Marc Simon, MD, MS

Title(s)Professor, Medicine
SchoolSchool of Medicine
ORCID ORCID Icon0000-0003-3080-3675 Additional info
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    Collapse Biography 
    Collapse Education and Training
    University of Pennsylvania, PhiladelphiaBSE05/1994Bioengineering
    University of Maryland, BaltimoreMD05/1998Medicine
    University of Pittsburgh, PittsburghMS05/2007Bioengineering
    University of Colorado School of Medicine and Affiliated Hospitals, DenverResident06/2001Internal Medicine
    UPMC, PittsburghFellow06/2004Cardiovascular Disease
    UPMC, PittsburghFellow06/2005Advanced Heart Failure and Transplantation
    Collapse Awards and Honors
    AHA2010  - 2012Claude R. Joyner, M.D. Research Award for Young Medical Researchers
    PFIZER2010  - 20112010 ASPIRE Young Investigator Research Award

    Collapse Overview 
    Collapse Overview
    CLINICAL INTERESTS: Dr. Simon is director of Pulmonary Vascular Disease and the Pulmonary Hypertension Comprehensive Care Center. He has expertise as a cardiologist specializing in pulmonary hypertension, advanced heart failure, and heart transplantation.

    RESEARCH INTERESTS: Dr. Simon’s research primary research focus involves developing new therapies for pulmonary hypertension and better understanding right-sided heart failure in pulmonary hypertension (PH). Notably, right-sided heart failure and PH are associated with poor outcomes and in particular have been noted to occur in another type of heart failure, called heart failure with preserved ejection fraction or HFpEF, in which the heart seems to function normally but causes difficulty breathing due to a stiffening of the heart and blood vessels.

    Collapse Research 
    Collapse Research Activities and Funding
    Operationalizing Patient-Reported Outcome Measurement with Electronic Health Records in Patients with Heart Failure
    Patient-Centered Outcomes Research Institute ASP-1502-27079May 1, 2019 - Jun 30, 2020
    Role: Co-Investigator
    Role Description: The goal of this grant is to operationalize the use of Patient-Reported Outcome Measurement with Electronic Health Records. A validated Patient-Reported Outcome Measurement will be administered in the heart failure clinics, and integrated with the Electronic Health Record for clinical use.
    A Phase II Trial of Metformin for Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction
    NIH R01AG058659May 1, 2018 - Feb 28, 2023
    Role: Principal Investigator
    Molecular Drivers of Vascular Stiffness and Metabolic Dysfunction in HIV-Induced Pulmonary Arterial Hypertension
    NIH R01HL138437Jul 1, 2017 - Jun 30, 2021
    Role: Co-Investigator
    LED-enabled Real- time BNP Detection based on flexible substrate
    National Science Foundation NSF CBET 1706620Jul 1, 2017 - Jun 30, 2020
    Role: Co-Investigator
    Role Description: The goal of this project is to develop a LED-enabled Real- time BNP Detection based on flexible substrate.
    Ventricular Morphological and Mechanical Response to LCZ696
    Novartis LCZ696BUSNC0TJan 1, 2017 - Aug 30, 2019
    Role: PI
    Role Description: This is a preclinical study of the effect of LCZ696 on right ventricular remodeling and tissue biomechanics in a pulmonary hypertension model.
    Nitrite benefits to mediate fatigability in older HFpEF patients
    NIH R56AG051637Aug 15, 2016 - Dec 31, 2018
    Role: Co-Investigator
    University of Pittsburgh Clinical and Translational Science Institute
    NIH UL1TR001857Jul 12, 2016 - May 31, 2021
    Role: Medical Director, Montefiore Clinical Translational Research Center; Core Director, Recruitment Inno
    Role Description: Medical Director, Montefiore Clinical Translational Research Center 2016-2020; Core Director, Recruitment Innovation Unit 2019-2020
    The Role of EBP50 in Right Heart Hypertrophy and Dysfunction in Pulmonary Hypertension-induced Pressure Overload
    University of Pittsburgh Vascular Medicine Institute (VMI) & UPMC Heart & Vascular Institute (HVI) VMI-HVI InnovatorMar 1, 2015 - Jun 30, 2016
    Role: Co-PI
    Role Description: This project studies the relationship between the scaffolding protein EBP50 and tissue biomechanics in PH.
    Immune dysfunction and pulmonary hypertension in primate model of HIV infection
    NIH R56HL126525Sep 3, 2014 - Aug 31, 2017
    Role: Co-Investigator
    Longitudinal evaluation of HIV-associated lung disease phenotypes
    NIH R01HL125049Aug 15, 2014 - Jun 30, 2019
    Role: Co-Investigator
    Mitochondrial function in RV failure
    University of Pittsburgh Vascular Medicine Institute (VMI) & UPMC Heart & Vascular Institute (HVI) VMI-HVI InnovatorJul 1, 2014 - Jun 30, 2015
    Role: Co-PI
    Role Description: This project studies the relationship between RV mitochondrial function and tissue biomechanics.
    Blended Collaborative Care for Heart Failure and Co-Morbid Depression
    NIH R01HL114016Aug 1, 2013 - Jul 31, 2021
    Role: Co-Investigator
    National Biological Sample and Data Repository for PAH
    NIH R24HL105333Mar 3, 2012 - Feb 29, 2016
    Role: Co-Investigator
    A Dose Escalation Study to Evaluate the Effect of Inhaled Nitrite on Cardiopulmonary Hemodynamics in Subjects with Pulmonary Hypertension
    Aires Pharmaceuticals PRO 11080686Dec 1, 2011 - Mar 30, 2018
    Role: PI
    Role Description: This is a phase 2 acute hemodynamic study of the effect of inhaled nitrite on patients with WHO groups 1, 2, and 3 pulmonary hypertension. This study is a pharmacokinetic and safety study as well.
    Therapeutic Targeting of Vascular Subphenotypes of Lung Disease
    NIH P01HL103455Jun 1, 2011 - Apr 30, 2021
    Role: Clinical Core Director
    2010 ASPIRE Young Investigator Research Award, "Right Ventricular Regional Contractile Response to Pulmonary Vascular Disease"
    PFIZER WS857357Nov 15, 2010 - Nov 30, 2011
    Role: PI
    Role Description: This project aims to quantify the sequence and magnitude of regional RV free wall (RVFW) contractile patterns using a high temporal and spatial resolution optical technique. In particular, how the normal contractile patterns are altered in pressure overload as seen in pulmonary vascular disease, and how such pathologic alterations can be mitigated by sildenafil will be studied via an animal model.
    Morphological and Mechanical Behavior of Right Ventricular Extracellular Matrix
    Pittsburgh Foundation M2010-0052Nov 1, 2010 - Oct 31, 2012
    Role: PI
    Role Description: The aim of this study is to better understand right ventricular morphology and function via biaxial biomechanics in order to improve outcomes in pulmonary hypertension.
    Right Ventricular Morphological and Mechanical Behavior
    American Heart Association 10BGIA3790022Jul 1, 2010 - Jun 30, 2012
    Role: PI
    Role Description: This is a novel, multidisciplinary approach to elucidate right ventricular (RV) myocardium mechanical behavior in the passive and active states to evaluate the effects of disease and treatment in a rat model of pulmonary hypertension. Unique tissue level bi-axial stress-strain data will be acquired to ultimately allow the connection between organ and cellular level events. A long-term goal will be to use the methodology developed with this project to quantify the RV mechanical behavior regionally and relate this to remodeling changes of the RV and extracellular matrix.
    University of Pittsburgh Clinical and Translational Science Institute
    NIH UL1TR000005Sep 30, 2006 - Jun 30, 2016
    Role: Medical Director of the Vascular Translational Research Center (CTRC) 12/1/2014 - 6/30/2016
    Right Ventricular Structure & Function
    NIH KL2RR024154Jul 1, 2006 - Jun 30, 2011
    Role: Clinical Research Scholar
    Role Description: The major goal of this multidisciplinary clinical research training grant is to train clinician-researchers. The scholar’s proposal aims to quantify regional right ventricular (RV) performance and develop it as to tool to assess global RV function in the setting of heart failure (HF) and pulmonary hypertension (PH) via a multidisciplinary mentored-sponsored project and a scholar-sponsored project.

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    Collapse Publications
    Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Researchers can login to make corrections and additions, or contact us for help. to make corrections and additions.
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    Altmetrics Details PMC Citations indicate the number of times the publication was cited by articles in PubMed Central, and the Altmetric score represents citations in news articles and social media. (Note that publications are often cited in additional ways that are not shown here.) Fields are based on how the National Library of Medicine (NLM) classifies the publication's journal and might not represent the specific topic of the publication. Translation tags are based on the publication type and the MeSH terms NLM assigns to the publication. Some publications (especially newer ones and publications not in PubMed) might not yet be assigned Field or Translation tags.) Click a Field or Translation tag to filter the publications.
    1. Gender Differences in Mortality After Left Ventricular Assist Device Implant: A Causal Mediation Analysis Approach. ASAIO J. 2021 06 01; 67(6):614-621. Nayak A, Hu Y, Ko YA, Mehta A, Liu C, Pennington J, Xie R, Cowger J, Kirklin JK, Kormos RL, Simon MA, Morris AA. PMID: 33060408.
      View in: PubMed   Mentions: 1     Fields:    Translation:Humans
    2. Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry. Ann Am Thorac Soc. 2021 04; 18(4):613-622. Kolaitis NA, Zamanian RT, de Jesus Perez VA, Badesch DB, Benza RL, Burger CD, Chakinala MM, Elwing JM, Feldman J, Lammi MR, Mathai SC, McConnell JW, Presberg KW, Robinson JC, Sager J, Shlobin OA, Simon MA, Kawut SM, Glidden DV, Singer JP, De Marco T, Pulmonary Hypertension Association Registry Investigators . PMID: 33064950.
      View in: PubMed   Mentions: 1     Fields:    
    3. Creation and Validation of a Novel Sex-Specific Mortality Risk Score in LVAD Recipients. J Am Heart Assoc. 2021 Apr 06; 10(7):e020019. Nayak A, Hu Y, Ko YA, Steinberg R, Das S, Mehta A, Liu C, Pennington J, Xie R, Kirklin JK, Kormos RL, Cowger J, Simon MA, Morris AA. PMID: 33764158.
      View in: PubMed   Mentions: 1     Fields:    
    4. Association between Preoperative Dynamic Measures of Vascular Load and Postoperative Hemodynamics in Patients with Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Thromboendarterectomy. Ann Am Thorac Soc. 2021 03; 18(3):551. Contijoch F, Wong D, Igata S, Mizzell AM, Auger W, DeMaria AN, Blanchard D, Waheed A, Bachman TN, Simon MA, Pinsky MR, Madani M. PMID: 33141597.
      View in: PubMed   Mentions:    Fields:    
    5. The Preimplantation Psychosocial Evaluation and Prediction of Clinical Outcomes During Mechanical Circulatory Support: What Information Is Most Prognostic? Transplantation. 2021 Mar 01; 105(3):608-619. Dew MA, Hollenberger JC, Obregon LL, Hickey GW, Sciortino CM, Lockard KL, Kunz NM, Mathier MA, Ramani RN, Kilic A, McNamara DM, Simon MA, Keebler ME, Kormos RL. PMID: 32345866.
      View in: PubMed   Mentions:    Fields:    Translation:Humans
    6. SCUBE1 Controls BMPR2-Relevant Pulmonary Endothelial Function: Implications for Diagnostic Marker Development in Pulmonary Arterial Hypertension. JACC Basic Transl Sci. 2020 Nov; 5(11):1073-1092. Sun W, Tang Y, Tai YY, Handen A, Zhao J, Speyer G, Al Aaraj Y, Watson A, Romanelli ME, Sembrat J, Rojas M, Simon MA, Zhang Y, Lee J, Xiong Z, Dutta P, Vasamsetti SB, McNamara D, McVerry B, McTiernan CF, Sciurba FC, Kim S, Smith KA, Mazurek JA, Han Y, Vaidya A, Nouraie SM, Kelly NJ, Chan SY. PMID: 33294740.
      View in: PubMed   Mentions:
    7. Nationwide variability in the use of induction immunosuppression for adult heart transplantation. J Card Surg. 2020 Nov; 35(11):3053-3061. Diaz-Castrillon CE, Seese L, Mathier MA, Keebler ME, Hickey GW, McNamara D, Simon MA, Horn E, Kilic A. PMID: 33016378.
      View in: PubMed   Mentions:    Fields:    Translation:Humans
    8. Diversity, Equity, and Inclusiveness in Medicine and Cardiology: Next Steps for JAHA. J Am Heart Assoc. 2020 10 20; 9(20):e019307. London B, Ahmad F, Eitzman DT, Gupta AK, Jneid H, Peterson P, Remme CA, Rice K, Schelbert EB, Simon MA, Sullivan LM, Weinberg JM. PMID: 32941090.
      View in: PubMed   Mentions: 1     Fields:    
    9. Angiotensin Receptor-Neprilysin Inhibition Attenuates Right Ventricular Remodeling in Pulmonary Hypertension. J Am Heart Assoc. 2020 07 07; 9(13):e015708. Sharifi Kia D, Benza E, Bachman TN, Tushak C, Kim K, Simon MA. PMID: 32552157.
      View in: PubMed   Mentions: 8     Fields:    Translation:Animals
    10. The Effects of Inhaled Sodium Nitrite on Pulmonary Vascular Impedance in Patients With Pulmonary Hypertension Associated with Heart Failure With Preserved Ejection Fraction. J Card Fail. 2020 Aug; 26(8):654-661. Bashline MJ, Bachman TN, Helbling NL, Nouraie M, Gladwin MT, Simon MA. PMID: 32446946.
      View in: PubMed   Mentions: 1     Fields:    
    11. mTORC1 in Pulmonary Arterial Hypertension. At the Crossroads between Vasoconstriction and Vascular Remodeling? Am J Respir Crit Care Med. 2020 05 15; 201(10):1177-1179. Goncharova EA, Simon MA, Yuan JX. PMID: 31968178.
      View in: PubMed   Mentions: 1     Fields:    Translation:Humans
    12. Current and Future Considerations in the Use of Mechanical Circulatory Support Devices: An Update, 2008-2018. Annu Rev Biomed Eng. 2019 06 04; 21:33-60. Simon MA, Bachman TN, Watson J, Baldwin JT, Wagner WR, Borovetz HS. PMID: 31167107.
      View in: PubMed   Mentions:    Fields:    Translation:Humans
    13. Left Ventricular Ejection Fraction Cut Point of 50% for Heart Failure With Preserved Ejection Fraction-Reply. JAMA Cardiol. 2018 10 01; 3(10):1023-1024. Simon MA, Nouraie M, Gladwin MT. PMID: 30027277.
      View in: PubMed   Mentions:    Fields:    Translation:Humans
    14. Association Between Hemodynamic Markers of Pulmonary Hypertension and Outcomes in Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. 2018 04 01; 3(4):298-306. Vanderpool RR, Saul M, Nouraie M, Gladwin MT, Simon MA. PMID: 29541759.
      View in: PubMed   Mentions: 31     Fields:    Translation:Humans
    15. Biomechanical and Hemodynamic Measures of Right Ventricular Diastolic Function: Translating Tissue Biomechanics to Clinical Relevance. J Am Heart Assoc. 2017 Sep 12; 6(9). Jang S, Vanderpool RR, Avazmohammadi R, Lapshin E, Bachman TN, Sacks M, Simon MA. PMID: 28899895.
      View in: PubMed   Mentions: 11     Fields:    Translation:Animals
    16. Chemokine receptor patterns and right heart failure in mechanical circulatory support. J Heart Lung Transplant. 2017 Jun; 36(6):657-665. Nayak A, Neill C, Kormos RL, Lagazzi L, Halder I, McTiernan C, Larsen J, Inashvili A, Teuteberg J, Bachman TN, Hanley-Yanez K, McNamara DM, Simon MA. PMID: 28209402.
      View in: PubMed   Mentions: 2     Fields:    Translation:Humans
    17. Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction. JCI Insight. 2016 11 03; 1(18):e89620. Simon MA, Vanderpool RR, Nouraie M, Bachman TN, White PM, Sugahara M, Gorcsan J, Parsley EL, Gladwin MT. PMID: 27812547.
      View in: PubMed   Mentions: 25     Fields:    Translation:HumansCTClinical Trials
    18. Non-invasive screening for cardiac allograft vasculopathy: go small or go home? J Heart Lung Transplant. 2015 Feb; 34(2):158-60. Teuteberg JJ, Simon MA. PMID: 25511745.
      View in: PubMed   Mentions: 1     Fields:    Translation:Humans
    19. RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart. 2015 Jan; 101(1):37-43. Vanderpool RR, Pinsky MR, Naeije R, Deible C, Kosaraju V, Bunner C, Mathier MA, Lacomis J, Champion HC, Simon MA. PMID: 25214501.
      View in: PubMed   Mentions: 81     Fields:    Translation:Humans
    20. Treatment for pulmonary arterial hypertension-associated right ventricular dysfunction. Ann Am Thorac Soc. 2014 Sep; 11(7):1101-15. Gomez-Arroyo J, Sandoval J, Simon MA, Dominguez-Cano E, Voelkel NF, Bogaard HJ. PMID: 25079379.
      View in: PubMed   Mentions: 10     Fields:    Translation:Humans
    21. Isolated right ventricular dysfunction in patients with human immunodeficiency virus. J Card Fail. 2014 Jun; 20(6):414-421. Simon MA, Lacomis CD, George MP, Kessinger C, Weinman R, McMahon D, Gladwin MT, Champion HC, Morris A. PMID: 24726418.
      View in: PubMed   Mentions: 5     Fields:    Translation:HumansCells
    22. Assessment and treatment of right ventricular failure. Nat Rev Cardiol. 2013 Apr; 10(4):204-18. Simon MA. PMID: 23399974.
      View in: PubMed   Mentions: 13     Fields:    Translation:Humans
    23. Comparison of outcomes for patients with nonischemic cardiomyopathy taking intravenous inotropes versus those weaned from or never taking inotropes at cardiac resynchronization therapy. Am J Cardiol. 2012 Sep 15; 110(6):857-61. Adelstein E, Bhattacharya S, Simon MA, Gorcsan J, Saba S. PMID: 22681865.
      View in: PubMed   Mentions: 1     Fields:    Translation:Humans
    24. Survival benefit of implantable cardioverter-defibrillators in left ventricular assist device-supported heart failure patients. J Card Fail. 2012 Feb; 18(2):140-5. Refaat MM, Tanaka T, Kormos RL, McNamara D, Teuteberg J, Winowich S, London B, Simon MA. PMID: 22300782.
      View in: PubMed   Mentions: 15     Fields:    Translation:Humans
    25. Decision tree for adjuvant right ventricular support in patients receiving a left ventricular assist device. J Heart Lung Transplant. 2012 Feb; 31(2):140-9. Wang Y, Simon MA, Bonde P, Harris BU, Teuteberg JJ, Kormos RL, Antaki JF. PMID: 22168963.
      View in: PubMed   Mentions: 16     Fields:    Translation:Humans
    26. Impact of renal function before mechanical circulatory support on posttransplant renal outcomes. Ann Thorac Surg. 2011 May; 91(5):1348-54. Singh M, Shullo M, Kormos RL, Lockard K, Zomak R, Simon MA, Bermudez C, Bhama J, McNamara D, Toyoda Y, Teuteberg JJ. PMID: 21524442.
      View in: PubMed   Mentions: 6     Fields:    Translation:Humans
    27. Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy: association of its resolution with improvements in ventricular function. JACC Cardiovasc Imaging. 2011 May; 4(5):445-56. Tanaka H, Tanabe M, Simon MA, Starling RC, Markham D, Thohan V, Mather P, McNamara DM, Gorcsan J. PMID: 21565730.
      View in: PubMed   Mentions: 13     Fields:    Translation:Humans
    28. Right ventricular dysfunction and failure in chronic pressure overload. Cardiol Res Pract. 2011 Mar 23; 2011:568095. Simon MA, Pinsky MR. PMID: 21559218.
      View in: PubMed   Mentions:
    29. Early adverse events as predictors of 1-year mortality during mechanical circulatory support. J Heart Lung Transplant. 2010 Sep; 29(9):981-8. Genovese EA, Dew MA, Teuteberg JJ, Simon MA, Bhama JK, Bermudez CA, Lockard KL, Winowich S, Kormos RL. PMID: 20580265.
      View in: PubMed   Mentions: 8     Fields:    Translation:Humans
    30. Pulsatile left ventricular assist device support as a bridge to decision in patients with end-stage heart failure complicated by pulmonary hypertension. J Heart Lung Transplant. 2010 Feb; 29(2):201-8. Nair PK, Kormos RL, Teuteberg JJ, Mathier MA, Bermudez CA, Toyoda Y, Dew MA, Simon MA. PMID: 20113910.
      View in: PubMed   Mentions: 9     Fields:    Translation:Humans
    31. Left ventricular remodeling and myocardial recovery on mechanical circulatory support. J Card Fail. 2010 Feb; 16(2):99-105. Simon MA, Primack BA, Teuteberg J, Kormos RL, Bermudez C, Toyoda Y, Shah H, Gorcsan J, McNamara DM. PMID: 20142020.
      View in: PubMed   Mentions: 13     Fields:    Translation:Humans
    32. Tissue Doppler imaging of right ventricular decompensation in pulmonary hypertension. Congest Heart Fail. 2009 Nov-Dec; 15(6):271-6. Simon MA, Rajagopalan N, Mathier MA, Shroff SG, Pinsky MR, López-Candales A. PMID: 19925505.
      View in: PubMed   Mentions: 12     Fields:    Translation:Humans
    33. Incidence and patterns of adverse event onset during the first 60 days after ventricular assist device implantation. Ann Thorac Surg. 2009 Oct; 88(4):1162-70. Genovese EA, Dew MA, Teuteberg JJ, Simon MA, Kay J, Siegenthaler MP, Bhama JK, Bermudez CA, Lockard KL, Winowich S, Kormos RL. PMID: 19766801.
      View in: PubMed   Mentions: 31     Fields:    Translation:Humans
    34. Phenotyping the right ventricle in patients with pulmonary hypertension. Clin Transl Sci. 2009 Aug; 2(4):294-9. Simon MA, Deible C, Mathier MA, Lacomis J, Goitein O, Shroff SG, Pinsky MR. PMID: 20443908.
      View in: PubMed   Mentions: 12     Fields:    Translation:Humans
    35. Insights into the effects of contraction dyssynchrony on global left ventricular mechano-energetic function. Pacing Clin Electrophysiol. 2009 Feb; 32(2):224-33. Johnson L, Simon MA, Pinsky MR, Shroff SG. PMID: 19170912.
      View in: PubMed   Mentions: 2     Fields:    Translation:AnimalsCells
    36. Correlation of tricuspid annular velocities with invasive hemodynamics in pulmonary hypertension. Congest Heart Fail. 2007 Jul-Aug; 13(4):200-4. Rajagopalan N, Saxena N, Simon MA, Edelman K, Mathier MA, López-Candales A. PMID: 17673871.
      View in: PubMed   Mentions: 10     Fields:    Translation:Humans
    37. Right ventricular dyssynchrony in heart failure: a tissue Doppler imaging study. J Card Fail. 2006 May; 12(4):263-7. Rajagopalan N, Dohi K, Simon MA, Suffoletto M, Edelman K, Murali S, López-Candales A. PMID: 16679258.
      View in: PubMed   Mentions: 5     Fields:    Translation:Humans
    38. Differential exercise performance on ventricular assist device support. J Heart Lung Transplant. 2005 Oct; 24(10):1506-12. Simon MA, Kormos RL, Gorcsan J, Dohi K, Winowich S, Stanford E, Carozza L, Murali S. PMID: 16210122.
      View in: PubMed   Mentions: 5     Fields:    Translation:Humans
    39. Myocardial recovery using ventricular assist devices: prevalence, clinical characteristics, and outcomes. Circulation. 2005 Aug 30; 112(9 Suppl):I32-6. Simon MA, Kormos RL, Murali S, Nair P, Heffernan M, Gorcsan J, Winowich S, McNamara DM. PMID: 16159839.
      View in: PubMed   Mentions: 46     Fields:    Translation:Humans
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