Digital Commons Network^™

Systematic Review And Meta-Analysis Of The Growth Performance And Carcass Composition Of Nile Tilapia (Oreochromis Niloticus) Fed Dietary Copra Meal, Tzodoq Obrero Magbanua, Janice A. Ragaza

Biology Faculty Publications

Introduction

Nile tilapia (Oreochromis niloticus) is one of the most cultured species in the aquaculture industry. However, its market price is affected by the increasing cost of fishmeal. Plant-based proteins are being used to mitigate the problem.

Methodology

This paper comprehensively quantified the growth performance and carcass composition of Nile tilapia fed copra meal via systematic review and meta-analysis. The literature review and paper selection were done based on the preferred reporting items for systematic reviews and meta-analysis method. The data from peer-reviewed papers that qualified from the inclusion screening criteria such as standard error reporting, feeding period, absence of …

Developing Guiding Principles For Technology-Based Rehabilitation Program By Engaging People With Motor Incomplete Tetraplegia, Alison Bell, Namrata Grampurohit, Gabrielle Kains, Ralph J. Marino

Department of Rehabilitation Medicine Faculty Papers

Background: Technology-aided rehabilitation is well established in the field of neurologic rehabilitation. Despite the widespread availability, the development of technology-based interventions that incorporate perspectives of the people who will use them is lacking.

Objectives: This qualitative study aims to understand how people with chronic motor incomplete cervical spinal cord injury view rehabilitation technology to improve upper extremity function and neuromuscular recovery to inform future intervention development.

Methods: Seven participants with chronic upper extremity impairment due to spinal cord injury/dysfunction trialed five rehabilitation technology devices. After a 30-45 min trial for each device, participants engaged in a semi-structured interview. Interviews were …

Fusion Polypeptides Binding Antibody Fc Domains And Integrin And Methods Of Use, Hong-Ming Hu, Jaina M Patel, Catherine T Dinh

Technology Transfer - Patents

No abstract provided.

How University Students Are Taught About Sustainability, And How They Want To Be Taught: The Importance Of The Hidden Curriculum, Lucy Millicent Turner, Smitha Hegde, Indrani Karunasagar, Rebecca Turner

School of Biological and Marine Sciences

Purpose: India is unique, having enshrined in law the teaching of sustainability education (SE) within all levels of formal education. This study aims to examine the integration and perceptions of SE within the higher education (HE) sector in India and identify any lessons that can be exported about the teaching of SE from the Indian HE environment. Design/methodology/approach: Focusing on a science-based teaching and research institute at a private university in India, a quantitative, cross-sectional study examined the extent to which SE was integrated into the university and how it was perceived by students and staff. Data were collected through …

Implementing Equal Access To Legal Capacity In Canada: Experience, Evidence, And Legal Imperative – Final Report, Faisal Bhabha, Ruby Dhanda, Kerri Joffe, Lana Kerzner, Brendon Pooran

Commissioned Reports, Studies and Public Policy Documents

Many Canadians with disabilities have long been discriminated against in the enjoyment and exercise of their legal capacity, especially people with developmental, cognitive, or psychosocial disabilities.

The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) seeks to correct this pervasive discrimination. It recognizes the right to equality in the exercise of legal capacity without discrimination based on disability.

This study was motivated by two primary issues: 1) longstanding concerns in the disability rights community about this discrimination; and 2) the findings and recommendations made by the United Nations “Committee on the Rights of Persons with Disabilities,” …

The Weekly Challenger, November 24, 2022, The Weekly Challenger, Et Al

Weekly Challenger Newspaper Collection

The November 24, 2022, issue of The Weekly Challenger.

Wakeful Rest Benefits Recall, But Not Recognition, Of Incidentally Encoded Memory Stimuli In Younger And Older Adults, Peter R Millar, David A Balota

2020-Current year OA Pubs

Older adults exhibit deficits in episodic memory tasks, which have often been attributed to encoding or retrieval deficits, with little attention to consolidation mechanisms. More recently, researchers have attempted to measure consolidation in the context of a behavioral experiment using the wakeful rest paradigm (i.e., a brief, quiet period of minimal stimulation, which facilitates memory performance, compared to a distractor task). Critically, older adults might not produce this effect, given established age differences in other episodic memory processes and mind-wandering. In three experiments, we directly compared younger and older adults in modified versions of the wakeful rest paradigm. Critically, we …

Stakeholder Engagement In Eight Comparative Effectiveness Trials In African Americans And Latinos With Asthma, Tiffany Dy, Winifred J Hamilton, C Bradley Kramer, Andrea Apter, Jerry A Krishnan, James W Stout, Stephen J Teach, Alex Federman, John Elder, Tyra Bryant-Stephens, Rebecca J Bruhl, Shawni Jackson, Kaharu Sumino

2020-Current year OA Pubs

BACKGROUND: The effects of stakeholder engagement, particularly in comparative effectiveness trials, have not been widely reported. In 2014, eight comparative effectiveness studies targeting African Americans and Hispanics/Latinos with uncontrolled asthma were funded by the Patient-Centered Outcomes Research Institute (PCORI) as part of its Addressing Disparities Program. Awardees were required to meaningfully involve patients and other stakeholders. Using specific examples, we describe how these stakeholders substantially changed the research protocols and in other ways participated meaningfully as full partners in the development and conduct of the eight studies.

METHODS: Using the method content analysis of cases, we identified themes regarding the …

Mahpic Malaria Systems Biology Data From Plasmodium Cynomolgi Sporozoite Longitudinal Infections In Macaques, Jeremy D Debarry, Xuntian Jiang, Daniel S Ory, Et Al.

2020-Current year OA Pubs

Plasmodium cynomolgi causes zoonotic malarial infections in Southeast Asia and this parasite species is important as a model for Plasmodium vivax and Plasmodium ovale. Each of these species produces hypnozoites in the liver, which can cause relapsing infections in the blood. Here we present methods and data generated from iterative longitudinal systems biology infection experiments designed and performed by the Malaria Host-Pathogen Interaction Center (MaHPIC) to delve deeper into the biology, pathogenesis, and immune responses of P. cynomolgi in the Macaca mulatta host. Infections were initiated by sporozoite inoculation. Blood and bone marrow samples were collected at defined timepoints for …

Structural Health Assessment Of Pavement Sections In The Southern Central United States Using Fwd Parameters, Nitish R. Bastola, Mena Souliman, Samer Dessouky, Raja Daoud

Civil Engineering Faculty Publications and Presentations

Various Departments of Transportation in the South-Central States and elsewhere have made extensive use of the Non-Destructive Testing (NDT) surface deflection bowl data. The falling weight deflectometer (FWD) test is a popular NDT-based test used by transportation authorities to evaluate the performance of flexible pavement. Nevertheless, it is rare to develop a method for evaluating pavement sections using FWD data from all sensors. There is a constant demand for DOTs and highway agencies to have a streamlined approach that can be applied directly to their databases. This research focuses on extending and verifying the concept of previously published area ratio …

Habitat Decline Of The Largest Known Indo-Pacific Humpback Dolphin (Sousa Chinensis) Population In Poorly Protected Areas Associated With The Hypoxic Zone, Lang Guo, Dingyu Luo, Riqing Yu, Chen Zeng, Nuoyan Huang, Hongri Wang, Yuping Wu

Biology Faculty Publications and Presentations

Reserve planning based on the investigation of the core habitat distribution of wild cetaceans is a powerful conservation strategy for protecting target species. However, studies on core habitats and their variations at the large-scale distribution of cetaceans are limited. In this study, we conducted a seven years (2015-2021) boat-based field observation surveys with highly applicable and generalized methods to analyze the habitat changes and how these changes influenced the largest known Indo-Pacific humpback dolphin (Sousa chinensis) population in the Pearl River Estuary (PRE), China. Our findings revealed that there is 3204 km2 of dolphin habitat in the PRE, and dolphin …

Securing The Nation’S Critical Infrastructures 1st Edition - Chapter 8, Stanley Mierzwa, Lauren Spath

Center for Cybersecurity

When you consider industries that were reinvented in recent history, you will find companies that continued to morph and remain relevant and viable and those who started off valid and in favor, but alas, perhaps didn’t make the sustainable cut. Consider, for example, Blockbuster Video, they were at the forefront of providing the legal rental of movies using physical media, such as a tape or DVD. They had the opportunity to transition from physical movie rentals to online—they had a customer base and name recognition. Do you see any Blockbuster Video stores around? Chances are you do not, and this …

Social Network Correlates Of Free And Purchased Insecticide-Treated Bed Nets In Rural Uganda, Sae Takada, Paul J. Krezanoski, Viola Nyakato, Vincent Bátwala, David R. Bangsberg, Nicholas A. Christakis, Akihiro Nishi, Jessica M. Perkins, Alexander C. Tsai, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Malaria is a major cause of mortality and morbidity in Uganda. Despite Uganda’s efforts to distribute bed nets, only half of households have achieved the World Health Organization (WHO) Universal Coverage Criteria (one bed net for every two household members). The role of peer influence on bed net ownership remains underexplored. Data on the complete social network of households were collected in a rural parish in southwestern Uganda to estimate the association between household bed net ownership and peer household bed net ownership.

Methods

Data on household sociodemographics, bed net ownership, and social networks were collected from all households …

Group Care In The First 1000 Days: Implementation And Process Evaluation Of Contextually Adapted Antenatal And Postnatal Group Care Targeting Diverse Vulnerable Populations In High-, Middle- And Low-Resource Settings, Nele Martens, Mathilde R. Crone, Ashna Hindori-Mohangoo, Manodj Hindori, Ria Reis, Iiir S. Hoxha, Jedidia Abanga, Shanaaz Matthews, Lizette Berry, Rianne M.J.J. Van Der Kleiji, M. Elske Van Den Akker-Van Marle, Astrid Van Damme, Florence Talrich, Katrien Beeckman, Christine Mc Court, Sharon Schindler Rising, Deborah Lynn Billings Phd, Marlies Rijnders

Publications

Background

Group care (GC) improves the quality of maternity care, stimulates women’s participation in their own care and facilitates growth of women’s social support networks. There is an urgent need to identify and disseminate the best mechanisms for implementing GC in ways that are feasible, context appropriate and sustainable. This protocol presents the aims and methods of an innovative implementation research project entitled Group Care in the first 1000 days (GC_1000), which addresses this need.

Aims

The aim of GC_1000 is to co-create and disseminate evidence-based implementation strategies and tools to support successful implementation and scale-up of GC in …

Enhanced Functionality And Bio-Accessibility Of Composite Pomegranate Peel Extract-Enriched "Boba Balls", Ayse Neslihan Dundar, Kubra Uzuner, Mahmud Ekrem Parlak, Oya Irmak Sahin, Furkan Turker Saricaoglu, Senay Simsek

Purdue University Libraries Open Access Publishing Fund

“Boba balls” or pearls have recently gained popularity for beverages or food toppings. “Boba balls” could be developed into functional foods by the encapsulation of bioactive compounds. In this study, gelatin/sodium alginate composite “Boba balls” enriched with pomegranate peel extract (PPE) at different concentrations (0, 1, 2, and 3%) were prepared. They were characterized in terms of physical, rheological, textural, morphological, and sensory properties, as well as in vitro digestion, bio-accessibility, and release kinetic of PPE. Adding PPE improved the “Boba” mix’s viscoelasticity and decreased the “Boba balls”’ hardness. The increasing PPE ratio significantly (p < 0.05) increased the antioxidant capacity and total phenolic content. The addition of PPE preserved the spherical shape of the “Boba balls”, and as the PPE ratio increased, new junction zones were observed in SEM images. The in vitro digestibility of PPE was significantly (p < 0.05) improved by preserving PPE from the mouth and gastric medium, and “Boba balls” showed the highest release and bio-accessibility in the intestinal medium. Consequently, PPE as a by-product could be successfully used at 2% concentration for enhancing the functionality and bio-accessibility of “Boba balls” without affecting sensory properties.

Framing Of Covid-19 In Newspapers: A Perspective From The Us-Mexico Border, Rifat Afrin, Ahasan Harun, Gayle Prybutok, Victor Prybutok

Information Systems Faculty Publications

The degree to which the media report a health emergency affects the seriousness with which the people respond to combat the health crisis. Engagement from local newspapers in the US has received scant scrutiny, even though there is a sizable body of scholarship on the analysis of COVID-19 news. We fill this void by focusing on the Rio Grande Valley area of the US-Mexico border. To understand the differences, we compared such local news coverage with the coverage of a national news outlet. After collecting the relevant news articles, we used sentiment analysis, rapid automatic keyword extraction (RAKE), and co-occurrence …

Association Of Bradycardia And Asystole Episodes With Dialytic Parameters: An Analysis Of The Monitoring In Dialysis (Mid) Study, Qandeel H Soomro, Nisha Bansal, Wolfgang C Winkelmayer, Bruce A Koplan, Alexandru I Costea, Prabir Roy-Chaudhury, James A Tumlin, Vijay Kher, Don E Williamson, Saurabh Pokhariyal, Candace K Mcclure, David M Charytan, Mid Investigators

Faculty, Staff and Students Publications

BACKGROUND: Bradycardia and asystole events are common among patients treated with maintenance hemodialysis. However, triggers of these events in patients on maintenance hemodialysis (HD), particularly during the long interdialytic period when these events cluster, are uncertain.

METHODS: The Monitoring in Dialysis Study (MiD) enrolled 66 patients on maintenance HD who were implanted with loop recorders and followed for 6 months. We analyzed associations of predialysis laboratory values with clinically significant bradyarrhythmia or asystole (CSBA) during the 12 hours before an HD session. Associations with CSBA were analyzed with mixed-effect models. Adjusted negative binomial mixed-effect regression was used to estimate incidence …

Stakeholder Engagement In Eight Comparative Effectiveness Trials In African Americans And Latinos With Asthma, Tiffany Dy, Winifred J Hamilton, C Bradley Kramer, Andrea Apter, Jerry A Krishnan, James W Stout, Stephen J Teach, Alex Federman, John Elder, Tyra Bryant-Stephens, Rebecca J Bruhl, Shawni Jackson, Kaharu Sumino

Faculty, Staff and Students Publications

BACKGROUND: The effects of stakeholder engagement, particularly in comparative effectiveness trials, have not been widely reported. In 2014, eight comparative effectiveness studies targeting African Americans and Hispanics/Latinos with uncontrolled asthma were funded by the Patient-Centered Outcomes Research Institute (PCORI) as part of its Addressing Disparities Program. Awardees were required to meaningfully involve patients and other stakeholders. Using specific examples, we describe how these stakeholders substantially changed the research protocols and in other ways participated meaningfully as full partners in the development and conduct of the eight studies.

METHODS: Using the method content analysis of cases, we identified themes regarding the …

Withdrawing Antipsychotics For Challenging Behaviours In Adults With Intellectual Disabilities: Experiences And Views Of Experts By Experience, Gerda De Kuijper, Joke De Haan, Shoumitro Deb, Rohit Shankar

Peninsula Medical School

People with intellectual disabilities (PwID) are frequently prescribed long-term antipsychotics for behaviours that challenge (BtC) despite the lack of proven effectiveness and the increased risks for side effects of these medications in this population. National and international good clinical practice guidelines recommend deprescribing antipsychotics for BtC, which is often not successful due to environmental and other factors. The involvement of all stakeholders, including PwID, is crucial for deprescribing. However, studies showed that PwID and/or their families are often not involved in decision-making regarding the (de)prescribing of antipsychotics despite their desire to get involved. Moreover, studies on the views of PwID …

Coating Formulation Change Leads To Inferior Performance Of Long-Lasting Insecticidal Nets In Papua New Guinea, Nakei Bubun, Evodia Anetul, Melanie Koinari, Timothy W Freeman, Stephan Karl

Faculty, Staff and Student Publications

BACKGROUND: Long-lasting insecticidal nets (LLINs) play a key role in reducing malaria transmission in endemic countries. In a previous study, the authors demonstrated a substantial decrease in the bioefficacy of LLINs for malaria prevention delivered to Papua New Guinea (PNG) between 2013 and 2019. This coincided with a rise in malaria cases in the country. The present study was aimed at determining the underlying cause of the reduced bioefficacy observed in these LLINs. The main hypothesis was that a change in the coating formulation of the respective LLIN product was responsible, and had led to significantly altered product properties and …

The Innate Immune System In Cardiovascular Diseases And Its Role In Doxorubicin-Induced Cardiotoxicity, Anchit Bhagat, Pradeep Shrestha, Eugenie S Kleinerman

Faculty, Staff and Student Publications

Innate immune cells are the early responders to infection and tissue damage. They play a critical role in the initiation and resolution of inflammation in response to insult as well as tissue repair. Following ischemic or non-ischemic cardiac injury, a strong inflammatory response plays a critical role in the removal of cell debris and tissue remodeling. However, persistent inflammation could be detrimental to the heart. Studies suggest that cardiac inflammation and tissue repair needs to be tightly regulated such that the timely resolution of the inflammation may prevent adverse cardiac damage. This involves the recognition of damage; activation and release …

Genomic Profiling For Clinical Decision Making In Myeloid Neoplasms And Acute Leukemia, Eric J Duncavage, Adam Bagg, Robert P Hasserjian, Courtney D Dinardo, Lucy A Godley, Ilaria Iacobucci, Siddhartha Jaiswal, Luca Malcovati, Alessandro M Vannucchi, Keyur P Patel, Daniel A Arber, Maria E Arcila, Rafael Bejar, Nancy Berliner, Michael J Borowitz, Susan Branford, Anna L Brown, Catherine A Cargo, Hartmut Döhner, Brunangelo Falini, Guillermo Garcia-Manero, Torsten Haferlach, Eva Hellström-Lindberg, Annette S Kim, Jeffery M Klco, Rami Komrokji, Mignon Lee-Cheun Loh, Sanam Loghavi, Charles G Mullighan, Seishi Ogawa, Attilio Orazi, Elli Papaemmanuil, Andreas Reiter, David M Ross, Michael Savona, Akiko Shimamura, Radek C Skoda, Francesc Solé, Richard M Stone, Ayalew Tefferi, Matthew J Walter, David Wu, Benjamin L Ebert, Mario Cazzola

Faculty, Staff and Student Publications

Myeloid neoplasms and acute leukemias derive from the clonal expansion of hematopoietic cells driven by somatic gene mutations. Although assessment of morphology plays a crucial role in the diagnostic evaluation of patients with these malignancies, genomic characterization has become increasingly important for accurate diagnosis, risk assessment, and therapeutic decision making. Conventional cytogenetics, a comprehensive and unbiased method for assessing chromosomal abnormalities, has been the mainstay of genomic testing over the past several decades and remains relevant today. However, more recent advances in sequencing technology have increased our ability to detect somatic mutations through the use of targeted gene panels, whole-exome …

Altered Expression Of Glycobiology-Related Genes In Parkinson’S Disease Brain, Jay S Schneider, Garima Singh

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The precise mechanisms initiating and perpetuating the cellular degeneration in Parkinson's disease (PD) remain unclear. There is decreased expression of the main brain gangliosides, and GM1 ganglioside in particular, in the PD brain along with decreased expression of the genes coding for the glycosyltranferase and the sialyltransferase responsible for the synthesis of these brain gangliosides. However, potentially important pathogenic mechanisms contributing to the neurodegeneration in PD may also include altered levels of expression of genes involved in glycosylation, sialylation and sphingolipid synthesis and metabolism. Although various studies have described pathological lipid and glycolipid changes in PD brain, there have been …

Validation Of Prediction Rules For Computed Tomography Use In Children With Blunt Abdominal Or Blunt Head Trauma: Protocol For A Prospective Multicenter Observational Cohort Study, Irma T Ugalde, Pradip P Chaudhari, Mohamed Badawy, Paul Ishimine, Kevan A Mccarten-Gibbs, Kenneth Yen, Nisa S Atigapramoj, Allyson Sage, Donovan Nielsen, P David Adelson, Jeffrey Upperman, Daniel Tancredi, Nathan Kuppermann, James F Holmes

Faculty, Staff and Student Publications

BACKGROUND: Traumatic brain injuries (TBIs) and intra-abdominal injuries (IAIs) are 2 leading causes of traumatic death and disability in children. To avoid missed or delayed diagnoses leading to increased morbidity, computed tomography (CT) is used liberally. However, the overuse of CT leads to inefficient care and radiation-induced malignancies. Therefore, to maximize precision and minimize the overuse of CT, the Pediatric Emergency Care Applied Research Network (PECARN) previously derived clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma in large cohorts of children who are …

Effect Of Suction Circuit Flushing With Chlorhexidine On The Occurrence Of Ventilator Associated Pneumonia Among Mechanically Ventilated Patients: A Quasi Experimental Study, M Eid, M Țânțu, J Latour, M Sultan, N Kandeel

School of Nursing and Midwifery

No abstract provided.

Withdrawing Antipsychotics For Challenging Behaviours In Adults With Intellectual Disabilities: Experiences And Views Of Experts By Experience, G De Kuijper, J De Haan, S Deb, R Shankar

Peninsula Medical School

People with intellectual disabilities (PwID) are frequently prescribed long-term antipsychotics for behaviours that challenge (BtC) despite the lack of proven effectiveness and the increased risks for side effects of these medications in this population. National and international good clinical practice guidelines recommend deprescribing antipsychotics for BtC, which is often not successful due to environmental and other factors. The involvement of all stakeholders, including PwID, is crucial for deprescribing. However, studies showed that PwID and/or their families are often not involved in decision-making regarding the (de)prescribing of antipsychotics despite their desire to get involved. Moreover, studies on the views of PwID …

Expanding Workplace Inclusion Of Employees Who Are Parents Of Children With Disabilities Through Diversity Training, Lisa M. Stewart, Julie M. Rosenzweig, Anna M. Malsch Tamarkin, Eileen Brennan, Jessica Lukefahr

School of Social Work Faculty Publications and Presentations

Employed parents raising children with disabilities manage exceptional care responsibilities along with their work careers. This study examines the effects of targeted diversity training on human resource (HR) professionals’ knowledge of the work–family experiences of these parents, and on their self-efficacy in providing workplace supports. Using computer-based training in field settings, 64 U.S. human resource professionals in an international company participated in two diversity training sessions. Data related to knowledge and efficacy of dependent and disability care were collected before the first training and immediately after the second. HR participants demonstrated significant increases from pretest to posttest on the trained …

An Effective Deep Learning Approach For The Classification Of Bacteriosis In Peach Leave, Muneer Akbar, Mohib Ullah, Babar Shah, Rafi Ullah Khan, Tariq Hussain, Farman Ali, Fayadh Alenezi, Ikram Syed, Kyung Sup Kwak

All Works

Bacteriosis is one of the most prevalent and deadly infections that affect peach crops globally. Timely detection of Bacteriosis disease is essential for lowering pesticide use and preventing crop loss. It takes time and effort to distinguish and detect Bacteriosis or a short hole in a peach leaf. In this paper, we proposed a novel LightWeight (WLNet) Convolutional Neural Network (CNN) model based on Visual Geometry Group (VGG-19) for detecting and classifying images into Bacteriosis and healthy images. Profound knowledge of the proposed model is utilized to detect Bacteriosis in peach leaf images. First, a dataset is developed which consists …

Representations Of Depression And Schizophrenia In The Community: The Role Of Illness And Risk Perceptions On Help-Seeking Intentions, David Dias Neto, Maria João Figueiras, Rita Sebastião

All Works

Illness perceptions (IPs) are important in understanding human reactions to illnesses, including mental health disorders. They influence risk perceptions and several variables relevant to the adjustment to a disorder, treatment seeking, and health outcomes. This study sought to compare IP, risk perception, and help-seeking intention for depression and schizophrenia in a community sample and to assess the mediating role of risk perception in the relationship between IP and help-seeking intention. A total of 380 adults participated in this study and filled out self-report measures of IPs, risk perceptions, and help-seeking intention. The previous diagnosis of depression was used to control …

Tuberculous Salpingitis - Possible Cause Of Salpingo-Enteric Fistula, Shayan Sirat Maheen Anwar, Anam Khan, Fahd Haroon, Frawa Mohsin

Department of Radiology

Salpingo-enteric fistula is a rare disease causing infertility. It occurs when there is a connection between fallopian tube and the intestine. It can be accurately diagnosed with hysterosalpingography. Fistulas mostly occur as a consequence of obstetric complications, however, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, iatrogenic causes, and trauma are other potential causes. The possibility of tuberculous salpingitis as a possible cause of salpingo-enteric fistula should always be considered in the developing countries where tuberculosis is endemic.