Bibliographie: Guerrina, Roberta/Masselot, Annick: Achille's Heel: How Gendered Ideologies Undermined the UK Efforts to Tackle Covid-19, Femina Politica – Zeitschrift für feministische Politikwissenschaft, 1-2021, S. 95-101. https://doi.org/10.3224/feminapolitica.v30i1.09

Non-communicable diseases (PTM) were currently a public health problem, one of them was Diabetes Mellitus (DM). DM type 2 one of the common, which is more than 90-95% and the fourth most prevalent PTM in South Sumatera with 4.386 cases. The problem that was often experienced by DM patient was the continued effect of hyperglycemia that caused peripheral neuropathy and could caused foot ulcers to have amputations. The longer a person was DM, more to had complications. The combination of active lower range of motion and heel raise exercise was one of physical exercise carried out by moving the lower extremities so that blood flow could smooth and transported nutrients to the peripheral. This study aimed to find out the effect of combination active lower range of motion and heel raise exercise on the risk of foot ulcer on typed 2 DM patient. This was a pre-experimental design with a one-group pretest-posttest. Intervention carried out for 6 days with a practice in the morning and evening. The samples through purposive sampling method were 16 people. The results before the intervention 43,8%n of respondents moderate risk and after intervention became low risk (75%). Analysis of marginal homogeneity statistical test showed that there was a significant influence on the risk of foot ulcer before and after intervention of combination active lower range of motion and heel raise exercise (p value 0,001), and there was a relation between compliance medication (p= 0,01), smoking status (p= 0,005) on the risk of foot ulcers. To reduce the risk of complications on DM patient, combination active lower range of motion and heel raise exercises could be applied independently to reduce the risk of diabetic foot ulcers.

Cities are complex, dynamic and ever-evolving. We need to understand how these cities work in order to predict, control or optimize their operations. We have identified some open issues related to network and data complexity that need to be solved to build feasible methods for these purposes. To this end, we first build multiscale graphs automatically to address a problem that is becoming increasingly relevant in the age of big data, where reducing the network complexity could easily determine the viability of the research in real-world applications. Next, we propose different methods from different fields to extract the essence of network dynamics from the vast amount of spatiotemporal traffic data. One such method is a new way of looking at traffic patterns, combining the field of pattern recognition - with a focus on computer vision - with the traffic domain. The inspiration comes from the fact that humans are the most sophisticated pattern recognizer in the world and we use specific visual features to recognize different complex patterns and we explore if these features can also be used to recognize traffic patterns. Finally, we explore different applications of such mobility patterns such as revealing the unknown correlation between supply and demand patterns, evaluating the scalability of the proposed approach by applying the method to the entire Dutch highway network and transferability by building similar network patterns for public transport networks. Thus, this thesis develops a series of efficient data-driven methods for extracting the mobility patterns of large-scale metropolitan networks and explore some of their applications. With the increasing availability of data in the transport domain, the Achilles heel is not data scarcity anymore but rather extracting insights from this massive amount of data. This thesis is a step forward in solving this complex problem by leveraging the increased acceptance of using machine learning as a worthy and effective method for network-wide analysis of traffic patterns.

Introduction Postoperative pancreatic fistula (POPF) is the Achilles’ heel of distal pancreatectomy. Surgeons use abdominal drains for early prediction, diagnosis, and timely management of POPF. The utility of drainage fluid in the prediction and diagnosis of POPF is a matter of debate. Patients and methods This is a retrospective cohort study of all patients who underwent distal pancreatectomy between January 2018 and January 2020. The present study aims to evaluate the association between drainage fluid amylase (DFA) and systemic inflammatory markers in the prediction of clinically relevant POPF. Results This study included 44 patients with a mean age of 40.3±16.3 years, and the female : male ratio was 2.7 : 1. POPF occurred in 11 (25%) patients. Of them, nine (20.5%) patients were managed by additional ultrasound-guided tube drainage. Higher drainage fluid amount and DFA-D1 were associated with a higher risk of POPF (P=0.036, and 0.009, respectively). The leukocytic count was significantly higher in POPF in the third postoperative day (POD) (P=0.032). POPF group had a significantly higher level of serum lactate dehydrogenase (LDH) on the fourth POD (P=0.001). Patients with high DFA-D1 (>330 IU/l), rising leukocytic count, and high serum LDH were significantly at higher risk of POPF (9/11 developed POPF, P=0.0001). Conclusion DFA-D1, rising leukocytic count, and high serum LDH level compromised a more robust predictive model for POPF. The cutoff value of DFA proposed by the ISGPF is applicable when combined with leukocytic count and serum LDH. Prospective large-scale studies are needed.

“Why do we have psychiatry?” inquires the sociologist Owen Whooley—not a question he asks as prelude to yet another “antipsychiatry screed,” but, he avers, rather “as a serious puzzle in need of explanation” (p. 5). All professions worry over the legitimacy of their authority, Whooley observes, but in this regard psychiatry exists in a class by itself. “Ignorance is the consistent driving force behind the history of American psychiatry,” he writes (p. 9, emphasis in original). Or, as Whooley declares in another generalizing passage, psychiatry suffers “at root” from repetition compulsion, “asserting its authority on the basis of its expertise, all the while knowing that such claims are built on the shakiest of intellectual foundations” (ibid.). This brings Whooley to his framing query: If psychiatry in the United States has survived, and (for quite a time after World War II) even managed remarkably to thrive, by what mechanisms has this survival been made possible?

On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing

Background Pressure sore, bed sores, and decubitus ulcer have the same meaning and are used to describe ischemic tissue loss resulting from prolonged pressure over bony prominence. They can develop anywhere in the body, but often are located in the trochanteric, ischial, heel, and sacral areas. Although tissue destruction can occur over areas like the scalp, shoulders, calves, and heels when a patient is lying down, ischial sores occur in wheelchair-bound patients who are sitting, making ‘pressure sore’ the better term. Objectives The purpose of the study is to describe our experience in the management of sacral pressure sore with a gluteus maximus myocutaneous flap, its feasibility and outcome. Patients and methods Our prospective study has been conducted in the Surgery Department of Benha University Hospital from February 2017 to February 2019 on 20 patients treated with a unilateral gluteus maximus myocutaneous flap to reconstruct the presacral defect due to pressure sore and all patients have signed informed consents before they have been involved in this study. Results Gluteus maximus flap in presacral pressure sores is a highly feasible and effective method for the treatment of presacral pressure ulcer defect. It has been associated with short operative time (average 45 min) and small amounts of intraoperative blood loss (average 338 ml), three cases out of 20 showed postoperative hematoma, two cases developed wound dehiscence, two cases developed infection, one case developed partial flap necrosis, four cases developed pigmentation, two cases developed keloid, and only one case developed postoperative recurrence. Conclusion The gluteus maximus myocutaneous flap is a useful, safe, and versatile flap for the repair of presacral decubitus ulcer by a simple approach. It may be recommended as the procedure of choice for surgical treatment of this type of wound.

Background: Plantar fasciitis is a common and recurring cause of heel pain in adults. Platelet-rich plasma (PRP) derived from autologous blood contains a high concentration of growth factors necessary for tissue healing and offer potential treatment for plantar fasciitis. Materials and Methods: The study was conducted in Coimbatore medical college hospital as a day care procedure. Between May and September 2017, 100 patients with chronic plantar fasciitis with a mean age of 40 years were included in this prospective study and were treated with single autologous PRP injection. All patients were assessed for the pain on the visual analog scale (VAS) and the American orthopedic foot and ankle score (AOFAS) both preinjection and postsingle injection of PRP. Results: The average pain perception before injection as assessed using VAS was observed to be 9.1. Before PRP injection, 72% of patients had severe limitation of activities and 28% of patients had moderate limitation of activities. Following the administration of PRP, VAS decreased to 1.6. Eighty-eight patients were completely satisfied; eight patients were satisfied with reservation, whereas four patients were unsatisfied with the treatment outcome. AOFAS improved from 52 to 90, thus establishing its therapeutic efficacy both at 8 weeks and 3 months posttreatment. Conclusion: The results of this study support that injection of autologous PRP is safe, does not affect the biomechanical function of the foot and is efficacious in improving plantar fasciitis.

Background/objectives: The objective behind this study was to observe the prevalence of forefoot pain among ladies due to regular wearing of high heeled shoes. Previous literature showed a significant association of foot pathologies with high heels, but very few studies have been found to highlight the relationship between high heels and forefoot pain. This study focuses on the said prevalence among female teachers and students of different universities in Faisalabad. Methods: The study design selected was a cross-sectional survey. The sample size was 200 based on a previous study. The study setting was different universities of Faisalabad. A simple random sampling technique was used to collect the sample. The self-generated questionnaire was used as a research tool. Results and conclusion: Results were interpreted using frequency distribution bar charts. Results showed that 77.5% of the study population complaint of forefoot pain due to the regular wearing of high heeled shoes. Others suggested either pain in mid-foot and heel or no pain at all. Keywords: Forefoot pain; High heeled

Plantar fasciitis is a disorder of the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually and it affects both feet in about one-third of cases. The researches review the literature pertaining to types of treatment and their efficacy. This article presents on overview on current knowledge on plantar fasciitis and focuses on etiology, diagnosis and treatment strategies, conservative treatment.

Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures. Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One, Department of Orthopaedics, People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision. They were 16 males and 4 females, aged from 16 to 60 years. According to the Sanders classification, there were 3 cases of type Ⅱ, 15 cases of type Ⅲ and 2 cases of type Ⅳ. Their fractures were reduced by traction, extruding, prying and direct visualization through the tarsal canal window; the bone plates were inserted through a small incision at the back of the heel and fixated by screws. Postoperative observation was done to address fracture healing, and length, width, height, Bohler angle and Gissane angle of the affected calcaneus, as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation. Results The operation time for a single foot ranged from 45 min to 70 min, averaging 64.5 min; the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times, averaging 4.5 times. Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change. No other wound complications occurred. Their follow up was carried out for 6 to 36 months (average, 17.3 months). The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months. The length (80.5 mm±4.2 mm), width (44.8 mm±5.2 mm), height (44.4 mm±3.0 mm), Bohler angle (25.0°±5.1°) and Gissane angle (113.8°±8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm, 50.5 mm ± 6.3 mm, 40.0 mm±4.4 mm, 12.0°±13.8° and 107.0°±13.3°) (all P<0.05). By the AOFAS ankle-hindfoot scale, functional recovery of the foot was excellent in 20, good in 3 and fair in 2 cases, giving an excellent to good rate of 92%. Conclusion In the treatment of closed calcaneal fractures, open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Tarsal Canal; Small incision

Foot is an uncommon location for unicameral bone cyst, and it is widely believed that calcaneal cysts are typically asymptomatic. We report a case of a bilateral calcaneal cyst in a 65-year-old man which produced unilateral symptoms where open curettage and autogenous bone grafting provided a significant symptomatic relief. Our patient had complete symptomatic relief following surgical curettage without any perioperative complications. Calcaneal bone cyst, although rare, forms an important differential diagnosis in patients presenting with heel pain where surgical management can be a viable option in cases refractory to conservative treatment.

The relationship between holding baggage and heel high

Reviewed by: On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing by Owen Whooley Susan Lamb Owen Whooley. On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing. Chicago: University of Chicago Press, 2019. xiv + 298 pp. $30.00 (978-0-226-61638-4). In his second book, On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing, sociologist Owen Whooley turns the sociology of knowledge approach on its head to study what effects the absence of knowledge can have on a medical specialty—in this case, our persistent ignorance about the fundamental mechanisms of mental illnesses. Unlike other successful disciplines and professions, he contends, American psychiatry was "shaped less by the knowledge it has secured and more by the ignorance it cannot resolve" (p. 197). The result, Whooley suggests, has been a cycle of professional crisis and reinvention, which he categorizes as five linear periods: the nineteenth-century asylum era; the psychobiological period of the early twentieth century; Freudian psychoanalysis after World War II; community psychiatry after John F. Kennedy signed the Community Mental Health Act in 1963; and, in the 1980s, the neo-Kraepelinian revolution rooted in revisions to the specialty's Diagnostic and Statistical Manual (DSM-III). He concludes that these epochs indicate an enduring pattern of epistemic crises and corresponding professional reinventions designed to mask or manage ignorance. In a systematic examination of the American Journal of Psychiatry, from its inception in 1844 (under various titles) to the present, Whooley observes that psychiatrists have long grappled openly with epistemological uncertainty. In Chapter 1, he suggests that asylum superintendents employed optimistic rhetoric to mask ignorance, which produced a "cult of curability" and gave them "absolute psychiatric authority" (p. 53) in the nineteenth century. Chapter 2 describes the reinvention of psychiatry in the next century under Adolf Meyer's program of psychobiology, which "promised to resolve ignorance by pursing it in all directions" until such efforts "coalesced into a complete picture of mental illness" [End Page 156] (p. 64). While psychobiology did not fulfill its promise, Whooley reckons, it gave rise to the discipline's habit of reinventing itself when faced with epistemological crises. After World War II, he argues in Chapter 3, psychoanalysts successfully sold their well-defined theory as an antidote to open-ended approaches, but in due course psycho-sexual reductionism gave rise to new crises. Chapter 4 flirts with a multifactorial explanation of the emergence of community psychiatry in the 1960s (e.g., the advent of anti-psychotic drugs and team-based approaches in medicine; changes in welfare policy that favored noninstitutional measures; reportage that exposed the failings of state hospitals; and, significantly, federal legislation mandating the creation of Community Mental Health Centers)—but, staying on message, Whooley ultimately concludes that deinstitutionalization resulted from psychiatrists' professional imperative "to mitigate psychiatric ignorance by diluting it" (p. 157). Chapter 5 describes how neo-Kraepelinians successfully pursued reinvention as an overt strategy by promoting the revised DSM-III as proof of a paradigm shift within the discipline, from psycho-dynamically to somatically oriented. Classification, they promised, was the solution to ignorance. According to Whooley, the conviction of that promise contrasts sharply with its failure today, and recent debates about DSM-V once again showcased psychiatrists' "lack of mastery" and "nervous fiddling" over that ever-elusive question: what are the mechanisms of mental illnesses? The strength of the monograph—in addition to its superbly crafted narrative and exposition—is its original frame and research questions. Whooley rightly asks: If professional authority rests upon a discipline's claim to esoteric knowledge, how did psychiatrists successfully professionalize and exercise power without ever achieving a basic understanding of their object(s) of study? Undoubtedly, historians of psychiatry and their students will find it valuable to join the author as he grapples with this question. What they won't find is new information about asylums, psychobiology, psychoanalysis, deinstitutionalization, or DSM; all of this Whooley deals with superficially even as he shows us new ways to consider these carefully-studied developments. Importantly, this is a sociology of American psychiatry, not a history of it, that relies principally on prescriptive and declarative statements made by psychiatrists—to...

Objective To investigate the clinical efficacy of tight suturing for shortening healing scar tissues in repair of Myerson type III old rupture of Achilles tendon. Methods A retrospective case series study was performed to analyze the clinical data of 16 patients with Myerson III type chronic Achilles tendon ruptures admitted to Sports Hospital Affiliated to Chengdu Sport University from January 2015 to December 2017. All of the patients were males with sports injuries, aged 19-71 years (mean, 40.6 years). The Achilles tendon defect was 5-7 centimeter (mean, 5.2 centimeter). The patients received tight suturing and shortening healing scar tissue for the repair. The operation time and surgical wound size were recorded. The clinical efficacy was evaluated by Amer-Lindholm standard and American 0rthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Meanwhile, the complications such as wound infection, Achilles tendon re-rupture, heel lifting weakness, muscle strength decline, ankle dysfunction, lameness and symptoms of sural nerve injury were recorded. Results All patients were followed up for 11-41 months, with an average of 26 months. The operation time ranged from 25-51 minutes, with an average of 37 minutes. The incision was 4-12 cm, averaging 7 cm. According to the Amer-Lindholm standard, 14 patients were graded as excellent and two were graded as good, with the excellent and good rate of 100%. AOFAS ankle-hindfoot score increased from (42.7±6.8)points before operation to (95.1±4.9)points at the last follow-up (P<0.05). During the follow-up, there were no complications such as infection, Achilles tendon rupture, heel lifting weakness, muscle strength decline, ankle joint dysfunction, lameness and gastrocnemial nerve injury. Conclusion For Myerson type III old rupture of Achilles tendon, tight suturing for shortening healing scar tissue can increase the postoperative function scores without wound infection or complications. Key words: Achilles tendon; Wounds and injuries; Cicatrix; Tight suture

The Kickstand technique is an extension added to the basic frame of modern external fixation to elevate an affected extremity. It is an affordable and modified external fixation in orthopedic trauma. Orthopedic physicians use this technique to prevent formation of pressure sores and relieve swelling in lower extremity of patients who require prolonged bed rest, because this technique makes the heel apart from the supporting surface and promotes circulation of venous blood lymph fluid. This paper briefly introduces the development of this technique and its efforts to improve quality of care and solve a clinical problem. To relieve the burden of healthcare for pressure sores and swelling in an affected lower extremity after surgery, this technique should be popularized. Key words: External fixators; Wounds and injuries; Edema; Pressure sores; Prevention; Kickstand technique

Objective To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. Methods From May, 2015 to February, 2018, 16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. All wounds were treated with one-stage dilatation and VSD to control infection. In cases of chronic calcaneal bone infection, the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement. The area of soft tissue defect on the lateral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm, and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm. The small donor area of the flap was sutured directly, and the larger area was repaired by skin grafting. Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing membrane formation 6 to 8 weeks after flap transplantation. All cases were followed-up, including 7 cases outpatient follow-up and 9 telephone follow-up. Results All the 16 flaps survived smoothly. The donor and recipient areas of the flaps healed primarily. All cases were followed-up for 3 to 13 months. The flaps had good shape, no swelling, similar color to heel skin and no pigmentation. Ankle flexion and extension were not restricted. Four cases with chronic osteomyelitis of calcaneus healed well after second-stage bone grafting, with an average healing time of 8.5 months. Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply. Key words: Lateral supramalleolar flap; Perforator of peroneal artery; Repair; Heel wound; Microsurgical technique

Purpose To assess superiority of paclitaxel drug-coated balloons (DCB) in prevention of neointimal hyperplasia and restenosis after treatment of symptomatic superficial femoral artery (SFA) occlusive lesions. Background Endovascular treatment (ET) has become the first choice for SFA atherosclerotic lesions. Despite enhanced immediate technical success, neointimal hyperplasia and restenosis remain the Achilles heel of ET. Patients and methods This prospective randomized controlled two-arm blind interventional study was conducted on 134 patients with symptomatic SFA atherosclerotic lesions. Patients were randomly allocated by using simple random allocation method, where 134 cards were used for allotment of cases into two groups (67 patients were assigned to group A, in which patients were subjected to treatment with paclitaxel DCB and other 67 were assigned to group B, where patients were subjected to treatment with plain old balloon angioplasty). Follow-up was for 2 years. Results Primary patency and limb salvage after 1 and 6 months were statistically insignificant in both groups (P=0.21 and 0.19 and 0.049 and 0.051, respectively), but after 12 and 24 months, primary patency and limb salvage were statistically highly significant in group A (P=0.0018 and 0.0011 and 0.0019 and 0.0023, respectively). Conclusion ET with DCB has equal risks but higher antirestenotic efficacy than plain old balloon angioplasty in femoropopliteal artery disease. The use of DCB increases patency and limb salvage. Stenting still has a rising role in bail-out in the treatment of SFA occlusive disease and is associated with better acute angiographic results.

Objective Ischemic wounds of the foot are the most common cause for major amputations in vascular surgical patients. It can be presumed that revascularization of the artery directly supplying the ischemic angiosome may be superior to indirect revascularization (IR) of the concerned ischemic angiosome. Patients and methods This prospective study enrolled patients with critical limb ischemia due to isolated infrapopliteal disease (stenosis of ≥70% or complete total occlusions of the crural arteries) presented to our Vascular Department between April 2017 and April 2018. We categorized the treatment groups into two main groups: direct revascularization (DR) and IR. We excluded patients with acute limb ischemia, inflow lesions above the knee, sepsis, myocardial infarction during the previous 14 days, blue toe syndrome (microembolization), and patients who cannot ambulate. Results In this study, there were 23 patients with forefoot ischemia, eight patients had ischemic heel, and two patients had mid-foot ischemia. All patients were followed at 1, 6, and 12 months postoperatively for wound healing, major amputation, or death. Wound healing at 1, 6, and 12 months for DR versus IR was 16.6 versus 9.09%, 56.3 versus 33.3%, and 93.75 versus 87.75%, respectively. The limb salvage rate in the DR group was 88.9% and in IR group was 72.7%. The mortality was 10% for DR and 15.4% for IR at 12 months. Conclusion To obtain better wound healing rates, DR of the ischemic angiosome should be considered whenever possible. Revascularization should not be denied to patients with indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.

Background: Pressure ulcers represent a common health problem among the immobilized patients that prolong their period of hospitalization. The skin care, reduction of pressure on the bone prominence areas, and mobilizing the bedridden patients can provide a significant difference in pressure ulcer development. Aim of the study was to evaluate the effect of skin care and bony prominence protectors on pressure ulcers among the hospitalized bedridden patients. A quasi-experimental research design was adopted. Setting: The study was carried out at the orthopedic and ICUs of Menoufia university hospital, Menoufia governorate, Egypt. Subjects: A total of 282 patients were recruited. Tools: Five tools were used included the structured questionnaire, Braden Scale for Predicting Pressure Sore Risk, Pressure Ulcer Scale for Healing, Katz Index of Independence in activities of daily living, and Glasgow Coma Scale. Results: The mean age for the patients was 48.7 ± 13.3 years old. Three quarters of the sample were adult and 25.5% was elderly patients with mean age 64.97 ± 5.21 years old. 96.2% of the adult patients and all the elderly patients had a high risk for bedsores. The reported causes for pressure ulcers were the increased level of dependence due to immobility, uncontrolled chronic diseases, urinary and fecal incontinence, anti-inflammatory and corticosteroid medications, obesity, edema, anemia and dementia. There was a reduction of pressure ulcer risk with a statistically significant difference between the pre and post-test for the Braden score and pressure ulcer healing score (P Conclusion: Skin care and bony prominence protectors can reduce the risk for pressure ulcers. Recommendations: The nurses should encourage the patient's mobility, assess the skin regularly, and provide skin care especially in the scapula, elbows and buttocks for the ICU patients and focused the skin care in the knee, heel, buttocks and toes for the orthopedic patients.