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Hepatitis C Diagnoses In An American Indian Primary Care Population, Hillary E. Norton, John T. Redd, Ralph T. Bryan May 2012

Hepatitis C Diagnoses In An American Indian Primary Care Population, Hillary E. Norton, John T. Redd, Ralph T. Bryan

Journal of Health Disparities Research and Practice

BACKGROUND: Despite large disparities in the burden of chronic liver disease, data on hepatitis C virus (HCV) infection among American Indians (AIs) are lacking. We reviewed hepatitis C diagnoses in 35,712 AI/AN primary care patients.

MAIN FINDINGS: At least one HCV-associated ICD-9 code was recorded in 251 (1%) patients between October 1, 2001 and September 30, 2003. An HCV enzyme-linked immunoassay (HCVEIA) was sent in 209 (83.0%); 206/209 (99%) were positive. Confirmatory testing was performed in 144/206 (70%) HCV-EIA positive patients; HCV infection was confirmed in 144 (100%). In the 90/144 (63%) charts with risk factor documentation, injection drug use …


Association Of Vitamin D Deficiency With Hypertension In Uninsured Women, Sreenivasa R. Chandana, Lakshmi P. Kocharla, Susan S. Harris, Radhika R. Kakarala May 2012

Association Of Vitamin D Deficiency With Hypertension In Uninsured Women, Sreenivasa R. Chandana, Lakshmi P. Kocharla, Susan S. Harris, Radhika R. Kakarala

Journal of Health Disparities Research and Practice

Vitamin D deficiency is an epidemic in the United States. Uninsured women are at high risk due to a lower intake of vitamin D and limited sun exposure. We examined the association between vitamin D deficiency and hypertension in 96 uninsured women at a County Free Medical Clinic in urban Michigan. Questionnaires were used to obtain information about demographics, medical history including hypertension, and dietary habits. Measurements including blood pressure and serum 25(OH)D level were also collected. Prevalence of hypertension was higher in subjects with 25(OH)D less than 50nmol/l compared with others (85% vs. 27.3%, p = 0.014). For every …


Raccoon Acclimation Towards Traps And Its Effect On Surveillance And Monitoring Of Zoonotic Diseases, Lindsay Rollend May 2012

Raccoon Acclimation Towards Traps And Its Effect On Surveillance And Monitoring Of Zoonotic Diseases, Lindsay Rollend

Master's Theses

Raccoons (Procyon lotor) serve as a source of infection with various pathogens for people, most notably, rabies. Raccoons are specifically targeted for the control of rabies in the United States, primarily due to the 100% fatality rate in humans and animals. There is no cure or treatment for rabies and vaccines may be administered to people if it is administered promptly. In order to evaluate how successful trapping of raccoons is by using conventional methods, motion sensing cameras were placed on traps in order to captured raccoon behaviors. Pictures were coded based on these behaviors (around the trap but not …


An Early Assessment Of The Potential Impact Of Texas' "Affiliation" Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum May 2012

An Early Assessment Of The Potential Impact Of Texas' "Affiliation" Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis provides an initial assessment of the implications for low-income women of Texas' "affiliation regulation," which would bar Planned Parenthood Federation of America (PPFA) clinics from participating in the Texas Women's Health Program (WHP). In 2010, more than 183,000 women were enrolled in the WHP, which provides health screening, family planning and birth control to low-income women, and nearly 106,000 received care through the program. In our analysis of WHP provider data, we find:

  • Planned Parenthood (PPFA) clinics are by far the dominant source of care under the WHP. In FY 2010, PPFA clinics accounted for approximately 49 percent …


Revised: An Early Assessment Of The Potential Impact Of Texas’ “Affiliation” Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum May 2012

Revised: An Early Assessment Of The Potential Impact Of Texas’ “Affiliation” Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.


The End Of Nowhere: The History Of Tuberculosis In Ri, Emma G. Sconyers May 2012

The End Of Nowhere: The History Of Tuberculosis In Ri, Emma G. Sconyers

Senior Honors Projects

The World Health Organization estimates that approximately one third of the word's current population had been infected with tuberculosis. Prior to the 1940's TB was considered an incurable, chronic affliction. Historically, many people were forcibly detained in tuberculosis sanatoria to lessen the spread of the disease; my great granfather being one of them. In 1939, without warning, he was taken from his pregnant, jobless wife and one-year-old daughter, who were left to fend for themselves for two years without government planning or assistance. He spent those two years at Wallum Lake Sanitorium in northern Rhode Island, a place my great-grandmother's …


A Mathematical Model For Dengue Fever In A Virgin Environment, Jason K. Bowman May 2012

A Mathematical Model For Dengue Fever In A Virgin Environment, Jason K. Bowman

Senior Honors Projects

Dengue is a mosquito-borne viral infection found in tropical and subtropical regions around the world. The disease was named in 1779 and the first recorded epidemic of it occurred simultaneously on three continents within the following decade. Dengue is characterized by flu-like symptoms and, while its symptoms are generally reported as quite unpleasant, is rarely fatal. However, in some cases patients can contract a more serious form of the disease, known as Dengue Hemorrhagic Fever, which is far more dangerous. The World Health Organization estimates that today over 2.5 billion people are at risk for Dengue (over 40% of the …


The Prevalence Of Essential Hypertension In Kasigau, Kenya, Lindsay Williams May 2012

The Prevalence Of Essential Hypertension In Kasigau, Kenya, Lindsay Williams

Mahurin Honors College Capstone Experience/Thesis Projects

Hypertension is the leading cause of cardiovascular disease worldwide. Cardiovascular disease (CVD) is a widespread chronic non-communicable disease (NCD) which is on the rise in developing countries. Evidence based on extensive research studies on risk factors for NCDs suggests that they could be easily significantly decreased by simply controlling their risk factors. Although high blood pressure has been recognized as a leading risk factor for CVD, little research has been done to document the prevalence and incidence of essential hypertension (EH) in lower socioeconomic developing countries. One such country is Kenya. It was found in our research study that Kasigau …


Immunizations For Adults And Children, Lynne J. Goebel, Nancy B. Norton, Maurice A. Mufson May 2012

Immunizations For Adults And Children, Lynne J. Goebel, Nancy B. Norton, Maurice A. Mufson

Internal Medicine

Vaccines represent the most important medical advance of the twentieth century. The time has passed when large numbers of children and adults suffered serious, life threatening illness from viruses including poliovirus, measles virus, influenza viruses, hepatitis B virus and varicella zoster virus or faced lifelong disability or death from bacterial infections including Hemophilus influenzae, meningococcus and pneumococcus, all infections that can be prevented now by effective vaccines.


Evaluation Of Pneumonia Virus Of Mice As A Possible Human Pathogen, Linda G. Brock, Ruth A. Karron, Christine D. Krempl, Peter L. Collins, Ursula J. Buchholz May 2012

Evaluation Of Pneumonia Virus Of Mice As A Possible Human Pathogen, Linda G. Brock, Ruth A. Karron, Christine D. Krempl, Peter L. Collins, Ursula J. Buchholz

United States Public Health Resources

Pneumonia virus of mice (PVM), a relative of human respiratory syncytial virus (RSV), causes respiratory disease in mice. There is serologic evidence suggesting widespread exposure of humans to PVM. To investigate replication in primates, African green monkeys (AGM) and rhesus macaques (n=4) were inoculated with PVM by the respiratory route. Virus was shed intermittently at low levels by a subset of animals, suggesting poor permissiveness. PVM efficiently replicated in cultured human cells and inhibited the type I interferon (IFN) response in these cells. This suggests that poor replication in nonhuman primates was not due to a general nonpermissiveness …


Prioritization Of Biomarker Targets In Human Umbilical Cord Blood: Identification Of Proteins In Infant Blood Serving As Validated Biomarkers In Adults, Nicole Hansmeier, Tzu-Chiao Chao, Lynn R. Goldman, Frank R. Witter, Rolf U. Halden May 2012

Prioritization Of Biomarker Targets In Human Umbilical Cord Blood: Identification Of Proteins In Infant Blood Serving As Validated Biomarkers In Adults, Nicole Hansmeier, Tzu-Chiao Chao, Lynn R. Goldman, Frank R. Witter, Rolf U. Halden

Environmental and Occupational Health Faculty Publications

Background: Early diagnosis represents one of the best lines of defense in the fight against a wide array of human diseases. Umbilical cord blood (UCB) is one of the first easily available diagnostic biofluids and can inform about the health status of newborns. However, compared with adult blood, its diagnostic potential remains largely untapped.

Objectives: Our goal was to accelerate biomarker research on UCB by exploring its detectable protein content and providing a priority list of potential biomarkers based on known proteins involved in disease pathways.

Methods: We explored cord blood serum proteins by profiling a UCB pool of 12 …


Effects Of Temperature On Emergence And Seasonality Of West Nile Virus In California, David M. Hartley, Christopher M. Barker, Arnaud Le Menach, Tianchan Niu, Holly Gaff, William K. Reisen May 2012

Effects Of Temperature On Emergence And Seasonality Of West Nile Virus In California, David M. Hartley, Christopher M. Barker, Arnaud Le Menach, Tianchan Niu, Holly Gaff, William K. Reisen

Biological Sciences Faculty Publications

Temperature has played a critical role in the spatiotemporal dynamics of West Nile virus transmission throughout California from its introduction in 2003 through establishment by 2009. We compared two novel mechanistic measures of transmission risk, the temperature-dependent ratio of virus extrinsic incubation period to the mosquito gonotrophic period (BT), and the fundamental reproductive ratio (R0) based on a mathematical model, to analyze spatiotemporal patterns of receptivity to viral amplification. Maps of BT and R0 were created at 20-km scale and compared throughout California to seroconversions in sentinel chicken flocks at half-month intervals. Overall, estimates of BT and …


Aptamer-Based Spr Biosensor For Detection Of Avian Influenza Virus, Hua Bai May 2012

Aptamer-Based Spr Biosensor For Detection Of Avian Influenza Virus, Hua Bai

Graduate Theses and Dissertations

Rapid and specific detection of avian influenza (AI) virus is urgently needed with the concerns over the outbreaks of highly pathogenic H5N1 avian influenza in animal and human infection. Aptamers are artificial oligonucleic acid that can specifically bind to target molecules. They show comparable affinity for target virus and better thermal stability than monoclonal antibodies. Those advantages make aptamers promising candidates in diagnostic and detection applications. The goal of this research was to use DNA&ndashaptamer as the specific recognition element in a portable surface plasmon resonance (SPR) biosensor for detection of AI H5N1 virus in poultry.

A SPR biosensor was …


Variables Associated With Critical Illness Among Clark County Residence Hospitalized With H1n1 Influenza A Virus During The 2009 Influenza Season., Jonathan P. Hyatt May 2012

Variables Associated With Critical Illness Among Clark County Residence Hospitalized With H1n1 Influenza A Virus During The 2009 Influenza Season., Jonathan P. Hyatt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background:In 2009, a novel H1N1 Influenza A virus was detected in the population. Because it can potentially affect a different population than the influenza strains circulating for the past 35 years, it is critical for physicians, practitioners and public health organizations to understand who is susceptible to this disease, and which sub-populations are most likely to suffer critical illness. The objective of this study was to examine the factors unique to 2009 H1N1 infection, with the goal of finding the variables associated with ICU admission (Critical Illness) in the Clark County 2009 H1N1 patient.

Methods:Factors that were assessed in this …


Modeling The Effects Of Substance Dependence On General Self-Reported Health Using Nominal Regression, Taylor Moseley May 2012

Modeling The Effects Of Substance Dependence On General Self-Reported Health Using Nominal Regression, Taylor Moseley

UNLV Theses, Dissertations, Professional Papers, and Capstones

The goal of this research project was to produce a model of the effects of drug dependence on general self-rated health. Due to power issues, two additional models, one for cocaine and one for heroin, were required. The models used data from the 2005-2009 National Survey on Drug Use and Health. The result of this effort was a ranking of the effects of drug dependence on general health for individuals and for the study population. The model controlled for infectious, chronic and mental illness as well as sociodemographic variables. Significantly increased odds ratios were found for alcohol, marijuana, analgesics, and …


Motivating Men Who Have Sex With Men To Get Tested For Hiv, Magaly M. Blas, Luis A. Menacho, Isaac E. Alva, E. Roberto Orellana May 2012

Motivating Men Who Have Sex With Men To Get Tested For Hiv, Magaly M. Blas, Luis A. Menacho, Isaac E. Alva, E. Roberto Orellana

School of Social Work Faculty Publications and Presentations

Although men who have sex with men (MSM) have the highest HIV prevalence in Peru, they are underserved by traditional preventive programs. Interestingly, in Peru the Internet and cell-phones have emerged as a convenient tool to reach this population.


Risk Factors For Secondary Infertility Among Women In Karachi, Pakistan., Neelofar Sami, Tazeen S. Ali, Saba Wasim, Sarah Saleem Apr 2012

Risk Factors For Secondary Infertility Among Women In Karachi, Pakistan., Neelofar Sami, Tazeen S. Ali, Saba Wasim, Sarah Saleem

Community Health Sciences

Background: Secondary infertility in developing countries is mostly attributable to blockage of the fallopian tubes due to adhesions caused by reproductive tract infections. There is a dearth of information on the prevalence and causes of secondary infertility from Pakistan. This paper presents results on factors associated with secondary infertility among married women in Karachi, Pakistan. Methods: A matched case-control study was conducted. Cases were women aged 15-35 years with history of at least one previous conception and currently seeking treatment for secondary infertility. Controls were women residing in the neighborhood of cases with at least one live birth and not …


Kadar Interferon Gamma Pada Kontak Serumah Dengan Penderita Tuberkulosis, Sri Andarini Indreswari, Suharyo Suharyo Apr 2012

Kadar Interferon Gamma Pada Kontak Serumah Dengan Penderita Tuberkulosis, Sri Andarini Indreswari, Suharyo Suharyo

Kesmas

Menurut World Health Organization sekitar sepertiga penduduk dunia telah terinfeksi kuman tuberkulosis dan deteksi dini pada kontak serumah dengan penderita memungkinkan upaya pengobatan dan pencegahan dilakukan dengan efektif. Penelitian ini bertujuan untuk membandingkan hasil pemeriksaan tes Mantoux dengan pemeriksaan serologis kadar interferon gamma (IFN - γ) pada kelompok kontak serumah dengan penderita tuberkulosis yang mempunyai hasil pemeriksaan basil tahan asam (BTA) positif. Penelitian ini menggunakan desain kohort pada kelompok terpajan dan tidak terpajan pada penderita tuberkulosis (umur > 15 tahun). Pemilihan subjek dilakukan secara acak sederhana dan jumlah yang digunakan adalah 34 orang pada masing-masing kelompok. Penelitian ini menggunakan tes Mantoux …


Demographics And Survival Of Aids Cases With Cancer, Washington, Dc, 1996-2006, Heather A. Young, Eric Engels, Anne-Marie Sufian-Kargbo, Alicia Vargas, Kathleen Rogers, Tiffany West, Amanda D. Castel Apr 2012

Demographics And Survival Of Aids Cases With Cancer, Washington, Dc, 1996-2006, Heather A. Young, Eric Engels, Anne-Marie Sufian-Kargbo, Alicia Vargas, Kathleen Rogers, Tiffany West, Amanda D. Castel

Epidemiology Faculty Publications

Background

Washington, DC (DC) has one of the highest HIV/AIDS rates in the U.S and cancer is the second leading cause of death among DC residents. This study sought to examine the demographic characteristics and survival of persons with AIDS defining cancers (ADCs) compared to those with non-AIDS defining cancers (NADCs) between the early HAART era (1996-2001) and the late HAART era (2002-2006) in DC.

Methods

Cases reported from 1996-2006 to the DC Cancer Registry and the AIDS Surveillance Registry were linked using a probabilistic matching algorithm. Cases were included if the cancer occurred from 4 months to 60 months …


Using State And Local Health Survey Data To Advance Phssr, Glen P. Mays Apr 2012

Using State And Local Health Survey Data To Advance Phssr, Glen P. Mays

Health Management and Policy Presentations

State and local health survey data can be used to evaluate the implementation and impact of public health delivery innovations in real-world practice settings.


Exploring The Social Determinants Of Sexually Transmitted Disease And High-Risk Sexual Behaviors, River Pugsley Apr 2012

Exploring The Social Determinants Of Sexually Transmitted Disease And High-Risk Sexual Behaviors, River Pugsley

Theses and Dissertations

Abstract 1: A multi-level assessment of disproportionate population sex ratios and high-risk sexual behaviors among STD clinic patients Low male-to-female sex ratios in a population may influence high-risk sexual behaviors, such as multiple sex partners and inconsistent condom use, which facilitate the transmission of STDs. This study used multi-level modeling to assess whether population sex ratios were associated with these two individual-level behaviors. All analyses were stratified by gender. Interview data were collected from patients (N = 9,203, 48% male) attending participating STD clinics. Interviews included information on socio-demographics and sexual behavior, including number of sex partners in the previous …


A Social Controversy: Autism Spectrum Disorder's Correlation To The Measles-Mumps-Rubella Vaccination, Lindsay A. Frye Apr 2012

A Social Controversy: Autism Spectrum Disorder's Correlation To The Measles-Mumps-Rubella Vaccination, Lindsay A. Frye

Senior Honors Theses

A 1998 research study lead by Dr. Andrew Wakefield linked the measles-mumps-rubella (MMR) vaccination as a probable cause to autism spectrum disorder. This publication has started a significant debate among healthcare professionals and instigated an anti-vaccination movement within the general population. This vaccination controversy was started by parents who readily accepted Wakefield’s findings as truth and frequently would choose to withdrawal the administration of vaccinations from their children’s care plans. There has also been disapproval by healthcare professionals over Wakefield’s study since numerous research teams have been unable to replicate his findings. This disagreement surrounding the MMR vaccination is likely …


A Communication Strategy To Address Health Inequities In Municipal Settings, Christine Unson, Ben Tyson, Angela Funaiole, Comfort Agaba Apr 2012

A Communication Strategy To Address Health Inequities In Municipal Settings, Christine Unson, Ben Tyson, Angela Funaiole, Comfort Agaba

Journal of Health Disparities Research and Practice

This study assessed knowledge of health inequities, importance and benefits/barriers of addressing inequities, and ways of communicating information about inequities among municipal officials. Five focus groups (N=47) were conducted with officials from economic development, land use and housing, public safety, education, and environment departments. Discussions were recorded, transcribed and analyzed for key themes. Findings show that participants had an uneven understanding of the symptoms and causes of health inequities and identified limitations to participating in health equity initiatives and collaborating with local health departments. Recommendations are that a communication strategy to reduce health inequities should aim to increase awareness of …


Infectious Syphilis In Non-Hispanic Blacks And Hispanics In An Urban Std Clinic, Tai Hunte, Maria L. Alcaide, Ricardo Franco, Khaled Deeb, Jose G. Castro Apr 2012

Infectious Syphilis In Non-Hispanic Blacks And Hispanics In An Urban Std Clinic, Tai Hunte, Maria L. Alcaide, Ricardo Franco, Khaled Deeb, Jose G. Castro

Florida Public Health Review

Syphilis is a complex infectious disease caused by Treponema pallidum and acquired through sexual contact or vertical transmission. The natural history of syphilis is divided in primary, secondary, latent and tertiary stages. The syphilis epidemic has evolved over the years. National rates of syphilis infection dropped to the lowest in 2000 and have since increased in certain populations. Men who have sex with men (MSM) account for 60% of new infections and high rates occur in individuals with human immune deficiency virus co-infection. This study describes and compares the demographic characteristics, risk factors, and clinical presentation ofinfectious syphilis cases diagnosed …


Can Kawasaki Disease Be Managed?, Alberto Coustasse, Julius Larry, Doohee Lee Apr 2012

Can Kawasaki Disease Be Managed?, Alberto Coustasse, Julius Larry, Doohee Lee

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but management of KD has received relatively little attention. In the US alone, about 5500 cases were estimated in 2009. KD is most common among Asian and Pacific Islander children but can affect all ethnicities and races. Timely and accurate diagnosis remains critical, but difficult: the etiology of KD is unknown, and no accurate diagnostic laboratory test has been developed. Continuing medical education can help physicians, clinicians, and nurse practitioners accurately diagnose and treat KD. A registry specific to KD or a surveillance system may be necessary …


Measles Vaccinaiton In Developing Nations: A Statistical Analysis Looking At Factors That Affect Measles Vaccination Percentages, Jeffrey Judkins Apr 2012

Measles Vaccinaiton In Developing Nations: A Statistical Analysis Looking At Factors That Affect Measles Vaccination Percentages, Jeffrey Judkins

Independent Study Project (ISP) Collection

Why do two developing countries in the same region have vastly different vaccination rates? What specific factors have the greatest influence on the vaccination rates in differing developing nations? This papers objective is to use a statistical model to try to determine what factors, education, healthcare system and infrastructure, play the largest role in impacting both positively the measles vaccination rate in 20 African countries. The results found only two of the six variables originally chosen to be statistically significant. These variables were the percentage of paved roads and the percentage of the GDP spent on education.


Special Ops: Vulnerable Populations And Tobacco Treatment, Chizimuzo T.C. Okoli, Audrey Darville Apr 2012

Special Ops: Vulnerable Populations And Tobacco Treatment, Chizimuzo T.C. Okoli, Audrey Darville

Nursing Presentations

  • Reasons for Smoking among individuals with co-morbid substance use (SUD)and/or psychiatric disorders (PD)
  • Smoking cessation treatment for individuals with co-morbid substance use (SUD) and/or psychiatric disorders (PD)
  • Smoking among the Homeless population


Road Construction As A Facilitator For Dengue Fever Transmission, Kate Billups Apr 2012

Road Construction As A Facilitator For Dengue Fever Transmission, Kate Billups

Environmental Studies Senior Seminar Projects

Although I plan to focus on the impact of road construction in tropical and subtropical regions on the spread and contraction of dengue fever, I hope to use this focus as a model that could help to create policies that would mitigate other diseases spread through insect contact. In places that road and railway construction have already become a part of the permanent foundation, medical infrastructure should be put into place to ensure that populations at increased risk to contract dengue fever have access to medical care to diminish rates of dengue hemorrhagic fever.

Paper prepared for the Environmental Studies …


Conflict Situation For Health Care Workers: A Case Study Of The Occupational Challenges In Kasangati Health Centre Iv And Their Implications For Patient Care., Shannon Mcdowell Apr 2012

Conflict Situation For Health Care Workers: A Case Study Of The Occupational Challenges In Kasangati Health Centre Iv And Their Implications For Patient Care., Shannon Mcdowell

Independent Study Project (ISP) Collection

Many factors influence a country’s ability to provide quality health services for its people. Particularly, quality health care hinges upon the availability of properly trained and equipped health care workers (HCWs) to deliver effective care. Resource-strained countries committed to the Millennium Development Goals are confronting the reality that shortages and uneven distribution of HCWs threaten their capacities to encourage and establish healthy communities. A scarcity in HCWs is one challenge of public health initiatives and places stress on existing HCWs. Other challenges faced by HCWs severely affect performance, motivation, and overall care-giving ability.

This study aims to examine the particular …


Factors That Influence Nonadherence Outpatient Medical Follow-Up By African Americans With Hiv/Aids At An Outpatient Infectious Disease Clinic, Cynthia Burrell Banks Apr 2012

Factors That Influence Nonadherence Outpatient Medical Follow-Up By African Americans With Hiv/Aids At An Outpatient Infectious Disease Clinic, Cynthia Burrell Banks

Health Services Research Dissertations

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) does not discriminate among different races, ethnicities or genders; however, African Americans carry a larger burden related to the HIV epidemic than others (CDC, 2010c; Cunningham, Sanchez, Heller & Sohler, 2007; Mugavero, et al., 2009). Persons living with HIV/AIDS (PLWHA) who do not adhere to their medical regimen, including failure to maintain contact with their health care provider for health care monitoring, tend to have poorer health outcomes from the disease as compared to HIV/AIDS patients who adhere to their medical regimen (Cunningham et al., 2006; Lima et al., 2009). African Americans represent …