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2019

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E-Learning Nutrition Education Program For Low-Income Adults: Perspectives Of Key Stakeholders, Sarah Stotz, Jung Sun Lee, Hui Rong, Deborah Murray Feb 2019

E-Learning Nutrition Education Program For Low-Income Adults: Perspectives Of Key Stakeholders, Sarah Stotz, Jung Sun Lee, Hui Rong, Deborah Murray

Journal of Extension

Through focus group interviews, we examined the perceptions of Extension peer nutrition educators (n = 6) and low-income adults (n = 8) regarding the feasibility of an e-learning nutrition education program, titled Food eTalk, tailored to Georgians eligible for Supplemental Nutrition Assistance Program Education (SNAP-Ed). Findings indicated two themes: (a) Participants have regular smartphone-based Internet access, and nutrition education e-learning programs should be designed to match typical smartphone use patterns and (b) recommendations to increase Food eTalk engagement involve carefully selected content and consideration to mandate SNAP-Ed participation. These findings are informing user-centered development of Food eTalk and may be …


Edible Insect Workshop Engages Public In Sustainable Food Conversation, James Jasinski, Ashley Kulhanek, Kate Shumaker Feb 2019

Edible Insect Workshop Engages Public In Sustainable Food Conversation, James Jasinski, Ashley Kulhanek, Kate Shumaker

Journal of Extension

A 6-hr train-the-trainer workshop focused on introducing the concept that insects may play a significant role in food security as the world population is projected to exceed 9 billion people by the mid 21st century. Workshop topics including cultural, nutritional, culinary, and commercial aspects surrounding edible insects were presented and packaged into a formal curriculum for later use by the participants. A 12-item sensory evaluation of insect-fortified foods provided participants a tangible experience with product palatability. By the end of the workshop, participants had increased various dimensions of their knowledge about edible insects and reported a generally positive perception toward …


In This Issuesystematic Revieworiginal Articlescase Report Feb 2019

In This Issuesystematic Revieworiginal Articlescase Report

Saudi Medical Journal

No abstract provided.


Methionyl-Trna Synthetase Novel Mutation Causes Pulmonary Alveolar Proteinosis, Mohammed Alzaid, Abdullah Alshamrani, Ayed Alenzi, Sarar Mohamed Feb 2019

Methionyl-Trna Synthetase Novel Mutation Causes Pulmonary Alveolar Proteinosis, Mohammed Alzaid, Abdullah Alshamrani, Ayed Alenzi, Sarar Mohamed

Saudi Medical Journal

The methionyl-tRNA synthetase (MARS) mutation is a very rare cause of congenital pulmonary alveolar proteinosis. We report a 6-month-old boy born with symmetrical intrauterine growth retardation presented with unexplained persistent tachypnea and hypoxemia associated with severe failure to thrive, anemia, hypoalbuminemia and hepatomegaly. Detailed pulmonary investigations including computed tomography chest scan, bronchoscopy and bronchoalveolar lavage revealed pulmonary alveolar proteinosis. Whole exome sequencing identified a homozygous novel variant in the MARS gene, c.854T>C p.(Ile285Thr).


The Surprising Reach Of Fda Regulation Of Cannabis, Even After Descheduling, Erika Lietzan, Sean M. O'Connor Feb 2019

The Surprising Reach Of Fda Regulation Of Cannabis, Even After Descheduling, Erika Lietzan, Sean M. O'Connor

Faculty Publications

As more states legalize cannabis, the push to "deschedule" it from the Controlled Substances Act is gaining momentum. At the same time, the Food and Drug Administration (FDA) recently approved the first conventional drug containing a cannabinoid derived from cannabis - cannabidiol (CBD) for two rare seizure disorders. This would all seem to bode well for proponents of full federal legalization of medical cannabis. But some traditional providers are wary of drug companies pulling medical cannabis into the regular small molecule drug development system. The FDA's focus on precise analytical characterization and on individual active and inactive ingredients may be …


Borderplex Business Barometer, Volume 3, Number 2, Thomas M. Fullerton Jr., Aaron Nazarian, Steven L. Fullerton, Sergio Olivas Feb 2019

Borderplex Business Barometer, Volume 3, Number 2, Thomas M. Fullerton Jr., Aaron Nazarian, Steven L. Fullerton, Sergio Olivas

Border Region Modeling Project

No abstract provided.


Financial Impact Of Penn State Extension's Know Your Numbers Dairy Program, Aaron Berger, Timothy W. Kelsey, Stephan J. Goetz, Robert C. Goodling Jr., Virginia A. Ishler Feb 2019

Financial Impact Of Penn State Extension's Know Your Numbers Dairy Program, Aaron Berger, Timothy W. Kelsey, Stephan J. Goetz, Robert C. Goodling Jr., Virginia A. Ishler

Journal of Extension

Dairy-related Extension programming is important in many states, but the economic impact of such programming has received little attention. We examined the impact of Know Your Numbers, an educational program offered by the Penn State Extension Dairy Team. Using follow-up evaluation data and the economic impact tool IMPLAN, we estimated that the program had a total financial impact of $9.5 million and an employment impact of 69 jobs in 2014. The overall financial impacts of the Dairy Team, given its abundance of other programming, likely are significantly higher. Our approach for estimating the economic impact of an Extension program can …


The Impact Of An Electrical Mini-Grid On The Development Of A Rural Community In Kenya, Abubakr Bahaj, Luke Blunden, Christopher Kanani, Patrick James, Issac Kiva, Zoe Matthews, Heather Price, Hildah Essendi, Jane Ealkingham, Gerard George Feb 2019

The Impact Of An Electrical Mini-Grid On The Development Of A Rural Community In Kenya, Abubakr Bahaj, Luke Blunden, Christopher Kanani, Patrick James, Issac Kiva, Zoe Matthews, Heather Price, Hildah Essendi, Jane Ealkingham, Gerard George

Research Collection Lee Kong Chian School Of Business

Electrical mini-grids can provide electrification to rural communities far from the national network. However the benefits of such schemes are disputed. We observed changes in two matched trading-centres in Makueni County, Kenya, neither of which were initially electrified. During the study a solar photovoltaic mini-grid scheme (13.5 kWp) was constructed in one of the trading-centres. After electrification there were relative increases in the number of businesses and business income. Comparing the households in the areas around the trading centres, perceived wealth increased more around the electrified trading centre. Qualitative interviews indicated improvements in service provision by the local school and …


Preferences For Physical Activity: A Conjoint Analysis Involving People With Chronic Knee Pain, Daniel Pinto, Ulf Bockenholt, Jungwha Lee, Rowland W. Chang, Leena Sharma, Daniel J. Finn, Allen W. Heinemann, Jane Louise Holl, Paul D. Hansen Feb 2019

Preferences For Physical Activity: A Conjoint Analysis Involving People With Chronic Knee Pain, Daniel Pinto, Ulf Bockenholt, Jungwha Lee, Rowland W. Chang, Leena Sharma, Daniel J. Finn, Allen W. Heinemann, Jane Louise Holl, Paul D. Hansen

Physical Therapy Faculty Research and Publications

Objective

To investigate individual preferences for physical activity (PA) attributes in adults with chronic knee pain, to identify clusters of individuals with similar preferences, and to identify whether individuals in these clusters differ by their demographic and health characteristics.

Design

An adaptive conjoint analysis (ACA) was conducted using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method to determine preference weights representing the relative importance of six PA attributes. Cluster analysis was performed to identify clusters of participants with similar weights. Chi-square and ANOVA were used to assess differences in individual characteristics by cluster. Multinomial logistic regression was …


Prevalence, Underlying Causes, And Preventability Of Sepsis-Associated Mortality In Us Acute Care Hospitals, Chanu Rhee, Travis M. Jones, Yasir Hamad, Anupam Pande, Jack Varon, Cara O'Brien, Deverick J Anderson, David K. Warren, Raymund B. Dantes, Lauren Epstein, Michael Klompas Feb 2019

Prevalence, Underlying Causes, And Preventability Of Sepsis-Associated Mortality In Us Acute Care Hospitals, Chanu Rhee, Travis M. Jones, Yasir Hamad, Anupam Pande, Jack Varon, Cara O'Brien, Deverick J Anderson, David K. Warren, Raymund B. Dantes, Lauren Epstein, Michael Klompas

Open Access Publications

Importance: Sepsis is present in many hospitalizations that culminate in death. The contribution of sepsis to these deaths, and the extent to which they are preventable, is unknown.

Objective: To estimate the prevalence, underlying causes, and preventability of sepsis-associated mortality in acute care hospitals.

Design, Setting, and Participants: Cohort study in which a retrospective medical record review was conducted of 568 randomly selected adults admitted to 6 US academic and community hospitals from January 1, 2014, to December 31, 2015, who died in the hospital or were discharged to hospice and not readmitted. Medical records were reviewed from January 1, …


Effectiveness Of Windrow Composting Methodology In Killing A Thermo-Tolerant Species Of Salmonella During Mortality Composting, Spencer Gabriel Myers Feb 2019

Effectiveness Of Windrow Composting Methodology In Killing A Thermo-Tolerant Species Of Salmonella During Mortality Composting, Spencer Gabriel Myers

Master's Theses

In a large agricultural operation, such as the one at Cal Poly San Luis Obispo, disposal of deceased animals is an immense issue. The cost of transporting and rendering every dead animal is inhibitory to the general function of the agricultural operations and their thin budget. Therefore, we propose that composting mortalities could be an economical alternative. Composting is a recognized method for taking animal waste products along with carbon waste and turning it into a pathogen-free, nutrient-rich topsoil. Carcass composting is in fact performed in other countries and states to varying degrees of success. However, the California EPA limits …


Association Between Asthma And Dental Caries Amongst 12 - 15 Years Old Children: A School-Based Cross-Sectional Study In Karachi, Pakistan, Wajeeha Zahid, Shafquat Rozi, Farhan Raza Khan, Nida Zahid, Muhammad Masood Kadir Feb 2019

Association Between Asthma And Dental Caries Amongst 12 - 15 Years Old Children: A School-Based Cross-Sectional Study In Karachi, Pakistan, Wajeeha Zahid, Shafquat Rozi, Farhan Raza Khan, Nida Zahid, Muhammad Masood Kadir

Community Health Sciences

Objective: The study aimed to determine an association between dental caries and asthma among 12 to 15 years old children.
Methods: This is a school-based cross-sectional study conducted from January to February 2016. A random sample of 544 children aged 12 - 15 years were enrolled from five private schools of Karachi. Dental caries was assessed using DMFT Index (Decayed, Missing, Filled teeth). The main exposure variable was asthma and information on it was collected through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire.
Results: The data was analyzed using Cox Proportional Hazard algorithm. Crude and adjusted …


Labrad : Vol 45, Issue 1 - February 2019, Aga Khan University Hospital, Karachi Feb 2019

Labrad : Vol 45, Issue 1 - February 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

  • Cardiac Manifestation of Inherited Metabolic Disorders
  • Utility of Plasma Homocysteine in Identifying Inherited Metabolic Disorders (IMDs)
  • Chediak-Higashi Syndrome, an Inherited Disorder in Phagocytic Function
  • Radiology-Pathology Correlation Rare Diseases of Bone
  • Dried Blood Spot (DBS) Sampling: A Method for Blood Collection without Venipuncture
  • Newborn Screening Program for Congenital Hypothyroidism
  • Rare Disease in Dermatopathology
  • Screening for Carbohydrate Metabolism Disorders by Sugar Chromatography in Urine
  • Hypophosphatasia a Rare Skeletal Disorder


Sustainable Solutions, Georgia Southern University Feb 2019

Sustainable Solutions, Georgia Southern University

Sustainable Solutions Newsletter (2016-2021)

  • Upcoming Events
  • Statesboro Campus
  • Armstrong Campus
  • Green Eagle Awards
  • What does Georgia Southern Recycle?
  • Programs
  • Campus in the Spotlight
  • Professional Development
  • Green Tip


Fast And Furious: Stroke Update 2019, Mary Kay Bader Feb 2019

Fast And Furious: Stroke Update 2019, Mary Kay Bader

Books, Presentations, Posters, Etc.

This lecture focuses on the AHA guidelines and how the Acute Stroke Team focuses the efforts in the first few hours after presentation. Audience will be made up of physicians, nurses and EMT/EMS personnel. The aims of the event include providing a couple ‘cutting edge’ key note speakers with varying expertise from different parts of the acute stroke care continuum.


Age-Related Changes In Myelin Of Axons Of The Corpus Callosum And Cognitive Decline In Common Marmosets, Kimberley A. Phillips, Chase M. Watson, Ari Bearman, Anna R. Knippenberg, J. Adams, C. N. Ross, S. D. Tardif Feb 2019

Age-Related Changes In Myelin Of Axons Of The Corpus Callosum And Cognitive Decline In Common Marmosets, Kimberley A. Phillips, Chase M. Watson, Ari Bearman, Anna R. Knippenberg, J. Adams, C. N. Ross, S. D. Tardif

Psychology Faculty Research

Executive control is a higher‐level cognitive function that involves a range of different processes that are involved in the planning, coordination, execution, and inhibition of responses. Many of the processes associated with executive control, such as response inhibition and mental flexibility, decline with age. Degeneration of white matter architecture is considered to be the one of the key factors underlying cognitive decline associated with aging. Here we investigated how white matter changes of the corpus callosum were related to cognitive aging in common marmosets (Callithrix jacchus). We hypothesized that reduction in myelin thickness, myelin density, and myelin fraction …


Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes Feb 2019

Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes

Dignity: A Journal of Analysis of Exploitation and Violence

Drs. Tro Kalayjian (Tapan, New York) and Brian Lenzkes (Santee, California) talk to Matt about his struggles with food, pornography, and alcohol addiction, and how changing his diet contributed to his recovery from his addictions. This report is excerpted from the audio podcast LowCarbMD, Episode 13 (https://itunes.apple.com/us/podcast/low-carb-md-podcast/ ), January 30, 2019). This podcast has filled us with immense hope for those struggling with addiction.


Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt Feb 2019

Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt

Physician Assistant Scholarly Project Papers

Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has …


Intermittent Fasting In Weight Management, Alyse Engen Feb 2019

Intermittent Fasting In Weight Management, Alyse Engen

Physician Assistant Scholarly Project Papers

Obesity is associated with a variety of medical conditions that adversely affect metabolic and cardiovascular health. In order for health care providers to adequately educate and promote weight management, they need to be aware of the various dietary regimens and the efficacy and adverse effects associated with each. The purpose of this study is to analyze research assessing the efficacy and health benefit of intermittent energy restriction and compare to the efficacy and health benefits of continuous energy restriction. This literature review assesses the efficacy, metabolic benefits, and cardiovascular benefits of both intermittent energy restriction and continuous energy restriction from …


Delaying Onset Of Diabetes In Native American Populatons, Seth Tramm Feb 2019

Delaying Onset Of Diabetes In Native American Populatons, Seth Tramm

Physician Assistant Scholarly Project Papers

Diabetes is a debilitating disease process caused by the body’s inability to control blood glucose levels. With over 30 million diabetics in the United States, and another 85 million prediabetics, the effects of this disease are wide-spread and far-reaching. Native American/Alaska Native populations have a nearly two-fold increase in incidence of diabetes when compared to non-native populations. Risk factors for diabetes in all populations include modifiable risks such as obesity, diet, physical inactivity as well as non-modifiable factors such as age, family history, and ethnicity. Studies have shown that early identification of symptoms, coupled with proper and intentional treatment can …


Understanding The Basics Of Rabbit Care, Nicloe Reed, Amanda Christensen Feb 2019

Understanding The Basics Of Rabbit Care, Nicloe Reed, Amanda Christensen

All Current Publications

This fact sheet is designed to give anyone interested in owning and raising rabbits an overview of the basics of rabbit care and the resources needed to get started.


Determination Of The Bioaccessible Fraction Of Cupric Oxide Nanoparticles In Soils Using An In Vitro Human Digestibility Simulation, J. Vassallo, K. Tatsi, R. Boden, R. D. Handy Feb 2019

Determination Of The Bioaccessible Fraction Of Cupric Oxide Nanoparticles In Soils Using An In Vitro Human Digestibility Simulation, J. Vassallo, K. Tatsi, R. Boden, R. D. Handy

School of Biological and Marine Sciences

No abstract provided.


Gaps In Safe Food Handling Practices Of Older Adults, Lelee Yap, Sarah L. Francis, Mack C. Shelley Ii, Doris Montgomery, Catherine J. Lillehoj Feb 2019

Gaps In Safe Food Handling Practices Of Older Adults, Lelee Yap, Sarah L. Francis, Mack C. Shelley Ii, Doris Montgomery, Catherine J. Lillehoj

Journal of Extension

We identified gaps in safe food handling practices that may be placing older adults at increased risk of food-borne illness. A convenience sample of 1,019 older adults completed the Food Safety Behavior Questionnaire. Majority groups among participants were those who were female, those who were White, and those who were widowed. Participants had lower adherences to safe practices related to temperature control, attention to sell-by/use-by dates on food packages, and cross-contamination. Adherences were significantly (p < .05) influenced by gender, race/ethnicity, age, marital status, and education. Our findings suggest the need for older adult–focused safe food handling education related to temperature control, product selection practices, and cross-contamination.


Refusal Bias In Hiv Data From The Demographic And Health Surveys: Evaluation, Critique And Recommendations, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung Feb 2019

Refusal Bias In Hiv Data From The Demographic And Health Surveys: Evaluation, Critique And Recommendations, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung

Research Collection School Of Economics

Non-response is a commonly encountered problem in many population-based surveys. Broadly speaking, non-response can be due to refusal or failure to contact the sample units. Although both types of non-response may lead to bias, there is much evidence to indicate that it is much easier to reduce the proportion of non-contacts than to do the same with refusals. In this article, we use data collected from a nationally-representative survey under the Demographic and Health Surveys program to study non-response due to refusals to HIV testing in Malawi. We review existing estimation methods and propose novel approaches to the estimation of …


Immediate Versus Delayed Exercise In Men Initiating Androgen Deprivation: Effects On Bone Density And Soft Tissue Composition, Dennis R. Taaffe, Daniel A. Galvao, Nigel Spry, David Joseph, Suzanne K. Chambers, Robert A. Gardiner, Dickon Hayne, Prue Cormie, David H.K. Shum, Robert U. Newton Feb 2019

Immediate Versus Delayed Exercise In Men Initiating Androgen Deprivation: Effects On Bone Density And Soft Tissue Composition, Dennis R. Taaffe, Daniel A. Galvao, Nigel Spry, David Joseph, Suzanne K. Chambers, Robert A. Gardiner, Dickon Hayne, Prue Cormie, David H.K. Shum, Robert U. Newton

Research outputs 2014 to 2021

OBJECTIVES: To examine whether it is more efficacious to commence exercise medicine in men with prostate cancer at the onset of androgen-deprivation therapy (ADT) rather than later on during treatment to preserve bone and soft-tissue composition, as ADT results in adverse effects including: reduced bone mineral density (BMD), loss of muscle mass, and increased fat mass (FM).

PATIENTS AND METHODS: In all, 104 patients with prostate cancer, aged 48-84 years initiating ADT, were randomised to immediate exercise (IMEX, n = 54) or delayed exercise (DEL, n = 50) conditions. The former consisted of 6 months of supervised resistance/aerobic/impact exercise and …


A Paleolithic Diet Lowers Resistant Starch Intake But Does Not Affect Serum Trimethylamine-N-Oxide Concentrations In Healthy Women, Angela Genoni, Johnny Lo, Philippa Lyons-Wall, Mary C. Boyce, Claus T. Christophersen, Anthony Bird, Amanda Devine Feb 2019

A Paleolithic Diet Lowers Resistant Starch Intake But Does Not Affect Serum Trimethylamine-N-Oxide Concentrations In Healthy Women, Angela Genoni, Johnny Lo, Philippa Lyons-Wall, Mary C. Boyce, Claus T. Christophersen, Anthony Bird, Amanda Devine

Research outputs 2014 to 2021

The Paleolithic diet excludes two major sources of fibre, grains and legumes. However, it is not known whether this results in changes to resistant starch (RS) consumption. Serum trimethylamine-N-oxide (TMAO) is produced mainly from colonic fermentation and hepatic conversion of animal protein and is implicated in CVD, but changes in RS intake may alter concentrations. We aimed to determine whether intake of RS and serum concentrations of TMAO varied in response to either the Paleolithic or the Australian Guide to Healthy Eating (AGHE) diets and whether this was related to changes in food group consumption. A total of thirty-nine women …


Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xinghui Zhao, Carlos J. Crespo, Multiple Additional Authors Feb 2019

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xinghui Zhao, Carlos J. Crespo, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination …


Global Surgery: Building Healthy Surgical Systems., Taylor Leposa, Bria Johnston, Sohail Asghar Dogar, Henry Rice, Tamara Fitzgerald Feb 2019

Global Surgery: Building Healthy Surgical Systems., Taylor Leposa, Bria Johnston, Sohail Asghar Dogar, Henry Rice, Tamara Fitzgerald

Department of Surgery Docs

Global Surgery (GS) is a movement that advocates access of every individual to safe and affordable surgery despite geographic location or socioeconomic status. It has recently received increased attention within the global health arena, but many patients are still without access to care because of geographical, social and economic disparities. Due to the multi-disciplinary nature of surgical services, GS requires that a worldwide network of healthy surgical systems be developed and sustained. Healthy surgical systems have many components, and this paper will briefly address 3 of those components: Improved access to care, safety and quality, and multidisciplinary strengthening.


Mandarin Assessment In Chinese-English Bilingual Preschoolers, Jennifer A. Chard Feb 2019

Mandarin Assessment In Chinese-English Bilingual Preschoolers, Jennifer A. Chard

Dissertations, Theses, and Capstone Projects

Immigrant children who grow up in linguistically and culturally diverse households are at risk for misdiagnosis for language impairment and inappropriate placement in or exclusion from special education classes. Research shows that native language testing is essential in determining eligibility for disability services, as reflected both in federal law (Individuals with Disabilities Education Improvement Act of 2004). However, despite growing agreement that native language assessment is a critical component to understanding the abilities and challenges bilingual students face, the standard assessments currently used are largely administered in Standard English and normed on monolingual English speakers. Few options are available to …


January 31, 2019, James Madison University Jan 2019

January 31, 2019, James Madison University

The Breeze, 2010-2019

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia.