Digital Commons Network^™

Co-Designing An International Nursing Course On Workplace Violence In Ethiopia, Sweden, And Tanzania: A Collective Autoethnography, Martin Salzmann-Erikson, Elisabet Eriksson, Tilahun Saol Tura, Tumbwene Mwansisya, Loveluck Mwasha, Malin Jordal

School of Nursing & Midwifery, East Africa

This study explores whether and how the co-creation of an international university course on workplace violence served as a site of transformative learning for us as nursing educators across Sweden, Ethiopia, and Tanzania. Using collaborative autoethnography, our team of six faculty members critically reflected on pedagogical assumptions, educator identities, and experiences of cross-cultural collaboration. The data comprised written reflections, meeting transcripts, and observational notes. Through this process, our pedagogical approaches and professional identities were reshaped, shifting from content deliverers to reflective co-learners within the cross-cultural partnership. Our analysis highlights the interplay of cultural negotiation, logistical frictions, and unspoken yet influential …

Incorporating Social Determinants Of Health Into A Screening Tool Using Machine Learning To Predict Lung Cancer Diagnosis Among High Risk Patients, Bianca Jackson

Theses and Dissertations (ETD)

This research aims to assess the impact of incorporating social determinants of health (SDoH) into prediction screening models for predicting lung cancer among high risk-patients. Lung cancer is typically diagnosed at a later stage when surival and health outcomes are poor. Screening guidelines are currently in place; however, patients at high risk can be missed. There is a need for short-term predictions, to better identify patients at an earlier stage. SDoH features, such as socioeconomic satus, can provide social context that improves identification of patients who might have otherwise been overlooked. The proposed framework includes developing an early detection tool …

Navigating “Being Seen”: Experiences Of Older Adult Arab Immigrants And Family Caregivers Accessing Health Care Services In Ontario, Selma Tobah, Lorie Donelle Phd, Rn, Fcan, Jodi Hall, Lloy Wylie, Sandra Regan

Publications

Immigrants to Canada face unique barriers to accessing health care including communication barriers, socioeconomic limitations, and a lack of health care system navigation knowledge. Arabs in particular face mainstream negative attitudes, propagated through political discourses as well as entertainment media. We sought to understand how older adult Arab immigrants and family caregivers accessed and experienced health care in Ontario. We conducted a critical constructivist grounded theory, using Charmaz’s approach to grounded theory. A critical constructivist grounded theory method asks not only “what” social processes are happening and “how” but also “why” and “who” benefits. Both older adult immigrant Arabs and …

Harnessing Team Science In Dementia Research: Insights From The Alzheimer’S Disease Research Group In South Carolina, Sayema Akter, Eric Mishio Bawa, Nicholas Riccardi, Daniel A. Amoatika, Margaret C. Miller Ms, Ph.D., Otis L. Owens Mph, Ph.D., Caps, Lorie Donelle Phd, Rn, Fcan, E Angela Murphy, Daping Fan, Melissa Moss, Mihyun Lim Waugh, Sue E. Levkoff Scd, Msw, Sm, Freda Allyson Hucek, Jean Neils-Strunjas Ph.D, Ccc-Slp, Swann Arp Adams Ph.D., Ms, Face, Roger Newman-Norlund, Sarah Newman-Norlund Ph.D., James Hardin Ph.D., John Absher, Bankole A. Olatosi Ph.D., Xiaoming Li Ph.D., Lumi Bakos Ph.D., Quentin Mccollum, Chris Rorden, Leonardo Bonilha, Daniela B. Friedman

Publications

Alzheimer's disease and related dementias (ADRD) are complex and rapidly growing public health challenges that require integrative, collaborative approaches. To meet this need, the Alzheimer's Disease Research Center (ADRC) of South Carolina, a state-funded partnership across multiple institutions, has embraced a team science model that brings together expertise from four key disciplines: neuroimaging-neurology, health sciences, molecular biology, and engineering. This paper highlights the work at the University of South Carolina (USC) and how each discipline contributes uniquely yet collaboratively within a recurring loop model framework. Extending from USC's Cancer Prevention and Control Program, the framework guides scientific growth through four …

Variations In Postpartum Readmission By Individual Race, Ethnicity, And Rurality In South Carolina, Curisa M. Tucker Phd, Rn, Yunqing Ma, Jiajia Zhang Ph.D., Md Utba Rashid, Jihong Liu Sc.D., Berry Campbell, Xiaoming Li Ph.D., Peiyin Hung Ph.D, Msph

Publications

Importance Racial and ethnic disparities in postpartum readmission (PPR) remain a critical public health concern, with non-Hispanic Black individuals experiencing rates up to 3 times as high as non-Hispanic White individuals. PPR is often associated with mental health disorders (MHDs) and substance use disorders (SUDs), and barriers to care are particularly acute in rural communities. Objective To investigate intersections in the associations of individual residential rurality and race and ethnicity with all-cause, MHD-, and SUD-related PPR throughout 1 year post partum. Design, Setting, and Participants This statewide retrospective cohort study used data from birth certificates linked to all-payer hospital data …

The Effectiveness Of Trauma-Informed Care Education On The Self-Efficacy Of Pediatric Nurses: An Integrative Literature Review, Mackenzi N. King

Honors Undergraduate Theses

Pediatric nurses often care for patients who have experienced various forms of trauma, including medical traumatic stress, abusive head trauma, child maltreatment, and sex trafficking. Trauma-informed care (TIC) is a clinical approach that acknowledges the psychological and physical effects of trauma, supports the identification of trauma survivors, and seeks to prevent re-traumatization during healthcare encounters. Research has highlighted the need to improve nurses' self-efficacy in delivering TIC effectively. This integrative literature review explores the impact of TIC training on pediatric nurses’ knowledge, confidence, and competence in providing TIC. A comprehensive literature search was conducted using CINAHL Ultimate, APA PsychInfo, and …

A Systematic Review Of Dietary Trends, Influencing Factors, And Their Impacts On Cardiovascular Health In Turkish Populations, Pelin L. Özoğlu

Honors Undergraduate Theses

Cardiovascular disease (CVD) is the leading cause of death globally, including in Türkiye. One key factor influencing CVD prevention is dietary patterns, which directly impacts cardiovascular health. Türkiye traditionally follows the Mediterranean diet (MedDiet), which is acclaimed for its cardiovascular benefits. Despite this, Türkiye continues to experience high rates of CVD, with projections indicating that CVD mortality will double for both men and women by 2030. It is crucial to address diet-related factors, including potential nutritional deficiencies, to reduce cardiovascular health risks.

This research aims to analyze the Turkish community's adherence to the Mediterranean diet to understand why CVD prevalence …

Survivorship From Pediatric And Adult Brain Tumors: The 2024 Brain Tumor Epidemiology Consortium Meeting Report, Scott L Coven, Roberta Mckean-Cowdin, Michael E Scheurer, Kimberly J Johnson, Luc Bauchet, Carol Kruchko, Ching C Lau, Quinn T Ostrom, John Villano, Yan Yuan, Friederike Erdmann

Center for Medical Ethics and Health Policy Staff Publications

The Brain Tumor Epidemiology Consortium (BTEC) is an international organization with membership of individuals from the scientific community with interests related to brain tumor epidemiology, including surveillance, classification, methodology, etiology, and factors associated with morbidity and survival. The 2024 annual BTEC meeting entitled “Survivorship from Pediatric and Adult Brain Tumors” was held in Mainz, Germany, USA, on May 15–17, 2024. The meeting gathered scientists from Africa, Australia, Europe, and North America and included 4 keynote sessions focusing on brain tumor survivorship across the age spectrum. The meeting included 3 abstract sessions, which also included scientific talks around brain …

Determining Space Requirements For Small And Sick Newborns And Their Mothers In Health Facilities: A Systematic Review, Natalie Strobel, Georgia Whisson, Derek Swe, Rajesh Mehta, Amy Budrikis, Karen Edmond

Research outputs 2022 to 2026

Background There are currently no World Health Organization and United Nations Children Fund benchmarks or ‘norms’ for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals. Methods We included simulation, experimental, and observational studies, as well as guidelines …

Proximity To Cancer Rehabilitation And Exercise Oncology By Geography, Race, And Socioeconomic Status, Kathryn H. Schmitz, Kathryn Demanelis, Mary E. Crisafio, Mary A. Kennedy, Anna L. Schwartz, Anna Campbell, Jessica Gorzelitz, Kelley C. Wood, Christopher M. Wilson, Raymond L. Scalise, Alex Vincent

Research outputs 2022 to 2026

Background: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates.

Methods: This cross-sectional study was conducted in 2022–2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5-year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural-Urban Continuum …

Measuring The Impact Of A Catchment Area Surveillance Tool On Cancer Center Adopters, Todd Burus, Caree R. Mcafee, Natalie P. Wilhite, Pamela C. Hull

Markey Cancer Center Faculty Publications

Background: The University of Kentucky Markey Cancer Center developed the data gathering and visualization platform Cancer InFocus (CIF) as a solution for cancer center catchment area surveillance. CIF was released in June 2022 and made available for use to other institutions through a no‐cost licensing agreement. The purpose of this study was to evaluate the impact CIF has had on cancer centers since its release.

Methods: The authors adapted an existing management evaluation framework to assess the impact of CIF across three spheres—idea dissemination, product engagement, and adopter satisfaction. This assessment included an online survey administered between the dates of …

Capturing Community Perspectives In A Statewide Cancer Needs Assessment: Online Focus Group Study, Jessica R. Thompson, Keeghan Francis, Caree R. Mcafee, Madeline Brown, Todd Burus, Melinda Rogers, Connie L. Sorrell, Elizabeth A. Westbrook, Lovoria B. Williams, Jennifer Redmond Knight, Elaine Russell, Natalie P. Wilhite, Pamela C. Hull

Markey Cancer Center Faculty Publications

Background: Kentucky has the highest all-site cancer incidence and mortality rates in the United States. Conducting needs assessments in a large geographic area, such as an entire state, poses challenges in collecting qualitative data from diverse rural and urban contexts. In 2021, a steering committee was formed to drive a multimethod, statewide cancer needs assessment (CNA) to identify the future priorities for all cancer-related care in Kentucky.

Objective: We aimed to report on the online focus group component of the CNA by documenting existing community resources and perceived needs across the cancer care continuum. In addition, we aimed to explore …

Examining Geographic Disparity: Variation In Cancer Outcomes Within Appalachia, Todd Burus, Pamela C. Hull, Krystle A. Lang Kuhs, Tianyan Gao, Christine F. Brainson, B. Mark Evers

Markey Cancer Center Faculty Publications

BACKGROUND: 

The Appalachian region of the US extends from the Mississippi Delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed.

STUDY DESIGN: 

We calculated 5-year age-adjusted US cancer incidence and mortality rates for 2017 to 2021, stratified into Appalachian and non-Appalachian populations, as well as Appalachian subregions, using the US Cancer Statistics Incidence Analytics Database and National Center for Health Statistics mortality files. Annual rates for 2004 to 2021 were also calculated.

RESULTS: 

In 2017 to 2021, all-site cancer incidence (466.6; 95% CI 465.5 to 467.6) …

Defining Barriers In Pulmonary Hypertension: Pulmonary Hypertension In Remote And Rural Settings In Australia: An Epidemiologic Study Aided By Echocardiography, Pyi Naing

Theses

Pulmonary hypertension (PH) is a common, complex, and potentially lethal haemodynamic condition with many underlying aetiologies. It is poorly understood, and diagnosis is usually made late in the disease process resulting in poor outcomes even in the developed world. An innovative universal framework is required to achieve early and accurate diagnosis for improved outcomes, especially in remote and rural areas. The thesis documents my substantial body of work that unlocks a collective framework to assist patients with PH, particularly in areas not classically serviced by tertiary level PH care.

The first chapter of my thesis outlines the history, important milestones …

The Potential Of Vitamin D As An Adjunct Therapy For Eczema, Kimberly Hill

Graduate Research Projects

No abstract provided.

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Environmental Gentrification And Health: An Exploratory Analysis Of New York City, Joyce Hu

Public Health Theses

Background: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between …

Assessing Environmental And Sociodemographic Risk Factors For Leptospira Infection In A Urban Informal Settlements: A Study In Salvador, Brazil, Sebastian Alonso Salazar

Public Health Theses

Background: Leptospirosis is a neglected zoonotic disease that disproportionately affects people living in areas with poor sanitation, water contamination and rodent infestation such as urban informal settlements. More than one billion people worldwide reside in such communities, and with increasing urbanization, coupled with environmental change, the risk of Leptospira transmission continues to increase. Despite its global burden, this disease is often underreported due to diagnostic challenges and limited healthcare access, particularly in urban informal settlements. Understanding the incidence and risk factors in these settings is essential for improving public health interventions. This study aims to estimate the annual incidence of …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

Continuous Monitoring Of Sterility: Bacterial Contamination And Disinfectant Performance In Dental Clinics, Nathaly Alsalloum, Tarek Aboajwa, Shuaib Alahmad, Nermin Almouhammad

International Arab Journal of Dentistry

Objectives: This study aimed to (1) evaluate contamination levels across three clinics (endodontic, extraction and surgery, and fixed prosthodontics), (2) identify the types and prevalence of bacteria, (3) estimate the effectiveness of a commercial disinfectant, and (4) determine the bacterial species most responsive to the disinfectant.

Methods: Equal surfaces (17.98 cm²) were swabbed, cultured on nutrient agar for the total aerobic microbial count before and after disinfection, and analyzed using settle plates. Bacterial identification was conducted through colony characteristics, Gram staining, and biochemical tests. Data were processed using SPSS version 26.

Results: The endodontic clinic exhibited …

Aestheticizing And Engendering Disease: The Case Of Tuberculosis, Abigail Dollries

Dartmouth College Master’s Theses

This thesis examines how tuberculosis, known in the nineteenth century as “consumption,” was aestheticized in American cultural and medical discourse, particularly in industrial cities of the North between 1830 and 1850. It addresses the paradox at the heart of the disease’s representation: while tuberculosis was medically pathologized, it was simultaneously romanticized, especially when afflicting elite white women. The central problem explored is how this aestheticization of illness functioned to reinforce gender, class, and racial hierarchies by transforming suffering into a symbol of virtue, refinement, and social status. Using a cultural-historical methodology, this project analyzes a range of sources, including medical …

Changing Climate, Changing Health: Perspectives From General Population In Mysuru, Lekhashree A, Manirsha P V, Paranthaman Chinnasamy, Srishti Arya, Sunil Kumar D

Digital Journal of Clinical Medicine

Background: Climate change has emerged as a major public health concern, contributing to rising morbidity and mortality worldwide. In India, increasing heat waves, unpredictable rainfall, and deteriorating air quality have intensified climate-sensitive health conditions. This study aims to assess the health impacts of climate change among the general population of Mysuru.

Methodology: A community-based cross-sectional study was conducted among 400 residents of Mysuru (April–June 2024). Participants were recruited through simple random sampling. Data were collected using a pre-tested semi-structured questionnaire via Google Forms. Analysis was performed using SPSS v26, with descriptive and inferential statistics.

Results: Among 400 participants, …

Scopolamine-Induced Modulation Of Serotonin And Dopamine Transporters Activity: Behavioral And Molecular Insights Into Rapid Antidepressant Action, Deepak Karunakaran

Theses and Dissertations

Major depressive disorder (MDD) affects over 350 million individuals worldwide and is characterized by profound dysregulation of serotonin (5-HT) and dopamine (DA) systems that govern mood, reward processing, and motivation. The serotonin transporter (SERT) and dopamine transporter (DAT), both dynamically regulated through phosphorylation, serve as critical determinants of synaptic monoamine signaling. Despite decades of therapeutic development, current antidepressants require 4-6 weeks to achieve efficacy, and approximately one-third to half of patients develop treatment-resistant depression. The emergence of rapid-acting antidepressants like ketamine represents a paradigmatic shift, demonstrating symptom relief within hours; however, ketamine's therapeutic potential remains constrained by abuse liability, dissociative …

Community-Level Factors Influencing The Duration Of Buprenorphine Treatment In Individuals With Opioid Use Disorder: A Cohort Study Using Us Longitudinal Claims Data, Paula A Jaimes-Buitron, Kehe Zhang, Yanmin Gong, Yuanxiong Guo, Cici Bauer, Carolina Vivas-Valencia

Faculty, Staff and Student Publications

Introduction: Buprenorphine is effective in reducing opioid-related morbidity and mortality; however, many patients discontinue treatment prematurely. While previous research has focused on individual-level predictors of retention, the influence of community context remains underexplored. This study aims to examine how community-level factors, such as social vulnerability, availability of buprenorphine-waivered providers and access to behavioural health services, affect the duration of buprenorphine treatment episodes for individuals with opioid use disorder (OUD).

Methods: We conducted a retrospective cohort study using longitudinal claims data from 2006 to 2022. Adults aged 18 and older who initiated buprenorphine treatment for OUD and maintained continuous enrolment were …

Large-Vessel Occlusion Stroke Knowledge And Training For Stroke Severity Assessment Among Emergency Medical Services Personnel In The United States, Kaiz S Asif, Robin Novakovic, Thanh N Nguyen, Santiago Ortega-Gutierrez, Youngran Kim, Amanda Jagolino-Cole, Sushanth Aroor, Alicia Castonguay, Prateek Kumar, Ashutosh P Jhadav, Dileep Yavagal, May Nour, Gabor Toth, Maxim Mokin, Sunil A Sheth, Mouhammad A Jumaa, Alhamza Al-Bayati, Mohamed Teleb, Ossama Y Mansour, Shashvat M Desai, Joshua Hartman, David S Liebeskind, Ameer E Hassan, Brijesh P Mehta, Svin Education And Speed Committees

Faculty, Staff and Student Publications

Background: Prehospital identification of large-vessel occlusion (LVO) stroke facilitates the development of a regional triage protocol that could lead to an improvement in intrahospital and interhospital workflows. This requires stroke education of emergency medical services (EMS) personnel to improve stroke recognition, severity assessment, and prenotification. However, the current state of EMS personnel's knowledge of LVO stroke, their training for stroke severity assessment, and their preferences for educational methods are unknown. We conducted a nationwide EMS survey across the United States to glean insights that can inform and customize future EMS educational efforts.

Methods: The Society of Vascular and Interventional Neurology, …

A Comparison Of Floating Catchment Area Parameters With Applications To A Dataset Of Clinics Enrolled In A Statewide Child And Adolescent Psychiatric Consultation Program, Jocelyn Hunyadi, Lara S Savas, Kehe Zhang, Jeanette E Deason, Ryan Ramphul, Melissa F Peskin, Erica L Frost, Cici Bauer

Faculty, Staff and Student Publications

INTRODUCTION: Healthcare resources are often crucial but limited, requiring careful consideration and informed allocation based on population needs and potential healthcare access. In resource allocation settings, availability and accessibility of resources should be examined simultaneously. The two-step floating catchment area (2SFCA) method has been previously used to evaluate spatial accessibility to healthcare resources and services, and to address health-related disparities. The 2SFCA methods have regained significant popularity during the COVID-19 pandemic, as their application proved crucial in addressing priority public health data analysis, modeling, and accessibility challenges. However, comprehensive comparisons of the 2SFCA method input parameters in the context of …

Clarification Of Public Health Pathways Toward Clinical Careers: A Pilot Study Describing A Benchmark Analysis Project, Elizabeth A. Brown, Melissa Feliciano, Daniel Martinez

Health Behavior, Policy & Management Faculty Publications

Introduction: Undergraduate public health programs have adapted the required basic sciences based on medical and technological advances and the needs of the public health workforce. We aim to demonstrate how a benchmark analysis project was used to improve curriculum and develop a model where basic sciences in public health can be used to build pathways to clinical graduate programs like medicine, pharmacy, physician assistant, etc.

Methods: Authors conducted a benchmark analysis of Bachelor of Science in Public Health (BSPH) Degrees (or public health-related degrees) in the southern region of the United States (US) to explore required basic sciences. Authors searched …

Disparities Between Reported And Actual Study Habits And Perceptions Among First Year Occupational Therapy Graduate Students, Melisa P. Kaye, Marcella Mccollum, Sydney Hanzalik

Journal of Occupational Therapy Education

Studying for exams forms a significant part of the occupational therapy graduate school experience. While successful completion of exams is a central focus for students, little time is devoted to explicitly teaching new graduate students how to most effectively study. Instead, when they enter their occupational therapy programs, students experience a steep learning curve, and often rely on previous habits or trial and error to discover the most efficacious study strategies. The purpose of this study was to examine the study behaviors, habits, and beliefs of new graduate students to gain insight into the prevalence of use of various study …

An Environmental Scan Of Preparation For Occupational Therapy Intraprofessional Collaboration In Ontario, Teresa R. Avvampato, Mark Hall, Dianna Fong-Lee, Marcia Finlayson

Journal of Occupational Therapy Education

Intraprofessional collaboration between occupational therapists (OTs) and occupational therapist assistants (OTAs) is important for safe, effective, and efficient occupational therapy services. However, challenges such as role misunderstandings in Canada exist, which impact OT-OTA intraprofessional collaboration and the quality of care provided. This study aimed to reveal the OT-OTA intraprofessional collaboration preparation taking place in Ontario, Canada, during entry-to-practice education. An explanatory sequential environmental scan was conducted, which involved a survey distributed to OT and OTA educators, followed by six focus groups: two with OT educators, two with OTA educators, and two with OT and OTA recent graduates. Key findings revealed …