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ORIGINAL ARTICLE08-30-2024
Meanings attributed to changes experienced by individuals after COVID-19 hospitalization
- Camila Harmuch
, - Jéssica dos Santos Pini ,
- Paula Antunes Bezerra Nacamura ,
- Anny Caroline Ribeiro Devechi ,
- Vinícius Brito de Souza , [ … ],
- Marcelle Paiano
Abstract
ORIGINAL ARTICLEMeanings attributed to changes experienced by individuals after COVID-19 hospitalization
Revista Brasileira de Enfermagem. 2024;77:e20230122
DOI 10.1590/0034-7167-2023-0122
- Camila Harmuch ,
- Jéssica dos Santos Pini ,
- Paula Antunes Bezerra Nacamura ,
- Anny Caroline Ribeiro Devechi ,
- Vinícius Brito de Souza ,
- Juliana Graciela Vestena Zillmer ,
- Maria Aparecida Salci ,
- Marcelle Paiano
Views0See moreABSTRACT
Objectives:
to understand the meanings attributed to the experiences of individuals after hospitalization for COVID-19.
Methods:
qualitative study, with a theoretical framework based on Symbolic Interactionism and a methodological approach grounded in Grounded Theory. Nineteen participants who had moderate and severe forms of COVID-19 after hospitalization were interviewed. Data collection took place between April and November 2021 through online interviews, and the data were analyzed using initial and focused coding in the MAXQDA software.
Results:
the data illustrate new meanings attributed to different aspects of life after hospitalization, including relationships with others, the environment, physical and mental health, finances, identity, and interactions with a new social reality.
Conclusions:
the meanings are intrinsically linked to the value of interpersonal relationships, the perception of their impact, and the consequences after hospitalization. This allows professionals to understand the importance of this information to improve care and prepare for future epidemics.
- Camila Harmuch
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ORIGINAL ARTICLE08-30-2024
Patient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital
- Amanda Lobato Lopes ,
- Rosana Aparecida Pereira ,
- Laura Martins Valdevite Pereira ,
- Felippe Micheli Costa de Castilho ,
- Fernanda Raphael Escobar Gimenes
Abstract
ORIGINAL ARTICLEPatient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital
Revista Brasileira de Enfermagem. 2024;77:e20230187
DOI 10.1590/0034-7167-2023-0187
- Amanda Lobato Lopes ,
- Rosana Aparecida Pereira ,
- Laura Martins Valdevite Pereira ,
- Felippe Micheli Costa de Castilho ,
- Fernanda Raphael Escobar Gimenes
Views0See moreABSTRACT
Objectives:
to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture.
Methods:
a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened.
Results:
all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors.
Conclusions:
with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution’s leaders.
- Amanda Lobato Lopes
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REVIEW08-30-2024
Educational actions conducted during the pandemic with primary health care professionals: a scoping review
- Bruna Dias França ,
- Kênia Lara Silva ,
- Lilian Cristina Rezende ,
- Francisco Carlos Felix Lana ,
- Simone de Pinho Barbosa
Abstract
REVIEWEducational actions conducted during the pandemic with primary health care professionals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230352
DOI 10.1590/0034-7167-2023-0352
- Bruna Dias França ,
- Kênia Lara Silva ,
- Lilian Cristina Rezende ,
- Francisco Carlos Felix Lana ,
- Simone de Pinho Barbosa
Views0See moreABSTRACT
Objectives:
to map the educational actions conducted with primary health care professionals during the COVID-19 pandemic.
Methods:
a scoping review conducted in August 2023, which covered databases such as CINAHL, Medline, LILACS, IBECS, BDENF, and Web of Science. In total, 32 publications were analyzed through content analysis.
Results:
the primary beneficiaries of the educational actions included 69% physicians, 56% nurses, 25% pharmacists, 13% social workers and dentists, 9% psychologists, community health agents, and laboratory professionals, and 6% nursing technicians, nutritionists, and physical educators. The predominant educational interventions were training sessions (mentioned in 19 publications), followed by Continuing Health Education (10 publications) and Continuing Education (three publications).
Final Considerations:
the educational interventions demonstrated positive impacts on professional practice, particularly the Continuing Health Education actions, which were notable for stimulating critical problem-solving among professionals.
- Bruna Dias França
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ORIGINAL ARTICLE08-30-2024
Negative affectivity in university students and its relationship with academic performance and professional outlook after COVID-19
- Bruna de Oliveira Alves ,
- Bárbara Guimarães Lourenço ,
- Bianca Bacelar Assis Araújo ,
- Luana Vieira Toledo ,
- Rafael Lopes Chaves , [ … ],
- Caroline de Castro Moura
Abstract
ORIGINAL ARTICLENegative affectivity in university students and its relationship with academic performance and professional outlook after COVID-19
Revista Brasileira de Enfermagem. 2024;77:e20240040
DOI 10.1590/0034-7167-2024-0040
- Bruna de Oliveira Alves ,
- Bárbara Guimarães Lourenço ,
- Bianca Bacelar Assis Araújo ,
- Luana Vieira Toledo ,
- Rafael Lopes Chaves ,
- Érika de Cássia Lopes Chaves ,
- Tânia Couto Machado Chianca ,
- Caroline de Castro Moura
Views0See moreABSTRACT
Objectives:
to evaluate the prevalence of negative affectivity in university students in the post-COVID-19 pandemic context and its relationship with academic performance and professional outlook.
Methods:
a cross-sectional study was conducted with undergraduate students from a public university in Minas Gerais between September 2022 and September 2023. Data were collected using a sociodemographic and psychosocial characterization questionnaire and the Depression, Anxiety, and Stress Scale 21. The relationships between negative affectivity, academic performance, and professional outlook were verified using the Kruskal-Wallis test, with a significance level of 5%.
Results:
a total of 585 students participated in the study. A high prevalence of depression, anxiety, and stress was found among university students in the post-COVID-19 context, with a notable severity of anxiety. A negative association was detected between the investigated negative affectivity, academic performance, and professional outlook.
Conclusions:
the results indicate an emotional vulnerability in university students, with a relationship between negative affectivity and a decline in academic performance and professional outlook.
- Bruna de Oliveira Alves
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REVIEW08-30-2024
Impact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review
- Luciana de Alcantara Nogueira ,
- Cristiano de Oliveira Ribeiro ,
- Leonel dos Santos Silva ,
- Yasmin Hiorrana dos Santos ,
- Luciana Puchalski Kalinke
Abstract
REVIEWImpact of financial toxicity on adults with cancer during the COVID-19 pandemic: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20240078
DOI 10.1590/0034-7167-2024-0078
- Luciana de Alcantara Nogueira ,
- Cristiano de Oliveira Ribeiro ,
- Leonel dos Santos Silva ,
- Yasmin Hiorrana dos Santos ,
- Luciana Puchalski Kalinke
Views0See moreABSTRACT
Objectives:
to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic.
Methods:
an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023.
Results:
out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative.
Conclusions:
the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients’ lives.
- Luciana de Alcantara Nogueira
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ORIGINAL ARTICLE08-30-2024
Risk of smoking cessation treatment dropout: a cohort to help (re)think care
- Janaina Pereira da Silva ,
- Adriana Ignácio de Pádua ,
- Ruan Víctor dos Santos Silva ,
- Felipe Lima dos Santos ,
- Poliana Silva de Oliveira , [ … ],
- Cinira Magali Fortuna
Abstract
ORIGINAL ARTICLERisk of smoking cessation treatment dropout: a cohort to help (re)think care
Revista Brasileira de Enfermagem. 2024;77:e20230537
DOI 10.1590/0034-7167-2023-0537
- Janaina Pereira da Silva ,
- Adriana Ignácio de Pádua ,
- Ruan Víctor dos Santos Silva ,
- Felipe Lima dos Santos ,
- Poliana Silva de Oliveira ,
- Priscila Norié Araujo-Betetti ,
- Joris Thievenaz ,
- Cinira Magali Fortuna
Views0See moreABSTRACT
Objectives:
to evaluate the relative risk of smoking cessation treatment dropout during its intensive phase.
Methods:
a retrospective and quantitative cohort study was developed from the electronic medical records of individuals who started smoking cessation treatment between 2015 and 2019 at a specialty clinic in a city in the interior of São Paulo, Brazil. The relative risk of dropping out of treatment was calculated using the Poisson regression model.
Results:
it was observed that out of the 396 (100.0%) individuals who started the treatment, 109 (27.5%) abandoned it before the end of the intensive phase. For each one-year increase in age, the risk of dropping out of smoking cessation treatment decreased by an average of 2%.
Conclusions:
the risk of dropping out of smoking cessation treatment is higher among younger individuals. It is necessary to rethink the care offered to younger adults to promote the continuity of treatment.
- Janaina Pereira da Silva
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ORIGINAL ARTICLE08-26-2024
Influence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
Abstract
ORIGINAL ARTICLEInfluence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
Revista Brasileira de Enfermagem. 2024;77(5):e20230293
DOI 10.1590/0034-7167-2023-0293
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
Views0See moreABSTRACT
Objectives:
to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department.
Methods:
retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses.
Results:
in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p<0.009), but was not dependent on the transfused blood component (p=0.124). The leukoreduction moment had no effect (p>0.050) on transfusion reactions, healthcare-associated infections, or mortality.
Conclusions:
patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.
- Natasha Dejigov Monteiro da Silva
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ORIGINAL ARTICLE08-26-2024
Driver’s license, head protection devices and severity of motorcyclists’ injuries in traffic accidents
Revista Brasileira de Enfermagem. 2024;77(5):e20230153
Abstract
ORIGINAL ARTICLEDriver’s license, head protection devices and severity of motorcyclists’ injuries in traffic accidents
Revista Brasileira de Enfermagem. 2024;77(5):e20230153
DOI 10.1590/0034-7167-2023-0153
Views0See moreABSTRACT
Objectives:
to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver’s license and use of helmets according to the severity of injuries.
Methods:
a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil.
Results:
170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14).
Conclusions:
people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.
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ORIGINAL ARTICLE06-04-2021
Information demands from families of children with Autism Spectrum Disorder
- Gisele Weissheimer ,
- Verônica de Azevedo Mazza ,
- Julia Mazul Santana ,
- Victoria Beatriz Trevisan Nobrega Martins Ruthes ,
- Cibelly Aliny Siqueira Lima Freitas
Abstract
ORIGINAL ARTICLEInformation demands from families of children with Autism Spectrum Disorder
Revista Brasileira de Enfermagem. 2021;74(5):e20200642
DOI 10.1590/0034-7167-2020-0642
- Gisele Weissheimer ,
- Verônica de Azevedo Mazza ,
- Julia Mazul Santana ,
- Victoria Beatriz Trevisan Nobrega Martins Ruthes ,
- Cibelly Aliny Siqueira Lima Freitas
Views0See moreABSTRACT
Objective:
to identify the information demands of families of children with Autism Spectrum Disorder.
Method:
this is a qualitative study conducted through semi-structured and audio-recorded interviews with 55 family members, in the states of Paraná, Ceará, and Macapá, between September 2018 and September 2019. Thematic category analysis and Qualitative Data Analysis Software resources were used for data organization.
Results:
it was identified that families need information regarding the characteristics of Autism Spectrum Disorder (definition, cause, possibility of cure, prognosis and the probability of having another child with Autism Spectrum Disorder); child’s routine and behavior; future rights and expectations.
Final considerations:
information demands are relevant to support professionals, health managers and other services in health care organization to support families of children with autism.
- Gisele Weissheimer
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01-27-2020
Comparison of Interpretive Description and Qualitative Description in the Nursing Scope
Revista Brasileira de Enfermagem. 2020;73(1):e20190339
Abstract
Comparison of Interpretive Description and Qualitative Description in the Nursing Scope
Revista Brasileira de Enfermagem. 2020;73(1):e20190339
DOI 10.1590/0034-7167-2019-0339
Views0Interpretive Description BasisID is a small scale qualitative research about a phenomenon regarded in the field that aims to extract themes and patterns. This approach begins with the critical analysis of clinical and theoretical knowledge in the field. It develops the initial conceptual framework, however it does not enter procedures details. Instead, this approach explains […]See more -
ORIGINAL ARTICLE03-30-2020
Professional skills for health promotion in caring for tuberculosis patients
- Amanda de Fátima Alves Costa ,
- Altamira Mendonça Félix Gomes ,
- Ana Fátima Carvalho Fernandes ,
- Lucilane Maria Sales da Silva ,
- Lorena Pinheiro Barbosa , [ … ],
- Priscila de Souza Aquino
Abstract
ORIGINAL ARTICLEProfessional skills for health promotion in caring for tuberculosis patients
Revista Brasileira de Enfermagem. 2020;73(2):e20180943
DOI 10.1590/0034-7167-2018-0943
- Amanda de Fátima Alves Costa ,
- Altamira Mendonça Félix Gomes ,
- Ana Fátima Carvalho Fernandes ,
- Lucilane Maria Sales da Silva ,
- Lorena Pinheiro Barbosa ,
- Priscila de Souza Aquino
Views0See moreABSTRACT
Objectives:
to understand the health promotion skills found in the speeches of health practitioners in care for TB patients.
Methods:
qualitative study, developed with seven practitioners involved in care for TB patients, identified from a sociocentric approach, whose speeches were submitted to analysis based on the health promotion skills model in the Galway Consensus.
Results:
there were four domains: Catalyzing change; Leadership; Planning; and Partnerships. These domains resulted from health education actions, contribution of management nursing practitioners, seeking to meet patients’ needs and articulation of professional sectors.
Final considerations:
there were some skill domains in the speeches of health practitioners, with the nurse being quoted in the development of essential skills for health promotion activities, such as catalyzing change and leading care for TB patients.
- Amanda de Fátima Alves Costa
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ORIGINAL ARTICLE10-18-2022
Adherence to antiretroviral therapy by adults living with HIV/aids: a cross-sectional study
- Mariana de Morais Fortunato Miranda ,
- Dayanne Rakelly de Oliveira ,
- Glauberto da Silva Quirino ,
- Célida Juliana de Oliveira ,
- Maria Lúcia Duarte Pereira , [ … ],
- Edilma Gomes Rocha Cavalcante
Abstract
ORIGINAL ARTICLEAdherence to antiretroviral therapy by adults living with HIV/aids: a cross-sectional study
Revista Brasileira de Enfermagem. 2022;75(2):e20210019
DOI 10.1590/0034-7167-2021-0019
- Mariana de Morais Fortunato Miranda ,
- Dayanne Rakelly de Oliveira ,
- Glauberto da Silva Quirino ,
- Célida Juliana de Oliveira ,
- Maria Lúcia Duarte Pereira ,
- Edilma Gomes Rocha Cavalcante
Views0See moreABSTRACT
Objective:
To verify the association between adherence to antiretroviral treatment by adults with HIV/AIDS and sociodemographic factors, social and clinical support.
Methods:
Cross-sectional study, with a quantitative approach. Participation of 230 patients. Questionnaires of sociodemographic characterization, social and clinical support, and assessment of adherence to antiretroviral treatment were used. Descriptive and inferential statistics were performed.
Results:
Adherence was classified as good/adequate. An association with sex, income, employment, and level of education was noted. In social support: having access to health services; communication with health professionals; health education; having support to allow venting/talking about issues; information on HIV/AIDS; and company for leisure. In the clinical profile: non-interruption of the drug treatment due to absence from the service or due to changes in the medical prescription.
Conclusion:
Adherence was classified as good/adequate and especially associated with social support factors, which should be enhanced in clinical practice.
- Mariana de Morais Fortunato Miranda
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ORIGINAL ARTICLE08-19-2019
Nursing practice in home care: the mediation of care by reflexivity
- Angélica Mônica Andrade ,
- Edna Aparecida Barbosa de Castro ,
- Maria José Menezes Brito ,
- Patrícia Pinto Braga ,
- Kênia Lara Silva
Abstract
ORIGINAL ARTICLENursing practice in home care: the mediation of care by reflexivity
Revista Brasileira de Enfermagem. 2019;72(4):956-963
DOI 10.1590/0034-7167-2018-0431
- Angélica Mônica Andrade ,
- Edna Aparecida Barbosa de Castro ,
- Maria José Menezes Brito ,
- Patrícia Pinto Braga ,
- Kênia Lara Silva
Views0See moreABSTRACT
Objective:
To analyze the practice of nurses in home care, considering the mediation of care by reflexivity.
Method:
Unique, qualitative case study, anchored in the dialectical framework. The participants were 13 nurses who work in home care in Minas Gerais. Data were obtained by participant observation and interview, and submitted to critical discourse analysis.
Results:
Nursing care at home involves the repetitions of everyday actions and a degree of unpredictability. Reflexivity, according to Schön’s theoretical framework, emerges as a component of professional practice that leads to the practice of care as a continuous assessment of work, and also to reflection on the challenges imposed by conflicting situations. Reflexivity also stems from professionals’ search for improvements in their practices.
Final considerations:
We identified the presence of actions and knowledge mobilized by the reflexivity of the nurse in the home care setting. The following were the elements of this reflexive practice: knowing-in-action, reflection-in-action and reflection reflection-in-action.
- Angélica Mônica Andrade
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ORIGINAL ARTICLE08-19-2019
Functional capacity and social support to people affected by cerebrovascular accident
- Raquel Janyne de Lima ,
- Cláudia Jeane Lopes Pimenta ,
- Maria Cristina Lins de Oliveira Frazão ,
- Gerlania Rodrigues Salviano Ferreira ,
- Tatiana Ferreira da Costa , [ … ],
- Kátia Neyla de Freitas Macedo Costa
Abstract
ORIGINAL ARTICLEFunctional capacity and social support to people affected by cerebrovascular accident
Revista Brasileira de Enfermagem. 2019;72(4):868-873
DOI 10.1590/0034-7167-2017-0854
- Raquel Janyne de Lima ,
- Cláudia Jeane Lopes Pimenta ,
- Maria Cristina Lins de Oliveira Frazão ,
- Gerlania Rodrigues Salviano Ferreira ,
- Tatiana Ferreira da Costa ,
- Lia Raquel de Carvalho Viana ,
- Kaisy Pereira Martins ,
- Kátia Neyla de Freitas Macedo Costa
Views0See moreABSTRACT
Objective:
To investigate the functional capacity and its relationship with the level of social support to people affected by cerebrovascular accident.
Methods:
Cross-sectional and quantitative research, conducted with 108 individuals with sequelae of cerebrovascular accident in João Pessoa/PB. Data were collected through interviews, using a sociodemographic instrument – the Barthel Index and the Social Support Scale.
Results:
We observed the prevalence of functional dependency in 93.5%, and the mild dependency stood out in 40.7%. Medium social support was the most found, with 48.2%. The predominant dimensions of social support were the material dimension, followed by the emotional. There was a significant association (p ≤ 0.05) between very serious dependency and high social support.
Conclusion:
The results found allow us to reflect on the need for involvement of health professionals in strengthening the social support of patients with disabling diseases, such as the cerebrovascular accident.
- Raquel Janyne de Lima
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ORIGINAL ARTICLE12-13-2019
Support systems in the pediatric intensive therapy unit: family perspective
- Jéssica Stragliotto Bazzan ,
- Viviane Marten Milbrath ,
- Ruth Irmgard Bärtschi Gabatz ,
- Marilu Correa Soares ,
- Eda Schwartz , [ … ],
- Deisi Cardoso Soares
Abstract
ORIGINAL ARTICLESupport systems in the pediatric intensive therapy unit: family perspective
Revista Brasileira de Enfermagem. 2019;72:243-250
DOI 10.1590/0034-7167-2018-0588
- Jéssica Stragliotto Bazzan ,
- Viviane Marten Milbrath ,
- Ruth Irmgard Bärtschi Gabatz ,
- Marilu Correa Soares ,
- Eda Schwartz ,
- Deisi Cardoso Soares
Views0See moreABSTRACT
Objective:
to identify and to analyze the support systems used by family members for the adaptation process to the child’s hospitalization in the intensive care unit.
Method:
qualitative research, conducted in a hospital located in the Southern Brazil. Data were collected between June and July 2017, through semi-structured interviews with family members of hospitalized children. The adaptation model and thematic analysis were used for data processing.
Results:
four themes emerged: family and friends as a support system; the family members of other hospitalized children as a support system; spirituality as a support system; health team as a support system.
Final considerations:
identifying the support systems used in the process of family adaptation and their manifestations of interdependence was possible. The need of the nurses to intensify the listening to strengthen the support system of the family members of the children hospitalized in the unit studied.
- Jéssica Stragliotto Bazzan
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ORIGINAL ARTICLE06-01-2020
Performance of nurses in the bed management service of a teaching hospital
Revista Brasileira de Enfermagem. 2020;73(4):e20190349
Abstract
ORIGINAL ARTICLEPerformance of nurses in the bed management service of a teaching hospital
Revista Brasileira de Enfermagem. 2020;73(4):e20190349
DOI 10.1590/0034-7167-2019-0349
Views0See moreABSTRACT
Objectives:
to analyze the performance of nurses in the Bed Management service of a public teaching hospital.
Methods:
descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used.
Results:
the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management.
Final Considerations:
understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse’s identity.
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