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2021

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Knowledge, Attitude, And Practice Regarding Covid-19 Among Residents Of Pesantren, Milla Herdayati, Juliana Karniastuti Jul 2021

Knowledge, Attitude, And Practice Regarding Covid-19 Among Residents Of Pesantren, Milla Herdayati, Juliana Karniastuti

Kesmas

Islamic boarding schools (pesantren) run the risk of COVID-19 transmission. The pesantren learning system is generally carried out collectively, with an all-day-long interaction between teachers and students. This paper presented a lesson on controlling COVID-19 outbreak in pesantren through Community Service Activities (CSA). The CSA was designed to empower the pesantren to prevent and control COVID-19 to become a safe place protected from COVID-19 spread. This was a relevant case study in a traditional Islamic boarding school (salafiah) in Lebak District, Banten. The study population (a total of 97 participants) consisted of the pesantren leader, the teachers (“Ustaz/Ustazah”) , and …


Burundi’S ‘Worst Enemy’: The Country’S Fight Against Covid-19, Emery Manirambona, Henna Reddy, Emmanuel Uwiringiyimana, Theogene Uwizeyimana, Archith Kamath, Sai Arathi Parepalli, Salvador Sun Ruzats, Blaise Ntacyabukura, Sheikh M. S. Islam, Attaullah Ahmadi, Don E. Lucero-Prisno Iii Jul 2021

Burundi’S ‘Worst Enemy’: The Country’S Fight Against Covid-19, Emery Manirambona, Henna Reddy, Emmanuel Uwiringiyimana, Theogene Uwizeyimana, Archith Kamath, Sai Arathi Parepalli, Salvador Sun Ruzats, Blaise Ntacyabukura, Sheikh M. S. Islam, Attaullah Ahmadi, Don E. Lucero-Prisno Iii

Kesmas

Coronavirus disease 2019 (COVID-19) has proved to be a severe global public health threat, causing high infection rates and mortality worldwide. Burundiwas not spared the adverse health outcomes of COVID-19. Although Burundi’s initial response to the COVID-19 pandemic was criticized, hope arose in June2020 when the new government instituted a plan to slow virus transmission that included public health campaigns, international travel restrictions, and masstesting, all of which proved effective. Burundi has faced many challenges in containing the virus, the first of which was the lack of initial preparedness and appropriate response to COVID-19. This was exacerbated by factors including …


The Psychological And Sleep-Related Impact Of Coronavirus Disease 2019 (Covid-19): A Systematic Review, Tetti Solehati, Cecep Eli Kosasih, Yanti Hermayanti, Henny Suzana Mediani Jul 2021

The Psychological And Sleep-Related Impact Of Coronavirus Disease 2019 (Covid-19): A Systematic Review, Tetti Solehati, Cecep Eli Kosasih, Yanti Hermayanti, Henny Suzana Mediani

Kesmas

The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on mental health and sleeps quality that is unprecedented in the 21st century.This systematic review aimed to assess the psychological impact of COVID-19 and its effect on people’s sleep. Systematic searches were conducted viaPubMed, ScienceDirect, and ProQuest from 2019 to August 2020, following PRISMA guidelines. Articles were selected based on eligibility criteria such as having a cross-sectional study design, assessing the general public’s mental health status or sleep problems, medical workers and non-medical workers duringthe COVID-19 pandemic, and using standardized and validated scales for measurement. The keywords: COVID-19 OR …


Covid-19 And The City: A Healthy City Strategy For Pandemic Challenges, From Planning To Action, Hamzah Hasyim, Patricia Dale Jul 2021

Covid-19 And The City: A Healthy City Strategy For Pandemic Challenges, From Planning To Action, Hamzah Hasyim, Patricia Dale

Kesmas

COVID-19 is a respiratory disease caused by SARS-CoV-2, a new coronavirus discovered in 2019. WHO declared COVID-19 is a respiratory disease causedby SARS-CoV-2 as a pandemic that the detection level of cases changed daily, and it can track almost in real-time. This paper used a narrative literaturereview to address issues of urban quality and lack of exercise. The specific aim was to discuss the concept of a healthy city, indicate a new urban model, andadvocate for the increased use of bicycles, outdoor gym/outdoor exercise, walking to reducing pollution, and improving physical, psychological, and social fitness. A healthy city can improve …


Effects Of Acute Beta-Alanine Ingestion And Immersion-Plus-Exercise On Connectedness To Nature And Perceived Pain, R. W. Salatto, Graham R. Mcginnis, Dustin W. Davis, Bryson Carrier, Jacob W. Manning, Mark Debeliso, James W. Navalta Jul 2021

Effects Of Acute Beta-Alanine Ingestion And Immersion-Plus-Exercise On Connectedness To Nature And Perceived Pain, R. W. Salatto, Graham R. Mcginnis, Dustin W. Davis, Bryson Carrier, Jacob W. Manning, Mark Debeliso, James W. Navalta

Kinesiology and Nutrition Sciences Faculty Research

This double-blinded, placebo-controlled, crossover study examined the effect of induced painful sensation (via acute Beta Alanine (B-ALA) ingestion) on Love and Care of Nature (LCN), heart rate (HR), rating of perceived exertion (RPE), and McGill Pain Questionnaire (MPQ) during outdoor exercise. Twenty participants volunteered on consecutive days to complete a 0.8 km (0.5 mi) up-hill hike after consuming either B-ALA (6.4 g) or placebo. Immediately after consumption participants answered LCN, RPE, and MPQ questionnaires, immersed in a natural environment for 45 min, and then completed a hike as quickly as possible without running. No difference in HR (p = 0.846), …


The Healthcare Needs Of Families Caring For Patients With Pulmonary Tuberculosis, Astuti Yuni Nursasi, Nadya Tiara Sabila, Muhamad Jauhar Jul 2021

The Healthcare Needs Of Families Caring For Patients With Pulmonary Tuberculosis, Astuti Yuni Nursasi, Nadya Tiara Sabila, Muhamad Jauhar

Jurnal Keperawatan Indonesia

Tuberculosis (TB) is a global public health problem. Families need to meet healthcare needs during the treatment of TB sufferers. This study aims to identify healthcare needs of families caring for patients with the disease. The cross-sectional study involved 83 families caring for TB patients. The research was conducted at a Primary Healthcare Center in an urban area in West Java. The results revealed that 60.2% of caregivers were 18–40 years old, 60.2% were female, 51.8% were senior high school educated, 43.4% were housewives, 86.7% had an income under the regional minimum wage, and 55.4% had cared for the TB …


Hypertension Self-Care Management During Covid-19 Pandemic Crisis In The Meranao Tribe: A Phenomenological Inquiry, Jonaid M. Sadang, Sittie Inshirah P. Macaronsing, Narima M. Alawi, Normala M. Taib, Hamdoni K. Pangandaman Jul 2021

Hypertension Self-Care Management During Covid-19 Pandemic Crisis In The Meranao Tribe: A Phenomenological Inquiry, Jonaid M. Sadang, Sittie Inshirah P. Macaronsing, Narima M. Alawi, Normala M. Taib, Hamdoni K. Pangandaman

Jurnal Keperawatan Indonesia

The COVID-19 crisis has been a challenging and stressful event for individuals with known underlying health problems, not to mention their higher risk of contracting the disease. This phenomenological inquiry was conducted to explore the common self-care practices of the Meranao tribe in the Province of Lanao del Sur, Philippines, concerning their management of hypertension amidst the ongoing pandemic health crisis. This study employed a descriptive-phenomenological approach. Ten known hypertensive adults participated in the study selected using purposive sampling. Data collection employed focus group discussion (FGD) and then analyzed using Colaizzi's approach. Four themes were derived which explained the common …


Abdominal Aortic Calcification Is Associated With A Higher Risk Of Injurious Fall-Related Hospitalizations In Older Australian Women, Abadi K. Gebre, Marc Sim, Alexander J. Rodríguez, Jonathan M. Hodgson, Lauren C. Blekkenhorst, Pawel Szulc, Nicola Bondonno, Kun Zhu, Catherine Bondonno, Douglas P. Kiel, John T. Schousboe, Richard L. Prince, Joshua R. Lewis Jul 2021

Abdominal Aortic Calcification Is Associated With A Higher Risk Of Injurious Fall-Related Hospitalizations In Older Australian Women, Abadi K. Gebre, Marc Sim, Alexander J. Rodríguez, Jonathan M. Hodgson, Lauren C. Blekkenhorst, Pawel Szulc, Nicola Bondonno, Kun Zhu, Catherine Bondonno, Douglas P. Kiel, John T. Schousboe, Richard L. Prince, Joshua R. Lewis

Research outputs 2014 to 2021

Backgrounds and aims: Abdominal aortic calcification (AAC) is associated with weaker grip strength, an established risk factor for fall-related hospitalizations. However, its association with long-term fall-related hospitalisations remains unknown. This study investigated the association between AAC and long-term fall-related hospitalizations in community-dwelling older women.

Methods: Fall-related hospitalizations were obtained from linked data over 14.5-years in a prospective cohort of 1053 older women (mean age 75.0 ± 2.6 years). At baseline (1998/99), AAC was assessed from lateral spine images obtained using dual-energy X-ray absorptiometry, and scored using a semi-quantitative method (AAC24, range 0–24). The presence of any AAC was defined by …


Establishing Reference Interval For Thyroid-Stimulating Hormone In Children Below Two-Year Ages In Pakistani Population, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Lena Jafri, Khadija N Humayun, Sibtain Ahmed, Aysha Habib Khan Jul 2021

Establishing Reference Interval For Thyroid-Stimulating Hormone In Children Below Two-Year Ages In Pakistani Population, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Lena Jafri, Khadija N Humayun, Sibtain Ahmed, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Introduction: Reference intervals (RIs) of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are age, assay and population specific. Currently, the age and assay-specific RIs for TSH are not available for children under two years of age. This study aimed to establish reference intervals for serum concentrations of TSH and FT4 in healthy children aged 1-24 months as per CLSI C28-A3 guidelines.
Methods: This prospective cross-sectional study was conducted in children from 1 to 24 months visiting the clinical laboratory for serum vitamin D testing but without any recent illness, hospitalization, medication and history of maternal thyroid diseases from August 2018 …


Qualitative Analysis Of Focus Group Data For Liver Cancer Prevention Program Planning, Jordan Alyce Swan Jul 2021

Qualitative Analysis Of Focus Group Data For Liver Cancer Prevention Program Planning, Jordan Alyce Swan

Summer Experience 2021

No abstract provided.


Segmentation For Assessment Of Lumbar Muscle Mass Metrics Using Quantitative Analysis, Esther Soyebo, Chrissherra Mills, Clifton Fuller Md, Phd Jul 2021

Segmentation For Assessment Of Lumbar Muscle Mass Metrics Using Quantitative Analysis, Esther Soyebo, Chrissherra Mills, Clifton Fuller Md, Phd

Summer Experience 2021

No abstract provided.


Predicting Patient-Reported Outcomes For Oropharyngeal Cancer Patients Treated With Radiotherapy: Evaluating The Efficacy Of Aucsymptom, Elizabeth E. Klettke, Lisanne V. Van Dijk Phd, Clifton Fuller Md, Phd Jul 2021

Predicting Patient-Reported Outcomes For Oropharyngeal Cancer Patients Treated With Radiotherapy: Evaluating The Efficacy Of Aucsymptom, Elizabeth E. Klettke, Lisanne V. Van Dijk Phd, Clifton Fuller Md, Phd

Summer Experience 2021

No abstract provided.


Determinants Of Patient-Reported Taste Disorders In Oropharyngeal Cancer Survivors, Christopher Wallace Ogboe, Puja Aggarwal, Katherine Hutcheson, Sanjay Shete Jul 2021

Determinants Of Patient-Reported Taste Disorders In Oropharyngeal Cancer Survivors, Christopher Wallace Ogboe, Puja Aggarwal, Katherine Hutcheson, Sanjay Shete

Summer Experience 2021

No abstract provided.


Associations Between Social Support And Depression, Stress, And Fruit And Vegetable Consumption Among African American Adults In Houston, Edom F. Kidane, Nga Nguyen, Alba Calzada, Lorna Mcneill Phd, Mph Jul 2021

Associations Between Social Support And Depression, Stress, And Fruit And Vegetable Consumption Among African American Adults In Houston, Edom F. Kidane, Nga Nguyen, Alba Calzada, Lorna Mcneill Phd, Mph

Summer Experience 2021

No abstract provided.


Development And Validation Of A High-Throughput 3d Cytotoxicity Assay To Predict Car T Cell Efficacy In Solid Tumors, Sara A. Mazrimas, Amer Najjar Jul 2021

Development And Validation Of A High-Throughput 3d Cytotoxicity Assay To Predict Car T Cell Efficacy In Solid Tumors, Sara A. Mazrimas, Amer Najjar

Summer Experience 2021

No abstract provided.


Development And Implementation Of An Evaluation Tool For Measuring Cultural Competency Learning Activities In Health And Sport Science Undergraduate Students, Diana Cuy Castellanos, Haozhou Pu, Rachel Piero Jul 2021

Development And Implementation Of An Evaluation Tool For Measuring Cultural Competency Learning Activities In Health And Sport Science Undergraduate Students, Diana Cuy Castellanos, Haozhou Pu, Rachel Piero

International Journal of Health Sciences Education

Due to the diversity within the healthcare system, it is important to promote cultural competency in healthcare providers. The integration of pedagogical approaches to cultural competency into health-related programs cannot be understated. Therefore, the purpose of this study was to develop an instrument to examine the student engagement in cultural competency-related activities within health-related degree programs and determine the relationship between engagement and cultural competency. Participants of the study included first- and fourth-year undergraduate students studying within a health-related program at a mid-sized, private university in the Midwestern US. Participants completed a cultural competency inventory questionnaire which included activities identified …


Impact Of Hispanic Ethnicity On Colorectal Cancer Surveillance Outcomes And Management In An Institutional Longitudinal Cohort Of Lynch Syndrome Patients, Gabriel A. Del Carmen, Laura Reyes-Uribe, Kyera Evans, Jennifer Kinnison, Valerie Sepeda, Diane Weber, Julie Moskowitz, Maureen Mork, Melissa Taggart, Selvi Thirumurthi, Miguel Rodriguez-Bigas, Patrick Lynch, Y. Nancy You, Eduardo Vilar Jul 2021

Impact Of Hispanic Ethnicity On Colorectal Cancer Surveillance Outcomes And Management In An Institutional Longitudinal Cohort Of Lynch Syndrome Patients, Gabriel A. Del Carmen, Laura Reyes-Uribe, Kyera Evans, Jennifer Kinnison, Valerie Sepeda, Diane Weber, Julie Moskowitz, Maureen Mork, Melissa Taggart, Selvi Thirumurthi, Miguel Rodriguez-Bigas, Patrick Lynch, Y. Nancy You, Eduardo Vilar

Summer Experience 2021

No abstract provided.


Increasing Referral Of Lbj Patients To The Active Living After Cancer (Alac) Program, Havisha Pedamallu, Patrick Cho, Ruth St. Fleur, Kendahl Servino, Miranda Baum, Margaret Raber, Karen Basen-Engquist Phd, Mph Jul 2021

Increasing Referral Of Lbj Patients To The Active Living After Cancer (Alac) Program, Havisha Pedamallu, Patrick Cho, Ruth St. Fleur, Kendahl Servino, Miranda Baum, Margaret Raber, Karen Basen-Engquist Phd, Mph

Summer Experience 2021

No abstract provided.


Tropical Forages For Monogastric Animals: Enhancing Smallholders Competitiveness In Local And Emerging Markets, Michael Peters, D. White, L. S. Muñoz, P. Sarria, N. Vivas, F. Holmann, M. Lundy, T. Oberthur, P. Lentes, A. Schmidt, Martin Mena, S. Fujisaka Jul 2021

Tropical Forages For Monogastric Animals: Enhancing Smallholders Competitiveness In Local And Emerging Markets, Michael Peters, D. White, L. S. Muñoz, P. Sarria, N. Vivas, F. Holmann, M. Lundy, T. Oberthur, P. Lentes, A. Schmidt, Martin Mena, S. Fujisaka

IGC Proceedings (1977-2023)

No abstract provided.


Sustaining Pastoral Linkages To High‐Value Livestock Markets Through Collective Action And Public‐Private Partnerships: A Case Study From Southern Ethiopia, S. Desta, D. Layne Coppock, G. Gebru, S. Tezera, L. Gizachew Jul 2021

Sustaining Pastoral Linkages To High‐Value Livestock Markets Through Collective Action And Public‐Private Partnerships: A Case Study From Southern Ethiopia, S. Desta, D. Layne Coppock, G. Gebru, S. Tezera, L. Gizachew

IGC Proceedings (1977-2023)

No abstract provided.


Affecting Absenteeism Through School-Based Health Services Delivery: A Configurational Comparative Methods Study Of Oregon's Public Secondary Schools, Kelly Elizabeth Coates Jul 2021

Affecting Absenteeism Through School-Based Health Services Delivery: A Configurational Comparative Methods Study Of Oregon's Public Secondary Schools, Kelly Elizabeth Coates

Dissertations and Theses

A student's ability to attend school regularly can be profoundly affected by poor health-related behaviors, illnesses, and chronic diseases that are left unaddressed and unattended. The delivery of health services in the school environment is uniquely positioned to interrupt the effects these health barriers to learning (HBLs) can have on subsequent diminished educational and health outcomes. The literature widely acknowledges the intersectionality between health and education, but no comprehensive overview exists of how different structures and processes within a school work (or do not work) together to lead to higher or lower student absenteeism. This research sought to fill that …


Super Solar, William Wilton Jul 2021

Super Solar, William Wilton

Honors Program: Expanded Learning Clubs

No abstract provided.


Composting Processes For Food Processing Wastes: A Review, Yung-Tse Hung, Kevin P. Holloman, Howard Paul, Christopher Huhnke Jul 2021

Composting Processes For Food Processing Wastes: A Review, Yung-Tse Hung, Kevin P. Holloman, Howard Paul, Christopher Huhnke

Civil and Environmental Engineering Faculty Publications

Composting of food processing waste was analyzed as a biological process and an engineered system. The goal is to establish fundamental principles and design criteria that would aid its adoption as waste management practice. Characteristics of the inflow, reactor, and outflow were evaluated. Success of the bioreactor was found to be largely dependent on microbial community structure, physical properties of biodegradable waste (BW), aeration, heat transfer, and time required for maturation. Static piles were the primary focus of this article for cost and energy efficiency.


Online-Delivered Group And Personal Exercise Programs To Support Low Active Older Adults' Mental Health During The Covid-19 Pandemic: Randomized Controlled Trial, Mark R. Beauchamp, Ryan M. Hulteen, Geralyn R. Ruissen, Yan Liu, Ryan E. Rhodes, Colin M. Wierts, Katrina J. Waldhauser, Samantha H. Harden, Eli Puterman Jul 2021

Online-Delivered Group And Personal Exercise Programs To Support Low Active Older Adults' Mental Health During The Covid-19 Pandemic: Randomized Controlled Trial, Mark R. Beauchamp, Ryan M. Hulteen, Geralyn R. Ruissen, Yan Liu, Ryan E. Rhodes, Colin M. Wierts, Katrina J. Waldhauser, Samantha H. Harden, Eli Puterman

Faculty Publications

Background: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults.

Objective: The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic.

Methods: The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which …


July 30, 2021 Ereporter, University Of Alabama At Birmingham Jul 2021

July 30, 2021 Ereporter, University Of Alabama At Birmingham

eReporter (campus newsletter)

No abstract provided.


Food Insecurity In Detroit: Exploring The Relationship Between Patient-Reported Food Insecurity And Proximity To Healthful Grocery Stores, Sara Santarossa, Alex B. Hill, Alexandra R. Sitarik, Mackenzie Taylor, Susan Hawkins, Katherine Scher, Aaron Sohaski, Mohammed Baseer, Rachael Dombrowski, Alexander Plum, Christine Lm Joseph Jul 2021

Food Insecurity In Detroit: Exploring The Relationship Between Patient-Reported Food Insecurity And Proximity To Healthful Grocery Stores, Sara Santarossa, Alex B. Hill, Alexandra R. Sitarik, Mackenzie Taylor, Susan Hawkins, Katherine Scher, Aaron Sohaski, Mohammed Baseer, Rachael Dombrowski, Alexander Plum, Christine Lm Joseph

Urban Studies and Planning Faculty Research Publications

Objective:
The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence.

Design:
A secondary data analysis that uses baseline data from a pilot intervention/feasibility study.

Setting:
Detroit, Michigan, USA.

Participants:
Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study …


The Impacts Of Cover Crops Species And Termination Dates On Arthropod Activity In A Corn Production System, Julia N.D. Campos Jul 2021

The Impacts Of Cover Crops Species And Termination Dates On Arthropod Activity In A Corn Production System, Julia N.D. Campos

Department of Entomology: Dissertations, Theses, and Student Research

Cover crops can reduce soil erosion, increase water infiltration, and provide an alternative strategy for weed management in cropping systems. Cover crops change the landscape composition by increasing plant biodiversity, potentially impacting pests and beneficial insects. Ecological principles suggest that cover crop management can influence the arthropods in the subsequent cash crop. However, the impact of management strategies such as cover crop species and termination date on arthropod activity in corn systems is not well understood. The objective of this study was to determine the impact of grass cover crop species (wheat, cereal rye, and triticale) in combination with four …


Urban Agroecology For Food Sovereignty And Biodiversity: Are Urban Community Farms Or Gardens More Effective?, Heidi L. Giancola Jul 2021

Urban Agroecology For Food Sovereignty And Biodiversity: Are Urban Community Farms Or Gardens More Effective?, Heidi L. Giancola

Master's Theses

Industrial agriculture is accurately criticized for eliminating biodiversity and destroying food sovereignty. Urban agroecosystems, usually individual plots in community gardens, are promoted to restore ecological services and equity to food systems. Recently, collectively tended urban community farms have developed, with explicit social justice goals. This study directly contrasts the effectiveness of the urban community farm and garden models. Spatial analysis is used to confirm that community farms enhance geographic access for healthy food priority areas compared to gardens in the San Francisco bay area. An online survey of farm staff and gardeners from Marin to Santa Clara County resulted in …


The Relationship Between Different Forms Of Exercise And Adhd Symptomatology, Matthew A. Reynolds Jul 2021

The Relationship Between Different Forms Of Exercise And Adhd Symptomatology, Matthew A. Reynolds

Master's Theses

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with executive function deficits as well as negative life outcomes in both childhood and adulthood. Current treatments to reduce symptoms of ADHD include stimulant medications that act as catecholamine agonists. These medications often cause undesirable side effects, to which end better understanding the effects of non- pharmacological treatments on symptoms of ADHD is critical. Research conducted in children suggests that exercise may be an effective tool for symptom reduction. However, the relationship between exercise and ADHD symptoms remains unclear for adults. The aim of this study was to address this …


Physical Health As A Predictor Of Change In Self-Reported Presenting Problems In Couple Therapy, As Mediated By Emotional Regulation, Janette J. Driscoll Jul 2021

Physical Health As A Predictor Of Change In Self-Reported Presenting Problems In Couple Therapy, As Mediated By Emotional Regulation, Janette J. Driscoll

Theses and Dissertations

Recent literature in couple therapy has demonstrated the effects of physical health on some common presenting problems; however, few studies have considered progress as a construct on its own, irrespective of client-identified presenting problem. The current study used an Actor-Partner Interdependence Mediated Model to determine the connection between each partner's physical health and their own and their partner's self-reported progress in couple therapy, mediated by each partner's emotional regulation. Physical health was measured every four sessions using the Health-Related Quality of Life scale, and progress was measured by the Presenting Problem Progress Questionnaire given each time a couple attended therapy. …