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Understanding The Impact Of Hospital Price Transparency Initiatives On Consumer Decision-Making To Purchase Healthcare Services, Neel Pathak Jan 2023

Understanding The Impact Of Hospital Price Transparency Initiatives On Consumer Decision-Making To Purchase Healthcare Services, Neel Pathak

All ETDs from UAB

This study examined the influence of hospital list price information on individuals' decision-making to purchase healthcare services. The study collected quantitative data from 550 individuals by administering a hospital price transparency survey. Findings indicate that awareness of hospital list prices and quality outcomes metrics was high, but utilization rates were relatively low among survey participants. Demographic variations were explored with respect to the awareness and utilization of hospital list prices. Quality outcomes and recommendations from friends, family, and physicians emerged as the most important attributes influencing decision-making to purchase healthcare services whereas hospital list prices and social media had a …

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In Their Own Words: A Case Study Utilizing Wordless Picture Books As Mentor Text In Writing Workshop With Young Multilingual Writers, Kathleen Hope Watkins Jan 2023

In Their Own Words: A Case Study Utilizing Wordless Picture Books As Mentor Text In Writing Workshop With Young Multilingual Writers, Kathleen Hope Watkins

All ETDs from UAB

Using case study and cross-case qualitative analyses, the researcher explored the utilization of wordless picture books as mentor texts with young multilingual learners in second grade. Eight students participated in the study and four focus students were highlighted through case studies. The researcher implemented three, 45-minutes lessons per week for 12 weeks, conducted three interviews with each participant, and analyzed work samples. Five themes emerged from the data: development of identity as an author, increased writing proficiency, maturation of writing behaviors, development of a writing community, and varying degrees of linguistic flexibility. Implications of this research included preservation of visual …

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Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao Jan 2023

Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao

All ETDs from UAB

The HIV care continuum is a public health model that outlines the steps or stages people with HIV go through from diagnosis to achieving and maintaining viral suppression. Retention in care, a key component of the HIV care continuum, is critical in achieving good health outcomes for people with HIV (PWH) and preventing HIV transmission. Consistent HIV care is essential for the health of PWH as a part of retention in care. De-spite no standard measure for retention in care to PWH, the missed (no-show) vis-its/appointments is one of the most commonly used methods for evaluating retention in HIV care. …

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An Exploration Of The Mental Health Experiences Of Young Women With Diminished Ovarian Reserve, Brittany M. Woods Jan 2023

An Exploration Of The Mental Health Experiences Of Young Women With Diminished Ovarian Reserve, Brittany M. Woods

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Infertility is a reproductive disease resulting in the inability to conceive. One in six individuals will experience infertility in their lifetime. Diminished ovarian reserve (DOR) reduces the quantity and/or quality of a female's oocyte pool and is a known cause of infertility. Although this occurs during normal ovarian aging in the late 30s and early 40s, DOR can also impact younger women, increasing their risk for psychological distress from an unexpected diagnosis. The purpose of this dissertation is to develop a deeper understanding of the mental health experiences of young women with DOR through the generation of three manuscripts. Manuscript …

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Spectroscopic And Electrical Characterization Of Cr:Al:Znse Gain Elements, Rick Harrington Watkins Jan 2023

Spectroscopic And Electrical Characterization Of Cr:Al:Znse Gain Elements, Rick Harrington Watkins

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Middle infrared (mid-IR) lasers have gained significant attention across various fields, including optics research, medical applications, and defense technologies. The mid-IR spectral region, spanning wavelengths between 2μm and 8μm, is particularly important due to its overlap with the molecular fingerprints, which enables the detection of organic and inorganic molecules through their rotational and vibrational frequencies. Transition metaldoped II-VI (TM:II-VI) chalcogenides, specifically Cr:ZnSe, are well-known laser materials for optically pumped mid-IR lasers, offering effective lasing capabilities in this spectral range. In addition to optical excitation, the wide-band semiconductor nature of Cr:ZnSe crystals holds the potential for direct electrical excitation, making them …

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Regulating Cancer Cell Metabolism During Hypoxia-Reoxygenation: Examing The Interplay Of Gasotransmitters And Glutaminolysis, Dianna L. Xing Jan 2023

Regulating Cancer Cell Metabolism During Hypoxia-Reoxygenation: Examing The Interplay Of Gasotransmitters And Glutaminolysis, Dianna L. Xing

All ETDs from UAB

Oxidative phosphorylation is an oxygen-dependent metabolic process that provides the majority of ATP used to support essential cellular functions. However, in cancer, limitations in oxygen availability occur during the development and metastasis of tumors. To compensate for the demands of rapidly proliferating cells, many cancers exhibit an increased demand for glycolysis, the TCA cycle, and glutaminolysis. In this thesis, extracellular flux technology and metabolomics were applied in a hypoxia-reoxygenation model to investigate the metabolic adaptations that occur in dynamic changes in oxygen and nutrient availability in cancer cells. We show the significance of glutaminolysis and its substrates in regulating cancer …

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Effects Of Dietary R, S-1, 3-Butanediol Diacetoacetate On Components Of Energy Balance And Hepatic Health, Kelsey A. Rushing Jan 2023

Effects Of Dietary R, S-1, 3-Butanediol Diacetoacetate On Components Of Energy Balance And Hepatic Health, Kelsey A. Rushing

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Objective: Exogenous ketone administration presents a possible treatment strategy for obesity and obesity-related diseases. The exogenous ketone ester, R,S-1,3-butanediol diacetoacetate (BD-AcAc2) decreases adiposity and hepatic steatosis in high-fat dietinduced obese mice. In our previous work, carbohydrate energy was removed and replaced with the ketone ester to produce isocaloric diets. The current investigation aimed to determine whether BD-AcAc2 decreases markers of hepatic steatosis and inflammation in lean mice on a high-fat, high-sugar (HFHS) diet without removing carbohydrate energy. Methods: Sixteen 11-week-old male C57BL/6J mice were randomized to one of two groups for 9 weeks (n = 8 per group): 1) Control …

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Understanding The Dual Role Of The Oncolytic Viruses And Natural Killer Cells In Targeting Neuroblastoma, Colin Harrington Quinn Jan 2023

Understanding The Dual Role Of The Oncolytic Viruses And Natural Killer Cells In Targeting Neuroblastoma, Colin Harrington Quinn

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Pediatric cancer is the leading cause of death by disease in children, and neuroblastoma accounts for roughly 15% of pediatric cancer related deaths. Neuroblastoma is a malignancy of neural crest origin and develops in the ganglia of the peripheral nervous system, most commonly arising in the adrenal glands. Advancements in therapy have significantly improved outcomes for children with low-risk neuroblastoma but for those with high-risk refractory, or relapsed disease, survival outcomes remain dismal and intervention with toxic chemotherapeutics often result in long term morbidities. The need for improved therapies for this patient population is dire. Immunotherapies offer a novel approach …

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Understanding Attitudes, Subjective Norms, And Intent Of Covid-19 Vaccine Hesitancy And Refusal Among African Americans In The United States Using The Theory Of Reasoned Action, Deandrea Lashay Martinez Jan 2023

Understanding Attitudes, Subjective Norms, And Intent Of Covid-19 Vaccine Hesitancy And Refusal Among African Americans In The United States Using The Theory Of Reasoned Action, Deandrea Lashay Martinez

All ETDs from UAB

COVID-19 vaccine hesitancy and vaccine refusal contributed to many African Americans not receiving the COVID-19 vaccine. The reasons for vaccine hesitancy and vaccine refusal were unclear by sociodemographic factors (income, gender, education, and age) among African Americans. This research explored attitudes, subjective norms, and intent of COVID-19 vaccine hesitancy and vaccine refusal among African Americans in the United States using the Theory of Reasoned Action. The two research questions were (1) Among African Americans, do age, income, gender, and education factors remain stable across three study cohorts in differentiating subjects who are COVID-19 vaccine hesitant versus refusal from 2020–2022? (2) …

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The Costly Performance Of Strength: An Exploration Of Mental Health Treatment Utilization Among Black Women In The Deep South, Amber N. Martin Jan 2023

The Costly Performance Of Strength: An Exploration Of Mental Health Treatment Utilization Among Black Women In The Deep South, Amber N. Martin

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Introduction: Strength is indoctrinated into the cultural tapestry of Black women, dating back to slavery, and passed down through intergenerational socialization. The incessant need for Black women to be strong diminishes their psychological health leading to poorer quality of life. Further, historical injustices and unethical practices in mental healthcare continue to perpetuate the need for Black women to perform in strength. The performance of strength is one explanation for the grave mental health disparities among Black women offering an opportunity to better understand their mental health needs. This project aims to center Black women within the cultural contextualization of the …

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Disenfranchisement: Voter Suppression In Alabama 1865-1965, Hayden C. Batt Jan 2023

Disenfranchisement: Voter Suppression In Alabama 1865-1965, Hayden C. Batt

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After the Civil War, Alabama responded negatively to the abolition of slavery and the passage of the Reconstruction Amendments. This is especially true of the 15th Amendment, which promised suffrage regardless of race or skin color. Alabamians used multiple methods to diminish the presence of African American voting, building the foundations for a white power structure and a segregated society. This thesis takes a broad scope, from 1865-1965, to analyze the methods of voter suppression, how these changed over time, and the ideological backing of voter suppression. Organized violence was the first method used to keep black men from the …

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Converging Crises: The Spanish Flu And Wwi's Influence Within Egon Schiele's Oeuvre, Mclean Boone Jan 2023

Converging Crises: The Spanish Flu And Wwi's Influence Within Egon Schiele's Oeuvre, Mclean Boone

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This thesis investigates the effect of the converging crises of WWI and the Spanish Flu in on the last artworks of Egon Schiele, and argues that these two events precipitated a shift in the artist’s theme, aesthetic, and technique in these 1918 artworks. Before his death from the Spanish Flu in late October, 1918, Schiele managed to produce nearly thirty paintings in the last two years of his career. While many scholars have discussed Schiele’s art in the context of personal maturation, I argue instead that Schiele’s aesthetic shift towards naturalism symbolized new modes of exploring ideas of life and …

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Impact Of Covid-19 On A Smoking Cessation Intervention: A Look At Recruitment And Retention, Elizabeth S. Hawes Jan 2023

Impact Of Covid-19 On A Smoking Cessation Intervention: A Look At Recruitment And Retention, Elizabeth S. Hawes

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While smoking prevalence rates have declined in the general population over the past 50 years, persons in the criminal legal population have disproportionally high rates of smoking. Previous research suggests that smoking cessation interventions and campaigns have missed targeting this population. Due to the COVD-19 pandemic, many ongoing clinical trials had to rapidly shift to using remote trials, including our smoking cessation trial with the criminal legal population. The purpose of this secondary analysis was to compare recruitment rate, study adherence, retention, NRT adherence, and quit attempts for participants who completed the study as planned (In Person), after implementation of …

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Correlates Of Life Space Mobility, Driving Frequency And Exposure Amon Older Blacks/African Americans And Whites With Diabetes, Henrietta Armah Jan 2023

Correlates Of Life Space Mobility, Driving Frequency And Exposure Amon Older Blacks/African Americans And Whites With Diabetes, Henrietta Armah

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Diabetes mellitus is one of the most common chronic diseases among older adults, affecting all aspects of daily living including restricted life space mobility, driving and building relationships outside of the home. The aim of this study was to investigate the covariate-adjusted associations of cognitive functioning, depressive symptoms, amount of support received and satisfaction with support with life space mobility, driving frequency and driving exposure among Blacks/African Americans and Whites with diabetes. The study used a representative sample of 247 older adults aged 65 and above from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health …

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Plasticity Characteristics Of Cxcr5+ Cd4+ T Memory Cells And Cxcr5- Non-Tfh Memory Cells, Ching-En Lee Jan 2023

Plasticity Characteristics Of Cxcr5+ Cd4+ T Memory Cells And Cxcr5- Non-Tfh Memory Cells, Ching-En Lee

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iv ability to differentiate into CXCR5- and CXCR5+ effector cells between the CCR7- and CCR7+ CXCR5+ CD4+ T memory cells, between WT and μMT CXCR5+ CD4+ T memory cells, as well as between Bcl6- and Bcl6+ CXCR5- non-Tfh memory cells. This finding did not support the hypothesis that the heterogeneous characteristics within CXCR5- non-Tfh memory cells and CXCR5+ CD4+ T memory cells significantly affect their abilities to differentiate into CXCR5- and CXCR5+ effector cells during recall responses.

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Relative Efficacy Of Innovative Endodontic Antimicrobial Agents, Ziqi Sally Liu Jan 2023

Relative Efficacy Of Innovative Endodontic Antimicrobial Agents, Ziqi Sally Liu

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Purpose: Novel endodontic antimicrobial agents would potentially improve outcomes of endodontic treatment, including regenerative endodontic therapy. The aim of this study was to determine the efficacy of a novel experimental compound, analogue #66, compared to tigecycline and other controls in an ex-vivo model. Materials and Methods: MIC determination with tigecycline and analogue #66 was done for Streptococcus mutans and Streptococcus intermedius. Forty single rooted extracted teeth were inoculated weekly for three weeks with S. intermedius to create a biofilm. All teeth were instrumented to 40/06 to working length and irrigated with 5% NaOCl. Teeth were randomly divided into 4 groups …

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An In Vitro Assessment Of The Antibacterial Activity, Biocompatibility, And Mineralization Inducing Potential Of Biodentine®Xp, Chandani Arjun Mantri Jan 2023

An In Vitro Assessment Of The Antibacterial Activity, Biocompatibility, And Mineralization Inducing Potential Of Biodentine®Xp, Chandani Arjun Mantri

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Purpose: The purpose of this study was to assess the in-vitro antibacterial activity, biocompatibility, and mineralization-inducing potential of Biodentine® XP. Methods: Four contemporary pulp capping materials, namely Dycal®, a calcium hydroxide, Theracal® LC, a resin calcium silicate and, tricalcium silicates namely Biodentine®, and Biodentine® XP were compared in the study. The antibacterial activity of the pulp capping materials included in the study was evaluated against Streptococcus mutans UA159 and Enterococcus faecalis ATCC 29212 and were determined by the direct culture test. The biocompatibility of these materials in preodontoblastic 17IIA11 cells were compared by the MTT assay and mineralization-inducing potential in …

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Genetic And Epigenetic Risk Scores For Chronic Kidney Disease In African Americans, Alana C. Jones Jan 2023

Genetic And Epigenetic Risk Scores For Chronic Kidney Disease In African Americans, Alana C. Jones

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Kidney disease is the tenth-leading cause of death in the United States (US). There are significant racial disparities within kidney disease: African Americans (AAs) have the highest rates of CKD and carry a four-fold higher risk of developing end-stage renal disease (ESRD). They are also less likely to undergo kidney transplants, and among those who do, are more likely to experience graft rejection. Additionally, until 2021, kidney function equations were shown to underestimate the severity of kidney disease in AA due to the use of race coefficients. Among all populations, genetic and epigenetic factors contribute to kidney disease. However, AAs …

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Optimization Of Progranulin Gene Therapy, A Potential Treatment For Frontotemporal Dementia, Shreya Natesh Kashyap Jan 2023

Optimization Of Progranulin Gene Therapy, A Potential Treatment For Frontotemporal Dementia, Shreya Natesh Kashyap

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Heterozygous loss of function mutations in the progranulin gene cause frontotemporal dementia, characterized by deficits in social behavior, language comprehension and motor function. Almost every frontotemporal dementia-related progranulin mutation is loss of function and results in progranulin haploinsufficiency. For this reason, progranulin replacement is a conceptually straightforward therapeutic strategy for patients with frontotemporal dementia caused by progranulin mutations. Here, we outline progranulin biology, progranulin deficient mouse models of frontotemporal dementia and preclinical interventions centered around increasing brain progranulin levels. We have demonstrated that blocking the progranulin C-terminus, which harbors the sortilin binding site, improves the cross-correctional capacity of neurotropic progranulin …

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Spilling The Tea, Memoir Of A Future's Past: A Scholarly Personal Narrative, Dominique Jerome Hector Jan 2023

Spilling The Tea, Memoir Of A Future's Past: A Scholarly Personal Narrative, Dominique Jerome Hector

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Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) individuals and topics have been at the precipice of media coverage and policy decisions for decades. With the passage of same sex marriage by the Supreme Court in 2015, this ushered in a new era of unearthing narratives that are unique to LGBTQ+ identities. Although this is a huge advancement for this population here within the United States, scholars have posited how these identities intersecting with other social constructs such as race, gender, socioeconomic status, and social justice have reimaged how LGBTQ+ identities are viewed and treated in the country. Although there is …

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Molecular Influences Of Racial Disparities In Pancreatic Neuroendocrine Tumors, Brendon Herring Jan 2023

Molecular Influences Of Racial Disparities In Pancreatic Neuroendocrine Tumors, Brendon Herring

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Pancreatic Neuroendocrine Tumors (PNETs) are highly heterogeneous neoplasms arising from the hormone-secreting cells of the endocrine pancreas. PNETs are broadly categorized as functional and non-functional based on the presence of symptoms associated with hormone secretion, which occurs in approximately 30% of cases. While functional tumors are all considered for resection because of these symptoms and their associated sequelae, non-functional tumors > 2cm are currently resected based on increased risk of developing metastatic disease. However, this criterion is based on data from predominantly White patients. Recent studies have shown that Black patients have much higher rates of lymph node metastatic disease at …

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Spatial/Temporal Zonation, Diversification, And Evolutionary Conservation Of Kidney Resident Macrophage Subpopulations In Mice And Humans After Kidney Injury, Elise Nicole Erman Jan 2023

Spatial/Temporal Zonation, Diversification, And Evolutionary Conservation Of Kidney Resident Macrophage Subpopulations In Mice And Humans After Kidney Injury, Elise Nicole Erman

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In the United States, acute kidney injury (AKI) affects nearly 20% of all intensive care unit patients. Additionally, over a third of Americans aged 50 or older suffer from stage 3 chronic kidney disease (CKD) or higher. AKI and CKD are encompassing terms for many etiologies and pathological processes that affect different regions of the kidney but converge at tissue inflammation and fibrosis. Macrophages perform vital homeostatic functions and can initiate or ameliorate inflammation and fibrosis. As the largest component of the kidney immune system, kidney resident macrophages (KRMs) have been implicated in both disease propagation and mitigation, yet the …

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Investigating Scientific Self-Concept In The General Chemistry Laboratory While Performing Course-Based Undergraduate Research Throughout A Pandemic, Josh Forakis Jan 2023

Investigating Scientific Self-Concept In The General Chemistry Laboratory While Performing Course-Based Undergraduate Research Throughout A Pandemic, Josh Forakis

All ETDs from UAB

Climate change, waste management crises, and global pandemics emphasize the need for a thriving science, technology, engineering, and mathematics (STEM) workforce, and one of the jobs of STEM educators is to provide meaningful educational experiences that engage STEM students in scientific practices, broaden their worldview, and prepare them for a future career in the scientific field. Undergraduate research experiences have been shown to benefit STEM students, but few students can participate, especially at early stages in their undergraduate studies. To broaden participation in undergraduate research, an honors general chemistry laboratory course was converted into a course-based undergraduate research experience (CURE) …

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Inkjet-Printed Reseroir Computing Network For In Situ Sensor Predictions, Steven D. Gardner Jan 2023

Inkjet-Printed Reseroir Computing Network For In Situ Sensor Predictions, Steven D. Gardner

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The technological achievements made with silicon-based transistors have led to nearly all the computing seen today, complete with benefits such as maximized operating speeds, parallel/tensor processing, minimized power overhead, etc. The silicon electronics industry is foundational to scientific progression with its profound impact on modeling, simulations, and fast/reliable computing. However, silicon-based transistors have evolved to meet their physical limitations and have saturated fields of innovation. New fields in computing outside of silicon-based methods have emerged as exotic materials enter the research domain. The suite of super-performing materials like Graphene, Carbon Nanotubes, and Molybdenum Disulfide have chaotic, non-linear behaviors that make …

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Modular Regulation And Function Of The Polypyrimidine Tract Binding Protein 1 (Ptbp1), Christine Carico Jan 2023

Modular Regulation And Function Of The Polypyrimidine Tract Binding Protein 1 (Ptbp1), Christine Carico

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RNA binding proteins (RBPs) are critical regulators of gene expression as they are responsible for the chaperoning and processing of every nascent RNA transcript. Many studies have investigated mechanisms of specificity of RBP function and have identified factors such as cell-specific expression of RBPs and differential preferences for RNA secondary structure. However, RBPs are often multi-domain proteins that contain repeats of various RNA binding domains (e.g., RNA recognition motif) and little work in the genomic era of transcriptomic interrogation has been done to define the contribution of individual domains to the overall protein function. Polypyrimidine tract binding protein 1 (PTBP1) …

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Microwave Plasma Cvd Sythesis Of Superhard Cnob Materials, Kallol Chakrabarty Jan 2023

Microwave Plasma Cvd Sythesis Of Superhard Cnob Materials, Kallol Chakrabarty

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Superhard materials are catching a lot of attention due to their unique properties and practical applications. When the hardness value of the material exceeds 40 GPa by the Vickers hardness test, the material is called superhard. Diamond is the hardest known material with a hardness value of 70-100 GPa. Although diamond is electrically insulating and thermally conductive, it has significant limitations. In addition to its high cost, it is prone to oxidation at temperatures above 800 °C and unsuitable for high-speed machining of ferrous alloys because of chemical reactions with iron group elements. Thus, diamond is unaffordable and unfavorable for …

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Functional Least Squares Minimization, Kyoung Joo Cox Jan 2023

Functional Least Squares Minimization, Kyoung Joo Cox

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In this thesis, we forecast the trend and price of a selected stock using four new algorithms and a previous mathematical model built from economic ‘tendencies’. We use a new variational regularization method to determine the coefficients of the delay differential equation in the previous mathematical model. We also apply our new approach to obtaining initial points for the regularization method as well as a technique for mitigating the exponential growth model error throughout the minimization process of the regularization method. Lastly, we use the newly discovered coefficients together with a new iterative improvement procedure and a knowledge of the …

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Unveiling The Molecular Features Of Cancer Health Differences Through Multi-Omics Data Analysis, Fengyuan Huang Jan 2023

Unveiling The Molecular Features Of Cancer Health Differences Through Multi-Omics Data Analysis, Fengyuan Huang

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Understanding the molecular features underlying cancer health differences is crucial for developing effective therapeutic strategies. Multi-omics data analysis, integrating various molecular layers such as genomics, transcriptomics, epigenomics, proteomics, and metabolomics, provides a comprehensive approach to characterize the molecular landscape of cancer differences. By integrating diverse omics data, researchers can identify genetic variations, gene expression patterns, epigenetic modifications, and protein alterations that contribute to differences in cancer progression, and treatment response. These molecular features can serve as potential biomarkers for predicting patient outcomes and guiding personalized treatment strategies. Furthermore, multi-omics data analysis enables the identification of molecular subtypes specific to different …

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Aging With Hiv And Comorbid Chronic Obstructive Pulmonary Disease, Jun Yeong Byun Jan 2023

Aging With Hiv And Comorbid Chronic Obstructive Pulmonary Disease, Jun Yeong Byun

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Older adults with human immunodeficiency virus (HIV) experience a high prevalence of chronic obstructive pulmonary disease (COPD). Considering having either HIV or COPD is related to worse health outcomes in older adults, aging with both HIV and COPD may synergistically and negatively affect the health outcomes of older people with HIV (PWH) and comorbid COPD. The purpose of this dissertation was to explore the aging of PWH with COPD. This purpose was accomplished through three articles: 1) an adaptation of a gerontological model investigating what is known about the aging of PWH and people with COPD and extrapolating that to …

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Impact Of Streptococcus Parasanguinis-Generated Reactive Nitrogen Species On Pseudomonas Aeruginosa Virulence And The Host Response, Joshua J. Baty Jan 2023

Impact Of Streptococcus Parasanguinis-Generated Reactive Nitrogen Species On Pseudomonas Aeruginosa Virulence And The Host Response, Joshua J. Baty

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Streptococcus parasanguinis is an oral commensal bacterium that produces hydrogen peroxide. Hydrogen peroxide can react with endogenous molecules such as nitrite to form reactive nitrogen intermediates (RNI). These S. parasanguinis-mediated RNI have been shown to inhibit oral pathogens such as Streptococcus mutans, Enterococcus faecalis, and Aggregatibacter actinomycetemcomitans. As such, S. parasanguinis plays a protective role in the oral microbial ecosystem by antagonizing and preventing colonization by oral pathogens. In addition to being an important organism for the health of the oral cavity, S. parasanguinis has also been associated with improved outcomes for people with cystic fibrosis. There are two explanations …

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