Digital Commons Network^™

Intergenerational Transmission Of Alexithymia As A Predictor Of Child Posttraumatic Stress Outcomes During Covid-19, Casey Burton

Theses and Dissertations

The objective of this study was to test the role of parent alexithymia in explaining why some children are functioning relatively well during the COVID-19 pandemic while others are experiencing poor mental health. Participants were 88 U.S. children (M_age = 9.94 years; 54.5% female; 59.1% White) and their parents/caregivers (68.2% female; 59.1% White). Two models were tested: a path model in which the association between parent alexithymia symptoms and child COVID-19-related posttraumatic stress symptoms (PTSS) was mediated by child alexithymia symptoms, and a moderator model in which the association between parent alexithymia symptoms and child PTSS was moderated …

Pupils’ Experience With E-Learning During Covid-19 Lockdown In Delta State., Gloria Ogheneghatowho Oyovwe-Tinuoye Dr, Esharenana E. Adomi Prof

Library Philosophy and Practice (e-journal)

This study scrutinised pupils’ experience with e-learning during COVID-19 lockdown in Delta State. The study adopted a descriptive survey research design with five (5) research objectives of the study. The questionnaire was constructed after consultation of related literature to ensure that pertinent items were encompassed in it. A self-constructed questionnaire entitled “Pupils Experience with E-Learning during COVID- 19 Lockdown Questionnaire (PEELDC19LQ) was designed by the researchers. The population of the study comprised of all pupils in Delta State who participated in e-learning to meet up with the third curriculum and eventually used for promotion for the next class. The researchers …

Rural Healthcare Workers` Knowledge, Attitude, And Practice Toward Covid-19 Two Years After The Pandemic Onset: Is Health Literacy Training Still Necessary?, Saeideh Valizadeh-Haghi, Shahabedin Rahmatizadeh, Ali Soleimaninejad, Elaheh Ahmadi, Adel Moqaddas

Library Philosophy and Practice (e-journal)

This study aimed to assess the level of knowledge, attitude, and practice regarding the coronavirus disease among Iranian rural and urban healthcare workers. The study population consisted of all healthcare experts and staff working in 38 rural health centers in Iran. An online questionnaire was distributed in November 2021. The anonymous questionnaire was comprised of a series of questions about demographic information; knowledge about COVID-19, the attitudes and preventive practices toward COVID-19. The majority of the participants (92.6%) had appropriate knowledge about COVID-19 disease. Most of the participants (77.2%) had a good attitude toward COVID-19 and 60.3% showed good practice. …

Deep Learning Augmentation For Medical Image Analysis, Fouzia Altaf

Theses: Doctorates and Masters

Deep learning is at the center of the current rise of computer aided diagnosis in medical imaging. This technology has the ability to mimic extremely complex mathematical functions for predictive tasks. These functions are encoded as computational models that are learned directly from data. Deep learning models are known to achieve human-level accuracy for predictive tasks. However, such a performance requires that the model is trained on a huge amount of training data. For computer aided diagnosis tasks, the relevant training data needs to be carefully annotated by medical experts. This process is laborious and expensive, which generally results in …

Effect Of Early Treatment With Fluvoxamine On Risk Of Emergency Care And Hospitalisation Among Patients With Covid-19: The Together Randomised, Platform Clinical Trial, Gilmar Reis, Eric J Lenze, Angela M Reiersen, Et Al

Open Access Publications

BACKGROUND: Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19.

METHODS: This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice …

Dysregulation Of The Leukocyte Signaling Landscape During Acute Covid-19, Isaiah R. Turnbull, Anja Fuchs, Kenneth E. Remy, Michael P. Kelly, Elfaridah P. Frazier, Sarbani Ghosh, Shin-Wen Chang, Monty B. Mazer, Annie Hess, Jennifer M. Leonard, Mark H. Hoofnagle, Marco Colonna, Richard S. Hotchkiss

Open Access Publications

The global COVID-19 pandemic has claimed the lives of more than 750,000 US citizens. Dysregulation of the immune system underlies the pathogenesis of COVID-19, with inflammation mediated tissue injury to the lung in the setting of suppressed systemic immune function. To define the molecular mechanisms of immune dysfunction in COVID-19 we utilized a systems immunology approach centered on the circulating leukocyte phosphoproteome measured by mass cytometry. We find that although COVID-19 is associated with wholesale activation of a broad set of signaling pathways across myeloid and lymphoid cell populations, STAT3 phosphorylation predominated in both monocytes and T cells. STAT3 phosphorylation …

Isolation Of Sars-Cov-2 In Viral Cell Culture In Immunocompromised Patients With Persistently Positive Rt-Pcr Results, Abby Sung, Adam L Bailey, Henry B Stewart, David Mcdonald, Meghan A Wallace, Kate Peacock, Candace Miller, Kimberly A Reske, Caroline A O'Neil, Victoria J Fraser, Michael S Diamond, Carey-Ann D Burnham, Hilary M Babcock, Jennie H Kwon

Open Access Publications

Immunocompromised adults can have prolonged acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive RT-PCR results, long after the initial diagnosis of coronavirus disease 2019 (COVID-19). This study aimed to determine if SARS-CoV-2 virus can be recovered in viral cell culture from immunocompromised adults with persistently positive SARS-CoV-2 RT-PCR tests. We obtained 20 remnant SARS-CoV-2 PCR positive nasopharyngeal swabs from 20 immunocompromised adults with a positive RT-PCR test ≥14 days after the initial positive test. The patients' 2

Back From The Future: Mediation And Prediction Of Events Uncertainty Through Event-Driven Models (Edms), Samuel Ogbeibu, James Gaskin

Faculty Publications

The event-driven model (EDM) is an emerging concept in human behavioural research, and understanding how EDMs can promote theory development remains a fundamental quest of predictive science. Traditionally, researchers have heavily depended upon theory confirmation and the inclusion of mediating constructs to clarify uncertainty associated with plausible events (e.g. political, socio-economic, technological, environmental). Though this approach has pushed the field forward, it has also steered mediation research towards largely ignoring the fundamental role of prediction as a key for better understanding future events represented by EDMs. Additionally, emerging research using partial least squares structural equation modelling to execute prediction-oriented analysis …

The First 20 Months Of The Covid-19 Pandemic: Mortality, Intubation And Icu Rates Among 104,590 Patients Hospitalized At 21 United States Health Systems, Michael C. Fiore, Li-Shiun Chen, Et Al.

2020-Current year OA Pubs

MAIN OBJECTIVE: There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic.

STUDY DESIGN AND METHODS: University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR …

Exploring How Online Responses Change In Response To Debunking Messages About Covid-19 On Whatsapp, Xingyu Ken Chen, Jin-Cheon Na, Luke Kien-Weng Tan, Mark Chong, Murphy Choy

Research Collection Lee Kong Chian School Of Business

Purpose: The COVID-19 pandemic has spurred a concurrent outbreak of false information online. Debunking false information about a health crisis is critical as misinformation can trigger protests or panic, which necessitates a better understanding of it. This exploratory study examined the effects of debunking messages on a COVID-19-related public chat on WhatsApp in Singapore. Design/methodology/approach: To understand the effects of debunking messages about COVID-19 on WhatsApp conversations, the following was studied. The relationship between source credibility (i.e. characteristics of a communicator that affect the receiver's acceptance of the message) of different debunking message types and their effects on the length …

The Moderating Effect Of Solar Radiation On The Association Between Human Mobility And Covid-19 Infection In Europe, Wenyu Zhao, Yongjian Zhu, Jingui Xie, Zhichao Zheng, Haidong Luo, Oon Cheong Ooi

Research Collection Lee Kong Chian School Of Business

The novel coronavirus disease 2019 (COVID-19) has caused a global pandemic. Some studies have suggested a negative association between sunlight intensity and COVID-19 infection, alluding to the belief that it might be safe to go out on sunny days. This paper examined whether solar radiation mitigated the association between human mobility and COVID-19 infection in Europe using a dynamic panel data model to investigate the effect of human mobility, solar radiation, and their interaction on COVID-19 infection. The results revealed that outgoing mobility was positively correlated and solar radiation was negatively correlated with COVID-19 infection at lag levels of 1, …

Factors Associated With Mask Use In New York City Neighborhood Parks During The Covid-19 Pandemic: A Field Audit Study, Lisa Hitch, Marie A. Sillice, Hanish Kodali, Katarzyna E. Wyka, Javier Otero Peña, Terry Tk Huang

Publications and Research

Background: Mask use is a cost-effective measure to decrease COVID-19 transmission. Mask mandates intend to increase mask compliance but are often ambiguous when it comes to public outdoor spaces.

Methods: We used a field audit study to examine mask use in New York City neighborhood parks during COVID-19. 1453 park visitors were observed in 13 parks during July–August 2020 using a modified and validated park use audit tool (System for Observing Play and Recreation in Communities) that included items on general and proper mask use (i.e., mask covering both nose and mouth). Generalized estimating equation regression was used to determine …

Safeguarding The Public: Why Workers’ Rights Education Should Be Required Learning For Nurses, Esperanza N. Sanchez

Touro Law Review

Nurses are integral to the delivery of quality health care in this country. They set aside their own needs and fears to provide care and other social services to people across a multitude of settings, taking on the burdens and stresses of others. However, our profit-driven health care system incentivizes employers to maximize productivity at reduced costs by asking nurses to do more with less. Nurses are expected to endure harsh working conditions, proven to be harmful to the nurses’ health and well-being, despite evidence showing that poor working conditions can lead to poor patient outcomes.

There are numerous worker …

Vitamin D Status And Mortality From Sars Cov-2: A Prospective Study Of Unvaccinated Caucasian Adults, Robert Barrett, Modar Youssef, Irfan Shah, Julia Ioana, Abdullah Al Lawati, Abdullah Bukhari, Suzanne Hegarty, Liam J. Cormican, Eoin Judge, Conor M. Burke, Catriona Cody, Joseph Feely, Katrina Hutchinson, William Tormey, Eoghan O’ Neill, Aoife O'Shea, Meabh Connolly, Daniel Mccartney, John L. Faul

Articles

COVID-19 and a low vitamin D state share common risk factors, which might explain why vitamin D deficiency has been linked with higher COVID-19 mortality. Moreover, measures of serum vitamin D may become lower during systemic inflammatory responses, further confounding the association via reverse causality. In this prospective study (recruited over 12 months), we examined whether the association between a low vitamin D state and in-hospital mortality due to SARS-CoV-2 pneumonia in unvaccinated subjects is explained by (i) the presence of shared risk factors (e.g., obesity, advanced age) or (ii) a reduction in serum 25(OH)D due to COVID-19 (i.e., reverse …

The Third International Hackathon For Applying Insights Into Large-Scale Genomic Composition To Use Cases In A Wide Range Of Organisms, Kimberly Walker, Divya Kalra, Rebecca Lowdon, Guangyi Chen, David Molik, Daniela C Soto, Fawaz Dabbaghie, Ahmad Al Khleifat, Medhat Mahmoud, Luis F Paulin, Muhammad Sohail Raza, Susanne P Pfeifer, Daniel Paiva Agustinho, Elbay Aliyev, Pavel Avdeyev, Enrico R Barrozo, Sairam Behera, Kimberley Billingsley, Li Chuin Chong, Deepak Choubey, Wouter De Coster, Yilei Fu, Alejandro R Gener, Timothy Hefferon, David Morgan Henke, Wolfram Höps, Anastasia Illarionova, Michael D Jochum, Maria Jose, Rupesh K Kesharwani, Sree Rohit Raj Kolora, Jędrzej Kubica, Priya Lakra, Damaris Lattimer, Chia-Sin Liew, Bai-Wei Lo, Chunhsuan Lo, Anneri Lötter, Sina Majidian, Suresh Kumar Mendem, Rajarshi Mondal, Hiroko Ohmiya, Nasrin Parvin, Carolina Peralta, Chi-Lam Poon, Ramanandan Prabhakaran, Marie Saitou, Aditi Sammi, Philippe Sanio, Nicolae Sapoval, Najeeb Syed, Todd Treangen, Gaojianyong Wang, Tiancheng Xu, Jianzhi Yang, Shangzhe Zhang, Weiyu Zhou, Fritz J Sedlazeck, Ben Busby

Faculty, Staff and Students Publications

In October 2021, 59 scientists from 14 countries and 13 U.S. states collaborated virtually in the Third Annual Baylor College of Medicine & DNANexus Structural Variation hackathon. The goal of the hackathon was to advance research on structural variants (SVs) by prototyping and iterating on open-source software. This led to nine hackathon projects focused on diverse genomics research interests, including various SV discovery and genotyping methods, SV sequence reconstruction, and clinically relevant structural variation, including SARS-CoV-2 variants. Repositories for the projects that participated in the hackathon are available at https://github.com/collaborativebioinformatics.

Rethinking Countercyclical Financial Regulation, Jeremy C. Kress, Matthew C. Turk

Georgia Law Review

The 2008 financial crisis exposed a longstanding problem in financial regulation: traditional regulatory strategies tend to be procyclical. That is, regulatory tools—most notably, bank capital requirements—incentivize excessive credit growth during economic expansions and insufficient lending during contractions. The procyclicality of U.S. financial regulation was a key driver of the housing bubble in the mid-2000s and the massive credit crunch that followed. To combat this phenomenon, Congress and the federal banking agencies attempted to mitigate procyclical boom-and-bust cycles by implementing regulatory approaches that were explicitly countercyclical. The Dodd-Frank Act and related post-crisis reforms included several countercyclical features that were designed to …

Daniel Gutiérrez, Yairy Mendez

Latinx Civil Rights

In this interview, Daniel discusses how Mexican American Studies is interpreted in Texas public schools and how this affected his own education and cultural identity. Daniel also shares how the COVID-19 pandemic affected his education during his transition from secondary to tertiary school.

Abilene Solano, Yairy Mendez

Latinx Civil Rights

Abilene Solano discusses the interpretation of Mexican American Studies in public school education. She also shares insights about her experiences attending public school and some of the challenges she faced being a first-generation student. Abilene relays how her graduating cohort was affected by the COVID-19 pandemic and how that affected her everyday life

Hydroxychloroquine/Chloroquine For The Treatment Of Hospitalized Patients With Covid-19: An Individual Participant Data Meta-Analysis, Leon Di Stefano, Jane A. O'Halloran, Adriana M. Rauseo, Et Al

2020-Current year OA Pubs

BACKGROUND: Results from observational studies and randomized clinical trials (RCTs) have led to the consensus that hydroxychloroquine (HCQ) and chloroquine (CQ) are not effective for COVID-19 prevention or treatment. Pooling individual participant data, including unanalyzed data from trials terminated early, enables more detailed investigation of the efficacy and safety of HCQ/CQ among subgroups of hospitalized patients.

METHODS: We searched ClinicalTrials.gov in May and June 2020 for US-based RCTs evaluating HCQ/CQ in hospitalized COVID-19 patients in which the outcomes defined in this study were recorded or could be extrapolated. The primary outcome was a 7-point ordinal scale measured between day 28 …

Virtual Adaptation Of An International Exchange Program In Medical Education, Celia Fung, Nicholas Maxwell, Stephen Powell, Michelle Benassai, Natalia Chunga, Jennifer Corcoran, William Barbosa, Marisabel Lopez, Betsy Hanampa, Melissa Llaiqui-Condori, Victor Delgado-Lazo, Karina Mendoza, Yanet Astete, Martin Flor, Sheyla Palacios, Blanca Valdovinos, Jorge Risco, Isabel Camargo, Ralph Jozefowicz, Karlo J Lizárraga

2020-Current year OA Pubs

Medical education has drastically transformed during the COVID-19 pandemic. Measures such as adopting telemedicine visits, minimizing the number of trainees on service, discontinuing external rotations, and converting in-person to online didactics have been broadly and swiftly implemented. While these innovations have promoted greater interconnectivity amongst institutions and made continuing medical education possible, international exchange programs in medical education are still largely disrupted. In response to the changing guidelines and restrictions necessitated by the COVID-19 pandemic, the authors used Kern's six-step approach to design and implement a virtual curriculum to replace the in-person activities of the 2020-2021 Neurology Peru-Rochester exchange program …

Parents’ Perceptions: Strategies To Motivate Lower-Elementary Children’S Virtual Emergency Learning During Covid-19, Brittany Harden

Walden Dissertations and Doctoral Studies

During the 2020–2021 school year, many students were forcibly shifted from traditional in-person learning to virtual emergency response learning (ERL) due to the COVID-19 pandemic. During this shift, many lower-elementary school students suffered socially, emotionally, and academically due to lack of infrastructure, social isolation, and the loss of direct instruction from educators. Because of this loss, many parents had different responsibilities to their children’s social, emotional, and academic well-being. Research has not provided practical, motivational strategies used by parents to motivate their lower-elementary school children during virtual ERL during COVID-19 pandemic. The purpose of this study was to examine parents’ …

Higher Amyloid Is Associated With Greater Loneliness Among Cognitively Normal Older Adults During The Covid-19 Pandemic [Version 2; Peer Review: 2 Approved], Abigail Kehrer-Dunlap, Rebecca Bollinger, Szu-Wei Chen, Audrey Keleman, Regina Thompson, Anne Fagan, Beau Ances, Susan Stark

2020-Current year OA Pubs

BACKGROUND: Loneliness has been associated with several consequences, including increased risk of developing Alzheimer disease (AD). Loneliness may arise during the preclinical phase of AD, but little is known about the relationship between loneliness and amyloid accumulation consistent with preclinical AD. Therefore, the purpose of this study was to examine the relationship between amyloid accumulation and subjective experiences of loneliness among cognitively normal older adults during the COVID-19 pandemic.

METHODS: A global Clinical Dementia Rating

RESULTS: The 108 participants had a mean age of 75.0 and an average amyloid accumulation of 22.2 ± 31.9. Mean UCLA Loneliness Scale scores were …

Self-Evaluation Of Educational Leadership Practices During Covid-19, Mike Coquyt

The Interactive Journal of Global Leadership and Learning

Due to the COVID-19 pandemic, school districts, and specifically, superintendents, are under increased pressure to lead. Irregularity and ambiguity are now the mantras of those tasked with leading in our schools. Many current research studies aim to evaluate the possible effects of COVID-19 on the system of education (Azorín, 2020; Hargreaves & Fullan, 2020), and advice on how to lead during a crisis (Harris & Jones, 2020; Leithwood et al., 2020, Netolicky, 2020). There are no standards or benchmarks to follow that could potentially aid school leaders as they navigate, lead, and make important decisions that affect how quality instruction …

Covid-19 Uncertainty And Monetary Policy Responses: Evidence From Emerging Market Economies, K.P. Prabheesh, Solikin M. Juhro, Cicilia Anggadewi Harun

Bulletin of Monetary Economics and Banking

This paper examines the effectiveness of monetary policy transmission in emerging economies during the COVID-19 outbreak. Using data from 14 emerging economies severely affected by the pandemic and the autoregressive distributed lag approach to cointegration, the study examines the effectiveness of monetary policy in affecting output, inflation, and credit. The study finds that: (1) In most economies, the monetary policy transmission to inflation is weakened due to the uncertainty created by the COVID-19 pandemic; (2) in a few economies, the transmission is found to be effective in stabilizing credit and output; and (3) the outbreak of the COVID-19 pandemic induced …

Corona, Syed Anjum Khan

HCA Healthcare Journal of Medicine

We all are witnessing unprecedented pain and suffering, enduring unsurpassed tribulations. As a doctor working in an intensive care unit each day, I carry the burden of my patients and their families, my coworkers, my own family and friends. I never think about myself, the burden on my soul.

Yet I believe there will be a better tomorrow. A new day, where COVID times will be remembered with tears in our eyes yet a comfort in our smile that it’s past.

Primary Care Practices In Western North Carolina: Adaptation To The Covid-19 Pandemic And Ongoing Challenges, Hannah R. Friedman, Joseph Konstanzer, Erica Richman, Brian Cass, Bryan Hodge, Sheri Denslow, Jacqueline Halladay

HCA Healthcare Journal of Medicine

Introduction

The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina.

Methods

Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021.

Results

Most practices were operating with normal hours, though some still operated with reduced hours. Many practices reported insufficient personal protective equipment (PPE) supplies. While most practices provided at least some care …

Knowledge, Attitudes, And Practices Of Saudi Citizens On Covid-19 Pandemic: A Multi-Region Survey, Maha Sanat Alreshidi, Nojoud Abdullah Daaya Alreshidi, Ebaa Felemban, Ferdinand Gonzales

Makara Journal of Health Research

Background: Although policies and guidelines may not always be optimal in all settings, a tailor-fitted guideline is appropriate. This study aims to determine the differences in the knowledge, attitudes, and practices (KAP) of Saudi citizens toward Coronavirus Disease 2019 (COVID-19).

Methods: A quantitative-comparative-correlational approach was carried out from March 21 to May 22, 2020. Descriptive statistics, ANOVA, and t-test were used to determine the differences in knowledge and demographic characteristics. Linear regression was used to determine relationships among KAP.

Results: The participants’ knowledge yielded 82.83%, positive attitudes (M = 2.10; SD = 1.15) and good …

Depression And Behavioral Changes Associated With Social Media Dependency During Covid-19 Pandemic Among University Students In Bangladesh: A Cross- Sectional Study, Sushmita Karmokar, Md. Ashraful Islam, Mohammad Hamid Al Muktadir, Rakibul Hasan, Abu Montakim Tareq, Mohammad Nurul Amin, Talha Bin Emran

Makara Journal of Health Research

Background: With its rapid spread, the coronavirus disease 2019 (COVID-19) pandemic had a detrimental effect on students’ psychological well-being, depression, and behavioral changes due to indefinite educational leaves, lockdowns, restricted outdoor activities, and excess use of social media. This study aims to assess the relationship of social media exposure with the psychological well-being, depression, and behavioral changes of Bangladeshi university students.

Methods: A web-based cross-sectional survey was carried out on 530 students from June 17 to July 10, 2020, to evaluate psychological well-being, depression, behavioral changes, and social media exposure via self-reported measures.

Results: The prevalence of …

The Effect Of Covid-19 Pandemic On Volatility Transmission Between The U.S. And Emerging Asia Stock Markets: A Case Study Of Tiger Cub Economies, Mien Nguyen Thi Ngoc, Tung Mai Son

Asia-Pacific Social Science Review

The globalization in financial markets has highlighted the importance of a clear understanding of volatility transmission among equity markets in different countries. This paper looks into the effect of the COVID-19 pandemic on the volatility transmission between the U.S. stock market and five emerging equity markets called Tiger Cub economies in Southeast Asia. As the result of the dynamic conditional correlation GARCH (DCC-GARCH), the U.S. stock market’s volatility links positively to these smaller economies’ volatilities, and these linkages become stronger during the pandemic. We also find evidence of statistically significant co-volatility across five Tiger Cub markets. Due to the increase …

Examining The Economic Impacts Of Restricted Energy Supply Chain On The Vietnamese Economy With Structure Path Analysis, Chung Van Nguyen

Asia-Pacific Social Science Review

The paper examines the impact of the restricted energy supply chain on key business sectors of Vietnam’s economy during the COVID-19 period by using structure path analysis combined with constrained fixed price multiplier to examine energy price changes for key business sectors of the economy between 2019 and 2020. The result shows that the change in coal price will likely lead to a downward trend in the overall price of the production. In particular, when the government restricts 10% of the energy supplies chain, the travel services, transportation services, trade, and repair services sectors will have the strongest impact on …