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Objectives To explore the association between clinical contexts and accuracy of manikin blood pressure readings by first-year medical students after first Simulation-Based-Education training. Methods This cross-sectional study, in controlled simulation settings, was comprised of 121 first-year medical student participants after their first Simulation-Based-Education training. Divided into three groups (n = 39, 42 and 40), participants measured blood pressure on three simulator arms assigned different clinical contexts: healthy young male, young female with hypotension, and elderly male with hypertension and diabetes. Each group performed the same protocol on three different days. A Chi-squared test was performed for between-day and between-case differences of correct answers, and one-way ANOVA with Bonferroni post-hoc comparisons was performed for manikin-settings deviation (reported Systolic Blood Pressure (SBP) - set SBP) among cases. Results The proportion of correct answers of on Day Two was significantly lower than on the other two days (χ2(2, N = 285) = 0.34, p = .84), but roughly comparable among cases (χ2(2, N = 285) = 24.07, p < .001). The mean of the differences of (SBPreported - SBPset) of Case Two (M = -6.68, SD = 8.91) was significantly lower than Case One (M = -3.07, SD = 9.11) and Three (M = -1.63, SD = 7.76) (F (2, 274) = 8.68, p < .001). Conclusions Although no statistical associations were found between clinical contexts and student performance in blood pressure measurement, student familiarity with diseases may be associated with performance in taking blood pressure. Day Two performance underscores the need to promote student confidence in diagnostic skills.

Background Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE’s effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. Methods Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins’ BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher’s Exact Tests. Results In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. Conclusions Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.

Thermodynamics of the formation of coordination polymers (CPs) or metal-organic frameworks (MOFs) has not been focused on, whereas many CPs or MOFs have been synthesized in a solution. With a view of separating Nd3+ and Dy3+ in an aqueous solution, we demonstrate that crystallization of the CPs of Nd3+ and Dy3+ based on dibutyl phosphoric acid (Hdbp) can be thermodynamically described; crystallization yields of [Ln(dbp)3] (Ln = Nd or Dy) complex are predicted well using a simple calculation, which takes the apparent solubility products (Kspa) for [Ln(dbp)3] and the acid dissociation constant of Hdbp into account. The Kspa values of [Nd(dbp)3] and [Dy(dbp)3] are experimentally determined to be (1.3 ± 0.1) × 10-14 and (2.9 ± 0.4) × 10-18 M4, respectively, at 20 °C. The ratio of these Kspa values, that is, ca. 4500, is significantly larger than the ratio of the solubility products for inorganic salts of Nd3+ and Dy3+. Therefore, Nd3+ and Dy3+ are selectively crystallized in an aqueous solution via the formation of CPs. Under optimized conditions, Dy3+ crystallization is preferable, whereas Nd3+ remains in the solution phase, where the ratio of the Dy molar content to the total metal content (i.e., Nd + Dy) in the crystal is higher than 0.9. The use of acids, such as HCl or HNO3, has no practical impact on the separation in an aqueous solution.

Since coordination polymers (CPs) are generally obtained as fine powders, the fabrication of a CP is an issue that should be addressed. A monolithic CP was successfully prepared through the lyophilization of a cyclohexane organogel of [Sm(dehp)3] consisting of Sm3+ and di-(2-ethylhexyl)phosphoric acid. The crystalline domains of the CP possibly act as cross-linking points, and the crystallization of cyclohexane is likely to generate the void space in the resulting cryogels. The architecture of the material can be varied by changing the volume ratio of cyclohexane to [Sm(dehp)3]. While the morphology observed through the scanning electron microscope was completely different from the as-synthesized material, powder X-ray diffraction analysis revealed that the crystalline structure did not change. The distribution coefficient and kinetic constant of ion exchange in the lanthanide series were improved by cryogel formation.

The increasing demand for neodymium (Nd)-magnets containing dysprosium (Dy) has necessitated the recovery of Nd and Dy from magnet scraps to ensure their supply. Thus, it is required to develop an environmentally friendly method for separating Nd3+ and Dy3+. Herein, we show that the formation of coordination polymers based on di(2-ethylhexyl) phosphoric acid (HDEHP) enables the fractional precipitation of Nd and Dy in ethanol–water solution because the solubility of the Dy coordination polymer is significantly lower than that of the Nd coordination polymer owing to coordination preference. The separation performance was found to be better in HNO3 than in HCl media. The characterization of the solid and liquid phases obtained from the Nd3+ and Dy3+ precipitation systems suggested that Nd3+– NO 3 - association inhibits the formation of Nd coordination polymers. The partial replacement of dehp− in the Nd coordination polymer by NO 3 - may weaken the binding strength of the framework, resulting in higher solubility. In addition, the formation of Nd(NO3)2+ in solution may shift the equilibrium against the precipitation reaction. However, when Nd3+ and Dy3+ coexist, Nd3+ precipitation is not accompanied by the replacement of dehp− by NO 3 - in the solid phase. This may be attributed to the incorporation of Nd3+ into the framework of the Dy coordination polymer. We conclude that the formation of Nd(NO3)2+ shifts the solution equilibrium and plays an important role in enhancing the separation performance in HNO3 than in HCl when Nd3+ and Dy3+ coexist.

Background Simulation health care education is widely used in medical education and has great potential. However, scenario-based simulation health care education for preventing health care–associated infections has not been described. Methods A single-center, prospective cohort study was conducted at Tokyo Medical University Hospital (1,015 beds), an acute care teaching hospital, from January 2011 to December 2014. Each training course was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (2 scenarios) and contact precaution with methicillin-resistant Staphylococcus aureus (1 scenario), while considering the timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and the use of alcohol-based hand disinfection and reduction of catheter-related bloodstream infection. Results There were 1,077 trainees. The total participation rate for hospital staff, which increased gradually during the study period, was 76% by the end of the study. The overall correlation between the use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (−0.94) was observed for the relation between the training course participation rate and the incidence of catheter-related bloodstream infection. Conclusions Our training course had a positive effect on hand hygiene. This study is the first effective scenario-based simulation health care education on hand hygiene and control of health care–associated infection.

In this paper the exchange of lanthanide(III) ions (Ln(3+)) between a solution and a coordination polymer (CP) of di(2-ethylhexyl)phosphoric acid (Hdehp), [Ln(dehp)3], is studied. Kinetic and selectivity studies suggest that a polymeric network of [Ln(dehp)3] has different characteristics than the corresponding monomeric complex. The reaction rate is remarkably slow and requires over 600 h to reach in nearly equilibrium, and this can be explained by the polymeric crystalline structure and high valency of Ln(3+). The affinity of the exchange reaction reaches a maximum with the Ln(3+) possessing an ionic radius 7% smaller than that of the central Ln(3+), therefore, the affinity of the [Ln(dehp)3] is tunable based on the choice of the central metal ion. Such unique affinity, which differs from the monomeric complex, can be explained by two factors: the coordination preference and steric strain caused by the polymeric structure. The latter likely becomes predominant for Ln(3+) exchange when the ionic radius of the ion in solution is smaller than the original Ln(3+) by more than 7%. Structural studies suggest that the incoming Ln(3+) forms a new phase though an exchange reaction, and this could plausibly cause the structural strain.

Against a backdrop of increasing demand, the recovery of neodymium (Nd) and especially dysprosium (Dy) from manufacturing scraps and used magnets has necessitated the development of Nd/Dy separation technologies. To this end, we suggest a simple and environmentally friendly separation method by fractional precipitation of coordination polymers (CPs)—extended complexes of metal ions and organic ligands. With the di(2-ethylhexyl) phosphoric acid ligand functioning as a precipitant, Dy was exclusively precipitated as a CP due to its precipitation equilibrium that is considerably different from that of Nd.

We isolated a HepG2-derived sub-clone (HepG2-Lipo), which possessed an increased lipoprotein synthesizing ability. HepG2-Lipo cells could secrete triglycerides (TG) and cholesterol at rates 9.4- and 6-fold higher, respectively, when compared to HepG2 cells. Real-time RT-PCR analysis revealed that the expression levels of sterol regulatory element-binding protein-1c and -2 were 2.9- and 1.5-fold higher than in HepG2 cells. Furthermore, two apolipoprotein (apo) genes (apoA-1 and apoB-100) in HepG2-Lipo cells were expressed at 2.8- and 1.9-fold higher levels when compared to those in parental cells. We examined the effects of three antihyperlipidemic agents on the lipoprotein profiles of HepG2-Lipo cells. Simvastatin at 5 microM selectively suppressed cholesterol secretion from HepG2-Lipo cells, and 500 microM fenofibrate inhibited both TG and cholesterol secretion from the cells.

Lactoferrin (LF), a member of the transferrin (TF) protein family, is an iron-binding protein that is known to interact with bacteria through a specific receptor. We examined the binding of bovine LF (bLF), bovine TF (bTF), and ovotransferrin (OTF) by Toxoplasma gondii using a fluorescence test and the streptavidin-biotin (SAB) method using biotin-streptavidin, and found that bLF, bTF, and OTF bound to the protein components of T. gondii. Furthermore, we confirmed that bLF, bTF, and OTF bound a 42 kDa soluble protein of T. gondii by far Western blot method. These results demonstrated that bLF binding proteins are present on T. gondii.

In Japan, many drug addiction rehabilitation centers (DARC) provide various types of recovery programs for drug addiction. The purpose of this study was to clarify the attitudes of DARC staff and users regarding job support programs. A nationwide questionnaire survey was conducted in 2009. The staff of 46 facilities and 606 users returned questionnaires. The results indicated that many (92.1%) users had work experience before entering the recovery programs provided by DARC and about half (49.3%) of the users reported being motivated to work. Although many DARC have established various job support programs, the users faced various levels of anxieties to get employed and 60.4% of the users expected to learn more detailed and concrete methods for finding a job. Through the DARC programs, the users gradually realize the significance of basic daily living skills such as maintaining their rhythm of life or neat and presentable appearance. And the more they get recovered the more they understand the significance of "self-care" and "interpersonal relationship skills". These findings indicate that job support programs for drug addicts should also focus on these recovery processes. More extensive job supports dealing with more practical issues and covering a wide variety of anxieties would be imperative.

Three kinds of coordination polymers ([M(dehp)3], M = Ce, Fe, or Al) were prepared by mixing the sodium form (Na(dehp)) of di(2-ethylhexyl) phosphoric acid and MCl3 in an ethanol-water binary mixture. They have monoclinic crystalline structure with similar lattice parameters. The lanthanide ion (Ln(3+) = La(3+), Sm(3+), Dy(3+), or Yb(3+)) exchange properties were studied in a 20 : 80 vol% ethanol-water binary mixture containing 2 mM Ln(NO3)3 at room temperature. The rate of Ln(3+) adsorption is relatively slow; it requires over 3 weeks to reach equilibrium. [M(dehp)3] has different Ln(3+) affinities depending on the kind of central metal ions: the affinity order at 3 week adsorption is Yb(3+)La(3+)Dy(3+)Sm(3+) for [Ce(dehp)3], La(3+)Sm(3+)Dy(3+)Yb(3+) for [Fe(dehp)3], and La(3+)Sm(3+), Dy(3+), Yb(3+) for [Al(dehp)3]. The difference in affinity order can be explained by two factors: the coordination preference and steric strain caused by the polymeric structure. The chemical and structural analyses suggested that the Ln(3+) adsorption progresses first by the central M(3+)/Ln(3+) exchange, followed by a morphological change to a rod-like or fibrous form by a solid phase reaction. In the case of [Fe(dehp)3], the eluted Fe(3+) may be hydrolyzed and precipitated as amorphous iron hydroxide.

Coordination polymers can be attractive ion exchange materials because of their crystallinity and semi-flexibility, which are rather opposing properties, and play integral and synergistic roles in introducing unique ion-exchange behavior. In this paper, Ln(3+)/Ce(3+) exchange (Ln(3+) = Nd(3+), Gd(3+), Dy(3+), or Lu(3+)) in a coordination polymer, [Ce(dehp)3], based on di(2-ethylhexyl)phosphoric acid (Hdehp) is studied by distribution coefficient measurements, ion-exchange isotherms, Kielland plot analysis, and morphology observation. The ion-exchange selectivity is in the order Nd(3+)Gd(3+)Dy(3+)Lu(3+) when a small amount of Ln(3+) is loaded, but Lu(3+) ≈ Nd(3+)Gd(3+) ≈ Dy(3+) for a high loading ratio. The Kielland plot suggests that a steric effect is involved in the reactions, which becomes stronger in the order of Nd(3+)/Ce(3+)Gd(3+)/Ce(3+)Dy(3+)/Ce(3+)Lu(3+)/Ce(3+) for exchange systems. This trend is attributable to the differences in the ionic sizes between an incoming Ln(3+) and original Ce(3+). Scanning electron microscopy observations reveal the generation of a new phase via the Ln(3+)/Ce(3+) exchange. Such a phenomena results from solid-solid transformation, rather than dissolution-recrystallization. The small steric strain in the Nd(3+)/Ce(3+) system leads to the formation of a Nd(3+)-and-Ce(3+) solid-solution, whereas the morphological change is possibly restrained by the strong strain caused by loaded Ln(3+) with an ionic size significantly smaller than the original Ce(3+).

Lupeol suppressed triglyceride and cholesterol secretion from HepG2-Lipo human hepatoma cells in a dose-dependent manner. Quantitative real-time RT-PCR analysis demonstrated that lupeol inhibited the expressions of sterol regulatory element-binding protein-1c and -2, fatty acid synthase, 3-hydroxy-3-methylglutaryl-Coenzyme A synthetase-1, and farnesyl-diphosphate farnesyl transferase-1, which are required for lipid synthesis in HepG2-Lipo cells. Furthermore, lupeol markedly inhibited apolipoproteinB-100 and microsomal triglyceride transfer protein in cells at the mRNA level. These results suggest that lupeol lowers lipid secretion from HepG2-Lipo cells by attenuating synthesis within the cells.

BackgroundIn Japan, nursing education is being reformed to improve nurses' competency. Interest in use of simulation-based education to increase nurses' competency is increasing.ObjectivesTo examine the effectiveness of simulation-based education in improving competency of cardiovascular critical care nurses.MethodsA training program that consisted of lectures, training in cardiovascular procedures, and scenario simulations was conducted with 24 Japanese nurses working at a university hospital. Participants were allocated to 4 groups, each of which visited 4 zones and underwent scenario simulations that included debriefings during and after the simulations. In each zone, the scenario simulation was repeated and participants assessed their own technical skills by scoring their performance on a rubric. Before and after the simulations, participants also completed a survey that used the Teamwork Activity Inventory in Nursing Scale (TAINS) to assess their nontechnical skills.ResultsAll the groups showed increased rubric scores after the second simulation compared with the rubric scores obtained after the first simulation, despite differences in the order in which the scenarios were presented. Furthermore, the survey revealed significant increases in scores on the teamwork scale for the following subscale items: “Attitudes of the superior” (P < .001), “Job satisfaction” (P = .01), and “Confidence as a team member” (P = .004).ConclusionsOur new educational approach of using repeated scenario simulations and TAINS seemed not only to enhance individual nurses' technical skills in critical care nursing but also to improve their nontechnical skills somewhat.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior This study aimed to analyze some indicators of the restructuring process of place identity of natives resident in Tibau do Sul, a coastal town in the state of Rio Grande do Norte state, in relation to changes occurring in this locale in the last few decades. The concept of place identity a complex psychological structure in constant process of restructuring stresses the focus of this analysis on the aspects referring to the relationships of people with their physical and social environment throughout the transition process from the former village of fishermen and peasant farmers to the current growing town. Interviews with insider informants on local history were carried out as a preliminary step to getting in touch with the native participants. In total, 29 native local residents were interviewed, according to a wide range of personal and professional roles, focusing on their cognitions in regard to their past and present relationships with this context, as well as those related to expectancy for the future. The analysis focused both on the elements of distinctiveness, continuity, self-esteem and self-efficacy, and on how each of them have been valued (positive or negative). The participants evaluations of themselves and of the locale, as well as their distinctions in relation to others (people and places) were, in general, very positive. Many elements of group and place continuity, and the possibility of the satisfaction of their needs were highlighted positively, especially comparing to similar situations in the past. The development of the town, related to tourism as well as to other former economic activities, seemed to contribute to the restructuring process of place identity in a way of achieving desirable states for its structure. The broadening of the analysis to consider a wider spatial and temporal context, however, shows that such positive evaluation can be said to hinder some coping strategies of local residents faced with unsustainable economic activities, oftentimes handled to favor a minority of the population Este estudo teve como objetivo analisar alguns indicadores do processo de reestruturação da identidade de lugar de nativos residentes na sede municipal de Tibau do Sul-RN, frente a mudanças ocorridas nessa localidade nas últimas décadas. O conceito de identidade de lugar estrutura psicológica complexa em constante processo de reestruturação destaca o enfoque dado à análise dos aspectos referentes às relações das pessoas com seu ambiente, físico e social, ao longo do processo de transição do antigo vilarejo de pescadores e agricultores que começa a ganhar contornos de cidade. A primeira etapa do estudo consistiu em entrevistas com conhecedores da história da localidade, como fase preparatória para a segunda etapa. Esta se referiu a entrevistas com 29 moradores da sede municipal nativos do local, de perfis pessoais e profissionais variados, e enfocou as cognições deles acerca de suas relações com esse contexto, no presente, passado e em suas expectativas de futuro. A análise focalizou os elementos de distintividade, continuidade, autoestima e autoeficácia, bem como o caráter valorativo (positivo ou negativo) atribuído a eles. A avaliação e distinção dos participantes acerca da localidade e de si próprios em relação a outros (pessoas e lugares) foi, de modo geral, muito positiva. Muitos elementos de continuidade do grupo e do lugar e a possibilidade de satisfação de suas necessidades foram destacados positivamente, especialmente comparando-se ao passado. O desenvolvimento turístico da cidade e de outras atividades econômicas anteriores pareceu contribuir para um processo de reestruturação da identidade de modo a atingir estados desejáveis para sua estrutura. A ampliação dessa análise em termos de um contexto temporal e espacial, no entanto, mostra que essa avaliação positiva pode dificultar algumas estratégias de enfrentamento pelos moradores frente a atividades econômicas insustentáveis, muitas vezes articuladas de modo a favorecer uma minoria da população

In Japan, the target mental disorders of preventive strategies for suicide had been limited to be mood disorder, but recently drug abuse are known to be significant as a cause of suicide because some researches has found the association between substance use disorder and suicidal behavior in Japan. However, the preventive plans for suicide of drug abusers has not been developed yet. In this study we would like to examine the risk factors of suicide ideation in Japanese drug abusers. We analyzed the data of 445 drug addicts from the Nationwide Research of Drug Addiction Rehabilitation Centers by Tokyo DARC and compared many variables including demographic factors, drug use status, family history, psychopathologies, treatment and daily life satisfactions between people with suicide ideations and without ideations. It was found that 182 cases (43.8%) had suicide ideations in a recent month, and that addicts who had suicide ideations had significantly shorter abstinence time, higher prevalence of victimized experiences before 15 years age, and more mental symptoms such as insomnia, depression, and psychotic symptoms, and more tendencies to use prescribed psychotropic drug than those without suicide ideation. These results suggested that to prevent suicide of drug abusers, we should pay attention to family histories, insomnia and abstinence periods, and help them recovery from psychological damages caused by childhood trauma without inappropriate medications.

The cyanide-resistant alternative oxidase (AOX) is a homodimeric protein whose activity can be regulated by the oxidation/reduction state and by α-keto acids. To further clarify the role of AOX in the skunk cabbage, Symplocarpus renifolius, we have performed expression and functional analyses of the encoding gene. Among the various tissues in the skunk cabbage, SrAOX transcripts were found to be specifically expressed in the thermogenic spadix. Moreover, our data demonstrate that the SrAOX protein exists as a non-covalently associated dimer in the thermogenic spadix, and is more sensitive to pyruvate than to other carboxylic acids. Our results suggest that the pyruvate-mediated modification of SrAOX activity plays a significant role in thermoregulation in the skunk cabbage.

Trypanosoma brucei, the causative agent of sleeping sickness in humans, requires transferrin (TF) for growth. Therefore, T. brucei has a TF receptor that allows it to obtain iron from TF. Lactoferrin (LF), a member of the TF family protein, is an iron-binding protein that is found in most biological fluids of mammals. LF has been shown to interact with some bacteria species by specific receptor-ligand binding. We examined the ability of T. brucei to bind bovine LF (bLF) by using a fluorescence test, streptavidin-biotin (SAB) microplate analysis, and far Western blotting using a biotin-streptavidin system. We found that bLF bound to components of T. brucei, and that bLF hydrolysate disrupted the sites responsible for binding to parasite proteins. Furthermore, bLF, human LF, bovine TF, and ovotransferrin bound same proteins of T. brucei, which exhibited molecular masses of 40 and 43 kDa. The N-terminal amino acid sequence of the 40 kDa bLF binding protein was identified as glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

Uncoupling proteins (UCPs) are a family of mitochondrial inner membrane proteins that have been implicated in heat production in mammalian cells. The inflorescences of several members of the arum lily family (Araceae) have also been shown to produce heat during flowering, but the involvement of UCP-mediated heat production in plants is not known. In this work a gene has been isolated termed HmUCPa that encodes for a putative uncoupling protein from Helicodiceros muscivorus, a highly thermogenic arum lily. RT-PCR analysis revealed that the expression of HmUCPa was ubiquitously found, both in thermogenic male florets and appendix, and the non-thermogenic female florets, spathe and club-shaped organs of the spadix. These results suggest that HmUCPa is not primarily involved in organ-specific heat production in H. muscivorus.

Two distinct mitochondrial energy dissipating systems, alternative oxidase (AOX) and uncoupling protein (UCP), have been implicated as crucial components of thermogenesis in plants and animals, respectively. To further clarify the physiological roles of AOX and UCP during homeothermic heat production in the thermogenic skunk cabbage (Symplocarpus renifolius), we identified the thermogenic cells and performed expression and functional analyses of these genes in this organism. Thermographic analysis combined with in situ hybridization revealed that the putative thermogenic cells surround the stamens in the florets of skunk cabbage and coexpress transcripts for SrAOX, encoding Symplocarpus AOX, and SrUCPb, encoding a novel UCP that lacks a fifth transmembrane segment. Mitochondria isolated from the thermogenic florets exhibited substantial linoleic acid (LA)-inducible uncoupling activities. Moreover, our results demonstrate that LA is capable of inhibiting the mitochondrial AOX pathway, whereas the proportion of pyruvate-stimulated AOX capacity was not significantly affected by LA. Intriguingly, the protein expression levels for SrAOX and SrUCPb were unaffected even when the ambient air temperatures increased from 10.3°C to 23.1°C or from 8.3°C to 24.9°C. Thus, our results suggest that functional coexpression of AOX and UCP underlies the molecular basis of heat production, and that posttranslational modifications of these proteins play a crucial role in regulating homeothermic heat production under conditions of natural ambient temperature fluctuations in skunk cabbage.