16 resultados para pre and posttest
em Instituto Politécnico do Porto, Portugal
Resumo:
Background: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. Objective: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy , effectiveness, and user satisfaction. Methods: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. Results: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students’ posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. Conclusions: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education.
Resumo:
Asthma is a chronic inflammatory disorder of the respiratory airways affecting people of all ages, and constitutes a serious public health problem worldwide (6). Such a chronic inflammation is invariably associated with injury and repair of the bronchial epithelium known as remodelling (11). Inflammation, remodelling, and altered neural control of the airways are responsible for both recurrent exacerbations of asthma and increasingly permanent airflow obstruction (11, 29, 34). Excessive airway narrowing is caused by altered smooth muscle behaviour, in close interaction with swelling of the airway walls, parenchyma retractile forces, and enhanced intraluminal secretions (29, 38). All these functional and structural changes are associated with the characteristic symptoms of asthma – cough, chest tightness, and wheezing –and have a significant impact on patients’ daily lives, on their families and also on society (1, 24, 29). Recent epidemiological studies show an increase in the prevalence of asthma, mainly in industrial countries (12, 25, 37). The reasons for this increase may depend on host factors (e.g., genetic disposition) or on environmental factors like air pollution or contact with allergens (6, 22, 29). Physical exercise is probably the most common trigger for brief episodes of symptoms, and is assumed to induce airflow limitations in most asthmatic children and young adults (16, 24, 29, 33). Exercise-induced asthma (EIA) is defined as an intermittent narrowing of the airways, generally associated with respiratory symptoms (chest tightness, cough, wheezing and dyspnoea), occurring after 3 to 10 minutes of vigorous exercise with a maximal severity during 5 to 15 minutes after the end of the exercise (9, 14, 16, 24, 33). The definitive diagnosis of EIA is confirmed by the measurement of pre- and post-exercise expiratory flows documenting either a 15% fall in the forced expiratory volume in 1 second (FEV1), or a ≥15 to 20% fall in peak expiratory flow (PEF) (9, 24, 29). Some types of physical exercise have been associated with the occurrence of bronchial symptoms and asthma (5, 15, 17). For instance, demanding activities such as basketball or soccer could cause more severe attacks than less vigorous ones such as baseball or jogging (33). The mechanisms of exercise-induced airflow limitations seem to be related to changes in the respiratory mucosa induced by hyperventilation (9, 29). The heat loss from the airways during exercise, and possibly its post-exercise rewarming may contribute to the exercise-induced bronchoconstriction (EIB) (27). Additionally, the concomitant dehydration from the respiratory mucosa during exercise leads to an increased interstitial osmolarity, which may also contribute to bronchoconstriction (4, 36). So, the risk of EIB in asthmatically predisposed subjects seems to be higher with greater ventilation rates and the cooler and drier the inspired air is (23). The incidence of EIA in physically demanding coldweather sports like competitive figure skating and ice hockey has been found to occur in up to 30 to 35% of the participants (32). In contrast, swimming is often recommended to asthmatic individuals, because it improves the functionality of respiratory muscles and, moreover, it seems to have a concomitant beneficial effect on the prevalence of asthma exacerbations (14, 26), supporting the idea that the risk of EIB would be smaller in warm and humid environments. This topic, however, remains controversial since the chlorified water of swimming pools has been suspected as a potential trigger factor for some asthmatic patients (7, 8, 20, 21). In fact, the higher asthma incidence observed in industrialised countries has recently been linked to the exposition to chloride (7, 8, 30). Although clinical and epidemiological data suggest an influence of humidity and temperature of the inspired air on the bronchial response of asthmatic subjects during exercise, some of those studies did not accurately control the intensity of the exercise (2, 13), raising speculation of whether the experienced exercise overload was comparable for all subjects. Additionally, most of the studies did not include a control group (2, 10, 19, 39), which may lead to doubts about whether asthma per se has conditioned the observed results. Moreover, since the main targeted age group of these studies has been adults (10, 19, 39), any extrapolation to childhood/adolescence might be questionable regarding the different lung maturation. Considering the higher incidence of asthma in youngsters (30) and the fact that only the works of Amirav and coworkers (2, 3) have focused on this age group, a scarcity of scientific data can be identified. Additionally, since the main environmental trigger factors, i.e., temperature and humidity, were tested separately (10, 28, 39) it would be useful to analyse these two variables simultaneously because of their synergic effect on water and heat loss by the airways (31, 33). It also appears important to estimate the airway responsiveness to exercise within moderate environmental ranges of temperature and humidity, trying to avoid extreme temperatures and humidity conditions used by others (2, 3). So, the aim of this study was to analyse the influence of moderate changes in air temperature and humidity simultaneously on the acute ventilatory response to exercise in asthmatic children. To overcome the above referred to methodological limitations, we used a 15 minute progressive exercise trial on a cycle ergometer at 3 different workload intensities, and we collected data related to heart rate, respiratory quotient, minute ventilation and oxygen uptake in order to ensure that physiological exercise repercussions were the same in both environments. The tests were done in a “normal” climatic environment (in a gymnasium) and in a hot and humid environment (swimming pool); for the latter, direct chloride exposition was avoided.
Resumo:
Psychosocial interventions have proven to be effective in treating social cognition in people with psychotic disorders. The current study aimed to determine the effects of a metacognitive and social cognition training (MSCT) program, designed to both remediate deficits and correct biases in social cognition. Thirty-five clinically stable outpatients were recruited and assigned to the MSCT program (n = 19) for 10 weeks (18 sessions) or to the TAU group (n = 16), and they all completed pre- and post-treatment assessments of social cognition, cognitive biases, functioning and symptoms. The MSCT group demonstrated a significant improvement in theory of mind, social perception, emotion recognition and social functioning. Additionally, the tendency to jump to conclusions was significantly reduced among the MSCT group after training. There were no differential benefits regarding clinical symptoms except for one trend group effect for general psychopathology. The results support the efficacy of the MSCT format, but further development of the training program is required to increase the benefits related to attributional style.
Resumo:
Context: Some chemicals used in consumer products or manufacturing (eg, plastics, pesticides) have estrogenic activities; these xenoestrogens (XEs) may affect immune responses and have recently emerged as a new risk factors for obesity and cardiovascular disease. However, the extent and impact on health of chronic exposure of the general population to XEs are still unknown. Objective: The objective of the study was to investigate the levels of XEs in plasma and adipose tissue (AT) depots in a sample of pre- and postmenopausal obese women undergoing bariatric surgery and their cardiometabolic impact in an obese state. Design and Participants: We evaluated XE levels in plasma and visceral and subcutaneous AT samples of Portuguese obese (body mass index ≥ 35 kg/m2) women undergoing bariatric surgery. Association with metabolic parameters and 10-year cardiovascular disease risk was assessed, according to menopausal status (73 pre- and 48 postmenopausal). Levels of XEs were determined by gas chromatography with electron-capture detection. Anthropometric and biochemical data were collected prior to surgery. Adipocyte size was determined on tissue sections obtained during surgery. Results: Our data show that XEs are pervasive in this obese population. Distribution of individual and concentration of total XEs differed between plasma, visceral AT, and subcutaneous AT, and the pattern of accumulation was different between pre- and postmenopausal women. Significant associations between XE levels and metabolic and inflammatory parameters were found. In premenopausal women, XEs in plasma seem to be a predictor of 10-year cardiovascular disease risk. Conclusions: Our findings point toward a different distribution of XE between plasma and AT in pre- and postmenopausal women, and reveal the association between XEs on the development of metabolic abnormalities in obese premenopausal women
Resumo:
Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukey's post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.
Resumo:
Objectives To evaluate the feasibility and acceptability of an exergame intervention as a tool to promote physical activity in outpatients with schizophrenia. Design Feasibility/Acceptability Study and Quasi-Experimental Trial. Method Sixteen outpatients with schizophrenia received treatment as usual and they all completed an 8-week exergame intervention using Microsoft Kinect® (20 min sessions, biweekly). Participants completed pre and post treatment assessments regarding functional mobility (Timed Up and Go Test), functional fitness performance (Senior Fitness Test), motor neurological soft signs (Brief Motor Scale), hand grip strength (digital dynamometer), static balance (force plate), speed of processing (Trail Making Test), schizophrenia-related symptoms (Positive and Negative Syndrome Scale) and functioning (Personal and Social Performance Scale). The EG group completed an acceptability questionnaire after the intervention. Results Attrition rate was 18.75% and 69.23% of the participants completed the intervention within the proposed schedule. Baseline clinical traits were not related to game performance indicators. Over 90% of the participants rated the intervention as satisfactory and interactive. Most participants (76.9%) agreed that this intervention promotes healthier lifestyles and is an acceptable alternative to perform physical activity. Repeated-measures MANOVA analyses found no significant multivariate effects for combined outcomes. Conclusion This study established the feasibility and acceptability of an exergame intervention for outpatients with schizophrenia. The intervention proved to be an appealing alternative to physical activity. Future trials should include larger sample sizes, explore patients' adherence to home-based exergames and consider greater intervention dosage (length, session duration, and/or frequency) in order to achieve potential effects.
Resumo:
Objetivo: avaliar as modificações ocorridas no âmbito da sequência de ativação o da sinergia extensora do MS e na sua influência sobre a capacidade de placing do polegar face à aplicação de um programa de intervenção em fisioterapia. Pretendeu-se também verificar as repercussões ao nível da participação dos indivíduos nas AVD`s. Metodologia: esta série de estudos de casos foi constituída por dois indivíduos com modificações nas componentes neuromotoras de movimento após AVE predominantes no MS. A avaliação dois indivíduos foi realizada em dois momentos PRE e POST separados por um período de intervenção de cerca de quinze semanas. Em cada momento de avaliação foi aplicada a F-MAMR, foi recolhido sinal electromiográfico dos músculos GD, DP, TLONG, TLAT e ABDPOL durante o movimento de alcance e usaram-se seis itens da CIF selecionadas de acordo com as necessidades sentidas. No momento PRE aplicou-se a MMSE para detetar défices cognitivos que interferissem com o processo de avaliação e de intervenção. O programa de intervenção foi individualizado e devidamente ajustado aos indivíduos, procurando que estes mantivessem um papel ativo durante a reabilitação. Esta foi realizada com a frequência de três vezes por semana e cada sessão teve cerca de quarenta e cinco minutos de trabalho ativo. Resultados: encontraram-se modificações na sequência de ativação muscular nos dois indivíduos e entre os indivíduos nos dois momentos de avaliação, nomeadamente no tempo de ativação muscular. O ABDPOL modificou o tempo em que iniciou atividade muscular e passou a recrutar atividade quase simultaneamente ao início do movimento da mão, verificando-se uma influência positiva da sinergia extensora do MS na capacidade de placing do polegar. Verificaram-se resultados positivos no estado sensório-motor do MS e na capacidade do indivíduo em participar em diversas AVD`s selecionadas de acordo com as necessidades. Conclusão: este estudo parece apontar para uma influência positiva nas modificações do nível de atividade da sinergia extensora do MS e na influência desta sobre a capacidade de placing do polegar durante o movimento de alcance, face a um programa de intervenção. Este estudo parece apontar também para uma influência positiva sobre a capacidade do indivíduo em participar em AVD`s selecionadas para a avaliação de acordo com necessidades sentidas.
Resumo:
Introdução: Após lesão do SNC o músculo pode perder a sua variabilidade e flexibilidade, tal como se verifica em indivíduos após AVE. A caracterização do tónus muscular tem sido um indicador a ter em atenção para o diagnóstico clínico. As alterações do tónus podem resultar de uma combinação de alterações neurais, como consequência dos processos inerentes à neuroplasticidade e alterações biomecânicas. Objectivo: Verificar quais as modificações no tónus muscular, segundo a escala de Tardieu, após a aplicação de um programa de reabilitação neuromotora baseado no conceito de Bobath em dois indivíduos com sequelas de AVE. Pretendeu-se também verificar as repercussões nas actividades funcionais. Participantes e métodos: Foram seleccionados dois indivíduos e aplicado um programa de reabilitação, durante onze semanas, e avaliados em dois momentos, antes da intervenção (PRE) e após a intervenção (APÓS). Aplicaram-se vários instrumentos de avaliação, nomeadamente a escala de Tardieu. O programa de reabilitação realizado baseou-se no conceito de Bobath. Resultados: Na escala de Tardieu, foi comum aos dois indivíduos melhorias a nível da qualidade de reacção muscular. Ambos os indivíduos apresentaram melhorias no controlo postural e equilíbrio, que se evidenciaram na CIF. Conclusão: Foi possível observar modificações no tónus muscular após aplicação de um programa de reabilitação e, consequentemente modificações na distribuição da carga na base de suporte, no alinhamento das estruturas articulares e musculares e na marcha. Ao longo da intervenção, observaram-se repercussões positivas em ambos os indivíduos, permitindo a estes realizar as AVDs com menor dificuldade
Resumo:
This paper aims at analysing the writing of the Portuguese author António Lobo Antunes, considered one of the major writers in European Literature with 26 books published, by focusing on the strategies deployed in his texts of creating micro-narratives within the main frame, and conveying the elements of individual and collective memory, past and present, the self and the others, using various voices and silences. Lobo Antunes incorporates in his writing his background as a psychiatrist at a Mental Hospital in Lisbon, until 1985 (when he decided to commit exclusively to writing), his experience as a doctor in the Portuguese Colonial War battlefield, but also the daily routines of the pre and post 25th of April 1974 (Portuguese Revolution) with subtle and ironic details of the life of the middle and upper class of Lisbon‘s society: from the traumas of the war to the simple story of the janitor, or the couple who struggles to keep their marriage functional, everything serves as material to develop and interweave a complex plot, that a lot of readers find too enwrapped and difficult to follow through. Some excerpts taken from his first three novels and books of Chronicles and his later novel – Ontem não te Vi em Babilónia (2006) – will be put forward to exemplify the complexity of the writing and the main difficulties of the reader, lost in a multitude of narrators‘ voices. Recently, Lobo Antunes has commented on his work stating: What I write can be read in the darkness. This paper aims at throwing some light by unfolding some of the strategies employed to defy new borders in the process of reading.
Resumo:
In order to decrease the risk of severe wildfire, prescribed fire has recently been adopted in Portugal and elsewhere in the Mediterranean as a major tool for reducing the fuel load instead of manual or mechanical removal of vegetation. There has been some research into its impact on soils in shrublands and grasslands, but to date little research has been conducted in forested areas in the region. As a result, the impact of prescribed fire on the physico-chemical soil characteristics of forest soils has been assumed to be minimal, but this has not been demonstrated. In this study, we present the results of a monitoring campaign of a detailed pre- and post-prescribed fire assessment of soil properties in a long-unburnt P. pinaster plantation, NW Portugal. The soil characteristics examined were pH, total porosity, bulk density, moisture content, organic matter content and litter/ash quantity. The results show that there was no significant impact on the measured soil properties, the only effect being confined to minor changes in the upper 1 cm of soil. We conclude that provided the fire is carried out according to strict guidelines in P. pinaster forest, a minimal impact on soil properties can be expected.
Resumo:
Introdução: No andebol, o ombro é elevado numa amplitude superior a 90º e move-se com elevada velocidade de execução o que pode originar deslocação anterior da cabeça do úmero e diminuição da rotação medial. A técnica MWM pode ser uma mais valia na correção da falha posicional e recuperação da amplitude de movimento de rotação medial da articulação gleno-umeral. Objetivo: Este estudo teve como objetivo verificar os efeitos imediatos da técnica de MWM na amplitude de movimento de rotação medial da articulação gleno-umeral em jogadores de andebol. Métodos: O presente estudo, duplamente cego, é do tipo experimental. Foram incluídos no estudo 30 indivíduos do sexo masculino, jogadores de andebol, distribuídos, aleatoriamente, em dois grupos de 15, experimental e controlo. Em ambos os grupos foi avaliada a amplitude de movimento da rotação medial da gleno-umeral, em dois momentos, pré e pós intervenção. O grupo experimental foi submetido à técnica de MWM no movimento de rotação medial da gleno-umeral no membro dominante. Ao grupo de controlo, foi solicitada a realização do movimento ativo de rotação medial no membro dominante, o fisioterapeuta manteve os mesmos contactos manuais mas não aplicou pressão na cabeça do úmero. Para a comparação entre os grupos experimental e controlo recorreu-se ao teste de Mann-Whitney e para analisar diferenças entre os dois momentos, para cada grupo, foi utilizado o teste de Wilcoxon. Resultados: Foram encontradas diferenças significativas no grupo experimental e controlo, contudo essa diferença foi superior no grupo experimental. Após a intervenção, o grupo experimental apresentou amplitudes de rotação medial da gleno-umeral significativamente mais elevadas às do grupo de controlo (U=0,50; p <0,001). Conclusão: A técnica de MWM para rotação medial produziu um aumento significativo na amplitude desse movimento.
Resumo:
O presente estudo teve como objetivo analisar em que medida o envolvimento de uma jovem de 19 anos, com incapacidade intelectual, na elaboração de um portefólio de transição para a vida ativa, se revela um processo promotor do autoconhecimento e exploração pessoal, através de uma identificação mais abrangente das suas experiências, interesses e competências funcionais. O efeito valorativo da elaboração do portefólio - processo desenvolvido ao longo de 27 sessões - no reconhecimento de experiências e interações positivas de funcionalidade que sejam tomadas, pela própria jovem, como um ponto de partida para novas oportunidades no domínio de uma vida adulta autónoma, foi avaliado através da condução de uma entrevista – nos momentos pré e pós elaboração do portefólio – e do registo contínuo da participação da jovem ao longo das sessões. O guião da entrevista procurou incorporar tópicos que permitissem obter, através da perspetiva da jovem, um retrato da sua funcionalidade e do seu perfil pessoal. Socorremo-nos de técnicas de análise de conteúdo para examinar mudanças no conteúdo do discurso da jovem, procurando, com base nessa análise, quantificar e analisar a diversidade de experiências, interesses, funcionalidades e suportes reconhecidas pela própria antes e após elaboração do portefólio. Os resultados deste estudo indicam que a elaboração do portefólio promoveu a construção de um maior autoconhecimento, pela jovem, das suas competências, interesses e aspirações - havendo no momento pós-elaboração do portefólio uma maior referência a aspetos positivos da sua funcionalidade, nestas dimensões de análise. Assim, este estudo parece sugerir que o processo de elaboração do portefólio poder-se-á afigurar como uma metodologia facilitadora na condução de uma transição consonante com os princípios avançados na abordagem de planeamento centrado na pessoa.
Resumo:
A promoção de competências de leitura é um tema central, tanto na educação regular, como na educação especial em crianças em idade pré-escolar e escolar. Todavia, as competências de leitura de indivíduos adultos com incapacidade intelectual são um domínio muito pouco estudado. São também escassos os estudos direcionados à avaliação dessas competências. Esta investigação propõe uma tradução/ adaptação do APAR (Assessment of Phonological Awareness and Reading), um protocolo de avaliação da consciência fonológica (CF) e da leitura especificamente concebido para a população em estudo. Procura-se também analisar os processos cognitivos envolvidos na leitura nos quais a intervenção produzirá resultados mais significativos e confirmar uma relação positiva entre a avaliação prévia de competências escolares em contexto formativo profissional e o efetivo desenvolvimento de competências de leitura. Foram avaliadas em dois momentos (pré e pós-teste) a CF e competências de leitura de 12 adultos com incapacidade intelectual ligeira, sendo estes sujeitos a um programa de intervenção, visando áreas menos desenvolvidas das suas competências que possibilitassem desempenhos de leitura mais fortes. Ao nível da análise quantitativa, foram comparados os resultados obtidos nos dois momentos de administração. No tratamento estatístico recorreu-se a análises de correlação de Spearman para determinar a presença de indicadores de desempenho ao nível da CF e ao cálculo de coeficientes de correlação de Pearson e Spearman para controlar variáveis externas como idade, sexo e habilitações literárias. Os resultados obtidos revelam desempenhos fracos ao nível da leitura/ compreensão textual e, em particular, da CF em pré-teste e ganhos significativos globais após implementação de uma intervenção baseada em medidas de avaliação prévia de competências de leitura/compreensão e CF
Resumo:
. Residents tend to have high expectations about the benefits of hosting a mega‐event. So, it was not surprising that the nomination of Guimarães, Portugal, as the 2012 European Capital of Culture (2012 ECOC) had raised great expectations in the local community towards its socio‐economic and cultural benefits. The present research was designed to examine the Guimarães residents’ perceptions on the impacts of hosting the 2012 ECOC approached in two different time schedules, the pre‐ and the post‐event, trying to capture the evolution of the residents` evaluation of its impacts. For getting the data, two surveys were applied to Guimarães` residents, one in the pre‐event phase, in 2011, and another in the post‐event phase, in 2013. This approach is uncommonly applied to Portugal data and it is even the first time it was done to a Portuguese European Capital of Culture. After a factor analysis, the results of t‐tests indicate that there were significant differences (p<0.05) between the samples from the pre‐ and post‐2012 ECOC on two positive impact factors (Community’ benefits and Residents’ benefits) and one negative impact factor (Economic, social and environmental costs). Respondents also showed a negative perception of the impacts in all dimensions, except Changes in habits of Guimarães residents.
Resumo:
In order to decrease the risk of severe wildfire, prescribed fire has recently been adopted in Portugal and elsewhere in the Mediterranean as a major tool for reducing the fuel load instead of manual or mechanical removal of vegetation. There has been some research into its impact on soils in shrublands and grasslands, but to date little research has been conducted in forested areas in the region. As a result, the impact of prescribed fire on the physico-chemical soil characteristics of forest soils has been assumed to be minimal, but this has not been demonstrated. In this study, we present the results of a monitoring campaign of a detailed pre- and post-prescribed fire assessment of soil properties in a long-unburnt P. pinaster plantation, NW Portugal. The soil characteristics examined were pH, total porosity, bulk density, moisture content, organic matter content and litter/ash quantity. The results show that there was no significant impact on the measured soil properties, the only effect being confined to minor changes in the upper 1 cm of soil. We conclude that provided the fire is carried out according to strict guidelines in P. pinaster forest, a minimal impact on soil properties can be expected.