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PubMed1985

A comparison of sector and linear array scanners for the measurement of the fetal femur.

This study was designed to determine whether differences between sector and linear array scanners introduce variability in fetal femur length measurements, used to determine gestational age. Twenty transducers from 15 machines were tested with the manufacturers' approval. Machines were coded to maintain anonymity. Three different sized sections of plastic straws were scanned in a water bath. All measurements were made by the same investigator. Measurements were adjusted to compensate for the difference in sound velocity in water, which introduced a 3.36 per cent error in apparent depth of the image for linear array scanners, and a 3.36 per cent error in apparent depth and length for sector scanners. A large variation in measurements was obtained, although the differences were usually within acceptable limits (approximately 4 per cent). Linear array scanners were found to give similar readings as sector scanners.

Embryonic and Fetal Development↗
PubMed1993

Identification of human gene functional regions based on oligonucleotide composition.

Accurate recognition of coding and intron regions within large regions of uncharacterized genomic DNA is an unsolved problem. A data base of more than 4,240,791 bp coding and 7,790,682 bp noncoding human sequences was extracted from GenBank to develop a function for locating coding regions in anonymous sequences. Several coding measures based on oligonucleotide preferences were tested on a control set that including 1/3 of all extracted sequences. An accuracy of separation of coding/noncoding regions is 87% for 9 bp oligonucleotides on 54 bp windows and 91% on 108 bp windows, respectively. For separation of coding/intron regions the accuracy is 89-90% for 8 bp oligonucleotides on 54 bp windows and up to 95% on 108 bp windows. Using the information about preferences of octanucleotides in protein coding and intron regions and significant triplet frequencies as a function of position near splice junctions, a joint splice site prediction scheme was developed. The accuracy of the joint scheme for predicting splice site positions on the test set was about 96-97%, which exceeds the accuracy of the previously reported splice site selection method based on a more complex artificial neural network approach. A model of splicing using poly-G(C) rich exon flanking sequences is suggested. A remarkable difference of oligonucleotide composition 5'- and 3'- gene regions is displayed and applied in a gene structure predictive system.

Exons↗
PubMed1996

[Prevalence of serum anti-hepatitis C virus antibodies and risk factors of contamination in the personnel of a hospital in the Paris region. A prospective survey].

OBJECTIVES: The aim of this prospective study was to estimate the prevalence of subjects with serum anti-HCV antibodies in a University Hospital in the Paris area, and to identify the risk factors associated with contamination. METHODS: Over an 18 month period, each person working in the hospital was systematically requested to fill out an anonymous questionnaire including 23 questions and to undergo a blood test for an anti-HCV assay during their annual medical visit. RESULTS: 557 (33%) of 1693 employees accepted to fill out the questionnaire and the anti-HCV assay. Serum anti-HCV antibodies were present in 9 subjects, which represents a prevalence of 1.6%, and serum RNA was positive by PCR, m 7. The prevalence was significantly higher in subjects working in clinical units (3.0%) compared to subjects working in non-clinical units (0.7%: P = 0.04) and in subjects with a history of acute hepatitis (5.5% vs 0.9%; P = 0.002%) Anti-HCV-positive subjects had more history of manipulating blood products than HCV-negative subjects (17.0 vs 8.8 years of exposure; P = 0.01), other human samples (17.0 vs 7.6 years; P = 0.01), and of having at risk contacts (16.7 vs 6.2 years; P = 0.0004). CONCLUSION: These results suggest the importance of systematic anti-HCV screening among health care workers particularly those in contact with patients.

Adult↗
PubMed1997

["Second opinion" in online radiology via Internet: report on implementation and analysis of reliability of findings in sectional images].

Numerous medical on-line services have already been established in the world-wide internet. In connection with the Information service TELESCAN, sponsored by the EU, a pilot project has been initiated which offers a radiological "second opinion" via the transmission of radiological findings and images that have been previously rendered anonymous. In addition to a description of the basic implementation, tests of the diagnostic certainty of the transmitted cranial computed tomographs have been performed. The CT images were digitized with a document camera, transmitted over the Internet, and then evaluated on the receiver's monitor. Both the transfer of originally generated digital image files (in ACR-NEMA or DICOM) as well as graphic files after digitization of X-ray films, for example by a document camera, is possible via electronic post (e-mail). Visualization by the receiver requires the use of current proprietary software for special medical image formats, while standard graphic formats such as GIFF or JPEG can be visualized with the usual Internet software. In an ROC analysis, 56 individual images of cranial computed tomographs, half with pathological findings such as space-occupying lesions, infarcts, or brain edema, were tested with regard to the diagnostic certainty after digitization and transmission. In comparison with the original film findings, there was a slight but statistically not significant reduction in diagnostic certainty of the images evaluated on screen after transfer via the Internet. We believe that this result is due to the low local resolution, low dynamic range, the high image noise and of CT arising from the window technique. The same parameters are probably valid for MRI. The result cannot be applied to conventional radiography including mammography because, in comparison to the mentioned image techniques, their local resolution is high and image noise is considerably lower.

Computer Communication Networks↗
PubMed1997

Smoking during pregnancy measured by population cotinine testing.

AIM: To establish a baseline cross-sectional prevalence of maternal smoking, measured by antenatal serum cotinine testing, in a population of pregnant women. METHODS: Residual sera from first and second routine antenatal blood samples were collected anonymously over a six-month period for pregnancies within the Canterbury region. Cotinine levels were measured by an ELISA test with a result of > 14 ng/mL indicative of active smoking. Only pregnancies ending in a confirmed live birth were considered in smoking prevalence calculations. There was a total of 1948 eligible residual blood samples. RESULTS: Of the 414 residual blood samples available for the first two months of pregnancy, 146 (35.3%) were found to be positive for cotinine. Smoking prevalence decreased over pregnancy so that by the third trimester 225 (26.8%) of 838 samples were cotinine positive. Infants born from smoking mothers had significantly lower birth weights. CONCLUSIONS: In 1994, a third of women tested in early pregnancy and a quarter of women tested in late pregnancy were identified as being smokers. Repeated objective cross-sectional surveys will allow accurate assessment of the efficacy of smokefree interventions both before and during pregnancy.

Birth Weight↗
PubMed1997

Stress in Air Force aviators facing the combat environment.

BACKGROUND: This paper evaluates the effect of stress on four squadrons of United States Air Force aviators in tactical high performance aircraft deployed for combat operations compared with U.S. based aircrew using the Beck Depression Inventory (BDI) as the evaluating instrument. METHODS: This is a retrospective cross-sectional study consisting of 42 aviators in deployed squadrons stationed overseas and involved in a contingency mission, and 15 subjects stationed in the U.S. and not exposed to combat conditions. Each subject was administered the test instrument, which was completed in privacy and with complete anonymity. RESULTS: The hypotheses of interest were: a) the proportion of individuals in the population of fighter aircrew who would report excessive stress is 0; and b) no significant differences would exist in the proportion of individuals with excessive stress in the various squadrons. Using statistical methodology, these hypotheses were rejected. CONCLUSION: It is concluded that more studies in each given circumstance are necessary.

Adult↗
PubMed2001

Repeat whole-blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs.

BACKGROUND: Evaluating plateletpheresis (PPH) and repeat community whole-blood (RWB) donors' responses to donation incentive programs is essential for developing effective donor retention programs. STUDY DESIGN AND METHODS: Using data from a 1998 anonymous questionnaire sent to 92,581 US blood donors, the prevalence of unreported deferrable risks, screening test reactivity, and response to incentives were compared in RWB and PPH donors by the use of weighted chi-square tests and logistic regression analyses. RESULTS: From 52,650 respondents, 38,884 RWB and 2,028 PPH donors were identified. Levels of screening test reactivity (1%) and unreported deferrable risks (UDRs, 2-3%) were similar in RWB and PPH donors. RWB and PPH donors were strongly encouraged or discouraged by similar incentives. Of the incentives that would encourage a higher proportion of UDR-free RWB donors to return, cholesterol screening and earning a blood credit appealed to >50 percent. Similar results were obtained for cholesterol screening in PPH donors. Community service or education credits, premarital screening, and cash had limited appeal for PPH and RWB donors, respectively, and would be more likely to differentially encourage donors with a UDR to return. CONCLUSION: Incentives that were associated with the greatest donor appeal and that minimized the potential recruitment of more risky donors were identified.

Adult↗
PubMed2005

Using prevalence data from the programme for the prevention of mother-to-child-transmission for HIV-1 surveillance in North Uganda.

OBJECTIVES: To validate the use of data from a programme for the prevention of mother-to-child transmission (PMTCT) in estimating HIV-1 prevalence in North Uganda. METHODS: The study was conducted at St. Mary's Hospital Lacor. We compared the estimated prevalence for 3580 attendees at the antenatal clinic who were selected for anonymous surveillance to that for 6785 pregnant women who agreed to undergo voluntary counselling and testing (VCT) for enrolment in the PMTCT programme. Log-binomial regression models were used to identify the factors associated with both VCT uptake and HIV-1 infection, which could bias the prevalence estimates based on PMTCT data. RESULTS: In 2001-2003, the age-standardized prevalence was similar (11.1% in the anonymous surveillance group and 10.9% in the VCT group). The estimates were also similar when compared for each year tested. Analogously, no important differences were observed in age-specific prevalence. Of the factors associated with HIV-1 infection, only time of residence at current address [prevalence proportion ratio (PPR) = 1.05; 95% confidence interval (CI), 1.00-1.10], marital status (PPR = 1.05; 95% CI, 1.01-1.10) and partner's occupation (PPR = 1.05; 95% CI, 1.01-1.10) were associated with VCT uptake, yet the associations were weak. CONCLUSIONS: The prevalence estimated based on the VCT data collected as part of the PMTCT programme could be used for HIV-1 surveillance in North Uganda. At the national level, however, it needs to be evaluated whether PMTCT data could replace, or instead be combined with, the data from sentinel surveillance.

Adult↗
PubMed1994

HIV testing, HIV infection and associated risk factors among inmates in south-eastern French prisons.

OBJECTIVES: To estimate HIV seroprevalence in the two main remand and short-stay prisons of south-eastern France and to gather linked anonymous risk-factor information. SETTING: Baumettes prison, Marseille, France between 16 November and 21 December 1992. PARTICIPANTS: Using a self-administered questionnaire about HIV testing and risk factors for HIV infection, 295 male and 137 female inmates were interviewed. The response rate was 96% (100 and 90% for men and women, respectively). At the same time, 279 of a total of 432 (65%) inmates were serologically tested for HIV; 153 (35%) declined to provide a blood sample. DESIGN: Anonymous cross-sectional and surveillance survey. RESULTS: Twenty per cent of participants (84 our of 432) were intravenous drug (heroin) users (IVDU), 51% of whom reported needle-sharing prior to incarceration; 23% reported more than two sexual partners during the last year, and 13% sexual intercourse with an IVDU during the last 5 years. HIV status was available for 356 inmates (82%; 65% from blood samples and 17% from the questionnaire); 39 were HIV-infected (10.9%; 95% confidence interval, 7.7-14.2). The inmates not tested for HIV reported proportionally less risky behaviours than non-HIV-infected inmates. HIV seroprevalence was significantly higher among recidivist inmates (19.9 versus 4.4%; P < 0.0001). The rate of HIV infection was particularly high among IVDU (34 out of 84; 40%). More female non-IVDU were HIV-infected than male non-IVDU (4.1 versus 0.6%; P = 0.04). CONCLUSIONS: This study demonstrates the high prevalence of HIV infection in south-eastern French prisons, especially among IVDU. The rates may be related to the high prevalence of risky drug practices and to delays in the development of HIV prevention programmes for IVDU in France. The higher seroprevalence rate among recidivist inmates might be the result of risk behaviours during imprisonment. Another hypothesis is that recidivist inmates are at greater risk of HIV infection because of higher levels of drug use.

AIDS Serodiagnosis↗
PubMed1998

Health of the Nation Outcome Scales (HoNOS). Research and development.

BACKGROUND: An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, "to improve significantly the health and social functioning of mentally ill people". METHOD: A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n = 197) of reliability and relationship to other instruments. RESULTS: The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales. CONCLUSIONS: The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymized and aggregated form for public health purposes, is therefore testable but has not yet been tested.

Health Policy↗
PubMed1998

Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study.

BACKGROUND: There are obvious advantages to increasing donor retention. However, for reasons of blood safety, certain donors may, in fact, be more desirable to retain than others. "Safe" donors are defined as those who provided a blood donation that was negative on all laboratory screening tests and who subsequently reported no behavioral risks in response to an anonymous survey. This study identifies the most important factors affecting the intention of "safe" donors to provide another donation. STUDY DESIGN AND METHODS: An anonymous survey asking about donation history, sexual history, injecting drug use, and recent donation experience was mailed to 50,162 randomly selected allogeneic donors (including directed donors) who gave blood from April through July or from October through December 1993 at one of the five United States blood centers participating in the Retrovirus Epidemiology Donor Study. Before mailing, questionnaires were coded to designate donors with nonreactive laboratory screening tests at their most recent donation. RESULTS: A total of 34,726 donors (69%) responded, with substantially higher response among repeat donors. According to reported intentions only, the vast majority of "safe" donors indicated a high likelihood of donating again within the next 12 months. Only 3.4 percent reported a low likelihood of donating again. A comparison of those likely to return and those unlikely to return reveals significant differences in demographics and in ratings of the donation experience. A higher proportion of those unlikely to return were first-time donors, minority-group donors, and donors with less education. The highest projected loss among "safe" donors was seen for those who gave a fair to poor assessment of their treatment by blood center staff or of their physical well-being during or after donating. CONCLUSION: These data suggest that efforts to improve donors' perceptions of their donation experience, as well as attention to the physical effects of blood donation, may aid in the retention of both repeat and first-time donors.

Adult↗
PubMed2004

Survival and recurrence after breast cancer in BRCA1/2 mutation carriers.

BACKGROUND: Genetic mutation is responsible for approximately 10% of breast cancers. The purpose of this study was to compare breast cancer survival and recurrence rates between BRCA1/2 mutation carriers and noncarriers. METHODS: Using the Columbia Presbyterian breast cancer database, we collected the tissue blocks of all patients younger than 65 years of age and of Jewish descent. The patients were contacted and the data updated. DNA was extracted from the tissue blocks and tested for the common mutations. The results of the genetic mutation and updated database were anonymized and merged. The survival and recurrence rates were compared between mutation carriers and noncarriers. RESULTS: A total of 739 breast cancer cases in 715 patients were identified. We were able to test 487 patients. We identified 30 BRCA1 and 21 BRCA2 mutation carriers, for an incidence of 10.36%. The median follow-up for the patients tested was 50 months. BRCA1 patients more frequently had estrogen- and progesterone-negative tumors and had a higher incidence of positive nodes. BRCA1 patients received chemotherapy more frequently. The incidence of in situ disease was similar for mutation and non-mutation carriers. BRCA1/2 mutation carriers had a higher incidence of bilateral disease. There was no difference in 5- or 10-year overall and breast cancer-specific survival between mutation and non-mutation carriers. CONCLUSIONS: Breast cancer patients with BRCA1/2 mutations have a similar outcome as non-mutation carriers.

Adult↗
PubMedDate not supplied

HIV testing behaviors and attitudes after adoption of name-to-code HIV case surveillance in Washington State.

Controversy over HIV reporting in Washington State raised concerns that name-to-code reporting might reduce HIV testing. We assessed HIV testing and the influence of reporting among people at risk for HIV. An anonymous survey was conducted 9 months after HIV reporting began. Recruitment for men who have sex with men was at bars; high-risk heterosexuals at a sexually transmitted disease clinic; and injection drug users at needle exchange sites. Eighty-nine percent of 267 participants had been tested for HIV at least once but only half reported testing regularly. Injection drug users and men who have sex with men were more likely than HRH to report regular testing. Main reasons for delaying testing were thinking that HIV exposure was unlikely or not wanting to think about being HIV positive; concern about government reporting was cited by only 2%. Over half the respondents hadn't heard about the new name-to-code HIV reporting mechanism, although 69% thought there was some type of HIV reporting. Only 18% correctly identified the mechanism of HIV reporting. HIV prevention programs should focus on the most common reasons for delaying or avoiding HIV testing: believing that one has not been exposed to HIV, and the fear of learning that one is HIV positive.

AIDS Serodiagnosis↗
PubMed2000

Evaluation of a problem-based learning workshop using pre- and post-test objective structured clinical examinations and standardized patients.

BACKGROUND: Osteoporosis is a health care issue in which family physicians play a major role. Although awareness of osteoporosis is high, recent studies suggest that application of recent advances in its treatment to the clinical setting may be low. We have developed a problem-based learning intervention for osteoporosis in which paired rheumatologists and family physicians developed nine problem-solving clinical scenarios. An educational matrix was used to link specific case scenarios with individual teaching objectives, developed via a previous needs assessment. Family physicians participated in the workshop, developing best practice responses to the clinical scenarios with a trained facilitator and content expert. METHODS: To assess the impact of this intervention, family physicians participated in a pre- and post-test evaluation, using objective structured clinical examinations and standardized patients. Objective structured clinical examination stations tested knowledge, skills, and judgment relating to osteoporosis with respect to risk factors, use of appropriate investigations including bone mineral densitometry (BMD), strategies for the prevention of osteoporosis (both pharmacologic and nonpharmacologic), treatment options for established osteoporosis (bisphosphonates and hormone replacement therapy), and management of recent osteoporosis fracture. Participants were evaluated using a predetermined score generated by their responses to objective structured clinical examinations and standardized patients (max. score = 101). Evaluations were conducted anonymously, although participants had access to their own pre- and post-test results for personal feedback. The impact of the workshop was assessed by comparing pre- and post-test responses by group, by individual, and by station. RESULTS: Participants demonstrated a significant improvement in their post-workshop scores. Of 40 participants, 26 showed improvement in score (> +10), 13 showed modest change (+1 to +10), and 1 showed a marked decrease (> -10). The greatest improvements were seen in the management of the male osteoporosis patient, determination of risk factors for osteoporosis, and the use and interpretation of bone mineral densitometry. Family physicians reported general satisfaction with the content and format of both the workshop and the evaluation process. IMPLICATIONS: We conclude that this type of problem-based learning intervention workshop results in improved knowledge, skills, and judgment in the management of osteoporosis by family physicians as objectively assessed using a pre- and post-test format including objective structured clinical examinations and standardized patients.

Clinical Competence↗
PubMed2000

Regional differences in HIV testing among European patients with sexually transmitted diseases: trends in the history of HIV testing and knowledge of current serostatus.

OBJECTIVES: To determine trends in (1) HIV testing and knowledge of current serostatus and (2) clinic-visits of aware HIV-infected patients and (3) to determine associates of incident HIV infection among patients with sexually transmitted disease (STD) in 15 countries participating in a European Community anonymous HIV seroprevalence survey. METHODS: Demographics, STD diagnosis, self-reported history of HIV tests and current HIV test results were collected for patients diagnosed with one of 12 pre-selected STDs. Incident HIV infections were determined among patients who reported prior HIV-negative test results. RESULTS: Between June 1990 and December 1996, 66560 STD patients were tested for HIV. Of these, 1581 (2.4%) reported a prior HIV-positive test. Of 41727 (62%) patients who reported no previous HIV test, 611 (1.4%) were HIV infected. Of 20785 (31%) patients who reported a prior HIV-negative test, 213 (1.0%) were HIV infected. Of 2467 (4%) patients without prior HIV test data available 123 (4.9%) were HIV infected. Overall, 63% of HIV-seropositive patients was aware of their HIV infection. Over time, the proportion of aware HIV-seropositive patients increased in some exposure categories in south and central Europe. Among the 11684 patients who reported dates of prior HIV-negative tests, 108 HIV infections were found. Compared with the north, HIV incidence was higher in the central region [odds ratio (OR), 1.23; 95% confidence interval (CI), 0.71-2.12] and in the south (OR, 4,39; 95% CI, 2.80-6.88) in all exposure categories except homosexual men. CONCLUSIONS: Two-thirds of patients with an STD had never been tested for HIV. Of all HIV infections found, 32% were undiagnosed, indicating missed opportunities for counselling, safe sex education and referral for treatment. HIV testing should be routinely offered to all STD patients.

AIDS Serodiagnosis↗
PubMed2000

Communicating genetic risk: pros, cons, and counsel.

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. This case is of a woman with a personal, and a strong family history of breast cancer, who considered genetic testing for mutations in the BRCA1 and BRCA2 genes. The details of the case have been altered to protect the patient's anonymity. The patient was very anxious and there was disagreement between her healthcare providers about the potential benefits of genetic testing. The discussion of the case focused on several controversial issues, particularly the ownership of genetic information, and who is responsible for disseminating information to the family members at risk. The difficulties in communicating risk, providing emotional support and coping with the continuing uncertainties about screening and intervention are reviewed with an overview of the molecular biology, inheritance, and epidemiology of the BRCA1 and BRCA2 genes.

Adaptation, Psychological↗
PubMed1999

Accuracy in naturally occurring anabolic steroid assays in cattle and first approach to quality control in Italy.

This study assessed the accuracy of 16 commercial and three self-produced kits and drew the basis for using an external quality control (EQC) system. The commercial kits were mainly developed for blood sex steroid determination in humans but also have been used in cattle. Parallelism, recovery and precision tests were performed for progesterone (P4), testosterone (T) and oestradiol (E2) assays. Moreover, anonymous QC samples were sent to be analysed to some Italian laboratories. All kits showed a fair degree of parallelism (P < 0.01), even though 2/7 kits for T and 1/6 kits for E2 determination showed a regression coefficient (r2) lower than 0.98. For P4, an acceptable range of accuracy was achieved in the recovery test only by 1/6 kits; two kits showed fair or great overestimation and two kits considerable underestimation. For T, an acceptable range of accuracy was achieved only by 1/7 kits. For E2, 4/6 kits presented a variable degree of underestimation and two kits showed great overestimation. In the intra-assay precision test quite good repeatability was achieved only using samples with high hormone concentrations. While assaying samples with low concentrations we found a number of RSD > 10%. Moreover, the laboratories participating in the EQC produced statistically different (P < 0.05) results, particularly for high and medium concentrations. In conclusion, the use of commercial kits for screening naturally occurring sex steroid concentrations in cattle blood, in the case of suspected illegal treatments, requires preventive validation procedures and the development of an opportune EQC system.

Anabolic Agents↗
PubMed1961

Identification of tubercle bacilli from Indian patients with pulmonary tuberculosis.

Pretreatment cultures of bacilli from Indian patients with active pulmonary tuberculosis admitted to a controlled domiciliary chemotherapy study by the Tuberculosis Chemotherapy Centre, Madras, were subjected to a series of in vitro tests designed to identify the bacilli as human or bovine tubercle bacilli, or as anonymous mycobacteria. For the purposes of comparison, pretreatment cultures from British patients with pulmonary tuberculosis were examined by the same series of identification tests.Cultures identifiable as mammalian tubercle bacilli were obtained from all the 341 Indian patients admitted to the chemotherapy study. Tests for niacin production were carried out on the cultures from 277 of these patients; all gave positive results, indicating that the bacilli in question were Mycobacterium tuberculosis var. hominis. The cultures from the Indian patients yielded results similar to those of the cultures from the British patients in all the in vitro tests except the thiacetazone-sensitivity test. In this test the Indian cultures differed from the British cultures, being on the average less sensitive and showing greater variation in sensitivity among themselves.

Animals↗