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44 studies
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- COPD (chronic lung disease)
A Study to Investigate the Effect of AZD6793 in Participants With Moderate to Very Severe Chronic Obstructive Pulmonary Disease
Testing two doses of a medicine versus placebo for COPD symptoms
📍 Research Site · Birmingham, AL · +39 more US sites · Get directions →
This Phase IIb dose-ranging study will evaluate the efficacy and safety of 2 different doses of AZD6793 compared with placebo tablets in participants with moderate to very severe chronic obstructive pulmonary disease.
- Rheumatoid arthritis
Dynamic Treatment Regiments for Glucocorticoid Tapering
Studying how people with rheumatoid arthritis respond to tapering steroid medicine
📍 VA Ann Arbor Healthcare System, Ann Arbor, MI · Ann Arbor, MI · +1 more US site · Get directions →
The purpose of this clinical trial is to better understand how people with rheumatoid arthritis (RA) respond to gradual dose reduction, or "tapering", of steroid medications like prednisone. Some people with RA have symptoms when steroid dose is reduced, while others don't.
- COPD (chronic lung disease)
To Evaluate the Effect of EXPD-101/FXS7553 Compared With Placebo in Patients With COPD Over 52 Weeks of Treatment
Testing two doses of a daily medicine versus placebo in people with COPD over 52 weeks
📍 DM Clinical Research - Phoenix · Phoenix, AZ · +11 more US sites · Get directions →
This is a Phase 2 study of the efficacy, safety, tolerability and pharmacokinetics of two doses of EXPD-101 in participants with COPD. Study participants will be randomized to receive either study drug or placebo administered once daily for 52 weeks.
- Type 2 diabetesHeart / cardiovascular disease
Acute and Chronic Effects of Oral Ketones in Subjects With HFrEF and Diabetes
Testing how drinking ketone drinks affects heart function in people with type 2 diabetes and heart
📍 University of Texas Health Science Center at San Antonio · San Antonio, TX · Get directions →
This study will provide insight into whether cardiac function changes with oral Ketone Esters (KE) administered to patients with Type 2 Diabetes Mellitus (T2DM) and Heart failure with reduced ejection fraction (HFrEF). Plasma ketones are avidly extracted by cardiac muscle and their uptake is not dependent upon insulin or influenced by insulin resistance.
- Rheumatoid arthritis
AlloNK®, an Allogeneic Non-genetically Modified, Cord Blood-derived NK Cell Therapy, in Combination With Rituximab, Studied in Relapsing Forms of B-cell Dependent Rheumatologic Diseases.
Testing safety and effects of cord blood immune cells plus rituximab for relapsing rheumatoid
📍 Artiva Investigational Site Tuscaloosa · Tuscaloosa, AL · +30 more US sites · Get directions →
A Basket Trial of Refractory Rheumatoid Arthritis (RA), Sjögren's Disease (SjD), Idiopathic Inflammatory Myopathies (IIMs) and Systemic Sclerosis (SSc) subjects to evaluate the safety and efficacy of AlloNK, a non-genetically modified allogeneic NK cell, in combination with rituximab.
- Rheumatoid arthritis
A Study to Assess the Safety and Efficacy of Different Doses of ELV001 to Treat Active Rheumatoid Arthritis in Patients With an Inadequate Response to Methotrexate and Tumor Necrosis Factor Inhibition (START SYNERGY)
Testing different doses of ELV001 for rheumatoid arthritis symptoms
📍 Arizona Arthritis & Rheumatology Associates · Gilbert, AZ · +21 more US sites · Get directions →
This is a Phase 2 randomized, double-blind, placebo-controlled study with a total duration of 32 weeks from Screening to End-of-Study (EOS) Visit. Approximately 180 participants are planned to be enrolled.
- Heart / cardiovascular disease
Improving Coronary Vascular Health in Women
Testing whether blood flow in heart arteries can be improved in women with HIV
📍 Massachusetts General Hospital · Boston, MA · Get directions →
Women with HIV have an increased risk of having a myocardial infarction (heart attack) as compared to women without HIV. One of the mechanisms underlying the increased risk of myocardial infarction among women with HIV may involve reduced ability to increase blood flow through large and small coronary arteries at times when increased flow of oxygen-carrying blood is needed.
- Rheumatoid arthritis
A Phase 1/2 Study of NKX019 in Subjects With Immune-Mediated Diseases (Ntrust-2)
Testing how safe and tolerable an immune-cell treatment is for rheumatoid arthritis
📍 Nkarta Investigational Site · Orange, CA · +14 more US sites · Get directions →
This is a Phase 1/2, open-label, multi-center, multi-cohort, non-randomized dose escalation and dose expansion basket study to determine the safety and tolerability of NKX019 (allogeneic CAR NK cells targeting CD19) in participants with autoimmune diseases.
- High blood pressureCOPD (chronic lung disease)
Breathe Easier With Tadalafil Therapy for Dyspnea in COPD-PH
Testing tadalafil to see if it improves shortness of breath in COPD with high blood pressure in the
📍 Rocky Mountain Regional VA Medical Center, Aurora, CO · Aurora, CO · +4 more US sites · Get directions →
The investigators will study whether the drug tadalafil improves shortness of breath in 126 Veterans with Chronic Obstructive Pulmonary Disease (COPD) and high blood pressure in the lungs. The investigators will also assess whether tadalafil improves quality of life, home daily physical activity, exercise endurance, the frequency of acute flares of COPD, blood pressure in the lungs, and lung function.
- Rheumatoid arthritis
"Effect of Vitamin E (α-Tocopherol) on Clinical Activity and Inflammation in Rheumatoid Arthritis"
Testing whether vitamin E lowers inflammation and symptoms in rheumatoid arthritis
📍 Civil Hospital of Guadalajara · Guadalajara, Jalisco · Get directions →
The objective of this clinical trial is to determine whether α-tocopherol (vitamin E) supplementation decreases inflammation and clinical activity in patients with rheumatoid arthritis (RA).The main questions to be answered are: * Is supplementation with vitamin E (α-tocopherol) for one month associated with decreased clinical activity and inflammation in patients with RA? Researchers will compare α-tocopherol with a placebo (a look-alike substance containing no active ingredient) to see if α-tocopherol effectively reduces inflammation and clinical activity in patients with rheumatoid arthritis.
- COPD (chronic lung disease)
Rademikibart Add-on Treatment of an Acute COPD Exacerbation (Seabreeze STAT COPD)
Testing an add-on treatment for adults having a COPD flare with type 2 inflammation
📍 University of Alabama at Birmingham Lung Health Center · Birmingham, AL · +21 more US sites · Get directions →
This is a Phase 2, multicenter study in adult participants with an acute COPD exacerbation and type 2 inflammation
- Rheumatoid arthritis
A Study to Evaluate Different Targeted Therapies for Patients With Rheumatoid Arthritis
Testing targeted treatments for people with moderate to severe rheumatoid arthritis
📍 Sun Valley Arthritis Center /ID# 278331 · Peoria, AZ · +39 more US sites · Get directions →
Rheumatoid Arthritis (RA) is a chronic inflammatory disease causing pain, stiffness, swelling and loss of joint function. This study will evaluate the efficacy and safety of targeted therapies through a series of substudies for the treatment of moderately to severely active Rheumatoid Arthritis (RA).
- Heart / cardiovascular diseaseLupus (SLE)
The Role of Anifrolumab in Improving Markers of Vascular Risk in Patients With Systemic Lupus Erythematosus (SLE) - IFN-CVD
Testing whether anifrolumab improves blood vessel risk markers in lupus
📍 National Institutes of Health Clinical Center · Bethesda, MD · Get directions →
Background: People with systemic lupus erythematosus (SLE) are at risk of developing complications in their blood vessels. This can increase the risk of heart attacks or stroke.
- COPD (chronic lung disease)
A Phase IIb Ensifentrine-glycopyrrolate Fixed-dose Combination Dose Ranging Study in Subjects With COPD
Testing different doses of two inhaled medicines for COPD symptoms
📍 SEC Clinical Research, LLC · Dothan, AL · +39 more US sites · Get directions →
This study will assess the safety and efficacy of fixed dose combinations of ensifentrine with two different glycopyrrolate dose levels compared to placebo and to the individual components of the fixed dose combinations, each administered twice a day via standard jet nebulizer, in adult subjects with chronic obstructive pulmonary disease (COPD).
- Lupus (SLE)Rheumatoid arthritisCrohn's / ulcerative colitis (IBD)
COVID-19 Booster and IIV Schedule in Immunocompromised Hosts
Testing COVID-19 booster and flu vaccine schedules in people with lupus, rheumatoid arthritis, or
📍 Maisonneuve -Rosemont Installation · Montreal, Quebec · Get directions →
The goal of this pragmatic embedded open-label, 2 x 2 factorial phase II randomized controlled trial is to evaluate strategies to improve COVID-19 booster and influenza vaccine immunogenicity in people living with immunocompromising conditions (PLIC). The main questions it aims to answer are: 1.
- COPD (chronic lung disease)
A Study to Learn About the Study Medicine Called PF-07275315 in People With Moderate to Severe Chronic Obstructive Pulmonary Disease
Testing how a study medicine affects safety and symptoms in people with COPD
📍 University of Alabama at Birmingham Lung Health Center · Birmingham, AL · +39 more US sites · Get directions →
The purpose of this clinical trial is to learn about the effects and safety of the study medicine PF-07275315 for the potential treatment of COPD. COPD is a condition that makes it difficult to breathe, which negatively impacts the quality of life and functioning of people who are affected.
- Obesity / overweightHigh blood pressureCOPD (chronic lung disease)
Feasibility of Semaglutide in Advanced Lung Disease
Testing whether semaglutide can be given safely to people with advanced lung disease
📍 University of Pennsylvania Perelman School of Medicine · Philadelphia, PA · Get directions →
The goal of this clinical trial is to learn whether semaglutide, an FDA-approved treatment for diabetes and obesity, is feasible and tolerable in patients with advanced lung disease. The main question\[s\] it aims to answer are: 1.
- COPD (chronic lung disease)
A Study to Evaluate Solrikitug in Participants With COPD (ZION)
Testing solrikitug in people with COPD to check safety and effects
📍 University of Alabama at Birmingham Hospital · Birmingham, AL · +39 more US sites · Get directions →
A Randomized, Double-blind, Placebo-controlled, Multiple Dose-Ranging Study to Assess the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Solrikitug in Participants with Chronic Obstructive Pulmonary Disease (COPD).
- Rheumatoid arthritis
An Extension Study to Assess Long-Term Safety and Efficacy of Afimkibart in Participants With Rheumatoid Arthritis
Testing the long-term safety and results of afimkibart in rheumatoid arthritis
📍 DM Clinical Research · Tomball, TX · Get directions →
The study will evaluate the long-term safety and efficacy of Afimkibart (also known as RO7790121) in participants with moderate to severe Rheumatoid Arthritis (RA) who have an inadequate response or intolerance to tumor necrosis factor (TNF) and/or Janus kinase (JAK) inhibitors, and who were previously treated with Afimkibart.
- Rheumatoid arthritis
A Study to Assess the Efficacy and Safety of RO7790121 in Participants With Moderate to Severe Rheumatoid Arthritis Who Have Not Responded to or Who Cannot Tolerate Tumor Necrosis Factor (TNF) and/or Janus Kinase (JAK Inhibitors)
Testing a new medicine versus placebo for rheumatoid arthritis after TNF or JAK drugs didn’t work
📍 SunValley Arthritis Center Ltd. · Peoria, AZ · +11 more US sites · Get directions →
This study will assess the efficacy and safety of Afimkibart (also known as RO7790121) compared with placebo in participants with moderate to severe rheumatoid arthritis (RA) who have an inadequate response or intolerance to TNF and/or JAK inhibitors.
- COPD (chronic lung disease)
A Study of WIN378 in Participants With Moderate to Severe COPD (Sirius)
Testing the right dose of a long-acting medicine for moderate to severe COPD
📍 WB Contracted Clinical Research Site · Miami Lakes, FL · +3 more US sites · Get directions →
This study is trying to identify the right dose of a long-acting medicine called WIN378 for people with moderate - severe chronic obstructive pulmonary disease (COPD). WIN378 blocks the action of a protein called TSLP that causes inflammation in the lung and may contribute to COPD control and symptoms.
- Lupus (SLE)Rheumatoid arthritis
A Phase 2 Master Protocol Assessing Inebilizumab and Blinatumomab in Autoimmune Diseases
Testing how safe inebilizumab and blinatumomab are in adults with lupus or rheumatoid arthritis
📍 HonorHealth Research and Innovation Institute · Scottsdale, AZ · +16 more US sites · Get directions →
The main objective is to assess the safety and tolerability of inebilizumab in adult participants with active and refractory systemic lupus erythematosus (SLE) with nephritis (Subprotocol A) and to assess the safety and tolerability of subcutaneous (SC) blinatumomab in adult participants with active and refractory SLE with and without nephritis (Subprotocol B Part A) and in adult participants with active refractory rheumatoid arthritis (RA) (Subprotocol C Part A). The trial will also assess the efficacy of SC blinatumomab in adult participants with active and refractory SLE with and without nephritis (Subprotocol B Part B and Subprotocol C Part B).
- Obesity / overweightHeart / cardiovascular disease
A Phase 2 Study to Evaluate the Pharmacodynamics, Safety and Tolerability of BGE-102 in Participants With Obesity and Cardiovascular Risk Factors
Testing how BGE-102 affects inflammation blood tests and safety in people with obesity and heart
📍 Site 108 · Chandler, AZ · +11 more US sites · Get directions →
The purpose of this study is to learn about the effects of BGE-102 on blood biomarkers including hsCRP, which is a lab value used to measure inflammation. BGE-102 decreases inflammation which may improve obesity and cardiovascular health.
- Obesity / overweightHeart / cardiovascular disease
Mechanisms of Semaglutide Therapy in Heart Failure Patients
Testing how semaglutide works in people with heart failure and obesity
📍 Greenstone Biosciences · Palo Alto, CA · +1 more US site · Get directions →
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, primarily used for treatment of type-2 diabetes mellitus. GLP-1 receptors are present on pancreatic islet β-cells, δ-cells and α-cells.
- Rheumatoid arthritis
A Dose Response Study to Evaluate the Efficacy and Safety of Oral AP1189 Administered in Disease-Modifying Anti-Rheumatic Drug (DMARD) naïve Participants Participants With Early Rheumatoid Arthritis
Testing different doses of an oral medicine with methotrexate in early rheumatoid arthritis
📍 Nouvelle Clinical Research LLC · Cutler Bay, FL · +2 more US sites · Get directions →
The study is a randomized, double blind, placebo-controlled, dose response, phase II, multicentre trial to evaluate the efficacy and safety of oral AP1189 administered at the doses of 40, 70, or 100 mg for 12 weeks in combination with methotrexate, in DMARD-naïve participants with early rheumatoid arthritis and active inflammation.
- COPD (chronic lung disease)
The Cardiovascular Consequences of Sleep Apnea Plus COPD (Overlap Syndrome)
Studying how sleep apnea together with COPD affects heart health
📍 UCSD Sleep Research · La Jolla, CA · Get directions →
Major progress has been made in the area of cardiovascular disease, but we believe that further progress will involve mechanistically addressing underlying respiratory causes including chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). The most common cause of death in COPD is cardiovascular, although mechanisms are unknown.
- Heart / cardiovascular disease💵 May compensate
Canagliflozin Targeting Vascular Inflammation
Testing canagliflozin to reduce blood vessel inflammation in cardiovascular disease
📍 University of Ottawa Heart Institute · Ottawa, Ontario · Get directions →
CANTOR SING is a pilot single center double blinded randomized study. The investigators will compare the effect of canagliflozin (300 mg daily - intervention arm) vs.
- Heart / cardiovascular disease
Combined Dose-Finding and CV Outcomes Study With CSL300 (Clazakizumab) in Adult Subjects With ESKD Undergoing Dialysis (POSIBIL6ESKD)
Testing a medicine to see its cardiovascular effects in adults on dialysis
📍 Nephrology of North Alabama · Decatur, AL · +39 more US sites · Get directions →
This is a two-part, phase 2b and phase 3 combined prospective, interventional, multicenter, randomized, double-blind, placebo-controlled study. Part 1: Phase 2b is a dose-finding study for CSL300 vs placebo.
- Rheumatoid arthritis
A Study to Investigate Efficacy and Safety of AZD1163 in Participants With Rheumatoid Arthritis
Testing how well and how safely AZD1163 works for people with rheumatoid arthritis
📍 Research Site · Glendale, AZ · +27 more US sites · Get directions →
Phase II study in participants with moderately-to-severely active rheumatoid Arthritis (RA) to evaluate efficacy and safety of AZD1163.
- Obesity / overweightHeart / cardiovascular diseaseHigh cholesterol
Akkermansia Muciniphilia and Metabolic Side Effects of ADT
Testing how Akkermansia gut bacteria relate to body and blood lipid changes in people with obesity
📍 London Health Sciences Centre - Victoria Hospital · London, Ontario · Get directions →
The overriding objectives of this study are: 1. Primary outcomes: 1.
- Rheumatoid arthritis
Reduced Intensity Conditioning for Non-Malignant Disorders Undergoing UCBT, BMT or PBSCT
Testing reduced-intensity transplant approaches for people with rheumatoid arthritis
📍 UPMC Children's Hospital of Pittsburgh · Pittsburgh, PA · Get directions →
The objective of this study is to evaluate the efficacy of using a reduced-intensity condition (RIC) regimen with umbilical cord blood transplant (UCBT), double cord UCBT, matched unrelated donor (MUD) bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) in patients with non-malignant disorders that are amenable to treatment with hematopoietic stem cell transplant (HSCT). After transplant, subjects will be followed for late effects and for ongoing graft success.
- COPD (chronic lung disease)
Hyper Polarized Xenon-129 MRI vs Xenon-133 Scintigraphy
Comparing a lung scan that uses xenon MRI with a radioactive scan for COPD
📍 University of Virginia Health System · Charlottesville, VA · Get directions →
Hyper polarized Xenon-129 MRI will be directly compared to a radioactive Xe-133 scintigraphy to detect defects in lung ventilation from airflow limitation. This study is conducted as a pilot study with intention to conduct a larger clinical trial.
- COPD (chronic lung disease)
Lung and Bone Marrow Transplantation for Lung and Bone Marrow Failure
Testing whether lung transplant first can improve lung function before bone marrow transplant for
📍 UPMC Presbyterian · Pittsburgh, PA · +1 more US site · Get directions →
The purpose of this study is to determine whether a lung transplantation prior to bone marrow transplantation (BMT) would allow for restoration of pulmonary function prior to BMT, allowing to proceed to BMT, to restore hematologic function.
- Heart / cardiovascular disease
Ertugliflozin in Chronic Heart Failure
Testing ertugliflozin and other medicines for heart failure symptoms
📍 Yale School of Medicine · New Haven, CT · Get directions →
The purpose of this study is to determine the effects on heart failure signs and symptoms of the use of either ertugliflozin, metolazone or placebo, in conjunction with intravenous loop diuretic use in acute settings and chronic oral loop diuretic therapy. There are two general purposes for this study.
- Heart / cardiovascular disease
Mesenchymal Stem Cells for the Treatment of Various Chronic and Acute Conditions
Testing stem cell treatment for safety and effects on heart disease
📍 Southern California Hospital at Culver City / Southern California Hospital at Hollywood / Multiple US-based Sub-Investigator Sites · Culver City, CA · Get directions →
This multi-arm, multi-site study investigates the safety, tolerability, and efficacy of stem cell therapy for the treatment of various acute and chronic conditions. Clinically observed initial findings and an extensive body of research indicate regenerative treatments are both safe and effective for the treatment of multiple conditions.
- Heart / cardiovascular diseaseHigh blood pressure
Sympathetic-vascular Dysfunction in Obesity and Insulin Resistance (Vitamin C Study)
Studying how vitamin C affects blood vessel function in obese adults with insulin resistance and
📍 University of Kansas Medical Center · Kansas City, KS · Get directions →
The main purpose of research is to examine and understanding the development of hypertension in obese adults with insulin resistance. Findings from our studies will identify unique mechanisms that can be targeted to limit increases in vascular dysfunction and reduce the excessively high prevalence of hypertension and risk for cardiovascular disease (CVD).
- High blood pressureCOPD (chronic lung disease)
Pulmonary Hypertension SOLAR
Testing a noninvasive MRI pattern to study lung blood vessel changes in pulmonary hypertension
📍 Duke University Medical Center · Durham, NC · Get directions →
The main goal of this study is to develop a noninvasive signature for pulmonary vascular remodeling in Group 3 PH patients, using hyperpolarized 129Xe magnetic resonance imaging (129Xe MRI). Such a signature may identify Group 3 PH responders to PAH-specific therapies.
- Obesity / overweightHeart / cardiovascular diseaseHigh blood pressure
PRECISION-BP: Precision Chronopharamacotherapy Targeting NP-RAAS-BP Rhythm Axis
Testing timing of blood pressure medicines in people with obesity and high blood pressure
📍 University of Alabama at Birmingham · Birmingham, AL · Get directions →
Obese individuals have a higher prevalence of nocturnal hypertension and non-dipping blood pressure (BP). These conditions are associated with an increased risk of cardiovascular (CV) events and death.
- COPD (chronic lung disease)
Oral Sildenafil for Exercise Capacity, Dyspnea and Cardiopulmonary Function in COPD
Testing sildenafil taken by mouth to improve exercise ability and breathing in people with COPD
📍 Clinical Physiology Laboratory · Edmonton, Alberta · Get directions →
Chronic obstructive pulmonary disease (COPD) is a condition characterized by airway obstruction. Patients with COPD experience significant shortness of breath on exertion.
- COPD (chronic lung disease)
Effect of Ensifentrine on Sputum Markers of Inflammation in COPD
Testing whether nebulized ensifentrine changes lung inflammation markers in people with COPD
📍 University of Alabama at Birmingham · Birmingham, AL · +2 more US sites · Get directions →
This is a randomized, double-blind, placebo-controlled, two-period cross-over study of nebulized ensifentrine (3 mg) or placebo administered BID for two 8-week Treatment Periods. All participants with receive both ensifentrine and placebo during participation.
- Heart / cardiovascular diseaseKidney disease
Effect of Dapagliflozin on Metabolomics and Cardiac Mechanics in Chronic Kidney Disease
Testing dapagliflozin with standard care on heart and lung function and blood metabolites in chronic
📍 Northwestern University · Chicago, IL · Get directions →
The goal of this study is to better understand the effects of a sodium-glucose transport protein 2 inhibitor, dapagliflozin, added on to standard of care on heart and lung function and circulating metabolites (substances created when our bodies break down food, drugs, or its own tissues) in patients with chronic kidney disease.
- Obesity / overweightHeart / cardiovascular disease
Effects of Tirzepatide on Muscle and Vascular Health in Obese Older Adults
Testing tirzepatide to see effects on muscle and blood vessels in older adults with obesity and
📍 University of Texas Health Science Center at San Antonio · San Antonio, TX · Get directions →
Obesity and type 2 diabetes mellitus (T2DM) represent major public health concerns in the aging community. Tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist recently approved for the treatment of T2DM and obesity has been shown to be effective at reducing weight, improving markers of T2DM control, and improving cardiovascular health.
- COPD (chronic lung disease)
Inhaled Treprostinil (Tyvaso Nebulizer) For COPD Patients With Hypoxemia
Testing an inhaled medicine to improve oxygen and lung blood flow in adults with COPD and low blood
📍 Duke Asthma Allergy and Airway Center · Durham, NC · Get directions →
The goal of this clinical trial is to evaluate whether inhaled Treprostinil (Tyvaso) can improve oxygen delivery and blood flow in the lungs in adults (age ≥40) with chronic obstructive pulmonary disease (COPD) and hypoxemia who have less severe reduction in lung blood volume (diffusing capacity of the lungs for carbon monoxide \[DLCO\] ≥45%). The main questions it aims to answer are: 1.
- COPD (chronic lung disease)
Clinical Trial of Omalizumab for Allergen Sensitized and Exposed Individuals With COPD
Testing omalizumab for COPD in people with allergies
📍 University of Alabama · Birmingham, AL · +22 more US sites · Get directions →
This research is being done to test if a drug called omalizumab can help people with Chronic Obstructive Pulmonary Disease (COPD) and allergies. Each participant will be in the study for about 16 months, including 1-3 months of screening, 12 months of receiving the study drug at a clinic, and a follow-up call one month after your final clinic visit.