Prospective Recipients Research Articles

Effectiveness, Acceptability, and Feasibility of a Telehealth HIV Pre-Exposure Prophylaxis Care Intervention Among Young Cisgender Men and Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial.

Despite its promise for HIV prevention, the uptake of pre-exposure prophylaxis (PrEP) has been slow, and there have been substantial inequities in PrEP access. Young men who have sex with men and transgender women of color are most in need of PrEP and least likely to have that need fulfilled. PrEP telehealth care, which provides remote PrEP care via electronic communication, seems well suited to address several of the challenges of PrEP provision, including discomfort with stigmatizing and difficult-to-access health care systems, transportation challenges, and privacy concerns, and address disparities in PrEP access. Research suggests that PrEP telehealth care has promise and is a favored option for many prospective recipients of PrEP. However, despite growing attention to telehealth approaches as an avenue for increasing access to PrEP amidst the COVID-19 pandemic, there have been no published randomized controlled trials (RCTs) on PrEP telehealth care to date, making it difficult to draw strong conclusions about the advantages or disadvantages of telehealth compared with usual PrEP care. We developed PrEPTECH, a telehealth intervention that focuses specifically on alleviating issues of stigma, access, cost, and confidentiality for young people with risk factors for HIV infection who are seeking PrEP care. Leveraging data from the 2017 observational pilot study, we redesigned and enhanced PrEPTECH. This study aims to assess the effectiveness, acceptability, and feasibility of a telehealth HIV PrEP care intervention, PrEPTECH, in increasing PrEP uptake. This is the protocol for an RCT of young cisgender men and transgender women who have sex with men in 4 regions within the United States: the San Francisco Bay Area, California; Los Angeles County, California; Miami-Dade County, Florida; and Broward County, Florida. Participants in the intervention arm received access to a web-based telehealth program, PrEPTECH, which offers a fully web-based pathway to PrEP, whereas those in the control arm received access to a dynamic web page containing publicly available informational resources about PrEP. Follow-up data collection occurred at 3 and 6 months. An analysis will be conducted on outcomes, including PrEP initiation, persistence, adherence, coverage, and medication prescription, as well as PrEPTECH acceptability and feasibility. The study was funded in 2019 and received institutional review board approval in 2020. The PrEPTECH intervention was developed over the next 1.5 years. Study recruitment was launched in February 2022 and completed in September 2022, with 229 participants recruited in total. Data collection was completed in April 2023. The results of this RCT will offer valuable evidence regarding the effectiveness, acceptability, and feasibility of telehealth HIV PrEP care interventions among young cisgender men and transgender women who have sex with men. ClinicalTrials.gov NCT04902820; https://clinicaltrials.gov/ct2/show/NCT04902820. PRR1-10.2196/47932.

Improving community welfare through Non-Cash Food Support Programs in Jeneponto Regency, South Sulawesi, Indonesia

To improve people’s welfare, policies are needed that can help people get above the poverty line. This study aims to describe how the implementation of the Non-Cash Food Assistance Program can improve the welfare of the people in Jeneponto Regency. This study uses a qualitative research design. Data collection techniques are through observation, in-depth interviews, and documentation. The results of the study show that the Non-Cash Assistance Program in Jeneponto Regency can improve people’s welfare which is marked by a decrease in the percentage of the poverty rate from 14.28 percent in 2021, down in 2022 to 13.73 percent. This decrease in the percentage of the poverty rate has made Jeneponto Regency no longer the Regency with the highest poverty rate in South Sulawesi Province. For services, it was found that e-warongs serving the community had low competence, which affected the quality of food sold by e-warongs to beneficiary families. This study concludes, improvement is needed in determining the target group by setting strict criteria for prospective program recipients, and it is necessary to have a cluster for each category, so that the formulation is also adjusted based on needs. Determination of providers must apply a competition system, so that the quality of basic ingredients is maintained at affordable prices.

Ionized Magnesium Correlates With Total Blood Magnesium in Pediatric Patients Following Kidney Transplant.

Abnormal serum magnesium (Mg) concentrations are common and associated with worse mortality in kidney-transplant recipients. Many kidney and transplant-related factors affect Mg homeostasis. The concentration of the active form, ionized Mg (iMg), is not measured clinically, and total Mg (tMg) and iMg correlations have conflicted. We hypothesized that iMg and tMg concentrations show poor categorical agreement (i.e., low, normal, and high) in kidney-transplant recipients but that ionized calcium (iCa) correlates with iMg. We retrospectively evaluated hypomagnesemia in kidney-transplant recipients over a 2-yr period. We prospectively collected blood at 0-28 days post-transplant to measure correlations between iMg and iCa/tMg. iMg and iCa concentrations in the reference ranges of 0.44-0.65 and 1.0-1.3 mmol/L, respectively, were considered normal. Fisher's exact test and unweighted kappa statistics revealed category agreements. Pearson's correlation coefficients and linear regression measured correlations. Among 58 retrospective kidney-transplant recipients, 54 (93%) had tMg<0.66 mmol/L, 28/58 (48%) received Mg supplementation, and 20/28 (71%) had tacrolimus dose adjustments during supplementation. In 13 prospective transplant recipients (N=43 samples), iMg and tMg showed strong category agreement (P=0.0003) and correlation (r=0.71, P<0.001), whereas iMg and iCa did not (P=0.7; r=-0.25, P=0.103, respectively). tMg and iMg exhibited strong correlation following kidney transplantation. However, iCa may not be an accurate surrogate for iMg. Determining the effect of Mg supplementation and the Mg concentration where supplementation is clinically necessary are important next steps.

The Effect of Using Financial Information Service System (SLIK) on Bad Credit Rate in Fintech Peer to Peer Lending

The development of Fintech Peer to Peer Lending (P2P Lending) in Indonesia is very rapid in supporting increased financial inclusion. Along with the increase in the value of loans disbursed through P2P Lending, the ratio of bad loans or what is often referred to as Non Performing Loans (NPL) also continues to increase. Literature review article "Can the Use of a Financial Information Service System (SLIK) Affect the Level of Bad Credit in Fintech Peer to Peer Lending?" is a scientific article that aims to build a research hypothesis on how one variable influences other variables. The method used in writing this literature review article uses the library research method. The sources used as material for research are through available data from the website of the Otoritas Jasa Keuangan (OJK) &amp; Asosiasi Fintech Pendanaan Bersama Indonesia (AFPI), academic online media, Google Scholar, Mendeley, and other online media. The results of this study provide information that can be used in efforts to minimize the occurrence of an increase in credit risk (NPL) in the P2P Lending industry, namely by taking preventive steps by making an effective creditworthiness assessment to prospective loan recipients through analysis of credit information data obtained from Sistem Layanan Informasi Keuangan (SLIK). Therefore, as an effort to restrain the rate of increase in the number of bad loans in the P2P Lending industry, a tool is needed to carry out an effective credit scoring (credit scoring) by integrating P2P Lending credit loan data into SLIK so that more credit data of prospective loan recipients can be obtained. comprehensive. More comprehensive data can provide more accurate results on credit scoring, and have a positive impact on loan repayment rates.

Hybrid Decision Tree Method and C4.5 Algorithm for a Recommendation System in Determining Recipients of Direct Cash Assistance (BLT)

Development of a recommendation system to determine recipients of Direct Cash Assistance (BLT) using the C4.5 algorithm hybrid method and decision tree. In the current era of digitalization, the BLT program is a solution for the Indonesian government to help people affected by the COVID-19 pandemic. In this study, we propose a recommendation system that combines the C4.5 algorithm and a decision tree to increase accuracy and efficiency in determining BLT beneficiaries. Primary data was obtained through interviews and observations, while secondary data was obtained from the village administration, written reports, journals, theses and previous research. The results showed that the C4.5 algorithm and decision tree hybrid method gave good performance in determining BLT recipients. The C4.5 algorithm is used to calculate the accuracy of the training data and testing data with a ratio of 80% : 20%, while the decision tree is used to create a decision tree that classifies prospective BLT recipients. This research fills in the previous research gap regarding the recommendation system for determining BLT beneficiaries. The results of this study are expected to provide useful information for the government in making decisions regarding the BLT program, especially at the village or sub-district level. With an accurate and efficient recommendation system, financial assistance can be provided to those who really need it, helping to meet the basic daily needs of affected communities.

Determination of Candidates for Madrasah Aliyah Student Scholarships Using The Simple Additive Weighting Method

Scholarships are a facility expected by some students who need financial assistance in their education. Case study research at MAN 3 Tangerang as a state Islamic senior high school, MAN 3 Tangerang has facilities to propose students who have achievements and need educational funding assistance to the Indonesian Ministry of Religion (Kemenag). Schools often find it difficult to determine which prospective students are most eligible for scholarships. This research is to help the school design and develop a decision support system (DSS) application with the Simple Additive Weighting (SAW) method. DSS application built using UML design and PHP (Hypertext Processor File) programming with MySQL database. The resulting DSS application has been able to provide a sequence of data for prospective scholarship recipients according to the criteria and weightings that have been set. Based on the data generated by the system, the principal can make a decision on who is entitled to a scholarship from the Ministry of Religion (Kemenag).

Decision Support System for Admission of Regional Government Scholarships in Merauke Regency Using the TOPSIS Method

Scholarship is a government program given to high school graduates to be able to continue their studies at the tertiary level. This is as stipulated in the Regent Regulation (PERBUP) No 25 of 2019 concerning "providing scholarships and educational assistance to students of Merauke Regency". In the scholarship acceptance selection activities in 2019, approximately 103 applicants were recorded, and 74 were successfully accepted. The process of selecting prospective scholarship recipients is currently being carried out, namely checking and comparing one by one with the applicant's data. Based on data in 2019, where there are applicants whose report card value data is incomplete but is accepted for a scholarship. This is considered to have an impact on the decision-making results of prospective scholarship recipients in subsequent years. In order to assist KESRA in selecting scholarship recipients, these obstacles can be overcome by using a decision support system. The design of this decision support system is carried out using the TOPSIS method, namely selecting the alternative that is the shortest distance from the positive ideal solution and the furthest distance from the negative ideal solution. The results obtained in this study are a system that can assist the People's Welfare in determining the selection of scholarship recipients based on the three predetermined criteria. Testing the accuracy of the system obtained is 67% and for testing the questionnaire to obtain a percentage of 66.67% which is in the "Agree" category.

PENERAPAN METODE TOPSIS DALAM SISTEM PENGAMBILAN KEPUTUSAN PEMBERIAN BANTUAN REHABILITASI RUMAH

The provision of assistance for the rehabilitation of uninhabitable houses to the community often results in fraud and errors in the process of selecting and providing assistance. The TOPSIS method is a method used to calculate in the decision-making process in determining prospective recipients of uninhabitable housing rehabilitation assistance. The results of the TOPSIS calculation from the system were then tested using the sensitivity test method by giving a weight change of 0.5 and 1 for each criterion weight. The test results in 2019 with a total of 25 families of data obtained the most sensitive criteria for adding a weight of 0.5, namely the criteria for work and life dependents with a percentage result of 92%, while for adding weight to 1 the most sensitive criterion is the job criteria with a percentage result of 96%. Black box testing of the system built is measured using a questionnaire media with 10 statement items given to 15 respondents which is calculated using a Likert Scale where the system built is highly approved which can be seen from the index percentage value greater than 80% (strongly agree).

Pendulum test parameters are useful for detecting knee muscle hypertonia and quantifying response to an intrathecal baclofen bolus injection.

Our objective was to determine which pendulum test parameters are useful for detecting hypertonia in the knee muscles and assessing the group and individual responses to intrathecal baclofen (ITB) bolus injection among prospective pump recipients. We included 15 neurological patients with lower limb hypertonia (mainly spinal cord injury, n = 7) and collected data the day before (baseline), and 2.5 and 5.0 h after the 50-µg ITB bolus injection. For comparison, data were collected in 15 healthy controls. The average over six test repetitions was obtained for the number of oscillations, swing time (SwingT), amplitudes of the first flexion and extension, maximum angular velocities of the first flexion (F1V) and extension (E1V), relaxation index, and damping coefficient (DampC). Across the patient group, all pendulum parameters indicated a significant decrease in hypertonia from baseline to postinjection (analysis of variance P ≤ 0.004), except DampC. On the basis of the cutoffs from the receiver operating characteristic curve, all parameters were good or excellent discriminators of hypertonia in patients from normotonia in controls (area under the curve ≥0.85), with the highest sensitivity for SwingT and E1V (≥93%). Furthermore, all parameters except F1V revealed a significant shift from preinjection hypertonia to postinjection normotonia among patients (McNamar test P ≤ 0.002, DampC excluded due to missing data), with the greatest responsiveness for E1V and relaxation index (≥73%). The results confirm the overall usefulness of pendulum test parameters in this patient population and indicate that some parameters are better at detecting hypertonia (SwingT, E1V) whereas others (E1V, relaxation index) are more responsive to the ITB injection.

Ostracism and sharing in an intergroup context.

Previous research suggests that social exclusion is linked to a decrease in individuals' prosocial behavior. However, this effect has not been examined in an intergroup context. We manipulated social acceptance (using the Cyberball game) to examine participants' sharing with ingroup or outgroup members in a minimal group paradigm. Results revealed that when the prospective recipient was a group member who rejected them, socially excluded participants shared less than their socially accepted counterparts. However, when faced with members of an outgroup, socially excluded participants showed similar levels of prosocial behavior as their socially accepted counterparts. Further results suggest that the tendency of socially excluded participants to act in a less prosocial manner toward members of a group that had rejected them was generalized to the group as a whole (including group members with whom there had been no previous interaction). We discuss the theoretical and practical implications of these findings.

PERANCANGAN APLIKASI PENILAIAN RUMAH TIDAK LAYAK HUNI MENGGUNAKAN METODE SIMPLE ADDITIVE WEIGHTING PADA KEGIATAN KEMENTERIAN PUPR

Determination of recipients of uninhabitable housing assistance (RTLH) is one of the problems that is of concern to the Directorate of Self-Help Housing of the Ministry of Public Works and Public Housing of the Republic of Indonesia, because the large number of data on incoming aid proposals makes it difficult to determine which beneficiaries deserve due to the limited budget. One way to determine beneficiaries is to use a decision system using the Simple Additive Weighting (SAW) method. This method will provide the value of the selected alternative preference as an indicator to determine the recipient of assistance as it can help the data processing team, stakeholders and leaders in the Directorate of Self-Help as the government which has a policy in determining the prospective recipients of the house renovation assistance objectively not subjectively. The data used was taken from data collection conducted by the field team in the Serang City area of Banten Province where the data obtained were 935 residents

Decision Support System for Prospective Scholarship Recipients Using SMARTER and Forward Chaining Method

The purpose of this research is to design and build a web-based decision support system application to determine prospective scholarship recipients at MAN 2 Yogyakarta and test its reliability. The Decision Support System is a problem solving system with supporting tools. This system can solve problems using algorithm methods. One of the decision support system methods that can be applied to scholarship cases at MAN 2 Yogyakarta is the Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER) method and forward chaining. The SMARTER method is a decision support method by determining the criteria and sub-criteria and their weight using the ROC (Rank Order Centroid). Meanwhile, the forward chaining method is a search method or a forward tracking technique that starts with existing information and combines rules to produce a conclusion or goal. The advantages of the DSS that have been developed are as follows. (1) The DSS built can be used by the scholarship selection team to recommend students who have the potential to get scholarships more quickly and objectively (2) The DSS for prospective scholarship recipients that was developed uses two methods of calculation, namely the Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER) and Forward Chaining methods, so that the prediction results are better and faster. The SMART method emphasizes more detailed criteria and the Forward Chaining Method allows for a faster selection process.

Implementation of K-Means and SAW Methods in Determining Non-Cash Food Aid Recipients

Determination of prospective non cash food assistance recipients, especially in Air Talas village, still uses a manual system so that in the process of determining the recipient there is a risk that the recipient will be inaccurate, so that the village government needs a system that can assist the process of determining prospective non cash food assistance recipients. This study aims to implement the K-Means and SAW methods in determining recipients of non cash food assistance in Air Talas village. The benefits of this research can help the Air Talas village government in determining and recommending prospective non cash food assistance recipients in accordance with established criteria, making it easier to filter, group, and rank appropriate population data according to criteria. In addition, this research is also useful for providing convenience to the community through data collection, clustering, and ranking in a transparent, real, and fast and accurate manner using decision support system software. The K-Means clustering method and the Simple Additive Weighting Ranking method were used in this study with data collection techniques through interviewing sources, in this case the village government, the social section of the community, and through collecting village archive data and relevant journals. The research location is Air Talas village with 316 data used. The results of the study are clustering data as much as 77 data obtained from feasible clusters. The cluster data was then tested using the accuracy value and obtained a value of 80%. Then the research is also in the form of ranking data using clustered data which obtains an accuracy value of 64%.

Maximizing the First-Year Planning Period for Scholarly Publications: Implications for Prospective CYFAR Grant Recipients

One of CYFAR's unique features is the built-in planning year for all grant recipients. We present our evaluation team’s approach during year 1 to establish a foundation and plan for scholarly publications during funding years 2–5. The systematic literature review provided the team with a better understanding of the culture and context of the project’s target population. Collaboration between PI/Co-PI and Evaluator served as a powerful tool to achieving this goal. Not only does this model benefit future CYFAR grant recipients’ and Extension professionals’ curriculum development and program evaluation, it can also inform recruitment efforts and community partnership development.

Analisis Efektivitas Promosi Perguruan Tinggi Dengan Penerapan Model AISAS

ABSTRACT Technological advances today, especially the internet of things, are widely used by people in their daily transactions, communication and searching for various information. One of the promotional media used in universities is in the form of visual communication media using the AISAS model in describing online promotions used by universities. This study aims to analyze the effectiveness of promotions carried out by the promotion of new student admissions (PMB) of Pekalongan University based on the concept of marketing communication and technological developments, namely attention, interest, search, action, and share (AISAS model). This study used a descriptive approach by distributing questionnaires to prospective new student recipients. With this research, it can be useful to evaluate the new student admissions section so that in making promotions, it is necessary to pay attention to the AISAS aspect so that the number of student applicants is much higher. The results of this study show that online promotion has a significant effect on attention, interest, and share. While promotion does not have a significant effect on search and action. Attention has a significant positive impact on interest. Interest has a significant positive effect on search. Search has a positive and significant effect on actions while actions do not have a significant effect on shares. Keywords: Marketing Communications, Promotion, College, AISAS

Incorporation of Genetic Studies in the Kidney Transplant Evaluation Clinic: The Value of a Multidisciplinary Approach.

Recent studies identified underlying genetic causes in a proportion of patients with various forms of kidney disease. In particular, genetic testing reclassified some focal segmental glomerulosclerosis (FSGS) cases into collagen type 4 (COL4)-related nephropathy. This knowledge has major implications for counseling prospective transplant recipients about recurrence risk and screening biologically related donors. We describe our experience incorporating genetic testing in our kidney transplant multidisciplinary practice. Patients' DNA was analyzed using whole exome sequencing for a comprehensive kidney gene panel encompassing 344 genes associated with kidney diseases and candidate genes highly expressed in the kidney. Results were correlated with phenotype by a multidisciplinary committee of nephrologists, renal pathologists, geneticists, and genetic counselors. Between October 2018 and July 2020, 30 recipient and 5 donor candidates completed testing. Among recipient candidates, 24 (80%) carried the diagnosis of FSGS, 2 (6.7%) tubulointerstitial nephritis, and 1 (3.3%) nephrolithiasis, and 3 (10%) had an unknown cause of kidney disease. The yield for pathogenic/likely pathogenic variants was 43.3%, with majority being COL4 variants (53.8%). Among those with FSGS diagnosis, the yield was 10 of 24 (41.6%), with 29% reclassified into a COL4-related nephropathy. Family history of kidney disease was the only clinical characteristic difference between recipients with positive and negative results (76.9 versus 29.4%; P = 0.025). One of 5 donors tested positive for a pathogenic/likely pathogenic variant and was excluded from donation. We conclude that thoughtful use of genetic testing can be valuable for kidney donor selection and transplant recipient management.

INFORMATION FOR THE IDENTIFICATION AND VERIFICATION OF PROSPECTIVE POVERTY SOCIAL ASSISTANCE RECIPIENTS

One important aspect of the poverty alleviation strategy is the availability of accurate poverty data, so that the government in providing social assistance (Bansos) can be right on target. The problem is that if there is an inaccuracy in the identification process when recording citizen data, it will affect the process of verifying and validating data on prospective Social Assistance recipients. Inaccuracies in prospective Social Assistance recipients can occur due to the process of collecting data on citizen identities and applying the wrong criteria for poverty requirements and the data is not up to date. The purpose of this research is to develop an information system to identify, verify, and validate data on prospective Social Assistance recipients. The identification stage for potential recipients of social assistance is carried out at the RT/RW and Kelurahan levels. The verification stage is carried out by fulfilling the requirements of the poverty criteria. Meanwhile, the validation stage is used to determine the ranking of potential social assistance recipients. The verification process is carried out at the Kelurahan and Kecamatan levels, while the validation process is at the Regency/City level. The waterfall method is used in the development of information system prototypes for prospective Social Assistance recipients with system analysis and design using use case, activity, and sequence diagrams. The prototype was tested with CRUD and trial &amp; error, the result is a prototype system application that is able to collect citizen data by applying a priority scale for prospective recipients of social assistance based on a web by fulfilling the requirements of 14 poverty criteria according to the Central Statistics Agency (BPS).

Analysis of Moral Reasoning in the Submission of Recipients of the Family Hope Program in Mazingo Tanose'o Village, Hiliduho District, Nias Regency in 2023

Moral reasoning is a person's ability to weigh alternative decisions and determine the possible direction of action that must be carried out in dealing with certain social situations, and the level of development of this ability. This research is motivated by problems caused by the submission of recipients of the Family Hope Program (PKH) in the implementation process, there are deviations from government regulations and policies related to PKH during the implementation of the plan. The submission of recipients of the Family Hope Program (PKH) in Mazingo Tanose'o Village, Hiliduho District, Nias Regency has not been based on Moral Reasoning. The purpose of this study is to determine the application of moral reasoning in the application of PKH recipients, the reasons for submitting the names of PKH recipients not yet based on Moral Reasoning and the efforts made so that the application of PKH recipients does not deviate from the rules. The research method used is a qualitative research method with a descriptive approach and with a total of 9 informants. The submission of PKH recipients has been based on the application of moral reasoning, but in its implementation the Village Head only has the authority to submit data on prospective PKH recipients. Efforts made so that the submission of PKH recipients does not deviate from the rules are that the Village Facilitator or the Social Service always updates the data, the Village Facilitator routinely conducts home visits to ensure the actual situation, as a community must provide original data to the Social Service and use PKH funds specifically for children's health and education.

Key informant perspectives on the enforcement of police-imposed barring notices and prohibition orders in Western Australia.

Individuals who engage in problematic behaviours within Australian night-time entertainment precincts can be banned from entering certain locations. Bans are expected to deter recipients, and prospective recipients, from further inappropriate behaviours. The collective effect is intended to reduce crime and increase community safety within entertainment precincts. This article explores key informant perspectives regarding the enforcement of two patron banning mechanisms (police barring notices and prohibition orders) used across Western Australia. Interviews were conducted with 54 participants, including licensees, venue staff, WA Police officers, ID scanner representatives, andRegistered Training Organisations. Few participants opposed patron banning in principle, but most identified limitations within the current operation of both provisions. Concerns were expressed about the effectiveness of enforcement, linked to questions about the way in which banned patron information is currently shared and the practicalities of identifying recipients of bans. Suggestions included improved data-sharing protocols and the wider use of ID scanners. With improvements to operational processes-particularly more effective sharing of banned patron data, and consideration of networked ID scanners-there is clear potential to improve the enforcement and increase the effectiveness of police barring notices and prohibition orders. This study is part of a wider project which has examined the use and effects of patron banning in WA. Additional findings are presented in further papers.

Klasterisasi Penerima Bantuan Sosial Menggunakan Metode Simple Additive Weighting

This research is about a decision support system using the Simple Additive Weighting method to help determine the recipients of social assistance wich provided by the government with the aim to improve their standard of living. Wedomartani Village has a fairly large area with a large population. The problem is that the number of potential beneficiaries is not proportional to the available social assistance quota, so it is necessary to select recipients based on certain criteria to fit the target. The Simple Additive Weighting (SAW) method has been used to determine the nomination of candidates for social assistance. From the results of data processing for prospective recipients of Bantuan Langsung Tunai Dana Desa (BLT-DD) in 2020, If the largest 25 are taken from it, it shows that the distribution of the poverty level of the population in the area is not evenly distributed, so a policy made by the sub-district government is needed for more specific poverty reduction.