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- OPEN ACCESSThrough the support of Dietitians of Canada (DC) and the Canadian Foundation for Dietetic Research (CFDR), the 2019 Research Showcase at the DC conference represented a wide variety of practice-based nutrition research projects in Canada.The 2019 Research Showcase consisted of several new elements this year. Early Bird abstracts were considered for either oral or oral ePoster sessions. New this year was the presentation of 11 Early Bird abstracts as oral presentations within the regular conference sessions: we called these “Lightning Rounds”. The remaining 27 Early Bird abstracts were presented as oral ePosters on June 6, 2019; authors presented their research in 2–3 minutes plus 2 minutes for questions, using their ePosters. For 2019, there were 3 concurrent oral ePoster sessions. All accepted, and presented, abstracts from the Early Bird submission are published in the Journal.This research event would not be possible without the commitment and dedication of many people. On behalf of DC and CFDR, we extend a special thank you to members of our abstract review committee: Susan Campisi (University of Toronto); Elaine Cawadias (Retired); Andrea Glenn (St. Francis Xavier University); Brenda Hartman (Brescia College, Western University) Mahsa Jessri (University of Ottawa); and Jessica Lieffers (University of Alberta).Thanks also to our moderators for the Oral ePosters: Barb Anderson (Acadian University); Jane Bellman (Dietitians of Canada); Brenda Hartman (Brescia College, Western University); Jessica Lieffers (University of Alberta); Dawna Royall (Dietitians of Canada); and Lee Rysdale (Northern Ontario School of Medicine).We enjoyed interacting with many of you at the oral research presentations as we highlighted the findings from our dietetic colleagues across our country!Finally, a special thank you to Gareth Willows Tribe and Michelle Naraine at CFDR for their assistance and support throughout the review process.Christina Lengyel, PhD, RDChair, 2019Early Bird CommitteeAssociate ProfessorDirector of the Dietetics ProgramHuman Nutritional SciencesUniversity of ManitobaJanis Randall Simpson, PhD, RD, FDCChair, 2019Late Breaking CommitteeProfessor EmeritaUniversity of GuelphExecutive Director, CFDR
- OPEN ACCESSBeing different is neither right nor wrong; it is just different. The dietetic profession as part of society holds many differences. These can be divisive, but learning to recognize the strengths that differences generate could lead to a stronger professional future. Three points arose when reflecting on professional experiences of a career of more than 3 decades. Recognizing different ways of creating and gathering knowledge, leading individuals and teams, and valuing the past as well as the future, will provide opportunities to explore our differences as individuals and as a profession. These themes appear at the intersections of values that could initiate inclusion or exclusion. Learnings from these intersections note that growth can occur even in the midst of adversity. Without understanding the junctions in our professional pathways, futures planning may not build upon the foundation of strengths, experiences, and values present within our profession. Learning to be a risk taker, to walk into the fear, has helped Laurie to shape a career that feels satisfying and successful. Suggested techniques to energize individual careers are provided.
- Michelle L. Marcinow PhD,
- Janis A. Randall Simpson PhD, RD,
- Susan J. Whiting PhD, and
- Andrea C. Buchholz PhD, RD
Purpose: Milk products (fluid milk, cheese, yogurt) typically provide a rich source of calcium and other nutrients, yet consumption is declining in Canada. This study examined milk product health beliefs among young adults and the association between these beliefs and dietary calcium intake.Methods: Seventy-nine participants (25 ± 4 y; 40 males) completed a milk product health belief questionnaire to determine a milk product health belief score (MPHBS) and a 3-day food record to assess dietary intake.Results: Despite generally positive views, young adults were uncertain about milk products in relation to health, weight management, and ethical concerns. Females would be more likely than males to increase milk product intake if they were confident that milk products are ethically produced. There was no significant association between MPHBS and dietary calcium intake. Energy-adjusted dietary calcium intake was positively associated with intakes of vitamin A (r = 0.3, P < 0.05), riboflavin (r = 0.5, P < 0.01), vitamin B12 (r = 0.5, P = < 0.01), vitamin D (r = 0.4, P < 0.01), phosphorus (r = 0.4, P < 0.01), zinc (r = 0.3, P < 0.01), and with milk and alternatives servings (r = 0.8, P < 0.01).Conclusion: Nutrition education efforts focused on increasing calcium-rich food consumption will help consumers to be better informed when making dietary choices.- Christine Lagacé BSc, MSc, RD,
- Natalie Carrier PhD, RD,
- Lita Villalon PhD, RD,
- Christina Lengyel PhD, RD,
- Susan Slaughter PhD, RN,
- Jill Morrison MSc, and
- Heather Keller PhD, RD
Purpose: To determine regular-texture menu variety offered in Canadian long-term care (LTC) homes and its association with residents’ food intake.Methods: Twenty-nine LTC menus from Alberta, Manitoba, New Brunswick, and Ontario were analyzed. Items offered during the regular-texture menu cycle were categorized according to Eating Well with Canada’s Food Guide food groups and variety scores were calculated per day and per week. Residents’ food intake was assessed by weighing and observing intake over 3 nonconsecutive days. Diet quality was determined using a mean adequacy ratio score (MAR) for regular and soft and bite-sized consumers (n = 394).Results: Average daily and weekly menu variety scores were 24 ± 5.8 and 78 ± 17.2, respectively, with significantly higher scores in Ontario (29 ± 2.7 and 102 ± 11.7). Of all the food groups, only the variety score for the “Other” food category was positively associated with protein intake. No associations were observed between variety and energy intake or MAR score.Conclusion: This study is the first in Canada to assess LTC menu variety. Although there was variability between provinces in menu variety, this was not associated with resident diet quality or intake.- Stephanie Aboueid MSc, RD,
- Catherine Pouliot RD,
- Billie Jane Hermosura MAdEd, MAN, RD,
- Ivy Bourgeault PhD, and
- Isabelle Giroux PhD, RD
Purpose: To understand the perception of dietitians regarding the effects of multidisciplinary settings and Electronic Health Records (EHRs) on their dietetic practice for weight management.Methods: Individual semi-structured interviews were conducted with 14 dietitians working in multidisciplinary settings in Ontario. All interviews were audio recorded and transcribed verbatim. Two researchers coded the data independently using a thematic analysis approach. All themes emerged inductively and were refined iteratively.Results: Most dietitians believed that working in a multidisciplinary setting allowed for interprofessional collaboration and time-effective referrals. Multidisciplinary clinics were perceived to improve patient care due to convenient scheduling, consistent messaging, and ongoing support. However, some dietitians reported instances of conflicting approaches and beliefs regarding weight management across health professionals. Dietitians suggested ways to address these conflicting approaches through clinical meetings and education. EHRs were perceived to allow for collaboration through facilitated communication and knowledge exchange; however, lack of interoperability between EHR platforms across different types of health care settings was perceived to be a barrier for optimal care.Conclusions: Overall, multidisciplinary settings were perceived to positively impact dietitians’ practices for weight management as they allow for interprofessional collaboration. Consistency in health messaging across health professionals should be emphasized through knowledge exchange.- Purpose: In this paper, we begin to set out language defining sustainable food systems (SFS) in Canada, through the voices of dietitians, and identify leverage points where dietitians can affect change.Methods: Dietitians of Canada members were invited to a Delphi Inquiry process; questions explored a vision of SFS in Canada, barriers to that vision, and actions. Results were independently analysed by 2 members of the research team who used the Framework for Strategic Sustainable Development to structure the data.Results: Fifty-eight members participated. The resultant vision describes a future food system in 15 thematic areas of the social and ecological systems. Barriers are described according to how they undermine sustainability. High-leverage actions areas included: (i) facilitating knowledge development within the profession and public, (ii) influencing organizational policy to support SFS, and (iii) and influencing public policy. Approaches to such action included: (i) facilitating cross-sectoral collaboration and (ii) applying reflexive approaches.Conclusions: This research suggests a multidimensional understanding of food systems sustainability among dietitians. The vision provides some language to describe what dietitians mean by SFS and can be used as a compass point to orient action. Action areas and approaches have the potential to drive systemic change while avoiding unintended consequences.
- Purpose: The purpose of this work was to assess Arab Muslim immigrant mothers’ acculturation level, to explore apparent links between acculturation level and experiences of dietary changes, and to gather information on factors affecting dietary acculturation.Methods: Semi-structured individual interviews focusing on food choices were conducted with 24 mothers who had been in Canada 5 years or more. An adapted version of an existing acculturation scale was used to assess participants’ perception of their own acculturation.Results: Arab Muslim mothers retain traditional food preparation. However, several factors led to changes in their daily food consumption such as children’s preferences, time concerns, and availability of Arabic food. No significant relation was found between measured levels of acculturation and the adoption of Canadian food behaviour or the retention of preparation and consumption of traditional foods (dietary acculturation); however, a greater length of stay in Canada was somewhat associated with limitations on preparing traditional food. The findings indicated that many of the Arab Muslim mothers interviewed retain important aspects of their traditional cuisine.Conclusions: Dietary acculturation for Arab Muslim immigrants to Canada involved a balance between carrying forward food-related traditions and adapting to Canadian culture, including Canada’s food culture.
- Melissa Anne Fernandez PhD, RD,
- Marie Marquis PhD, RD,
- Sophie Desroches PhD, RD,
- Mylène Turcotte MSc, RD, and
- Véronique Provencher PhD, RD
Purpose: To explore the associations between full-time employment status, food skills, and diet quality of Canadian parents. Methods: A sample of Canadian parents (n = 767) were invited to complete a web-based survey that included sociodemographic variables, questions about food skills, and a validated food frequency questionnaire. Results were analyzed with linear and logistic regression models, controlling for sociodemographic variables and multiple testing. Results: After controlling for covariates and multiple testing, there were no statistically significant differences in foods skills between parents’ employment status. Time was the most reported barrier for meal preparation, regardless of work status, but was significantly greater for full-time compared with other employment status (P < 0.0001). Additionally, parents who worked full-time had lower odds of reporting food preferences or dietary restrictions (P = 0.0001) and health issues or allergies (P = 0.0003) as barriers to food preparation, compared with parents with other employment status. These results remained statistically significant even after controlling for covariates and multiple testing. Conclusions: Overall, food skills did not differ significantly between parents’ employment status. Time, however, was an important barrier for most parents, especially those working full time. To promote home-based food preparation among parents, strategies to manage time scarcity are needed.- Purpose: To examine overall usual fruit and vegetable (FV) intake and preferences among grade 5–8 students participating in the Northern Fruit and Vegetable Program (NFVP) over 3 years (2014–2016). Methods: In each year, a survey was administered 4 months into the NFVP in Northern Ontario, Canada. Results: A total of 4744 students participated (2014 = 1551; 2015 = 1617; 2016 = 1576). Overall usual FV intake did not change over the 3 years, yet preferences generally increased. FVs offered by the NFVP were rated higher on preference than those not offered (fruit P < 0.001; vegetables P < 0.005). In each year, participants were more likely to consume a higher overall usual fruit intake if they had higher preference for fruit as offered by the NFVP (all P < 0.05) as opposed to not offered by the NFVP (all P > 0.05). For vegetables, participants were more likely to consume higher overall usual vegetables if they had a higher preference for vegetables as offered (all P < 0.05) and not offered by the NFVP (all P < 0.05). Conclusions: This study documented that higher preferences for fruit (as offered) and vegetables (as offered and not offered) were associated with higher overall usual FV intakes within each of the 3 years.
- Purpose: To describe prenatal nutrition care currently delivered by Family Health Teams (FHTs) and Community Health Centres (CHCs) in Ontario, from the perspectives of health care providers, and to identify opportunities for improving care.Methods: Ten 1-hour, interdisciplinary focus groups were conducted in FHTs and CHCs, involving a total of 73 health care providers. Focus groups ranged in size from 3 to 11 team members, and at least 3 different professions participated in each group. The shared perspectives and experiences on prenatal nutrition care were collected using a semi-structured interview guide and analyzed using thematic analysis.Results: Limited time was spent on prenatal nutrition education and counselling. Two themes emerged describing gaps in care: (i) providing care in “borderline” high-risk pregnancies (i.e., impaired glucose tolerance) and (ii) providing care around gestational weight gain. Providers envisioned improving services offered by increasing preventative care, empowering providers to provide more nutrition care, facilitating patient self-care, and building a 1-stop shop “medical home”.Conclusions: This study’s findings can guide strategies to mobilize current nutritional knowledge into routine prenatal care, and the shared vision for improvement will inform the routes for new practice that are supported by health care professionals.
- Vanessa Vucea MSc,
- Heather H. Keller PhD, RD,
- Jill M. Morrison MSc,
- Lisa M. Duizer PhD,
- Alison M. Duncan PhD, RD, and
- Catriona M. Steele PhD
Purpose: To describe the prevalence and characteristics of modified-texture food (MTF) consumers when applying standard diet terminology.Methods: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study including 32 long-term care (LTC) homes located in 4 Canadian provinces. Resident characteristics were collected from health records using a defined protocol and extraction form. Since homes used 67 different terms to describe MTFs, diets were recategorized using the International Dysphagia Diet Standardization Initiative Framework as a basis for classification.Results: MTFs were prescribed to 47% (n = 298) of participants (n = 639) and prevalence significantly differed among provinces (P < 0.0001). Various resident characteristics were significantly associated with use of MTFs: dysphagia and malnutrition risk, dementia diagnosis, prescription of oral nutritional supplements; lower body weight and calf circumference; greater need for physical assistance with eating; poor oral health status; and dependence in all activities of daily living.Conclusions: This is the first study that used a diverse sample of LTC residents to determine prevalence of MTF use and described consumers. The prevalence of prescribed MTFs was high and diverse across provinces in Canada. Residents prescribed MTFs were more vulnerable than residents on regular texture diets. These findings add value to our understanding of MTF consumers.- Allison Fielding BSc, RD,
- Lorian M. Taylor PhD, RD,
- Stephanie Moriartey PhD, RD, and
- Janet Stadynk BSc, RD
Purpose: The study aim was to evaluate a patient experience survey, the Assessment of Registered Dietitian Care Survey (ARCS), that is aligned with a nutrition counselling approach (NCA) and evidence-based chronic disease care for use in outpatient registered dietitian (RD) practice. Methods: Criterion and construct validity were examined using Pearson correlation coefficients and principal components analyses, respectively. Reliability was examined using Pearson correlations and Cronbach’s α. Acceptability was evaluated by survey response rate and readability. Kruskall–Wallis test was used to detect differences between RD scores. Results: A total of 479 survey packages were returned (46% response rate). Criterion validity indices were high (r = 0.91 and 0.94, P < 0.001) between Patient Assessment of Chronic Illness Care (PACIC) and NCA subscales, respectively, and lower with overall patient satisfaction (r = 0.63–0.65, P < 0.001). Construct validity revealed 2 factors for PACIC and NCA subscales. There was high internal reliability for the PACIC, 5As, and NCA (Cronbach’s α > 0.7) and test–retest reliability showed an adequate consistency over time (r = 0.70, P < 0.05). The tool was able to detect differences in scores between RDs (P < 0.05). Conclusions: More research is warranted to explore ceiling effects and sensitivity to intervention in similar practice settings. The NCA subscale has acceptable reliability and validity to measure patient experience of RD care.- Purpose: To evaluate whether interpretive “health” labels placed in vending machines in recreation centres represented products’ nutrient content when compared with provincial nutrition guidelines. Methods: A cross-sectional audit (November 2015 – April 2016) of 139 vending machines in recreation facilities found 525 foods and beverages in 17 machines labelled by vendors according to healthfulness. Product nutrient content was compared with provincial nutrition guideline criteria. Cross-tabulation and weighted Cohen’s kappa evaluated agreement between vendor interpretive labels and guideline ranks. Descriptive statistics evaluated how mislabelled products deviated from recommended nutrient content. Mann–Whitney tests compared nutrient content of “healthy” and “unhealthy” labelled products. Results: Almost one-third of all products were mislabelled by vendors with 72% of those labelled healthier than their actual guideline rank. Energy, total fat, sugar, and sodium contents exceeded recommended levels in one-third to one-half of mislabelled products. Overall, products labelled healthy by vendors were significantly lower in energy, sodium, and fat compared with those labelled unhealthy; however, not for all food types (e.g., bars, fruit snacks, nuts). Conclusions: For certain product categories, vendor interpretive nutrition labels poorly represented products’ nutrient content according to provincial nutrition guidelines. Dietitians may be a valuable resource to help implement nutrition guidelines to create credible interpretive product labelling systems.
- Purpose: The current study aimed to characterize grocery shopping and dinner preparation behaviours among young people in Canada and to examine associations with eating habits.Methods: A cross-sectional online survey was conducted with 2008 participants aged 16–24 from across Canada. The survey measured self-reported grocery shopping and dinner preparation behaviours, frequency of eating breakfast and eating meals prepared away from home, frequency of vegetable and fruit intake, and socio-demographic characteristics. Chi-square tests examined differences in proportions; logistic and linear regressions examined dietary habits, including covariates for grocery shopping and dinner preparation and socio-demographics.Results: Overall, 37.3% had helped with grocery shopping in the past week, and 84.3% had participated in dinner preparation at least 1 day in the past week. Engaging in shopping at least once weekly was associated with increased vegetable and fruit consumption only, whereas more frequent engagement in dinner preparation was associated with increased vegetable and fruit consumption, more frequent breakfast consumption, and fewer meals consumed that were prepared away from home (P < 0.001 for all).Conclusions: Increased participation in grocery shopping and dinner preparation were associated with healthier dietary habits. Interventions that increase these behaviours may contribute to improving dietary behaviours among adolescents and young adults.
- Purpose: Our study compared the prevalence of food insecurity among 3 student groups attending Memorial University of Newfoundland (MUN): International (INT), Canadian out-of-province (OOP), and Newfoundland and Labrador (NL). Factors associated with food insecurity were also investigated.Methods: Data were collected via an online survey distributed to an estimated 10 400 returning MUN students registered at a campus in St. John’s, NL. Respondents were recruited through e-mails, posters, and social media. Ten questions from the Canadian Household Food Security Survey Module adult scale were asked to assess food security. Logistic regression was used to compare rates of food insecurity between the three population subgroups.Results: Of the 971 eligible student respondents, 39.9% were food insecure (moderate or severe). After controlling for program type, parental status, living arrangement, and primary income source, OOP and INT students were 1.63 (95% CI = 1.11–2.40) and 3.04 (95% CI = 1.89–4.88) times more likely, respectively, to be food insecure than NL students.Conclusions: Approximately 40% of participating MUN students experienced food insecurity, a higher proportion than reported for the overall provincial population. Groups at high risk of food insecurity include INT students, students with children, and those relying on government funding as their primary income.
- Purpose: To explore the extent to which knowledge- and skill-based learning regarding social justice and/or social justice advocacy is included in the course descriptions of required courses of accredited, English-speaking dietitian training programs in Canada.Methods: This study is a mixed-methods content analysis of required course descriptions sampled from university academic calendars for accredited, English-speaking dietitian training programs across Canada.Results: Quantitative analysis showed that required course descriptions (n = 403) included few instances of social justice-related terminology (n = 63). Two themes emerged from the qualitative analysis: competing conceptualizations of social issues and dietitians’ roles; prioritization of science-based knowledge and ways of knowing.Conclusions: Accredited, English-speaking dietitian training programs in Canada appear to include little knowledge- or skill-based learning regarding social justice issues and advocacy. Supporting future dietitians to pursue leadership roles in redressing social injustices and socially just dietetic practice may require more explicit education and training about social justice issues and advocacy skills.
- Trisha Baydock RD,
- Savita Bector RD, MSc,
- Lorian M. Taylor RD, PhD, and
- Gregory Hansen MD, FRCP(C), MPH, MSc
Purpose: The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis.Methods: In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embedded branching logic questions developed to address major facets of sepsis, critical illness, and nutrition. The survey instrument assimilated all data in an anonymous manner, so respondents could not be linked to their answers.Results: Of the 64 RDs who responded (57% response rate), the majority practiced in adult intensive care (81%), within an academic center (59%), and in a mixed unit (73%). A wide variability of Canadian RDs’ opinions and practice was reported in determining energy requirements, enteral nutrition (EN) practice, EN with vasoactive agents, parenteral nutrition (PN), and supplemental micronutrients.Conclusions: Practice variability of Canadian RDs likely reflects gaps in both evidence and guidelines for severe sepsis. Further research efforts are needed to customize nutritional requirements in the patient with evolving sepsis, EN with patients at high risk for gastrointestinal dysfunction, optimizing PN, and the role of micronutrients.- Purpose: Internationally, there is debate on whether a nutrient or a food-based approach to policy is more effective. This study describes the food/beverage availability in schools in Nova Scotia through a comparison of a traditional nutrient classification (“Maximum/Moderate/Minimum”), currently used in the provincial school policy and a simplified food-based system (“Core/Extra”).Methods: School food environment audits were conducted in schools (n = 25) to record the food and beverages available. Registered dietitians categorized information using both the nutrient-based and simplified food-based classification systems. Number and percent in each category were described for items.Results: Food and beverage items consisted of breakfast, lunch, snacks, beverages, and vending of which 81% were permissible by the policy, whereas only 54% were categorized as Core. Many snacks and vending items classified as Extra fell within either Moderate (45% and 35%, respectively) or Minimum (29% and 33%, respectively) categories.Conclusions: Dietitians have a role to support interpretation of classification systems for school nutrition policies. The nutrient-based classification used in the policy permitted some items not essential to a healthy diet as defined by the Extra food-based classification. However, the food-based Core/Extra categorization had less detail to classify nutrients.
- OPEN ACCESSVancouver, British Columbia was the host city of the 2018 Dietitians of Canada Annual Conference.Through the support of Dietitians of Canada (DC) and Canadian Foundation for Dietetic Research (CFDR), the 2018 Research Showcase was an informative exchange of research and experience-sharing efforts. The submissions for this year’s CFDR event represented the diversity of dietetic research conducted within Canada.The 2018 Research Showcase highlighted the Early Bird abstracts in 2 formats; some as 10 minutes oral sessions and others as ePosters with a short oral component. The Late Breaking abstracts were displayed as ePosters.This research event would not be possible without the commitment and dedication of many people. On behalf of DC and CFDR, we would like to extend a special thank you to members of our Early Bird abstract review committee: Susan Campisi (University of Toronto); Elaine Cawadias (Retired); Andrea Glenn (St. Francis Xavier University); Mahsa Jessri (University of Ottawa); Jessica Lieffers (University of Saskatchewan). Members of the Late Breaking abstract review committee included: Laurie Drozdowski (University of Alberta); Laura Forbes (Co-chair)(University of Guelph); Joann Herridge (Hospital for Sick Children); Grace Lee (Toronto General Hospital); Lee Rysdale (Northern Ontario School of Medicine); Jessica Wegener (Ryerson University); Sarah Woodruff Atkinson (University of Windsor).We would also like to thank all of our moderators, Pierrette Buklis (CFDR Board), Marcia Cooper (Health Canada), Jenny Gusba (CFDR Board), Brenda Hartman (Brescia College), Paula Brauer (University of Guelph), Dawna Royall (DC), and MaryAnne Smith (DC), who kept our research presentation sessions on time during the conference. Finally, a special thank you to France Bertrand and Michelle Naraine at CFDR for their assistance and support throughout the review process.We enjoyed interacting with many of you at the oral research presentations as we highlighted the research findings from our dietetic colleagues across our country!Christina Lengyel, PhD, RDChair, 2018Early Bird Abstracts Review CommitteeAssociate ProfessorDirector of the Dietetics ProgramFood and Human Nutritional SciencesUniversity of ManitobaJanis Randall Simpson, PhD, RD, FDCChair, 2018Late Breaking Abstracts Review CommitteeProfessor EmeritaUniversity of GuelphExecutive Director, CFDR
- OPEN ACCESSThis article is a version of the Ryley–Jeffs Memorial Lecture, delivered on 8 June 2018. It discusses weight bias and the intersections with homophobia, racism, and misogyny, and how these impact health. While the dominant discourse attests that people can lose weight and keep it off, evidence informs us that maintenance of weight loss is unlikely. Using a flawed epistemological framework, obesity has been declared a disease, and weight bias been perpetuated. Weight bias is pervasive, both in the general public and amongst health professionals, often using inappropriate tools to assess the impact of weight on health. This contributes to overlooking the life circumstances that truly cause morbidity: social determinants of health such as income, social connectedness and isolation, adverse childhood experiences, and cultural erasure. A variety of tools dietitians can use to appropriately assess health risk are provided, along with examples of actions that can be taken to reduce weight bias. Dietitians who are leading the profession in taking action against weight bias and stigma are profiled.
