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Articles 3361 - 3390 of 74524
Full-Text Articles in Entire DC Network
Assessing Pharmacy Student Knowledge, Intent To Practice, And Perceptions Of Current Learning As It Pertains To Pharmacist Furnishing Of Hormonal Contraception In Pennsylvania, Ashley Sargent, Bs, Nicasia D'Allesandro, Bs, Danielle Mayer, Pharmd, Bcacp
Assessing Pharmacy Student Knowledge, Intent To Practice, And Perceptions Of Current Learning As It Pertains To Pharmacist Furnishing Of Hormonal Contraception In Pennsylvania, Ashley Sargent, Bs, Nicasia D'Allesandro, Bs, Danielle Mayer, Pharmd, Bcacp
College of Pharmacy Posters
Objectives:
- Assess student pharmacist knowledge of pharmacist prescribing of hormonal contraceptives and important details in order to safely and effectively prescribe
- Assess student pharmacist attitudes and intention of offering this service if Pennsylvania allows for this innovative role
- Assess student perceptions of curricular education to provide direct pharmacy access to hormonal contraception
Medicine And Surgery Residents' Perspectives On The Impact Of Covid-19 On Graduate Medical Education., Tanvi Rana, Christopher Hackett, Timothy Quezada, Abhishek Chaturvedi, Veli Bakalov, Jody Leonardo, Sandeep Rana
Medicine And Surgery Residents' Perspectives On The Impact Of Covid-19 On Graduate Medical Education., Tanvi Rana, Christopher Hackett, Timothy Quezada, Abhishek Chaturvedi, Veli Bakalov, Jody Leonardo, Sandeep Rana
COVID-19 Papers, Posters, and Presentations
The COVID-19 crisis has had an unprecedented impact on resident education and well-being: social distancing guidelines have limited patient volumes and forced virtual learning, while personal protective equipment (PPE) shortages, school/daycare closures, and visa restrictions have served as additional stressors. Our study aimed to analyze the effects of COVID-19 crisis-related stressors on residents' professional and personal lives. In April 2020, we administered a survey to residents at a large academic hospital system in order to assess the impact of the pandemic on residency training after >6 weeks of a modified schedule. The primary outcome was to determine which factors or …
Improving Suicide Screening And Safety Plan Documentation Rates In Behavioral Health Clinics, Brandi Hrasdzira
Improving Suicide Screening And Safety Plan Documentation Rates In Behavioral Health Clinics, Brandi Hrasdzira
Doctor of Nursing Practice
Suicide is the 10th leading cause of death in the United States with over 47,000 people dying in 2017 from suicide alone (NIMH, 2019). In the United States, one in three people who die by suicide were seen by a behavioral health provider within the same year (McCabe et al., 2018). The purpose of this project was to determine if suicide screenings and safety plans are being completed and documented properly; how many patients are refusing to complete the patient health questionnaire (PHQ-9) and is there a pattern present in these patients. Objectives are to improve the rates of suicide …
Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois
Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois
Doctor of Nursing Practice
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …
Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato
Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato
Doctor of Nursing Practice
Heart disease is the leading cause of morbidity and mortality in Americans with type 2 diabetes mellitus. The American Diabetes Association recommends statins and lifestyle modifications for all patients with type 2 diabetes mellitus for the prevention of atherosclerotic cardiovascular events. A patient-centered approach to primary prevention is encouraged, yet there are no specific instructions regarding implementation. The Statin Choice Decision Aid is a tool designed to facilitate shared decision-making between the patient and the provider in the clinical setting. The 2018 American College of Cardiology/American Heart Association guidelines for the primary prevention of atherosclerotic cardiovascular disease for patients with …
Implementation Of A Guideline For Major Depressive Disorder In A Private Practice Clinic, Doreen Phillips
Implementation Of A Guideline For Major Depressive Disorder In A Private Practice Clinic, Doreen Phillips
Doctor of Nursing Practice
Major depressive disorder (MDD) is a chief mental health illness that carries a profound economic burden. Many who suffer from MDD find little to no relief with traditional pharmacological interventions.The 2010 American Psychiatric Association Guidelines for Treatment of Patients with MDD recognized TMS as a second-line treatment choice. Several double-blind, randomized controlled trials illustrated the efficacy and safety of TMS as a viable treatment option for MDD. The purpose of this project was to implement standardized processes through the use of a treatment guideline to help provide comprehensive treatment options for patients suffering from moderate to severe major depressive disorder …
Incorporating Hiv Pre-Exposure Prophylaxis In Primary Care, Daniel Manesh
Incorporating Hiv Pre-Exposure Prophylaxis In Primary Care, Daniel Manesh
Doctor of Nursing Practice
In 2012, the Food and Drug Administration approved a combination medication named Truvada (tenofovir/emtricitabine) as a prophylactic treatment to prevent HIV transmission. Truvada is also known as pre-exposure prophylaxis (PREP). PREP is a one-pill-a-day regimen proven to be 99% effective against HIV-1 transmission from sex and intravenous drug injection when taken daily. The uptake of PREP remains low because primary care providers fail to identify patients who meet the requirements to start PREP and fail to prescribe PREP for patients at risk. The purpose of this quality improvement project was to increase the uptake of PREP in patients at risk …
Increasing Adherence To Measurement-Based Depression Management In Primary Care, Renad Saadat
Increasing Adherence To Measurement-Based Depression Management In Primary Care, Renad Saadat
Doctor of Nursing Practice
Background and Review of Literature. Approximately 11 million Americans 18 years or older experienced a severe symptom of depression leading to impairment in 2017. The severity of depressive symptoms is often miscalculated in primary care as measurement-based tools for the diagnosis and ongoing reassessment varies. Purpose. The purpose of the project was to increase provider adherence in using the patient health questionnaire-9 (PHQ-9) for ongoing evaluation of the severity of depressive symptoms in patients with depression at a primary care clinic in San Antonio, Texas. Objectives. The main objective of this Doctor of Nursing Practice project is …
Establishing A Structured Mentorship Program For Novice Advanced Practice Registered Nurses In The Veterans Health Care System, Rodney Duckett
Establishing A Structured Mentorship Program For Novice Advanced Practice Registered Nurses In The Veterans Health Care System, Rodney Duckett
Doctor of Nursing Practice
Background. Mentorship is an age-old strategy still widely sought after to increase integration into the workforce. Employers of new APRNs must be aware that newly graduated APRNs are inexperienced. To maximize the employers’ investment, training on proper integration should be a high priority. This Doctor of Nursing Practice (DNP) project addressed this quality improvement issue through the implementation of a structured mentorship program to improve the overall transitioning of newly hired APRNs in the Veterans Health Care System (VHCS). Problem. The VHCS lacks a formalized, structured mentorship program for newly graduated APRNs entering the VA System. Intervention. Seven APRN mentors …
Forage News [2020-12], Department Of Plant And Soil Sciences, University Of Kentucky
Forage News [2020-12], Department Of Plant And Soil Sciences, University Of Kentucky
Forage News
No abstract provided.
The Influence Of Affect On Hpv Vaccine Decision Making In An Hpv Vaccine Naïve College Student Population, Lynne B. Klasko-Foster, Sarahmona M. Przybyla, Heather Orom, Elizabeth Gage-Bouchard, Marc T. Kiviniemi
The Influence Of Affect On Hpv Vaccine Decision Making In An Hpv Vaccine Naïve College Student Population, Lynne B. Klasko-Foster, Sarahmona M. Przybyla, Heather Orom, Elizabeth Gage-Bouchard, Marc T. Kiviniemi
Health, Behavior & Society Faculty Publications
The HPV vaccine is recommended for all adolescents starting at age 11, but coverage is low, especially in the young adult population. The CDC is prioritizing catch-up vaccination and has expanded recommendations for all young adults to age 26. College students may be ideal targets for HPV vaccine interventions as they typically have on-site clinics that offer prevention services and students are in the position to make decisions about their own healthcare. We examined the risk perceptions of 101 HPV vaccine-naïve college students, both in terms of risk cognition (beliefs about susceptibility to HPV-related cancers and genital warts) and affect …
Cutr Connections [December 2020], Cutr
Seriously Doe: Why A Hybrid Approach To Regulating Deer Farms Is Right For West Virginia, Jordan R. Mcminn
Seriously Doe: Why A Hybrid Approach To Regulating Deer Farms Is Right For West Virginia, Jordan R. Mcminn
West Virginia Law Review
No abstract provided.
Downeast Maine Mat Expansion Project: Year 2 Data Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba
Downeast Maine Mat Expansion Project: Year 2 Data Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba
Substance Use Research & Evaluation
This report summarizes the Year 2 activities of the Healthy Acadia Downeast Maine MAT Expansion Project. Through a collaborative effort of Healthy Acadia, its providers, the Downeast Substance Treatment Network and Downeast Substance Use Response Coalition, the project utilized multiple evidence-based strategies to combat opioid use disorder (OUD) in Downeast Maine.
FMI: M. Lindsey Smith, PhD, [email protected]
Navigating Academia During The Covid-19 Pandemic: Can You Do It All?, Abha Rai, Kristen Ravi
Navigating Academia During The Covid-19 Pandemic: Can You Do It All?, Abha Rai, Kristen Ravi
Social Work: School of Social Work Faculty Publications and Other Works
The goal of this reflection paper is to draw from our own experiences of starting new tenure-track faculty positions in social work departments amid a global pandemic. By drawing from our experiences, we hope to reflect on strategies and resources utilized. By discussing our approach, we endeavor to provide support to other academics across the world. We believe these resources and strategies will be useful as we continue to live in the “new normal.”
Oceanside Transit Center Transit-Oriented Development (Otc Tod): Revisioning North San Diego's County Transit Hub, Chad Johnston
Oceanside Transit Center Transit-Oriented Development (Otc Tod): Revisioning North San Diego's County Transit Hub, Chad Johnston
City and Regional Planning
Many California coastal communities lack a supply of housing, produce high levels of greenhouse gas emissions by daily auto commuters but have existing local and commuter rail stations with large fields of parking surrounding it. Transit-Oriented Development (TOD) integrates the building of housing, retail, office, and public space together focused around transit stations. This infill of development locates people within comfortable walking distance, usually within a quarter-mile, of a public trail transit station reducing automobile dependence for local trips or commuting for work.
The Oceanside Transit Center (OTC) is a major railway interchange, serving as a gateway to the San …
Gender Differences In Communication With One's Mother And Father And Its Effects On Feelings Of Depression Among Young Adults, Ethan Nicolas Blanchard
Gender Differences In Communication With One's Mother And Father And Its Effects On Feelings Of Depression Among Young Adults, Ethan Nicolas Blanchard
All Theses
Depression among young adults is a growing concern that becomes more severe every year. Several factors can contribute to one’s feelings of depression including how much someone communicates their feelings to their parents. Communication with parent’s relationship to depression among young adults is a largely unexplored area of research that this study covers. The purpose of this study is to test gender differences in communication with one’s parents and how parental communication affects feelings of depression. Using the third wave of the National Study of Youth and Religion (NSYR), a nationally representative data set consisting of 1680 young adults living …
Decentralized Decision Making For Limited Resource Allocation Using A Private Blockchain Network In An Iot (Internet Of Things) Environment With Conflicting Agents, Vignesh Prabhu
All Theses
Blockchains have gotten popular in recent times, owing to the security, anonymity, and lack of any third-party involvement. Blockchains essentially are record keeping tools that record any transactions between involved parties. One of the key aspects of handling and navigating of any autonomous traffic on the streets, is secured and simple means of communication. This thesis explores distribution of minimum resources between multiple autonomous agents, by settling conflicts using events of random nature. The thesis focusses on two specific events, tossing of a coin and the game of rock, paper, and scissors (RPS). An improvement on the traditional game of …
Predicting In-Hospital Mortality After An In-Hospital Cardiac Arrest: A Multivariate Analysis, Talal Alnabelsi, Rahul Annabathula, Julie Shelton, Marc Paranzino, Sarah Price Faulkner, Matthew Cook, Adam J. Dugan, Sethabhisha Nerusu, Susan S. Smyth, Vedant A. Gupta
Predicting In-Hospital Mortality After An In-Hospital Cardiac Arrest: A Multivariate Analysis, Talal Alnabelsi, Rahul Annabathula, Julie Shelton, Marc Paranzino, Sarah Price Faulkner, Matthew Cook, Adam J. Dugan, Sethabhisha Nerusu, Susan S. Smyth, Vedant A. Gupta
Gill Heart & Vascular Institute Faculty Publications
Aim of the study: Most survivors of an in-hospital cardiac arrest do not leave the hospital alive, and there is a need for a more patient-centered, holistic approach to the assessment of prognosis after an arrest. We sought to identify pre-, peri-, and post-arrest variables associated with in-hospital mortality amongst survivors of an in-hospital cardiac arrest.
Methods: This was a retrospective cohort study of patients ≥18 years of age who were resuscitated from an in-hospital arrest at our University Medical Center from January 1, 2013 to September 31, 2016. In-hospital mortality was chosen as a primary outcome and unfavorable discharge …
On The Plastic-Free Path: Plastic-Free Living, Hannah Natzke
On The Plastic-Free Path: Plastic-Free Living, Hannah Natzke
Honors Projects
What is living plastic-free like? This project explores the trials and triumphs of living a plastic-free life. Although this project is only mandates that the participant lives plastic-free for a month, it still investigates the challenges faced by longer plastic-free living.
Epidemiology Of Covid-19 And Predictors Of Outcome In Nigeria: A Single-Center Study., Olayinka Rasheed Ibrahim, Bello Muhammed Suleiman, Suleiman Bello Abdullahi, Taofeek Oloyede, Abdallah Sanda, Maruf Sanusi Gbadamosi, Bashir Olajide Yusuf, Rabilu Yandoma Iliyasu, Lawal Magaji Ibrahim, Adamu Danladi Dawud, Sulaiman Saidu Bashir, Nwawueze Efam Okonta, Wasinda Francis Umar, Abiodun Gbenga Tekobo, Muhammadu Sani Abubakar, Bashir Taiye Aminu, Shuaibu Onoruoyiza Ibrahim, Rasaq Olaosebikan, Olugbenga Ayodeji Mokuolu
Epidemiology Of Covid-19 And Predictors Of Outcome In Nigeria: A Single-Center Study., Olayinka Rasheed Ibrahim, Bello Muhammed Suleiman, Suleiman Bello Abdullahi, Taofeek Oloyede, Abdallah Sanda, Maruf Sanusi Gbadamosi, Bashir Olajide Yusuf, Rabilu Yandoma Iliyasu, Lawal Magaji Ibrahim, Adamu Danladi Dawud, Sulaiman Saidu Bashir, Nwawueze Efam Okonta, Wasinda Francis Umar, Abiodun Gbenga Tekobo, Muhammadu Sani Abubakar, Bashir Taiye Aminu, Shuaibu Onoruoyiza Ibrahim, Rasaq Olaosebikan, Olugbenga Ayodeji Mokuolu
Department of Pharmacology and Experimental Therapeutics Faculty Papers
There is a paucity of information regarding the epidemiology and outcome of COVID-19 from low/middle-income countries, including from Nigeria. This single-center study described the clinical features, laboratory findings, and predictors of in-hospital mortality of COVID-19 patients. Patients admitted between April 10, 2020 and June 10, 2020 were included. Forty-five patients with a mean age of 43 (16) years, predominantly male (87%), presented with fever (38%), cough (29%), or dyspnea (24%). In-hospital mortality was 16%. The independent predictors of mortality were hypoxemia (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.3-5.1) and creatinine > 1.5 mg/dL (aOR: 4.3; 95% CI: 1.9-9.8).
A Critical Review On The Plants Used For The Treatment Of Ulcer In Kerala, Jincy Jacob, Jipnomon J, Nancy J
A Critical Review On The Plants Used For The Treatment Of Ulcer In Kerala, Jincy Jacob, Jipnomon J, Nancy J
Bulletin of Faculty of Pharmacy Cairo University
Peptic ulcer disease and its complications remain the cause of significant morbidity worldwide, representing a major burden for health care resources. Although potent anti-ulcer drugs are available, most of them produce several side effects, thus emphasizing the need to search for new alternatives. As high as 80% of the world population depends on plant- derived medicines for the first line of primary health care, reinforcing the theory that plant extracts can be good sources of new drugs. This review focuses to consolidate the evidence-based information on antiulcer plants used in Kerala accumulated in databases (Google Scholar, PubMed, Scopus, Science Direct …
Nursing Education Amidst Covid-19: Obstacles And Way Forward, Farida Bibi Mughal, Nasreen Rafiq, Bibi Hajira Irshad Ali
Nursing Education Amidst Covid-19: Obstacles And Way Forward, Farida Bibi Mughal, Nasreen Rafiq, Bibi Hajira Irshad Ali
School of Nursing & Midwifery
No abstract provided.
Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir
Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir
School of Nursing & Midwifery
Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …
Evolving Nurse Leadership Role In 2020, Nasreen Rafiq, Farida Bibi Mughal
Evolving Nurse Leadership Role In 2020, Nasreen Rafiq, Farida Bibi Mughal
School of Nursing & Midwifery
No abstract provided.
The Impact Of A Digital Intervention On Perceived Stress, Resiliency, Social Support, And Intention To Leave Among Newly Licensed Nurses: A Randomized Controlled Trial, Lisa Concilio
Electronic Theses and Dissertations
The nursing shortage has been deemed a public health crisis with the turnover rate of newly licensed nurses (NLNs) growing (Robert Wood Johnson Foundation, 2014). One out of five NLNs are leaving the profession due to work dissatisfaction and feelings of inadequacy (National Academy of Medicine, 2017). NLN attrition during the first year of hire has been associated with feelings of overwhelming stress and decreased sense of support which negatively impact patient safety (Spence Laschinger et al., 2016). As seasoned nurses are attempting to retire amidst a nursing shortage (American Association of Colleges of Nursing, 2018), NLNs require more support …
New Hints Towards A Precision Medicine Strategy For Idh Wild-Type Glioblastoma., K White, K Connor, J Clerkin, B M Murphy, M Salvucci, A C O'Farrell, M Rehm, D O'Brien, J H M Prehn, S P Niclou, M L M Lamfers, M Verreault, A Idbaih, Roel G W Verhaak, A Golebiewska, A T Byrne
New Hints Towards A Precision Medicine Strategy For Idh Wild-Type Glioblastoma., K White, K Connor, J Clerkin, B M Murphy, M Salvucci, A C O'Farrell, M Rehm, D O'Brien, J H M Prehn, S P Niclou, M L M Lamfers, M Verreault, A Idbaih, Roel G W Verhaak, A Golebiewska, A T Byrne
Faculty Research 2020
Glioblastoma represents the most common primary malignancy of the central nervous system in adults and remains a largely incurable disease. The elucidation of disease subtypes based on mutational profiling, gene expression and DNA methylation has so far failed to translate into improved clinical outcomes. However, new knowledge emerging from the subtyping effort in the IDH-wild-type setting may provide directions for future precision therapies. Here, we review recent learnings in the field, and further consider how tumour microenvironment differences across subtypes may reveal novel contexts of vulnerability. We discuss recent treatment approaches and ongoing trials in the IDH-wild-type glioblastoma setting, and …
Persort Facilitates Characterization And Elimination Of Persister Subpopulation In Mycobacteria., Vivek Srinivas, Mario L Arrieta-Ortiz, Amardeep Kaur, Eliza Jr Peterson, Nitin Baliga
Persort Facilitates Characterization And Elimination Of Persister Subpopulation In Mycobacteria., Vivek Srinivas, Mario L Arrieta-Ortiz, Amardeep Kaur, Eliza Jr Peterson, Nitin Baliga
Articles, Abstracts, and Reports
Mycobacterium tuberculosis (MTB) generates phenotypic diversity to persist and survive the harsh conditions encountered during infection. MTB avoids immune effectors and antibacterial killing by entering into distinct physiological states. The surviving cells, persisters, are a major barrier to the timely and relapse-free treatment of tuberculosis (TB). We present for the first time, PerSort, a method to isolate and characterize persisters in the absence of antibiotic or other pressure. We demonstrate the value of PerSort to isolate translationally dormant cells that preexisted in small numbers within Mycobacterium species cultures growing under optimal conditions but that dramatically increased in proportion under stress …
Sitc Cancer Immunotherapy Resource Document: A Compass In The Land Of Biomarker Discovery., Siwen Hu-Lieskovan, Srabani Bhaumik, Kavita Dhodapkar, Jean-Charles J B Grivel, Sumati Gupta, Brent A Hanks, Sylvia Janetzki, Thomas O Kleen, Yoshinobu Koguchi, Amanda W Lund, Cristina Maccalli, Yolanda D Mahnke, Ruslan D Novosiadly, Senthamil R Selvan, Tasha Sims, Yingdong Zhao, Holden T Maecker
Sitc Cancer Immunotherapy Resource Document: A Compass In The Land Of Biomarker Discovery., Siwen Hu-Lieskovan, Srabani Bhaumik, Kavita Dhodapkar, Jean-Charles J B Grivel, Sumati Gupta, Brent A Hanks, Sylvia Janetzki, Thomas O Kleen, Yoshinobu Koguchi, Amanda W Lund, Cristina Maccalli, Yolanda D Mahnke, Ruslan D Novosiadly, Senthamil R Selvan, Tasha Sims, Yingdong Zhao, Holden T Maecker
Articles, Abstracts, and Reports
Since the publication of the Society for Immunotherapy of Cancer's (SITC) original cancer immunotherapy biomarkers resource document, there have been remarkable breakthroughs in cancer immunotherapy, in particular the development and approval of immune checkpoint inhibitors, engineered cellular therapies, and tumor vaccines to unleash antitumor immune activity. The most notable feature of these breakthroughs is the achievement of durable clinical responses in some patients, enabling long-term survival. These durable responses have been noted in tumor types that were not previously considered immunotherapy-sensitive, suggesting that all patients with cancer may have the potential to benefit from immunotherapy. However, a persistent challenge in …
The Effect Of Entry Of Generic Antibiotics On Prescriptions Of The Antibiotic: The Case Of Sulfamethoxazole-Trimethoprim, Ian James Davis
The Effect Of Entry Of Generic Antibiotics On Prescriptions Of The Antibiotic: The Case Of Sulfamethoxazole-Trimethoprim, Ian James Davis
All Theses
The nonrenewable nature of antibiotic therapy has led many medical professionals, policy makers, and researchers to questions regarding the optimal use of antibiotics. To build out a more robust understanding of antibiotic usage and its contributing factors, careful attention must be paid to the study of antibiotic demand and its characteristics. The purpose of this paper is to estimate the effect of generic entry on antibiotic demand through changes in the probability of prescription using sulfamethoxazole-trimethoprim as a case study. The data used are visits where sulfamethoxazole-trimethoprim could have been prescribed pooled from the National Ambulatory Medical Care Surveys over …