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Full-Text Articles in Medicine and Health Sciences

The Future Of Public Health: Developing The Workforce Through Public Health Americorps, Kristi James May 2024

The Future Of Public Health: Developing The Workforce Through Public Health Americorps, Kristi James

Georgia Public Health Association Annual Meeting and Conference

The American Public Health Association (APHA) and its Alliance for Disease Prevention and Response worked closely with the Public Health AmeriCorps program (PHACP), CDC and AmeriCorps on a set of activities which strengthen workforce capacity. Within APHA and its Alliance for Disease Prevention and Response team, the assigned project consists of providing opportunities for Public Health AmeriCorps members and grantees to make new connections and increase engagement with those in the field. The overall goal of the project is to address the critical need for public health professionals by supporting the recruitment, training, and development of the next generation of …


Application Of Ultrasound For Difficult Vascular Access In Obstetric Patients, Carly Mccleland May 2024

Application Of Ultrasound For Difficult Vascular Access In Obstetric Patients, Carly Mccleland

Doctor of Nursing Practice Projects

This project aimed to create a three-tiered educational program to introduce the benefits of ultrasound application for peripheral IV placement in obstetrical patients. The main goals of this project were to increase successful first-attempt IV placement in obstetric patients who may be difficult to obtain IV access on. The first tier of education consisted of presenting findings from the literature review as an educational PowerPoint to all project stakeholders. The second tier of education included stakeholders practicing using the ultrasound for PIV placement on mannequin arms. The third tier, which is still on going, included implementation of the first two …


Procedural Sedation Training: Competency Verification Through Simulation, Christine Hawknuff May 2024

Procedural Sedation Training: Competency Verification Through Simulation, Christine Hawknuff

Doctor of Nursing Practice Projects

A 450-bed tertiary hospital in Central Illinois lacked a standardized process for competency verification for procedural sedation care by registered nurses (RNs). Despite recommendations by many organizations, there are no consistent or standardized guidelines for verifying competency in nursing care of the procedural sedation. This project implemented a Procedural Sedation Training Course which comprised an in-person prelearning lecture, a group simulation learning experience, and an individual verification of competency through simulation.

Fifty-six RNs completed the Procedural Sedation Training Course and demonstrated competency through simulation, and 24 of these RNs completed a procedural sedation within the eight-month pilot period. Qualitative and …


Development Of An Online Teaching Platform To Improve Access To Postgraduate Pathology Training In Sub-Saharan Africa, Richard Byers, Anita Byers, Chibamba Mumba, Angela Mutuku, Jennifer Singer-Rupp, Michael Wilson, Kenneth Fleming, Shahin Sayed May 2024

Development Of An Online Teaching Platform To Improve Access To Postgraduate Pathology Training In Sub-Saharan Africa, Richard Byers, Anita Byers, Chibamba Mumba, Angela Mutuku, Jennifer Singer-Rupp, Michael Wilson, Kenneth Fleming, Shahin Sayed

Pathology, East Africa

Background: Resource barriers to the provision of accessible training in cancer diagnosis in lower- and middle-income countries (LMICs) limit the potential of African health systems. Long-term provision via teaching visits from senior pathologists and trainee foreign placements is unsustainable due to the prohibitive costs of travel and subsistence. Emerging eLearning methods would allow pathologists to be trained by experts in a cheaper, more efficient, and more scalable way.

Purpose: This study aimed to develop an online teaching platform, starting with hematopathology, for trainee pathologists in sub-Saharan Africa, initially in Nairobi, Kenya, and Lusaka, Zambia.

Methods: Course materials …


Development Of An Evidence-Based Crna Preceptor Training Program, Emmanuel Mensah Apr 2024

Development Of An Evidence-Based Crna Preceptor Training Program, Emmanuel Mensah

Doctor of Nursing Practice Scholarly Projects

A preceptor is an experienced clinician who is expected to facilitate a student's learning experience. Preceptorship is the relationship between a staff nurse and student, focusing on the development of clinical skills and knowledge. Initially introduced by Florence Nightingale in the 1800s, the concept was quickly adopted by nurse anesthetists and is a staple of the anesthesia practice today. As it stands, many Certified Registered Nurse Anesthetists (CRNA) preceptors do not receive formal training in their role, which may lead to a decrease in teaching ability and confidence to face broad teaching-learning issues. A lack of preparation hinders preceptor outcomes …


Development Of Teacher Training Program, Manual, & Curriculum Guide For Inclusive Dance Studio, From An Occupational Therapy Perspective, Susanna C. Dunn Apr 2024

Development Of Teacher Training Program, Manual, & Curriculum Guide For Inclusive Dance Studio, From An Occupational Therapy Perspective, Susanna C. Dunn

OTD Capstone Projects

This capstone project was completed in collaboration with MOVE Inclusive Dance, a nonprofit, inclusive dance studio specifically serving individuals of all ages with various disabilities. A needs assessment conducted with the staff at MOVE necessitated a cohesive teacher manual, including teacher training protocol, disability index, safety precautions, sample class activities, curriculum guide, and more. The focus of this capstone was to create and distribute a teacher training manual to dance teachers at MOVE Inclusive Dance. The teacher training manual was created using anonymous pre and post test qualitative and quantitative surveys to assess teacher perceptions regarding feelings of confidence and …


An Exploration Of Self-Reported Training Needs For Anxiety Interventions Among Primary Care Behavioral Health Consultants, Katherine Buckheit, Ryan Willard, Kyle Possemato, Robyn Shepardson, Abigail Lashinsky, Jen Funderburk Apr 2024

An Exploration Of Self-Reported Training Needs For Anxiety Interventions Among Primary Care Behavioral Health Consultants, Katherine Buckheit, Ryan Willard, Kyle Possemato, Robyn Shepardson, Abigail Lashinsky, Jen Funderburk

The Journal of Integrated Primary Care

Introduction: Despite the need for greater training in evidence-based interventions for the treatment of anxiety in primary care behavioral health (PCBH), there are limited data on which interventions are desired by behavioral healthcare consultants (BHCs). The objective of this study was to identify which interventions BHCs desired more training in when treating anxiety in PCBH practice, and to examine if this preference was associated with theoretical orientation. Method: We conducted an online survey of PCBH providers regarding their training preferences for treatment of anxiety symptoms. The final sample comprised 291 BHCs recruited from e-mail listservs of national professional organizations. Providers …


Cortisol Production In Female Soccer Players, Katelyn Seagraves Apr 2024

Cortisol Production In Female Soccer Players, Katelyn Seagraves

ASPIRE 2024

Cortisol is released from the adrenal glands when there is an apparent stressor. Exercise, while beneficial, is seen as stress to the body and incites increased cortisol release. Cortisol is known to increase with exercise, and higher-intensity exercise tends to raise cortisol more compared to lower intensities. However, less is known about interval training and cortisol concentrations.

This review of literature dives into the background of cortisol: how it's produced, what systems it regulates, and differences in production based on gender, stressors, exercise intensity, and duration. This paper identifies some knowledge gaps and links training intensities in soccer to cortisol …


Cortisol Production In Female Soccer Players, Katelyn Seagraves Apr 2024

Cortisol Production In Female Soccer Players, Katelyn Seagraves

Honors Projects

Cortisol is released from the adrenal glands when there is an apparent stressor. Exercise, while beneficial, is seen as stress to the body and incites increased cortisol release. Cortisol is known to increase with exercise, and higher-intensity exercise tends to raise cortisol more compared to lower intensities. However, less is known about interval training and cortisol concentrations.

This review of literature dives into the background of cortisol: how it's produced, what systems it regulates, and differences in production based on gender, stressors, exercise intensity, and duration. This paper identifies some knowledge gaps and links training intensities in soccer to cortisol …


The Role Of Acgme-International In Enhancing Opportunities Of Residents For Advanced Subspecialty Training, James A. Arrighi, Lorraine C. Lewis, Thomas J. Nasca Apr 2024

The Role Of Acgme-International In Enhancing Opportunities Of Residents For Advanced Subspecialty Training, James A. Arrighi, Lorraine C. Lewis, Thomas J. Nasca

Department of Medicine Faculty Papers

No abstract provided.


Use Of Technology In Training Periop 101 Students, John Carroll, Bsn, Rn. Cnor. Tcrn, Rnfa, Annamarie R. Vrobel, Bsn, Rv, Cpt, Sarah Germanovich, Msn, Rn, Cnor, Tcrn Feb 2024

Use Of Technology In Training Periop 101 Students, John Carroll, Bsn, Rn. Cnor. Tcrn, Rnfa, Annamarie R. Vrobel, Bsn, Rv, Cpt, Sarah Germanovich, Msn, Rn, Cnor, Tcrn

Jefferson Hospital Staff Papers and Presentations

Presented at the 2024 Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo.


The Effect Of A Single Cycle Of Ischemia On Bar Velocity During Bench Press Exercise, Marta Bichowska-Pawęska, Dawid Gaweł, Robert Trybulski, Jakub Jarosz, Kinga Łosińska, Krzysztof Fostiak, Joao Guilherme Vieira Feb 2024

The Effect Of A Single Cycle Of Ischemia On Bar Velocity During Bench Press Exercise, Marta Bichowska-Pawęska, Dawid Gaweł, Robert Trybulski, Jakub Jarosz, Kinga Łosińska, Krzysztof Fostiak, Joao Guilherme Vieira

Baltic Journal of Health and Physical Activity

Introduction: The main goal of this study was to investigate the effects of a single cycle of ischemia applied before the bench press exercise on acute bar velocity changes. Materials and Methods: Twelve physically active males participated in the study. The experiment followed a rando-mized, cross-over design under two testing conditions. The experimental condition involved the application of a single cycle of ischemia (5 minutes; 80% arterial occlusion pressure [AOP]) before the first set of bench press exercise (2 sets at 60% 1RM). The control condition did not use ischemia. The peak and mean bar velocities were measured using a …


Addressing Bias In Slp Problem-Based Tutorials Through Critical Reflexivity, Curriculum Development And Instructor Training, Harmonie Chan, Courtney Tidd, Justine Hamilton, Deidre Sperry, Michelle Phoenix Feb 2024

Addressing Bias In Slp Problem-Based Tutorials Through Critical Reflexivity, Curriculum Development And Instructor Training, Harmonie Chan, Courtney Tidd, Justine Hamilton, Deidre Sperry, Michelle Phoenix

Teaching and Learning in Communication Sciences & Disorders

Racism is prevalent in the fields of healthcare and education in North America and speech-language pathology and audiology are no exception. Systemic and individual racism in educational, training, and clinical settings creates barriers for student entry and success, and negatively impacts client care. Although the ability to serve clients of diverse backgrounds is a crucial skill for students and clinicians, current educational curricula appears insufficient in supporting culturally diverse students and preparing all students to work with culturally diverse populations. This is, in part, due to a lack of diverse representation in education and clinical settings, bias experienced by SLP …


Implementation Of Unit-Based Preceptor Orientation: The Effects On Perceived Orientee Competence And Self-Confidence Of The Precepting Cvicu Nurse, Laura K. Marcum Jan 2024

Implementation Of Unit-Based Preceptor Orientation: The Effects On Perceived Orientee Competence And Self-Confidence Of The Precepting Cvicu Nurse, Laura K. Marcum

DNP Projects

Purpose: The purpose of this study was to assess how unit-specific preceptor training impacted the perceived readiness of new graduate nurses, self-confidence of preceptors, and the correlated job satisfaction.

Background: The nurse attrition rate is resulting in inexperience at the bedside. Nursing inexperience leads to lower quality patient care. If improving the efficiency of training and education can improve perceived readiness, then in turn we can increase the longevity of our new nurses. Improving the longevity of nurses has significant implications on the budget of each hospital, the patient outcomes, and the staff’s resulting job satisfaction.

Methods: New graduate nurse …


Mentoring The Mentor: A Mentor Training Program, Sheri Gillis Jan 2024

Mentoring The Mentor: A Mentor Training Program, Sheri Gillis

Regis University Student Publications (comprehensive collection)

Mentorship has played an important role in nursing and nursing education for decades. However, there have yet to be any standard qualifications or training programs for those who mentor others. Poor mentorship increases faculty turnover, stress, and poor student outcomes. A quality improvement initiative was implemented in the Associate Degree Nursing Program using an evidence-based approach. Using a pre-post survey design with convenience sampling, five (N=5) nursing faculty met the qualifications to participate in the mentor training program. The Mentor Efficacy (MES) survey, which consisted of 30 questions, was administered to measure the participants' feelings of self-efficacy in the mentoring …


Different Methods Of Winning, Losing, And Training In Combat Sports And Their Relationship With Overall Competitive Winningness, Oliver R. Barley, Craig A. Harms Jan 2024

Different Methods Of Winning, Losing, And Training In Combat Sports And Their Relationship With Overall Competitive Winningness, Oliver R. Barley, Craig A. Harms

Research outputs 2022 to 2026

This study aimed to investigate how overall competitive winningness in combat sports depended on patterns of victory and loss, as well as training habits. Competitors (N = 280) from several combat sports participated in the study. The online survey included questions on self-reported patterns of victory (and loss), training habits, general demographics (e.g., age), and sport-specific information (e.g., stage of career and competitive style). Overall, it was found across four models that reflected diversity of winningness in combat sports that the most important predictors of competitive winningness were loss by points (negative), loss by submission (negative), loss (negative) or victory …


Analyzing Sex Differences In Human Performance Through 3d Isotonic Resistance, Jacob M. Cunha Jan 2024

Analyzing Sex Differences In Human Performance Through 3d Isotonic Resistance, Jacob M. Cunha

University of the Pacific Theses and Dissertations

Appraisal of scientific literature and understanding continues to grow in the domain of human performance. The effects of sex on concentric resistance training and power output are not well understood. Recent advancements in technology permit more precise measurements of force output and the kinematic changes elicited by training stress. A unique device in capturing kinematic performance output is Proteus Motion. The machine produces an external magnetic load through a protruding apparatus connected to a gyrosphere, which in turn captures concentric movement through all three planes of movement (sagittal, coronal, transversal). The aim of this study is to investigate power output …


Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik Dec 2023

Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik

Doctor of Nursing Practice (DNP) Projects

Developing and Implementing an Infection Prevention Practice Fellowship Program

Abstract

Background: The COVID-19 pandemic placed huge demands on infection prevention programs (Blanchard et al., 2022), seriously taxing a profession already mired with progressively increasing workload and responsibilities (Bryant et al., 2016).

Local Problem: In a rapidly changing environment, infection preventionists (IPs) contend with pandemic surges, emerging infections, and supply chain disruptions. The NCAL Region of an integrated health system experienced IP turnover, and in the absence of a formal training program, newly hired IPs experienced variable to no opportunities to develop their competencies.

Methods: A literature review on infection prevention …


Transformational Leadership Training For Leaders, Kristie Gilliland Dec 2023

Transformational Leadership Training For Leaders, Kristie Gilliland

Electronic Theses and Dissertations

The purpose of the study was to evaluate the impact of transformational leadership training on improving a leader’s skills and knowledge in performing daily operations and interacting with frontline staff, decreasing attrition. Ineffective leadership contributes to staff dissatisfaction, poor performance, and attrition. The literature supports transformational leadership is effective in leading teams of nurses and contributes to staff autonomy, staff satisfaction, decreased attrition, and improved patient outcomes. A quasi-experimental research study was completed on a leadership team in a managed care organization. Fourteen leaders with anywhere from 1 to more than 6 years of leadership experience were evaluated. Lewin’s change …


Exploring Midwives’ Challenges And Strategies To Provide Care In Maternity Settings During The Harsh Winter Weather In The Northern Areas Of Pakistan: A Qualitative Study, Sana Sultan Nov 2023

Exploring Midwives’ Challenges And Strategies To Provide Care In Maternity Settings During The Harsh Winter Weather In The Northern Areas Of Pakistan: A Qualitative Study, Sana Sultan

Theses & Dissertations

Background: Midwives play a vital role in enhancing the quality of care and achieving substantial reductions in maternal and newborn mortality rates. However, in Gilgit Baltistan, the harsh winter weather and frequent heavy snowfall present distinct challenges for midwives providing essential maternal care. These challenges can lead to an increased risk of maternal infections and newborn hypothermia. Consequently, the limited accessibility to healthcare facilities due to frequent harsh winter weather and the resulting scarcity of resources like heating, electricity, and water exacerbate the situation.
Objective: The study aims to explore the challenges and barriers midwives face in maternity settings and …


Stress Response To Winter Warfare Training: Potential Impact Of Location, Lauren M. Visconti, Andrea C. Givens, Lorraine P. Turcotte, Laura Arrington, Karen R. Kelly Nov 2023

Stress Response To Winter Warfare Training: Potential Impact Of Location, Lauren M. Visconti, Andrea C. Givens, Lorraine P. Turcotte, Laura Arrington, Karen R. Kelly

International Journal of Exercise Science: Conference Proceedings

Winter Warfare Training (WWT) is a critical component of military training to prepare individuals to move effectively in harsh conditions. Moving through snow and heavy terrain increases overall stress to the entire human system. PURPOSE: The purpose of this effort was to quantify the stress response during WWT to determine the level of physiological adaptation to extreme environments. METHODS: Mountain and mobility operators (age: 31.5±1.4 years; height: 71.1±0.5 inches; weight: 192.5±6.6 lbs.; body fat percentage: 18.0±5.0%) were recruited for this effort. Participants engaged in baseline laboratory metrics at their home station located in Colorado (CO) prior to WWT for one …


Strategy For Expanding Nutrition Professionals’ Competency: A Pilot Case Study In Dissemination And Implementation Science Training, Ayron E. Walker, Elizabeth A. Claydon, Samantha E. Scarneo-Miller, Daniel Totzkay, Melissa D. Olfert Nov 2023

Strategy For Expanding Nutrition Professionals’ Competency: A Pilot Case Study In Dissemination And Implementation Science Training, Ayron E. Walker, Elizabeth A. Claydon, Samantha E. Scarneo-Miller, Daniel Totzkay, Melissa D. Olfert

Health Behavior Research

Dissemination and Implementation (D&I) science trainings are essential to build knowledge among a variety of current and future health professionals.

The objective of this study was to pilot-test and assess implementation of a nutrition-specific D&I science training.

Participants (students enrolled in nutrition and public health programs) completed pre/post surveys and exit interviews. Descriptive statistics and a qualitative thematic analysis used deductive coding; in which coding and theme development are directed by existing concepts. Initial coding was completed by one researcher and validated by an additional researcher to describe and provide examples of the categories the Kirkpatrick Model and Implementation Outcomes …


Effectiveness Of Staff Training On Trauma-Informed Care, Brandy Tramel Williams Oct 2023

Effectiveness Of Staff Training On Trauma-Informed Care, Brandy Tramel Williams

Doctoral Projects

The connection between experiencing trauma and the development of substance use disorder is widely recognized. Although trauma is more prevalent among individuals with substance use disorders, healthcare professionals have limited access to training focused on trauma informed care. It is crucial for those working in addiction treatment to receive training and education on trauma informed care to understand the impact of trauma and its association with substance use disorders.

This DNP project's objective was to develop and evaluate an educational presentation for staff emphasizing the importance of trauma-informed care in the context of addiction. The effectiveness of this intervention was …


Cardiac Tamponade: Innovative Sternotomy Simulation Model For Training Pediatric Cardiac Intensive Care Team, Tolu Akinpelu, Mohammed Alhendy, Malarvizhi Thangavelu, Karen Weaver, Nicole Muller, James Mcelroy, Daniel Nento, Utpal Bhalala Sep 2023

Cardiac Tamponade: Innovative Sternotomy Simulation Model For Training Pediatric Cardiac Intensive Care Team, Tolu Akinpelu, Mohammed Alhendy, Malarvizhi Thangavelu, Karen Weaver, Nicole Muller, James Mcelroy, Daniel Nento, Utpal Bhalala

Research Symposium

Introduction: Cardiac tamponade occurring after cardiac surgery is rare but life threatening and requires simultaneous resuscitation and emergent sternotomy by the intensive care team. A simulated scenario using innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the face validity of this innovative mannequin, the confidence level and crisis resource management skills of the team during sternotomy to manage postoperative cardiac tamponade.

Methods: The simulation case scenario was developed using innovative sternotomy mannequin for children’s hospital cardiac intensive care unit (CICU) teams. The case involved a 3-year old male, intubated, mechanically …


Qi In Resident Leadership Workshop, Heidi Y. Pareja, Chelsea H. Chang, Daniel Aragon, Deepu George Sep 2023

Qi In Resident Leadership Workshop, Heidi Y. Pareja, Chelsea H. Chang, Daniel Aragon, Deepu George

Research Symposium

Background: Many residency programs provide some type of leadership training for chief residents. As these emerging leaders transition into their role, it is imperative to provide them with skills and knowledge to help them develop their leadership style. UTRGV’s department of Graduate Medical Education (GME) organized their first “Resident Leader Workshop” for all rising Chiefs and GME Resident Leadership Council (RLC) members. Using a pre and post survey, participants provided feedback on the effectiveness of knowledge and skills presented during the workshop.

Methods: All residency and fellowship rising Chiefs and GME RLC members were invited. The workshop took place …


Disabilities And Medicine: From Stairs To Stares, Christopher Denham Aug 2023

Disabilities And Medicine: From Stairs To Stares, Christopher Denham

HCA Healthcare Journal of Medicine

The current state of medicine has done little to correct the imbalance of underrepresented groups in the physician workforce. In this editorial, a psychiatric resident physician retells his experience as an individual who is completing his medical training while being affected by a neuromuscular disorder and how it impacts his daily life. The primary goal of this paper is to elucidate the need for greater representation and understanding of the disabled physician workforce.


(2021) Challenges To Interdisciplinary Behavioral Health Training During A Pandemic: A Qualitative Self-Review, Krystal Vaughn, George Hebert Aug 2023

(2021) Challenges To Interdisciplinary Behavioral Health Training During A Pandemic: A Qualitative Self-Review, Krystal Vaughn, George Hebert

Louisiana Journal of Counseling

This paper explores the new challenges that interdisciplinary health care training clinics have experienced for the respective disciplines of counseling and psychology amid the COVID-19 pandemic. Previous challenges among these disciplines has always included the differences in specialty areas, ethical codes; and practicum and internship requirements. This current qualitative self-review identified three emergent themes from a training/service delivery perspective: Cessation of In-person Training; Cessation of In-person Assessments and Therapy; and Certification Requirements for Telehealth. Each theme is discussed from both a benefit lens and a challenge lens considering a possible future time where these modifications may need to be adopted …


Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo Aug 2023

Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo

Master's Projects and Capstones

Problem: Transition patients at the end-of-life are those patients who are not mentally ready or physically eligible for hospice thus not enrolled in a Palliative or Hospice Program. Only one-third of the Transition patient census had completed and filed advance care plans. Healthcare providers are obligated to perform life-saving measures unless documented otherwise. A lack of advance care planning can create complicated scenarios and cause discordant care incidents.

Context: End-of-life care is a delicate subject to navigate conversations with patients. With holistic care being a large component of hospice and palliative care, it is important to have updated and accurate …


Robot Revolution: Impacting Adoption Of The Technology, Cece Noland Aug 2023

Robot Revolution: Impacting Adoption Of The Technology, Cece Noland

MSN Capstone Projects

The author examined the value of robotic guidance platforms in spine surgery, and then implemented an improvement project to positively impact internal (Medtronic employee) adoption of the technology. By promoting adoption, robotics will continue to advance the standard of care for spine surgery patients. This paper is to meet fulfillment of requirements for NURS5382 Capstone.


Recognition Of And Response To Obstetric Emergencies: Developing A Virtual Competency-Based Orientation Program, Susan Morrison Aug 2023

Recognition Of And Response To Obstetric Emergencies: Developing A Virtual Competency-Based Orientation Program, Susan Morrison

Student Scholarly Projects

In order to improve outcomes in the perinatal setting, the development of a Virtual Competency-Based Orientation Program (CBO) toolkit is vital. Two toolkits, namely the Alliance for Innovation on Maternal Health (AIM) and the California Maternal Quality Care Collaborative (CMQCC), have been identified as effective in enhancing perinatal outcomes. AIM is a national initiative focused on improving maternal health outcomes, promoting safer birth practices, and saving lives through the implementation of best practices. CMQCC is a multi-stakeholder organization in California committed to eliminating preventable morbidity, mortality, and racial disparities in maternity care. Both AIM and CMQCC CBO toolkits incorporate research, …