scholarly journals Clinical observation of alveolar surface active substances in the treatment of neonatal respiratory distress syndrome at different periods

2019 ◽  
Author(s):  
Han Han ◽  
Xiao-xia Li ◽  
Xiang-hua Shuai ◽  
Zhi-qun Zhang ◽  
Jing Li ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Rescue Therapy ◽  
Total Duration ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Systemic Hemodynamic ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Mechanical ventilation joint PS replacement therapy is an effective method in treatment of NRDS recognized, PS treatment of children with early can improve the oxygenation by increasing gas exchange area, but before FiO 2 to reduce the application of PS can cause local and/or systemic hemodynamic changes, making the use of PS has some potential problems, such as increasing the incidence of the IVH, PH, PDA and so on. SR rescue therapy can be divided into early treatment and delayed treatment, but the specific boundary point of the appropriate time period has not been clear. This paper aims to compare the efficacy differences of PS administration at different time periods and provide basis for the selection of clinical application period of PS. Methods: Case-control study . 135 children diagnosed with NRDS in neonatology department of our hospital. The patients were divided into two groups according to the use time of PS. Group A was applied within 3 hours after birth, and group B was applied 3 hours after birth. The changes of blood gas analysis parameter，mechanical ventilation time, incidence of complications, hospital stay and mortality were compared between the two groups. Results : The decrease of blood gas PaCO 2 in group A before and after treatment was more significant than that of group B (P<0.05), but the improvement of PaO 2 and OI in group B was better than that in group A (P<0.05). Although there were significant differences in birth weight between the two groups, there were no significant differences in the total duration of mechanical ventilation and mortality (P>0.05). Except PDA and BPD, there was no significant difference in the incidence of common complications between the two groups. Conclusion: PS treatment within 3 hours after birth can better improve ventilation, reduce the incidence of PDA. It can also help to reduce the death rate of high-risk children and the total duration of mechanical ventilation.

scholarly journals Clinical Study on the Effects of Different Positions on Supine Hypotensive Syndrome in Cesarean Section after Lumbar Anesthesia

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Chunyan Zhao ◽  
Yi Tang ◽  
Cibo Chen ◽  
Bingchun Xia
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Supine Position ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Significant Difference ◽  
Group A ◽  
Hypotensive Syndrome ◽  
Group B

Aim: To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia. Methods: 600 full-term parturient were randomly divided into 4 groups. The patented positioning pads (patent number: ZL 2017 2 0618886.5) in our department was used in the left-leaning position. The parturient lied in a supine position for anesthesia in, and then the group of positioning pads was placed after turning into the lateral position. The parturient were divided into group A (supine position), group B (left-leaning to 10 °), group C (left-leaning to 20 °), and group D (30 °). Observation index: Main index: Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using a position pad and with the use of patent positioning pads in different tilt angles (10°, 20°, 30°). Minor index: 1) the use and frequency of vasoactive drugs, whether a left-leaning operating bed or uterine displacement is required; 2) the consciousness of the parturient; 3) newborn’s Apgar scores of 1 minute, 5 minutes, and 10 minutes after birth; 4) whether the obstetrician can perform the operation smoothly in the corresponding left leaning position. Results: The blood pressure at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C (P<0.05). There were significant differences at different timings in group A and group B, and the decline was more significant at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered (P<0.05). The pH value of blood gas analysis of newborns in group A, group B and group C was between 7.25 and 7.37, and there was no significant difference between the three groups (P?0.05). Conclusion: The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.

Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection

2020 ◽  
Vol 106 (3) ◽  
pp. 203-211 ◽  
Author(s):  
Marco Rispoli ◽  
Rosario Salvi ◽  
Antonio Cennamo ◽  
Davide Di Natale ◽  
Giovanni Natale ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Rehabilitation Program ◽  
Pulmonary Complications ◽  
Gas Analysis ◽  
Blood Gas ◽  
Postoperative Pulmonary Complications ◽  
Home Based ◽  
Before And After ◽  
Group A ◽  
Group B

Objective: To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. Methods: This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). Results: All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis ( n = 6), pneumonia ( n = 1), respiratory failure ( n = 1), and pulmonary embolism ( n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor ( p = 0.001). Conclusions: Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

scholarly journals The effect of clamped and unclamped umbilical cord samples on blood gas analysis

2021 ◽  
Author(s):  
Elisabetta Colciago ◽  
Simona Fumagalli ◽  
Elena Ciarmoli ◽  
Laura Antolini ◽  
Antonella Nespoli ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Cross Sectional Study ◽  
Gas Analysis ◽  
Blood Collection ◽  
Large Sample Size ◽  
Blood Gas ◽  
Delayed Cord Clamping ◽  
Cross Sectional ◽  
High Risk Women ◽  
Significant Difference

Abstract Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.

scholarly journals Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome

2018 ◽  
Vol 40 (12) ◽  
pp. 740-748 ◽  
Author(s):  
Cátia Ferreira ◽  
Ângela Melo ◽  
Ana Fachada ◽  
Helena Solheiro ◽  
Nuno Nogueira Martins
Keyword(s):  
Umbilical Cord Blood ◽  
Apgar Score ◽  
Umbilical Artery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Neonatal Hypoxia ◽  
Total Cohort ◽  
Group A ◽  
Minute Apgar Score

Objective To analyze if umbilical artery pH (pHua) ≤7.00 and umbilical artery blood deficit (BDua) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. Methods This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A—women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B—all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pHua ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21–37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35–21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03–6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29–177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20–99.60; p = 0.006). Conclusion The pHua and the BDua are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia.

scholarly journals Comparison of Blood Gas Analysis between Benchtop and Handheld Device

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Phey Liana ◽  
Iza Netiasa Haris ◽  
Yan Effendi Hasyim
Keyword(s):  
Clinical Decision Making ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
P Value ◽  
Strong Positive Correlation ◽  
Blood Gas ◽  
Cross Sectional ◽  
Handheld Device ◽  
Arterial Blood ◽  
Significant Difference

The use of blood gas analysis is to determine the Acid-base status required to treat patients with emergency conditionssuch as metabolic disorders and respiratory diseases. Benchtop device is commonly used in hospitals to analyze blood gas;however, handheld devices are recently more often used in emergency settings due to its quick and simple process. Thisstudy was performed to compare blood gas analysis results between the i-STAT handheld device and the Nova pHox Ultrabenchtop device that were currently being used in the central laboratory. This cross-sectional study was conducted by using42 arterial blood patients that were measured with i-STAT handheld device dan Nova pHox Ultra benchtop device. The pH,pCO2, and pO2 parameters were then evaluated. The data were analyzed using Spearman's correlation test, Mann-Whitneytest, and Bland-Altman plots. This study showed a very strong positive correlation for all parameters. Mann-Whitneycomparison test showed that there was no significant difference between the result of the two devices (p-value > 0.05). Allparameters showed that 95% of plots were within the acceptable limit. There was no clinical significance on the mean biasesof blood gas results between both devices. The i-STAT and Nova pHox Ultra devices showed a good agreement for bloodgas measurement. Therefore, both devices can be used interchangeably with minimal effect on clinical decision-making.

Effect of high frequency oscillatory ventilation combined with pulmonary surfactant in the treatment of acute respiratory distress syndrome after cardiac surgery: a prospective randomized controlled trail

2021 ◽  
Author(s):  
Yi-Rong Zheng ◽  
Yu-Qing Lei ◽  
Jian-Feng Liu ◽  
Hong-Lin Wu ◽  
Ning Xu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
High Frequency ◽  
Pulmonary Surfactant ◽  
Distress Syndrome ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
High Frequency Oscillatory ◽  
Length Of Hospitalization

Abstract Objective: This study aimed to evaluate the effects of pulmonary surfactant (PS) combined with high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) in infants with acute respiratory distress syndrome (ARDS) after congenital cardiac surgery.Method: A total of 61 infants with ARDS were eligible and were randomized to the CMV + PS group (n= 30) or the HFOV + PS group (n= 31) between January 2020 and December 2020. The primary outcomes were the improvement of the arterial blood gas analysis. The incidence of mechanical ventilation duration, length of hospitalization, and the incidence of complications were considered as secondary outcomes.Results: A total of 61 infants completed the study. In HFOV + PS group, the blood gas analysis results were significantly improved (P<0.05), while, duration of mechanical ventilation and length of hospitalization were shorter than CMV + PS group (P<0.05). But the incidences of complications had no statistical significance between the two groups (P>0.05).Conclusions: Compared with the CMV + PS group, HFOV + PS significantly improved the ABG variables and shortened the length of hospitalization and mechanical ventilation in infants with ARDS after cardiac surgery.

scholarly journals Will women’s choice of position in first stage of labor affect labor process?

2020 ◽  
Vol 9 (4) ◽  
pp. 1515
Author(s):  
Shubha Rao ◽  
Shylabhirami Sridharan ◽  
Akhila Vasudeva ◽  
Roopa P. S.
Keyword(s):  
Pregnant Women ◽  
Neonatal Outcome ◽  
Total Duration ◽  
Labor Process ◽  
Recumbent Position ◽  
Observation Study ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Type Of Delivery

Background: Controlling the process of childbirth has disabled the parturient to embrace the most spontaneous position of delivery but constricting her to assume a recumbent position. Objective of this study was to study if alternating comfortable maternal positioning i.e., recumbent and alternative position have any influence in the process of labor, type of delivery, neonatal well-being.Methods: Study conducted an observation study on term pregnant women. Study inclusion criteria included all term pregnant women. Exclusion criteria included multiple pregnancies, preterm patient, severe pre-eclampsia, and eclampsia, preterm premature rupture of membranes, sever intrauterine growth restricted fetus. The measured date were maternal general characteristics, duration of labor process, type of delivery and neonatal outcome. Patients were divided into two groups. Group A - if they spent more than 50% in a recumbent position and Group B - any other alternating position.Results: A total 250 women were equally included in this study. The demographic characteristics were matched in both groups and found no significant difference. In the process of labor, Group B had a difference of 1 hours as compared to Group A and the rate of cervical dilation was also faster in Group B. Both of these variables were found to be statistically significant. However, there were no significant difference in the terms of type of delivery and neonatal outcome.Conclusions: The ancient practice of recumbent position during labor is to be discarded as alternating maternal position during the process of labor may a positive influence on the total duration labor. However even though it may or may not have an influence on the other outcome such as route of delivery and neonatal outcome, it is best to encourage women to move and deliver in the most comfortable position.

Electroacupuncture Reduces the Dose of Midazolam Monitored by the Bispectral Index in Critically Ill Patients with Mechanical Ventilation: An Exploratory Study

2012 ◽  
Vol 30 (2) ◽  
pp. 78-84 ◽  
Author(s):  
Xia Zheng ◽  
Jian-biao Meng ◽  
Qiang Fang
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Bispectral Index ◽  
Critically Ill Patients ◽  
Additional Treatment ◽  
Acupuncture Points ◽  
Sedative Drug ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective Electroacupuncture, a modern variation on a traditional Chinese treatment, might be useful for sedation and analgesia. This study aims to investigate whether electroacupuncture can modify the dose of midazolam monitored by the bispectral index (BIS) in critically ill patients with mechanical ventilation. Methods Orotracheally intubated patients undergoing mechanical ventilation were randomly assigned into three groups (groups A, B and C). All patients were given an intravenous infusion of midazolam. Patients in group A received no additional treatment. Patients in group B were given acupuncture without electrical stimulation at acupuncture points GV24 and EX–HN3 ( Yintang) for 6 h simultaneously, and patients in group C were given electroacupuncture to the same points as in group B. Results Maintaining the BIS between 60 and 80, the hourly mean one dose of midazolam within the first 6 h after sedation in group C was 0.05 (±0.02 mg/kg per hour), which was significantly lower than both group A (0.08±0.03 mg/kg per hour, p<0.001) and group B (0.07±0.01 mg/kg per hour, p<0.021). The doses in groups A and B showed no significant difference. Between-group comparison analysis of hepatic and renal function and severe adverse reactions all showed no significant difference between the three groups. Conclusions Electroacupuncture appears to reduce markedly the dose of sedative drug required in critically ill patients with mechanical ventilation monitored by BIS, without any obvious severe adverse action, and larger studies to confirm the effect are justified.

scholarly journals Perbandingan Nilai PETCO2 dan PACO2 pada Pasien dengan Pemasangan Ventilasi Mekanik

1970 ◽  
Vol 4 (1) ◽  
Author(s):  
Baskoro Soetioputro ◽  
F. Sri Susilaningsih ◽  
Titin Mulyati
Keyword(s):  
Mechanical Ventilation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Regulation Of Respiration ◽  
Blood Gas ◽  
Altman Plot ◽  
Cross Sectional ◽  
Bland Altman Plot ◽  
Consecutive Sampling ◽  
Arterial Blood

Pasien dengan ventilasi mekanik perlu dilakukan pemantauan CO2 karena berperan penting pada regulasi pernapasan dan keseimbangan asam-basa tubuh. Pemantauan CO2 dapat dilakukan dengan mengukur PaCO2 melalui analisis gas darah arteri. Pengukuran PaCO2 tidak dapat dilakukan secara kontinu sehingga perlu sering dilakukan pengambilan darah arteri yang dapat menimbulkan komplikasi. Pengukuran PETCO2 dapat memantau CO2 secara kontinu dan non invasif. PETCO2 adalah tekanan parsial CO2 ekspirasi yang diukur pada saat akhir volume tidal pernapasan. Penelitian ini bertujuan membandingkan nilai PETCO2 dan PaCO2 pada pasien dengan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Rancangan penelitian yang digunakan adalah prospective cross sectional. Pemilihan sampel dilakukan secara consecutive sampling. Penelitian dilakukan terhadap 21 pasien yang menggunakan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Data PETCO2 dicatat pada saat perawat mengambil sampel darah arteri untuk pemeriksaan analisis gas darah. Didapatkan 122 pasang data nilai PETCO2 dan PaCO2. Data yang diperoleh dianalisis dengan Bland-Altman plot. Hasil penelitian nilai PETCO2 berada pada rentang 14-67 mmHg dan nilai PaCO2 berada pada rentang 17-77 mmHg. Bias nilai PETCO2 dan PaCO2 adalah -4,6475 mmHg lebih rendah daripada estimasi nilai bias ±5 mmHg sehingga bisa diterima secara klinik. Presisi nilai PETCO2 adalah 12,7969 mmHg (limit of agreement= 1,7509; -11,0460) lebih tinggi daripada estimasi nilai presisi ±5 mmHg sehingga tidak bisa diterima secara klinik. Kesimpulan dari penelitian ini adalah pengukuran PETCO2 tidak dapat menggantikan pengukuran PaCO2, tetapi pengukuran PETCO2 dapat digunakan untuk memperkirakan nilai PaCO2 pasien dengan ventilasi mekanik.Kata kunci: PETCO2, PaCO2, ventilasi mekanik. Comparison of PETCO2 and PACO2 Values in Patients with Mechanical VentilationAbstractPatients with mechanical ventilation need to be monitored for the CO2 value because it has an important role in regulation of respiration and body acid-base equilibrium. Monitoring of CO2 can be done by measuring PaCO2 through arterial blood gas analysis. Measurement of PaCO2 could not be done continuously so that the arterial blood are needed to be taken quite often which could cause complication. The measurement of PETCO2 can monitor the CO2 continuously and non-invasively. PETCO2 is partial pressure of CO2 expiration that is measured at the end of respiration tidal volume. This study aimed to compare the PETCO2 value and PaCO2 in patients with mechanical ventilation in GICU Dr. Hasan Sadikin Hospital. The research design was prospective cross-sectional using consecutive sampling method. The total sample was 21 patients who used mechanical ventilator in GICU Dr. Hasan Sadikin Hospital Bandung. The PETCO2 data were recorded when the patients’ arterial blood sample were taken for blood gas analysis test. The total of 122 pair date of PETCO2 and PaCO2 values were recorded. The data were analyzed using Bland-Altman plot. The results showed that the PETCO2 value ranged from 14 – 67 mmHg and the PaCO2 values ranged from 17 – 77 mmHg. The deviation of PETCO2 and PaCo2 was -4.6475 mmHg, which is lower than the estimation of ± 5 mmHg deviation, therefore the PETCO2 measurement can be accepted clinically. The precision of PETCO2 was 12.7969 mmHg (limit of agreement = 1.7509; -11.0460) which is higher than the estimation of precision value of ±5 mmHg, therefore it cannot be accepted clinically. In conclusion, the PETCO2 measurement could not replace the PaCO2 measurement, however, PETCO2 measurement can be used to predict the value of PaCO2 for patients with mechanical ventilation.Keywords: Mechanical ventilation, PETCO2, PaCO2.

scholarly journals Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

2020 ◽  
Author(s):  
Jun Ma ◽  
Wenlin Shangguan ◽  
Liang-wan Chen ◽  
Dong-Shan Liao
Keyword(s):  
Mechanical Ventilation ◽  
Ventricular Septal Defect ◽  
Clinical Effect ◽  
Septal Defect ◽  
Operation Time ◽  
Ventilation Time ◽  
Significant Difference ◽  
Group A ◽  
Mechanical Ventilation Time ◽  
Group B

Abstract Background: To analyze the clinical effect of two different ways of minimally invasive transthoracic closure in children with ventricular septal defect (VSD) Methods: From January 2015 to July 2019, 294 children with VSD were enrolled in the Fujian Medical University Union Hospital, who underwent VSD closure through the left sternal fourth intercostal incision (group A: n = 95) and the lower sternal incision (group B: n = 129) Results: The operation time, bleeding volume, postoperative mechanical ventilation time, postoperative ICU monitoring time, postoperative hospitalization time and complication rate in group A were significantly lower than those in group B (P < 0.05). There was no significant difference between the two groups in the operation success rate, mechanical ventilation time and total hospitalization cost (P > 0.05). Conclusion : The transthoracic closure of ventricular septal defect through the left sternal fourth intercostal incision is feasible, safe, cosmetic, and worth popularizing.

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