THE THREE-STAGE MODEL OF VOLUNTEERS' DURATION OF SERVICE

The main objective of this paper was to describe the latest results of a longitudinal study carried out by our research team with a sample of social work volunteers, whose one-year follow-up has just been completed, allowing us to draw up what we have called the “Three-stage model of volunteers' duration”. Use of this model overcomes some of the apparent contradictions between the different models of volunteerism. For example, for the Functional Model, motivations, and more specifically their satisfaction, would be the best predictors of service duration, however, for the Role Identity Model, what best predicts service duration would be role identity. We assume that in the initial phase of volunteerism, motivations and their satisfaction are more closely related to service duration than role identity. Nevertheless, to predict longer duration of service and greater involvement, the fundamental variable is organizational commitment. Finally, the Role Identity Model is that which best explains sustained volunteerism. Instruments used included the Organizational Commitment Questionnaire (Mowday, Steers, & Porter, 1979) reduced and adapted by Dávila & Chacón, and The Role Identity Scale (Grube & Pilavin, 2000, adapted by Dávila & Chacón, 2004).

24-hour changes in ACTH, corticosterone, growth hormone, and leptin levels in young male rats subjected to calorie restriction

Calorie restriction of young male rats increases plasma prolactin, decreases luteinizing hormone (LH) and testosterone, and disrupts their 24 h secretory pattern. To study whether this could be the consequence of stress, we examined the 24 h variations of plasma adrenocorticotropic hormone (ACTH) corticosterone, growth hormone (GH), leptin, and adrenal corticosterone. Rats were submitted to a calorie restriction equivalent to a 66% of usual intake for 4 weeks, starting on day 35 of life. Controls were kept in individual cages and allowed to eat a normal calorie regimen. Significantly lower ACTH levels were detected in calorie-restricted rats. Plasma corticosterone levels during the light phase of the daily cycle were significantly higher in calorie-restricted rats. Time-of-day variation in plasma ACTH and corticosterone levels attained significance in calorie-restricted rats only, with a maximum toward the end of the resting phase. The daily pattern of adrenal gland corticosterone mirrored that of circulating corticosterone; however, calorie restriction reduced its levels. Plasma ACTH and corticosterone correlated significantly in controls only. Calorie restriction decreased plasma GH and leptin, and it distorted 24h rhythmicity. In a second study, plasma ACTH and corticosterone levels were measured in group-caged rats, isolated control rats, and calorie-restricted rats during the light phase of the daily cycle. Plasma ACTH of calorie-restricted rats was lower, and plasma corticosterone was higher, compared with isolated or group-caged controls. The changes in the secretory pattern of hormones hereby reported may be part of the neuroendocrine and metabolic mechanisms evolved to maximize survival during periods of food shortage.

Efficacy of lifestyle interventions in physical health management of patients with severe mental illness

Awareness of the importance of maintaining physical health for patients with severe mental illnesses has recently been on the increase. Although there are several elements contributing to poor physical health among these patients as compared with the general population, risk factors for cardiovascular disease such as smoking, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and obesity are of particular significance due to their relationship with mortality and morbidity. These patients present higher vulnerability to cardiovascular risk factors based on several issues, such as genetic predisposition to certain pathologies, poor eating habits and sedentary lifestyles, high proportions of smokers and drug abusers, less access to regular health care services, and potential adverse events during pharmacological treatment. Nevertheless, there is ample scientific evidence supporting the benefits of lifestyle interventions based on diet and exercise designed to minimize and reduce the negative impact of these risk factors on the physical health of patients with severe mental illnesses.

Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial

Background

Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)—anxiety, depression, and somatic symptom disorders—and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate.

Objective

We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction.

Methods

Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain.

Results

This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018.

Conclusions

We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries.

ClinicalTrial

International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3)

d24-hour changes in circulating prolactin, follicle-stimulating hormone, luteinizing hormone and testosterone in male rats subjected to social isolation

BACKGROUND: This work analyzes the effect of social isolation (a mild stressor) on the 24-h variation of pituitary-testicular function in young Wistar rats, assessed by measuring circulating levels of prolactin, FSH, LH and testosterone. METHODS: Animals were either individually caged or kept in groups (4-5 animals per cage) under a 12:12 h light-dark cycle (lights on at 0800 h) for 30 days starting on day 35 of life. Rats were killed at 4-h intervals during a 24-h cycle, beginning at 0900 h. RESULTS: Isolation brought about a decrease in prolactin, LH and testosterone secretion and an increase of FSH secretion. In isolated rats the 24-h secretory pattern of prolactin and testosterone became modified, i.e., the maximum in prolactin seen in control animals at the beginning of the activity span was no longer detected, whereas the maximum in circulating testosterone taking place at 1700 h in controls was phase-delayed to 2100 h in isolated rats. CONCLUSION: Social isolation affects the 24-h variation of pituitary-testicular function in young rats. Secretion of prolactin, LH and testosterone decreases, and secretion of FSH increases, in isolated rats. The maximum in prolactin seen in group-caged rats at the beginning of the activity span is not observed in isolated rats. The maximum in circulating testosterone taking place at the second part of the rest span in controls is phase-delayed to the light-dark transition in isolated rats.

Immunohistochemical expression of estrogen receptor beta in normal and tumoral canine mammary glands

To date, two isoforms of estrogen receptors (ER) have been identified, cloned, and characterized from several species, estrogen receptor-alpha (ERalpha) and estrogen receptor-beta (ERbeta). Although the presence of ERalpha has been demonstrated in normal and tumoral canine mammary tissues, the issue of ERbeta expression has not been addressed in the dog. In this study, we have analyzed the expression of ERbeta in formalin-fixed, paraffin-embedded tissue samples of nonaltered mammary gland, 30 malignant (six complex carcinoma, 12 simple carcinoma, three carcinosarcoma, and nine carcinoma or sarcoma in benign tumor), and five benign (one fibroadenoma, one complex papilloma, one complex adenoma, and two benign mixed tumors) mammary tumors of the dog by using a polyclonal ERbeta antibody and the avidin-biotin-peroxidase complex immunohistochemical technique. Our results show that high numbers of normal ductal and acinar epithelium and approximately one third of canine mammary tumors express ERbeta. This expression was higher in benign than in malignant tumors. Furthermore, expression was higher in complex and mixed histologic subtypes of malignant tumors when compared with simple subtypes.

Functioning and symptomatic outcomes in patients with bipolar I disorder in syndromal remission: a 1-year, prospective, observational cohort study

BACKGROUND

Recent studies demonstrate that many Bipolar Disorder (BD) patients experience mild symptoms and/or suffer significant functional impairment during periods of syndromal remission, suggesting greater relapse risk and need for more intensive therapeutic strategies. However, most studies have cross-sectional designs and other methodological limitations. This study aimed to prospectively evaluate whether the presence of subsyndromal symptoms and level of functionality have long-term consequences in BD patients in syndromal remission.

METHODS

A 1-year, prospective, observational cohort study of BD patients in syndromal remission assessed participants at study entry and 3, 6 and 12months after baseline on a range of clinical, social and functional outcomes.

RESULTS

A total of 473 BD patients were screened at 51 study sites across Spain. Finally, 398 patients with bipolar I disorder in syndromal remission were included. After the 12-month, follow-up period, 87.6% of patients remained in syndromal remission, 79.9% of patients were free of subsyndromal symptoms, but only 53.5% had normal levels of functionality. Patients without subsyndromal symptoms and with normal levels of functionality at baseline had longer time to relapse, lower relapse risk, fewer changes on medication and hospitalizations, better employment, less medical/psychiatric leaves and better functional household membership.

LIMITATIONS

Limitations of this study are related with its naturalistic design.

CONCLUSIONS

In a prospectively assessed BD cohort with all patients in syndromal remission at baseline, syndromal remission was not always accompanied by normal functioning and/or the presence subsyndromal symptoms. Interventions, including medication and psychosocial approaches, should go beyond syndromal remission and target subsyndromal symptoms and functional recovery.

Chronobiological features of the immune system. Effect of calorie restriction

The circadian organization of living organisms is fully established being a key component the activity of the neuro-endocrin-immune system that maintains the homeostasis. Secondary lymph organs, such as submaxillary lymph nodes and spleen, have been shown to exhibit a 24 h variation in blastogenic proliferative capacity and distribution of B and T subsets, with specific achrophases depending on the parameter studied or the lymphoid organ considered. However, less is known about the thymus. The immune system has been shown to change by calorie restriction, although no information is available about possible effects in 24 h variations. Similar questions can be posed for the neuro-endocrine system. As an example, some data are shown in this article about the effects of calorie restriction on the neuro-endocrin-immune system in growing male Wistar rats. Calorie restriction blunted the circadian secretory pattern of TSH observed in the control group that was characterized by the existence of two peaks at 17:00 or 01:00 h and that explained the low basal metabolic rate of these animals under this experimental condition. Concerning the immune system, the thymus gland exhibited 24 h variations in T, B and immature cells in both control and calorie-restricted male rats, thus confirming the circadian organization of the immune system. Moreover this circadian organization was changed by calorie restriction.

Volunteer Functions Inventory: A systematic review

The objective of this research study was to conduct a systematic review of the research on volunteers using Clary et al.’s VFI (1998). A total of 48 research studies including 67 independent samples met eligibility criteria. The total sample of the studies analyzed ranged from 20375 to 21988 participants, depending on the motivation analyzed. The results show that the Values factor obtained the highest mean score, both overall and in each type of volunteering, whereas the lowest scores were for the Career and Enhancement factors. Studies conducted with samples with a mean age under 40 years obtain higher scores on Career and Understanding scales when compared to studies in older samples. The group of studies with less than 50% women yield higher mean scores on the Social scale than studies with more than 50% women in the sample. All the scales show reliability coefficients between .78 and .84. Only eight of the articles provide data on the reliability of the scale with a mean value of .90. Of the 26 studies that performed factor analysis, 18 confirmed the original structure of six factors.

Blood glucose control and quality of health care in non-insulin-treated patients with Type 2 diabetes in Spain: a retrospective and cross-sectional observational study

AIMS

To assess blood glucose control and quality of health care provided to non-insulin-treated patients with Type 2 diabetes mellitus in routine clinical practice in Spain.

METHODS

In this observational, retrospective, cross-sectional study, patients were grouped as either having good or suboptimal blood glucose control according to International Diabetes Federation or American Diabetes Association HbA(1c) goals. Clinical and socio-demographic data and compliance with the main standard level of care recommendations of the International Diabetes Federation were recorded during a routine visit. Correlates of glucose control were analysed by logistic regression.

RESULTS

Many patients were grouped as having suboptimal control under International Diabetes Federation (61.9%) or American Diabetes Association (45.0%) criteria. The mean number of accomplished International Diabetes Federation recommendations (7.3 out of 11) was higher for endocrinologists (than for internists or primary care physicians), and significantly more patients under their care were in the good glucose control group (than with primary care physicians). More recommendations were associated with blood glucose control using International Diabetes Federation than American Diabetes Association criteria, demanding higher quality of health care for achieving stricter goals. Some recommendations were poorly observed, particularly those concerning patients' education on diabetes, the prompt prescription of effective treatments and monitoring of complications. Diabetes complications were associated with being in the suboptimal control group. Patients' education on diabetes and HbA(1c) monitoring were associated with being in the good control group.

CONCLUSIONS

These results demonstrate the need for improvement in the management of patients with non-insulin-treated Type 2 diabetes in actual clinical practice in Spain. Such improvement would entail a stricter adherence to International Diabetes Federation recommendations.

Consequences of the North American Free Trade Agreement for health services: a perspective from Mexico

OBJECTIVES

The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade.

METHODS

The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed.

RESULTS

Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity.

CONCLUSIONS

NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries.

Moral Absolutism, Self-Deception, and Moral Self-Concept in Men Who Commit Intimate Partner Violence

The objective of this study is to show compatible data with the idea that men who commit intimate partner violence are uninhibited about the moral consequences of their behaviors, probably because they feel certainty about the rightness of their moral values and they strongly deceive themselves to maintain a good moral self-concept, and thus a good level of well-being. To do that, we compare their scores with those obtained by an opposite sample regarding the use of violence, made up of professional male psychologists who work in the social field trying to teach others alternative strategies to violence.

Comparative immunohistochemical study of stellate cells in normal canine and equine adenohypophyses and in pituitary tumours

The presence and distribution of S100 protein (alpha and beta subunits), cytokeratin polypeptides, glial fibrillary acidic protein, neurofilaments, vimentin, neuron specific enolase, synaptophysin, HLA class II DR antigen, and pituitary hormones (prolactin, adrenocorticotropic hormone and human chorionic gonadotrophin) in stellate cells were studied immunohistochemically in four normal canine pituitary glands, five canine pituitary adenomas, two canine pituitary carcinomas and two equine pituitary adenomas (with surrounding normal glandular tissue). Stellate cells of the pars distalis and pars intermedia of canine and equine adenohypophyses showed a strong reaction with antibodies against S100 protein subunits alpha and beta. They also reacted with antibody against high and low molecular weight cytokeratins, but not with those against other intermediate filament proteins, neuroendocrine markers, the HLA-class II DR antigen or the pituitary hormones. Other populations of cells expressing both subunits of the S100 protein were polygonal cells of the pars distalis of the adenohypophysis (horse) and marginal epithelial cells of the pars intermedia of the adenohypophysis (dog and horse). Some pituitary tumours had S100-immunoreactive cells with a distribution of alpha and beta subunits that differed between the two species. Some canine tumours (one adenoma and one carcinoma) expressed only the alpha subunit, but both of the equine adenomas expressed alpha and beta protein subunits. Some of the S100-immunoreactive tumour cells reacted with RCK-102 (cytokeratins 5+8) antibody in the dog but not in the horse. The results suggested that canine and equine stellate cells of the adenohypophysis are more closely related to epithelial than to glial cells, as is the case in cattle, sheep and goats but not human beings or mice. No subpopulation of cells of bone marrow origin could be identified among canine stellate cells, as they lack MHC class II antigen. The results also suggested that the presence of S100-immunoreactive cells is more striking in canine and equine tumours than in human tumours.

Modification of the Daily Activity Pattern of the Diurnal Triatomine Mepraia spinolai (Hemiptera: Reduviidae) Induced by Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) Infection

Mepraia spinolai, (Porter) 1934, is a diurnal triatomine endemic to Chile and a wild vector of the protozoan Trypanosoma cruzi, (Chagas) 1909, which causes Chagas disease. Behavioral changes in M. spinolai induced by this parasite have been reported previously, which include detection of a potential host, defecation latency, and some life history traits. In this study we assessed changes in locomotor and daily activity due to infection with T. cruzi. No difference was detected in distance traveled between infected and uninfected individuals. However, the groups differed in their daily activity patterns; infected individuals showed significant reduction of movements during the light phase and concentrated their activity in the dark phase. Uninfected individuals showed no differences in locomotor activity between the phases. The results suggest that T. cruzi induces a displacement in the activity of M. spinolai toward the dark phase of the circadian cycle, which may improve its vector competence.

Differential responses of circulating prolactin, GH, and ACTH levels and distribution and activity of submaxillary lymph node lymphocytes to calorie restriction in male Lewis and Wistar rats

OBJECTIVES

Calorie restriction has been associated with anorexia in growing individuals, but the mechanisms involved are not known. Also, the effects of carbohydrates and lipid restriction in growing individuals were not studied. The aim of this study was to determine whether 66% calorie restriction (lipids and carbohydrates) differentially affects growing rats of the Wistar or Lewis strains.

METHODS

Growing male Wistar and Lewis rats were subjected to 66% calorie restriction for 4 weeks. Plasma prolactin, growth hormone (GH), and adrenocorticotropic hormone (ACTH) levels were measured by specific radioimmunoassays. Likewise, lymphocytes from submaxillary lymph nodes were aseptically obtained to study absolute number of lymphocytes, cell surface markers (CD4+, CD8+, CD4+CD8+, B, and T cells), and proliferation.

RESULTS

The body weight gain was lower in Lewis than in Wistar rats and was blunted in both strains by calorie restriction. Wistar and Lewis rats exhibited differential patterns of plasma prolactin, ACTH, and GH levels as well as proliferative capacities of T and B cells and their distribution in the submaxillary lymph nodes. Calorie restriction increased plasma prolactin and ACTH levels in Lewis as compared with Wistar rats. However, the plasma GH levels were diminished in both strains of rats by calorie restriction. All changes in plasma prolactin ACTH and GH levels seemed to correlate with the modifications observed in the distributions of T and B subsets in the submaxillary lymph nodes as well as in their proliferative capacity.

CONCLUSIONS

Calorie restriction differentially modifies the secretory patterns of prolactin, GH, and ACTH in Lewis and in Wistar rats. These changes may explain, at least in part, the associated modifications in the proliferative capacity of submaxillary lymph node lymphocytes and in their distribution.

P-119 A MODIFIED CHEVREL AS AN ALTERNATIVE WALL CLOSURE TECHNIQUE FOR PATIENTS WITH ABDOMINAL HYPERTENSION

 

Abdominal compartment syndrome is a pontentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vacular thrombosis or mesenteric ischemia. A descompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging.

Aim

This study aims to describe short term results after a modified Chevrel technique for midline incisional repair in patients witch abdominal hypertension.

Materials & Methods

We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension.

Results

Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intra-abdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed buldging. A decrease in intrabdominal pressure was achieved in all patients.

Conclusion

The modified Chevrel technique can be used as a closure option for midline ventral hernias in cases where the entire abdominal wall cannot be used.

[Education, investigation and action in international health: Unit of International Studies in Public Health, Mexico]

The internationalization of health causes, conditions, and responses require the consolidation of a vigorous academic and pragmatic tradition of international health. The Unit for International Studies in Public Health constitutes an interinstitutional effort for the training of human resources, research, consulting and practice in health needs and actions that go beyond national borders and that affect two or more countries. The main objectives of the Unit are, on the one hand, to develop a conceptual framework and consolidate international health as a field of public health and, on the other, to foster international technical cooperation among the national institutions that conform the Unit and foreign universities, governments of developing and developed countries, and international organizations. The strategies of the Unit are: interinstitutional and intrainstitutional collaboration, consolidation of multidisciplinary teams, integration of research-teaching-service, and external resources fund-raising. The functioning of the Unit is based on an academic program and on an international technical cooperation program.

Rate of hepatitis C reinfection after successful direct-acting antivirals treatment among people who inject drugs in Spain: the LIVERate study

BACKGROUND

Hepatitis C virus (HCV) reinfection following successful treatment threatens the achievement of HCV elimination. The primary aim of this study is to assess reinfection rate three years after sustained virologic response (SVR) in people who inject drugs (PWID) that are on opioid agonist treatment (OAT) who underwent anti-HCV treatment with interferon-free regimens.

METHODS

Observational, non-interventional, prospective, descriptive study carried out in Spanish tertiary public hospitals between 2017 and 2022. Participants comprised 186 adult HCV infected individuals, 85.5% males with a mean age (Standard Deviation, SD) of 50.1 (5.9). All were enrolled in an OAT program at baseline and had attained SVR 12 weeks after therapy completion with an interferon-free treatment. Baseline data were abstracted from medical chart information collected through the routine clinical practice.

RESULTS

The overall rate of HCV reinfection three years after SVR12 among PWID was 1.2 new cases per 100 person-years of follow-up at a median of 15.9 months. In the subgroup analyses, those with injection drug practice and without a stable housing had higher reinfection rates.

CONCLUSION

Although PWID in OAT present a low rate of reinfection by HCV after successful treatment, a closer monitoring in the first year and strengthening inter-consultations with services responsible for monitoring addiction in these patients will be crucial to reduce risky behaviors avoiding HCV reinfection.

How Satisfaction Lead to Volunteer Role Identity? Revisiting Identity Salience applied to Volunteer Research

Many studies have considered satisfaction as a necessary precursor for developing volunteer role identity (VRI). However, the mechanism involved in that relationship and whether diverse types of satisfaction from volunteering literature are part of this relationship remain unclear. We propose that satisfaction may promote the development of VRI by augmenting the identity saliency of the volunteer role. To address identity salience, we adopt a dual-concept approach, measuring the identity importance and identity invocation of the volunteer role. To investigate the hypothesis, we performed multiple general lineal mediation models employing identity importance and identity invocation as simultaneous mediators of the satisfaction-VRI relationship. A sample of 227 volunteers from different organizations completed an online questionnaire remotely. The results indicate that task satisfaction and motivational satisfaction, but not organizational satisfaction, significantly predict volunteer role identity-both directly and indirectly through the mediating roles of identity importance and identity invocation. Future work may continue investigating the paths through which satisfaction and other factors may promote volunteer role identity.

[Conceptual basis of international health]

International health is becoming an important field of study and practice due mainly to the increasing complexity of international relationships which imply both changes in the epidemiologic profile of the population, and transformations of health care delivery systems. At the same time, the character of health problems does not recognize the geographical boundaries of nations; instead, it may open or reinforce new areas of cooperation or conflict in the international arena. The many interactions between international relations and health impose the need to build and consolidate an academic and intellectual tradition of international health, which supports its efforts to generate knowledge and leads its practical applications. International health is experiencing important conceptual and strategic changes which have to be taken into account if educational programs, research projects, and national, binational and multinational health actions are to be comprehensive in their approach, scope, and focus. This article identifies those conceptual and strategic changes, proposes basic definitions, the universe for action, and the disciplinary base of the new international health. In short, the article proposes the transition towards a new international health concept and practice.