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Pain

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Development And Validation Of The Pain Resilience And Optimism Scale (Pros), Wonjin Seo Jan 2024

Development And Validation Of The Pain Resilience And Optimism Scale (Pros), Wonjin Seo

Electronic Thesis and Dissertation Repository

Numerous self-report questionnaires have been used in pain research to explore patients' experiences. However, these questionnaires often employ negatively worded items that can potentially worsen patients' distress. In response to the emergence of positive psychology, this thesis aimed to develop a new questionnaire that adopts a positive and strengths-focused approach, incorporating resilience, to replace the negative items found in existing tools such as the Pain Catastrophizing Scale (PCS). First, the effectiveness of the Connor-Davidson Resilience Scale (CD-RISC) in measuring resilience following trauma was assessed through a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments …


Psychological Distress, Resilience, And The Impact On Quality Of Life In Breast Cancer Survivors With Taxane-Induced Peripheral Neuropathy, Lauren Schwab Nov 2023

Psychological Distress, Resilience, And The Impact On Quality Of Life In Breast Cancer Survivors With Taxane-Induced Peripheral Neuropathy, Lauren Schwab

USF Tampa Graduate Theses and Dissertations

The purpose of this dissertation study was to longitudinally examine psychological distress (depressive symptoms and anxiety symptoms), resilience, and the impact on quality of life (QOL) in breast cancer survivors (BCS) with taxane-induced peripheral neuropathy (TIPN). The specific aims were 1) to describe psychological distress (depressive and anxiety symptoms) in BCS with TIPN and the impact on QOL using a scoping review; 2) to determine the relationship between psychological distress, QOL, and resilience in BCS with TIPN over time in a 16-week randomized controlled trial (RCT); and 3) to determine if resilience moderates psychological distress and QOL in BCS with …


Unveiling Pain: Wearables For Objective Pain Measurement, Hanqing Tang Jun 2023

Unveiling Pain: Wearables For Objective Pain Measurement, Hanqing Tang

Masters Theses

">">Pain perception is a subjective experience that differs significantly among individuals, often leading to inconsistencies in assessment and management. A critical issue within this context is the gender bias in pain evaluation, which contributes to unequal treatment and perpetuates gender inequality within the healthcare system. This thesis presents an in-depth investigation of the problem and proposes the development of a wearable device for objective pain assessment. Physiological parameters — Electrocardiography (ECG) can be collected from cardiac sound signals auscultated by fabrics via nanometre-scale vibrations. Machine learning methods can accurately classify heart rate and acute pain intensity of participants. …


Connecting Linguistic Expressions And Pain Relief Through Transformer Model Construction And Analysis, Sarah M. Chacko May 2023

Connecting Linguistic Expressions And Pain Relief Through Transformer Model Construction And Analysis, Sarah M. Chacko

Computer Science Senior Theses

Chronic pain is a widespread problem that significantly impacts quality of life. Overprescription and abuse of pain medication continues to be a major public health issue and can further burden patients due to a fragmented health care system. Previous research has suggested a possible psychological basis to pain and the potential for safer, non-pharmacological alternatives for pain relief. This project leverages language models to study chronic pain development and relief through psychological treatments, which will be assessed through responses to post-treatment interviews. A transformer-based natural language processing model is employed to identify connections between language expressions and pain on a …


A Comparison Of Erector Spinae Plane Block And Epidural Analgesia For Major Abdominal Surgery, Charles Serrano May 2023

A Comparison Of Erector Spinae Plane Block And Epidural Analgesia For Major Abdominal Surgery, Charles Serrano

Doctor of Nursing Practice Projects

A large tertiary care center in central Illinois saw an increase in erector spinae plane (ESP) block administration for abdominal surgery patients, but many anesthesia providers at the facility were not acquainted with the ESP block. This project aimed to develop a comprehensive educational program concerning the ESP block compared to thoracic epidural analgesia for major abdominal surgery patients and ultimately improve patient care. The program introduced the relevant anatomy, indications, technique, advantages, and disadvantages of ESP block and epidural analgesia. Additionally, the risks, benefits, and costs of both adjunctive therapies were compared. The current literature shows that the thoracic …


Effects Of Cannabichromene On Pain And Neuroinflammation In Hiv-1 Tat Transgenic Mice, Sydney Wheeler Apr 2023

Effects Of Cannabichromene On Pain And Neuroinflammation In Hiv-1 Tat Transgenic Mice, Sydney Wheeler

Honors Theses

HIV-1 TransActivator of Transcription (Tat) is a vital regulatory protein involved in HIV replication and implicated in development of HIV-associated pain and neurocognitive deficits. Tat is thought to contribute to these pathologies through proinflammatory pathways. Developing mechanisms to curb Tat-mediated inflammation is a key step in improving the quality of life of those living with HIV. Both recreational and medicinal cannabis use is prevalent among many people living with HIV; given this prevalence and the perceived anti-inflammatory benefits of cannabis use, it is important to investigate how chemical constituents of cannabis may impact HIV. In the present study, the effects …


Pectoralis Nerve Block Compared To Thoracic Paravertebral Nerve Block In The Mastectomy Patient: Evidence-Based Practice Recommendations, Eric Boyer Apr 2023

Pectoralis Nerve Block Compared To Thoracic Paravertebral Nerve Block In The Mastectomy Patient: Evidence-Based Practice Recommendations, Eric Boyer

Doctor of Nursing Practice Scholarly Projects

Patients undergoing a mastectomy are at increased risk of becoming opioid dependent. Most patients undergoing a mastectomy are diagnosed with breast cancer, and the use of opioids is known to aid in cancer metastasizing due to the suppression of the body's natural killer cells. In addition, regional anesthesia, also known as a nerve block, has long provided a reduction in sensation by blocking the nerve pathway, thus numbing the feeling of pain in the operative area. The Pectoralis nerve block (PECS) and the Thoracic Paravertebral block (TPVB) are used in patients undergoing a mastectomy to help reduce the severity of …


Perioperative Pain Control: Evaluating Best Practices In Perioperative Pain Measures, Lisa M. Malakowsky Mar 2023

Perioperative Pain Control: Evaluating Best Practices In Perioperative Pain Measures, Lisa M. Malakowsky

Doctor of Nursing Practice Projects

Background

Postoperative pain is contributing to the nation's opioid epidemic. Pain is an unpleasant sensation felt by the patient. When it is experienced postoperatively, it is a result of the surgical process. Patients up to 80% worldwide state that their pain is not controlled to their satisfaction. When postoperative pain is not treated adequately, it can contribute to chronic pain.

Purpose

Perioperative pain assessment and treatment policy at a rural critical access hospital and compare it to evidence-based guidelines for best practice. The project assessed the patient's pain treatment effectiveness compared to the pain management policy by using the CDC …


Mesenchymal Stem Cell Use In The Treatment Of Osteoarthritis: A Literature Review, Samantha Arrizon, Nolan Barnes, Teresa Del Toro, Lei Wena Herme, Vanessa Mendoza, Thi Tran, Reeta Zamro Jan 2023

Mesenchymal Stem Cell Use In The Treatment Of Osteoarthritis: A Literature Review, Samantha Arrizon, Nolan Barnes, Teresa Del Toro, Lei Wena Herme, Vanessa Mendoza, Thi Tran, Reeta Zamro

Physician Assistant Studies | Literature Reviews

Mesenchymal stem cell (MSC) therapies have been growing in popularity in research due to their anti-inflammatory, immunomodulatory, and regenerative properties. Many ongoing clinical trials are investigating the safety and efficacy of MSC therapies to treat osteoarthritis, also known as “wear and tear” arthritis. As the average life expectancy increases, with age people are more prone to developing this disease, therefore, increasing its prevalence. This condition is progressive and will lead to functional decline, decreased quality of life, and increased medical costs. Our focus is to discuss the efficacy of mesenchymal stem cell injections in alleviating pain, improving functionality, and slowing …


Virtual Reality Pain Intervention For Pediatric Burn Patients, Tanya Ann Hinrichs Jan 2023

Virtual Reality Pain Intervention For Pediatric Burn Patients, Tanya Ann Hinrichs

Theses and Graduate Projects

Burns can be devasting trauma in the pediatric population, leading to lifelong physical and psychological pain and anxiety. Burn pain management is complicated and undertreated traditionally. The purpose of this scholarly project is to examine the use of virtual reality (VR) for distraction in pediatric patients who have experienced a burn to determine if VR improves pain management during painful procedures. A literature review revealed a gap in pain management in pediatric burn survivors with just traditional pharmacologic analgesia during painful procedures. Leininger’s Culture Care Theory provides a theoretical framework for this project’s purpose to determine if implementing a virtual …


Benefits Of Medical Thc For Neurological Disorders In The U.S., Andrew Lester, Alexandria Gartin Jan 2023

Benefits Of Medical Thc For Neurological Disorders In The U.S., Andrew Lester, Alexandria Gartin

Theses, Dissertations and Capstones

Introduction: The introduction of THC into the medical field has allowed medical professionals to offer a new treatment option to aid in their patients treatment plan by decreasing their symptoms of side effects of other medications used for their conditions.

Methodology: This study utilized a literature review. Five databases were used to collect 116 total sources. These sources were reviewed and reduced to 33 sources that were used in the written research. Of these, 16 sources were used in the results section.

Purpose of the Study: The purpose of this research was to analyze the prescription use of …


Cultural Perspectives In Pain And Palliative Care, Loan Lagué Jan 2023

Cultural Perspectives In Pain And Palliative Care, Loan Lagué

Master's Projects

Culturally and linguistically diverse (CALD) patients are constantly challenged by the different levels on which lack of cultural competency or bias occurs in healthcare. This literature review focuses on the healthcare providers’ experiences when providing pain and palliative care to CALD populations and explores the challenges that may result in health inequalities. A review of current literature was conducted using PubMed, CINHAL, Sage Journals, Ovid, and Science Direct electronic databases. Sixteen published articles between 2015-2023 were reviewed. Findings from this review identified factors that induce poor quality palliative, pain, and end-of-life (EOL) care among culturally diverse groups. Improving quality of …


The Effectiveness Of Laser Acupuncture In Pain Management: A Systematic Review, June Park Jan 2023

The Effectiveness Of Laser Acupuncture In Pain Management: A Systematic Review, June Park

Theses and Graduate Projects

Background: Pain is a common symptom across many medical conditions that patients experience. Pain management is complex and may need a combination of several management techniques. Laser acupuncture(LA) has been previously used as an adjunct to conventional pain treatments.

Objective: This systematic review aims to evaluate the effectiveness of laser acupuncture in various fields of medical situations such as chronic pain, low back pain, osteoarthritis, osteoporosis, postoperative pain and dental procedures.

Methods: A computer based literature search of databases through GoogleScholar and PubMed was used to identify randomized controlled trials(RCTs) published after 2018 that studied the effect of LA in …


Registered Nurses’ Perceptions Regarding Postoperative Pain Management And Opioids For Adolescents, Susan Miller Jan 2023

Registered Nurses’ Perceptions Regarding Postoperative Pain Management And Opioids For Adolescents, Susan Miller

Walden Dissertations and Doctoral Studies

More than 2.4 million children undergo surgery annually in the United States and many experience postoperative pain. Poor pain management causes negative outcomes to both the individual and society. Increased rates of prescription drug misuse and rising death rates for adolescents from drug overdoses underscore the need for improvements in pain management. However, there is a lack of research, limited guidelines, and significant provider variability in managing adolescents’ acute postoperative pain. The purpose of this qualitative study was to explore the topic of acute postoperative pain management for adolescents through the lens of registered nurses (RNs). Nurses play an essential …


Registered Nurses’ Perceptions Regarding Postoperative Pain Management And Opioids For Adolescents, Susan Miller Jan 2023

Registered Nurses’ Perceptions Regarding Postoperative Pain Management And Opioids For Adolescents, Susan Miller

Walden Dissertations and Doctoral Studies

More than 2.4 million children undergo surgery annually in the United States and many experience postoperative pain. Poor pain management causes negative outcomes to both the individual and society. Increased rates of prescription drug misuse and rising death rates for adolescents from drug overdoses underscore the need for improvements in pain management. However, there is a lack of research, limited guidelines, and significant provider variability in managing adolescents’ acute postoperative pain. The purpose of this qualitative study was to explore the topic of acute postoperative pain management for adolescents through the lens of registered nurses (RNs). Nurses play an essential …


Knowledge & Attitudes Towards Pediatric Pain With Needle-Based Procedures In The Emergency Department Setting, Charlstyn Paige Brown Jan 2023

Knowledge & Attitudes Towards Pediatric Pain With Needle-Based Procedures In The Emergency Department Setting, Charlstyn Paige Brown

DNP Projects

PURPOSE: By the time a child enters kindergarten, they may have faced as many as thirty-three vaccine-related injections. Throughout these experiences, parents and patients associated pain and fear regarding the administration of multiple vaccines concurrently to a child has played a role in vaccine hesitancy and refusal. Parents and patients experience associated fear and pain regarding the administration of multiple concurrent scheduled vaccines, thus leading to vaccination hesitancy and refusal. In addition to scheduled immunizations, there is also the possibility of unexpected needle-based procedures taking place when emergencies arise. The purpose of the study is to explore the current …


The Lived Experiences Of Pain And Fatigue In Persons Living With Neurological Conditions: A Phenomenological Study, Lauren L. Kane Oct 2022

The Lived Experiences Of Pain And Fatigue In Persons Living With Neurological Conditions: A Phenomenological Study, Lauren L. Kane

Electronic Thesis and Dissertation Repository

Purpose: The aim of the study was to understand the experiences and impact of pain and fatigue and to further explore the relationship between participants' descriptions of their lived experiences with these phenomena within and across multiple sclerosis, Parkinson's disease, and cerebral palsy. Methods: Semi-structured interviews were used to interview nine participants about their experiences of living with pain and fatigue in their respective conditions. A new phenomenological approach was adopted, and data was analyzed inductively using interpretive phenomenological analysis. Results: Three final themes including a lack of understanding, negative perceptions of pain and fatigue, and coping strategies used to …


An Interpretative Phenomenological Analysis Of The Lived Experience Of Parental Caregivers For Children With Severe Epidermolysis Bullosa, Michael J. Valentine May 2022

An Interpretative Phenomenological Analysis Of The Lived Experience Of Parental Caregivers For Children With Severe Epidermolysis Bullosa, Michael J. Valentine

Theses and Dissertations

Providing care to child with a chronic, rare diseases has been identified as a major life stressor with a myriad of negative physical and mental health consequences. These stresses have previously been found to create burden that may impair caregiving efforts and increase the risk of mortality for both the caregiver and affected child. Many rare diseases affect children. It is not known how caregiver burden and the source of stress varies by disease. Qualitative methods have been used to understand caregiver experience with the rare disease, epidermolysis bullosa (EB), but no such studies have occurred in the United States. …


Ethical Sensitivity Of Padis Care Among Critical Care Nurses: A Mixed Methods Study, Denise Waterfield May 2022

Ethical Sensitivity Of Padis Care Among Critical Care Nurses: A Mixed Methods Study, Denise Waterfield

Theses & Dissertations

Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. To better understand the complexities of PADIS care, two reviews of the literature were completed. The first is an integrative review of the use of PADIS assessment tools by critical care nurses. The second is a qualitative systematic review of the literature on the integration of care ethics and nursing workload. Ethical sensitivity of everyday …


Vasovagal Syncope During Venipuncture:Alleviating Symptoms Through Leg Muscle Tension And Moving Toes Sequentially, Velina Andrewski May 2022

Vasovagal Syncope During Venipuncture:Alleviating Symptoms Through Leg Muscle Tension And Moving Toes Sequentially, Velina Andrewski

Doctor of Nursing Practice Projects

Venipuncture is a common medical procedure and is considered safe and routine. However, intermittent cases occur where patients develop symptoms of lightheadedness, nausea, weakness, and occasionally a full syncopal episode due to needle phobia, blood phobia, and pain associated with venipuncture. Vasovagal Reactions (VVR) or Vasovagal Syncope (VVS) during a venipuncture procedure can be distressing for the patient, the clinician, and disruptive to clinic routines. This paper examines whether techniques such as simple leg tensing and wiggling of toes can reduce or abort VVR/VVS completely as the patient undergoes venipuncture. Clinicians were instructed in techniques to use if the patient …


Efficacy Of Δ-9-Tetrahydrocannabinol For Hiv-Related Neuropathic Pain, Kaia Horne May 2022

Efficacy Of Δ-9-Tetrahydrocannabinol For Hiv-Related Neuropathic Pain, Kaia Horne

Honors Theses

Despite the availability and success of antiretroviral therapeutics, ~30% of patients living with HIV experience neuropathic pain that is often intractable. The mechanisms are not known, but there is evidence to support a role for the HIV virotoxins, Tat and/or gp120, which can damage or degenerate neurons and peripheral nerves. One mechanism by which Tat and gp120 promote nerve damage involves the stimulation of proinflammatory cytokine production from immune cells which can damage or kill bystander cells. Notably, compounds found in Cannabis exert anti-inflammatory effects and many studies report HIV patients to consume more marijuana than seronegative individuals. When people …


Pain Is Personal: Understanding Pain Relativity And The Importance Of The Biopsychosocial Model, Riley Kathleen Magoon '22 May 2022

Pain Is Personal: Understanding Pain Relativity And The Importance Of The Biopsychosocial Model, Riley Kathleen Magoon '22

Honor Scholar Theses

Pain is undoubtedly a universal concept; however, the way in which one experiences pain is vastly different depending on the individual. These variations are due to pain reflecting one’s identity which encompasses expansive factors including age, sex, ethnicity, coping mechanisms, and past experiences. Because pain is multidimensional, healthcare providers need to integrate a method that treat patients comprehensively. The biopsychosocial approach prioritizes extensive assessment and treatment as well as consistent communication between patient and provider. For healthcare to implement more effective and empathetic care, the biopsychosocial model needs to be integrated in more fields of medicine. This implementation begins with …


Ameliorative Effects Of Minor Cannabinoids Over Hiv-1 Tat-Mediated Visceral Pain, Charlie Worth Apr 2022

Ameliorative Effects Of Minor Cannabinoids Over Hiv-1 Tat-Mediated Visceral Pain, Charlie Worth

Honors Theses

As the total number of people living with HIV continues to rise across the world, an effective HIV treatment is still sought after. While modern-day advanced therapies exist for mitigating much of the negative effects of HIV, the virus remains evasive and problematic in the central nervous system. Thus, even with treatment, many people living with HIV continue to suffer from a plethora of symptoms. However, a large proportion of HIV-positive patients claim to feel a reduction in those persevering symptoms after cannabis usage. This anecdotal evidence has sparked interest in the efficacy of cannabis constituents for HIV therapy. This …


Music As A Treatment For Perceived Postoperative Pain In Adults: A Critically Appraised Topic, Savannah G. Mcdaniel Apr 2022

Music As A Treatment For Perceived Postoperative Pain In Adults: A Critically Appraised Topic, Savannah G. Mcdaniel

Honors College Theses

Clinical Question: In postoperative patients, how does listening to music affect perceived pain levels? Clinical Bottom Line: There is consistent evidence to suggest music decreases perceived pain in postoperative patients undergoing nasal septal surgery, open heart surgery, total knee replacement surgery, and general orthopedic surgeries requiring hospitalization. Athletic trainers can confidently implement music during patients’ post-operative care sessions to help reduce pain.


Proposal Of A Clinical Practice Guideline For A Non-Pharmacologic Music Listening Complementary Pain Therapy, Alec Smith, Sean Lawler, Joel Griffith Apr 2022

Proposal Of A Clinical Practice Guideline For A Non-Pharmacologic Music Listening Complementary Pain Therapy, Alec Smith, Sean Lawler, Joel Griffith

Doctor of Nursing Practice Scholarly Projects

Background: As many as 65% of post-surgical patients experience moderate to severe pain. Post-surgical pain is associated with a variety of negative physical and psychological consequences for patients. Currently, medical treatments for postoperative pain rely heavily on pharmaceuticals which can cause adverse side effects. Opioid analgesics, most notably, cause hypoventilation, apnea, and in some cases, dependence and addiction. In 2017, in response to state and national opioid prescription reduction programs, The Joint Commission (TJC) began requiring healthcare institutions to provide patients with non-pharmacologic pain treatment modalities. These pain treatment modalities, also known as complementary therapies, include music listening interventions, which …


The Genetics Of Pain: An Exploration Of Gene-By-Environment Interactions And Their Effects On Pain, Mohamad F. Fakhereddin Jan 2022

The Genetics Of Pain: An Exploration Of Gene-By-Environment Interactions And Their Effects On Pain, Mohamad F. Fakhereddin

Electronic Thesis and Dissertation Repository

The findings presented in this dissertation are part of the bigger SYMBIOME project which aims to use the biopsychosocial model of pain to develop a prognostic clinical phenotype for people that experience musculoskeletal (MSK) trauma. Chapter 2 presents an exploratory analysis to assess the relationships between genetic polymorphisms and pain severity and interference. Early childhood trauma was also explored as a moderator between genetic polymorphisms and pain outcomes. For pain severity, major allele carriers (A/A and G/A) of FKBP5 rs9394314 reported significantly higher scores than minor allele carriers (G/G). Further, major allele carriers who had at least one adverse childhood …


Does The Application Of Kt Tape Decrease Pain In Chronic Low Back Pain?, Jordan Vitelli Jan 2022

Does The Application Of Kt Tape Decrease Pain In Chronic Low Back Pain?, Jordan Vitelli

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine “Does the application of KT tape decrease pain in chronic low back pain?”

Study Design: A systematic review of three randomized controlled trials (RCTs) published between 2018 and 2019.

Data Sources: The three RCTs were published in English in peer reviewed journals and obtained from PubMed. The studies were selected based on their relevance to the clinical question.

Outcome Measured: The outcome measured within all three RCTs was pain intensity using the Visual Analog Scale (VAS). The VAS scoring ranges from 0 to 10, defining 0 as no pain …


Does Dance Therapy During Active Labor Reduce Labor Pain?, Sarah E. Naber Jan 2022

Does Dance Therapy During Active Labor Reduce Labor Pain?, Sarah E. Naber

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine “Does dance therapy during active labor decrease labor pain?”

STUDY DESIGN: A systematic review of two randomized control trials and a cohort study that were published in English between 2014 and 2020.

DATA SOURCES: Three studies were obtained from PubMed, Alt HealthWatch, and AMED. They were all published in peer-reviewed journals and chosen based on their relevance to the clinical question proposed.

OUTCOMES MEASURED: The main outcome measured in all three studies is pain during active labor. Pain was measured in all studies using the visual analog scale (VAS). …


Is Transcutaneous Electrical Nerve Stimulation (Tens) An Effective Treatment For Pain Caused By Knee Osteoarthritis?, Zuhra Nassery Jan 2022

Is Transcutaneous Electrical Nerve Stimulation (Tens) An Effective Treatment For Pain Caused By Knee Osteoarthritis?, Zuhra Nassery

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “is TENS an effective treatment for pain caused by knee osteoarthritis?”.

Study Design: A systematic review of three randomized controlled trials (RCTs) published between 2012 and 2019.

Data Sources: All RCTs were discovered utilizing PubMed. The articles were published in English in peer-reviewed journals and selected based on applicability and pertinence to the clinical question as well as the incorporation of patient-oriented outcomes.

Outcome Measured: Knee pain was the outcome measured using the Visual Analog Scale (VAS), which requires participants to draw a mark between the …


The Efficacy Of The Role Of Therapeutic Play In Alleviating Pain Or Anxiety In Pediatric Cancer Patients, Savannah B. Duke Jan 2022

The Efficacy Of The Role Of Therapeutic Play In Alleviating Pain Or Anxiety In Pediatric Cancer Patients, Savannah B. Duke

Honors Undergraduate Theses

Aim: To evaluate the efficacy of therapeutic play in alleviating pain or anxiety in the pediatric cancer patient.

Background: Therapeutic play is an intervention often incorporated within the care of pediatric cancer patients and children with other disease processes to promote well-being. Even though play therapy is supported by research, nurses have the option to implement nursing care interventions in a play-like manner. Therapeutic play is an individualized technique that provides an intentional opportunity for children to express their emotional responses in a controlled environment.

Method: The databases used in this search included CINAHL, MEDLINE, APA PsycINFO, ERIC, and Education …