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2022

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Fp-22-25 Marriage Rate In The U.S.: Geographic Variation, 2021, Gabrielle Juteau Jan 2022

Fp-22-25 Marriage Rate In The U.S.: Geographic Variation, 2021, Gabrielle Juteau

National Center for Family and Marriage Research Family Profiles

No abstract provided.

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Effect Of Saliva Contamination On Crown Retention Strengths Of Resin And Rmgi Cements, Bushra Nizami Jan 2022

Effect Of Saliva Contamination On Crown Retention Strengths Of Resin And Rmgi Cements, Bushra Nizami

All ETDs from UAB

Background: The most common contaminant in the oral cavity is saliva. Many studies have shown that contamination with saliva negatively affects the strength of the resin-dentin bond. A literature review by Nair et al reported that 64.6% of studies on the topic show a detrimental effect of salivary contamination on adhesive materials. No published studies were found that thoroughly studied the effects of saliva contamination on RMGIs and resin cements with regards to crown retention rates. Objective: To study the effect of salivary contamination on crown retention strengths of RMGI and resin cements at various stages of bonding and in …

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The Effect Of Maxillary Sinus Anatomical Variations, Surgical Considerations, And Patient Factors On Volumetric Changes Following Lateral Wall Sinus Floor Elevation Technique For Up To 8 Years, Mengyi Shi Jan 2022

The Effect Of Maxillary Sinus Anatomical Variations, Surgical Considerations, And Patient Factors On Volumetric Changes Following Lateral Wall Sinus Floor Elevation Technique For Up To 8 Years, Mengyi Shi

All ETDs from UAB

jectives: The aim of this retrospective study is to assess the long-term dimensional stability, or shrinkage, of the lateral window sinus grafts using cone beam computed tomography scans (CBCT) and radiographic software. Material and Methods: All patients from UAB Periodontal Graduate Clinic with available records of sinus augmentation via the lateral window approach with delayed implant placement between 2014 and 2019 were screened for having two follow up CBCT scans of diagnostic quality. The first scan must be completed within 6-9 months of lateral window sinus floor elevation (LWSFE) and prior to implant placement. The second CBCT must be taken …

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A Comparison Of Growth Factor Release Between Platelet Rich Fibrin And Recombinant Human Platelet Derived Growth Factor Bb (Rhpdgf-Bb) And Beta-Tricalcium Phosphate: An In Vitro Analysis, Maggie Ann Misch Jan 2022

A Comparison Of Growth Factor Release Between Platelet Rich Fibrin And Recombinant Human Platelet Derived Growth Factor Bb (Rhpdgf-Bb) And Beta-Tricalcium Phosphate: An In Vitro Analysis, Maggie Ann Misch

All ETDs from UAB

Patients presenting with significant alveolar bone loss can pose challenges for the clinician. Traditional bone augmentation techniques may be inadequate in achieving necessary gains to restore missing teeth with dental implants. The adjunctive use of growth factors may accelerate the healing process and enhance tissue regeneration. GEM21S is a product that includes a recombinant growth factor approved by the Federal Drug Administration for oral surgery. It is delivered as a two-component system: 1) recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and 2) betatricalcium phosphate (β-TCP).[1] The research on GEM 21S for ridge augmentation is mostly limited to case studies.[2- 4] Biologically, …

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Effect Of Etch Time On Sbs Of Machinable Lithium Disilicate Glass Ceramics Using Variolink Esthetic Lc, Mayur Chandrakant Nayee Jan 2022

Effect Of Etch Time On Sbs Of Machinable Lithium Disilicate Glass Ceramics Using Variolink Esthetic Lc, Mayur Chandrakant Nayee

All ETDs from UAB

The purpose of this study is to measure the shear bond strength between dental cement and four different machinable, lithium disilicate glass ceramics, under varied etch time with hydrofluoric acid. Ten specimens each of 4 different machinable blocks of lithium disilicate were mounted in cylinders of pink acrylic resin. Each specimen was subjected to etching with hydrofluoric acid, rinsing with water from an air / water nozzle, drying with compressed air, application of a silane primer (Monobond Plus, Ivoclar Vivadent) for at least 60 seconds, then mounted in an Ultradent jig and Variolink Esthetic LC (Ivoclar Vivadent) cement extruded through …

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Regional Variations In The Incidence Of Brain Glioma In Adults In Alabama, Mina Lobbous Jan 2022

Regional Variations In The Incidence Of Brain Glioma In Adults In Alabama, Mina Lobbous

All ETDs from UAB

Purpose: Gliomas are the most common primary brain tumor in adults in the US with an annual age-adjusted incidence rate of 4.67 to 5.73 per 100,000 persons. Exposure to ioniz-ing radiation is the only established risk factor for non-hereditary glioma risk. There are several sources of carcinogenic contaminants in northeast Alabama and western Georgia with the Coosa River serving as the region’s primary water source. In this study, we aimed to examine the incidence rate of glioma in northeast Alabama compared to the rest of the state as well as the association of possible environmental exposure on disease risk and …

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Measuement Of Translucency, Biaxial Flexural Strength, And Radiopacity Of Different Lithium Disilicate Materials, Preshtha Mangla Jan 2022

Measuement Of Translucency, Biaxial Flexural Strength, And Radiopacity Of Different Lithium Disilicate Materials, Preshtha Mangla

All ETDs from UAB

Objective: To measure translucency parameter, biaxial flexural strength, radiopacity and microstructure of various lithium disilicate materials used for dental restorations. Materials and Methods: CAD/CAM lithium disilicate glass-ceramic blocks: IPS e.max CAD (Ivoclar Vivadent), CerecTessera (Dentsply Sirona), and Amber Mill (Hassbio America) were used (shade A2, HT, and MT). Blocks of each material were milled (PrograMill PM7, Ivoclar Vivadent) into cylinders (diameter = 14 mm) and cut using circular sectioning saw (IsoMET 1000 Precision Saw, Buehler) into disc-shaped specimens (thickness = 1.00 ± 0.05 mm) (n=5/group). They were hand polished to 1200 grit with SiC paper under water lubrication. The translucency …

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A Systematic Study Of Data Security Issues In Smart Home Iot Devices, Hilal Nur Issi Jan 2022

A Systematic Study Of Data Security Issues In Smart Home Iot Devices, Hilal Nur Issi

All ETDs from UAB

The best description of IoT comes from the International Telecommunication Union (ITU), which defines it as "a global infrastructure for the information society, enabling advanced services by interconnecting things based on existing and evolving interoperable information and communication technologies" (ITU, 2013). Different things, equipment, and household are employed in daily living in our world. The advantages that smart technology provides have piqued the curiosity of academics and practitioners alike. Home appliances have received a lot of attention, since smart technology has been extensively explored and put into practice. A great deal of research has gone into automating the house, making …

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The Association Between Paraquat Exposure And Parkinson's Disease Mortality: A County-Level Ecological Study In The United States, Alexander Kozuch Jan 2022

The Association Between Paraquat Exposure And Parkinson's Disease Mortality: A County-Level Ecological Study In The United States, Alexander Kozuch

All ETDs from UAB

Objectives: The current study reports the results of an ecological study regarding the association between PQ exposure and Parkinson’s disease mortality in the United States. Methods: The outcome of interest for this study was mortality due to Parkinson’s disease, obtained from CDC Wonder. The exposure of interest was PQ exposure at the county level which was obtained from the United States Geological Survey (USGS). Statistical analysis was done using the mortality data, grouped into ten-year age groups, and focused on data from 2015-2019 to account for the lag time between initial Paraquat exposure and Parkinson’s Disease mortality. A Negative Binomial …

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The Relationship Between Psychological Profiles And Longitudinal Pain Trajectories In People With Chronic Knee Pain, Daniel Alexander Kusko Jan 2022

The Relationship Between Psychological Profiles And Longitudinal Pain Trajectories In People With Chronic Knee Pain, Daniel Alexander Kusko

All ETDs from UAB

Considerable evidence demonstrates that radiographic findings (e.g., osteophytes) are only modestly associated with the severity of knee pain, suggesting that other biopsychosocial factors likely influence symptom severity. Multiple psychological factors have been linked to worse health outcomes in people with chronic knee pain; however, it remains unclear whether psychological profiles might help explain variability in knee pain severity. The primary goal of this study was to identify unique psychological differences among people with and without chronic knee pain, and then examine whether psychological profiles longitudinally predicted knee pain trajectories over two years. Individuals with (n = 175) and without (n …

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Diagnostic Electrophysiology Of The Eye, Brooke Nicole Conner-Tsang Jan 2022

Diagnostic Electrophysiology Of The Eye, Brooke Nicole Conner-Tsang

All ETDs from UAB

Aging and age-related changes in the brain are known to parallel functional and anatomical changes in the eye, especially in certain degenerative diseases. This study explores the potential of combining ERG, specifically the Pattern Electroretinogram (PERG), which has a black and white checkerboard pattern, and OCT tests to monitor retinal ganglion cell health. We compared ERG and OCT findings from ten normal females, ages ranging from 18 to 30 years old to ascertain if ganglion cell layer volume is a reliable indicator of ganglion cell function as measured by ERG. Our results from these healthy subjects will serve as prelude …

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Use Of Force By Correctional Officers: A Test Of General Strain And Scial Bond Theories, Benjamin Hixon Jan 2022

Use Of Force By Correctional Officers: A Test Of General Strain And Scial Bond Theories, Benjamin Hixon

All ETDs from UAB

Use of force in corrections is significantly less studied when compared to other fields, such as policing. This is a problem as unnecessary and unjustified use of force in corrections needlessly raises the violence level in correctional facilities, which endangers persons in custody and correctional officers alike. The current study examines use of force in corrections using a theoretical approach. First, Robert Agnew’s general strain theory is applied to understand use of force encounters between persons in custody and correctional officers. Second, Travis Hirschi’s social bond theory is used to investigate whether certain social bonds may relate to reductions in …

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Intracerebral Hemorrhage Hospitalizations And Outcomes: Comparisons Between Institutional And National Data, Zhuobin Huang Jan 2022

Intracerebral Hemorrhage Hospitalizations And Outcomes: Comparisons Between Institutional And National Data, Zhuobin Huang

All ETDs from UAB

Intracerebral hemorrhage (ICH) is associated with a high risk of in-hospital mortality therefore we decided to define the effect of procedures and other risk factors on in-hospital mortality among different regions in the US. South and UAB Hospital. We used 2 datasets, the University of Alabama at Birmingham Hospital data and the National Inpatient Sample (NIS). We included 425 patients with a diagnosis of intracerebral hemorrhage over 18 years of age from the UAB Hospital stroke registry between 2016 to 2019; in NIS between 2016 to 2018, 68525 patients age 18 or above met inclusion criteria selected by International Classification …

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A 15-Year Retrospective Analysis On After-Hours Dental Emergencies In A Children's Hospital Setting, Alexandra An-Yen Chen Jan 2022

A 15-Year Retrospective Analysis On After-Hours Dental Emergencies In A Children's Hospital Setting, Alexandra An-Yen Chen

All ETDs from UAB

Dental emergencies are one of the most common oral health complications and can exhibit a detrimental impact on a child’s physical and psychological development; additionally, it may impose economic challenges for the family. Purpose: The purpose of this study was to analyze the after-hours dental emergency visits in the past 15 years at the Children’s of Alabama (COA) Hospital Emergency Department. Methods: A retrospective chart review between January 2007 and December 2021 was conducted. Patients’ demographics, type of dental complaint, and management were evaluated for overall characteristics in the 15 years and trends in 5-year increments. The impact of the …

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Correlates Of Early Adversity In Children And Adolescents: Examining The Interrelatedness Of Aggression, Post-Traumatic Stress, And Suicidal Behaviors, Elizabeth Mcrae Jan 2022

Correlates Of Early Adversity In Children And Adolescents: Examining The Interrelatedness Of Aggression, Post-Traumatic Stress, And Suicidal Behaviors, Elizabeth Mcrae

All ETDs from UAB

The negative outcomes associated with adverse childhood experiences, especially child maltreatment ACEs (CM-ACEs), often emerge concomitantly with these experiences and have cascading negative effects across the lifespan. For example,childhood aggression, post-traumatic stress, and suicidal behaviors have all been identified as negative sequelae of CM-ACEs. They have been associated with each other, as well, and share several common underlying mechanisms. Thus, it might be that these outcomes collectively exacerbate the risk of experiencing negative effects of CM-ACEs, yet most existing research has examined these risk factors independently. Moreover, these outcomes often emerge early in development, yet most related research has been …

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Nox2-Derived Superoxide And Mda5-Dependant Responses Contribute To Autoimmune Diabetes, Samuel Isaac Blum Jan 2022

Nox2-Derived Superoxide And Mda5-Dependant Responses Contribute To Autoimmune Diabetes, Samuel Isaac Blum

All ETDs from UAB

NADPH oxidase 2 (NOX2)-derived superoxide, a precursor for many reactive oxygen species (ROS), regulates cell signaling, cellular trafficking, melanoma differentiation-associated protein 5 (MDA5) responses, and Type 1 diabetes (T1D). Previously, we demonstrated that NOX2-derived superoxide promotes chemokine synthesis, spontaneous and virus-accelerated T1D, and MDA5 responses to coxsackievirus B3 (CVB3), an associated environmental trigger for T1D. Yet, it remains unknown if ROS is necessary for diabetogenic T cell trafficking into islets or how MDA5 responses affect T1D. First, using non-obese diabetic (NOD) mice that contain an in-frame deletion within the helicase 1 domain of MDA5 (ΔHel1) or lack MDA5 expression (KO), …

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Changes In Pain Intensity And Physical Activity Levels In Individuals With Acetabular Dysplasia Undergoing Periacetabular Osteotomy: A Longitudinal Cohort Study, Naif Z. Alrashdi Jan 2022

Changes In Pain Intensity And Physical Activity Levels In Individuals With Acetabular Dysplasia Undergoing Periacetabular Osteotomy: A Longitudinal Cohort Study, Naif Z. Alrashdi

All ETDs from UAB

Acetabular dysplasia (AD) is a condition of the hip joint that is characterized by incomplete acetabulum development leading to lack of bony coverage of the femoral head. As a result of intra-articular injury from lack of bony congruency, often, individuals with AD report hip joint instability, pain, decreased hip-related function, and are at high risk for early development of hip osteoarthritis (OA). AD is primarily affects young-to-middle-aged adults, is more common in females and those with history of a breech birth position. Periacetabular osteotomy (PAO) is the currently-recommended surgical treatment for AD that aims to reposition the acetabulum to increase …

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A Pilot Mixed Methods Study Examining Factors Affecting Return To Work Among African American Stroke Survivors, Kristin D. Ashley Jan 2022

A Pilot Mixed Methods Study Examining Factors Affecting Return To Work Among African American Stroke Survivors, Kristin D. Ashley

All ETDs from UAB

BACKGROUND: Stroke is a highly prevalent and disabling condition among African Americans. Although there is limited research regarding barriers and facilitators to return to work among stroke survivors, evidence suggests that African American stroke survivors return to work (RTW) less frequently than Caucasians. Most of the research on this topic has been conducted in European countries, leaving significant knowledge gaps on RTW among African Americans in the United States. The purpose of this study was to identify factors that affect RTW for African American stroke survivors and then build upon those results to better understand facilitators and barriers to RTW. …

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The Relationship Between State Level Funding, Designated Trauma Centers, And Trauma Related Morbidity, Ginger Henry Jan 2022

The Relationship Between State Level Funding, Designated Trauma Centers, And Trauma Related Morbidity, Ginger Henry

All ETDs from UAB

This study examined the relationship of funding and the number of designated trauma centers and age-adjusted trauma mortality across the 50 states. State level funding was defined as monies that were paid to the designated trauma hospitals in aggregate by state and by year for the years 2008 to 2017. The number of designated trauma hospitals were considered in the categories of total number of state trauma hospitals and designation levels 1 through 4. Age-adjusted mortality included the ICD-10 codes for trauma from the WISQARS database. The strategic adaptation theory was used to inform the trauma hospital manager’s need to …

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Mice With Ghrh Deficiency Are Resistant To The Detrimental Health Effects Of High Fat Diet, Joseph Jablonsky Jan 2022

Mice With Ghrh Deficiency Are Resistant To The Detrimental Health Effects Of High Fat Diet, Joseph Jablonsky

All ETDs from UAB

According to our previous study, mice with a CRISPR/Cas9 mediated deletion of the GHRH gene have decreased bodyweight, respiratory exchange ratio (RER), energy expenditure compared to wild type animals, and increased insulin sensitivity and enhanced longevity. Calorie restriction enhances lifespan and delays multiple aging related phenotypes; however it is not known how these animals respond to nutritional stressors such as high fat diet (HFD) during the aging process. We subjected 18 month old GHRH-/- male and female mice to a high fat diet to determine differences in response to HFD in aged animals. After HFD exposure, GHRH-/- mice have increased …

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Spike-And-Slab Additive Models And Scalable Algorithms For High Dimensional Data Analysis, Boyi Guo Jan 2022

Spike-And-Slab Additive Models And Scalable Algorithms For High Dimensional Data Analysis, Boyi Guo

All ETDs from UAB

There are proposals that extend classical additive models (AMs) to accommodate high-dimensional data (p >> n) using group sparse regularization. However, the sparse regularization may induce excess shrinkage when estimating smooth functions, damaging predictive performance. Moreover, most of these AMs consider an “all-in-allout” approach for functional selection, rendering them difficult to answer if nonlinear effects are necessary. While some Bayesian models can address these shortcomings, model fitting can create a new challenge, scalability. In this dissertation, we propose Bayesian hierarchical additive models to address the previous shortcomings: we consider the smoothing penalty for proper shrinkage of curve interpolation via reparameterization. A …

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Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki Jan 2022

Three Essays On Federally Qualified Health Centers: Competition, Patient-Centered Medical Home Adoption, Quality Quartiles Ranking And Financial Performance, Hani Al-Maliki

All ETDs from UAB

he following three essays examine the Federally Qualified Health Center (FQHC) industry. The first essay attempts to provide a description on what constitutes a competitive environment for FQHCs located in California, the second explores the impact of FQHC market competition on Patient Centered Medical Home (PCMH) adoption, and the third essay aims to test the relationship between the adoption of PCMH and FQHCs’ performance. The first essay utilizes Porter's Five Forces model to identify competitive forces in the FQHCs environment to fill a gap in the literature. Building on the first essay, the second essay using Porter’s generic strategies explores …

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A Population-Based Assessment Of Severe Maternal Morbidity Among Non-Hispanic Black Women In The United States, Lisa R. Allen Jan 2022

A Population-Based Assessment Of Severe Maternal Morbidity Among Non-Hispanic Black Women In The United States, Lisa R. Allen

All ETDs from UAB

Non-Hispanic Black women (Black women) are disproportionately affected by adverse maternal health outcomes as compared to women of other races. Little is known about the distribution of adverse maternal health outcomes among Black women. Using the 2014 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), a nationally representative sample of hospital discharges in the United States (U.S.) from January 1 through December 31, 2014, we examined severe maternal morbidity (SMM) experienced during delivery hospitalization among Black women. We conducted population-based, cross-sectional studies to examine the distribution of SMM prevalence; assess within-race …

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A Framework For Enterprise Systems Based On Process Improvement, Abdulrahman Alharthi Jan 2022

A Framework For Enterprise Systems Based On Process Improvement, Abdulrahman Alharthi

All ETDs from UAB

We introduce a framework for enterprise systems based on process-centered analysis. Because technology has drastically altered many aspects of our lives, such as work, leisure, travel, government, and company interactions worldwide, companies must strategically consider the Internet of Things in order to thrive in the new economy. Tanik and Jololian offered early work in this area, and included an analysis of the T-Strategy introduced by R.T. Yeh et al. in their book “Zero-time.” Our approach builds on this decade-old work, and involves the introduction of information flow analysis to process improvement [1]. We have identified two key points: centralization and …

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A Framework For Designing Blockchain Systems In A Smart City Setting, Mohammad Alhefdi Jan 2022

A Framework For Designing Blockchain Systems In A Smart City Setting, Mohammad Alhefdi

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As main characteristics of successful smart cities, the high demand for increased data security and accessibility and citizen engagement mean the role of blockchain technology has begun to increase. Nonetheless, blockchain technology also faces several challenges, which have slowed its adoption. In response, this dissertation introduces a framework for designing blockchain systems in a smart city setting and considers the smart city and blockchain challenges. Researchers have proposed several smart city models that study and analyze the complexity of smart cities to improve city security, functionality, services, and smartness. The proposed information-theoretical modeling approach to generate an innovated blockchain model …

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Teaching Economic Values: A Mixed Methods Study Of Kindergarten Curricula, Values, Practices, And Teachers' Perspectives In Saudi Arabia, Hanaa Abualsoud Jan 2022

Teaching Economic Values: A Mixed Methods Study Of Kindergarten Curricula, Values, Practices, And Teachers' Perspectives In Saudi Arabia, Hanaa Abualsoud

All ETDs from UAB

The primary purpose of this study was to investigate Saudi teachers' practices in developing economic values for kindergarten children, in Eastern region (Qatif city). The researcher also looked at teachers' awareness of Saudi Vision 2030 educational goals. The research was conducted using a convergent mixed methods design. In the quantitative strand, data was collected from 263 teachers using questionnaires. Data was collected from seven knowledgeable teachers using semi-structured interviews in the qualitative strand. The qualitative and quantitative data were analyzed independently through content analysis for the qualitative data and a Google Forms for quantitative data. Results from both strands were …

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Teacher Perception, Experience, And Attitudes On Student Achievement In A Title I High School In Central Alabama, Marvin Augusta Carter Jan 2022

Teacher Perception, Experience, And Attitudes On Student Achievement In A Title I High School In Central Alabama, Marvin Augusta Carter

All ETDs from UAB

The purpose of this study was to share the lived experiences of teachers regarding how they supported student achievement in a Title I high school. After almost 60 years of Title I initiatives, the achievement gap between students in poverty and other more affluent students has not changed in any statistically significant manner (Jimenez-Castellanos, 2010). Due to the lack of academic growth for students in Title I schools as compared to students in non-Title I schools, parents, policymakers, and other stakeholders have increased pressure on educators and educational researchers to identify student achievement barriers and implement the use of effective …

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The Relationship Between Nurse And Therapy Staffing Levels And The Medicare Patient-Driven Payment Model Reimbursement During The Covid-19 Pandemic, Roland T. Shapley Jan 2022

The Relationship Between Nurse And Therapy Staffing Levels And The Medicare Patient-Driven Payment Model Reimbursement During The Covid-19 Pandemic, Roland T. Shapley

All ETDs from UAB

The Patient Driven Payment Model (PDPM) brought about a paradigm shift in the way skilled nursing facilities are reimbursed, by linking complexity of care to beneficiary need, expanding case-mix adjusted components by including a non-therapy ancillary and speech language pathology component, and limiting the volume of therapy services provided. The COVID-19 pandemic wreaked havoc upon the nursing home industry that gave rise to high patient and staff infections and fatalities, declining occupancy rates, and nursing shortages, compelling the Department of Health and Human Services to provide $4.9 billion in CARES Funding to skilled nursing facilities (SNFs). Using Payroll Based Journal, …

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Shared Savings Bonus In Mssp And Its Association With Length Of Participation, Terry D. Knight Jan 2022

Shared Savings Bonus In Mssp And Its Association With Length Of Participation, Terry D. Knight

All ETDs from UAB

Accountable Care Organizations (ACOs) are integrated groups of providers responsible for reducing cost and improving quality for a group of individuals. Medicare began using these organizations in 2012, after the passage of the Affordable Care Act (ACA), to move away from traditional fee-for-service reimbursement. This alternative payment model is the Medicare Shared Savings Program (MSSP). MSSP affords ACOs the opportunity to receive a portion of the savings they achieve if specific cost targets and quality benchmarks are met. Length of participation time in the alternative payment model may increase the ACOs’ ability to achieve savings. The analysis of MSSP savings …

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Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock Jan 2022

Applying The Hospitalist Model Of Care To Cardiovascular Acute Care Delivery, Ginger K. Biesbrock

All ETDs from UAB

The hospitalist model for managing patients in the hospital setting has been in existence for over 20 years. The hospitalist model for non-specialty care has been found to improve the efficiency of care, maintain quality of care, and support a higher degree of guideline adherence. However, there has been little research focusing on the use of the hospitalist model for specialty care. As cardiovascular programs have begun to adopt the hospitalist model, many are asking if this model is more effective than the traditional model. The main concern is the potential disruption to the patient-physician relationship that occurs with the …

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