Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-07-01T14:48:51Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - ALEX BRUNO SOARES.pdf: 8182673 bytes, checksum: a1b0d71f1ed56ef8997cc9047c27db27 (MD5) / Made available in DSpace on 2016-07-01T14:48:51Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - ALEX BRUNO SOARES.pdf: 8182673 bytes, checksum: a1b0d71f1ed56ef8997cc9047c27db27 (MD5) Previous issue date: 2016-03-14 / O sulco vocal é definido como uma depressão longitudinal na prega vocal paralela à sua borda livre. Sua característica vocal mais marcante é a soprosidade da voz, que decorre de um fechamento incompleto da glote. Outro parâmetro vocal seria a aspereza, pela diminuição da vibração da onda mucosa na prega vocal. Aspectos acústicos vocais, como a frequência de voz, jitter e shimmer podem estar alterados também em indivíduos com sulco vocal. Os estudos de avaliação de voz em indivíduos com sulco vocal, em geral, selecionam uma população sintomática, excluindo-se possíveis indivíduos com sulco que não apresentam queixa vocal. Assim, torna-se necessário estudar esta população assintomática para se obter uma melhor caracterização vocal desta entidade. O objetivo deste estudo foi caracterizar a voz de indivíduos adultos assintomáticos com sulco vocal. Buscou-se comparar as características perceptivo-auditivas, acústicas e autoperceptivas da voz entre indivíduos com laringe com modelo anatômico padrão de prega vocal e com sulco vocal. Foram avaliados 26 indivíduos adultos, 13 com sulco vocal, e 13 indivíduos sem sulco vocal. Todos os participantes foram submetidos à microlaringoscopia de suspensão, autoavaliação da voz, avaliação perceptivo-auditiva da voz e avaliação acústica. Entre os indivíduos com sulco vocal, 78% dos sulcos vocais eram do tipo I, 22% eram sulcos do tipo II. Na avaliação perceptivo-auditiva, houve piores escores em indivíduos portadores de sulco vocal, com diferença estatisticamente significante em relação ao grupo controle, nos parâmetros grau global de disfonia e rugosidade, ambos em grau discreto. Na autoavaliação da voz e na avaliação acústica não foi encontrada diferença estatisticamente significante entre os dois grupos. Conclui-se que indivíduos sem queixas de voz portadores de sulco vocal do tipo I podem apresentar alterações discretas na qualidade vocal, com característica de rugosidade. A alteração de voz nesses casos não causa impacto em sua qualidade de vida. / The sulcus vocalis is defined as a longitudinal depression in parallel vocal fold to the free edge. Its most striking feature is the vocal blowing voice, which stems from an incomplete closure of the glottis. Another vocal parameter would be the roughness, the reduction of the mucosal wave vibration of the vocal folds. vocal acoustic aspects such as the frequency of voice jitter and shimmer can also be altered in patients with vocal fold. Voice evaluation studies in patients with sulcus generally select a symptomatic population, excluding possible groove carriers that do not have vocal complaints. Thus, it becomes necessary to study this asymptomatic population to obtain a better characterization of this voice entity. The aim of this study was to characterize the voice of adults with asymptomatic sulcus. We sought to compare the auditory perception characteristics, acoustic and voice self-perceptual among individuals with larynx with standard anatomical model of vocal fold and sulcus. We evaluated 26 adult subjects, 13 with sulcus, and 13 individuals without sulcus. All participants underwent suspension microlaryngoscopy, voice self-assessment, perceptual evaluation of voice and acoustic evaluation. Among individuals with sulcus, 78% of vocal grooves were type I, 22% were furrows type II. In the perceptual assessment, there was worse scores in individuals with sulcus, with statistically significant difference from the control group, the parameters overall degree of dysphonia and roughness, both in mild. In the self-assessment of voice and acoustic analysis revealed no statistically significant difference between the two groups. Individuals without voice complaints carriers sulcus type I may have subtle changes in vocal quality roughness feature. Changing voice in these cases, no impact on their quality of life.

Orientador: Ivone Panhoca / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T19:21:56Z (GMT). No. of bitstreams: 1 Guimaraes_MichelleFerreira_M.pdf: 3257210 bytes, checksum: b0cb64faae1ee6b05d701f96bebce7c0 (MD5) Previous issue date: 2006 / Resumo: A voz e a habilidade vocal são diferentes em cada indivíduo. Devido aos escassos estudos sobre a qualidade vocal de adolescentes durante a puberdade, o presente estudo tem como objetivo identificar os seguintes parâmetros da análise acústica da voz: freqüência fundamental, seus índices de perturbação a curto prazo {jitter e shimmer), proporção GNE (glottal noise excitation), ruído, semitons e intensidade; correlacioná-los entre e si e também com o grau do desenvolvimento puberal de adolescentes do sexo masculino. Métodos: Foram sujeitos desse estudo 46 adolescentes do sexo masculino, com idade entre ] 3 e 15 anos, estudantes de uma escola estadual de Campinas, onde foi feita a coleta dos dados. Os adolescentes foram submetidos à gravação da voz, em gravador digital. Solicitou-se emissão sustentada da vogal /s/ e fala encadeada: contagem de 1 a 10, emissão dos meses do ano e leitura de um trecho pré-estabelecido. Em seguida foram avaliados por uma médica pediátrica para caracterização do grau do desenvolvimento puberal de acordo com os estágios descritos por Tanner (G1 a G5). A análise vocal foi realizada com o programa acústico Voz Metria®. Resultados: A maioria dos adolescentes está entre G3 e GA, a freqüência fundamental média é de 261,5Hz e todos apresentaram freqüência fundamental acima de 200Hz. Jitter manteve-se com média de 0,26% (dentro dos padrões de normalidade). Shimmer mostrou-se alterado em 38 dos 46 indivíduos, apresentando média de 8,41%, considerado acima do limite de normalidade. A proporção GNE e ruído estão dentro dos limites de normalidade para todos os adolescentes, porém todos apresentaram quantidade de semitons acima do esperado. A freqüência fundamental é mais aguda em G4 e G5 (p=0,003), shimmer é alterado em freqüências mais agudas (p=0,008). Conclusão: Os adolescentes estudados possuem freqüência fundamental de característica infantil e feminina, apesar de estarem no início do desenvolvimento puberal adulto, além disso, a maioria deles apresentou shimmer alterado. A maturação da voz provavelmente ocorre após a maturação do desenvolvimento puberal / Abstract: Voice and voice ability are different in each person. Due to scarce studies about adolescents' voice, this study purpose to correlate voice fundamental frequency and its quotients of perturbation at short terra (jitter and shimmer), GNE (glottal noise excitation) values, half-tone, present noise, intensity and the degree of puberty development in male teenagers. Methods: It is a transversal study with 46 boys, with age varying from 13 to 15 years, students from a public school in Campinas (Brazil), where the study was performed. The adolescent's voices were recorded in digital recorder and the speech samples consisted of the vowel /e/ in sustained phonation, counting (from 1 to 10), saying the months of the year and reading. Afterwards, the pediatrician evaluated and characterized the puberty development according to the Tanner stages. The vocal analysis was made in Vox Metria® acoustic programmer. Results: Most of the boys were in G3 and G4 Tanner stages, the mean of fundamental frequency was 261.5Hz and all the adolescents had FO > 200Hz. The mean of jitter was 0.26%, showing it was at normality standard. Shimmer was increased in 38 of 46 boys, which mean was 8.41%. The values of GNE and noise were in the normality limit; nevertheless the half-tones were above the standard. The fundamental frequency was high-pitched in boys with G4 e G5 (p=0,003) and shimmer was increased in high-pitched (p=0,008). Conclusion: These boys have fundamental frequency with childish and feminine characteristics although they are in the beginning of adult genitals development, most of they have alteration in shimmer values. Voice maturation probably occurs after pubertal maturation / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Orientador: Agricio Nubiato Crespo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T05:24:30Z (GMT). No. of bitstreams: 1 Spina_AnaLucia.pdf: 396844 bytes, checksum: 5539ff9f308e6cec8023d63bdaf5f554 (MD5) Previous issue date: 2009 / Resumo: A percepção vocal é um debate ativo da neurociência e um desafio para pesquisadores na atualidade. Este estudo verificou se a auto-avaliação vocal feita pelo paciente disfônico é concordante com a avaliação vocal feita pelo fonoaudiólogo e se essa concordância sofre influência das variáveis: idade, sexo, uso profissional da voz, diagnóstico laringoscópico clínico ou diferentes avaliadores. Correlacionou a avaliação vocal feita pelo fonoaudiólogo e a auto-avaliação feita pelo sujeito disfônico ao protocolo QVV. Verificou também, a habilidade para perceber variação de freqüência em sons vocais e som instrumental. Comparou a habilidade perceptiva entre sujeitos com disfonia funcional, sujeitos com voz normal e cantores. Correlacionou a habilidade de percepção às variáveis: sexo, idade, escolaridade, experiência preliminar com canto, avaliação da qualidade vocal feita pelo fonoaudiólogo e auto-avaliação vocal feita pelo sujeito. O estudo contou com dois grupos distintos. Grupo I: 245 sujeitos submetidos a avaliação perceptiva da voz feita pelo fonoaudiólogo, auto-avaliação da voz e aplicação do protocolo QVV. No Grupo II: foi realizada, em 242 sujeitos, avaliação da percepção de variação de freqüência de sons vocais, feita por meio do som /a/ prolongado, emitido por voz masculina e feminina; e avaliação da percepção de variação de freqüência com som instrumental por meio de teclado virtual. No grupo I: a concordância da avaliação vocal entre fonoaudiólogos e auto-avaliação vocal foi baixa e não sofreu influência das variáveis estudadas. O protocolo QVV revelou sensibilidade tanto para a qualidade vocal avaliada pelo fonoaudiólogo, como para a qualidade vocal avaliada pelo próprio sujeito disfônico. No grupo II: em relação à percepção de variação de freqüências nos sons vocais e som instrumental, cantores apresentaram habilidade superior de percepção para voz e instrumento; sujeitos disfônicos tiveram maior dificuldade em perceber variações de freqüência em voz e instrumento do que sujeitos com voz normal; sexo e idade não influenciaram na habilidade de percepção; sujeitos com maior grau de escolaridade e experiência preliminar com canto mostraram melhor habilidade percepção; quanto pior a classificação da qualidade vocal nas disfonias pior a percepção. / Abstract: Voice perception has been actively debated by neuroscientists and is a challenge for researchers nowadays. This study compared the auditory voice-perception assessments of experienced speech therapists and patients (self-assessment). The influence of age, gender, professional voice use, clinical diagnosis and evaluation by different professionals were also determined. A correlation between vocal assessment performed by the speech-therapist and self-assessment performed by the dysphonic subject was carried out through the VRQOL protocol. The study also observed the ability to perceive pitch variation in vocal and instrumental sounds. A comparison was made between the perceptive ability of subjects with functional dysphonia, subjects with normal voice and singers. A correlation between perceptive ability and gender, age, educational level, previous singing experience, perceptive vocal quality assessed by speech-therapists and self-perception of vocal quality. The study considered two groups. Group I: 245 subjects with voice-perception assessment carried out by the speech-therapist, patients self-assessment and results obtained from the V-RQOL protocol. Group II: 242 subjects evaluated for their perception of pitch variation for vocal sounds that was a sustained /a/ performed by female and male voices and perception of pitch variation for instrumental sounds performed by a virtual keyboard. Group I: levels of agreement between the speech-therapist vocal assessment and patients self-assessment were low and were not influenced by the age, gender, professional voice use, clinical diagnosis and evaluation by different professionals. The V-RQOL protocol was sensitive both to vocal quality as assessed by the speech-therapist and the dysphonic patient. Group II: singers showed better ability in perceiving vocal and instrumental sounds, dysphonic subjects had more difficulty in perceiving pitch variation for vocal and instrumental sounds than subjects with normal voices. Age and gender did not influence perception ability. Subjects with higher educational levels and previous singing experience had better perceptive ability. In the dysphonic group the worse the voice quality the worse the perception. / Universidade Estadual de Campi / Ciencias Biomedicas / Doutor em Ciências Médicas

Orientador: Carlos Takahiro Chone / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T02:51:56Z (GMT). No. of bitstreams: 1 Rossi_VanelideCassiaColombo_M.pdf: 1971545 bytes, checksum: 76507557399a5e7e6017a3ddb0651662 (MD5) Previous issue date: 2013 / Resumo: OBJETIVO: Avaliar qualidade de vida e voz de pacientes tratados de câncer avançado de laringe por laringectomia total ou quimioradioterapia exclusiva com preservação de órgão. MATERIAL E MÉTODOS: 30 pacientes tratados de câncer avançado de laringe livres da doença há pelo menos quatro anos: dez laringectomizados totais sem produção de voz esofágica (SVE); dez laringectomizados totais com voz traqueoesofágica (VTE) e dez com voz laríngea. A qualidade de vida foi mensurada pelos protocolos SF-36; Qualidade de Vida em Voz (QVV) e Índice de Desvantagem Vocal (IDV), aplicados no mesmo dia. RESULTADOS: No SF-36, observou-se que pacientes que receberam quimioradioterapia exclusiva apresentam melhor qualidade de vida do que o grupo de VTE e SVE. No QVV observou-se que a qualidade de vida relacionada à voz é menor no grupo SVE. No IDV grupo SVE apresenta escore maior para IDV total, emocional, funcional e orgânica. DISCUSSÃO: Qualidade de vida e voz dos pacientes tratados com quimioradioterapia é melhor do que os pacientes tratados cirurgicamente. A qualidade de vida demonstrou-se alterada independente da modalidade de tratamento realizada. Pacientes com reabilitação vocal após cirurgia apresentaram qualidade de vida próxima àqueles pacientes com laringe preservada. CONCLUSÃO: Os resultados sugerem que o tratamento quimioradioterápico e a laringectomia total com prótese traqueoesofágica preservam melhor a qualidade de vida do que a laringectomia total sem prótese traqueosofágica. A laringectomia total sem prótese traqueoesofágica esta associada à menor qualidade de vida e maior índice de desvantagem vocal / Abstract: OBJECTIVE: To evaluate quality of life and voice in patients with advanced cancer of larynx treated with total laryngectomy or exclusive chemoradiotherapy with preservation of organs. MATERIAL AND METHODS: 30 patients treated for advanced cancer of larynx, free from disease there were at least four years: ten total laryngectomy patients without production of esophageal speech (EVS); ten total laryngectomy patients with tracheoesophageal voice (TEV) and ten with laryngeal voice. The quality of life was measured by SF-36; Voice-Related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 observed that patients treated with exclusive chemoradiotherapy present better quality of life than group of TEV and EVS. In V-RQOL it was observed that the quality of life related to voice is lower in the EVS group. In VHI group EVS presents higher scores for overall VHI, emotional, functional and organic. DISCUSSION: Quality of life and voice in patients treated with chemoradiation is better than the surgically treated patients. Quality of life was demonstrated altered independently of treatment modality performed. Patients with speech rehabilitation after surgery showed quality of life next to those patients with preserved larynx. CONCLUSION: The results suggest that chemoradiation and total laryngectomy with tracheoesophageal best preserve the quality of life than total laryngectomy without tracheoesophageal prosthesis. Total laryngectomy without tracheoesophageal prosthesis is associated with lower quality of life and greater voice handicap index / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Voice control as a potential method of human-computer interaction is steadilyincreasing, most recently with watches, cars and household appliances. Theelderly should be in focus for more digital development since they aresensitive to bad design. The purpose of the study therefore intends to includethis group in a survey of how a voice control system for beds can be formedfor the residents of a retirement home.  The aim was to study selected components of a system that the elderly couldinteract with using their voice to control their adjustable beds. Limitationswere conducted mainly in the technical aspects of this system by excluding theuse of a technical prototype. The survey was performed using two methods.First, residents of a retirement home were individually interviewed to confirmand strenghten the purpose of the study, that they would benefit of having avoice controlled system to complement the current handheld controller ofeach of their beds. The results of the interviews lay the foundation for thesecond part of the study: user tests of a simulated system. In these tests,selected parts of a hypothetical voice control system were evaluated forusefullness. The results indicate that participants valued simplicity over complexfunctions in a voice control system. In the feedback test, participantspreferred voice over sound as information-carrying. Thus, voice control ofbeds should be developed with a simple design that is conceptually the same,or very similar, to the participants mental model of the handheld controller.

Philosophiae Doctor - PhD / In all countries, regardless of culture and level of development, science and technology(S&T) are seen as key areas for further material development and welfare. A certain proportion of the population needs to develop S&T-related skills and competences at a high level. But also for the majority, who will not enter such careers, S&T are key subjects to master the challenges in everyday life and for full participation in democracy. In our efforts to make S&T attractive as careers and as a key subject for mastering challenges in everyday life, we need to know more about the interests, concerns and values of the learners.The study of Zimbabwean learners sought to find what students like to learn in science, their interest in science lessons, use of science principles in everyday life and what attitudes they have about the environment. Learners’ attitudes to S&T were also measured by an open ended question that sought their ideas on what they would like to research on if they were scientists.The empirical basis for this thesis is data collected with the ROSE instrument, developed by a team of international scholars in S&T education. Data used in this thesis is from twenty one secondary schools in Zimbabwe (N=734) targeting sixteen year old learners.Comparisons are made with twenty eight other countries.Factor analysis and descriptive statistics has been used to make comparisons of Zimbabwean and international trends.The Zimbabwean sample generally showed a mismatch between their expectations and realities of the science education curriculum. Results suggested that Science education was largely irrelevant to their needs and interests. Many out-of-class experiences were not explored in science classes. However, the sensitivity of learners to significant issues around their lives, such as AIDS and other diseases showed in their wish to research to cure those infected.The newly found voice of the learners will provide new insights on how to improve science education in Zimbabwe in such a way that it is able to meet the hopes, aspirations and the perceived interests, needs and priorities of the learners. Rapid developments in mundane applications of science and technology require that the curriculum negotiates a level that empowers learners to cope with a technologically driven world.For the development of capabilities to understand and use science and technology, either in daily life or study at higher levels the science education debate must periodically consider needs, views and concerns of the learners themselves among other stakeholders.

Voice training has been influenced by separatist attitudes which have allowed for classes which train the body to be separate from those which train the voice. This study acknowledges that to train an actor in separate compartments and then expect the completeness of human expression in performance, is to train under false pretences. There is a need to address the imbalance of separatism and this is examined within the context of voice training. An holistic approach to voice training forms the basis of the argument, which focuses on the need to re-educate the notion of physicality in voice training. Chapter one proposes an understanding of the notion of physicality by drawing on the attitudes of selected theatre practitioners towards the physical nature of the theatre encounter. The expressive energies of the actor's body are responsible for the physicalisation of a play; for this reason the movement of voice and speech is not only examined as source movement, but also as the movement of an actor's response and communication. Chapter two examines some practices which led to attitudes of separatism in voice training, and introduces prevalent practices which are attempting to involve the energy of the physical experience. Chapter three proposes that the Alexander technique be used as the foundation for an awareness of individual physicality. Where chapter one examines the theory of this notion, chapter three proposes an experiential understanding of the same. The Alexander technique is a training in effective body use and it's principles are fundamental to an awareness of body use and functioning. It is argued that these principles should underlie a re-education of physicality. The final chapter of the thesis argues for physicality in South African voice training programmes which would complement the physicality of contemporary theatre forms. It is hoped that this study will provide further incentive for the continued review and adjustment of drama training in South Africa.

This qualitative study answers the call to include students’ voices in research on learning by listening to students’ perspectives about their learning experiences. Student voice inquiries into learning typically explore students’ perspectives of their learning experiences in school for enhancing teaching practice. The present study explores students’ perspectives of their learning experiences both in and out of school and elicits students’ voices through written narrative, in combination with more common approaches to student voice inquiry. The purpose of which is to inform teaching practice that better supports and facilitates students’ learning. The two research questions that guide this inquiry are: What do senior high school students’ written narratives, focus group discussion, and related written comments about their most memorable learning experiences reveal about their learning? And what do these students’ voices reveal about what they have in common in their learning? The common themes across the 24 student participants are presented as a supportive framework for classroom discussion about most memorable learning experiences. Practical implications are discussed for teaching practice and research with participant co-researchers.

This dissertation explores the collaborative process and use of language that went into the creating the United States Constitution in 1787. From a technical communication perspective, the collaborative process explored did not develop any new theories on collaboration, but instead, allows scholars to track the emergence of a well-documented America collaborative process from the early period of the developing American nation on a document that has remained in use for over 235 years. in addition to examining this collaborative process, the author also discusses the use of passive voice and negative language in the first article of the Constitution.

Background: Vocal tremor affects over half a million Americans. Tremor can affect structures within the respiratory, laryngeal, velopharyngeal, or oral regions (Critchley, 1949). No study has related the of tremor severity in structures in all four of these regions to the severity of vocal tremor. Purpose: The purpose of this study was (a) to describe the distribution and severity of tremor throughout the vocal tract and (b) to relate that to the severity of the voice tremor. We hypothesized that tremor would be widespread throughout the vocal tract, but most prevalent in the larynx, specifically in the true vocal folds. Additionally, we expected vocal tremor severity to be directly related to the distribution and severity of tremor in structures of the vocal tract. Method: Twenty adults with vocal tremor and two age-matched controls participated in the study. Two judges, experienced in assessment of laryngeal movement disorders, rated the tremor severity in each of 15 structures during sustained /i/, /s/, /h/, and rest breathing, and the severity of the voice tremor during sustained /i/, /s/, and /h/. Results: A novel finding of this study was the identification of distribution and severity of tremor in vocal tract structures associated with mild, moderate, and severe vocal tremor. Participants with mild voice tremor tended to show tremor limited to structures of the larynx, and in some cases, the velopharynx, and on average, had three structures affected (most commonly true vocal folds, supraglottic structures, and hypopharynx). Participants with moderate voice tremor tended to show tremor in the larynx and velopharynx, and on average, had five structures affected (most commonly true vocal folds, supraglottic structures, hypopharynx, vertical laryngeal movement, and some other velar, oral, or respiratory structure). Those with severe voice tremor showed tremor in the larynx, velopharynx, and beyond and on average, had eight structures affected (most commonly true vocal folds, supraglottic structures, hypopharynx, vertical laryngeal movement, anterior and lateral chest movement, velum, and jaw). A second novel finding, obtained through regression analyses, was that tremor severity of the supraglottic structures and vertical laryngeal movement contributed the most to the voice tremor severity during sustained phonation (r=0.77, F=16.17, p<0.0001). A strong positive correlation (r=0.72) was found between the Tremor Index, a composite value of the distribution and severity of structural tremor, and the severity of the voice tremor during sustained phonation. The correlation between the severity of tremor in the true vocal folds and the voice tremor was moderate (r=0.46). Mean voice tremor severity was greater in participants over age 75 (mean=2.25) than those between 66 and 75 years (mean=1.5) and under age 65 (mean=1.8). Mean Tremor Index, was greater in participants over age 65 (mean TI=68) than those under age 65 (mean=41). In this group of 20 participants, laryngeal/hypopharyngeal structures were most frequently (95%) and severely (rated 1.7 out of 3) affected, followed by velopharyngeal (40% occurrence, 1.3 severity), respiratory (40% occurrence, 1.1 severity), and oral (40% occurrence, 1.0 severity) regions during sustained phonation. Tremor was also identified more often and with greater severity in the larynx for sustained /s/ (70% occurrence, 1.7 severity), /h/ (40% occurrence, 1.7 severity), and rest breathing (45% occurrence, 1.6 severity) than other regions. During the voiceless and rest breathing tasks, the greatest tremor severity was noted in the true vocal folds. Conclusion: Evaluation of the distribution and severity of tremor may be useful in guiding behavioral and medical treatment of voice tremor and for providing prognostic information regarding response to laryngeal botulinum toxin injection.