Barriers to retention in inpatient and residential drug treatment among persons who use opioids and/or injection drugs living in the rural U.S.

AIM: Barriers to retention in inpatient and residential care for persons who use drugs are understudied in the rural context. We sought to better understand barriers to retention in inpatient and residential drug treatment in a large, multi-site, geographically diverse sample of persons who use opioids and/or injection drugs in the rural U.S. METHODS: We conducted semi-structured individual interviews with persons currently using opioids and/or injection drugs in 9 U.S. states, including Illinois, Kentucky, Massachusetts, North Carolina, New Hampshire, Ohio, Oregon, Vermont, and Wisconsin. Content areas included substance use history and experiences with all modalities of drug treatment. We performed initial structural coding followed by an iterative "open-coding" process of itemizing and categorizing content within each code, and a multi-coder memoing process to summarize themes. We identified themes using three levels of the Social-Ecological Model (SEM): individual, interpersonal, and facility-level (organizational) barriers. RESULTS: Among 304 interviewed, over half (n = 166, 54 %) reported having experienced inpatient and residential treatment. Lack of treatment retention was driven by interrelated factors at all levels of the SEM. Person-level factors inhibiting retention included lack of readiness to stop using, which was particularly true for court-ordered treatment, and dislike of "freedom limitations". The sole interpersonal-level factor was the influence of other patients on re-initiation of drug use. Facility-level barriers included unaddressed withdrawal symptoms and lack of access to MOUD, staff relatability, inadequate staff training, and, particularly in residential treatment, lack of structure and supervision. Lack of preparation for coping with real-world triggers was seen as a barrier to engagement in ongoing treatment. CONCLUSION: Barriers to retention in inpatient and residential substance use treatment were present at three levels of the SEM. Interviews suggest much room for improvement in inpatient and residential drug treatment programs with respect to improving access to MOUD, tailoring content to better address social challenges in the rural context, and improving quality control measures with respect to staff and resident supervision.

Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.

BACKGROUND: In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS: We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS: We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION: In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Aqueous extract OF Moringa oleifera Lam leaves added to freezing extenders damages goat sperm membranes.

BACKGROUND: Semen cryopreservation is a biotechnology used frequently in animal production; however, there are some obstacles, such as those caused by high levels of reactive oxygen species (ROS). Moringa oleifera (MO) is known as a potent source of antioxidants and might be an important adjuvant. OBJECTIVE: The objective of this study was to determine the effect of different concentrations of MO extract supplementation on goat semen cryopreservation efficiency. MATERIALS AND METHODS: Ejaculates (n=6) from four goat breeders were pooled and diluted in skimmed milk (SM) or Tris-egg yolk (TEY)-based extenders and supplemented with different concentrations of MO extract (0, 1, 2 and 5 mg/mL). After the freeze-thaw cycle, sperm kinetics and viability were assessed. RESULTS: With the SM extender, straightness, wobble and plasma membrane integrity were lower than in the control group (P < 0.05). With the TEY extender, wobble was lower in with 5 mg/mL MO extract than in the control group (P < 0.05). As regards sperm ultrastructure, evaluated by SEM, the MO extract, regardless of the diluent used, damaged the membrane of sperm cells in a dose-dependent manner. CONCLUSION: The addition of aqueous extract of MO leaves in both diluents at all concentrations tested affects the parameters of sperm progressivity and damages the plasma membrane in a dose-dependent manner. DOI: 10.54680/fr23310110712.

Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort.

BACKGROUND: We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS: We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS: For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION: Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.

Attraction, Oviposition Preferences, and Olfactory Responses of Corn-Infesting Ulidiidae (Diptera) to Various Host-Based Substrates.

Fresh market sweet corn (Zea mays L., convar. saccharata var. rugosa, Poales: Poaceae) ears produced in Florida are damaged by the larvae of Euxesta stigmatias Loew, Euxesta eluta Loew, and Chaetopsis massyla Walker (Diptera: Ulidiidae) that renders ears unmarketable. No standard lure exists for monitoring these pests. Oviposition substrate and attractant bioassays were designed to identify attractive substrates for further semiochemical investigation. Frass from the fall armyworm, Spodoptera frugiperda J.E. Smith (Lepidoptera: Noctuidae), was more attractive than other ovipositional substrates tested for E. eluta and C. massyla, and resulted in greater ovipositional output. Tassel-derived armyworm frass was more attractive than leaf-derived frass for oviposition. Frass also resulted in greater oviposition output by two species. In attraction bioassays, frass was generally preferred over the corresponding corn tissue, and only C. massyla demonstrated a preference for silk-frass over tassel-frass. The most promising substrates were then evaluated by electroantennography (EAG) to quantify olfactory responses. Frass volatiles also elicited greater antennal responses than corn volatiles. With tassel-frass, greater amplitude EAG responses were recorded from immature E. eluta female antennae, while mature female E. stigmatias exhibited greater responses. Equivalent antennal response to silk-frass was observed from E. eluta. Overall, silk-frass elicited the greatest EAG responses among all three fly species. Our results indicate that armyworm frass is an important resource in the chemical ecology of corn-infesting silk flies, and this substrate warrants further investigation for potential attractants that may facilitate development of novel management tools for these pests.

Host Selection, Growth, and Survival of Melonworm (Lepidoptera: Crambidae) on Four Cucurbit Crops Under Laboratory Conditions.

The melonworm, Diaphania hyalinata L. (Lepidoptera: Crambidae), is one of the most serious insect problems affecting cucurbit production. We evaluated the relative preference and suitability of yellow squash, zucchini, cucumber, and watermelon to melonworm by measuring its oviposition, larval feeding preference, survivorship, and developmental responses in the laboratory. Whole plants were used for oviposition study, whereas host leaf discs were used for all the other studies. Watermelon feeding resulted in the longest larval development period (14.3 d), greatest prepupal weights and survivals rates (92%; first instar to adult) among the four crops. However, for watermelon, adult oviposition preference (199.5 eggs/♀), egg survival (70%), and larval feeding (4.1% defoliation) were numerically or statistically lowest, and larval head capsule widths and whole-body lengths were smallest. When differences occurred among these variables, yellow squash, zucchini, and cucumber were each typically higher (or quicker to develop) than watermelon. So why do melonworm adults not prefer watermelon, or at least select it as frequently as squash and cucumber when ovipositing? The answer likely is that there might be some variation in the important chemical components among these cucurbits. We suggest that comparison of kairomones and allomones from watermelon and related cucurbits would be very useful for determining the combination resulting in the lowest risk of damage to the more susceptible cucurbits (assuming the levels can be modified without seriously affecting the crops).

Variable Pyrethroid Susceptibility Among the Sweet Corn-Infesting Ulidiidae (Diptera) in Florida and New Baseline Susceptibilities.

Florida sweet corn is intensively treated to prevent infestation from the corn-infesting picture-winged fly complex (hereafter referred to as silk flies, Diptera: Ulidiidae). Previous bioassays performed on Euxesta stigmatias Loew demonstrated some pyrethroids performed weakly, while others were more efficacious and with longer-lasting residual activity. Since the last published bioassays, new active ingredients have been made available, other species in the complex discovered, and label restrictions increased for some products. For these reasons, topical bioassays were performed on the three most common species to assess insecticide efficacy of current commercial products labeled for either silk fly or fall armyworm ( Spodoptera frugiperda (J.E. Smith), Lepidoptera: Noctuidae) control. Bioassays were conducted using formulated product mixed in water and applied using a Generation III Research Spray Booth. The median lethal concentration ratio (LC 50 ) of beta-cyfluthrin with and without the pyrethroid synergist piperonyl butoxide was investigated. Acetamiprid, chlorantraniliprole, carbaryl, and flubendiamide did not result in high mortality to any species tested. Euxesta eluta Loew was susceptible to all other insecticides tested, and exhibited the lowest LC 50 to beta-cyfluthrin. Both Chaetopsis massyla Walker and E. stigmatias recovered from several pyrethroid treatments. Euxesta stigmatias also had the highest beta-cyfluthrin LC 50 , and piperonyl butoxide restored beta-cyfluthrin efficacy and lowered the LC 50 s of all three species.

Distribution of Zelus longipes (Hemiptera: Reduviidae) in south Florida corn fields and its functional response to corn-infesting picture-winged flies (Diptera: Ulidiidae).

The milkweed assassin bug, Zelus longipes (L.) (Hemiptera: Reduviidae), is a generalist predator and a potential biological control agent of picture-winged flies (Diptera: Ulidiidae), which cause considerable economic damage to sweet corn yields in Florida. We studied the potential of Z. longipes as a biocontrol agent of four ulidiid pests in corn fields: Euxesta stigmatias Loew, Euxesta eluta Loew, Euxesta annonae F., and Chaetopsis massyla Walker. Within-plant and within-field distributions of Z. longipes and ulidiids and functional responses of Z. longipes to ulidiid prey were determined. Highest numbers of Z. longipes and ulidiids in the R1, R2, and R3 corn stages were generally in the basal or middle leaves at 09:00 h EST, ears at 13:00 h EST, and top and tassel at 17:00 h EST. Hence, there seemed to be a coordinated migration of Z. longipes and ulidiids from the lowest to the highest parts of the corn plant during the day. Within the corn field, aggregated (clumped) distributions were most common for Z. longipes and ulidiids especially in the later R2 and R3 stages based on Taylor's power law, Iwao's patchiness regression, index of dispersion, and Lloyd's patchiness indices of dispersion. However, predator and prey populations were lower in the R1 stage, and there were inconsistent results for dispersion indices among times of day and between predators and prey. Ulidiid distributions in R1 were mostly regular (uniform) at 13:00 h EST, but aggregated at 09:00 h and 17:00 h. However, Z. longipes R1 distributions were mostly aggregated at 13:00 h, but random or regular at 09:00 h and 17:00 h EST. Handling times for male and female Z. longipes were 1.0-1.39 h and 0.67-0.97 h, respectively, and each had a type II functional response to E. stigmatias, E. eluta, and E. annonae and consumed about five flies per day. Although the population abundance of Z. longipes can vary between seasons, it appears to be a promising biocontrol agent of ulidiid flies in corn.

Assessing abundance and distribution of an invasive thrips Frankliniella schultzei (Thysanoptera: Thripidae) in south Florida.

Within-plant and within-field distribution of larvae and adults of an invasive thrips species, Frankliniella schultzei (Trybom) on cucumber, Cucumis sativus L. was studied in 2008 and 2009 in Homestead, Florida. The majority of thrips were found inhabiting flowers of cucumber plants and little or none was found on the other parts of the plant. Thrips were aggregated in the field, as indicated by the two regression models, Taylor's power and Iwao's patchiness regression. Iwao's patchiness regression provided a better fit than Taylor's power law. The distribution was clumped during the initial stages of infestation at the edges of the field and became random thereafter. However, with increase in population density, thrips again formed aggregates in the field. Based on the average pest density per flower in a ∼0.25-ha field, minimum sample size (number of flowers) required at the recommended precision level (0.25) was 51. The number of samples required at two levels of predetermined pest density was also calculated, which would help growers in collecting optimum number of samples required to determine the correct threshold level of pest in fields. Results from seasonal abundance indicated that density of thrips peaked during the fifth week of sampling with an average of 25 and 34 adults per ten flowers during autumn 2008 and 2009, respectively. Results from these studies will help growers and extension personnel in understanding the abundance and distribution of F. schultzei in the field, which are important components required in developing a sound management program.

Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different?

Anesthesiologists can offer much more then stable blood pressure and heart rate in the intraoperative period. By choosing appropriate anesthetic techniques they can tremendously influence perioperative stress. This may positively impact on the overall surgical outcome. One of the most intriguing aspects of neuraxial anesthesia is its ability to attenuate the stress response to surgery. At present there is no agreement on the clinical importance of such a response but there is substantial indirect evidence that it may play an important role in a patient's outcome. Neuraxial anesthesia supplemented by general anesthesia is justified and can be safely used in cardiac surgery. The authors of this expert opinion prefer spinal anesthesia to thoracic epidural anesthesia and have been using it routinely for the last 20 years without any neurological complications. The risk of spinal hematoma from a 27G spinal needle prior to full heparinization is unknown but in our opinion is remote. Both epidural and spinal techniques can and should have a place in modern cardiac anesthesia practice and should be further investigated.

Biological parameters of Scirtothrips dorsalis (Thysanoptera: Thripidae) on selected hosts.

Since its establishment in Florida in 2005, Scirtothrips dorsalis Hood, a highly polyphagous species, has become an economically important pest of ornamental plants and a potentially significant pest of vegetable and fruit crops. Fruit and vegetable production in Florida is trending toward significant adoption of organic methods and use of widely dispersed small fields in rapidly urbanizing landscapes. Landscape plants may serve as refugia from which S. dorsalis recruits can disperse to nearby fruit and vegetable plantings. Therefore, information on this pest's biology including how it is affected by various host species is needed to develop effective integrated pest management (IPM) programs. In the greenhouse and laboratory condition, we studied the effects of various host plants, development, diel flight activity, oviposition, and demographics of S. dorsalis. The pest preferred Jalapeño pepper and Knockout rose over the other hosts, and it was most active between 1000 and 1600 hours EST. Irrespective of the host species, the duration of each of the immature stadia varied within a narrow range, and their respective sizes were quite similar. Demographic parameters quantified included gross reproduction rate (GRR), net reproductive rate (R(o)), intrinsic rate of increase per day (R(m)), finite rate of increase per day (λ), and mean generation time (T). The pest population may increase by a factor of ≈ 1.09/d, so that it may double in 8 or 9 d. The above information should be helpful in the development of sound programs to manage S. dorsalis on various crops and in the formulation of detection strategies by quarantine officers.

Sexual Behavior, Mental Health, Substance Use, and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City.

Relatively little research has examined the personal sex lives of indoor male sex workers (MSWs) or possible connections in this group between sexual behavior and factors related to HIV risk. As part of a larger project, this study collected data from 30 agency-based indoor MSWs (mean = 22.4 years) about their sexual behavior, mental health, and substance use. Few HIV risk behaviors with clients occurred. Drug use and mental health problems were relatively frequent, but not related to increased risk behavior. Instead, MSWs appeared to employ rational decision-making and harm-reduction strategies. Conceptualization of MSW sexual behavior may be required where HIV risk is not attributed to sex work per se, but to other influences such as economic and relational factors.

Prevalence of Acanthamoeba and other naked amoebae in South Florida domestic water.

The purpose was to identify the prevalence of naked amoebae in tap water in south Florida to ascertain the risk of amoebal infections of the cornea in contact lens wearers. Over the course of a 2-year period, water samples were collected from sites throughout Broward, Palm Beach, and Dade counties, Florida. The presence of amoebae in samples was based on an enrichment cultivation method appropriate for Acanthamoeba. Amoebae were identified using diagnostic features discernable by light microscopy. A total of 283 water samples were processed and amoebae were noted in 80 of these. Acanthamoeba were found on 8 occasions (2.8%). The genera Hartmannella and Vahlkampfia, rarely involved in keratitis cases, were found in 3.5% and 2.8% of samples, respectively. A total of 19 different naked amoebae were recorded and amoebae (regardless of genus) were present in 19.4% of all samples. Previous surveys in England and Korea have shown that acanthamoebae are found in 15 to 30% of tap water samples in the home and have been associated with corneal infection in contact lens wearers. The incidence of acanthamoebae infection in the USA (2.8%) has been found to be lower than that in the UK and it has been postulated that this is related to the lack of a storage water tank in the roof loft space. However, the level of treatment of municipal water is clearly not effective at killing amoebal cysts (or trophozoites) as evidenced by the high occurrence of amoebae (19.4%) in this study.

A longitudinal, qualitative analysis of the context of substance use and sexual behavior among 18- to 29-year-old men after their release from prison.

Substance use, sexual behavior, and reincarceration among 89 men from 5 state prisons across the USA, aged 18-29 years, were examined in relation to individual patterns of coping with community reintegration after their release from prison. Analyses of a series of qualitative interviews conducted over a 6-month period post-release revealed three global reintegration coping patterns: moving toward successful reintegration, resuming behavioral patterns that preceded incarceration, and reintegrating through withdrawal or isolation. Four key contextual factors that differentiated these three coping patterns were the consistency and extensiveness of social relationships, the nature of social support, and the degree of structural stability (e.g., stable employment and housing). Participants were assigned a Likert scale score (1 for poor rating to 3 for better rating) for their pattern of global reintegration and for their rating on each of the four contextual factors across the longitudinal qualitative interviews. Collectively, these five factors differentiated the prevalence and frequency of substance use, patterns of sexual behavior, and incidence of reincarceration as assessed by a quantitative survey administered 6 months post-release. Poorer ratings on all five contextual indices were related to the use of substances other than marijuana and alcohol. Men with less consistent social relationships reported more sexual partners. However, vaginal or anal sex without a condom was associated with greater social consistency and greater structural stability, possibly due to the presence of a steady main partner. Reincarceration was significantly associated with poorer global reintegration ratings, more negative social support, and less structural stability. These findings highlight the need to consider the role of social and structural support systems in HIV and sexually transmitted infection risk reduction interventions for men after their release from prison.

Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability.

Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates.

Gender roles and HIV sexual risk vulnerability of Roma (Gypsies) men and women in Bulgaria and Hungary: an ethnographic study.

Roma, the largest ethnic minority group in Central and Eastern Europe, have cultures that are traditional, often closed, and autonomous of majority populations. Roma communities are characterized by pervasive social health problems, widespread poverty, limited educational opportunities, and discrimination. Although some evidence suggests high levels of HIV sexual risk behaviour among Roma, little is known about the cultural and social context in which risk behaviour occurs. In-depth interviews were used to elicit detailed information about types of sexual partnerships and sexual risk behaviour practices occurring in them, use and perception of protection, knowledge and beliefs about AIDS and STDs, and sexual communication patterns in a sample of 42 men and women aged 18-52 living in Roma community settlements in Bulgaria and Hungary. Analysis of the interview data revealed that men have great sexual freedom before and during marriage, engage in a wide range of unprotected practices with primary and multiple outside partners, and have much more relationship power and control. In contrast, women are expected to maintain virginity before marriage and then sexual exclusivity to their husbands. Condom use is not normative and is mainly perceived as a form of contraception. Although awareness of AIDS was common, it was generally not perceived as a personal threat. Misconceptions about how HIV is transmitted are widespread, and women - in particular - had very little knowledge about STDs, HIV transmission, and protective steps. There is an urgent need for the development of HIV prevention programs culturally sensitive to Roma populations in Eastern Europe, where HIV rates are rapidly rising.

Acanthamoeba keratitis update-incidence, molecular epidemiology and new drugs for treatment.

A reliable figure for the expected incidence of Acanthamoeba keratitis of one per 30000 contact lens wearers per year has now been obtained from a combination of three cohort and three Questionnaire Reporting Surveys; 88% of cases wore hydrogel lenses and 12% wore rigid lenses. This figure now provides a basis for the expected number of cases against which to judge either epidemic outbreaks or effects of prevention with disinfecting solutions, better hygiene, or the use of disposable lenses. Molecular biology of Acanthamoeba has advanced considerably in the last 10 years with new automated sequencing technology. This has allowed the construction of a genotype identification scheme with 13 different genotypes against which to compare clinical isolates for epidemiological investigations or pathogenicity markers. So far, only four genotypes have been associated with keratitis of which the majority have been T4 but T3, T6, and T11 have each caused individual cases. Each genotype is heterogenous and can be further subdivided by comparison of sequences of diagnostic fragments of 18S rDNA, riboprinting by PCR-RFLP of 18S rDNA, or by mitochondrial DNA RFLP. Drug therapy has been revolutionised with the introduction of the biguanides-chlorhexidine or polyhexamethylene biguanide-with most but not all infections quickly resolving. Failure can still occur occasionally and further research is needed on more effective combination chemotherapy. A number of guanidines have been identified in this paper that could be usefully pursued as part of combination chemotherapy along with the alkylphosphocholines.