The Abbey School Headteacher, Healthybenefitsplus Com Amerigroup Otc, Articles B

While the OMIM database is open to the public, users seeking information about a personal registered for member area and forum access. 2023 ICD-10-CM Diagnosis Code Q79.8 - ICD10Data.com Mosaicism in ASXL3-related syndrome: Description of five patients from three families. 1779 Massachusetts Avenue A rare, genetic, syndromic intellectual disability disorder with a variable phenotypic presentation typically characterized by microcephaly, severe feeding difficulties, failure to thrive, severe global development delay that frequently results in absent/poor speech, moderate to severe intellectual disability and hypotonia. 3. Familial Bainbridge-Ropers syndrome: Report of familial ASXL3 inheritance and a milder phenotype. Bainbridge-Ropers Syndrome ( BRPS ) - MalaCards Update List ; Entry Statistics ; Phenotype-Gene Statistics ; Downloads . (2017) reported 12 unrelated patients with BRPS confirmed by genetic analysis. (615485) (Updated 08-Dec-2022) Balasubramanian et al. Family finds answers, hope after discovery of rare genetic disorder Most patients presented in early infancy with feeding difficulties, poor overall growth, relative microcephaly, and hypotonia. 5: 11, 2013. ClinicalTrials.gov, an affiliate of NIH, provides current information on clinical research studies in the United States and abroad. De novo nonsense variant in ASXL3 in a Chinese girl causing Bainbridge-Ropers syndrome: A case report and review of literature. [Full Text: https://doi.org/10.1093/hmg/ddv499]. Quality of life and the functional consequences depends on the severity of the developmental delay and intellectual disability. Hyperventilation-athetosis in ASXL3 deficiency (Bainbridge-Ropers) syndrome. Molec. accessible. De novo truncating mutations in ASXL3 are associated with a novel clinical phenotype with similarities to Bohring-Opitz syndrome. This article about a disease, disorder, or medical condition is a stub. A gene is a set of biochemical instructions that tell a cell how to manufacture a protein. (from j med genet 1997 feb;34(2):92-8). Information provided in your contribution (including your email address) will be stocked in .CSV files that will be sent as an email to Orphanet's teams. Decoding the byssus fabrication by spatiotemporal secretome analysis of scallop foot. Bainbridge-Ropers Syndrome and ASXL3 Families - Facebook Bohring-Opitz Syndrome - Symptoms, Causes, Treatment | NORD #615485 seizure control) as warranted. Bainbridge-Ropers syndrome (BRPS) [OMIM#615485] is a neurodevelopmental disorder, characterized by delayed psychomotor development with generalized hypotonia, intellectual disability with poor or absent speech, feeding difficulties, growth failure, specific craniofacial and minor skeletal features. Have a good day!! [PubMed: 28100473, related citations] Note: Electronic Article. Table of Contents. SNOMEDCT: 773400009; Healthy volunteers may also participate to help others and to contribute to moving science forward. MalaCards based summary: About ASXL3/Bainbridge-Ropers Syndrome (BRS) - ASXL Rare Research Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Delineating the phenotypic spectrum of Bainbridge-Ropers syndrome: 12 new patients with de novo, heterozygous, loss-of-function mutations in ASXL3 and review of published literature. National Center for Health Statistics - ICD-10-CM Fiscal Year: Select Fiscal Year: FY2023 - October 1, 2022 FY2022 - includes January 2022 Addenda FY2021 - includes January 2021 Addenda FY2020 - includes April 1, 2020 Addenda FY2019 - October 1, 2018 58 Mutations in this gene have been identified in human patients with Bainbridge-Ropers syndrome, which is characterized by feeding difficulties, developmental delay and other features. A number sign (#) is used with this entry because Bainbridge-Ropers syndrome (BRPS) is caused by heterozygous mutation in the ASXL3 gene (615115) on chromosome 18q12. of the OMIM's operating expenses go to salary support for MD and PhD I would love to see what help anyone can provide. Srivastava et al. Most also had autistic features and 11 were in a special needs school. Individuals with this condition have intellectual disability, severe feeding problems, motor skill issues, and increased mortality. He was diagnosed with Bainbridge-Ropers syndrome (BRS), a rare genetic motor planning disorder. Bainbridge-Ropers syndrome (BRPS) is a recently described developmental disorder caused by de novo truncating mutations in ASXL3 gene. Consult doctors, other trusted medical professionals, and patient organizations. There is no definitive antenatal diagnosis available, however ultrasound may show intrauterine growth retardation which should be investigated further. Bainbridge-Ropers syndrome (BRS; OMIM 615485) is characterized by failure to thrive, craniofacial defects, feeding problems, global developmental delay, hypotonia, intellectual disability and delays in language acquisition ( Bainbridge et al., 2013; Russell and Graham, 2013 ). Changing lives of those with rare disease. Presentation is usually in the first months of life; however, intrauterine growth retardation has been reported in some cases. The patients had common, if variable, dysmorphic features, including prominent forehead, narrow head, hypertelorism, down- or upslanting palpebral fissures, strabismus, high-arched eyebrows, long tubular nose, prominent nasal bridge, broad or bulbous nasal tip, low columella, open mouth with everted lower lip, high-arched palate, and crowded teeth. Only 1 subject had brain MRI, which showed global mild white matter volume loss, secondary brainstem hypoplasia, and bilateral hypoplasia/dysplasia of cerebellar tonsils. ", "Familial BainbridgeRopers syndrome: Report of familial ASXL3 inheritance and a milder phenotype", https://en.wikipedia.org/w/index.php?title=BainbridgeRopers_syndrome&oldid=1139079027, Short description is different from Wikidata, Articles with unsourced statements from September 2021, Creative Commons Attribution-ShareAlike License 3.0. Millie McWilliams has Bainbridge-Ropers syndrome, in which she is missing two DNA bases in the ASXL3 gene. BainbridgeRopers syndrome is a very rare genetic disorder characterized by abnormalities including severe psychomotor development, feeding problems, severe postnatal growth delays, intellectual disabilities, and skeletal abnormalities. medical or genetic condition are urged to consult with a qualified physician for diagnosis and for answers to personal questions. New Codes for Cytokine Release Syndrome (CRS) - Find-A-Code The mutation happens randomly and is not usually inherited from parents. Orphanet: "De novo truncating mutations in ASXL3 are associated with a novel clinical phenotype with similarities to Bohring-Opitz syndrome", "What is a gene mutation and how do mutations occur? This by far is I find is one of the hardest things I have tried to find correct code for. In a child with Bainbridge-Ropers syndrome (BRPS; 615485), Bainbridge et al. [Bainbridge-Ropers syndrome with ASXL3 gene variation in a child and literature review]. Treatment of Self-Injury in Bainbridge-Ropers Syndrome: Replication and Extensions of Behavioral Assessments. Deciphering Developmental Disorders Study. Learn More Our Mission. Novel Splicing Mutation in B3GAT3 Associated with Short - Hindawi It was firstly reported in 2013 by Bainbridge . This page is currently unavailable. ICD 10 Codes: What They Mean and How to Look Them Up - Verywell Health De novo truncating mutations in ASXL3 are associated with a novel clinical phenotype with similarities to Bohring-Opitz syndrome. Driving Simulator Brake Reaction Parameters After Total Hip Arthroplasty According to Different Surgical Approaches. Joint laxity and ulnar deviation of wrists are also frequently observed. How a US teen developed an app to help his sister talk Della has a rare genetic condition called Bainbridge-Ropers Syndrome which affects her ability to speak. Bainbridge-Ropers syndrome - Rare Primary Care News Clinical Synopsis - #615485 - BAINBRIDGE-ROPERS SYNDROME; BRPS - OMIM Genetic diagnosis of developmental disorders in the DDD study: a scalable analysis of genome-wide research data. Donations are tax deductible to the fullest extent of the law. We hope you find it helpful, and thanks for stopping by! [Genetic analysis and prenatal diagnosis for a Chinese pedigree affected with Bainbridge-Ropers syndrome]. Currently GARD aims to provide the following information for this disease: Population Estimate: This section is currently in development. Bainbridge-Ropers Syndrome is caused by a de novo (new) mutation of the ASXL3 gene. Richards SACMG Laboratory Quality Assurance Committee. Intellectual disability ranges from moderate to severe. ICD-10 Codes: Lookup & Conversion A few patients had nonspecific minor abnormalities on brain imaging. Laurence-moon syndrome is a separate entity. Bainbridge-Ropers syndrome symptoms, treatments & forums - PatientsLikeMe 615485 - BAINBRIDGE-ROPERS SYNDROME; BRPS Toggle navigation . There were no phenotypic differences between patients with mutations in the different cluster regions. H02382 Bainbridge-Ropers syndrome Human diseases in ICD-11 classification [BR:br08403] 20 Developmental anomalies Multiple developmental anomalies or syndromes . [PubMed: 26647312] Less than 100 cases have been reported in literature and databases to date. Bainbridge-Ropers syndrome (BRS; OMIM 615485) is characterized by failure to thrive, feeding problems, global developmental delay, hypotonia, intellectual disability (ID) and delays in language acquisition ( 1 ). This is the American ICD-10-CM version of Q79.8 - other international versions of ICD-10 Q79.8 may differ. Tax ID: 82-3890665, 2023 ASXL Rare Research Endowment Foundation, Medical disclaimer Privacy policy Contact, Read more about what causes ASXL-related disorders, Bainbridge-Ropers Syndrome and ASXL3 Families support group. The following resources have been approved by our Medical and Scientific Advisors as relevant reading for families looking to learn more about Bainbridge-Ropers Syndrome: Gene Reviews: ASXL3-Related Disorder (Bainbridge-Ropers Syndrome), American Journal of Medical Genetics: Expanding the phenotype of ASXL3-related syndrome: A comprehensive description of 45 unpublished individuals with inherited and de novo pathogenic variants in ASXL3, American Journal of Human Genetics: Familial Bainbridge-Ropers syndrome: Report of familialASXL3inheritance and a milder phenotype, Genome Medicine: De novo truncating mutations in ASXL3 are associated with a novel clinical phenotype with similarities to Bohring-Opitz syndrome. Authors Schaida Schirwani 1 2 , Emily Woods 2 , David A Koolen 3 . Reference: Data from the Newborn Screening Codingand Terminology Guide is available here. Participants with a disease may participate to help others, but also to possibly receive the newest treatment and additional care from clinical study staff. UniProtKB/Swiss-Prot: Global developmental delay and postnatal microcephaly: Bainbridge-Ropers syndrome with a new mutation in ASXL3. Were funding research grants and we support the ASXL Patient Registry and Biobank. offers rare disease gene variant annotations and links to rare disease gene literature. A syndrome that is characterized by delayed psychomotor development, severe intellectual disability with poor or absent speech, hypotonia, feeding difficulties, poor growth, and dysmorphic facial features and that has material basis in heterozygous mutation in the ASXL3 gene on chromosome 18q12. The two best things you can do to advance research into Bainbridge-Ropers Syndrome are, participate in the registry and biobank and. Donations are an important 04/10/2018 Edit History: joanna : 08/20/2021 joanna : 08/20/2021 joanna : 05/11/2018 ckniffin : 04/11/2018 . Novel splicing mutation in the ASXL3 gene causing Bainbridge-Ropers syndrome. Patient organizations are available to help find a specialist, or advocacy and support for this specific disease. This is an informational website run by families with information about Bainbridge-Ropers Syndrome. Q87.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Thank you, I will keep looking back for responses. A human homolog of Additional sex combs, ADDITIONAL SEX COMBS-LIKE 1, maps to chromosome 20q11. Bainbridge Roper Syndrome is a rare genetic syndrome associated with a mutation in the ASXL3 gene. GENECARDS SUITE PRODUCTS ARE FOR RESEARCH USE ONLY, DO NOT PROVIDE MEDICAL ADVICE AND ARE NOT FOR USE IN DIAGNOSTIC PROCEDURES. 5. for Bainbridge-Ropers Syndrome, Severe Feeding Difficulties-Failure to Thrive-Microcephaly Due to Asxl3 Deficiency Syndrome, Causative germline mutation (loss of function). Hum. To get in touch with the Orphanet team, please contact. 75 Our Information Specialists are available to you by phone or by filling out our contact form. 1900 Crown Colony Drive March 14, 2018 Autism, Autism Spectrum Disorder, Bainbridge-Ropers Syndrome, Dr. Robin Kochel, Genetics, Nicole Blanton, SPARK for autism. JavaScript is disabled. #1. As germline mosaicism has been described, prenatal diagnosis may be considered where the pathogenic variant has previously been identified in a family member. Researchers from participating institutions use the database to search for and invite patients or healthy volunteers who meet their study criteria to participate. In some cases, the mutation occurs in a person's egg or sperm cell but is not present in any of the person's other cells. Talk to a trusted doctor before choosing to participate in any clinical study. Bainbridge-Ropers syndrome is inherited in an autosomal dominant manner. Large-scale discovery of novel genetic causes of developmental disorders. About PURA syndrome. (It is often impossible to tell exactly when a de novo mutation happened.) 80816 - Gene ResultASXL3 ASXL transcriptional regulator 3 [ (human)] Scientific Director, OMIM. Leos Lighthouse raises funds for research and hosts a family meetup. Background Bainbridge-Ropers syndrome is caused by monoallelic ASXL3 variants on chromosome 18. When Della Calder was just one year old, Caitlin Calder noticed troubling issues with her daughter's early development. Familial Bainbridge-Ropers syndrome: Report of familial ASXL3 ASXL3 is one of approximately 20,000-25,000 genes that . As genetic testing becomes more widely accessible, we are learning of more people who have been living undiagnosed with Bainbridge-Ropers Syndrome for many years. Case report : a novel ASXL3 gene variant in a Sudanese boy. Rozpowszechnienie: nieznane. Please join your colleagues by making a De novo dominant ASXL3 mutations alter H2A deubiquitination and transcription in Bainbridge-Ropers syndrome. Suite 500 Downs SM, van Dyck PC, Rinaldo P, et al. National Center for Advancing Translational Sciences. P.O. 5: 11, 2013. To ensure long-term funding for the OMIM project, we have diversified impaired intellectual development, severe to profound, nonspecific white matter abnormalities on brain imaging. [Full Text], Balasubramanian, M., Willoughby, J., Fry, A. E., Weber, A., Firth, H. V., Deshpande, C., Berg, J. N., Chandler, K., Metcalfe, K. A., Lam, W., Pilz, D. T., Tomkins, S., DDD Study. Wikipedia: Delineating the phenotypic spectrum of Bainbridge-Ropers syndrome: 12 new patients with de novo, heterozygous, loss-of-function mutations in ASXL3 and review of published literature. Mar 31, 2016. Comorbid Psychiatric Aspects of Bainbridge-Ropers Syndrome. [PubMed: 23383720, images, related citations] A case of Bainbridge-Ropers syndrome with breath holding spells and Unique, an organization that provides information on rare disorders, has a downloadable document about Bainbridge-Ropers Syndrome. A de novo nonsense mutation in ASXL3 shared by siblings with Bainbridge-Ropers syndrome. Affected individuals may also display autistic features. You must log in or register to reply here. Corrigendum to "Childhood-onset generalized epilepsy in Bainbridge-Ropers syndrome" [Epilepsy Res. They all have Bainbridge-Ropers syndrome. Further expanding the clinical phenotype in Bainbridge-Ropers syndrome There has been limited research on Bainbridge-Ropers Syndrome and the other two ASXL syndromes (ASXL1/Bohring-Opitz Syndrome and ASXL2/Shashi-Pena Syndrome). Patient organizations can help patients and families connect. Novel de novo frameshift variant in the ASXL3 gene in a child with microcephaly and global developmental delay. Ada Hamosh, MD, MPH All had feeding difficulties necessitating a feeding tube, failure to thrive, hypotonia, and developmental delay with absent speech and poor or absent independent walking. Pervasive exposure of wild small mammals to legacy and currently used pesticide mixtures in arable landscapes. Bainbridge-Ropers syndrome is a very rare genetic disorder characterized by abnormalities including severe psychomotor development, feeding problems, severe postnatal growth delays, intellectual disabilities, and skeletal abnormalities. 1.4K members Join group About Discussion More About Discussion About this group This page is dedicated to families with children who have Bainbridge Ropers-Syndrome and ASXL3 genetic mutation. Clinical Features Symptoms ASXL3-related syndrome can affect communication, social, and learning skills. Genetic counseling should be proposed to individuals having the disease-causing mutation informing them that, for each pregnancy, there is 50% risk of passing the mutation to offspring. Mild prominence of the Sylvian fissure in a Bainbridge-Ropers syndrome patient with a novel frameshift variant in ASXL3. (2013) reported 4 individuals from 4 unrelated families with phenotypic features similar to those of Bohring-Opitz syndrome (605039) but with no specific recognizable syndromic diagnosis. Module 1 Flashcards | Quizlet . Bainbridge-Ropers Syndrome has not been studied well enough to know what the life expectancy is for someone with Bainbridge-Ropers Syndrome. Resource(s) for Medical Professionals and Scientists on This Disease: This information is currently in development. For all other comments, please send your remarks via contact us. Associated manifestations should also be coded. Cause: GARD does not currently have information about the cause of this condition. Best answers. 2. (2017) noted that 5 of the identified mutations occurred within the original cluster region, whereas 7 occurred 3-prime to this region, suggesting a second cluster region between codons 1045 and 1444. Quincy, MA 02169 Many rare diseases have limited information. We dont know how many people have an accurate diagnosis. The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment. [2], Diagnosis can only be made by genetic testing. Bainbridge-Ropers syndrome (BRPS) is a developmental disorder characterized by delayed psychomotor development, severe intellectual disability with poor or absent speech, hypotonia, feeding difficulties, poor growth, and dysmorphic facial features (summary by Srivastava et al., 2016). Only comments seeking to improve the quality and accuracy of information on the Orphanet website are accepted. Compound heterozygous mutation of the ASXL3 gene causes autosomal recessive congenital heart disease. How a US teen developed an app to help his sister talk - BBC News -the traits caused by Millie's syndrome are Mendelian traits In this context, annotation back-references refer to codes that contain: "Present On Admission" is defined as present at the time the order for inpatient admission occurs conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA. ASXL3/Bainbridge-Ropers Syndrome For more information, visit GARD. Contreras-Capetillo SNPinto-Escalante D. Whole exome sequencing diagnoses the first fetal case of Bainbridge-Ropers syndrome presenting as pontocerebellar hypoplasia type 1. Entry - #615485 - BAINBRIDGE-ROPERS SYNDROME; BRPS - OMIM [citation needed], This condition was first described by Bainbridge et al in 2013.[2]. Note, GARD cannot enroll individuals in clinical studies. OMIM: The ASXL3 is part of the ASXL gene family involved in gene expression during embryogenesis and they participate as epigenetic scaffolds capable of interacting with complex . If this is your first visit, be sure to check out the. Using whole-exome and whole-genome sequencing, Bainbridge et al. Zesp Bainbridge'a-Ropers'a Bainbridge MN, Hu H, Muzny DM, Musante L, Lupski JR, Graham BH, Chen W, Gripp KW, Jenny K, Wienker TF, Yang Y, Sutton VR, Gibbs RA, Ropers HH. MR spectroscopy was normal. One copy of Millie's ASXL3 gene is missing two DNA bases, creating an inappropriate "stop" codon and shortening the encoded proteins. New and Revised ICD-10-CM Codes for 2023. Caitlin Calder, a parent of a child with Bainbridge-Ropers Syndrome, created the Bainbridge-Ropers Syndrome and ASXL3 Families support group as a private Facebook page in 2014 with just a handful of members. Joint laxity and ulnar deviation of wrists are also frequently observed. We estimate that there are approximately 150-200 people diagnosed in the world. A (n) chromosome is a long DNA molecule wrapped around proteins and wound tightly. Changes in these genes are associated with Bohring-Opitz Syndrome, Shashi-Pena Syndrome, and Bainbridge-Ropers Syndrome. ICD-10 Games Learn codes with classic games like Flashcards and Hangman. Bainbridge-Ropers Syndrome Awareness Day is February 5. Genet. Copyright 2023 NORD National Organization for Rare Disorders, Inc. All rights reserved. Brunner syndrome is a rare genetic disorder associated with a mutation in the MAOA gene.It is characterized by lower than average IQ (typically about 85), problematic impulsive behavior (such as pyromania, hypersexuality and violence), sleep disorders and mood swings. PURA syndrome - About the Disease - Genetic and Rare Diseases De novo mutations may explain genetic disorders in which an affected child has a mutation in every cell in the body but the parents do not, and there is no family history of the disorder. I would love to see what help anyone can provide. Breath-holding spells with choreathetoid movements have been previously described. Signs and symptoms [ edit] Morphological features of this syndrome include: [1] Arched eyebrows Anteverted nares This patient had mild global hypotonia, normal growth, and global developmental delay with . 2023 ICD-10-CM | CMS - Centers for Medicare & Medicaid Services These 2022 ICD-10-CM codes are to be used for discharges occurring from October 1, 2021 through September 30, 2022 and for patient encounters occurring from October 1, 2021 through September 30, 2022. Rare Diseases Resources for Refugees/Displaced Persons, section General Data Protection Regulation and data privacy (GDPR) and Confidentiality), Orphan designation(s) and orphan drug(s) (0). Orphanet: Bohring Opitz syndrome De novo dominant ASXL3 mutations alter H2A deubiquitination and Unlike ASXL1 and ASXL2 mutations, ASXL3 mutations are rare events in acute myeloid leukemia with t(8;21). Three patients had controlled seizures and several had sleep problems. Childhood-onset generalized epilepsy in Bainbridge-Ropers syndrome. From Next Generation Sequence to the Phenotype: Exploring the Bainbridge-Ropers syndrome (BRPS; OMIM:615485) was first described in 2013 and is characterized by failure to thrive, feeding problems, hypotonia, intellectual disability (ID), autism, postnatal growth retardation, abnormal facial features with arched eyebrows, anteverted nares and delays in language acquisition [ 1 ]. Differential diagnosis includes other syndromes with moderate-severe intellectual disability and poor language. review the literature and organize it to facilitate your work. About the ICD-10 Code Lookup. All had delayed psychomotor development with moderate to profound intellectual disability and delayed walking. The patients, who ranged in age from 4 to 22 years, were ascertained from the Deciphering Developmental Disorders (DDD) project. Bainbridge-Ropers syndrome (BRPS) is a developmental disorder characterized by delayed psychomotor development, severe intellectual disability with poor or absent speech, hypotonia, feeding difficulties, poor growth, and dysmorphic facial features (summary by Srivastava et al., 2016). Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Genome Med. [PubMed: 26647312, related citations] The 2022 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2022. Three of the subjects had similar clinical histories, including severe psychomotor retardation, feeding problems, severe postnatal growth retardation, arched eyebrows, anteverted nares, and ulnar deviation of the hands. A syndrome characterized by psychomotor retardation, feeding problems, severe postnatal growth retardation in some patients, arched eyebrows, anteverted nares, and ulnar deviation of the hands. A case of Bainbridge-Ropers syndrome with breath holding spells and intractable epilepsy: challenges in diagnosis and management. [Bainbridge-Ropers syndrome with ASXL3 gene variation in a child and Other frequent gastrointestinal features include gastroesophageal reflux and constipation. (2016) identified 3 de novo heterozygous frameshift or nonsense mutations in the ASXL1 gene (615115.0005-615115.0007). In other cases, the mutation occurs in the fertilized egg shortly after the egg and sperm cells unite. Icd-10-cm Functional proteomics of the epigenetic regulators ASXL1, ASXL2 and ASXL3: a convergence of proteomics and epigenetics for translational medicine. However, the symptoms can be treated. In 2022, the ICD codes will change again with the addition of two numbersone that precedes the letter and one that comes at the end. Novel Nonsense Mutation in ASXL3 causing Bainbridge-Ropers Syndrome. Phone: 203-263-9938 Delineating the phenotypic spectrum of Bainbridge-Ropers syndrome: 12 new patients with de novo, heterozygous, loss-of-function mutations in ASXL3 and review of published literature. J. Med. Delineating the phenotypic spectrum of Bainbridge-Ropers syndrome: 12 new patients with de novo, heterozygous, loss-of-function mutations in ASXL3 and review of published literature . There is significant variability in the severity of symptoms of people who have Bainbridge-Ropers Syndrome and we dont yet have a good understanding of why that is.