The effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to intensive care unit
Red color represents old content. It may be empty showing addition in the new version.
Green color represents new content. It may be empty showing deletion in the new version.
Inline
Side by side
Added new contents,
deleted old contents,contents that are not changed.
New table contents
New table contents
Old table contents
Old table contents
Unchanged contents
Unchanged contents
Added new contents, contents that are not changed.
Deleted old contents, contents that are not changed.
Old table contents
Old table contents
Unchanged contents
Unchanged contents
New table contents
New table contents
Unchanged contents
Unchanged contents
Protocol summary
Evaluation of the effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to the intensive care unit
The effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to the intensive care unit
Evaluation of theThe effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to the intensive care unit
بررسی اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به کرونا ویروس(2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به کرونا ویروس(2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
بررسی اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به کرونا ویروس(2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
Evaluation of 28-day mortality, serum level of acute-phase reactive protein CRP, the ratio of serum level of acute-phase reactive protein level C to albumin
Evaluation of ICU mortality, 28-day mortality, serum level of acute-phase reactive protein CRP, the ratio of serum level of acute-phase reactive protein level C to albumin, the number of ventilator-dependent days
Evaluation of ICU mortality, 28-day mortality, serum level of acute-phase reactive protein CRP, the ratio of serum level of acute-phase reactive protein level C to albumin, the number of ventilator-dependent days
بررسی میزان مرگ و میر 28 روزه، سطح سرمی پروتئین واکنشگر فاز حاد CRP ، نسبت سطح سرمی پروتئین واکنشگر فاز حاد سطح سی به آلبومین
ارزیابی مرگ و میر در بخش مراقبت های ویژه، مرگ و میر 28 روزه، سطح سرمی پروتئین واکنشی فاز حاد CRP، نسبت سطح سرمی سطح پروتئین واکنشی فاز حاد C به آلبومین، تعداد روزهای وابسته به ونتیلاتور
بررسی میزانارزیابی مرگ و میر در بخش مراقبت های ویژه، مرگ و میر 28 روزه، سطح سرمی پروتئین واکنشگرواکنشی فاز حاد CRP، نسبت سطح سرمی سطح پروتئین واکنشگرواکنشی فاز حاد سطح سیC به آلبومین، تعداد روزهای وابسته به ونتیلاتور
General information
2
3
23
2022-04-25, 1401/02/05
2022-07-23, 1401/05/01
2022-0407-2523 00:00:00
2022-07-29, 1401/05/07
2022-12-21, 1401/09/30
2022-0712-2921 00:00:00
empty
In order to increase the accuracy of the study and improve its design, according to the suggestions of clinical guidance professors, the present plan was updated.
In order to increase the accuracy of the study and improve its design, according to the suggestions of clinical guidance professors, the present plan was updated.
empty
به جهت افزایش دقت مطالعه و بهبود طراحی آن با توجه به پیشنهادات اساتید راهنمای بالینی طرح حاضر بروز رسانی گردید.
به جهت افزایش دقت مطالعه و بهبود طراحی آن با توجه به پیشنهادات اساتید راهنمای بالینی طرح حاضر بروز رسانی گردید.
Determining the effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to intensive care unit
The effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to intensive care unit
Determining theThe effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to intensive care unit
تعیین اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به ویروس کرونا (2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به ویروس کرونا (2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
تعیین اثر مکمل یاری ال کارنیتین بر میزان مرگ و میر و سطح سرمی پروتئین واکنشگر C در بیماران چاق مبتلا به ویروس کرونا (2019-nCov) دچار نارسایی حاد تنفسی بستری در بخش مراقبت های ویژه
Patients over 18 years
Diagnosis of clinical and laboratory signs of severe Covid-19
Body mass index above 29.9 kg per square meter based on the weight in the file
Completion of the informed consent form by the patient or his / her legal guardian
Patients over 18 years
Diagnosis of clinical and laboratory signs of severe Covid-19
Body mass index above 29.9 kg per square meter based on the weight in the file
Completion of the informed consent form by the patient or his / her legal guardian
Severe COVID-19 patients who are admitted to the medical ICU (MICU) and will require respiratory support
Patients with normal GI function who receive enteral feeding
Patients over 18 years Diagnosis of clinical and laboratory signs of severe Covid-19 Body mass index above 29.9 kg per square meter based on the weight in the file Completion of the informed consent form by the patient or his / her legal guardian Severe COVID-19 patients who are admitted to the medical ICU (MICU) and will require respiratory support Patients with normal GI function who receive enteral feeding
بیماران بالای 18 سال
تشخیص علائم بالینی و آزمایشگاهی ابتلا به فرم شدید کووید-19
شاخص توده بدنی بالای 29.9 کیلوگرم بر متر مربع بر اساس وزن مندرج در پرونده
تکمیل فرم رضایت نامه آگاهانه توسط بیمار و یا قیم قانونی آن
بیماران بالای 18 سال
تشخیص علائم بالینی و آزمایشگاهی ابتلا به فرم شدید کووید-19
شاخص توده بدنی بالای 29.9 کیلوگرم بر متر مربع بر اساس وزن مندرج در پرونده
تکمیل فرم رضایت نامه آگاهانه توسط بیمار و یا قیم قانونی آن
بیماران شدید کووید-19 که در ICU پزشکی (MICU) بستری شده اند و به حمایت تنفسی نیاز دارند
بیماران با عملکرد گوارش طبیعی که تغذیه روده ای دریافت می کنند
بیماران بالای 18 سال تشخیص علائم بالینی و آزمایشگاهی ابتلا به فرم شدید کووید-19 شاخص توده بدنی بالای 29.9 کیلوگرم بر متر مربع بر اساس وزن مندرج در پرونده تکمیل فرم رضایت نامه آگاهانه توسط بیمار و یا قیم قانونی آن بیماران شدید کووید-19 که در ICU پزشکی (MICU) بستری شده اند و به حمایت تنفسی نیاز دارند بیماران با عملکرد گوارش طبیعی که تغذیه روده ای دریافت می کنند
Receive any L-carnitine supplement in the last 6 months
Participate in any other research project
History of liver and kidney disease
Pregnancy and lactation
Any allergy to L-carnitine
Receive any L-carnitine supplement in the last 6 months
Participate in any other research project
History of liver and kidney disease
Pregnancy and lactation
Any allergy to L-carnitine
Patients who stayed in the ICU for < 72 hours
Patients who receive parenteral nutritional support
Patients treated with different drug regimens from the routine ICU protocol
Patients will be ongoing treatment with cisplatin, phenobarbital, phenytoin, pivalic acid, valproic acid, ifosfamide, and levetiracetam
Any gastrointestinal disorders that lead to stopping enteral feeding for more than 48 hours
Receive any L-carnitine supplement in the last 6 months Participate in any other research project History of liver and kidney disease Pregnancy and lactation Any allergy to L-carnitine Patients who stayed in the ICU for < 72 hours Patients who receive parenteral nutritional support Patients treated with different drug regimens from the routine ICU protocol Patients will be ongoing treatment with cisplatin, phenobarbital, phenytoin, pivalic acid, valproic acid, ifosfamide, and levetiracetam Any gastrointestinal disorders that lead to stopping enteral feeding for more than 48 hours
دریافت هر گونه مکمل ال کارنیتین در 6 ماه گذشته
شرکت در هر گونه طرح تحقیقاتی دیگر
سابقه ابتلا به بیماری های کبدی و کلیوی
بارداری و شیردهی
هر گونه آلرژی به ال کارنیتین
دریافت هر گونه مکمل ال کارنیتین در 6 ماه گذشته
شرکت در هر گونه طرح تحقیقاتی دیگر
سابقه ابتلا به بیماری های کبدی و کلیوی
بارداری و شیردهی
هر گونه آلرژی به ال کارنیتین
بیمارانی که کمتر از 72 ساعت در ICU ماندند
بیمارانی که حمایت تغذیه ای تزریقی دریافت می کنند
بیماران تحت درمان با رژیم های دارویی متفاوت از پروتکل روتین ICU
بیماران تحت درمان با سیس پلاتین، فنوباربیتال، فنی توئین، پیوالیک اسید، والپروئیک اسید، ایفوسفامید و لوتیراستام خواهند بود.
هر گونه اختلال گوارشی که منجر به قطع تغذیه روده ای برای بیش از 48 ساعت شود
دریافت هر گونه مکمل ال کارنیتین در 6 ماه گذشته شرکت در هر گونه طرح تحقیقاتی دیگر سابقه ابتلا به بیماری های کبدی و کلیوی بارداری و شیردهی هر گونه آلرژی به ال کارنیتین بیمارانی که کمتر از 72 ساعت در ICU ماندند بیمارانی که حمایت تغذیه ای تزریقی دریافت می کنند بیماران تحت درمان با رژیم های دارویی متفاوت از پروتکل روتین ICU بیماران تحت درمان با سیس پلاتین، فنوباربیتال، فنی توئین، پیوالیک اسید، والپروئیک اسید، ایفوسفامید و لوتیراستام خواهند بود. هر گونه اختلال گوارشی که منجر به قطع تغذیه روده ای برای بیش از 48 ساعت شود
Primary outcomes
#1
empty
ICU mortality
ICU mortality
empty
مرگ در آی سیو
مرگ در آی سیو
empty
from beginning until ICU follow up
from beginning until ICU follow up
empty
از شروع مطالعه تا انتهای پیگیری در آی سیو
از شروع مطالعه تا انتهای پیگیری در آی سیو
empty
Record and view the file
Record and view the file
empty
مشاهده و ثبت اطلاعات در پرونده
مشاهده و ثبت اطلاعات در پرونده
#2
empty
The number of ventilator-dependent days
The number of ventilator-dependent days
empty
تعداد روزهای وابسته به ونتیلاتور
تعداد روزهای وابسته به ونتیلاتور
empty
The beginning of the intervention until day 7
The beginning of the intervention until day 7
empty
از شروع مطالعه تا انتهای پیگیری 7 روزه
از شروع مطالعه تا انتهای پیگیری 7 روزه
empty
Record and view the file
Record and view the file
empty
مشاهده و ثبت اطلاعات در پرونده
مشاهده و ثبت اطلاعات در پرونده
Secondary outcomes
#1
APACHE Ⅱ Questionnaire Score
length of stay in the ICU
APACHE Ⅱ Questionnaire Scorelength of stay in the ICU
امتیاز پرسشنامه APACHE II
طول مدت بستری در آی سیو
امتیاز پرسشنامه APACHE IIطول مدت بستری در آی سیو
beginning of intervention
beginning of intervention until 7 days later
beginning of intervention until 7 days later
شروع مداخله
شروع مداخله و 7 روز بعد
شروع مداخله و 7 روز بعد
APACHEⅡ questionnaire
record and view of files
APACHEⅡ questionnairerecord and view of files
پرسشنامه APACHEⅡ
مشاهده و ثبت
پرسشنامه APACHEⅡمشاهده و ثبت
Sponsors / Funding sources
#1
Name of organization / entity - English:
Name of organization / entity - Persian:
Full name of responsible person - English: Saeid Hadi
Full name of responsible person - Persian: سعید هادی
Street address - English: West Fatemi Ave., Tehran
Street address - Persian: تهران، خیابان فاطمی غربی
City - English: tehran
City - Persian: تهران
Province: Tehran
Country: Iran (Islamic Republic of)
Postal code: 9178939419
Phone: +98 936 607 1074
Fax:
Email: hadiv941@mums.ac.ir
Web page address:
Name of organization / entity - English:
Name of organization / entity - Persian:
Full name of responsible person - English: Saeid Hadi
Full name of responsible person - Persian: سعید هادی
Street address - English: West Fatemi Ave., Tehran
Street address - Persian: تهران، خیابان فاطمی غربی
City - English: Tehran
City - Persian: تهران
Province: Tehran
Country: Iran (Islamic Republic of)
Postal code: 9178939419
Phone: +98 936 607 1074
Fax:
Email: hadiv941@mums.ac.ir
Web page address:
Name of organization / entity - English: Name of organization / entity - Persian: Full name of responsible person - English: Saeid Hadi Full name of responsible person - Persian: سعید هادی Street address - English: West Fatemi Ave., Tehran Street address - Persian: تهران، خیابان فاطمی غربی City - English: tehranTehran City - Persian: تهران Province: Tehran Country: Iran (Islamic Republic of) Postal code: 9178939419 Phone: +98 936 607 1074 Fax: Email: hadiv941@mums.ac.ir Web page address:
Protocol summary
Study aim
The effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to the intensive care unit
Design
Clinical trial with control group, with parallel groups, double-blind, randomized, phase 3 on 40 patients. Numbers in closed envelopes were used for randomization.
Settings and conduct
A total of 40 adult patients with acute coronavirus-induced respiratory infection admitted to the Army Hospital ICU referred by an Intensive Care Specialist will be enrolled in the study after obtaining informed consent to participate in the study. Entry of each patient into the case or control group will be random and with the help of numbers in closed envelopes. Commercial L 3-carnitine capsule supplement with a dose of 3000 mg and starch as a placebo that is randomly packed and covered (blinding) is gavaged to patients for 7 days.
Participants/Inclusion and exclusion criteria
Obese men and women; over the age of 18; with acute respiratory failure due to coronavirus; hospitalized in the intensive care unit; individuals who wish to participate if they have no history of liver or kidney disease and are not pregnant or breastfeeding.
Intervention groups
Oral supplement with a high dose of L- carnitine (3000 mg) in patients with acute coronavirus-induced respiratory infection in the intensive care unit
Main outcome variables
Evaluation of ICU mortality, 28-day mortality, serum level of acute-phase reactive protein CRP, the ratio of serum level of acute-phase reactive protein level C to albumin, the number of ventilator-dependent days
General information
Reason for update
In order to increase the accuracy of the study and improve its design, according to the suggestions of clinical guidance professors, the present plan was updated.
Acronym
IRCT registration information
IRCT registration number:IRCT20220418054581N1
Registration date:2022-06-11, 1401/03/21
Registration timing:prospective
Last update:2022-08-14, 1401/05/23
Update count:1
Registration date
2022-06-11, 1401/03/21
Registrant information
Name
Vahid Hadi
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 937 127 8375
Email address
mostafa.arabi.nu@gmail.com
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2022-07-23, 1401/05/01
Expected recruitment end date
2022-12-21, 1401/09/30
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The effect of L-carnitine supplementation on mortality and serum levels of C-reactive protein in obese patients with coronavirus (nCov-2019) with acute respiratory failure admitted to intensive care unit
Public title
Effect of L-carnitine on mortality in obese patients with coronavirus
Purpose
Supportive
Inclusion/Exclusion criteria
Inclusion criteria:
Patients over 18 years
Diagnosis of clinical and laboratory signs of severe Covid-19
Body mass index above 29.9 kg per square meter based on the weight in the file
Completion of the informed consent form by the patient or his / her legal guardian
Severe COVID-19 patients who are admitted to the medical ICU (MICU) and will require respiratory support
Patients with normal GI function who receive enteral feeding
Exclusion criteria:
Receive any L-carnitine supplement in the last 6 months
Participate in any other research project
History of liver and kidney disease
Pregnancy and lactation
Any allergy to L-carnitine
Patients who stayed in the ICU for < 72 hours
Patients who receive parenteral nutritional support
Patients treated with different drug regimens from the routine ICU protocol
Patients will be ongoing treatment with cisplatin, phenobarbital, phenytoin, pivalic acid, valproic acid, ifosfamide, and levetiracetam
Any gastrointestinal disorders that lead to stopping enteral feeding for more than 48 hours
Age
From 18 years old
Gender
Both
Phase
3
Groups that have been masked
Participant
Care provider
Investigator
Outcome assessor
Data analyser
Sample size
Target sample size:
40
Randomization (investigator's opinion)
Randomized
Randomization description
After admitting the patient to the intensive care unit and obtaining the eligible criteria for inclusion in the study, individuals were randomly assigned envelopes containing unique codes generated by the standard site (www.sealedenvelope.com). Codes with groups (A and B) were initially produced by one of the project facilitators who is not involved in any clinical phases of intervention and sampling and will remain with them until the end of the study and other researchers until the end of the study of the concept of codes and the groups will remain uninformed. On the envelopes, only the codes A or B are inserted to specify two separate groups. After assigning each envelope to the patient admitted to the study, the envelope is opened and the code inside the envelope, which contains two letters and a number (for example, XY3), which has no meaning and does not indicate any meaning, and is completely random, will be inserted on the supplement box. Patients are only classified according to code A or B, and the numbers in the envelope are not a criterion for classification or indication of belonging to a specific group. These codes are used only for labeling on medicine and placebo BOXS.
Blinding (investigator's opinion)
Double blinded
Blinding description
The drugs and placebos in this study are exactly the same. In the present study, L-carnitine and placebo capsules are produced in exactly the same volume, color, odor, and size and are provided to the nurse or nutritionist in the same package. All researchers conducting the study, nurses, physicians, and data collectors will be kept blind to the type of supplements and groups assigned. As each patient enters the study, an envelope containing the code is randomly selected, and after opening the envelope, the code inside it is recorded on the supplement box of the same group as the code on the envelope and is assigned to the patient. Therefore, before and after selecting the patient, none of the researchers and the clinical team will be aware of the type of supplement the patient is receiving.After assigning a supplement or placebo to the patient, the nurse dissolves the supplements or placebo in 30 cc of water and feeds the patient every 8 hours through a nasogastric tube. For this reason, the nurse, physician, and patient will not be informed of the type of supplement or placebo received during the study.
Placebo
Used
Assignment
Parallel
Other design features
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Ethics committee of Artesh University of Medical Sciences
Street address
West Fatemi Ave, Tehran
City
Tehran
Province
Tehran
Postal code
9178939419
Approval date
2021-12-22, 1400/10/01
Ethics committee reference number
IR.AJAUMS.REC.1400.257
Health conditions studied
1
Description of health condition studied
Acute respiratory infection caused by coronavirus
ICD-10 code
J06.9
ICD-10 code description
Acute upper respiratory infection, unspecified
Primary outcomes
1
Description
28 days mortality
Timepoint
From the beginning of the intervention up to 28 days
Method of measurement
Record and view the file
2
Description
Serum level of acute phase reactive protein C
Timepoint
The beginning of the intervention and day 7
Method of measurement
Biochemically and using the appropriate kit
3
Description
Ratio of serum level of acute phase C-reactive protein to albumin
Timepoint
The beginning of the intervention and day 7
Method of measurement
Biochemically and using the appropriate kit
4
Description
ICU mortality
Timepoint
from beginning until ICU follow up
Method of measurement
Record and view the file
5
Description
The number of ventilator-dependent days
Timepoint
The beginning of the intervention until day 7
Method of measurement
Record and view the file
Secondary outcomes
1
Description
length of stay in the ICU
Timepoint
beginning of intervention until 7 days later
Method of measurement
record and view of files
2
Description
Serum levels of neutrophils and lymphocytes
Timepoint
beginning of intervention and 7 days later
Method of measurement
By biochemical methods and related kits
Intervention groups
1
Description
Intervention group: Oral supplement with high dose of carnitine capsule (1000 mg / 3 times a day) in patients with acute pulmonary infection due to coronavirus in the intensive care unit
Category
Treatment - Drugs
2
Description
Control group: Oral supplement supplement with starch capsule water (1000 mg / 3 times a day) in patients with acute pulmonary infection caused by coronavirus in intensive care unit
Category
Placebo
Recruitment centers
1
Recruitment center
Name of recruitment center
Army 550-bed hospital
Full name of responsible person
Vahid Hadi
Street address
Bahar Ave.
City
Mashhad
Province
Razavi Khorasan
Postal code
9178939419
Phone
+98 937 127 8375
Email
hadiv941@mums.ac.ir
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Artesh University of Medical Sciences
Full name of responsible person
Saeid Hadi
Street address
West Fatemi Ave., Tehran
City
Tehran
Province
Tehran
Postal code
9178939419
Phone
+98 936 607 1074
Email
hadiv941@mums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Artesh University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic
Person responsible for general inquiries
Contact
Name of organization / entity
Neyshabour University of Medical Sciences
Full name of responsible person
Seyyed Mostafa Arabi
Position
assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Nutrition
Street address
Janbazan Street
City
Mashhad
Province
Razavi Khorasan
Postal code
9178939419
Phone
+98 935 351 9127
Email
mostafa.arabi.nu@gmail.com
Person responsible for scientific inquiries
Contact
Name of organization / entity
Neyshabour University of Medical Sciences
Full name of responsible person
Seyyed Mostafa Arabi
Position
assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Nutrition
Street address
Sayyad Shirazi Street
City
Mashhad
Province
Razavi Khorasan
Postal code
9178939419
Phone
+98 935 351 9127
Email
mostafa.arabi.nu@gmail.com
Person responsible for updating data
Contact
Name of organization / entity
Neyshabour University of Medical Sciences
Full name of responsible person
Seyyed Mostafa Arabi
Position
assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Nutrition
Street address
Sayyad Shirazi Street
City
Mashhad
Province
Razavi Khorasan
Postal code
9178939419
Phone
+98 935 351 9127
Email
mostafa.arabi.nu@gmail.com
Sharing plan
Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available
Study Protocol
Undecided - It is not yet known if there will be a plan to make this available
Statistical Analysis Plan
Undecided - It is not yet known if there will be a plan to make this available
Informed Consent Form
Undecided - It is not yet known if there will be a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available
Analytic Code
Undecided - It is not yet known if there will be a plan to make this available
Data Dictionary
Undecided - It is not yet known if there will be a plan to make this available