BGuthrie Photos: MD -- Silver Spring -- Natl Museum of Health and Medicine (Forest Glen Annex) -- Exhibit:

BGuthrie Photos: MD -- Silver Spring -- Natl Museum of Health and Medicine (Forest Glen Annex) -- Exhibit: [Normal Text] [1 col] [2] [3] [4] [5] [6] [7] [8] [9] [10] [Bruce Guthrie Photos home page]

[1]

NMHMAA_240216_01.JPG

[2]

NMHMAA_240216_04.JPG

[3]

NMHMAA_240216_05.JPG

[4]

NMHMAA_240216_08.JPG

[5]

NMHMAA_240216_10.JPG

[6]

NMHMAA_240216_11.JPG

[7]

NMHMAA_240216_13.JPG

[8]

NMHMAA_240216_15.JPG

[9]

NMHMAA_240216_18.JPG

[10]

NMHMAA_240216_21.JPG

[11]

NMHMAA_240216_22.JPG

[12]

NMHMAA_240216_24.JPG

[13]

NMHMAA_240216_26.JPG

[14]

NMHMAA_240216_28.JPG

[15]

NMHMAA_240216_30.JPG

[16]

NMHMAA_240216_33.JPG

[17]

NMHMAA_240216_35.JPG

[18]

NMHMAA_240216_36.JPG

[19]

NMHMAA_240216_38.JPG

[20]

NMHMAA_240216_43.JPG

[21]

NMHMAA_240216_44.JPG

[22]

NMHMAA_240216_46.JPG

[23]

NMHMAA_240216_48.JPG

[24]

NMHMAA_240216_52.JPG

[25]

NMHMAA_240216_53.JPG

[26]

NMHMAA_240216_55.JPG

[27]

NMHMAA_240216_58.JPG

[28]

NMHMAA_240216_59.JPG

[29]

NMHMAA_240216_61.JPG

[30]

NMHMAU_240216_01.JPG

[31]

NMHMAU_240216_03.JPG

[32] NMHMAU_240216_04.JPG

[33] NMHMAU_240216_05.JPG

[34] NMHMAU_240216_06.JPG

[35] NMHMAU_240216_07.JPG

[36] NMHMAU_240216_08.JPG

[37] NMHMAU_240216_09.JPG

[38]

NMHMAU_240216_14.JPG

[39] NMHMAU_240216_17.JPG

[40] NMHMAU_240216_18.JPG

[41] NMHMAU_240216_20.JPG

[42]

NMHMAU_240216_24.JPG

[43] NMHMAU_240216_27.JPG

[44] NMHMAU_240216_28.JPG

[45] NMHMAU_240216_30.JPG

[46] NMHMAU_240216_31.JPG

[47]

NMHMAU_240216_33.JPG

[48]

NMHMAU_240216_34.JPG

[49]

NMHMAU_240216_37.JPG

[50]

NMHMAU_240216_43.JPG

[51]

NMHMAU_240216_44.JPG

[52] NMHMAU_240216_46.JPG

[53] NMHMAU_240216_47.JPG

[54]

NMHMAU_240216_49.JPG

[55]

NMHMAU_240216_50.JPG

[56]

NMHMTM_240216_01.JPG

[57]

NMHMTM_240216_03.JPG

[58] NMHMTM_240216_08.JPG

[59] NMHMTM_240216_13.JPG

[60]

NMHMAL_230610_01.JPG

[61]

NMHMAL_230610_03.JPG

[62]

NMHMAL_230610_05.JPG

[63]

NMHMAL_230610_08.JPG

[64]

NMHMAL_230610_13.JPG

[65]

NMHMAL_230610_14.JPG

[66]

NMHMAL_230610_16.JPG

[67]

NMHMAL_230610_19.JPG

[68]

NMHMAL_230610_23.JPG

[69] NMHMAL_230610_26.JPG

[70]

NMHMAL_230610_29.JPG

[71]

NMHMAL_230610_30.JPG

[72]

NMHMAL_230610_31.JPG

[73]

NMHMAL_230610_33.JPG

[74]

NMHMAL_230610_35.JPG

[75]

NMHMAL_230610_37.JPG

[76]

NMHMAL_230610_39.JPG

[77]

NMHMAL_230610_41.JPG

[78]

NMHMAL_230610_44.JPG

[79] NMHMHS_191031_001.JPG

[80]

NMHMHS_191031_005.JPG

[81] NMHMHS_191031_010.JPG

[82] NMHMHS_191031_015.JPG

[83] NMHMHS_191031_021.JPG

[84] NMHMHS_191031_022.JPG

[85] NMHMHS_191031_025.JPG

[86] NMHMHS_191031_027.JPG

[87] NMHMHS_191031_029.JPG

[88]

NMHMHS_191031_031.JPG

[89] NMHMHS_191031_038.JPG

[90] NMHMHS_191031_040.JPG

[91] NMHMHS_191031_042.JPG

[92] NMHMHS_191031_045.JPG

[93] NMHMHS_191031_048.JPG

[94] NMHMHS_191031_050.JPG

[95]

NMHMHS_191031_056.JPG

[96]

NMHMHS_191031_058.JPG

[97] NMHMHS_191031_062.JPG

[98] NMHMHS_191031_065.JPG

[99] NMHMHS_191031_066.JPG

[100] NMHMHS_191031_068.JPG

[101] NMHMHS_191031_078.JPG

[102] NMHMHS_191031_080.JPG

[103] NMHMHS_191031_082.JPG

[104] NMHMHS_191031_087.JPG

[105] NMHMHS_191031_089.JPG

[106] NMHMHS_191031_091.JPG

[107] NMHMHS_191031_096.JPG

[108] NMHMHS_191031_100.JPG

[109] NMHMHS_191031_106.JPG

[110] NMHMHS_191031_109.JPG

[111] NMHMHS_191031_115.JPG

[112]

NMHMHS_191031_119.JPG

[113] NMHMHS_191031_122.JPG

[114] NMHMHS_191031_125.JPG

[115] NMHMHS_191031_128.JPG

[116] NMHMHS_191031_131.JPG

[117] NMHMHS_191031_134.JPG

[118] NMHMHS_191031_136.JPG

[119]

NMHMHS_191031_138.JPG

[120]

NMHMHS_191031_142.JPG

[121]

NMHMHS_191031_145.JPG

[122]

NMHMHS_191031_148.JPG

[123] NMHMHS_191031_151.JPG

[124]

NMHMHS_191031_154.JPG

[125]

NMHMHS_191031_157.JPG

[126] NMHMHS_191031_159.JPG

[127] NMHMHS_191031_162.JPG

[128]

NMHMHS_191031_168.JPG

[129] NMHMHS_191031_173.JPG

[130]

NMHMHS_191031_181.JPG

[131]

NMHMHS_191031_187.JPG

[132] NMHMHS_191031_189.JPG

[133]

NMHMHS_191031_193.JPG

[134] NMHMHS_191031_195.JPG

[135] NMHMHS_191031_199.JPG

[136] NMHMHS_191031_201.JPG

[137] NMHMHS_191031_203.JPG

[138] NMHMHS_191031_205.JPG

[139] NMHMHS_191031_207.JPG

[140] NMHMHS_191031_209.JPG

[141] NMHMHS_191031_212.JPG

[142] NMHMHS_191031_213.JPG

[143] NMHMHS_191031_215.JPG

[144] NMHMHS_191031_216.JPG

[145] NMHMHS_191031_222.JPG

[146] NMHMHS_191010_03.JPG

[147]

NMHMHS_191010_07.JPG

[148]

NMHMHS_191010_10.JPG

[149] NMHMHS_191010_13.JPG

[150] NMHMHS_191010_14.JPG

[151] NMHMHS_191010_16.JPG

[152] NMHMHS_191010_18.JPG

[153] NMHMHS_191010_21.JPG

[154] NMHMHS_191010_25.JPG

[155] NMHMHS_191010_29.JPG

[156] NMHMHS_191010_31.JPG

[157]

NMHMHS_190919_001.JPG

[158] NMHMHS_190919_007.JPG

[159] NMHMHS_190919_012.JPG

[160] NMHMHS_190919_017.JPG

[161]

NMHMHS_190919_020.JPG

[162] NMHMHS_190919_024.JPG

[163] NMHMHS_190919_026.JPG

[164]

NMHMHS_190919_028.JPG

[165]

NMHMHS_190919_034.JPG

[166]

NMHMHS_190919_037.JPG

[167]

NMHMHS_190919_040.JPG

[168] NMHMHS_190919_043.JPG

[169]

NMHMHS_190919_046.JPG

[170]

NMHMHS_190919_050.JPG

[171]

NMHMHS_190919_055.JPG

[172]

NMHMHS_190919_058.JPG

[173]

NMHMHS_190919_061.JPG

[174]

NMHMHS_190919_065.JPG

[175]

NMHMHS_190919_068.JPG

[176]

NMHMHS_190919_074.JPG

[177]

NMHMHS_190919_079.JPG

[178]

NMHMHS_190919_085.JPG

[179]

NMHMHS_190919_091.JPG

[180]

NMHMHS_190919_100.JPG

[181]

NMHMHS_190919_102.JPG

[182]

NMHMHS_190919_109.JPG

[183] NMHMHS_190919_115.JPG

[184] NMHMHS_190919_118.JPG

[185] NMHMHS_190919_121.JPG

[186] NMHMHS_190919_125.JPG

[187] NMHMHS_190919_128.JPG

[188] NMHMHS_190919_131.JPG

[189] NMHMHS_190919_138.JPG

[190] NMHMHS_190919_141.JPG

[191] NMHMHS_190919_144.JPG

[192] NMHMHS_190919_146.JPG

[193] NMHMHS_190919_152.JPG

[194] NMHMHS_190919_155.JPG

[195] NMHMHS_190919_158.JPG

[196] NMHMHS_190919_161.JPG

[197] NMHMHS_190919_164.JPG

[198] NMHMHS_190919_169.JPG

[199] NMHMHS_190919_174.JPG

[200] NMHMHS_190919_180.JPG

[201] NMHMHS_190919_183.JPG

[202] NMHMHS_190919_186.JPG

[203] NMHMHS_190919_189.JPG

[204] NMHMHS_190919_192.JPG

[205] NMHMHS_190919_197.JPG

[206] NMHMHS_190919_201.JPG

[207] NMHMHS_190919_204.JPG

[208] NMHMHS_190919_208.JPG

[209] NMHMHS_190919_214.JPG

[210] NMHMHS_190919_217.JPG

[211]

NMHMBW_190803_001.JPG

[212]

NMHMBW_190803_005.JPG

[213]

NMHMBW_190803_021.JPG

[214]

NMHMBW_190803_028.JPG

[215]

NMHMBW_190803_031.JPG

[216]

NMHMBW_190803_041.JPG

[217] NMHMBW_190803_046.JPG

[218] NMHMBW_190803_050.JPG

[219] NMHMBW_190803_058.JPG

[220] NMHMBW_190803_061.JPG

[221]

NMHMBW_190803_065.JPG

[222]

NMHMBW_190803_072.JPG

[223]

NMHMBW_190803_079.JPG

[224] NMHMBW_190803_087.JPG

[225] NMHMBW_190803_091.JPG

[226] NMHMBW_190803_093.JPG

[227] NMHMBW_190803_096.JPG

[228] NMHMBW_190803_098.JPG

[229] NMHMBW_190803_100.JPG

[230] NMHMBW_190803_103.JPG

[231] NMHMBW_190803_105.JPG

[232] NMHMBW_190803_108.JPG

[233] NMHMBW_190803_110.JPG

[234] NMHMBW_190803_114.JPG

[235] NMHMBW_190803_116.JPG

[236] NMHMBW_190803_119.JPG

[237] NMHMBW_190803_121.JPG

[238] NMHMBW_190803_125.JPG

[239] NMHMBW_190803_128.JPG

[240] NMHMBW_190803_134.JPG

[241] NMHMBW_190803_136.JPG

[242] NMHMBW_190803_138.JPG

[243] NMHMBW_190803_141.JPG

[244] NMHMBW_190803_147.JPG

[245]

NMHMSH_190803_04.JPG

[246]

NMHMSH_190803_11.JPG

[247]

NMHMSH_190803_16.JPG

[248]

NMHMSH_190803_18.JPG

[249]

NMHMSH_190803_19.JPG

[250]

NMHMSH_190803_21.JPG

[251]

NMHMSH_190803_22.JPG

[252]

NMHMSH_190803_25.JPG

[253]

NMHMSH_190803_27.JPG
$Victims of shark attack suffer from exhaustion, blood loss, and the effects of near drowning. The bite usually affect a limb, creating incising and crushing wounds to the victim. These people sometimes sustain loss of muscle, but rarely bone fractures. During the first half of the twentieth century, victims of shark attacks rarely survived their trauma, but improved methods for treating shock and improved antibiotics ensure that victims can recover from the attacks, assuming hemorrhage is controlled as soon as possible.$

[254]

NMHMSH_190803_34.JPG

[255]

NMHMSH_190803_39.JPG

[256] NMHMSH_190803_41.JPG

[257]

NMHMSH_190803_45.JPG

[258]

NMHMSH_190803_56.JPG

[259] NMHMSH_190803_59.JPG

[260]

NMHMSH_190803_63.JPG

[261]

NMHMSH_190803_66.JPG

[262]

NMHMSH_190803_72.JPG

[263]

NMHMSH_190803_77.JPG

[264]

NMHMEB_190331_01.JPG

[265]

NMHMEB_190331_10.JPG

[266] NMHMEB_190331_17.JPG

[267] NMHMEB_190331_18.JPG

[268]

NMHMEB_190331_21.JPG

[269]

NMHMEB_190331_30.JPG

[270]

NMHMEB_190331_35.JPG

[271]

NMHMEB_190331_39.JPG

[272] NMHMEB_190331_42.JPG

[273] NMHMEB_190331_48.JPG

[274] NMHMEB_190331_51.JPG

[275]

NMHMEB_190331_60.JPG

[276] NMHMEB_190331_64.JPG

[277] NMHMEB_190331_68.JPG

[278] NMHMEB_190331_71.JPG

[279] NMHMEB_190331_73.JPG

[280] NMHMEB_190331_76.JPG

[281] NMHMEB_190331_81.JPG

[282] NMHMEB_190331_82.JPG

[283] NMHMEB_190331_86.JPG

[284]

NMHMIW_190331_001.JPG

[285] NMHMIW_190331_006.JPG

[286] NMHMIW_190331_010.JPG

[287] NMHMIW_190331_012.JPG

[288] NMHMIW_190331_014.JPG

[289] NMHMIW_190331_017.JPG

[290]

NMHMIW_190331_018.JPG

[291] NMHMIW_190331_029.JPG

[292] NMHMIW_190331_031.JPG

[293] NMHMIW_190331_036.JPG

[294] NMHMIW_190331_038.JPG

[295] NMHMIW_190331_041.JPG

[296] NMHMIW_190331_044.JPG

[297] NMHMIW_190331_047.JPG

[298] NMHMIW_190331_049.JPG

[299] NMHMIW_190331_052.JPG

[300] NMHMIW_190331_054.JPG

[301] NMHMIW_190331_062.JPG

[302] NMHMIW_190331_065.JPG

[303] NMHMIW_190331_069.JPG

[304] NMHMIW_190331_071.JPG

[305] NMHMIW_190331_079.JPG

[306] NMHMIW_190331_087.JPG

[307] NMHMIW_190331_091.JPG

[308] NMHMIW_190331_097.JPG

[309] NMHMIW_190331_102.JPG

[310] NMHMIW_190331_107.JPG

[311] NMHMIW_190331_113.JPG

[312] NMHMIW_190331_118.JPG

[313] NMHMIW_190331_120.JPG

[314] NMHMIW_190331_125.JPG

[315] NMHMIW_190331_132.JPG

[316] NMHMIW_190331_136.JPG

[317] NMHMIW_190331_139.JPG

[318] NMHMIW_190331_151.JPG

[319] NMHMIW_190331_156.JPG

[320] NMHMIW_190331_164.JPG

[321] NMHMIW_190331_168.JPG

[322] NMHMIW_190331_178.JPG

[323] NMHMIW_190331_181.JPG

[324] NMHMIW_190331_184.JPG

[325] NMHMIW_190331_192.JPG

[326] NMHMIW_190331_200.JPG

[327] NMHMIW_190331_205.JPG

[328] NMHMIW_190331_210.JPG

[329] NMHMIW_190331_215.JPG

[330] NMHMIW_190331_218.JPG

[331] NMHMIW_190331_222.JPG

[332] NMHMIW_190331_225.JPG

[333] NMHMIW_190331_230.JPG

[334] NMHMIW_190331_235.JPG

[335] NMHMIW_190331_241.JPG

[336] NMHMIW_190331_243.JPG

[337] NMHMIW_190331_247.JPG

[338] NMHMIW_190331_253.JPG

[339] NMHMIW_190331_260.JPG

[340] NMHMIW_190331_263.JPG

[341] NMHMIW_190331_265.JPG

[342] NMHMIW_190331_270.JPG

[343] NMHMIW_190331_276.JPG

[344] NMHMIW_190331_279.JPG

[345] NMHMIW_190331_289.JPG

[346] NMHMIW_190331_295.JPG

[347] NMHMIW_190331_302.JPG

[348] NMHMIW_190331_305.JPG

[349] NMHMIW_190331_308.JPG

[350] NMHMIW_190331_312.JPG

[351]

NMHFLU_190203_005.JPG

[352]

NMHFLU_190203_009.JPG

[353]

NMHFLU_190203_012.JPG

[354]

NMHFLU_190203_016.JPG

[355]

NMHFLU_190203_020.JPG

[356]

NMHFLU_190203_024.JPG

[357]

NMHFLU_190203_028.JPG

[358]

NMHFLU_190203_032.JPG

[359]

NMHFLU_190203_036.JPG

[360]

NMHFLU_190203_041.JPG

[361] NMHFLU_190203_048.JPG

[362]

NMHFLU_190203_052.JPG

[363]

NMHFLU_190203_058.JPG

[364]

NMHFLU_190203_061.JPG

[365]

NMHFLU_190203_067.JPG

[366]

NMHFLU_190203_072.JPG

[367]

NMHFLU_190203_077.JPG

[368] NMHFLU_190203_085.JPG

[369] NMHFLU_190203_088.JPG

[370]

NMHFLU_190203_091.JPG

[371]

NMHFLU_190203_095.JPG

[372] NMHFLU_190203_100.JPG

[373]

NMHFLU_190203_102.JPG

[374]

NMHFLU_190203_110.JPG

[375]

NMHFLU_190203_114.JPG

[376]

NMHFLU_190203_124.JPG

[377]

NMHFLU_190203_128.JPG

[378]

NMHFLU_190203_137.JPG

[379]

NMHFLU_190203_141.JPG

[380]

NMHFLU_190203_144.JPG

[381]

NMHFLU_190203_147.JPG

[382]

NMHFLU_190203_153.JPG

[383]

NMHFLU_190203_156.JPG

[384]

NMHFLU_190203_159.JPG

[385]

NMHFLU_190203_163.JPG

[386]

NMHFLU_190203_167.JPG

[387]

NMHFLU_190203_170.JPG

[388]

NMHFLU_190203_175.JPG

[389]

NMHFLU_190203_178.JPG

[390]

NMHFLU_190203_182.JPG

[391]

NMHFLU_190203_188.JPG

[392]

NMHMVN_180702_06.JPG

[393] NMHMVN_180702_08.JPG

[394]

NMHMVN_180702_11.JPG

[395]

NMHMVN_180702_15.JPG

[396] NMHMVN_180702_21.JPG

[397]

NMHMVN_180702_24.JPG

[398]

NMHMVN_180702_26.JPG

[399] NMHMVN_180702_30.JPG

[400] NMHMVN_180702_34.JPG

[401]

NMHMVN_180702_37.JPG

[402] NMHMVN_180702_41.JPG

[403] NMHMVN_180702_45.JPG

[404]

NMHMVN_180702_48.JPG

[405] NMHMVN_180702_51.JPG

[406] NMHMVN_180702_57.JPG

[407] NMHMLI_150808_02.JPG

[408]

NMHMLI_150808_10.JPG

[409]

NMHMLI_150308_002.JPG

[410]

NMHMLI_150308_008.JPG

[411]

NMHMLI_150308_012.JPG

[412]

NMHMLI_150308_020.JPG

[413]

NMHMLI_150308_027.JPG

[414]

NMHMLI_150308_035.JPG

[415]

NMHMLI_150308_059.JPG

[416]

NMHMLI_150308_065.JPG

[417]

NMHMLI_150308_074.JPG

[418]

NMHMLI_150308_082.JPG

[419]

NMHMLI_150308_092.JPG

[420]

NMHMLI_150308_108.JPG

[421]

NMHMLI_150308_112.JPG

[422]

NMHMLI_150308_123.JPG

[423] NMHMLI_150308_131.JPG

[424] NMHMLI_150308_134.JPG

[425] NMHMLI_150308_138.JPG

[426]

NMHMLI_150308_152.JPG
$Case History in The Medical and Surgical History of the War of the Rebellion, Part I, Vol. II, Surgical History, 1870: President Abraham Lincoln's case history was described as one of three recorded cases of a contre coup injury in "The Medical and Surgical History of the War of the Rebellion." In the 19th century, contre coup was described as a fracture of the skull opposite a wound, caused by the transmitted force of the brain. In Lincoln's case, contre coup was evidenced by the fracture of the orbits. Current understanding of contre coup involves trauma of the brain, rather than the skull.$

[427]

NMHMLI_150308_172.JPG

[428] NMHMLI_150308_184.JPG

[429]

NMHMLI_150308_202.JPG

[430]

NMHMLI_150308_212.JPG

[431]

NMHHWH_130607_001.JPG
$The following pictures are from the page <a href="/graphlib.nsf/keys/2013_MD_NMHM_WHACKed">2013_MD_NMHM_WHACKed</a> MD -- Silver Spring -- Natl Museum of Health and Medicine (Forest Glen Annex) -- Exhibit: WHACK'ed (Traumatic Brain Injury) (12 photos from 2013)<br>WHACK'ed … and then everything was different: portraits of traumatic brain injury survivors Eliette Markhbein The Therapeutic Arts Program, New York City, New York, United States My show, WHACK'ed . . . and then everything was different, honors traumatic brain injury (TBI) survivors who changed perceptions of TBI and disability and became role models for millions. The series of large scale portraits personify the various causes of TBI as well as the diversity of people it affects. The portraits include those of rock and movie stars Keith Richards and George Clooney, as well as Congresswoman Gabrielle Giffords, ABC-TV news correspondent Bob Woodruff, retired ARMY SPEC Claudia Carreon (a veteran of the Iraqi war), Hall of Fame athletes Troy Aikman (NFL) and Pat Lafontaine (NHL), Alexis Verzal (a very spirited 5-year-old who was shaken and thrown into a wall at age 2), Trisha Meili (the "Central Park Jogger"), and Timothy Pruce (New York Brain Injury Association Vice-President). The concept and formalism of my work is informed by my personal experience with traumatic brain injury and evokes the need to reassemble fragments of a pre-existing identity in order to create a new self. Thus the drawing, cutting, and collage technique used throughout the series is a reflection and a silent testimony to the three phases of traumatic brain injury: Fractured, Reassembled, Whole. First drawn in charcoal on paper based on photographs cropped to desired intimacy, the images are then imperfectly cut with scissors into squares and reassembled as portraits on painted canvas. I use paper to draw the portraits because like a human being, paper is organic, resilient, and fragile. It bends, absorbs, and rips; and bears witness to its endurance by exhibiting its scars in the process. Each portrait is organized in a grid formation that reflects both an inward and outward representation of TBI. The uneven grid effect resulting from the drawing, cutting, and collage technique illustrates how TBI disrupts sensory and perceptual processes (such as the seamless way the mind functions pre-injury -- a phenomenon one is unconscious of until it is lost) and substitutes it with jagged awareness and fractured perceptions. The grid also acts as a metaphor for the support and structure TBI survivors require in order to live a productive and rewarding life. Like the philosopher Emmanuel Levinas, I believe the face is not only the outward sign of a personage, but the naked essence of humanity. As such, it reveals an extraordinary vulnerability and an astonishing resilience. By representing faces of TBI survivors on a large scale, I hope to elicit emotional intimacy and universality. I want my work to raise awareness of Traumatic Brain Injury so the public better understands its symptoms and is more prepared to support injured soldiers returning from Iraq and Afghanistan, as well as their families, as they transition and adapt to a new life. Based on my experience as an artist-in-residence at The Mount Sinai Rehabilitation Center in New York and the success of using art as a modality for the rehabilitation of TBI patients, I have partnered with the Brain Injury Association of America and the Society for Arts in Healthcare to educate the public and raise awareness about TBI. The portraits will tour the country and be auctioned after the touring exhibit to raise funds to support an Artists-in-Residence program to serve people with TBI in hospitals and rehabilitation facilities throughout the United States.$