Assessment of Rapid SARS-CoV-2 Testing with Lateral Flow Immunoassay among Asymptomatic Healthcare Workers in Makati Medical Center

Aims: Corona Virus Disease-19 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the gold standard for diagnosis is still reverse transcription Polymerase Chain Reaction (RT-PCR), it is not readily available. Serologic testing is considered to be a faster method of identifying individuals who may have been exposed and developed antibodies against SARS-CoV-2. Methodology: This was an ambirectional observational study aimed to determine the prevalence of exposure to COVID-19 infection among asymptomatic healthcare workers in Makati Medical Center, a tertiary hospital in the Philippines, using rapid antibody testing (lateral flow immunoassay) in May 2020. Results: A total of 1557 asymptomatic healthcare workers were included in the study. Majority belonged to the paramedical group (52%). Twenty (1.3%) healthcare workers were IgM positive while 17 (1.1%) tested positive for IgG. Three healthcare workers (0.2%) tested positive for both antibodies. Participants with history of being quarantined who tested positive for either IgM or IgG were significantly higher compared to those who tested negative for both antibodies (55%, 33.3%, 41.2% vs 28.5%, p = 0.036). Those with diabetes had 6.8 times higher risk of being IgM positive and IgG negative (p=0.001). In addition, those with diabetes were more likely (13.6 times) to be positive in both tests (p=0.034). Conclusion: There was a low prevalence (2.6%) of COVID-19 infection among healthcare workers of Makati Medical Center. Among those with positive serologic test, diabetes mellitus, history of exposure and history of quarantine were risk factors associated with COVID-19 infection.

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SARS-CoV-2 Seroprevalence in Healthcare Workers of Kaunas Hospitals during the First Wave of the COVID-19 Pandemic

Medicina ◽

10.3390/medicina57020148 ◽

2021 ◽

Vol 57 (2) ◽

pp. 148 ◽

Cited By ~ 1

Author(s):

Laura Pereckaitė ◽

Asta Dambrauskienė ◽

Daiva Urbonienė ◽

Saulius Sadauskas ◽

Kęstutis Petrikonis ◽

...

Keyword(s):

Healthcare Workers ◽

Lateral Flow ◽

Immunoglobulin M ◽

Lateral Flow Immunoassay ◽

Enzyme Linked Immunosorbent Assay ◽

Antibody Testing ◽

Serum Samples ◽

Positive Group ◽

Percent Agreement ◽

Specific Igg

Background and objective: Serologic testing is a useful additional method for the diagnosis of COVID-19. It is also used for population-based seroepidemiological studies. The objective of the study was to determine SARS-CoV-2 seroprevalence in healthcare workers of Kaunas hospitals and to compare two methods for specific SARS-CoV-2 antibody testing. Materials and Methods: A total of 432 healthcare workers in Kaunas hospitals were enrolled in this study. Each participant filled a questionnaire including questions about their demographics, contact with suspected or confirmed COVID-19, acute respiratory symptoms, and whether they contacted their general practitioner, could not come to work, or had to be hospitalized. Capillary blood was used to test for SARS-CoV-2 specific immunoglobulin G (IgG) and immunoglobulin M (IgM) a lateral flow immunoassay. Serum samples were used to test for specific IgG and IgA class immunoglobulins using semiquantitative enzyme-linked immunosorbent assay (ELISA) method. Results: 24.77% of study participants had direct contact with a suspected or confirmed case of COVID-19. A total of 64.81% of studied individuals had at least one symptom representing acute respiratory infection, compatible with COVID-19. Lateral flow immunoassay detected SARS-CoV-2 specific IgG class immunoglobulins in 1.16% of the tested group. Fever, cough, dyspnea, nausea, diarrhea, headache, conjunctivitis, muscle pain, and loss of smell and taste predominated in the anti-SARS-CoV-2 IgG-positive group. Using ELISA, specific IgG were detected in 1.32% of the tested samples. Diarrhea, loss of appetite, and loss of smell and taste sensations were the most predominant symptoms in anti-SARS-CoV-2 IgG-positive group. The positive percent agreement of the two testing methods was 50%, and negative percent agreement was 99.66%. Conclusions: 1.16% of tested healthcare workers of Kaunas hospitals were anti-SARS-CoV-2 IgG-positive. The negative percent agreement of the lateral flow immunoassay and ELISA exceeded 99%.

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Occupational Sharp Injury and Splash Exposure among Healthcare Workers in a Tertiary Hospital

Journal of Laboratory Physicians ◽

10.1055/s-0041-1731135 ◽

2021 ◽

Author(s):

Roshan Mathew ◽

Ritin Mohindra ◽

Ankit Sahu ◽

Rachana Bhat ◽

Akshaya Ramaswami ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis B ◽

Healthcare Workers ◽

Hepatitis B Surface Antigen ◽

Tertiary Hospital ◽

Needle Stick Injury ◽

Medical Procedures ◽

Immunodeficiency Virus ◽

History Of ◽

Hepatitis C Virus Antibody

Abstract Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.

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Serologic SARS-CoV-2 testing in healthcare workers with positive RT-PCR test or Covid-19 related symptoms

10.1101/2020.10.25.20219113 ◽

2020 ◽

Author(s):

Giovanni Visci ◽

Vittorio Lodi ◽

Roberta Bonfiglioli ◽

Tiziana Lazzarotto ◽

Francesco S. Violante ◽

...

Keyword(s):

Healthcare Workers ◽

Lateral Flow ◽

Public Hospitals ◽

Lateral Flow Immunoassay ◽

Enzyme Linked Immunosorbent Assay ◽

Limited Information ◽

Rt Pcr ◽

Positive Serology ◽

Serologic Response ◽

Pcr Test

AbstractBackgroundLimited information is available on prevalence and determinants of serologic response to SARS-CoV-2 infection among healthcare workers (HCWs).MethodsWe analyzed the results of serologic testing with chemiluminescence immunoassay analyzer (CLIA), lateral flow immunoassay (LFIA) and enzyme-linked immunosorbent assay (ELISA) test among 544 HCWs with at least one positive RT-PCR test and 157 HCWs with Covid-19 related symptoms without a positive RT-PCR test from public hospitals in Bologna, Northern Italy. Tests were performed between March and August 2020. We fitted multivariate logistic regression models to identify determinants of positive serology.ResultsThe sensitivity of SARS-CoV-2 was 75.2% (LFIA) and 90.6% (CLIA). No differences in seropositivity were observed by sex, while older HCWs had higher positivity than other groups, and nurses had higher positivity compared to physicians, but not other HCWs. An estimated 73.4% of HCWs with Covid-19 symptoms without RT-PCR test were not infected with SARS-CoV-2.ConclusionsOur study provides the best available data on sensitivity of serologic tests and on determinants of serologic response among HCWs positive for SARS-CoV-2, and provide evidence on the low specificity of Covid-19 related symptoms to identify infected HCWs.SummaryThe sensitivity of SARS-CoV-2 lateral flow immunoassay serology in healthcare workers (HCWs) was 75.2%. Older HCWs and nurses had higher positivity than other groups. An estimated 73.4% of HCWs with Covid-19 symptoms without RT-PCR test were not infected with SARS-CoV-2.

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Serosurveillance of SARS CoV 2 among the healthcare workers of a tertiary care teaching institution in Central Kerala during the post lockdown phase

10.1101/2021.01.27.21250502 ◽

2021 ◽

Author(s):

Aboobacker Mohamed Rafi ◽

Maglin Monica Lisa Joseph Tomy ◽

Ronnie Thomas ◽

Chithra Valsan ◽

U G Unnikrishnan ◽

...

Keyword(s):

United States ◽

Health Care ◽

Health Care Workers ◽

Healthcare Workers ◽

The United States ◽

P Value ◽

Antibody Testing ◽

Medical College ◽

Care Workers ◽

History Of

AbstractBackgroundKerala was the first state to have the confirmed case of COVID-19 in the country and it was first confirmed in Thrissur district on 30 January2020.Our institute being in the heart of the city had to take adequate measures to mitigate the spread and treat the required patients by keeping its staff safe & Healthy. The hallmark of COVID 19 infection is high infectivity, pre-symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalizations, and deaths. Kerala was the first state to confirm community transmission in July 2020.Health care workers being in the forefront in the war against COVID19 are very prone in acquiring the infection and are possible to be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV2 antibodies in the population contributes to the epidemiological understanding of the disease. The intent of the study is to do an antibody testing in our hospital to find the serosurveillance of SARS CoV 2 among the healthcare workers in our hospital.AimTo estimate the seropositivity of SARS CoV 2 among the healthcare workers at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, six months after revoking the lockdownMethodologyA cross sectional study among the health care workers of the medical college. Multistage Sampling was done with the hospital block as the first stage and departments as the second stage. In the final stage of sampling the test individuals were selected on a first come first served basis after the antibody test availability was declared open and free for all staff. A consent form and a Google form were given to all staff who volunteered for participating in the study. Each consented participant recruited into the investigation completed a questionnaire which covers details regarding demographics, exposure history, Residence & travel. Blood sample was collected and Anti-SARS COV2 IgG antibody testing which targets the Spike Protein 1(SP1) was done using the VITROS chemiluminescence platform (Orthoclinical diagnostics, USA). Sampling & testing ranged over a time frame from September 5th to December 15th, 2020ResultsJubilee Mission Medical College has 2785 working staff at the time of study. A total of 420 staff consented and their samples were tested. 37 staff members tested positive for COVID-19 antibody, yielding an overall prevalence of 8.75% (95% CI, 6.23–11.86). 86.5 % (32/37) of them were having a history of COVID-19 Antigen / RT PCR Positivity. We identified a statistically significant linear trend (p value =0.00001), between seropositivity and the degree of severity of COVID 19. Among the various factors which increase the risk of seroconversion, history of undergoing quarantine (p value < 0.001), contact with a confirmed case (p value = 0.002), contact with a caregiver for COVID 19 (p value =0.001) and history of Upper respiratory symptoms (p value =0.001), were found to be significantly associated with positive serology.ConclusionsThe overall seropositivity in the current study was found to be 8.75% which is comparable to seroprevalence studies conducted in the United States and Wuhan in China. The pattern of seropositivity across the different category of health workers observed in the present study showed a higher prevalence among nurses. This result is also in agreement with a recent published report from united states. Various measures advised by the national and state health authorities were adequately adhered to. Keeping track of the pattern of development of immunity in the community is part of understanding the illness and forecasting the spread. For the tested HCW, it will boost up morale by ending uncertainty. For the hospital administration it will help in decision making about relative focusing of interventions on patients in general and HCWs. By knowing the immunity status of HCWs, the Institution will be able to contribute authentically to the development of intervention strategies and guidelines from time to time, besides following the available guidelines. Being an educational institution, it is obligatory to train all the elements of care delivery to the future generation of health care workers. Getting experienced from a small but relevant sample was expected to facilitate larger community study envisaged in peripheral areas Jubilee served

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THE EARLY HISTORY OF HAND SURGERY IN THE PHILIPPINES AND HIGHLIGHTS IN MY EXPERIENCE AT THE NATIONAL ORTHOPAEDIC HOSPITAL MANDALUYONG AND THE OUR LADY OF LOURDES HOSPITAL, MANILA

Hand Surgery ◽

10.1142/s0218810406003231 ◽

2006 ◽

Vol 11 (03) ◽

pp. 109-133

Author(s):

Eugenio M. Inocentes

Keyword(s):

Medical Center ◽

Hand Function ◽

Hand Surgery ◽

Armed Forces ◽

The Philippines ◽

Sunday Morning ◽

Hand Surgeon ◽

Orthopaedic Hospital ◽

Foreign Guest ◽

History Of

Several years ago, while attending a Philippines Orthopaedic Association (PDA) Annual Convention, held at the Westin Philippine Plaza Hotel, Manila in December, I had the opportunity to meet with Professor Yoshikazu Ikuta, a well-known microsurgery and hand surgeon from Japan and one of the foreign guest speakers. I had been invited to work with him at the Armed Forces of the Philippines (AFP) Medical Center on the case of a high ranking general of the AFP, with a hand contracture disability problem. The case was referred to him by Dr. Evaristo Sanchez, Chief of Orthopaedics and the Commanding General of the AFP Medical Center. He had been pre-scheduled for surgery the next day, a Sunday morning, the day before Prof. Ikuta was due to return to Japan. After a brief examination and evaluation of the generals affected hand, in the operating room with Prof. Ikuta, just before he was placed under general anaesthesia, we performed the operation together. The operation did not involve microsurgery. The procedures done were multiple combined Bunnell-Zancolli pulley advancements and MP-joint volar capsulorraphies plus flexor tendon releases in the volar forearm, which although quite extensive, were only palliative, to minimise and improve on the contracture deformities, in preparation for a final re-evaluation for possible later, more definitive tendon transfers for hand function. However, I never received any further information regarding the results of our surgery. Recently, I have been honoured and invited again by Prof. Ikuta, presently the Editor-in-Chief of the Hand Surgery Journal (Asian Volume), this time to write the history of hand surgery in the Philippines and add to it, "Highlights in my experience at the National Orthopaedic Hospital, Mandaluyong, and the Our Lady of Lourdes Hospital, Manila", the last portion of which is on paralytic disabilities of the Hand. I am deeply grateful to Prof. Ikuta for giving me this honour and opportunity to present the total experience, favourable and unfavourable, of a hand surgeon from a developing country, like the Philippines. Furthermore, this would afford me also, the chance to be able to make known to readers of this now prestigious journal, the philosophical thoughts which led me to unwittingly originate or come up with and develop a few of my own "Long Tendon Rerouting Procedures" which may possibly and hopefully merit as this author's title contribution to surgery of the hands.

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Oral candidiasis in HIV-uninfected pediatric population in areas with limited fungal diagnosis: A case study from a tertiary hospital, Tanzania

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211016964 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110169

Author(s):

Martha F. Mushi ◽

Neema Loi ◽

Stephen E. Mshana

Keyword(s):

Medical Center ◽

Pediatric Population ◽

Oral Candidiasis ◽

Multivariate Logistic Regression Analysis ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Candida Spp ◽

Cross Sectional ◽

History Of

Background: Oral candidiasis (OC) is an indirect indicator of cell-mediated immunodeficiency with a high predictive value of disseminated candidiasis. Here, we report the prevalence and factors associated with laboratory-confirmed OC in human immunodeficiency virus (HIV)-uninfected children with clinical OC attending the outpatient clinic or admitted in pediatric wards of the Bugando Medical Center (BMC). Methods: A cross-sectional study was conducted between January and June 2017. Social demographic and clinical data were collected using a pre-tested data collection tool. Oral swabs were collected using a sterile cotton swab and mycological culture was done to detect Candida spp. followed by susceptibility testing as per European Committee on Antimicrobial Testing (EUCAST) guidelines. Data were analyzed using STATA version 13 following study objectives. Results: A total of 325 non-repetitive oral swabs from HIV-uninfected children aged between 2 and 156 months were collected. Candida spp. were detected in 123 (37.8%) children. One (1.8%) C. albicans isolate was resistant to fluconazole, voriconazole, and posaconazole with minimum inhibitory concentrations (MIC) of 256 μg/ml, 32 μg/ml, and 0.31 μg/ml, respectively. Upon multivariate logistic regression analysis, being a male child (OR 2, 95% CI 1.2–3.2, p = 0.008) and having a history of antibiotic use (OR 1.8, 95% CI 1.1–2.8, p = 0.017) independently predicted laboratory-confirmed OC among HIV-uninfected children. Conclusion: Only a third of children with clinical OC were laboratory confirmed, and this was more likely in male children with a history of antibiotic use. Most of the isolates were highly susceptible to commonly used antifungal agents like fluconazole. Treatment of children at risk should be prioritized to reduce associated morbidity.

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Acceptability, usability and performance of lateral flow immunoassay tests for SARS-CoV-2 antibodies: REACT-2 study of self-testing in non-healthcare key workers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab496 ◽

2021 ◽

Author(s):

Bethan Davies ◽

Marzieh Araghi ◽

Maya Moshe ◽

He Gao ◽

Kimberly Bennet ◽

...

Keyword(s):

Point Of Care ◽

Venous Blood ◽

Fire Service ◽

Lateral Flow ◽

Lateral Flow Immunoassay ◽

Antibody Testing ◽

Prevalence Studies ◽

Similar Performance ◽

Self Test ◽

The Uk

Abstract Background Seroprevalence studies are essential to understand the epidemiology of SARS-CoV-2. Various technologies, including laboratory assays and point-of-care self-tests, are available for antibody testing. The interpretation of seroprevalence studies requires comparative data on the performance of antibody tests. Methods In June 2020, current and former members of the UK Police forces and Fire service performed a self-test lateral flow immunoassay (LFIA), had a nurse-performed LFIA and provided a venous blood sample for ELISA . We present the prevalence of antibodies to SARS-CoV-2; the acceptability and usability of self-test LFIAs; and determine the sensitivity and specificity of LFIAs compared to laboratory ELISA. Results In this cohort of 5189 current and former members of the Police service and 263 members of the Fire service, 7.4% (396/5,348; 95% CI, 6.7-8.1) were antibody positive. Seroprevalence was 8.9% (6.9-11.4) in those under 40 years, 11.5% (8.8-15.0) in those of non-white ethnicity and 7.8% (7.1-8.7) in those currently working. Self-test LFIA had an acceptability of 97.7% and a usability of 90.0%. There was substantial agreement between within-participant LFIA results (kappa 0.80; 0.77-0.83). The LFIAs had a similar performance: compared to ELISA, sensitivity was 82.1% (77.7-86.0) self-test and 76.4% (71.9-80.5) nurse-performed with specificity of 97.8% (97.3-98.2) and 98.5% (98.1-98.8) respectively. Conclusion A greater proportion of this non-healthcare key worker cohort showed evidence of previous infection with SARS-CoV-2 than the general population at 6.0% (5.8-6.1) following the first wave in England. The high acceptability and usability reported by participants and similar performance of self-test and nurse-performed LFIAs indicate that the self-test LFIA is fit for purpose for home-testing in occupational and community prevalence studies.

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Google Analytics and quick response for advancement of gold nanoparticle-based dual lateral flow immunoassay for malaria – Plasmodium lactate dehydrogenase (pLDH)

Analytical Methods ◽

10.1039/c7ay01645j ◽

2017 ◽

Vol 9 (41) ◽

pp. 5943-5951 ◽

Cited By ~ 9

Author(s):

Christian L. Mthembu ◽

Myalowenkosi I. Sabela ◽

Mbuso Mlambo ◽

Lawrence M. Madikizela ◽

Suvardhan Kanchi ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Gold Nanoparticle ◽

Healthcare Workers ◽

Malaria Diagnosis ◽

Lateral Flow ◽

Lateral Flow Immunoassay ◽

Quick Response ◽

Community Healthcare ◽

Community Healthcare Workers

An assay with quick response barcodes improves malaria diagnosis, and enhances systems transferring data among community healthcare workers.

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Clinical Utility of a Highly Sensitive Lateral Flow Immunoassay as determined by Titer Analysis for the Detection of anti-SARS-CoV-2 Antibodies at the Point-of-Care

10.1101/2020.07.30.20163824 ◽

2020 ◽

Author(s):

Amanda Haymond ◽

Claudius Mueller ◽

Hannah Steinberg ◽

K. Alex Hodge ◽

Caitlin W Lehman ◽

...

Keyword(s):

Neutralizing Antibodies ◽

Best Practice ◽

Point Of Care ◽

Neutralization Assay ◽

Lateral Flow ◽

Lateral Flow Immunoassay ◽

Enzyme Linked Immunosorbent Assay ◽

Antibody Testing ◽

Roc Curve Analysis ◽

Viral Neutralization

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), became a pandemic in early 2020. Lateral flow immunoassays for antibody testing have been viewed as a cheap and rapidly deployable method for determining previous infection with SARS-CoV-2; however, these assays have shown unacceptably low sensitivity. We report on nine lateral flow immunoassays currently available and compare their titer sensitivity in serum to a best-practice enzyme-linked immunosorbent assay (ELISA) and viral neutralization assay. For a small group of PCR-positive, we found two lateral flow immunoassay devices with titer sensitivity roughly equal to the ELISA; these devices were positive for all PCR-positive patients harboring SARS-CoV-2 neutralizing antibodies. One of these devices was deployed in Northern Italy to test its sensitivity and specificity in a real-world clinical setting. Using the device with fingerstick blood on a cohort of 27 hospitalized PCR-positive patients and seven hospitalized controls, ROC curve analysis gave AUC values of 0.7646 for IgG. For comparison, this assay was also tested with saliva from the same patient population and showed reduced discrimination between cases and controls with AUC values of 0.6841 for IgG. Furthermore, during viral neutralization testing, one patient was discovered to harbor autoantibodies to ACE2, with implications for how immune responses are profiled. We show here through a proof-of-concept study that these lateral flow devices can be as analytically sensitive as ELISAs and adopted into hospital protocols; however, additional improvements to these devices remain necessary before their clinical deployment.

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The early detection of immunoglobulins via optical-based lateral flow immunoassay platform in COVID-19 pandemic

PLoS ONE ◽

10.1371/journal.pone.0254486 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254486

Author(s):

Pang-Yen Chen ◽

Cheng-Hao Ko ◽

C. Jason Wang ◽

Chien-Wei Chen ◽

Wei-Huai Chiu ◽

...

Keyword(s):

Early Detection ◽

False Negative ◽

Test Strip ◽

Lateral Flow ◽

Lateral Flow Immunoassay ◽

Quantitative Detection ◽

Global Public Health ◽

Rt Pcr ◽

Antibody Testing ◽

Igg Antibody

The coronavirus disease (COVID-19) is the global public health challenge currently persisting at a grand scale. A method that meets the rapid quantitative detection of antibodies to assess the body’s immune response from natural COVID-19 illness or vaccines’ effects is urgently needed. In the present study, an attempt was made to integrate a newly designed spectrometer to the COVID-19 test strip procedure; this augmentation provides the quantitative capacity to a lateral flow immunoassay (LFIA). Optical interpretation of results by quantitative α index, rather than visual qualification, can be done quickly, in 5–10 minutes. The developed product was compared with several other serological IgM/IgG antibody reagents on the market by recruiting 111 participants suspected of having COVID-19 infection from March to May 2020 in a hospital. Taking RT-PCR as the diagnostic gold standard, the quantitative spectral LIFA platform could correctly detect all 12 COVID-19 patients. Concerning RT-PCR negative patients, all three antibody testing methods found positive cases. The optical-based platform exhibited the ability of early detection of immunoglobulins of RT-PCR negative patients. There was an apparent trend that elevation of IgM levels in the acute phase of infection; then IgG levels rose later. It exhibited the risk of a false-negative diagnosis of RT-PCR in COVID-19 testing. The significant detection ability of this new optical-based platform demonstrated clinical potential.

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