Hats off to local knitters!

Communications TeamNews

Staff at Hull Women and Children’s Hospital have been overwhelmed by kindness following an appeal for help on facebook.

Ward Housekeeper, Sarah Hames, issued the call-out via the hospital’s facebook page after the Labour and Delivery Ward began to run short of knitted hats for newborns.

Within hours, the appeal had been shared far and wide, reaching in excess of 215,000 people in the first 24 hours. And the buzz created by the post has now translated into hundreds of new baby hats, bundles of which are continuing to arrive daily at the Women and Children’s Hospital.

Sarah says:

“We like to be able to give every baby born in the hospital a knitted hat which they can take away, as it then makes a lovely keepsake for both parents and the child in the years to come.

“We have a number of groups who knit for us on a regular basis to ensure both newborns and premature babies can each receive a hat.

“Due to recent holidays and other reasons, we began to get low on hats, and knowing that knitting is becoming more popular as a hobby again, we thought we’d ask to see if anyone could help us and the babies in our care in the short term.”

Over 500 knitted hats have already been received since the original request was made two weeks ago.

“Local knitters have done us proud, but hats have also been received from as far afield as Scarborough and Scotland,” Sarah continues.

“We’ve been overwhelmed by the generosity of people; we had no idea when we asked for knitters to help plug the gap that we would receive so many beautiful hats, and we appreciate every single one.”

Staff on the Labour and Delivery Ward are sending thank you cards to those who supply their contact details with their parcels.

The hospital continues to welcome donations of knitted hats only. Hats must be close knit and washable to 60 degrees. Donations should be addressed to the Ward Coordinator, Labour and Delivery Ward, Hull Women and Children’s Hospital, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ.

“It’s the greatest gift you can give”

Communications TeamNews

One person could save or transform the lives of up to nine others – make sure you sign the register this Organ Donation Week, 4 – 10 September 2017

Specialist Nurses will be encouraging people to talk loud and proud about their wishes after they die, during National Organ Donation Week next week (4 – 10 September).

Alex Wray, Raz Igasan and Sarah Plant, all Specialist Nurses in Organ Donation, work across the Emergency Department and two Intensive Care Units at Hull Royal Infirmary and Castle Hill Hospital.

The team coordinates transplants between patients from this area and suitable matches across the country, and their work has contributed to some 381 people across the Yorkshire and Humber region receiving organ transplants in 2016/17.

Research carried out by NHS Blood and Transplant shows that more than 80% of people support organ donation but fewer than half (49%) have ever talked about it.

In a bid to raise awareness and get those conversations started between friends and loved ones this week, Hull University Teaching Hospitals NHS Trust’s team of Specialist Nurses for Organ Donation will be involved in:

  • The unveiling of a fire engine in partnership with Humberside Fire and Rescue, fully wrapped in the ‘Yes I donate’ branding (Wednesday 6 September)
  • Speaking to shoppers and passers-by in St Stephen’s Shopping Centre to share information and encourage people to join the Donor Register (Thursday 7 September)
  • Taking part in the UK Rescue Organisations Challenge, hosted by Humberside Fire & Rescue, at the KCOM Stadium. The team will be encouraging people to talk to loved ones about their wishes around organ donation, and encouraging people to take part in a game of Operation Donation! (Friday 8 and Saturday 9 September)

Alex Wray, Specialist Nurse in Organ Donation says:

“One donor can save or transform the lives of up to nine people, and yet three people die in the UK every day waiting for a transplant.

“In our field of work, we often find that people have not even discussed organ donation with their families, or they may have signed the Organ Donor Register but never mentioned this to loved ones. If a family doesn’t want to proceed with donation, even if that was the wish of their loved one while they were alive, we can’t go ahead, so it’s really important for anyone who wants to be an organ donor to have a conversation with their nearest and dearest to let them know.

“Should it come to it, it can be a very helpful thing for a family to see something positive come from a bereavement. Of course any loss if difficult, but knowing you have helped to save the life of someone else can often be a factor in helping people cope and work through their grief.”

Research shows that women are 30% more likely to start a conversation about organ donation than men, but whoever you are and whatever your views, make them known. Don’t leave your family to make a difficult decision without knowing what you wanted.

For more information, call and see the Specialist Nurses in Organ Donation at the events listed above, or contact NHS Blood and Transplant on 0300 123 23 23 / www.organdonation.nhs.uk

Hull chosen to trial new care pathway for bereaved parents

Communications TeamNews

Hospital staff in Hull will be taking part in a national project designed to improve the quality of care for bereaved parents.

The National Bereavement Care Pathway (NBCP), which has the support of the Department of Health, has been developed to improve the quality of bereavement care experienced by parents and families at all stages of pregnancy and baby loss up to 12 months.

Hull University Teaching Hospitals NHS Trust is one of just 11 organisations across the country to be chosen to trial the NBCP; designed to cover the whole parental journey and their contact with hospital professionals. It is set to include new materials, guidelines, and training for staff to improve the care they offer, such as training in how to talk to bereaved parents and the kind of facilities which should be available for them.

From October, staff including midwives, gynaecology nurses, paediatric nurses, obstetricians and paediatricians will begin working with the NBCP project team to understand the impact and the effectiveness of the new pathway for parents who have lost a young child.

The Trust was selected by a Core Group* of charities and professional bodies who are leading the NBCP, including SANDS (the Stillbirth and Neonatal Death charity), the Royal College of Midwives, and The Miscarriage Association.

Sue Cooper (pictured) is the Bereavement Midwife based within Hull Women and Children’s Hospital. She says:

“Losing a child is an incredibly difficult experience and something that no parent should ever have to go through. If they do, however, it’s important that we as health professionals are able to provide the right advice, information and support for bereaved parents.

“The quality of care and the empathy shown to parents at a time when they are struggling with a whole range of different emotions is crucial, and our role in guiding bereaved parents through this difficult time is not to be underestimated.  How we care for bereaved families when their baby dies can have long-lasting effects; good care cannot remove parents’ pain and grief, but it can help them through a devastating experience.

“For those reasons, we’re really pleased to have been chosen to pilot the new care pathway. We’re not only hoping to improve the care we personally provide for bereaved parents, but it will mean a lot to know that what we do here in Hull and East Yorkshire will go on to shape and improve services provided for others right across the country.”

Clea Harmer, Chief Executive of Sands and Chair of the Core Group, says:

“I am delighted that we have so many enthusiastic partners across the country who want to work with us in improving bereavement care for those parents when a baby dies.

“We were inundated with offers of support and I am excited by the potential impact that the pathway will have in the 11 sites, in the first instance. We look forward to learning from their experiences before wave 2 begins and the wider roll out later next year.”

The 11 sites were chosen as they are representative of geography, capacity and specialism. Hospital staff are about to embark on training in the NBCP before the pilot begins locally in October.  A second wave of pilot sites is planned for April of 2018, ahead of a wider national roll out in October 2018.

For further information visit: www.sands.org.uk/professionals/projects-improve-bereavement-care/national-bereavement-care-pathway

The 11 pilot sites are:

  • Hull University Teaching Hospitals NHS Trust
  • Heart of England NHS Foundation Trust
  • Wirral University Teaching Hospital
  • Liverpool Women’s Hospital Trust
  • Walsall Healthcare NHS Trust
  • Northern Devon Healthcare NHS Trust (Barnstaple Hospital)
  • Medway (Maritime) NHS Foundation Trust
  • West Middlesex, Chelsea & Westminster
  • Barking, Havering & Redbridge University Trust –Queens Hospital, Romford
  • Ipswich Hospital NHS Trust
  • York Teaching Hospital NHS Trust

The Core Group comprises:

  • Sands (Stillbirth and neonatal death charity)
  • Bliss
  • The Lullaby Trust
  • The Miscarriage Association
  • ARC (Antenatal Results & Choices)
  • Royal College of Obstetricians and Gynaecologists
  • Royal College of Midwives
  • Royal College of Nursing
  • Neonatal Nurses Association
  • Institute of Health Visiting
  • NHS England
  • Representative of the UK health research
    community

Complementary therapy for cancer patients

Communications TeamNews, Queen's Centre

A new service offering complementary therapies for people who have survived cancer is set be launched in East Yorkshire.

Staffed entirely by volunteers, qualified therapists will donate their time and expertise to enhance the well-being of people who are undergoing or have been through cancer treatment.

The service will offer reflexology, pedicures, manicures, facials and gentle massage, and has been initiated by Hull University Teaching Hospitals NHS Trust‘s Survivorship Team.

Sarah Guest, Clinical Nurse Specialist based at the Queen’s Centre for Oncology & Haematology says:

“Being diagnosed with cancer at any age can bring on many different emotions. It’s natural for people to be worried, but for some patients, it can lead to fear, anxiety, stress, or even depression.

“Complementary therapies are a fantastic way of helping to people to relax and alleviating these types of symptom, so we began to look into the possibility of running a complementary therapy service for our patients.”

The complementary therapy service will run every Monday and Tuesday at the Queen’s Centre in Cottingham, and each treatment typically last for an hour. Therapists will always ensure each treatment is safe to be combined with a patient’s medication or course of cancer treatment before they begin.

“The therapists providing the treatments for us are doing so in their own time, and we are so grateful for this,” Sarah continues.

“Being able to offer our patients a way of relaxing and taking time out for themselves will really help to enhance the range of services our team already offers, and will be a welcome distraction at what can be a very difficult time”.

Patients are being invited to make bookings now, prior to the service launching at the start of September. Patients will not be charged for treatments, but will be asked for a contribution which will then be invested back into the Survivorship Team and its work to support people living with and beyond cancer.

For more information, contact the Survivorship Team on (01482) 461091.

300% rise in patients recruited to clinical trials

Communications TeamNews

Patients in Hull and the East Riding continue to play a leading part in advances in medical treatment, according to figures released today.

Data published today by the National Institute for Health Research (NIHR) show that Hull University Teaching Hospitals NHS Trust is among the highest performing Trusts in the country for recruitment of patients into clinical trials.

The figures show that 72,931 people across the Yorkshire and Humber region have taken part in NHS clinical research during the past financial year, 2016/17.

More locally, Hull University Teaching Hospitals NHS Trust recorded a near-300% increase in the number of patients saying ‘yes’ to involvement in clinical research, which can range from completing simple lifestyle questionnaires right through to drug trials or the use of novel medical devices.

Within the space of a year, the Trust has gone from recruiting 2,304 people in 2015/16 to an impressive 9,118 in 2016/17. This means the Trust now ranks 26th in the national recruitment table out of a total of 240 participating organisations.

James Illingworth, Research and Development Manager for Hull University Teaching Hospitals NHS Trust says:

“We are delighted to have seen such a huge rise in the number of people taking part in research with us in the past year. This underlines our commitment as a Trust to using research, and people’s participation in this, as a means of improving the health and well-being of people across Hull and East Yorkshire.

“Research is vitally important in the field of healthcare. It helps us develop cures, it helps us measure the effectiveness of drugs and treatments, it helps us understand people and the human body better, and ultimately it helps us to make decisions which could be hugely beneficial for groups of patients in the future.

“People who haven’t come across or taken part in clinical trials before may have an idea of what they involve, and that often involves medication and science labs, but in reality, the types of research we undertake vary markedly, from straightforward surveys to  questionnaires and the testing of blood samples through to studies of body image and drug trials.”

Current research underway at Hull University Teaching Hospitals NHS Trust includes:

  • a study looking at how to manage post-operative hypothermia in critical care through the use of a new warming blanket, as compared to forced air warming blankets in patients who become hypothermic after surgery
  • assessing the clinical and cost effectiveness of a novel post-operative wound dressing versus current standard care in the prevention of Surgical Site Infections in vascular surgery
  • a study testing the hypothesis that stopping some conventional drug treatments, compared with continuing on these treatments, improves or stabilises renal function in patients with progressive stage 4 or 5 chronic kidney disease (CKD)

James continues:

“Whether they realise it or not, most patients coming into hospital today and receiving treatment will have benefited from patients before them agreeing to take part in research in one form or another.

“Our dedicated research workforce, combined with highly skilled support staff, continue to work incredibly hard to ensure we are able to offer research opportunities to patients and service users across a wide range of clinical areas.  We also enjoy a strong academic partnership with the University of Hull, and in the last year, we sought to focus in particular on health and lifestyle choices, and service users’ perspectives on the hospital patient journey.

“We believe that an organisation which actively promotes, and is in involved in, clinical research is one that will deliver high quality care and a good patient experience. The data published today show that, in Hull and East Yorkshire, we have a healthy foundation on which to build and ensure that aspiration is achieved”.

Nationally, the number of participants recruited into clinical research studies in 2016-17 exceeded 665,000, the highest number of clinical research participants in any given year.

 

Heart monitoring by smartphone

Communications TeamNews

New injectable technology means doctors could know there’s a problem before you do

Patients experiencing unexplained blackouts are set to have their hearts monitored using a new device, no bigger than three matchsticks, and their smartphone.

For some time, implantable loop recorders have been fitted in patients for cardiac monitoring, but at the size of a computer USB stick, they were visible under skin, had to be surgically implanted in a cath lab, and patients had to return to hospital regularly for the data to be reviewed.

But now advances in technology mean that doctors could soon know there’s a problem before the patient does, as Lee Wise, Cardiac Physiologist based at Castle Hill Hospital explains:

“It was when I was working as a locum at another Trust that I first saw the very small devices being used. It struck me that they had so many benefits, so when I came back to Castle Hill, I made a point of getting them introduced.

“Traditional loop recorders are about the size of a USB stick. They have to be implanted in the cath labs, which involves making a surgical incision and then closing it with sutures. This creates scar tissue, and the device is still very noticeable under the skin. The new loop recorders are much smaller; about the size of three matchsticks laid side by side; which means they can be ‘injected’ into the skin and the opening glued shut, making the device barely noticeable once in place.

“As well as benefiting patients receiving the new recorders, there are also huge benefits for the hospital. The fitting of each traditional loop recorder takes around 20 to 25 minutes in a cath labs, whereas inserting the new device can be completed in most clinic rooms in just a couple of minutes. It’s less stressful for the patient and, crucially, frees up the time of clinicians, theatres and follow-up clinics to deal with other patients and procedures. Conservative estimates suggest we could save at least 250 clinic appointments each year by using the new devices, as well as creating considerable capacity for the cath labs.

But perhaps the most exciting thing is the potential which the new loop recorders offer for round the clock monitoring.

“We are currently using two small devices, the Medtronic Reveal LINQ and the St Jude’s Confirm,” Lee continues.

The LINQ device has an activator which patients can use to instruct the device to start recording, and it wirelessly transmits the information it collects at the end of each day to a secure website. The Confirm device does a similar thing, but data is transmitted by the patient, quickly and conveniently, using a smartphone app.

“As irregular cardiac patterns aren’t always physically noticeable by the patient, this means there is potential for the clinician caring for them to spot a concern based on the data they receive before the patient is even aware something’s wrong.”

This is one of the UK’s few physiologist-led services. The team, comprising Lee Wise, Debbie Leggott and Renjith Antony, began to ‘inject’ the new loop recorders at the end of June in six patients, and a further eight patients received a new small loop recorder earlier this month.

Lee continues:

“The implantable loop recorders are very clever devices, and whether large or small, they can help us to identify the causes of some people’s blackouts or identify other previously undiagnosed cardiac issues, in particular atrial fibrillation (AF).

“Research suggests that if the heart is in AF for longer than six minutes at a time, the patient is at increased risk of stroke. Longer term, there’s a lot of scope for us to get involved with research projects alongside our stroke team, and to realise our vision of a ‘one stop’ clinic for blackouts; where the new loop device could be implanted on the same day as the clinic appointment.”

Latch on to expert support

Communications TeamNews

Breast feeding support group

Breastfeeding Awareness Week, 31 July – 6 August 2017

Specialist clinics designed to help new mums in the crucial early days of breastfeeding will be launched in Hull next week.

The benefits of breastfeeding have been widely known for some time, but despite some mums’ best efforts, they still have difficulty giving their baby the best possible start.

Now Hull University Teaching Hospitals NHS Trust Infant feeding Coordinators, Anna Lee Hughes and Pippa Stott, will be using Breastfeeding Awareness Week (31st July – 6th August 2017) to launch their new specialist infant feeding clinics.  The clinics will take place weekly, every Monday, Wednesday and Friday, and are designed to help women in the crucial first month after having their baby.

The clinics will be held in relaxed surroundings within the Fatima Allam Birth Centre, and will be supported by the Goodwin Breastfeeding Peer Support Team*.

Anna Lee Hughes, Infant Feeding Coordinator within Hull Women and Children’s Hospital says:

“Women have lots of different things to think about when they’ve just had a baby and, naturally, feeding is often high up the list. It is well known that, if women are given access to specialist advice and support with breastfeeding in the very early stages, they are more likely to be successful. In turn, breastfeeding can strengthen babies’ immune systems in the early months, helps to create a strong bond between mum and baby, and can even reduce a woman’s risk of breast and ovarian cancers longer term.

“For several months, we have been holding a number of ‘pilot’ clinics to determine how best to offer breastfeeding support to new mums in the early weeks, and determine what they would want out of such a service. Using the feedback we’ve received, we’re now pleased to announce a regular series of clinics will begin this week within the Women and Children’s Hospital to help with issues such position and attachment, baby weight loss and increasing milk supply.  Our specialist midwives will also be assisted in the clinic by members of the Goodwin Breastfeeding Peer Support Team, who can offer general breastfeeding advice and mum-to-mum support.”

Nicola Jones was one of the first mums to attend one of the pilot clinics. She says:

“We needed a lot of support in the beginning with position, and then it was just about reassurance that what I was doing, and how my baby was feeding, was right.

“The clinic support really helped and gave me confidence to carry on. Six months on and it seems like second nature.  I can’t believe it was ever that difficult. I’m so glad I was able to get the support and advice I needed to stick with it.”

The infant feeding clinics are open to any woman who has given birth in the Hull and East Riding area.  Women will be referred to the clinics for specialist breastfeeding support by their community midwife if there are issues around weight loss or supply which they have been unable to support to improve.  Women can also refer themselves for peer support by contacting the Goodwin Trust. 

The launch of the clinics is just one initiative taking place locally to mark Breastfeeding Awareness Week. The Infant Feeding Coordinators and Peer Supporters will also be talking to women in the antenatal clinic, and gifting each with a ‘golden moments’ keyring. The keyring is designed to introduce the topic of breastfeeding and highlight its benefits for both mum and baby’s health and wellbeing.

Midwives and nurses from the neonatal and children’s wards will also have a stand in the entrance to the Women and Children’s Hospital throughout the week.  They will be sharing advice and displaying information about the ‘Big Latch On’ events taking place regionally and nationally, where women gather to breastfeed and offer peer support.

This group of staff has also come together to form several new internal working groups aimed at improving and ensuring best practice for breastfeeding mums and babies under the group name, “HEY! Let’s support our mums to breastfeed.”

More details about the ‘Big Latch On’ events can be found at www.biglatchon.org  The team will also feature on the City of Culture’s ‘Challenge Hull’ page throughout Breastfeeding Awareness Week , where you will also be able to find out more about support and activities in relation to breastfeeding throughout the city.

A journey of discovery after 50 years

Communications TeamNews

The daughter of a prominent figure in the history of Hull’s hospitals returned to the city today for a trip down Memory Lane.

Jan Bennett is the daughter of Henrietta Brocklehurst, a pharmacist, founder of Hull’s Brocklehurst Chemist chain, and former Chairman of the Hull (A) Group Hospitals Management Committee for some 16 years, from 1958 to 1974.

Mrs Brocklehurst oversaw a number of key developments during her time in her hospital role, including the demolition of the old Western General Hospital and the opening of the Hull Royal Infirmary Tower Block some 50 years ago by Her Majesty, the Queen.

Prompted by Hull’s spell in the limelight as UK City of Culture 2017, Jan and her husband Peter, who now live in Bath, journeyed to Hull Royal Infirmary to do some fact-finding on her late mother as well as her father, E A Brocklehurst, another pharmacist and former Sheriff of Hull.

Jan, a retired GP, and Peter, a former General Physician, visited Hull Royal Infirmary earlier today where they met with Trust Chief Executive, Chris Long, for a quick chat about their family ties to the hospital.

The pair then met with Mike Pearson, who looks after the Trust Archive, and they spent some time looking through memorabilia, old film reel, newspaper cuttings and photos featuring Mrs Brocklehurst. Mike had also arranged for them to see first-hand a special plaque which had been made and dedicated to Jan’s late mother, before they continued on to visit the Trust’s Brocklehurst Building.

Jan says:

“I have early memories of Hull as a youngster and of spending time in the air raid shelter.

“When the Hull Royal Infirmary Tower Block was opened by the Queen, I was a house officer training in Aberdeen, but my older sister and I came back to Hull to be with mum and to attend the opening.

“I remember we were lucky enough to be introduced to the Queen; she acknowledged us and we shook hands, and I still have the glove we shook hands with now.

“Mum was a fiery character and all those years ago, she would often be found on the golf course, looking for consultants who should have been at work, demanding they get back to Outpatients!

“It’s great that the hospital still has all these items, but it’s a shame that people like mum; people who helped to build the city in essence; have almost been forgotten.

“The City of Culture is great for Hull, and the city has certainly been getting its share of the spotlight. It’s a special time and these celebrations were the motivating factor for me making contact with the hospital now and starting my journey of discovery about mum’s life.”

Whilst in Hull, Jan and Peter have also visited Hull History Centre and plan to do some exploring in the city centre.

Baby footprints project reaches half way point

Communications TeamNews

Our Born into a City of Culture project reached its exciting half way stage, as panel number 6 of 12, representing June, was erected in the entrance to the Women and Children’s Hospital earlier today.

The project involves taking the footprint of every baby born in Hull in 2017 and using these images to create a unique piece of artwork. The babies’ footprints represent leaves, while midwives handprints also feature as the trunks of the trees.

Every month, a new panel is installed, and to mark the half way point, a mum and baby born in each of the first six months of the year were invited back for a mini celebration this morning. The artwork to date features more than 2,300 baby footprints, and will be complete by January 2018.

Vicky Turner (pictured far right) is mum to Travis, who is almost seven weeks old and whose footprint features in the June panel. She says:

“We’re really proud to be a part of this project. It’s great to know that Travis’s footprint is up there on the wall, and it’s lovely to have the midwives’ represented on the artwork too. Their hand prints show the journey that they’ve been on as well, helping young babies to grow and keeping all of us safe.”

The Born into a City of Culture project is supported by the Hull 2017 Creative Communities programme.

Postcards featuring images of the baby footprint panels are available for sale within the Women and Children’s Hospital, priced £1 each. Each postcard represents two months (January and February; March and April; and the latest is May and June) and the whole set will be complete in 6 postcards.

 

 

Proud of our People, Pride in Hull

Communications TeamNews

Hospital staff will be joining one of Hull’s biggest parties of the year this weekend, as Hull University Teaching Hospitals NHS Trust shows its pride in more ways than one.

Members of HEY Let’s Sing, the Hull University Teaching Hospitals NHS Trust staff choir, will be performing for the second consecutive year at Pride in Hull tomorrow.

In 2016, this talented group of staff, which includes radiographers, midwives and therapists, were chosen to perform on the main stage. This year, they have been invited back again to help raise awareness of LGBT+ issues and to join in the celebrations, performing at the Bandstand in Queen’s Gardens at 3 and 4pm.

As well as treating revellers to favourites from Fleetwood Mac and Katy Perry, HEY Let’s Sing will also be joining in the Pride in Hull parade. The parade begins at 12 noon from Hull College, when the 30 strong group of health professionals will join the procession on foot, weaving and waving their way through the city’s crowds.

Bonnie Gray, Web Developer and Co-Founder of the HEY Let’s Sing Choir says:

“Taking part in Pride last year was such a great feeling; there was a really safe, supportive and celebratory atmosphere and it felt very inclusive too.

“It was a real honour to be a part of the celebrations then and to be able to perform on the main stage, so to be invited back for a second year is just fantastic.”

Saturday’s festivities will mark the start of a week full of Pride celebrations, and to ensure Hull University Teaching Hospitals NHS Trust is playing its part in raising awareness, a number of Trust delivery vehicles have been emblazoned with rainbow stripes and a 5ft Pride flag will also fly from the top of the Hull Royal Infirmary tower block next week.

Simon Nearney, Director of Workforce for Hull University Teaching Hospitals NHS Trust says:

“Our Trust is extremely proud of the people who work here and of our city as a whole, so for Hull to be chosen as the focus for the UK’s first ever national Pride event is just brilliant.

“As an employer of over 8,000 people, we are fully committed to the principles of equality and diversity. Opportunities like Pride in Hull give us the chance to celebrate our remarkable people, to showcase the city, and to embrace the rich diversity we have here.

“This weekend’s event promises a real party atmosphere, and as one of the city’s major employers, we’re proud to be at the heart of it.”