection and disease. A major problem is the fact that no non-human species naturally develop disease similar to human dengue fever (DF) or dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Apart from other risk factors for severe dengue such as host genetics and secondary infection with a heterologous DENV, virus virulence is a risk factor that is not well characterized.

Dengue viruses (DENV) cause 50-100 million cases of acute febrile disease every year, including 500,000 reported cases of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Viral factors have been proposed to influence the severity of the disease, but markers of virulence have never been identified on DENV. Three DENV serotype-1 isolates from the 2007 epidemic in Cambodia that are derived from patients experiencing the various clinical forms of dengue were characterized both phenotypically and genetically. Phenotypic characteristics in vitro, based on replication kinetics in different cell lines and apoptosis response, grouped isolates from DF and DHF patients together, whereas the virus isolate from a DSS patient showed unique features: a lower level of replication in mammalian cells and extensive apoptosis in mosquito cells. Genomic comparison of viruses revealed six unique amino acid residues in the membrane, envelope, and in non-structural genes in the virus isolated from the DSS patient.