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2022

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Evaluating Impact Of An Online Leadership Course For Newly Graduated Occupational Therapists, Gobika Sithamparanathan, Meera Premnazeer, Andrea Duncan Jan 2022

Evaluating Impact Of An Online Leadership Course For Newly Graduated Occupational Therapists, Gobika Sithamparanathan, Meera Premnazeer, Andrea Duncan

Journal of Occupational Therapy Education

Leadership has been established as a key competency for occupational therapists, however the literature on how occupational therapists conceptualize leadership is limited. Additionally, there is a dearth of literature on best practices to develop occupational therapists’ leadership skills and there is yet to be an evaluation of an online educational approach. This study aimed to understand if an online educational platform contributed to the development of leadership skills among occupational therapists. Participants were newly graduated occupational therapists who participated in a four-week Leadership Skills Development massive open online course (MOOC). This study used a mixed methods quasi-experimental design with two …


Exploration Of A Short-Term Learning Community Focused On Evidence-Based Occupational Therapy Interventions For Children And Youth With Autism, Christine T. Myers, Sandra Brown, Ashley Parigian Jan 2022

Exploration Of A Short-Term Learning Community Focused On Evidence-Based Occupational Therapy Interventions For Children And Youth With Autism, Christine T. Myers, Sandra Brown, Ashley Parigian

Journal of Occupational Therapy Education

Continuing education (CE) for occupational therapists typically takes place in workshops, seminars, or webinars with little support for practice change after the event concludes. Continuing education that occurs over an extended time with opportunities for social learning and competence assessment may improve knowledge translation. This study explored how pediatric occupational therapists who participated in a short-term, online learning community acquired new knowledge about evidence-based interventions from learning activities and how they applied this new knowledge to practice. Weekly modules with facilitated discussions, competency self-assessment, and peer-reviewed journal article readings occurred over a six-week period. An exploratory design included content analysis …


Permission To Learn: Intentional Use Of Art And Object-Mediated Strategies To Develop Reflective Professional Skills, Mary Anne Peabody, Susan Noyes, Mary Anderson Jan 2022

Permission To Learn: Intentional Use Of Art And Object-Mediated Strategies To Develop Reflective Professional Skills, Mary Anne Peabody, Susan Noyes, Mary Anderson

Journal of Occupational Therapy Education

Reflective practice is considered a highly valued graduate attribute in the field of occupational therapy. Occupational therapy educators influence and shape how students develop into reflective practitioners. Reflective practice requires a set of complex thinking skills that are typically focused on personal experiences and can be broken down into pre-requisite skills that aid in the teaching and learning process. This article introduces a six component Permissions model used with graduate level students during their first semester that combines experiential learning and pre-requisite skills of reflective practice. The model includes three broad domains: self-awareness, observation, and effective communication and six pre-requisite …


Using A Service Learning - Peer Mentoring Project To Prepare Ot Students For Their Role In Post-Secondary Transition Services, Annmarie T. Kinsella, Nancy R. Hollins Jan 2022

Using A Service Learning - Peer Mentoring Project To Prepare Ot Students For Their Role In Post-Secondary Transition Services, Annmarie T. Kinsella, Nancy R. Hollins

Journal of Occupational Therapy Education

A service-learning pilot project involving occupational therapy (OT) students and individuals with intellectual and developmental disabilities (IDD) is described. The purpose of this pilot project, developed using Transformative Learning Theory, was to determine if service-learning could be a viable approach to provide in-depth learning in areas only superficially covered in a typical OT curriculum. The objectives of this experience were focused on developing the knowledge and skills needed to address a noted gap in OT practice, post-secondary transition services for individuals with IDD. Using a peer-mentor approach, OT students were matched with young adults with IDD for a fieldwork Level …


Community-Based Ot Program Planning: A Virtual Level Ii Fieldwork Program Developed In Response To The Global Pandemic, Tara Collins, Virginia E. Koenig, Stephanie J. Wong, Michelle Buccinna, Rena B. Purohit, Shifra K. Leiser, Debra Cullinane Jan 2022

Community-Based Ot Program Planning: A Virtual Level Ii Fieldwork Program Developed In Response To The Global Pandemic, Tara Collins, Virginia E. Koenig, Stephanie J. Wong, Michelle Buccinna, Rena B. Purohit, Shifra K. Leiser, Debra Cullinane

Journal of Occupational Therapy Education

The purpose of this article is to explain how an occupational therapy (OT) program in a university setting developed a virtual Level II community-based fieldwork program in response to the COVID-19 global pandemic. This virtual fieldwork program, guided by the PRECEDE-PROCEED Planning Model (PPM), was designed to help keep students on track with their academic goals while providing them with experiential learning that would increase their confidence in OT program planning and promote their professional development. Outcome measures for this study consisted of a pre-and post-fieldwork survey that asked participants to rank their self-perceived confidence in five distinct areas of …


Implementation And Outcomes Of An Education Focused Professional Development Series For Occupational Therapy Practitioners, Oaklee Rogers, Sara Stephenson, Gina Buban Jan 2022

Implementation And Outcomes Of An Education Focused Professional Development Series For Occupational Therapy Practitioners, Oaklee Rogers, Sara Stephenson, Gina Buban

Journal of Occupational Therapy Education

As new educational programs emerge and student enrollment increases, the demand for new academicians, fieldwork educators, and capstone mentors is growing rapidly within the occupational therapy (OT) profession. Academic programs must prepare practitioners to teach and supervise their students who will become OTs and occupational therapy assistants (OTA). In conjunction with the state OT association, one university doctoral OT program created and implemented a free education-focused professional development series for community partners who were interested in developing their teaching knowledge and skills. The series covered unique aspects of OT and OTA education: fieldwork, the doctoral capstone experience and project, and …


Occupation-Centered Anatomy And Applied Biomechanics Courses: Design And Outcomes, Rose Mcandrew, Vicki K. Kaskutas Jan 2022

Occupation-Centered Anatomy And Applied Biomechanics Courses: Design And Outcomes, Rose Mcandrew, Vicki K. Kaskutas

Journal of Occupational Therapy Education

Occupation-centered course design allows occupational therapy (OT) educators to differentiate ourselves from other professions while communicating the distinct value of occupation to our students. While there have been numerous calls to action for centering occupation in the OT classroom and proposed models to approach course design, there is limited literature on occupation-centered course design in specific courses, notably foundational science courses like anatomy and applied biomechanics. In this study, we outline our course design process in two courses taught concurrently, as well as our prospective study to determine if an occupation-centered course design allowed students to meet objectives and the …


Active Learning And Occupational Therapy Theory: A Mixed Methods Study Of A Course Redesign, Mackenzie L. Feldhacker, Diana R. Feldhacker Jan 2022

Active Learning And Occupational Therapy Theory: A Mixed Methods Study Of A Course Redesign, Mackenzie L. Feldhacker, Diana R. Feldhacker

Journal of Occupational Therapy Education

The use of theory to guide practice is what distinguishes an occupational therapist’s professional judgment and reasoning from simply technical skills. However, occupational therapists continue to lack confidence and skills in understanding application of theory to inform practice. Thus, effective course design related to theory is imperative in professional formation. This study assessed the effectiveness of a graduate-level occupational therapy theory course redesigned using andragogical, learner-centered, and active learning principles to address gaps in applying and understanding theory. A mixed methods retrospective cohort design was utilized. This included a pretest/post-test survey along with end-of-semester course and instructor evaluation. Eighty-four students …


Improving Empathy Of Occupational Therapy Students Through Reading Literary Narratives, Cavenaugh Kelly Jan 2022

Improving Empathy Of Occupational Therapy Students Through Reading Literary Narratives, Cavenaugh Kelly

Journal of Occupational Therapy Education

This study explored the impact of teaching empathy to occupational therapy students through the close reading of literary narratives. The study defined empathy as a dynamic process involving Theory of Mind (ToM), emotional resonance, and empathy as a willful act. Empathy is an espoused value of occupational therapy challenged by the modern demands of the market-driven health care system, and research suggests reading literary narratives, or stories with qualities of literature, facilitates greater empathy. Prior studies have also indicated that practicing with greater empathy improves health outcomes and makes occupational therapy sessions more client centered. In this study, a quasi-experimental …


Development And Content Validity Of The Personal-Professional Development Tool For Occupational Therapy Students During Community-Based Service Learning, Michaela Fraser, Pat Precin Jan 2022

Development And Content Validity Of The Personal-Professional Development Tool For Occupational Therapy Students During Community-Based Service Learning, Michaela Fraser, Pat Precin

Journal of Occupational Therapy Education

As community-based service-learning becomes more widely used in occupational therapy (OT) education, valid and reliable outcome measures are needed to ensure that student learning outcomes are meaningfully and consistently measured. Currently, educators may use instructor-developed questionnaires that have not been validated or employ narrowly focused or overly prescriptive surveys borrowed from other disciplines that may not fully capture the skills that are necessary for competent entry-level practice. Grounded in the Occupational Adaptation Model, the Personal-Professional Development Tool (PPDT) was developed to meet this need. The PPDT was designed as a non-normative, self-referential rating scale that OT students use to set …


Using Self-Assessment And Reflection To Develop Self-Efficacy In Occupational Therapy Assistant Fieldwork Students, Kristy Meyer, Julie Hunley Jan 2022

Using Self-Assessment And Reflection To Develop Self-Efficacy In Occupational Therapy Assistant Fieldwork Students, Kristy Meyer, Julie Hunley

Journal of Occupational Therapy Education

Many occupational therapy students navigate the transition to the Level II fieldwork experience effortlessly, while others require support due to a lack of perceived self-efficacy. This perception dramatically impacts fieldwork performance and challenges academic fieldwork coordinators to support students struggling to believe in their own capabilities. This study utilized a quantitative quasi-experimental research design with a purposive sample of 16 occupational therapy assistant students to determine if an educational intervention increased perceived self-efficacy and overall confidence. Data collected from the Student Confidence Questionnaire (SCQ) pre, and post-intervention provided insight into the students’ report of perceived self-efficacy and overall confidence during …


The Relationship Between Emotional Intelligence And Performance On Occupational Therapy Fieldwork, Kimberlea D. Dudzinski, Michele Gregoire Gill Jan 2022

The Relationship Between Emotional Intelligence And Performance On Occupational Therapy Fieldwork, Kimberlea D. Dudzinski, Michele Gregoire Gill

Journal of Occupational Therapy Education

This mixed methods study explored the relationship between emotional intelligence (EI) and overall student performance during occupational therapy (OT) fieldwork. The purpose of this study was to determine whether EI was predictive of student performance during the clinical portion of the academic program. In the first phase of this two-part study, 42 students enrolled in either a Master of Occupational Therapy program or an Occupational Therapy Assistant Program completed the Genos Emotional Intelligence Inventory (short form). Student scores on this brief measure of EI were correlated with scoring on the American Occupational Therapy Association’s Level II Fieldwork Performance Evaluation (FWPE) …


Factors Impacting Ot And Ota Student Feedback Use During Level Ii Fieldwork Experiences, Beth Ann Hatkevich, Emily R. Pottkotter, Nicole Stotz Jan 2022

Factors Impacting Ot And Ota Student Feedback Use During Level Ii Fieldwork Experiences, Beth Ann Hatkevich, Emily R. Pottkotter, Nicole Stotz

Journal of Occupational Therapy Education

Feedback is used in experiential learning to help occupational therapy (OT) and occupational therapy assistant (OTA) students develop the specific knowledge and skills needed to become entry-level practitioners. However, many students do not use the feedback given by fieldwork (FW) educators or perceive it as helpful in improving performance. Therefore, this study aimed to identify factors impacting the integration of feedback for OT/OTA students during Level II FW experiences. An invitation email was sent to 102 students from two OT and two OTA education programs in Ohio to participate in a survey regarding their Level II FW experiences. The survey …


Exploring Evidence Based Practice Implementation By Occupational Therapists: Implications For Fieldwork, Angela Benfield, Helen Jeffery Jan 2022

Exploring Evidence Based Practice Implementation By Occupational Therapists: Implications For Fieldwork, Angela Benfield, Helen Jeffery

Journal of Occupational Therapy Education

A fieldwork education model is used in occupational therapy to develop competency of professional skills, including evidence-based practice (EBP) and clinical reasoning. This quantitative study explored factors influencing implementation rates of EBP in New Zealand registered occupational therapists to better understand students’ experience of evidence-based practice while on fieldwork. An online survey exploring beliefs and practices related to clinical competence, professional reasoning and EBP was conducted. The survey included questions about related beliefs, the measure of Evidence Informed Professional Thinking (EIPT; Benfield & Johnston, 2020), and the Implementation Climate Scale (ICS; Ehrhart et al., 2014). The mean scores on the …


A Snapshot Of How Entry-Level Occupational Therapy Programs Collect And Use Doctoral Capstone Outcomes, Andrew D. Rivera, Theresa Delbert, Whitney Lucas Molitor, Anne F. Kiraly-Alvarez, Danielle Friberg, Anna Domina, Autumn Clegg Jan 2022

A Snapshot Of How Entry-Level Occupational Therapy Programs Collect And Use Doctoral Capstone Outcomes, Andrew D. Rivera, Theresa Delbert, Whitney Lucas Molitor, Anne F. Kiraly-Alvarez, Danielle Friberg, Anna Domina, Autumn Clegg

Journal of Occupational Therapy Education

Entry-level occupational therapy doctorate (OTD) programs are required to gather program evaluation data regarding the doctoral capstone for accreditation purposes. This study aims to describe the processes used by a sample of OTD programs to gather doctoral capstone outcome data and to determine the type of data collected in order to understand the perspectives regarding doctoral capstone outcomes by doctoral capstone coordinators (DCCs) within the United States. The investigators used purposeful sampling to recruit DCCs at accredited entry-level OTD programs in the United States. The most common outcome data collected included information about the doctoral capstone experience from students, student …


Exosomal-Long Non-Coding Rnas Journey In Colorectal Cancer: Evil And Goodness Faces Of Key Players, Nehal I. Rizk, Ahmed I. Abulsoud, Mohamed M. Kamal, Dina H. Kassem, Nadia M. Hamdy Jan 2022

Exosomal-Long Non-Coding Rnas Journey In Colorectal Cancer: Evil And Goodness Faces Of Key Players, Nehal I. Rizk, Ahmed I. Abulsoud, Mohamed M. Kamal, Dina H. Kassem, Nadia M. Hamdy

Pharmacy

Exosomes are nano-vesicles (NVs) secreted by cells and take part in cell-cell communications. Lately, these exosomes were proved to have dual faces in cancer. Actually, they can contribute to carcinogenesis through epithelial-mesenchymal transition (EMT), angiogenesis, metastasis and tumor microenvironment (TME) of various cancers, including colorectal cancer (CRC). On the other hand, they can be potential targets for cancer treatment. CRC is one of the most frequent tumors worldwide, with incidence rates rising in the recent decades. In its early stage, CRC is asymptomatic with poor treatment outcomes. Therefore, finding a non-invasive, early diagnostic biomarker tool and/or suitable defender to combat …


2-Arylquinolines As Novel Anticancer Agents With Dual Egfr/Fak Kinase Inhibitory Activity: Synthesis, Biological Evaluation, And Molecular Modelling Insights, Amgad Albohy Jan 2022

2-Arylquinolines As Novel Anticancer Agents With Dual Egfr/Fak Kinase Inhibitory Activity: Synthesis, Biological Evaluation, And Molecular Modelling Insights, Amgad Albohy

Pharmacy

No abstract provided.


A Novel Cyanopyridine Derived Fluorescent Sensor For Selective Determination Of Uranyl Ions In Different Water Samples, Ekram Hany Mohamed, Amany R Salem, Abeer M. El-Naggar,, Mohammed A. Amin,, Mohamed S. S. Attia Jan 2022

A Novel Cyanopyridine Derived Fluorescent Sensor For Selective Determination Of Uranyl Ions In Different Water Samples, Ekram Hany Mohamed, Amany R Salem, Abeer M. El-Naggar,, Mohammed A. Amin,, Mohamed S. S. Attia

Pharmacy

A newly developed spectrofluorometric method is based on the fabrication of an optical cyanopyridine derived sensor, 4-(6-diaryl)-2-oxo -1,2-dihydropyridine-3-carbonitrile using microwave irradiation. The fluorescence intensity of the proposed chemo sensor was obviously quenched in DMSO owing to the presence of UO22+ ions at λex/λem = 320/360 nm. The quenching effect of the cyano-derivative based sensor was found to be proportional to the concentration of UO22+ ion ranging between 9.60 × 10–9–5.28 × 10–5 mol L−1 with a detection and quantification limits of 1.71 × 10–11 and 5.2 × 10–11 mol L−1, respectively. © 2021, Akadémiai Kiadó, Budapest, Hungary.


Elucidating The Molecular Basis Of Spontaneous Activation In An Engineered Mechanosensitive Channel, Kalyan Immadisetty, Adithya Polasa, Reid Shelton, Mahmoud Moradi Jan 2022

Elucidating The Molecular Basis Of Spontaneous Activation In An Engineered Mechanosensitive Channel, Kalyan Immadisetty, Adithya Polasa, Reid Shelton, Mahmoud Moradi

Chemistry & Biochemistry Faculty Publications and Presentations

Mechanosensitive channel of large conductance (MscL) detects and responds to changes in the pressure profile of cellular membranes and transduces the mechanical energy into electrical and/or chemical signals. MscL can be activated using ultrasonic or chemical activation methods to improve the absorption of medicines and bioactive compounds into cells. However, re-engineering chemical signals such as pH change can trigger channel activation in MscL. This study elucidates the activation mechanism of an engineered MscL at an atomic level through a combination of equilibrium and non-equilibrium (NE) molecular dynamics (MD) simulations. Comparing the wild-type (WT) and engineered MscL activation processes suggests that …


Analyzing Factors Influencing Secondary Agricultural Education Teachers’ Skill Level In Welding, Rafael Bakhtavoryan, Douglas D. Lavergne Jan 2022

Analyzing Factors Influencing Secondary Agricultural Education Teachers’ Skill Level In Welding, Rafael Bakhtavoryan, Douglas D. Lavergne

Faculty Publications

The effects of secondary agricultural education teachers’ demographic characteristics on their propensity to become more skilled in welding were examined by estimating an ordered logit model for teachers in Northeast Texas. The sample of teachers was derived from the Agricultural Mechanic Competency Development survey for 2015. According to the estimation results, relative to female, being male was positively associated with being more skilled in welding. Compared to having a Master’s degree, having only a Bachelor’s degree was negatively associated with being more skilled in welding. Having five or less years of teaching positively affected becoming more skilled in welding compared …


Frontmatter (Volume 42, Issue 3), Paul B. Mojzes Jan 2022

Frontmatter (Volume 42, Issue 3), Paul B. Mojzes

Occasional Papers on Religion in Eastern Europe

No abstract provided.


Soft, Sharp, And Evil Power: The Russian Orthodox Church In The Russian Invasion Of Ukraine, Alar Kilp, Jerry G. Pankhurst Jan 2022

Soft, Sharp, And Evil Power: The Russian Orthodox Church In The Russian Invasion Of Ukraine, Alar Kilp, Jerry G. Pankhurst

Occasional Papers on Religion in Eastern Europe

This paper examines the enactment of soft/sharp/evil power by the Russian Orthodox Church and its leaders during a month before the major exertion of hard power by the Russian military and one month after the invasion of Ukraine. In the period from January 25 until March 25, 2022, 27 messages of the leading actors in the Church–Patriarch Kirill and Metropolitan Hilarion, head of the Department of External Church Relations (DECR)–are closely examined. The results are presented and discussed in four thematic sections: 1) soft power: the religious approach to the Russian World; 2) Sharp power: the territorial expansion of the …


Frontmatter (Volume 42, Issue 6), Paul B. Mojzes Jan 2022

Frontmatter (Volume 42, Issue 6), Paul B. Mojzes

Occasional Papers on Religion in Eastern Europe

No abstract provided.


Modulation Of Ptz-Induced Convulsions In Rats Using Topiramate Alone Or Combined With Low Dose Gamma Irradiation: Involving Akt/M-Tor Pathway, Marwa Safar Jan 2022

Modulation Of Ptz-Induced Convulsions In Rats Using Topiramate Alone Or Combined With Low Dose Gamma Irradiation: Involving Akt/M-Tor Pathway, Marwa Safar

Pharmacy

The current study evaluates the anticonvulsant effect low dose whole body gamma irradiation (LDR) alone or combined with topiramate against pentylenetetrazole (PTZ)-induced convulsions. Male Wister rats received either saline or PTZ (75mg/kg i.p.). The other three groups were pretreated with single low dose radiation (0.5Gy), topiramate (50mg/kg, p.o., seven days) and TPM with LDR respectively before PTZ injection. Racine’ score, latency, and duration of the convulsions were assessed. Glutamate and GABA were measured. AKT/m-TOR signaling pathway including AKT (protein kinase B), mammalian target of rapamycin (m-TOR), protein S6, and caspase 3 were also assessed. Measurements of markers of oxidative stress …


Telmisartan: An Angiotensin Receptor Blocker Regulates Osteoclastogenesis Via Inhibition Of The Erk Triggering In Osteoporotic Male Rats, Marwa Safar Jan 2022

Telmisartan: An Angiotensin Receptor Blocker Regulates Osteoclastogenesis Via Inhibition Of The Erk Triggering In Osteoporotic Male Rats, Marwa Safar

Pharmacy

No abstract provided.


Remdesivir Analog As Sars-Cov-2 Polymerase Inhibitor: Virtual Screening Of A Database Generated By Scaffold Replacement, Amgad Albohy, Mohamed A. Said, Mohamed A. Abdelrahman, Hany Said Jan 2022

Remdesivir Analog As Sars-Cov-2 Polymerase Inhibitor: Virtual Screening Of A Database Generated By Scaffold Replacement, Amgad Albohy, Mohamed A. Said, Mohamed A. Abdelrahman, Hany Said

Pharmacy

By the end of 2019, a novel strain of the corona viral family named SARS-CoV-2 emerged in Wuhan, China and started to spread worldwide causing one of the most dangerous lethal pandemics. Researchers utilized various reported inhibitors and drug databases for virtual screening analysis against this novel strain. Later on, they succeeded to fish and repurpose remdesivir, an antiviral nucleotide analogue that inhibits RNA polymerase of the Ebola virus, as a promising candidate against SARS-CoV-2. In this study, we used the interactions of the co-crystallized metabolite of remdesivir with SARS-CoV-2 RdRp isozyme (PDB 7BV2) to design an analog with potential …


Introduction, Carmen M. Mccallum Jan 2022

Introduction, Carmen M. Mccallum

Faculty Scholarship 2022

No abstract provided.


Intrinsic Motivation Is Not Enough: Exploring The Decision To Pursue Promotion To Full Professor, Margaret Roberts Jan 2022

Intrinsic Motivation Is Not Enough: Exploring The Decision To Pursue Promotion To Full Professor, Margaret Roberts

University of the Pacific Theses and Dissertations

The academic career path for tenure track faculty in most four-year universities in the United States allows those who earn tenure to make an individual choice about whether to pursue promotion to the rank of full professor. Limited research exists on the intrinsic motivators that individuals possess and draw upon to push past obstacles or challenges they encounter along their academic career journey. This study explored the role of intrinsic motivation in the decision of tenured associate professors to pursue promotion to full professor. Using a basic qualitative research design, this inquiry involved two in-depth interviews each with seven participants. …


Empowerment By Design: Classroom Innovation And Inquiry Through Design Thinking And Action Research, Cory Rayala Jan 2022

Empowerment By Design: Classroom Innovation And Inquiry Through Design Thinking And Action Research, Cory Rayala

University of the Pacific Theses and Dissertations

Increasingly standardized and assessment-driven educational systems are failing to meet the needs of many students, replacing their love of learning with a fear of failure. Importantly, the fear of failure is a common mindset of not only students but also teachers, administrators, and policymakers. This qualitative, action research study is situated in a design thinking/growth mindset conceptual theory that posits that the design thinking process can serve as a meaningful growth mindset opportunity for teachers and students. The prototyping mindset inherent in design thinking may mitigate the fear of failure by focusing on rapid iteration rather than striving for perfection. …


Cultural And Gender Shifts: Trends And Factors Hmong Male Students Face In Pursuit Of Higher Education, Sai Yang Xiong Jan 2022

Cultural And Gender Shifts: Trends And Factors Hmong Male Students Face In Pursuit Of Higher Education, Sai Yang Xiong

University of the Pacific Theses and Dissertations

The educational trends in the attainment of Hmong American students in higher education have grown significantly over the past 40+ years. However, modern academia is still somewhat new to most United States Hmong refugees since their resettlement in 1975 after the Vietnam War. Hmong students are children of refugee immigrants who came to the United States with no formal schooling, limited English proficiency, and a low-socioeconomic background. Hmong parents believe that having an education will enable their children to seek employment, perform well in society, and gain financial stability. The purpose of this study was to analyze challenges that contribute …