Michael Siderine

• Responsible for summarizing and abstracting key patient data from medical records and translating it into AIS and ICD-10 codes
• Inputting coded data into the Joint Trauma Registry and Brook Army Medical Center Registry to facilitate analysis of trends by healthcare professionals
• Facilitating improvements in standard of care and diagnostics by keeping abreast of advances in medical technology within the armed services
• Demonstrating strong multitasking abilities, quick learning aptitude, and the initiative to work independently with minimal supervision
• Proficient in computer usage, particularly with Microsoft Office, and adept at deciphering doctor's handwritten notes
• Experienced in job analysis and realignment, ensuring efficient workflow and task allocation
• Utilizing clinical judgment to identify, compare, and resolve data quality issues, and evaluating large datasets for accuracy
• Collaborating with the Joint Trauma Service team to rectify data quality errors and assess their impact on business operations.
• Communicated effectively with staff, patients, and insurance companies by email and telephone.
• Followed up with medical staff regarding missing information in patient records.
• Used classification manuals to gain additional knowledge of disease and diagnoses processes.

• Managed various surgical procedures, including Orthopedics, Total Joints, Spine, General Surgery, Vascular Surgery, Otolaryngology, and Urology
• Demonstrated expertise in Orthopedics, Total Joints, Spine, General Surgery, Vascular Surgery, Otolaryngology, and Urology services
• Conducted orientation for new staff and provided hands-on training for new Orthopedic equipment
• Assisted anesthesia providers in airway management, intubation, regional blocks, and handling emergent situations
• Evaluated pre-operative patient data, including critical lab values, for discussion with the patient's caregivers
• Maintained knowledge of surgical instrumentation and equipment assembly and function
• Ensured optimal surgical outcomes by managing factors such as instrumentation, implants, special equipment, effective timeout procedures, and environmental factors
• Provided psychosocial support and ensured alignment between the patient, planned surgical intervention, and operative site
• Maintained aseptic techniques and supervised the healthcare team to reduce the risk of patient infection in the operating room.
• Demonstrated adaptability when assigned to different units or shifts as needed, seamlessly integrating into diverse healthcare teams while maintaining exceptional performance levels.

• Overseeing surgical procedures across a wide range of specialties, including Trauma Surgery, Orthopedics, Total Joints, Spine, Neurosurgery, Robotic General and Thoracic Surgery, General Surgery, Vascular Surgery, Otolaryngology, and Urology
• Demonstrating proficiency in each of these specialties, ensuring optimal patient care and surgical outcomes
• Providing orientation for new staff members and delivering hands-on training, particularly in the use of new Orthopedic equipment
• Assisting anesthesia providers in managing airways, intubation, regional blocks, and responding to emergent situations
• Evaluating pre-operative patient data, including critical lab values, and collaborating with caregivers to ensure comprehensive patient care planning
• Maintaining knowledge of surgical instrumentation and equipment assembly and functionality
• Assuming accountability for all aspects contributing to optimal surgical outcomes, including instrumentation, implants, special equipment, effective timeout procedures, and ensuring a conducive environment of care
• Offering psychosocial support to patients, ensuring alignment between the patient, planned surgical intervention, and operative site
• Taking responsibility for infection prevention through meticulous application of aseptic techniques and supervising the healthcare team in the operating room.
• Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
• Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
• Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.

• Overseeing surgical procedures across diverse specialties including Trauma Surgery, Orthopedics, Total Joints, Spine, Neurosurgery, Robotic General and Thoracic Surgery, General Surgery, Vascular Surgery, Otolaryngology, and Urology
• Demonstrating expertise in each specialized area, ensuring high-quality patient care and surgical outcomes
• Providing and supervising orientation for new staff members, with a particular focus on hands-on training for new Orthopedic equipment
• Assisting the anesthesia provider in managing airways, intubation, regional blocks, and addressing emergent situations
• Assessing pre-operative patient data, including critical lab values, and collaborating with caregivers to develop comprehensive care plans
• Maintaining proficiency in the assembly and operation of surgical instrumentation and equipment
• Holding accountability for all aspects contributing to optimal surgical outcomes, including instrumentation, implants, special equipment, efficient timeout procedures, and ensuring a conducive care environment
• Offering vital psychosocial support to patients, ensuring alignment between patient identity, planned surgical intervention, and operative site
• Implementing principles of aseptic techniques and providing direction and supervision to the healthcare team to minimize the risk of patient infection in the operating room.
• Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
• Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.

• Overseeing and managing surgical procedures across a broad range of specialties, including Trauma Surgery, Orthopedics, Total Joints, Spine, Neurosurgery, Robotic General and Thoracic Surgery, General Surgery, Vascular Surgery, Otolaryngology, and Urology, while also providing guidance to new staff members
• Developing and conducting comprehensive orientation programs for new team members, with a focus on providing hands-on training tailored to the utilization of new Orthopedic equipment
• Collaborating closely with anesthesia providers to ensure effective management of patients' airways, intubations, regional blocks, and swift response to emergent situations
• Analyzing pre-operative patient data, including critical lab values, to facilitate informed discussions with caregivers involved in the patient's care continuum
• Maintaining a robust understanding of surgical instrumentation and equipment assembly and functionality, while ensuring continuous training and proficiency among the team
• Assuming accountability for all factors contributing to optimal surgical outcomes, encompassing instrumentation, implants, special equipment, efficient timeout procedures, and the maintenance of an optimal care environment
• Providing crucial psychosocial support by accurately identifying patients and ensuring seamless alignment between the patient, planned surgical intervention, and operative site
• Implementing and upholding stringent aseptic techniques to minimize the risk of patient infection, while providing direct supervision and guidance to the healthcare team in the operating room.
• Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
• Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
• Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
• Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.

• Orchestrates and delivers therapeutic and administrative services essential for the comprehensive care of PCU patients
• Executes nursing interventions in alignment with hospital and departmental policies and procedures, fostering the hospital's mission
• Provides specialized care tailored to young adult patients aged 18-39, adult patients aged 40-64, and geriatric patients aged 65 and above
• Attains advanced proficiency in addressing the psychosocial, spiritual, pathophysiological, and therapeutic aspects specific to patients necessitating step-down care and cardiac monitoring
• Takes charge of assessing, prioritizing, and intervening to avert life-threatening circumstances
• Collaborates with Respiratory Therapists to oversee patients' care involving BIPAP and High Flow oxygen devices
• Engages in life-saving measures during emergencies, directing and supporting team members as required
• Assists and advises physicians during residents' examination and treatment processes
• Actively participates in initiatives aimed at planning, evaluating, and enhancing the quality of patient care
• Supports the insertion of arterial lines, PICC, and Central Lines as part of patient care procedures
• Performs blood draws from arterial, CVP, and other invasive lines
• Accompanies and monitors patients during transitions to other departments for diagnostic tests or procedures
• Conducts ongoing assessments of critically ill patients as per established protocols
• May accompany patients during interfacility transfers to ensure continuity of care
• Rapidly responds to Code Blue situations and implements life-saving measures according to ACLS protocol standards.
• Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
• Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.

• Oversight of various programs including Ventilator-Associated Events, Sterile Processing, Construction, and COVID response across all Audie Murphy Clinics and Hospitals
• Collaborating with the physician chairperson and healthcare professionals to address Ventilator- Associated Events, and presenting data to the Infection Control Committee
• Mentoring and supervising a team of over fifteen Infection Prevention representatives, providing guidance on education, hand hygiene practices, and tracer activities to uphold patient safety standards
• Planning, executing, overseeing, and assessing the Infection Prevention & Control Program within the command
• Successfully leading mock Joint Commission surveys and actual Joint Commission surveys by facilitating extensive tracer activities and meticulous planning
• Conducting infection surveillance across the South Texas VA enterprise, focusing on Ventilator-Associated Events and Surgical Site Infections
• Regular engagement with hospital leaders, including directors, executives, and chief nursing officers
• Active participation in multiple committees, such as the emergency management working group, Sterile Process, Construction committee, space utilization and planning committee, and Ethics committee
• Providing guidance on health practices and delivering orientation and department-specific training to nurses and staff throughout the South Texas VA, aiming to enhance infection prevention measures and promote overall well-being.
• Gathered and submitted data to regulatory agencies for mandatory report infections such as Ventilator Acquired Pnemonuia.

• Initiated and collaborated on plans to optimize airflow within the Covid-19 unit, transitioning from positive to negative airflow
• Provided recommendations to the director regarding the replacement of plastic barriers with warm and hot zones, and the relocation of patient rooms from warm zones
• Coordinated and delivered therapeutic and administrative services essential for the care of Step-Down ICU (PCU) patients
• Adhered to nursing care protocols outlined by hospital and departmental policies, aligning with the institution's mission
• Delivered specialized care tailored to young adult patients aged 18-39, adult patients aged 40-64, and geriatric patients aged 65 and above
• Acquired advanced knowledge in psychosocial, spiritual, pathophysiological, and therapeutic aspects relevant to patients requiring step-down care and cardiac monitoring
• Took responsibility for assessing, prioritizing, and intervening to prevent life-threatening situations
• Collaborated with Respiratory Therapists to manage patients on BIPAP and High Flow oxygen devices
• Engaged in life support activities during emergencies, providing guidance and assistance to team members as needed
• Assisted and supported physicians during resident examinations and treatments
• Participated in initiatives aimed at planning, evaluating, and enhancing the quality of patient care
• Assisted with the insertion of arterial lines, PICC, and Central Lines as part of patient care procedures
• Conducted blood draws from arterial, CVP, and other invasive lines
• Accompanied and monitored patients during transitions to other departments for diagnostic tests or procedures
• Conducted ongoing assessments of critically ill patients in accordance with established protocols
• May accompany patients during interfacility transfers to ensure continuity of care
• Responded to Code Blue situations and implemented life-saving measures according to ACLS protocol standards.
• Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
• Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
• Educated patients on health maintenance strategies after discharge to prevent readmission or future complications.
• Maintained a high level of clinical competency by staying abreast of emerging trends and research findings within the field of emergency medicine.

• As the COVID Travel Lead Nurse for a 12-bed COVID unit with a team comprising one Nurse and two Clinical Nurse Aids, my responsibilities include: Strategizing and coordinating all COVID-19 testing protocols to ensure timely and efficient results
• Planning and overseeing dialysis treatments for residents assigned to the COVID-19 unit
• Collaborating with the McKinney Nurse Manager to identify and facilitate the transfer of residents requiring a higher level of care
• Monitoring and adjusting specialized equipment utilized for patient care, and accurately interpreting and documenting electronic displays
• Promptly initiating corrective actions in response to any adverse symptomatology displayed by patients
• Providing comprehensive bedside care, particularly for wound care in post-surgery patients, and implementing patient education plans focusing on wound care
• Performing tasks such as changing dressings, inserting catheters, and initiating IVs as required
• Assisting physicians during resident examinations and treatment procedures, offering valuable insights and support
• Responding swiftly and effectively to life-saving situations in adherence to nursing standards and established protocols
• Conducting ongoing assessments to prioritize interventions aimed at preventing life-threatening situations, and executing life support activities during emergencies while providing clear direction and assistance to team members.
• Enhanced patient recovery by providing compassionate and attentive care tailored to individual needs.
• Contributed to a positive rehabilitation environment through effective communication with patients, families, and healthcare team members.
• Maintained accurate documentation of patient progress and reported changes in condition to supervising nurses and therapists.
• Assisted therapists in implementing treatment plans for optimal patient outcomes.

• As the Nurse Manager of the Main Operating Room, overseeing Robotic Surgery, Otolaryngology, General Surgery, Equipment management, Attendants, Anesthesia Technicians, and OR Construction, my responsibilities encompassed: Collaborating closely with the Robotic Team Lead Surgeon to facilitate the procurement of a Second XI robot in 2020, enhancing our surgical capabilities
• Conducting comprehensive orientation and annual competency assessments for new employees, utilizing an innovative training program
• Setting the standard for comprehensive care delivery within the department and ensuring adherence to professional standards and regulations, while proactively addressing any deficiencies
• Demonstrating proficiency in delivering age-specific and developmentally appropriate patient care
• Conducting regular assessments of patient care, situational factors, and environmental conditions, and effectively coordinating procurement of necessary supplies and equipment
• Prioritizing and intervening in peri-operative settings to mitigate life-threatening situations
• Managing fiscal resources and human capital, actively participating in budget development and collaborating with healthcare professionals across the organization
• Supervising and evaluating the performance of nursing and allied healthcare staff to ensure high-quality care delivery
• Implementing quality improvement initiatives to optimize OR operations, resulting in streamlined processes and improved efficiency
• Cultivating a collaborative work environment through team-building strategies and promoting ongoing professional development opportunities
• Utilizing problem-solving skills to address conflicts, improve access to care, and enhance patient outcomes.
• Enhanced interdisciplinary collaboration through effective communication and coordination among healthcare team members.
• Improved patient outcomes by developing and implementing comprehensive clinical programs and initiatives.
• Streamlined processes for increased efficiency in patient care delivery, reducing wait times and improving overall satisfaction.
• Ensured compliance with regulatory standards and best practices through diligent oversight of clinical procedures, documentation, and staff training.
• Managed complex patient cases, collaborating with multidisciplinary teams to develop personalized treatment plans.

• In my role, I have undertaken various responsibilities to ensure optimal patient care and safety: Assisting the anesthesia provider in managing the patient's airway, performing intubations, administering regional blocks, and addressing emergent situations
• Conducting thorough assessments of patient pre-operative data, including critical lab values, and discussing relevant findings with caregivers involved in the patient's care
• Maintaining a comprehensive understanding of the assembly and functionality of surgical instrumentation and equipment
• Assuming accountability for all factors contributing to an optimal surgical outcome, including instrumentation, implants, special equipment, efficient timeout procedures, and ensuring a conducive environment of care
• Providing essential psychosocial support to patients, ensuring alignment between the patient, planned surgical intervention, and operative site
• Taking responsibility for minimizing the potential for patient infection by adhering to principles of aseptic techniques and providing direction and supervision to the healthcare team in the operating room
• Demonstrating proficiency in various operative services, including General Surgery, Orthopedics, Sports, Spine, Plastic surgery, Urology, and Otolaryngology.

• As the Infection Control Nurse, I spearheaded numerous initiatives aimed at enhancing infection prevention measures and promoting patient safety: Conducted comprehensive site visits to all regional branch health clinics, including a groundbreaking Clinic and Birthing Center in Japan
• This initiative marked the introduction of inpatient care services for maternity patients in the southern part of the Japan region, benefiting active duty personnel, contractors, and family members
• Established, implemented, and managed departmental training, goals, objectives, policies, and procedures in accordance with USNH Yokosuka Infection Control guidelines
• Reviewed and revised hospital policies and procedures to ensure alignment with infection control standards, contributing to the hospital's mission, values, and strategic plan
• Provided leadership in conducting multiple departmental training sessions on infection prevention protocols and maintenance of sterility standards
• Developed and updated unit policies and procedures to ensure compliance with regulatory agencies such as Joint Commission (JC), Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), and other county, state, and federal entities
• Ensured prompt communication of policy changes to staff members
• Generated reports and promptly responded to short-notice taskers, demonstrating efficiency and responsiveness in meeting organizational needs
• Contributed to the establishment and implementation of evidence-based nursing standards of practice, further enhancing patient care quality and safety
• Played a key role in the success of the Sterile Processing Department, recognized by the Joint Commission as a 'best practice' department
• This achievement led to Yokosuka Naval Hospital earning the Joint Commission Golden Seal of Approval, underscoring our commitment to excellence in healthcare delivery.
• Conducted regular audits of clinical practices related to infection control measures, identifying areas for improvement and providing targeted recommendations.

• In my capacity as a healthcare professional, I have made significant contributions to enhancing operational standards and compliance within the Core Facility and Branch Health Clinics
• Some key accomplishments include: Enhanced all Core Facility and Branch Health Clinic standard operating procedures to align with rigorous standards set forth by AAMI, AORN, and the Joint Commission, ensuring adherence to best practices in healthcare delivery
• Led multiple on-site audits utilizing Joint Commission and APIC audit tools to assess compliance across Yokosuka Naval Hospital and its five regional clinics in Japan and South Korea, ensuring adherence to regulatory guidelines and standards
• Ensured diligent monitoring and compliance of Performance Measures, actively tracking metrics impacting quality measures to uphold high standards of care delivery
• Managed the Sterile Processing Department, recognized by the Joint Commission as a 'best practice' department
• Through effective leadership and strategic management, our efforts culminated in Yokosuka Naval Hospital earning the prestigious Joint Commission Golden Seal of Approval, underscoring our commitment to excellence in healthcare delivery.
• Improved sterile processing department efficiency by implementing streamlined workflows and procedures.
• Managed a team of sterile processing technicians, providing ongoing training and support to ensure high-quality performance.
• Reduced instrument turnover time by optimizing the decontamination process and improving organization within the department.
• Conducted regular audits of sterilization processes, ensuring compliance with industry standards and best practices.
• Developed policies and procedures for the handling, storage, and transportation of sterile instruments, ensuring consistently safe practices throughout the facility.

• In my role as Clinical Coordinator for 7 Main ORs, and as Charge Nurse for Orthopedics, Sports and Trauma, and Staff Nurse for General Surgery, Gynecology, Otolaryngology, and Urology, I have undertaken various responsibilities: Directed and managed multi-disciplinary operations during a Code Black (bomb threat), facilitating the safe evacuation of surgical patients
• I played a crucial role in arranging the transportation of a surgical patient from the OR into an ambulance and ensured their evacuation from the blast area
• Additionally, I volunteered to provide post-anesthesia care unit (PACU) care to patients until the all-clear was given
• Assessed, prioritized, and intervened to prevent life-threatening situations, executing life support activities during emergencies and providing guidance to team members
• Ensured safe patient transfer/transport into the Japanese healthcare system by assessing patient needs, selecting appropriate methods and personnel, and addressing the emotional needs of patients and their families during transport
• Demonstrated expertise in the assembly and functionality of surgical instrumentation and equipment, including fracture tables, beach chairs, and Wilson frames
• Assisted surgeons with skin preparation and draping of patients and provided efficient patient-centered care during the pre-operative phase
• Maintained accurate documentation of patient progress in accordance with established policies and procedures
• Actively fostered collaborative partnerships with clinicians, physicians, service-line leadership, and ancillary service lines to achieve common goals and enhance patient care.
• Enhanced patient safety by meticulously following surgical protocols and guidelines.
• Streamlined operating room efficiency by effectively preparing and organizing medical instruments and equipment.
• Reduced postoperative complications through diligent monitoring of patients during the recovery process.
• Improved team communication and collaboration, implementing strategic huddles before each surgery.
• Collaborated with interdisciplinary teams to develop comprehensive care plans for surgical patients, optimizing outcomes.
• Decreased surgical site infections by adhering to aseptic techniques and maintaining a sterile operating environment.

• As the Nurse Manager for the weekend shift, I oversee and coordinate nursing operations to ensure the delivery of high-quality patient care during weekends
• My responsibilities include: Staffing: I am responsible for scheduling nursing staff to ensure adequate coverage for all units and departments during weekend shifts
• Supervision: I provide supervision and support to nursing staff, ensuring adherence to hospital policies, procedures, and standards of care
• Patient Care: I monitor patient care activities, assess patient needs, and intervene as necessary to ensure optimal patient outcomes
• Problem-solving: I address any issues or concerns that arise during the weekend shift, collaborating with staff to find solutions and maintain the smooth functioning of operations
• Communication: I facilitate communication between nursing staff, physicians, and other healthcare providers to promote effective teamwork and collaboration
• Quality Improvement: I participate in quality improvement initiatives, identifying areas for improvement and implementing strategies to enhance patient care quality and safety
• Emergency Response: I am prepared to respond to emergencies and crisis situations, coordinating efforts to ensure prompt and appropriate patient care delivery
• Education and Training: I provide education and training to nursing staff as needed, keeping them informed about new policies, procedures, and best practices
• Overall, my role as Nurse Manager for the weekend shift is to ensure that nursing operations run smoothly, patients receive high-quality care, and staff are supported in their roles.
• Enhanced interdisciplinary collaboration through effective communication and coordination among healthcare team members.

• In my role, I have been entrusted with critical responsibilities aimed at ensuring efficient and effective surgical care delivery: Evaluated and prioritized all surgical battle casualties, directing them to the most suitable operating theater for prompt surgical intervention, optimizing patient outcomes
• Oversaw the management of surgical instrument sets and supplies, ensuring the availability of approved resources and facilitating timely surgical care allocation to maximize the number of patients receiving optimal treatment
• Led and managed the Orthopedic Multi Trauma team, coordinating their efforts to provide comprehensive care to patients with complex orthopedic injuries resulting from trauma
• Provided assistance in General Surgery Trauma Procedures, offering support and expertise to ensure the successful management of traumatic surgical cases
• Collaborated with the Oral Maxillofacial/Plastic Surgery team, contributing to the delivery of specialized surgical procedures and ensuring seamless coordination of care for patients requiring complex oral, facial, or reconstructive surgery.
• Optimized resource allocation by regularly monitoring clinic operations and adjusting staffing levels as needed.
• Managed complex patient cases, collaborating with multidisciplinary teams to develop personalized treatment plans.

In my role, I have fulfilled various responsibilities to ensure the smooth and efficient delivery of patient care:

• Assisted the anesthesia provider in managing the patient’s airway, performing intubations, administering regional blocks, and providing support during emergencies, ensuring the safety and comfort of the patient throughout the perioperative period.
• Conducted comprehensive assessments of patient pre-operative data, including critical lab values, and communicated relevant findings to caregivers involved in the patient’s care, facilitating informed decision-making and optimal patient outcomes.
• Maintained a proficient understanding of the assembly and function of surgical instrumentation and equipment, ensuring their proper use and availability during surgical procedures.
• Took accountability for all factors contributing to an optimal surgical outcome, including instrumentation, implants, special equipment, efficient timeout procedures, and other aspects of the care environment, striving to ensure the highest standards of patient safety and quality of care.
• Monitored nursing care, patient assessment processes, and treatment implementations.
• Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
• Continually updated clinical knowledge by attending conferences, seminars or webinars related to Charge Nursing competencies.
• Mentored and supervised junior nurses, fostering a supportive and professional work environment.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.

In my roles as Charge Nurse across various departments, including the Medical/Surgical Ward, Cardiac Step-Down Unit, PACU, and Staff Nurse in the ER, I have undertaken significant responsibilities:

• Facilitated safe patient care and transport within the hospital, ensuring patients received timely and appropriate care across different units and departments.
• Played a pivotal role in orienting ten staff nurses to the diverse environments of inpatient care, providing comprehensive training and guidance to ensure they were equipped to deliver high-quality care in various settings.
• Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
• Monitored nursing care, patient assessment processes, and treatment implementations.
• Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
• Participated in quality improvement initiatives, contributing to the development of best practices within the department.
• Served as a liaison between nursing staff, physicians, and management, fostering open communication channels among all parties involved in patient care.
• Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.
• Evaluated patient histories, complaints, and current symptoms.