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2023

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Jiann-Ping Hsu College Of Public Health Magazine, Georgia Southern University Jan 2023

Jiann-Ping Hsu College Of Public Health Magazine, Georgia Southern University

College of Public Health: News & Publications

  • Message from the Dean: Stuart H. Tedders, PhD
  • Remembering Dr. Evans Afriyie-Gyawu
  • Exploring Research Focus Areas
  • Alumni Feature: Overcoming Hurdles
  • Research Feature: It's a weighted issue.
  • Research Feature: The effectiveness of lactation cookies
  • Period Equity Movement Earns National Recognition
  • Leaving Her Mark
  • Georgia on Our Mind
  • Center for Addiction Recovery: Transforming Lives through Comprehensive Support
  • Center for Public Health Practice and Research: The LEAD Academy: A Hospital Leadership Training Program
  • Office of Practice and Research: Continued Engagement in Practice and Research
  • Office of Teaching and Learning
  • Office of Health Equity and Community: Engagement Continued Engagement in Practice and Research
  • Awards, …


Advance (Fall 2023), Georgia Southern Division Of Continuing And Professional Education Jan 2023

Advance (Fall 2023), Georgia Southern Division Of Continuing And Professional Education

Division of Continuing & Professional Education

  • Job Projections
  • Information Technology
  • International Trade
  • Career in the Medical Field
  • Medical Certifications
  • Retain Your Talent
  • Customized Training Options
  • Leadership
  • SHRM Certification Courses
  • Manufacturing
  • Process Improvement
  • Personal Enrichment
  • Upcoming Conferences


Eagle Accountant - 2023, Georgia Southern University Jan 2023

Eagle Accountant - 2023, Georgia Southern University

Eagle Accountant

  • Accounting Advisory Council
  • Advisory Council Spotlight
  • Accreditation & Rankings
  • Commencement 2023
  • Cover Story: Ironman
  • Student Spotlight: Soaring to New Heights
  • Student Spotlight: Reconciling Expectations with Reality
  • Accounting Day 2023
  • Student Organizations & Activities
  • Junior Achievement
  • Faculty Awards
  • Faculty Research, Publications, & Service
  • Alumni Spotlight: An Eagle on Pennsylvania Avenue
  • Alumni Notes, Awards, & Recognition
  • In Memoriam


2023 Fall Commencement, Georgia Southern University Jan 2023

2023 Fall Commencement, Georgia Southern University

Commencement Programs

No abstract provided.


Eagle Executive Magazine, Georgia Southern University Jan 2023

Eagle Executive Magazine, Georgia Southern University

College of Business: News & Publications

  • From the Desk of Dean Amason
  • Eagles on Pennsylvania Avenue
  • Professional Development Day
  • Feature: Internships Plant the Seeds for Career Success
  • Student Org Spotlight
  • Alumni
  • Young Alumni Board


Covid-19 And The Physio4fmd Trial: Impact, Mitigating Strategies And Analysis Plans, Louise Marston, Novere M Le, Federico Ricciardi, Irwin Nazareth, Alan Carson, Mark Edwards, Laura H. Goldstein, Jonathan Marsden, Hayley Noble, Markus Reuber, Jon Stone, Rachael M. Hunter, Glenn Nielsen Jan 2023

Covid-19 And The Physio4fmd Trial: Impact, Mitigating Strategies And Analysis Plans, Louise Marston, Novere M Le, Federico Ricciardi, Irwin Nazareth, Alan Carson, Mark Edwards, Laura H. Goldstein, Jonathan Marsden, Hayley Noble, Markus Reuber, Jon Stone, Rachael M. Hunter, Glenn Nielsen

School of Health Professions

Introduction Functional motor disorder (FMD) is a common cause of disabling neurological symptoms such as weakness and tremor. Physio4FMD is a pragmatic, multicentre single blind randomised controlled trial to evaluate effectiveness and cost effectiveness of specialist physiotherapy for FMD. Like many other studies this trial was affected by the COVID-19 pandemic. Methods The planned statistical and health economics analyses for this trial are described, as well as the sensitivity analyses designed to assess the disruption caused by COVID-19. The trial treatment of at least 89 participants (33%) was disrupted due to the pandemic. To account for this, we have extended …


Differential Response And The Reduction Of Child Maltreatment And Foster Care Services Utilization In The U.S. From 2004 To 2017, Michelle Johnson-Motoyama, Donna K. Ginther, Rebecca Phillips, Oliver W.J. Beer, Lisa Merkel-Holguin, John Fluke Jan 2023

Differential Response And The Reduction Of Child Maltreatment And Foster Care Services Utilization In The U.S. From 2004 To 2017, Michelle Johnson-Motoyama, Donna K. Ginther, Rebecca Phillips, Oliver W.J. Beer, Lisa Merkel-Holguin, John Fluke

School of Health Professions

By 2014, the majority of U.S. states had implemented differential response (DR), a system policy that seeks to serve families of low-to moderate-risk for child maltreatment through family engagement, diversion from formal child protective services investigations, and service provision. However, the effects of DR programs on child welfare dynamics have yet to be evaluated nationally using causal methods. Using a quasi-experimental study design with data drawn from the National Child Abuse and Neglect Data System from 2004 to 2017, we found states with DR programs had approximately 19% fewer substantiated reports, 25% fewer children substantiated for neglect, and a 17% …


Uptake, Distribution And Elimination Of Palladium-Doped Polystyrene Nanoplastics In Rainbow Trout (Oncorhynchus Mykiss) Following Dietary Exposure, Nathaniel J. Clark, Farhan R. Khan, Charlotte Crowther, Denise M. Mitrano, Richard C. Thompson Jan 2023

Uptake, Distribution And Elimination Of Palladium-Doped Polystyrene Nanoplastics In Rainbow Trout (Oncorhynchus Mykiss) Following Dietary Exposure, Nathaniel J. Clark, Farhan R. Khan, Charlotte Crowther, Denise M. Mitrano, Richard C. Thompson

School of Health Professions

No abstract provided.


Religious Exemption, Lgbt Rights, And The Social Construction Of Harm And Freedom, Emily Kazyak, Kelsy Burke, Maia Behrendt, Marissa Oliver Jan 2023

Religious Exemption, Lgbt Rights, And The Social Construction Of Harm And Freedom, Emily Kazyak, Kelsy Burke, Maia Behrendt, Marissa Oliver

Department of Sociology: Faculty Publications

In this article, we examine how courts make decisions in religious exemption cases that implicate LGBT rights in a wide range of contexts including education, employment, and medical care. Through an in-depth qualitative analysis of 50 federal cases decided between 1990 and 2020, we demonstrate a shift in how anti-LGBT sentiment is expressed by parties bringing religion-based claims—from a broad condemnation of LGBT identity to a narrow condemnation of same-sex marriage—and find that courts are more likely to rule in favor of the latter. We show how courts construct competing understandings of harm and religious freedom depending on the context …


Making The Case: Examining Outcomes Of Religious‑Based Claims In Federal Litigation Involving Lgbt Rights, Emily Kazyak, Kelsy Burke, Marissa Oliver, Maia Behrendt Jan 2023

Making The Case: Examining Outcomes Of Religious‑Based Claims In Federal Litigation Involving Lgbt Rights, Emily Kazyak, Kelsy Burke, Marissa Oliver, Maia Behrendt

Department of Sociology: Faculty Publications

Introduction In this manuscript, we analyze 62 US federal cases from 1990 to 2020 that implicate the issue of religious freedom and LGBT rights. Popular and scholarly commentary on the advancement of LGBT rights in the twenty-first century has speculated a rise in religious exemption litigation as a strategy to oppose such rights. Yet, we lack empirical data to confirm or reject this assumption and to understand patterns and trends within such cases.

Methods We perform bivariate analyses to examine trends with regard to how the court rules on these cases.

Results Our findings show that religious litigants are not …


Nebraskans Attitudes Towards Innovations In Food Production And Processing 2019 And 2020 – Methodology Report, Julia Mcquillan Jan 2023

Nebraskans Attitudes Towards Innovations In Food Production And Processing 2019 And 2020 – Methodology Report, Julia Mcquillan

Department of Sociology: Faculty Publications

SURVEY QUESTIONS


Voices From The Field: Brexit, Citizenship And Agricultural Labour, Richard Yarwood, Gina Kallis, Leonie Boland Jan 2023

Voices From The Field: Brexit, Citizenship And Agricultural Labour, Richard Yarwood, Gina Kallis, Leonie Boland

School of Geography, Earth and Environmental Sciences

Drawing on a case-study of Cornwall in the South-West of England, this paper has three main aims. First, it seeks to listen to the voices of migrant workers and, in doing so, learn more about their experiences of moving to, and working in, the British countryside. Second, it evaluates the impact of Brexit on their lives and, in particular, how it influences their decision to work in the UK or elsewhere. Finally, consideration is given to the significance of citizenship to their lives, both as a formal contract with the EU and as a lived experience.


Poo Matters! A Scoping Review Of Impact Of Constipation On Epilepsy, Alexandra Gabrielsson, Samuel Tromans, Lance Watkins, Lisa Burrows, Richard Laugharne, Rohit Shankar Jan 2023

Poo Matters! A Scoping Review Of Impact Of Constipation On Epilepsy, Alexandra Gabrielsson, Samuel Tromans, Lance Watkins, Lisa Burrows, Richard Laugharne, Rohit Shankar

Peninsula Medical School

BACKGROUND: Epilepsy is a common neurological disorder which frequently presents with co-morbid physical health conditions, including constipation. However, the nature of the relationship between the two conditions has not been well defined. AIM: To quantify constipation's relationship with epilepsy and anti-seizure medication (ASM). METHOD: A scoping review registered on PROSPERO (CRD42022320079) with suitable search terms was conducted and reported in accordance with PRISMA guidance. CINAHL, Embase, PsycInfo and MEDLINE electronic databases were searched by an information specialist. The Joanna Briggs Institute (JBI) critical appraisal tools alongside the Oxford Centre for Evidence Based Medicine (OCEBM) levels of evidence were used to …


Intra-Articular Injection Therapy In Knee Osteoarthropathy: A Narrative Review, Alan Chang, Yi-Hsiang Chiu, Chueh-Hung Wu, Tyng-Guey Wang Jan 2023

Intra-Articular Injection Therapy In Knee Osteoarthropathy: A Narrative Review, Alan Chang, Yi-Hsiang Chiu, Chueh-Hung Wu, Tyng-Guey Wang

Rehabilitation Practice and Science

Knee osteoarthropathy is a common degenerative joint disorder that can cause pain and functional impairment in affected individuals. Various intra-articular injection therapies have been explored as potential treatments for knee osteoarthropathy, including corticosteroid, hyaluronic acid, dextrose and platelet-rich plasma. Intra-articular corticosteroid injection is commonly used for short-term pain relief. Patients with higher baseline pain level and milder changes of degeneration on imaging may benefit more from corticosteroid injection. However, excessive use may lead to detrimental effects on joint tissues. Intra-articular hyaluronic acid injections have demonstrated positive effects in improving pain and function, as well as delaying the need for total …


Efficacy Of A Compound Swallowing Training Program Incorporating Neuromuscular Electrical Stimulation On Postoperative Chronic Dysphagia In Patients With Tongue Cancer, U-Hin Lai, Yu-Chi Huang, Ching-Yi Liao, Xiao-Rou Ding, Chau-Peng Leong Jan 2023

Efficacy Of A Compound Swallowing Training Program Incorporating Neuromuscular Electrical Stimulation On Postoperative Chronic Dysphagia In Patients With Tongue Cancer, U-Hin Lai, Yu-Chi Huang, Ching-Yi Liao, Xiao-Rou Ding, Chau-Peng Leong

Rehabilitation Practice and Science

Objective: To investigate therapeutic effects of a compound swallowing training program(CSTP) that includes neuromuscular electrical stimulation, swallowing muscle strengthening, posture training, food texture modification, and the use of adaptive feeding devices on chronic dysphagia after surgical treatment of tongue cancer(TC), and review the long-term swallowing outcomes and possible adverse effects.

Materials and methods: In this retrospective longitudinal study, we included patients with chronic dysphagia after surgical treatment of TC, who received a total of 10 CSTPs three times weekly, for one hour each time. Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Swallowing Performance Rating Scale (SPS) scores were compared …


The Taiwan Version Of The Milestones 2.0 Project For Physical Medicine And Rehabilitation Residents, Kai-Hua Chen, Shin-Liang Pan, Wen-Hsuan Hou, Nai-Hsin Meng, Jan-Wei Chiu, Huan-Jui Yeh, Hung-Chou Chen, Yu-Chi Huang, Ming-Miau Tsai, Yen-Nung Lin, Hung Yu Cheng, Tsan-Hon Liou, Chung Chao Liang, Simon Tang, Wai-Keung Lee, Chung-Lan Kao, Jiunn-Horng Kang, Yu-Tai Chang, Co Yih Siow, Jin-Shin Lai Jan 2023

The Taiwan Version Of The Milestones 2.0 Project For Physical Medicine And Rehabilitation Residents, Kai-Hua Chen, Shin-Liang Pan, Wen-Hsuan Hou, Nai-Hsin Meng, Jan-Wei Chiu, Huan-Jui Yeh, Hung-Chou Chen, Yu-Chi Huang, Ming-Miau Tsai, Yen-Nung Lin, Hung Yu Cheng, Tsan-Hon Liou, Chung Chao Liang, Simon Tang, Wai-Keung Lee, Chung-Lan Kao, Jiunn-Horng Kang, Yu-Tai Chang, Co Yih Siow, Jin-Shin Lai

Rehabilitation Practice and Science

Background: Milestones provide a framework for evaluating the trajectory of residency performance, which is one of the important works promoted by the Joint Commission of Taiwan for improving the quality of residency training. The current report aims to (1) introduce the translation and modification of the Taiwan version of the Milestones 2.0 Project for Physical Medicine and Rehabilitation Residents (Taiwan PMR Milestones 2.0 Project), (2) document the preliminary data in the first year and (3) highlight the ongoing and future plan. Methods: In January 2022, the Taiwan Academy of Physical Medicine and Rehabilitation organised a Milestones working group consisting of …


Prognosis Of Paraplegia After Receiving Transarterial Chemoembolization For Recurrent Hepatocellular Carcinoma: A Case Report, I-Wei Chen, Hsueh-Chou Lai, Chien-Lin Lin Jan 2023

Prognosis Of Paraplegia After Receiving Transarterial Chemoembolization For Recurrent Hepatocellular Carcinoma: A Case Report, I-Wei Chen, Hsueh-Chou Lai, Chien-Lin Lin

Rehabilitation Practice and Science

Transarterial chemoembolization (TACE) is the standard treatment for patients with Barcelona clinic liver cancer staging system stage B hepatocellular carcinoma. However, various TACE complications have been reported, and spinal infarction is one of the rarest. To date, only six specific case reports written in English have been published. We report a rare case of TACE-related spinal cord infarction and compare this case with cases in other reports and literature reviews. The patient experienced a sudden onset of paraplegia, sensory impairment below the T8 dermatome and had difficultly voiding immediately after TACE. The T2WI and DWI found hyperintensity 3.5 hours after …


Entrapment Of The Deep Branch Of The Radial Nerve By An Intramuscular Lipoma: A Case Report, Yann-Rong Chen, Ying-Chen Kuo, Yu-Hsien Lin, Yu-Ting Lin Jan 2023

Entrapment Of The Deep Branch Of The Radial Nerve By An Intramuscular Lipoma: A Case Report, Yann-Rong Chen, Ying-Chen Kuo, Yu-Hsien Lin, Yu-Ting Lin

Rehabilitation Practice and Science

Lipomas are benign tumors that are common in subcutaneous tissue and are usually asymptomatic. However, intramuscular lipomas, which are less common, can cause nerve compression in rare cases. Herein, we report the case of a 61-year-old man with an intramuscular lipoma on his right forearm. The lipoma entrapped the deep branch of the radial nerve and caused wrist drop and finger drop. A nerve conduction examination and electromyography were conducted to quantify the degree of and localize the nerve injury. Sonography provided the initial diagnosis of a lipoma, which was verified with magnetic resonance imaging. The lipoma was resected, and …


Referred Pain: A Case Report On Shoulder Pain Caused By A Mediastinal Tumor, Cheng-I Chen, Yao-Jen Chen Jan 2023

Referred Pain: A Case Report On Shoulder Pain Caused By A Mediastinal Tumor, Cheng-I Chen, Yao-Jen Chen

Rehabilitation Practice and Science

Shoulder pain has many etiologies, with the most common causes being the shoulder joint itself and the surrounding soft tissues, such as tendons, bursae, or ligaments. However, rare pathologies can occur. This report presents a case of chronic right shoulder pain eventually diagnosed as a rare case of extra-skeletal osteosarcoma. The referred right shoulder pain was likely caused by tumor invasion of the pericardium, whose sensory innervation is provided by the phrenic nerve. The purpose of this case report is to highlight the fact that, although rare, neoplasm can be a cause of shoulder pain. Rather than just relieving symptoms, …


Ultrasonography Can Be Early Diagnostic Modality For Pediatric Calcaneus Fractures: A Case Report, Ying-Chu Chen, Szu-En Chen Jan 2023

Ultrasonography Can Be Early Diagnostic Modality For Pediatric Calcaneus Fractures: A Case Report, Ying-Chu Chen, Szu-En Chen

Rehabilitation Practice and Science

Although calcaneus fractures may be the most common pediatric tarsal bone fracture, most occult calcaneus fractures are not visible on plain radiography, resulting in delayed diagnosis. However, ultrasonography can aid early diagnosis of this fracture with an unspecified mechanism of injury and unremarkable radiographic findings. In a pediatric patient with progressive ankle swelling and pain, initial plain radiography was unremarkable, and antibiotics were administered for suspected infective arthritis. After limping developed, ultrasonography showed symmetric growth plates of bilateral distal tibia, fibula, and tarsal bone; a step-off calcaneus cortex with periosteal reaction; increased power Doppler flow; and probe tenderness, indicating a …


Effects Of Alcohol Consumption Following Resistance Training: A Narrative Review Of Physical Performance And Metabolic Recovery, Yueh-Tung Pan, Chueh-Hung Wu Jan 2023

Effects Of Alcohol Consumption Following Resistance Training: A Narrative Review Of Physical Performance And Metabolic Recovery, Yueh-Tung Pan, Chueh-Hung Wu

Rehabilitation Practice and Science

Background: Resistance training is a popular exercise modality that aims to increase muscle strength, power, and endurance. Meanwhile, alcohol is a widely used recreational beverage that has been found to negatively affect physical performance and recovery. Thus, understanding the effects of alcohol consumption following resistance training is crucial for athletes and fitness enthusiasts. Method: A literature search from 2010 to 2022 was conducted on the PubMed database to identify relevant studies investigating the effects of alcohol consumption after resistance training. The following search terms were used: "alcohol," "resistance training," "physical performance," "recovery," and "metabolism." Only studies published with human participants …


Effect Of Repetitive Transcranial Magnetic Stimulation On Gait Function And Strength Among Patients With Spinal Cord Injury: A Meta-Analysis, Yen-Ting Chen, Yu-Chi Su, Yu-Ching Lin Jan 2023

Effect Of Repetitive Transcranial Magnetic Stimulation On Gait Function And Strength Among Patients With Spinal Cord Injury: A Meta-Analysis, Yen-Ting Chen, Yu-Chi Su, Yu-Ching Lin

Rehabilitation Practice and Science

Purpose: This meta-anaylysis investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the context of spinal cord injury (SCI). The study focused on assessing its impact on muscle strength and gait speed, measured through the lower extremities motor score of the American Spinal Injury Association (ASIA) and 10-Meter Walk Test scores(10MWT). Methods: The PubMed, Cochrane Library, and Embase databases were searched for articles published through Oct 2023. We enrolled only randomized controlled trials. The Cochrane Collaboration risk of bias tool was used for quality assessment. Outcomes were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). We …


The Gift Of Mourning, Harris B. Bechtol Jan 2023

The Gift Of Mourning, Harris B. Bechtol

All Faculty Scholarship (Archived)

Is mourning possible? Or impossible? And if impossible, in what sense impossible? What does this mean, in turn, for what we do as human beings in the face of the normal, natural experience of mourning the death of the other? How can we mourn? How should we mourn? For some, these questions arise on account of the death of a beloved pet, a friend, a child, a spouse, and/or a parent. Perhaps they arise even on account of the death of their own faith in God, others, humanity, and/or the universe. Yet since 2020, these questions have become especially emphatic …


Cozie Apple: An Ios Mobile And Smartwatch Application For Environmental Quality Satisfaction And Physiological Data Collection, Federico Tartarini, Mario Frei, Stefano Schiavon, Xuan Yun Chua, Clayton Miller Jan 2023

Cozie Apple: An Ios Mobile And Smartwatch Application For Environmental Quality Satisfaction And Physiological Data Collection, Federico Tartarini, Mario Frei, Stefano Schiavon, Xuan Yun Chua, Clayton Miller

Research Collection College of Integrative Studies

Collecting feedback from people in indoor and outdoor environments is traditionally challenging and complex to achieve in a reliable, longitudinal, and non-intrusive way. This paper introduces Cozie Apple, an open-source mobile and smartwatch application for iOS devices. This platform allows people to complete a watch-based micro-survey and provide real-time feedback about environmental conditions via their Apple Watch. It leverages the inbuilt sensors of the smartwatch to collect physiological (e.g., heart rate, activity) and environmental (sound level) data. This paper outlines data collected from 48 research participants who used the platform to report perceptions of urban-scale environmental comfort (noise and thermal) …


Alpha-Gal Syndrome: The End Of Red Meat Consumption?, Checkwube Obianyo, Marina Eremeeva Jan 2023

Alpha-Gal Syndrome: The End Of Red Meat Consumption?, Checkwube Obianyo, Marina Eremeeva

Eagles Talking About the Public’s Health

No abstract provided.


Heavy Metals In Baby Food: It’S Time For Public Health Researchers To Wake Up, Sarah Sejoro, Atin Adhikari Jan 2023

Heavy Metals In Baby Food: It’S Time For Public Health Researchers To Wake Up, Sarah Sejoro, Atin Adhikari

Eagles Talking About the Public’s Health

No abstract provided.


Improving Cervical Cancer Screening In Sub-Saharan Africa, Nigeria: Reaching Levels Of Cervical Cancer Prevention In Developed Countries, Chigozie Alexandra Ogwara, Biyi-Olutunde Olusegun, Yelena Tarasenko Jan 2023

Improving Cervical Cancer Screening In Sub-Saharan Africa, Nigeria: Reaching Levels Of Cervical Cancer Prevention In Developed Countries, Chigozie Alexandra Ogwara, Biyi-Olutunde Olusegun, Yelena Tarasenko

Eagles Talking About the Public’s Health

No abstract provided.


Addressing Racial Disparities In Maternal Health Through Policy, Alexandria Alford, Alisha Riggins, Joanne Chopak-Foss, Sarah Sejoro, Tobi Oloyede, Mambwe Mutiti Jan 2023

Addressing Racial Disparities In Maternal Health Through Policy, Alexandria Alford, Alisha Riggins, Joanne Chopak-Foss, Sarah Sejoro, Tobi Oloyede, Mambwe Mutiti

Eagles Talking About the Public’s Health

No abstract provided.


Healthcare Price Transparency In The U.S. – A Panacea?, Foram Patel, Linda Kimsey, Melvin Lamboy-Ruiz, Yelena Tarasenko Jan 2023

Healthcare Price Transparency In The U.S. – A Panacea?, Foram Patel, Linda Kimsey, Melvin Lamboy-Ruiz, Yelena Tarasenko

Eagles Talking About the Public’s Health

No abstract provided.


Mining Health Informatics Job Advertisements: Insights For Higher Education Programs And Job Seekers, Ahmed El Noshokaty, Mohammad A. Al-Ramahi, Omar El-Gayar, Abdullah Wahbeh, Tareq Nasralah Jan 2023

Mining Health Informatics Job Advertisements: Insights For Higher Education Programs And Job Seekers, Ahmed El Noshokaty, Mohammad A. Al-Ramahi, Omar El-Gayar, Abdullah Wahbeh, Tareq Nasralah

Computer Information Systems Faculty Publications (Archived)

This paper used web scraping and data mining to analyze 831 health informatics job advertisements on indeed.com. Results showed that 87% of jobs explicitly required a college degree in a related field, 41% of jobs preferred a graduate degree, while 29% preferred or required professional certification. The analysis showed that preferred skills were analytics problem solving, communication skills, oral communication, interpersonal skills, project management, statistics, and critical thinking. The analysis also showed that college degrees, certifications, and the above-mentioned skill set are in high demand for working in the field of health informatics, especially in states with large populations and …