Digital Commons Network^™

The Rna-Binding Protein Hur Modulates The Expression Of The Disease-Linked Ccl2 Rs1024611g-Rs13900t Haplotype, Feroz Akhtar, Joselin Hernandez-Ruiz, Ya-Guang Liu, Roy G. Resendez, Denis Feliers, Liza D. Morales, Alvaro Diaz-Badillo, Donna M. Lehman, Rector Arya, Juan Carlos Lopez-Alvarenga, John Blangero, Ravi Duggirala, Srinivas Mummidi

School of Medicine Publications

CC-chemokine ligand 2 (CCL2) is involved in the pathogenesis of several diseases associated with monocyte/macrophage recruitment, such as HIV-associated neurocognitive disorder (HAND), tuberculosis, and atherosclerosis. The rs1024611 (alleles: A>G; G is the risk allele) polymorphism in the CCL2 cis-regulatory region is associated with increased CCL2 expression in vitro and ex vivo, leukocyte mobilization in vivo, and deleterious disease outcomes. However, the molecular basis for the rs1024611-associated differential CCL2 expression remains poorly characterized. It is conceivable that genetic variant(s) in linkage disequilibrium (LD) with rs1024611 could mediate such effects. Previously, we used rs13900 (alleles: C>T) in the CCL2 …

Identifying The Best Cutoff Value Of The Fecal Occult Blood Immunochemical Test In The Detection Of Advanced And Neoplastic Colorectal Lesions [Identificación Del Mejor Punto De Corte De La Prueba Inmunoquímica De Sangre Oculta En Heces En La Detección De Lesiones Colorrectales Avanzadas Y Neoplásicas], Patricia Gaggero, Eduardo Fenocchi, Cecilia Silva, Juan C. Lopez-Alvarenga, Natalia Lambert, Fabian Batista, Sergio Sobrino-Cossio, Jonathan R. White, Adolfo Parra-Blanco

School of Medicine Publications

Objective: Screening is an effective tool for detecting colorectal lesions in asymptomatic subjects. There is a positive correlation between fecal immunochemical test (FIT) values and the size of tumors. Despite the efficacy of screening, the detection of colorectal cancer (CRC) remains low. The primary objective was to evaluate the best FIT cutoff value for detecting advanced adenomas and CRC among individuals at average risk in a country with a high incidence and morbidity from CRC.

Methods: This observational and prospective study analyzed consecutive cases in 1461 asymptomatic subjects with a positive FIT (≥ 100 ng hemoglobin [Hb]/ mL) referred for …

Spinning-Induced Exertional Rhabdomyolysis Without Acute Kidney Injury, Yolanda V. Gutierrez, Ronald Shaju, Alyssa L. Sepulveda, Joaquin Rivera, Aamir Ahmad

School of Medicine Publications

Rhabdomyolysis is a condition with a myriad of causes, including both traumatic and non-traumatic. Traumatic conditions are observed in crush injuries, compartment syndrome, and fractures, while non-traumatic rhabdomyolysis is commonly seen due to exertional heat stroke, extreme physical exercise, and dehydration. This case report explores two cases of extreme non-traumatic rhabdomyolysis caused by indoor cycling, also known as spinning. A common complication of severe rhabdomyolysis is acute kidney injury (AKI), which increases the risk of renal failure. Rapid interventions such as aggressive intravenous fluids are necessary to prevent kidney function loss. In this case report, two sisters, on two separate …

Beyond Hemostasis: A Narrative Review On The Multifaceted Therapeutic Potential Of Ankaferd Blood Stopper, Salima E. Tibi, Muhammad Hashir Nazir, Saleha Nazir, Bhumi Daishik Patel, Gayatri Misra, Tirath Patel, Fatima Nasir, Muhammad Farhan, Nana Sardarova, Nikhilesh Anand

School of Medicine Publications

Background: Effective hemorrhage control is essential in managing trauma and surgical patients, with uncontrolled bleeding being a leading cause of mortality. Ankaferd Blood Stopper (ABS), a hemostatic agent historically used in Anatolia, has gained recognition for its ability to modulate red blood cell-fibrinogen interactions to form a stable protein network for rapid bleeding cessation.

Objective: This review explores the multifaceted applications of ABS, evaluating its efficacy, safety, and potential therapeutic roles across various medical fields, including hemostasis, wound healing, antimicrobial activity, and antineoplastic effects.

Methods: A comprehensive synthesis of clinical trials, case reports, and experimental studies was conducted to assess …

Early Detection In Oral Cancer: Are We Prepared For Artificial Intelligence-Driven Precision Medicine?, Nikil Kumar, Sinnha Kumari, Sadia Sultana, Muhammad Saad Khan, Tirath Patel, Nikhilesh Anand

School of Medicine Publications

Oral cancer, particularly oral squamous cell carcinoma, remains a serious health concern, with a poor prognosis and a late diagnosis. Leukoplakia, erythroplakia, lichen planus, and submucous fibrosis are examples of oral potentially malignant disorders that must be detected early but are not always so by traditional, laborious, and subjective diagnostic techniques. In oral cancer, artificial intelligence (AI) and precision medicine are becoming game-changing technologies that enhance individualized care, treatment planning, and diagnostic precision. Complex imaging and histopathology data may be analyzed using machine learning and deep learning algorithms, particularly convolutional neural networks, which can identify patterns that are invisible to …

Una Nueva Herramienta Para Estimar El Volumen Muscular Independientemente De La Edad, El Sexo Y El Nivel De Actividad Física, José J. Rivera-Sánchez, Laura P. Burgos-Morelos, Daniel Castillo-Castillo, Gerardo Méndez-Suárez, Juan C. Lopez-Alvarenga, Damián Carrillo-Ruíz

School of Medicine Publications

Antecedentes: Actualmente, la evaluación del volumen muscular requiere técnicas invasivas o de imagen, lo que aumenta los costos y retrasa la evaluación, y las mediciones antropométricas con frecuencia son inexactas.

Objetivo: Desarrollar una fórmula matemática para estimar el volumen del cuádriceps.

Material y métodos: Se evaluaron 127 sujetos: 40 adultos sedentarios de 20 a 35 años, 47 atletas adultos de 20 a 45 años y 40 adultos sedentarios de 70 a 94 años. Se dividieron en grupos de desarrollo y de validación. Se realizaron mediciones de variables antropométricas y fuerza de agarre, y se desarrolló la fórmula de predicción del …

Training Tomorrow’S Hand Surgeons: Clinical, Leadership, And Structural Trends In Fellowship Education, Ogonna N. Nnamani Silva, Aaron I. Dadzie, Chinenye Ogbonnah, Lydia A. Helliwell, Abhiram R. Bhashyam, Catherine M. Curtin, Tamara D. Rozental, Krystle R. Tuaño

School of Medicine Publications

Purpose: Hand surgery fellowships include trainees from orthopedic, plastic, and general surgery. These pathways present an opportunity to examine variations in graduate medical education structures, such as program size, sponsoring department, and leadership composition. Limited research exists on the characteristics of these programs. The purpose of this study is to assess the structural and leadership characteristics of the Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States. We hypothesized that characteristics (ie, faculty-to-fellow ratios and case volume) vary by specialty sponsorship. Leadership, although shaped by merit-based criteria, faces challenges in achieving broader demographic diversity.

Methods: A …

Tuberculosis Presenting As Multiple Pulmonary Nodules Mimicking Malignancy, Abdel Martinez Borrego, Fatimah Bello, Brandon Cantazaro, Luisa Montoya, Frank Mediola

School of Medicine Publications

Multiple pulmonary nodules often raise concern for metastatic malignancy; however, the differential diagnosis is broad and includes infectious, inflammatory, granulomatous, vascular, and benign etiologies. Tuberculosis (TB), although uncommon, can present with multiple nodules that closely mimic metastatic disease on advanced imaging, requiring careful clinicoradiologic and microbiologic correlation. We describe a woman in her 50s who presented with dyspnea and new-onset heart failure, in whom imaging revealed mediastinal lymphadenopathy and bilateral pulmonary nodules concerning for malignancy. Evaluation was limited by concurrent COVID-19 infection, and CT-guided biopsy demonstrated necrotizing granulomas without evidence of malignancy or infection. She later re-presented with fever and …

Pediatric Both Bone Fracture Leading To Median Nerve Entrapment: A Case Report, Joshua Lyndon Dale, Frank Gerold

School of Medicine Publications

Introduction: Both-bone forearm fractures are common in pediatric patients and most often result from a fall onto an outstretched hand. Although rare, nerve entrapments, particularly of the median nerve, can occur, especially following closed reduction.

Case report: We present the case of a 13-year-old male who sustained a both-bone forearm fracture while on vacation in Mexico. The injury was managed with closed reduction and casting. Despite appropriate treatment, the patient developed progressive numbness, tingling, and thenar atrophy in the median nerve distribution. Electromyography and nerve conduction studies confirmed significant median nerve dysfunction. Surgical exploration revealed the median nerve entrapped in …

Associations Of Blood Pressure Level And Variability With Cortical Thickness: A Cross-Sectional Analysis From The Maracaibo Aging Study, Romeo De Leon, Shana Garza, Silvia Mejia-Arango, Kristina Vatcheva, Sokratis Charisis, Claudia L. Satizabal, Luis J. Mena, Joseph H. Lee, Joseph D. Terwilliger, Eron Manusov

School of Medicine Publications

Background: Although high blood pressure (BP) level and variability are associated with Alzheimer's Disease (AD), their relationship with cortical thickness in brain regions that are associated with AD is unclear. Furthermore, the role of 24-hour BP has not been examined. We investigated the associations of office and ambulatory BP measures with cortical thickness in brain regions implicated in AD.

Methods: We performed a cross sectional analysis of 304 participants without dementia from a population-based study with office and 24-hour BP and magnetic resonance imaging (MRI) data. We considered cortical thickness values derived from 10 regions throughout the frontal, parietal, and …

Reduced Threat-Related Neural Efficiency: A Possible Biomarker For Pediatric Anxiety Disorders, Julia O. Linke, Reut Naim, Simona P. Haller, Parmis Khosravi, Beck Scheinberg, Meghan E. Byrne, Anita Harrewijn, Ellen Leibenluft, Melissa A. Brotman, Anderson M. Winkler, Daniel Samuel Pine

School of Medicine Publications

Objective: Pediatric anxiety disorders are common and predict adult psychopathology, yet current treatments, such as cognitive-behavioral therapy (CBT), produce lasting remission in less than 50% of affected youths. To support the search for improved, mechanistically grounded interventions, this study evaluated neural efficiency, defined as similarity in functional connectivity between a threat task and rest, as a potential biomarker. The study evaluated neural efficiency in relation to anxiety diagnosis and treatment response.

Methods: The authors compared 103 youths with an anxiety disorder diagnosis (mean age, 12.5 years [SD=2.91], 62% female) to 103 youths with no psychiatric diagnosis (mean age, 13.4 years …

Coffin–Lowry Syndrome: A Systematic Review Of Rps6ka3 Confirmed Cases And Implications For Diagnosis And Counseling, Sabyasachi Maity, Miranda Montion, Danielle Boothe, Mona Attarpour, Ivy Mageto, Simran Agarwal, Rujul Patel, Chloe Lark, Bharathi Gadad, Nikhilesh Anand

School of Medicine Publications

Background: Coffin–Lowry syndrome (CLS) is a rare X-linked disorder caused by pathogenic variants in RPS6KA3, presenting with intellectual disability, distinctive facial and skeletal features, and variable systemic involvement. Advances in genomic technologies have expanded the mutation spectrum, yet genotype phenotype correlations remain incompletely understood.

Methods: We conducted a systematic review of published cases (n = 72) following PRISMA guidelines. Demographic, phenotypic, and genotypic data were extracted, standardized, and summarized using descriptive statistics. Associations between mutation type and key clinical features were assessed with Chi-square or Fisher’s exact tests. Diagnostic approaches and global distribution were also analyzed.

Results: The cohort …

3d-Printed Soy Protein And Microalga Films: A Sustainable Approach With Antioxidant Functionality, Sorour Barekat, Buse Dogan, Sibel Uzuner, Ali Ubeyitogullari

Food Science Faculty Publications and Presentations

This study investigated the optimization and fabrication of soy protein isolate (SPI)-green microalga (MA) 3D-printed films. For optimizing 3D printing, the effects of MA concentration, nozzle size (0.52-0.81 mm), and speed (10-20 mm/s) were examined. The printed films were then dried, and color, mechanical properties, water vapor permeability, structure, and antioxidant activity were analyzed. All the formulations showed shear-thinning behavior and rapid recovery. The concentration of 3 % MA, nozzle size of 0.72 mm, and printing speed of 20 mm/s were selected as the optimized conditions for the best 3D printability. Compared with the control, their elongation at break decreased …

Gender-Specific Behavior Reductions In Spontaneous Locomotive And Rearing In A Rat Model Of Paclitaxel-Induced Peripheral Neuropathy: A Pilot Study, Serena Jiyeon Kim, Kevin Cao, Patrick M Dougherty, Kathleen E Mcdonough, Saba Javed

Faculty, Staff and Students Publications

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) from agents like paclitaxel causes sensory loss and functional impairment, with limited treatment options. To better model patient-relevant outcomes, we used open field video tracking in rodents to assess gait, anxiety, and exploratory behavior. This approach provides a more comprehensive assessment of CIPN-related deficits beyond pain responses.

Methods and materials: Adult male and female Sprague Dawley rats were given paclitaxel (Taxol; 24 mg/kg cumulative dose) or a vehicle over 8 days. Their distance traveled, time spent in the center and outer zones of the OF test, and rearing behaviors were recorded using a PhenoTyper 4500 …

Phase 1 Trial Of Withania Somnifera Leaf Extract (Rh324) In Advanced Non-Small Cell Lung Cancer Including [18f]Fdg Pet/Ct As A Short-Term Metabolic Biomarker To Assess Efficacy: A Novel Model For Assessment Of Complimentary Therapies In Early Phase Human Clinical Trials, Jin Uk Heo, Santosh Rao, Herbert B Newton, Afshin Dowlati, Raymond F Muzic, Arash Kardan

Faculty, Staff and Students Publications

Background: Withania somnifera (WS), commonly known as ashwagandha, has been used in the traditional medical system of India. It has shown significant activity against numerous solid tumor varieties in pre-clinical in vitro and in vivo studies. This study focuses on RH324 (ReHeva Biosciences, Columbus, OH), a pharmaceutical-grade formulation derived from WS, which has received FDA allowance for clinical development as a botanical drug in the treatment of cancer.

Methods: A phase 1 open label dose ranging study of oral RH324 in advanced non-small cell lung cancer (NSCLC) was conducted. The primary endpoint of the study was assessment of short-term safety …

‘The Way We Do Our Translation’: A Case Study Of Translation Policy For Spanish Speakers In The Public Parks Of Sonoma County, California, Gabriel González Núñez, Ángel María Casas Grageab, Christina Guerrero Harmon

Writing and Language Studies Faculty Publications

Signs in public spaces can provide essential information. Especially at times of crises, and in places where there are large populations who speak a minoritized language, translation is often employed to create multilingual signage for the benefit of the community. After all, translated signs appear because some authority considers that a certain message is important enough to be visibly communicated to the public, including those who do not speak the State’s preferred language. The decision as to whether to translate or not certain signs may seem arbitrary, but one would hope that it is the result of a guided policy …

"Just Let Your Soul Glo": Humorous Music In Black American Comedy Films, Drew Brady

Music Theses and Dissertations

In this thesis, I inspect ways in which music has been used to create humor and meaning in black American cinema. In doing so, I address gaps in film music scholarship, as music in comedy films and in black cinema are both neglected topics. I suggest that humor in these films arises out of a particular blend of musical irony, parody, and satire, the exact combination of which is contingent on various historical, cultural, and political factors. In order to track this trend, I analyze humorous music in eight films, each representing a unique manifestation of this tradition: Watermelon Man …

Applied Machine Learning In Mineral Prospectivity Mapping In The South Pass-Granite Mountains Of Wyoming, Carl D. York

Graduate Theses/Dissertations

The South Pass-Granite Mountains, comprised of Archean to Tertiary rocks embedded with an Archean greenstone belt in Central Wyoming, have historically been mined for gold, iron, steel, and silver. Rare earth elements have been of increasing interest in the region and thus, several datasets have become available. Knowledge driven and data driven models are used in mineral prospectivity mapping with input data including geological mapping, geochemical data, geophysical (USGS Critical Mineral magnetic and gravity data), radiometric (U, Th, K) data and multispectral remote sensing data. Mineral prospectivity has seen a rapid improvement in recent years using advancements in machine learning …

Drone Dichotomy: Investigating The Application Of Unmanned Aerial Systems For Offensive And Defensive Chemical, Biological, Radiological, And Nuclear-Related Tasks, Evan Jacob Martinovitch

Graduate Theses/Dissertations

This thesis investigates the application of unmanned aerial systems (UAS) for both offensive and defensive chemical, biological, radiological, and nuclear (CBRN) tasks to determine if they serve as a force multiplier on the modern battlefield. As CBRN weapons reemerge as realistic threats alongside the rapid proliferation of UAS, the intersection of these fields presents unique challenges and opportunities. Through a methodology that examines the history of the UAS-CBRN intersection, military doctrine, and the status of UAS technology, this research evaluates the capability of current and emerging UAS against specific CBRN delivery, reconnaissance and surveillance, and decontamination tasks. The analysis conducted …

Nonbinary Gender Performance And Self-Identification In Mary Shelley's Frankenstein, Lillian R. Durr

Graduate Theses/Dissertations

Mary Shelley’s 1818 novel Frankenstein, a text informed by a rich Romantic era philosophical tradition, has produced an expansive contemporary body of transgender studies scholarship. Building on transgender literary studies of Frankenstein, my thesis analyzes the difference between the monster’s internalized self-perceived identity and their externally performed and perceived identity. I interpret the difference between the monster’s internal and external identity as an analogy through which to understand contemporary nonbinary experiences. The “performance” of gender that Judith Butler describes is a limited expression of an internal, inescapable, ontological experience of self-identification. The monster’s own social experience illustrates the …

The Confidence-Man Goes To The Moving Panorama: Herman Melville’S Confidence Narrator And United States Imperialism, Bradley J. Lee

Graduate Theses/Dissertations

This thesis argues that Herman Melville fashioned his novel The Confidence-Man; His Masquerade (1857) after the moving panorama, a popular entertainment technology contemporary with the novel. More specifically, the thesis argues that the novel recalls Banvard’s Mississippi Panorama (1846). Using Jay Leyda’s The Melville Log and John Hanners’ record of Banvard’s performances, I establish beyond reasonable doubt the possibility that Melville saw this painting, or, at the very least, was aware of it, its content, and its social position. Tracing the novel’s engagement with this panorama reveals what seems at first to be its imperialist, Manifest Destinarian undertones. The novel’s …

Small Mammal Communities Within And Land Coverage Around Southwestern Missouri Prairies, Kaitlyn J. Bebensee

Graduate Theses/Dissertations

Land alterations can reduce the amount of suitable habitat necessary for persistence of an associated species. Within such constrained habitats, limited resources may elicit competition, which could cause shifts in abundance and occurrence of species. Missouri prairies have been declining in size, making it imperative to collect reference data on mammal populations within and land use types around remnants. For this study, I trapped small mammals in Southwestern Missouri prairies because they can be indicators of environmental health and can vary in abundance between prairies. I focus on the diet of two dominant small mammals, Peromyscus maniculatus and Microtus ochrogaster …

Northern Luzon In A Taiwan Flashpoint: The Philippines’ Place In U.S. Strategy, Carson Keller

Graduate Theses/Dissertations

While the defense of Taiwan from a potential invasion by the People’s Republic of China (PRC) has long been a topic of debate and scrutiny in U.S. strategic thinking, the role of its southern neighbor, the Philippines, has received far less attention. This thesis argues that northern Luzon would constitute key terrain in a cross-strait conflict and may become an early target of People’s Liberation Army (PLA) operations. Its proximity to Taiwan and position along the Luzon Strait, particularly the Bashi Channel, places it at the center of efforts to control access to the hypothetical battlespace. Drawing on PLA and …

Flow Regime Shifts And Channel Morphological Adjustments In Response To Changing Climate Patterns: Examples From Gasconade River, Missouri, Usa, Katherine E. Brand

Graduate Theses/Dissertations

Recent changes in climate patterns due to anthropogenic inputs (i.e. greenhouse gases/CO₂) have caused alterations to precipitation events leading to altered flow regimes. Changes in the magnitude and frequency of flood events results in physical adjustments to river morphology, including changes in width and depth. As rivers experience more frequent and larger flood events, they accommodate by changing their morphological characteristics. The Gasconade River, a tributary of the Missouri River located in southcentral Missouri, USA, has exhibited recent patterns of acute bank erosion with limited understanding of its causes and effects on the river. This study aims to understand how …

Genomic Signatures Of Decline And Recovery In An Endangered Bat, Myotis Grisescens, Marxe Altman-Orbach

Graduate Theses/Dissertations

Tremendous population declines may result in the loss of genetic diversity, which can, in turn, lead to reduced adaptive potential, overexpression of deleterious phenotypes, and further population declines. In this way, genetic drift from a severe demographic decline may ultimately lead to an extinction vortex. However, populations that avoid the loss of genetic diversity may remain viable, despite demographic crashes. Therefore, understanding genetic diversity is vital for assessing the conservation status of species that have undergone declines, and can even reflect the effectiveness of management actions. I investigated signatures of genetic bottlenecks in the gray bat (Myotis grisescens), …

Inherited Sins: Essays, Claire Ellerman

Graduate Theses/Dissertations

Joan Didion said of her book, The Year of Magical Thinking, that, “the reason I had to write it down, is that no one had ever told me what it was like.” She was trying to make sense of her grief following the death of her husband, and in doing so, wrote a piece of creative nonfiction (CNF) that explores her own life in and around the larger ideas of mourning, connection, and moving forward. This is the ultimate aim of creative nonfiction: writing to make sense of our lives in relation to the world around us. In this …

United States Mainstream Meat Market Entry: An Analysis On Speciality Goat Meat Products, Madison Raye Schmitz

Graduate Theses/Dissertations

Understanding consumers' perspectives and motivations is key when looking into making goat meat more accepted in the mainstream meat market. Previous research has shown there is a demand for goat meat from different populations in the US. Consumers also care more about the quality of the food they purchase. Understanding that goat meat has lower cholesterol and is leaner than other red meat is important to incorporating goat meat in niche consumer markets. Providing consumers with a product that is familiar to them is more acceptable than giving consumers a cut of meat they are unfamiliar with. Standard products like …

Gene Editing And The Accessibility Of Bioterrorism: Rethinking Global Biosecurity In The Post-Covid-19 Era, Nicholas Morales

Graduate Theses/Dissertations

COVID‑19 demonstrated how a single biological event can strain health systems, disrupt supply chains, undermine national security, and erode public trust. This shock occurred as biotechnology became dramatically more accessible: gene editing and synthetic biology tools once limited to specialized laboratories are now widely available through inexpensive equipment, open‑source data, and decentralized expertise.

This expanded access accelerates innovation but also broadens the threat landscape. The ability to reconstruct pathogens using publicly available sequences and mail‑order DNA shows that complex biological synthesis is no longer confined to state programs. These risks are amplified by opaque biotechnology activities in China, Russia, and …

Using 1:1 Behavior-Analytic Instruction To Enhance Outcomes Of A Social-Emotional Learning Curriculum: A Retrospective Single-Case Clinical Evaluation, Cierra Vandermeer

Graduate Theses/Dissertations

Social-Emotional Learning (SEL) is the process through which people acquire and apply skills to manage emotions, form relationships, make responsible decisions, and pursue personal and shared goals, and these competencies shape identity development and daily functioning (Collaborative for Academic, Social, and Emotional Learning [CASEL], 2020). While there are many SEL programs and curricula that exist for school-aged children, there are few curricula that a) have a focus on 1:1 instruction for preschool to primary-aged children, and b) integrate and incorporate Applied Behavior Analysis (ABA) principles. This thesis reviewed a retrospective case study of a six-year-old female-identifying student who participated in …

Eastern Fox Squirrel (Sciurus Niger) Occupancy In A Southern Missouri Woodland, Daniel Garten

Graduate Theses/Dissertations

Species occupancy, which relates the probability of presence of a species at a specific place and time, is an important component of conservation and wildlife management. Principally it is used for estimation of a species’ distribution as well as understanding species interactions and quantifying environmental effects. The purpose of this study was to analyze occupancy of the Eastern Fox Squirrel (Sciurus niger) across multiple seasons (2019–2022) at Bull Shoals Field Station (BSFS), and to identify potential covariates associated with detection and colonization. Data were drawn from camera trap surveys from 26 sites during summer and fall seasons. Multi-season occupancy models …