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Topic:Hospitalization

Hospitalization of horses involves the admission of equine patients to veterinary facilities for the diagnosis, treatment, and management of various medical conditions. This process is typically initiated when a horse requires intensive monitoring, specialized care, or advanced medical interventions that cannot be adequately provided in a non-clinical setting. Common reasons for equine hospitalization include surgical procedures, severe injuries, colic, respiratory disorders, and infectious diseases. During hospitalization, horses are monitored for vital signs, administered medications, and provided with supportive care tailored to their specific needs. This page compiles peer-reviewed research studies and scholarly articles that explore the protocols, outcomes, and advancements in the hospitalization of horses, providing insights into best practices and innovations in equine clinical care.
Fecal microbiota transplant for treatment of diarrhea in adult hospitalized horses-111 cases (2013-2018).
Open veterinary journal    September 30, 2023   Volume 13, Issue 9 1135-1140 doi: 10.5455/OVJ.2023.v13.i9.9
Quattrini C, Bozorgmanesh R, Egli P, Magdesian KG.Fecal microbiota transplant (FMT) is increasingly administered as part of the treatment of colitis in horses, yet there is little data as to its effectiveness. Retrospective evaluation of the effects of FMT on discharge status, fecal consistency, length of hospitalization, and improvement in clinical signs in horses hospitalized for diarrhea. Retrospective case-control study. Medical records of adult horses (>1 year old) that received at least one transfaunation treatment (2013-2018) in two referral hospitals were identified through a medical records database search. Medical records of contemp...
Clinical findings, surgical techniques, prognostic factors for short-term survival and long-term outcome in horses with acquired inguinal hernias: Ninety-eight cases (2005-2020).
Veterinary surgery : VS    August 31, 2023   doi: 10.1111/vsu.14023
François I, Lepage OM, Schramme MC, Salciccia A, Detilleux J, Grulke S.To report findings, outcome and determine variables associated with survival in horses with acquired inguinal hernia (AIH). Methods: Retrospective study. Methods: A total of 98 cases in 97 horses. Methods: The medical records (2005-2020) of horses diagnosed with AIH were reviewed. Retrieved data included signalment, history, clinical variables, surgical aspects, postoperative complications, and short- and long-term outcomes. Logistic regression analyses were used to determine factors associated with short-term survival (p < .05). Results: Manual reduction was attempted in a third of the...
Survival of formalin intoxication in a 13-year-old Thoroughbred gelding.
Equine veterinary journal    August 16, 2023   doi: 10.1111/evj.13982
Lovett A, Vokes J, Loghides N, Johnstone L, Sykes B.Formalin intoxication via the gastrointestinal route has not been previously reported in the horse. Whereas ingestion of formalin in humans, although rare, is well documented. Majority of human cases are either accidental, suicidal or homicidal and often lead to fatality, with a reported lethal formaldehyde dose equating to 0.12 - 0.16 g/kg bwt. Objective: To describe a single case report of the clinical management of an adult horse referred to a veterinary teaching hospital following accidental administration of 10% formalin via nasogastric tube. Methods: A 13-year-old Thoroughbred gelding or...
Clostridioides difficile infection in thoroughbred horses in Japan from 2010 to 2021.
Scientific reports    August 11, 2023   Volume 13, Issue 1 13099 doi: 10.1038/s41598-023-40157-x
Uchida-Fujii E, Niwa H, Senoh M, Kato H, Kinoshita Y, Mita H, Ueno T.We encountered 34 Clostridioides difficile (C. difficile) infection (CDI) cases among Thoroughbred horses in Japan from 2010 to 2021. Among them, 79.4% (27/34) either died or were euthanised. The risk factors associated with CDI and mortality among Japanese Thoroughbred horses remain unclear. We used genetic methods to examine C. difficile strains and their relationships with prognosis. Twenty-two (64.7%) cases were hospitalised at the onset of colitis. Outcomes were balanced for hospitalisation rates at the onset of colitis. The mortality rates of cases treated with metronidazole (65.0%) were...
Relationship between the Cycle Threshold Value (Ct) of a Salmonella spp. qPCR Performed on Feces and Clinical Signs and Outcome in Horses.
Microorganisms    July 30, 2023   Volume 11, Issue 8 1950 doi: 10.3390/microorganisms11081950
Amory H, Cesarini C, De Maré L, Loublier C, Moula N, Detilleux J, Saulmont M, Garigliany MM, Lecoq L.The objective of this retrospective study was to evaluate the clinical significance of fecal quantitative real-time polymerase chain reaction (qPCR) results when taking the cycle threshold values (Ct) into account. The study included 120 qPCR-positive fecal samples obtained from 88 hospitalized horses over a 2-year period. The mean Ct of the qPCR test was evaluated in regard to (1) clinical outcome and (2) systemic inflammatory response syndrome (SIRS) status (no SIRS, moderate SIRS, or severe SIRS) of the sampled horses. An ROC analysis was performed to establish the optimal cut-off Ct valu...
Use of an equine compression suit to manage a deep axillary wound in a horse.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    July 12, 2023   Volume 33, Issue 4 467-471 doi: 10.1111/vec.13311
Tallon RE, Gough RL, McGovern KF.To describe the use of an equine compression suit to manage a deep axillary wound in a Thoroughbred filly with bilateral pneumothorax. Methods: A 2-year-old Thoroughbred filly was referred for management of a deep wound to the left axilla. Packing and bandaging of the area were initially attempted, but this became repeatedly dislodged, and bandaging was discontinued. The filly subsequently developed widespread subcutaneous emphysema, and the wound was slow to granulate. Acute onset respiratory distress occurred 11 days after admission, secondary to bilateral worsening pneumothorax, and requir...
Ultrasonographic Assessment of Small Intestinal Motility Following Hyoscine Butylbromide Administration in Horses: A Pilot Study.
Journal of equine veterinary science    July 1, 2023   Volume 128 104878 doi: 10.1016/j.jevs.2023.104878
Haugaard SL, McGovern KF, Tallon R, Gough R, Watrobska N.Horses commonly receive hyoscine butylbromide (HB) prior to hospital admission for colic. This could alter the appearance of the small intestine (SI) on ultrasound scan and affect clinical decision making. The aim of this study was to assess the impact of HB on ultrasonographically assessed SI motility and heart rate. Six horses hospitalised for medical colic with no significant abnormalities on baseline abdominal ultrasound examination were included. Ultrasound was performed in three locations (right inguinal, left inguinal and hepatoduodenal window) before and at 1, 5, 15, 30, 45, 60, 90, an...
An evaluation of the effect of equine-facilitated psychotherapy on patients with substance use disorders.
PloS one    June 28, 2023   Volume 18, Issue 6 e0286867 doi: 10.1371/journal.pone.0286867
Machová K, Juríčková V, Kasparová A, Petrová K, Sládková B, Svobodová I.Equine Facilitated Psychiatry and Psychology (EFPP) is a supportive non-pharmacological treatment program used in the treatment of patients with substance use disorder. The aim of this study was to evaluate a possible change in patient's health and health-related quality of life between the first and fourth session of the EFPP program using the Assessment of Quality of Life (AQoL) and the Health of the Nation Outcome Scales (HoNOS). The Human-Animal Interaction Scale (HAIS) and a 5-point Likert-type scale was used for an assessment of patient's mood in the experimental group. The study sample ...
Audit of animal-related injuries at UK veterinary schools between 2009 and 2018.
The Veterinary record    June 13, 2023   Volume 193, Issue 7 e3171 doi: 10.1002/vetr.3171
Tulloch JSP, Fleming KM, Pinchbeck G, Forster J, Lowe W, Westgarth C.Animal-related injuries pose a significant risk to the veterinary profession. This study aimed to describe the incidence, demographics, context and consequences of animal-related injuries at UK veterinary schools. A multicentre audit of accident records (2009-2018) across five UK veterinary schools was performed. Injury rates were stratified by school, demographics and species. The context and cause of the injury were described. Multivariable logistic models explored factors associated with medical treatment, hospital visits and time off work. An annual rate of 2.60 (95% confidence interval 2....
Red blood cell distribution width to platelet ratio in neonatal foals with sepsis.
Journal of veterinary internal medicine    June 12, 2023   Volume 37, Issue 4 1552-1560 doi: 10.1111/jvim.16793
Scalco R, de Oliveira GN, da Rosa Curcio B, Wooten M, Magdesian KG, Hidai ST, Pandit P, Aleman M.Rapid and accurate markers to aid diagnosis of sepsis are needed in neonatal foals. The CBC variable red blood cell distribution width (RDW) to platelet ratio (RPR) is associated with inflammatory response and linked to poor outcomes of sepsis in human patients. Objective: Explore the correlation of RPR with sepsis in neonatal foals and evaluate RPR predictive and prognostic value. Methods: Three hundred seventeen hospitalized neonatal foals ≤7 days of age that had a CBC and physical exam performed at admission between 2012 and 2021. Methods: Retrospective case-control study. Clinical reco...
Recumbency decreases mare and foal survival following in-hospital dystocia management.
Equine veterinary journal    May 25, 2023   doi: 10.1111/evj.13956
Roe H, Macpherson M, Denagamage T, Hopper S, Woodie B, Embertson R.Mare and foal survival are increased with prompt dystocia management. Data regarding mortality outcomes in mares and foals, when mares are recumbent at admission for dystocia resolution, are scarce. Objective: To evaluate recumbency at hospital admission as a risk factor for survival of mares and foals following dystocia management. Subsequent mare fertility was also evaluated. Methods: Retrospective cohort. Methods: Data were obtained from medical records at Rood and Riddle Equine Hospital of mares with dystocia between 1995 and 2018. Mare signalment, ambulation status, survival data and foal...
Critical Care of the Colic Patient: Monitoring, Fluid Therapy, and More.
The Veterinary clinics of North America. Equine practice    May 9, 2023   Volume 39, Issue 2 287-305 doi: 10.1016/j.cveq.2023.03.011
Barton C, Hassel DM.A successful outcome to management of the critical colic patient is highly dependent on how the patient is monitored and treated, particularly, in the perioperative period. In this article, we will provide an update on monitoring techniques, advances in fluid therapy, nutrition management and pharmacotherapeutic agents, inclusive of pain monitoring and management, prokinetics, and management of systemic inflammatory response syndrome and the hypercoagulable state.
Preliminary Investigation of Side Effects of Polymyxin B Administration in Hospitalized Horses.
Antibiotics (Basel, Switzerland)    May 5, 2023   Volume 12, Issue 5 854 doi: 10.3390/antibiotics12050854
van Spijk JN, Beckmann K, Wehrli Eser M, Stirn M, Steuer AE, Saleh L, Schoster A.Neuro- and nephrotoxicity of polymyxins are known but clinical studies in horses are lacking. The aim of this study was to describe neurogenic and nephrogenic side effects of hospitalized horses receiving Polymyxin B (PolyB) as part of their treatment plan. Twenty horses diagnosed with surgical colic ( = 11), peritonitis ( = 5), typhlocolitis ( = 2), pneumonia, and pyometra (each = 1) were included. Antimicrobial treatment was randomized to GENTA (gentamicin 10 mg/kg bwt q24 h IV, penicillin 30.000 IU/kg q6 h IV) or NO GENTA (marbofloxacin 2 mg/kg bwt q24 h IV, penicillin 30.000 IU/kg q6 h IV...
Multi-Centered Field Evaluation of a Salmonella spp. Point-of-Care PCR Assay Using Equine Feces and Environmental Samples.
Journal of equine veterinary science    May 5, 2023   Volume 126 104538 doi: 10.1016/j.jevs.2023.104538
Pusterla N, Naranatt P, Swadia H, Winfield L, Hartwig A, Barnum S, Mendonsa E.The introduction of microfluidic card technology has opened the field for rapid point-of-care (POC) molecular assays, including fecal and environmental Salmonella spp. testing. The purpose of this study was to evaluate a novel POC PCR assay for the detection of Salmonella spp. in feces and environmental samples. A total of 143 fecal samples and 132 environmental samples were collected for POC PCR Salmonella spp. testing as well as qPCR testing. Each sample was inoculated into selenite broth and incubated for 18 to 24 hours. For the POC PCR assay, 14 μl of selenite broth were mixed with 126 μ...
Repeat Celiotomy-Current Status.
The Veterinary clinics of North America. Equine practice    April 28, 2023   Volume 39, Issue 2 325-337 doi: 10.1016/j.cveq.2023.03.012
Freeman DE, Bauck AG.Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical ma...
Zinc Status of Horses and Ponies: Relevance of Health, Horse Type, Sex, Age, and Test Material.
Veterinary sciences    April 16, 2023   Volume 10, Issue 4 295 doi: 10.3390/vetsci10040295
van Bömmel-Wegmann S, Gehlen H, Barton AK, Büttner K, Zentek J, Paßlack N.Little is known about the animal- and diet-related factors that could interfere with the plasma zinc (Zn) concentrations of equines. Additionally, the adequacy of plasma to reflect changes in the Zn intake is unclear. In the first part of this study, the plasma Zn concentrations of hospitalized horses and ponies ( = 538) were measured and evaluated for the impact of the age, sex, horse type, and internal diseases of the animals. In the second part, the effects of increasing dietary Zn chloride hydroxide and Zn methionine supplementations were assessed on the plasma and mane hair Zn concentrati...
Plasma UCHL-1 as a Biomarker of Brain Injury in Hospitalized Foals With Neonatal Encephalopathy.
Journal of equine veterinary science    April 7, 2023   Volume 126 104490 doi: 10.1016/j.jevs.2023.104490
Ryan CA, Giguère S, Morresey PR.A plasma biomarker such as ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) to distinguish neonatal encephalopathy (NE) from other disorders and provide prognostic information would be useful for equine practitioners. In this prospective study, plasma UCHL-1 was measured in 331 hospitalized foals ≤4 days of age. Clinical diagnoses of neonatal encephalopathy only (NE group, n = 77), sepsis only (Sepsis group, n = 34), concurrent sepsis and NE (NE+Sepsis group, n = 85), or neither sepsis nor NE (Other group, n = 101) were made by the attending veterinarian. Plasma UCHL-1 concentration...
Horse-riding hazards: an observational cohort study mapping equestrian related injuries at a Scandinavian trauma centre.
BMC sports science, medicine & rehabilitation    March 28, 2023   Volume 15, Issue 1 46 doi: 10.1186/s13102-023-00646-y
Franzén Lindgren E, Hammarqvist F, Ahl Hulme R.Horse-riding is practiced on a regular basis by 500,000 people in Sweden. It is reputed to be one of the most dangerous sports. On average, there were 1756 acute injuries and three fatalities each year between 1997 and 2014 in Sweden related to horses. The primary aim of this study was to outline the injury spectrum related to equestrian activities cared for at a large Swedish trauma centre. The secondary aim was to identify trends in clinical outcomes and to investigate the association between age and such outcomes. Methods: The electronic medical records system at Karolinska University Hosp...
Short-Term Survival and Postoperative Complications Rates in Horses Undergoing Colic Surgery: A Multicentre Study.
Animals : an open access journal from MDPI    March 20, 2023   Volume 13, Issue 6 1107 doi: 10.3390/ani13061107
Spadari A, Gialletti R, Gandini M, Valle E, Cerullo A, Cavallini D, Bertoletti A, Rinnovati R, Forni G, Scilimati N, Giusto G.The occurrence of colic could be influenced by the characteristics of a population, geographical area, and feeding management. The aim of this study was to report the short-term postoperative complications and survival rates and to identify factors that might affect the outcome of horses that underwent colic surgery in three Italian surgical referral centres. Data of horses subjected to colic surgery in three referral centres (2018-2021) were analysed. Comparisons of the outcomes were performed using a Mann-Whitney or a Chi square test. Areas under the receiver operating characteristic (ROC) c...
Development of a classification system for equine postoperative complications and its application in a cohort of 190 horses undergoing emergency laparotomy.
The Veterinary record    March 12, 2023   Volume 192, Issue 11 e2782 doi: 10.1002/vetr.2782
Gandini M, Giusto G.Accurate reporting of postoperative complications is paramount to understanding procedural outcomes, comparing procedures and assuring quality improvement. Standardising definitions of complications in equine surgeries will improve the evidence of their outcomes. To this end, we proposed a classification for postoperative complications and applied it to a cohort of 190 horses undergoing emergency laparotomy. Methods: A classification system for postoperative complications in equine surgery was developed. Medical records of horses that underwent equine emergency laparotomy and recovered from an...
Horse and Cattle-Related Trauma: A Retrospective Review of Injuries and Management in a Regional Queensland Hospital.
Cureus    March 3, 2023   Volume 15, Issue 3 e35746 doi: 10.7759/cureus.35746
Savage G, Liesegang A, Campbell J, Lyon M, Fry D.Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation. Methods: We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma,...
Longitudinal study of the short- and long-term effects of hospitalisation and oral trimethoprim-sulfadiazine administration on the equine faecal microbiome and resistome.
Microbiome    February 27, 2023   Volume 11, Issue 1 33 doi: 10.1186/s40168-023-01465-6
Theelen MJP, Luiken REC, Wagenaar JA, Sloet van Oldruitenborgh-Oosterbaan MM, Rossen JWA, Schaafstra FJWC, van Doorn DA, Zomer AL.Hospitalisation and antimicrobial treatment are common in horses and significantly impact the intestinal microbiota. Antimicrobial treatment might also increase levels of resistant bacteria in faeces, which could spread to other ecological compartments, such as the environment, other animals and humans. In this study, we aimed to characterise the short- and long-term effects of transportation, hospitalisation and trimethoprim-sulfadiazine (TMS) administration on the faecal microbiota and resistome of healthy equids. In a longitudinal experimental study design, in which the ponies served as the...
Serum amyloid A does not predict non-survival in hospitalised adult horses with acute colitis.
The Veterinary record    February 13, 2023   Volume 192, Issue 7 e2644 doi: 10.1002/vetr.2644
Runge KE, Bak M, Vestergaard A, Staerk-Østergaard J, Jacobsen S, Pihl TH.Predicting non-survival in horses with acute colitis improves early decision making. Therefore, this study aimed to determine the prognostic value of serum amyloid A (SAA) and other clinicopathological and clinical variables in adult horses with acute colitis. Clinical variables, SAA and other blood biomarkers, including plasma L-lactate (lactate), were assessed in 176 horses with acute colitis. A multivariate model for the prediction of non-survival was constructed. Icelandic horses were analysed separately. Admission SAA was similar in survivors (median 548 mg/L; range 0-5453 mg/L) and...
Standing Surgical Management of Splint Bone Fractures in 13 Horses: A Comparison to Management Under General Anaesthesia.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    February 9, 2023   Volume 36, Issue 3 148-156 doi: 10.1055/s-0043-1761241
Auffret V, Bonilla AG. The aim of this article was to describe the technique and outcomes of standing surgical management of splint bone fractures and to compare outcome variables and hospitalization cost to a group with similar fractures treated under general anaesthesia. Methods:  It is a single-institution retrospective study. Surgical technique, surgical time, hospitalization cost and complications were retrieved from the medical records of horses treated surgically for splint bone fractures (2008-2020). Owner telephone follow-up provided data about athletic outcome, client satisfaction and cosmetic appeara...
JMM Profile: Japanese encephalitis virus: an emerging threat.
Journal of medical microbiology    February 8, 2023   Volume 71, Issue 12 doi: 10.1099/jmm.0.001620
Sewgobind S, Johnson N, Mansfield KL.Japanese encephalitis (JE) is an infection that occurs predominantly in Asia and the Pacific Islands. It is transmitted by mosquito bites, with the main vector being Culex tritaeniorhynchus, and is maintained in enzootic cycles involving pigs, wild birds and mosquitoes. JE is caused by infection with Japanese encephalitis virus (JEV), a zoonotic pathogen that also causes disease in mammals such as pigs and horses. In humans, most symptoms are mild or flu-like but can progress to encephalitis. Pigs are considered amplification hosts, and sows may have gestational complications. Horses may exhib...
Horse-related injury patterns: a single center report.
Journal of orthopaedic surgery and research    February 2, 2023   Volume 18, Issue 1 83 doi: 10.1186/s13018-023-03549-3
Hoffmann MF, Bernstorff M, Kreitz N, Roetman B, Schildhauer TA, Wenning KE.For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics. Methods: From one level I trauma center, between July 2019 and July 2022 ...
The hypothalamic-pituitary-adrenal axis response to ovine corticotropin-releasing-hormone stimulation tests in healthy and hospitalized foals.
Journal of veterinary internal medicine    January 18, 2023   Volume 37, Issue 1 292-301 doi: 10.1111/jvim.16604
Johnson K, Peterson J, Kopper J, Dembek K.The hypothalamic-pituitary-adrenocortical axis (HPAA) response to sepsis can be impaired in critical illness. Corticotropin-releasing hormone (CRH) stimulation test might assess HPAA function in foals. Objective: To evaluate plasma cortisol, ACTH, arginine vasopressin (AVP), and endogenous CRH (eCRH) response to different doses of ovine CRH (oCRH). Methods: Healthy (n = 14) and hospitalized (n = 15) foals <7 days of age. Methods: In this prospective randomized study, oCRH (0.1, 0.3, and 1 μg/kg) was administered intravenously and blood samples were collected before, 15, 30, 60, and ...
Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses.
Equine veterinary journal    January 16, 2023   doi: 10.1111/evj.13926
Gandini M, Giusto G.In jejunocaecal anastomosis leaving a necrotic ileal stump has been implicated in complications and poor outcomes. Elective inversion of the necrotic stump using a nasogastric tube has been previously described, although this procedure can be cumbersome and can cause caecocolic orifice occlusion. Objective: To describe the use of a new device for elective inversion of necrotic ileal stumps. Methods: Case report. Methods: Details of the four horses that underwent intestinal resection and anastomosis with elective inversion of the ileal stump were retrieved from their medical records. For each c...
Proximal Interphalangeal Arthrodesis in Horses: A Meta-Analysis of Retrospective Studies.
Journal of equine veterinary science    January 14, 2023   Volume 122 104226 doi: 10.1016/j.jevs.2023.104226
de Souza AF, Paretsis NF, De Zoppa ALDV.The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size ...
Hospital-acquired and zoonotic bacteria from a veterinary hospital and their associated antimicrobial-susceptibility profiles: A systematic review.
Frontiers in veterinary science    January 9, 2023   Volume 9 1087052 doi: 10.3389/fvets.2022.1087052
Sebola DC, Oguttu JW, Kock MM, Qekwana DN.Hospital-acquired infections (HAIs) are associated with increased mortality, morbidity, and an economic burden due to costs associated with extended hospital stays. Furthermore, most pathogens associated with HAIs in veterinary medicine are zoonotic. This study used published data to identify organisms associated with HAIs and zoonosis in veterinary medicine. Furthermore, the study also investigated the antimicrobial-susceptibility profile of these bacterial organisms. Unassigned: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Revie...