HypersalivationNCT04132765
Turkish Validation of The Drooling Impact Scale
An observational study of Hypersalivation and Cerebral Palsy, run by Marmara University at 1 site in Turkey (Türkiye).
Trial summary
The aim of this study is to investigate the reliability and construct validity of the Turkish version of the Drooling Impact Scale in children with cerebral palsy Read more about this study
- Who is it for?
- Ages 4 to 16 years
- Conditions the study is for
- Hypersalivation, Cerebral Palsy
- What is being tested?
- Drooling Impact Scale, Drooling Frequency and Severity Scale and The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™)
- Type of treatment
- Pill or oral medicine
- How many people
- 30 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 25 Nov 2019to 30 Aug 2020
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 4 to 16 years
- All sexes
- No healthy volunteers
- Child
Study population: Patients with unilateral or bilateral, spastic, dyskinetic or mixed type cerebral palsy at between the ages of 4-16 and GMFCS level 3,4,5
Who may be able to join
- Patients with unilateral or bilateral cerebral palsy at between the ages of 4-16
- Spastic, dyskinetic or mixed type cerebral palsy
- GMFCS level 3,4,5
- Stable drooling within at least one month
Who cannot join
- Active infection of salivary glands
- Upper respiratory tract infection at the time of testing
- History of anticholinergic drug intake in the past three weeks
- Occurance of any above between test and re-test assessment that may interfere with the results
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Esra Giray
Istanbul, 34899
Esra Giray, 05558134394, girayesra@hotmail.com
About this study
Official title: Reliability and Construct Validity of the Turkish Version of the Drooling Impact Scale Among Children With Cerebral Palsy
The aim of this study is to investigate the reliability and construct validity of the Turkish version of the Drooling Impact Scale in children with cerebral palsy
Read the detailed description
Drooling is common among several neurologic disorders such as cerebral palsy, Parkinson's disease, amyotrophic lateral sclerosis, which are the main diseases that physiatrist are one of the leading physicians involved in whose management 1. Drooling can be seen either as anterior drooling, unintentional leaving of saliva from mouth to outside of the body, or posterior drooling, invisible spill of saliva from mouth through pharyngeal isthmus and then to respiratory or digestive tract, inside the body 2. Anterior drooling causes psycho-social impairment, skin problems, infections, bad odor, dehydration, dentation problems and wet clothes and tools while posterior drooling may result in morbidity by posing a risk for aspiration pneumonia. Despite the frequency and significance of the condition, there is still a paucity of research and inadequate evidence about the various treatments and valid and reliable outcomes available. A major problem for research into interventions to reduce drooling is that there is no valid and reliable measurement tool of saliva control. There is no questionnaire in Turkish to evaluate the effects of drooling as well as drooling interventions.The aim of this study is to investigate the reliability and construct validity of the Turkish version of the Drooling Impact Scale in children with cerebral palsy.
- Conditions
- Hypersalivation, Cerebral Palsy
- Being tested
- Drooling Impact Scale, Drooling Frequency and Severity Scale, The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™), Drooling Quotient (DQ), Patient and caregiver visual analog scale (VAS) for drooling
- Keywords
- cerebral palsy, drooling impact scale, hypersalivation, validity
- Medical subject headings
- Sialorrhea, Cerebral Palsy
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Drooling Impact ScaleOther
A scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores.
Drooling Frequency and Severity ScaleOther
In this scale, parents or care givers were asked to rate the severity and frequency of drooling, classifying severity of drooling using a 5-level domain ranging from 1 (dry) to 5 (profuse drooling). The frequency of drooling was classified using a 4-level domain ranging from 1(no drooling) to 4 (constant drooling)
The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™)Other
A quality of life scale that measure caregivers' perspectives on the health status, comfort, well being, and ease of caregiving of children with severe developmental disabilities. CPCHILD consists of 36 items distributed over six sections representing the following domains: (1) Personal Care (eight items); (2) Positioning, Transfer, and Mobility (eight items); (3) Communication and Social Interaction (seven items); (4) Comfort, Emotions, and Behaviour (nine items); (5) Health (three items); and (6) Overall Quality Of Life (one item). For the sections which involve the performance of skills, the degree of difficulty of accomplishing each task or activity was rated on a 7-point ordinal scale anchored by 0 ('No problem at all') to 6 ('Impossible').
Drooling Quotient (DQ)Other
DQ is a semi-quantitative method that assesses the presence of newly formed saliva on the lips every 15 seconds with 40 observations in 10 minutes, expressed as a percentage based on the ratio between the number of observed drooling episodes and the total number of observations.
Patient and caregiver visual analog scale (VAS) for droolingOther
Patients will be asked to score their children's drooling severity on a visual analog scale (0-100 mm, 0 none to 100 severe)
Functional Oral Intake Scale (FOIS)Other
Functional Oral Intake Scale (FOIS) which is a 7-point ordinal scale document the functional level of oral intake of food and liquid.
number of bibs daily usedOther
Parents will be asked their children's number of bibs daily used.
number of hospital admissions per year related to respiratory infectionsOther
Parents will be asked their children's number of hospital admissions per year related to respiratory infections.
Gross Motor Function Classification System (GMFCS)Other
The GMFCS describes self-initiated movement and use of assistive devices (walkers, crutches, canes, wheelchairs) for mobility during an individual's usual activity.
Manual Ability Classification System (MACS)Other
The MACS is also a simple, five-point ordinal classification system and was designed for use in children ages 4-18 years. The MACS is a validated measure in cerebral palsy that can be used to classify a child's typical use of both hands and upper limbs.
Communication Function Classification System (CFCS)Other
The CFCS is a simple, five-point ordinal classification system that assesses everyday communication (not optimal communication) of children with cerebral palsy.
Eating and Drinking Ability Classification System (EDACS)Other
EDACS is a measure to assess eating and drinking ability for children with CP, ages 3 and older. This classification is a simple five-point ordinal system.
| Study group | Role | What they receive |
|---|---|---|
| Patients with cerebral palsy | Patients with cerebral palsy at between the ages of 4-16 years and at Gross Motor Function Classification Levels of 3,4,5 Receives: Other: Drooling Impact Scale; Other: Drooling Frequency and Severity Scale; Other: The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™); Other: Drooling Quotient (DQ); Other: Patient and caregiver visual analog scale (VAS) for drooling; Other: Functional Oral Intake Scale (FOIS); Other: number of bibs daily used; Other: number of hospital admissions per year related to respiratory infections; Other: Gross Motor Function Classification System (GMFCS); Other: Manual Ability Classification System (MACS); Other: Communication Function Classification System (CFCS); Other: Eating and Drinking Ability Classification System (EDACS) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Drooling Impact Scale
A scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores.
Measured: Day 0
Drooling Impact Scale
A scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores.
Measured: Day 3
Secondary outcomes (11)
Drooling Frequency and Severity Scale
n this scale, parents or care givers were asked to rate the severity and frequency of drooling, classifying severity of drooling using a 5-level domain ranging from 1 (dry) to 5 (profuse drooling). The frequency of drooling was classified using a 4-level domain ranging from 1(no drooling) to 4 (constant drooling)
Measured: Day 0
The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™)
A quality of life scale that measure caregivers' perspectives on the health status, comfort, well being, and ease of caregiving of children with severe developmental disabilities. CPCHILD consists of 36 items distributed over six sections representing the following domains: (1) Personal Care (eight items); (2) Positioning, Transfer, and Mobility (eight items); (3) Communication and Social Interaction (seven items); (4) Comfort, Emotions, and Behaviour (nine items); (5) Health (three items); and (6) Overall Quality Of Life (one item). For the sections which involve the performance of skills, the degree of difficulty of accomplishing each task or activity was rated on a 7-point ordinal scale anchored by 0 ('No problem at all') to 6 ('Impossible').
Measured: Day 0
Drooling Quotient (DQ)
DQ is a semi-quantitative method that assesses the presence of newly formed saliva on the lips every 15 seconds with 40 observations in 10 minutes, expressed as a percentage based on the ratio between the number of observed drooling episodes and the total number of observations.
Measured: Day 0
Patient and caregiver visual analog scale (VAS) for drooling
Patients will be asked to score their children's drooling severity on a visual analog scale.
Measured: Day 0
Functional Oral Intake Scale (FOIS)
Functional Oral Intake Scale (FOIS) which is a 7-point ordinal scale document the functional level of oral intake of food and liquid.
Measured: Day 0
number of bibs daily used
Parents will be asked their children's number of bibs daily used.
Measured: Day 0
number of hospital admissions per year related to respiratory infections
Parents will be asked their children's number of hospital admissions per year related to respiratory infections.
Measured: Day 0
Gross Motor Function Classification System (GMFCS)
The GMFCS describes self-initiated movement and use of assistive devices (walkers, crutches, canes, wheelchairs) for mobility during an individual's usual activity.
Measured: Day 0
Manual Ability Classification System (MACS)
The MACS is also a simple, five-point ordinal classification system and was designed for use in children ages 4-18 years. The MACS is a validated measure in cerebral palsy that can be used to classify a child's typical use of both hands and upper limbs.
Measured: Day 0
Communication Function Classification System (CFCS)
The CFCS is a simple, five-point ordinal classification system that assesses everyday communication (not optimal communication) of children with cerebral palsy.
Measured: Day 0
Eating and Drinking Ability Classification System (EDACS)
EDACS is a measure to assess eating and drinking ability for children with CP, ages 3 and older. This classification is a simple five-point ordinal system.
Measured: Day 0
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Oct 2019
- Study start25 Nov 2019
- Primary completion30 Aug 2020 (estimated)
- Study completion30 Aug 2020 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for HypersalivationStudies of the same condition, open and under way.
- More trials run by Marmara UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case only
- Time perspective
- Prospective
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Marmara University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Evrim Karadag Saygi, Prof, Study chair, Marmara UniversityNida Yektauşakları, PT, Principal investigator, Marmara University School of Health SciencesFatma Özer, Student, Principal investigator, Marmara University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04132765
- Sponsor's protocol ID
- 09.2019.963
- Status last verified
- Oct 2019
- First submitted
- 17 Oct 2019
- Last updated
- 27 Nov 2019
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: The data that support the findings of this study will be available on request from the corresponding author (EG). The data will not be publicly available due to their containing information that could compromise the privacy of research participants.
Publications
Lakraj AA, Moghimi N, Jabbari B. Sialorrhea: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel). 2013 May 21;5(5):1010-31. doi: 10.3390/toxins5051010.
PubMed 23698357Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MA, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012 Mar;171(3):409-14. doi: 10.1007/s00431-011-1570-y. Epub 2011 Sep 20.
PubMed 21932013Pesheva P, Kuklinski S, Schmitz B, Probstmeier R. Galectin-3 promotes neural cell adhesion and neurite growth. J Neurosci Res. 1998 Dec 1;54(5):639-54. doi: 10.1002/(SICI)1097-4547(19981201)54:53.0.CO;2-2.
PubMed 9843155
Study at a glance
From the registry record, last updated by the sponsor on 27 Nov 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Reliability and Construct Validity of the Turkish Version of the Drooling Impact Scale Among Children With Cerebral Palsy
- ClinicalTrials.gov ID
- NCT04132765
- Acronym / sponsor ID
- 09.2019.963
- Conditions
- Hypersalivation, Cerebral Palsy
- Keywords
- cerebral palsy, drooling impact scale, hypersalivation, validity
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 30 participants (estimated)
- Lead sponsor
- Marmara UniversityUniversity, hospital or other
- Study start
- 25 Nov 2019 (actual)
- Primary completion
- 30 Aug 2020 (estimated)
- Study completion
- 30 Aug 2020 (estimated)
- First posted
- 21 Oct 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim of this study is to investigate the reliability and construct validity of the Turkish version of the Drooling Impact Scale in children with cerebral palsy
Detailed description
Drooling is common among several neurologic disorders such as cerebral palsy, Parkinson's disease, amyotrophic lateral sclerosis, which are the main diseases that physiatrist are one of the leading physicians involved in whose management 1. Drooling can be seen either as anterior drooling, unintentional leaving of saliva from mouth to outside of the body, or posterior drooling, invisible spill of saliva from mouth through pharyngeal isthmus and then to respiratory or digestive tract, inside the body 2. Anterior drooling causes psycho-social impairment, skin problems, infections, bad odor, dehydration, dentation problems and wet clothes and tools while posterior drooling may result in morbidity by posing a risk for aspiration pneumonia. Despite the frequency and significance of the condition, there is still a paucity of research and inadequate evidence about the various treatments and valid and reliable outcomes available. A major problem for research into interventions to reduce drooling is that there is no valid and reliable measurement tool of saliva control. There is no questionnaire in Turkish to evaluate the effects of drooling as well as drooling interventions.The aim of this study is to investigate the reliability and construct validity of the Turkish version of the Drooling Impact Scale in children with cerebral palsy.
Study design
- Observational model
- Case only
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with cerebral palsy | – | Other: Drooling Impact Scale, Other: Drooling Frequency and Severity Scale, Other: The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™), Other: Drooling Quotient (DQ), Other: Patient and caregiver visual analog scale (VAS) for drooling, Other: Functional Oral Intake Scale (FOIS), Other: number of bibs daily used, Other: number of hospital admissions per year related to respiratory infections, Other: Gross Motor Function Classification System (GMFCS), Other: Manual Ability Classification System (MACS), Other: Communication Function Classification System (CFCS), Other: Eating and Drinking Ability Classification System (EDACS)Patients with cerebral palsy at between the ages of 4-16 years and at Gross Motor Function Classification Levels of 3,4,5 |
Who may qualify
- Ages
- 4 to 16 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
- Study population
- Patients with unilateral or bilateral, spastic, dyskinetic or mixed type cerebral palsy at between the ages of 4-16 and GMFCS level 3,4,5
Key inclusion criteria (4 listed)
- Patients with unilateral or bilateral cerebral palsy at between the ages of 4-16
- Spastic, dyskinetic or mixed type cerebral palsy
- GMFCS level 3,4,5
- Stable drooling within at least one month
Key exclusion criteria (4 listed)
- Active infection of salivary glands
- Upper respiratory tract infection at the time of testing
- History of anticholinergic drug intake in the past three weeks
- Occurance of any above between test and re-test assessment that may interfere with the results
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Drooling Impact ScaleA scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores. | Other | Patients with cerebral palsy |
| Drooling Frequency and Severity ScaleIn this scale, parents or care givers were asked to rate the severity and frequency of drooling, classifying severity of drooling using a 5-level domain ranging from 1 (dry) to 5 (profuse drooling). The frequency of drooling was classified using a 4-level domain ranging from 1(no drooling) to 4 (constant drooling) | Other | Patients with cerebral palsy |
| The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™)A quality of life scale that measure caregivers' perspectives on the health status, comfort, well being, and ease of caregiving of children with severe developmental disabilities. CPCHILD consists of 36 items distributed over six sections representing the following domains: (1) Personal Care (eight items); (2) Positioning, Transfer, and Mobility (eight items); (3) Communication and Social Interaction (seven items); (4) Comfort, Emotions, and Behaviour (nine items); (5) Health (three items); and (6) Overall Quality Of Life (one item). For the sections which involve the performance of skills, the degree of difficulty of accomplishing each task or activity was rated on a 7-point ordinal scale anchored by 0 ('No problem at all') to 6 ('Impossible'). | Other | Patients with cerebral palsy |
| Drooling Quotient (DQ)DQ is a semi-quantitative method that assesses the presence of newly formed saliva on the lips every 15 seconds with 40 observations in 10 minutes, expressed as a percentage based on the ratio between the number of observed drooling episodes and the total number of observations. | Other | Patients with cerebral palsy |
| Patient and caregiver visual analog scale (VAS) for droolingPatients will be asked to score their children's drooling severity on a visual analog scale (0-100 mm, 0 none to 100 severe) | Other | Patients with cerebral palsy |
| Functional Oral Intake Scale (FOIS)Functional Oral Intake Scale (FOIS) which is a 7-point ordinal scale document the functional level of oral intake of food and liquid. | Other | Patients with cerebral palsy |
| number of bibs daily usedParents will be asked their children's number of bibs daily used. | Other | Patients with cerebral palsy |
| number of hospital admissions per year related to respiratory infectionsParents will be asked their children's number of hospital admissions per year related to respiratory infections. | Other | Patients with cerebral palsy |
| Gross Motor Function Classification System (GMFCS)The GMFCS describes self-initiated movement and use of assistive devices (walkers, crutches, canes, wheelchairs) for mobility during an individual's usual activity. | Other | Patients with cerebral palsy |
| Manual Ability Classification System (MACS)The MACS is also a simple, five-point ordinal classification system and was designed for use in children ages 4-18 years. The MACS is a validated measure in cerebral palsy that can be used to classify a child's typical use of both hands and upper limbs. | Other | Patients with cerebral palsy |
| Communication Function Classification System (CFCS)The CFCS is a simple, five-point ordinal classification system that assesses everyday communication (not optimal communication) of children with cerebral palsy. | Other | Patients with cerebral palsy |
| Eating and Drinking Ability Classification System (EDACS)EDACS is a measure to assess eating and drinking ability for children with CP, ages 3 and older. This classification is a simple five-point ordinal system. | Other | Patients with cerebral palsy |
Primary outcome
Drooling Impact Scale
Time frame: Day 0
A scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores.
Drooling Impact Scale
Time frame: Day 3
A scale with 10 items which are scored with visual analog scale from1 to 10. Drooling impact increases with increased scores.
11 secondary outcomes
Drooling Frequency and Severity Scale
Time frame: Day 0
The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD™)
Time frame: Day 0
Drooling Quotient (DQ)
Time frame: Day 0
Patient and caregiver visual analog scale (VAS) for drooling
Time frame: Day 0
Functional Oral Intake Scale (FOIS)
Time frame: Day 0
number of bibs daily used
Time frame: Day 0
number of hospital admissions per year related to respiratory infections
Time frame: Day 0
Gross Motor Function Classification System (GMFCS)
Time frame: Day 0
Manual Ability Classification System (MACS)
Time frame: Day 0
Communication Function Classification System (CFCS)
Time frame: Day 0
Eating and Drinking Ability Classification System (EDACS)
Time frame: Day 0
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Nov 2019.
- Results publication: PubMed 23698357Lakraj AA, Moghimi N, Jabbari B. Sialorrhea: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel). 2013 May 21;5(5):1010-31. doi: 10.3390/toxins5051010.
- Results publication: PubMed 21932013Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MA, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012 Mar;171(3):409-14. doi: 10.1007/s00431-011-1570-y. Epub 2011 Sep 20.
- Results publication: PubMed 9843155Pesheva P, Kuklinski S, Schmitz B, Probstmeier R. Galectin-3 promotes neural cell adhesion and neurite growth. J Neurosci Res. 1998 Dec 1;54(5):639-54. doi: 10.1002/(SICI)1097-4547(19981201)54:53.0.CO;2-2.
- Sialorrhea: A Guide to Etiology, Assessment, and ManagementLink provided by the sponsor.
- Individual participant dataSharing planned: No. The data that support the findings of this study will be available on request from the corresponding author (EG). The data will not be publicly available due to their containing information that could compromise the privacy of research participants.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Evrim Karadag Saygi, Prof study chair
Marmara University
Nida Yektauşakları, PT principal investigator
Marmara University School of Health Sciences
Fatma Özer, Student principal investigator
Marmara University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Hypersalivation and Cerebral Palsy, run by Marmara University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 27 Nov 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Esra Giray, MD (+905558134394, girayesra@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Drooling Impact Scale (time frame: Day 0). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04132765, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Nov 2019.