Digital Commons Network^™

Political Polarization Harms Public Health, Shana Kushner Gadarian, Jay Van Bavel, Kai Ruggeri, Eric Knowles

Population Health Research Brief Series

Political polarization poses considerable risks to well-being. Both ideological polarization (“extremification” of policy positions and ideological orientations) and affective polarization (out-party hate) have increased over the past several decades with detrimental effects on public health. This brief summarizes the impacts of political polarization on public health in the U.S., highlighting the COVID-19 pandemic as a case study on the health risks of polarization. The authors show that, in the United States, one of the strongest predictors of COVID-19 prevention behaviors, such as social distancing and vaccination, was political partisanship. Gaps in these behaviors between Republicans and Democrats increased over the …

Understanding Contributing Factors To Injury Severity And Improper Driver Actions In Work Zone Crashes And Evaluating Smart Work Zone Applications For Safety Improvement, Rakesh Rangaswamy

USF Tampa Graduate Theses and Dissertations

A work zone can be described as a roadway designated for construction, maintenance, or other activities that temporarily disrupt the normal traffic flow. Due to this disrupts in traffic conditions, work zones may bring sudden shifts in driving experience, depending on the sort of work zone present, creating unpredictable maneuvers, and putting both motorists and workers at risk. To understand these issues, this study uses work zone accident data obtained from Florida and uses several methodological techniques, including the mixed logit model with variance and mean heterogeneity, temporal instability test, log-likelihood test, out-of-sample analysis, and ANOVA test.

Firstly, this study …

Association Of Binge Alcohol Use With Functional Outcomes Among Individuals With Covid-19 Infection, Sebastian T. Tong, Michael Gottlieb, Imtiaz Ebna Mannan, Zihan Zheng, Manisha Sinha, Michelle Santangelo, Kristyn Gatling, Efrat Kean, Phillip Watts, Ralph Wang, Juan Carlos Montoy, Ahamed Idris, Samuel Macdonald, Ryan Huebinger, Mandy Hill, Kelli N O'Laughlin, Nicole L. Gentile, Jocelyn Dorney, Caitlin Malicki, Joann G. Elmore, Kate Diaz Roldan, Gary Chan, Zhenqiu Lin, Robert A. Weinstein, Kari A. Stephens

Department of Medicine Faculty Papers

AIMS: Alcohol consumption along with negative sequelae from excess alcohol intake increased during the COVID-19 pandemic. We evaluated the association between binge alcohol use and long-term functional outcomes among COVID-19-positive individuals.

METHODS: Using a prospective, longitudinal, multisite cohort study design, we evaluated the association between binge alcohol use and mental and physical functional outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS)-29 scores three and six months postinfection. Eligible patients were those who presented with COVID-19-like symptoms, tested positive for COVID-19, and completed a three-month survey. Binge drinking was identified at the time of infection using the Tobacco, Alcohol, Prescription medication …

Peran Dukungan Sosial Masyarakat Terhadap Stigma Pada Penyintas Covid-19, Silvi Fatmala Sari, Khoiriyah Isni

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. COVID-19 continues to kill people in Indonesia. One of the reasons for the rise in COVID-19 cases is the stigma experienced by COVID-19 survivors and their families in Bumi Jawa Village, Batanghari Nuban District, East Lampung Regency, Lampung Province. The kind of stigma received includes rejection of self-isolation, a lack of community empathy, and social support during the isolation phase.

Objective. The purpose of this study is to assess the impact of community social support on community stigma toward COVID-19 survivors in Bumi Jawa Village, Batanghari Nuban District, East Lampung Regency, Lampung Province.

Method. This study is a …

Navigating The Aftermath: Evaluating The Impact Of Covid-19 On Nurse Well-Being Resource Use, Vida Vizgirda Phd, Jd, Rn, Rachelle Lancaster Phd, Rn, Bree Aguilar Msn, Rn-Bc, Kim Karch Bsn, Crrn, Pmgt-Bc, Mary Hook Phd, Rn

Nursing Research & Professional Development Conference

Background: Nurses were experiencing occupational stress with negative psychological effects before COVID-19. The pandemic intensified healthcare delivery demands and took an emotional toll. Healthcare organizations worked to enhance existing wellness programs and develop new resources to support coping and resilience. Little is known about the actual use of wellness resources by nurses.

Purpose: To explore nurses’ wellness resource utilization three years after the start of COVID-19.

Method:A secondary data analysis of a descriptive cross-sectional dataset examined wellness resources use by nurses employed by the Midwest region of a large non-profit healthcare system. The analysis focused on nurse characteristics, psychological …

Patient-Reported Convenience And Effectiveness Of Telehealth For Breast Cancer Management, Akshara Singareeka Raghavendra, Kristofer Jennings, Gil Guerra, Debu Tripathy, Meghan S Karuturi

Faculty, Staff and Student Publications

Background: Before the coronavirus disease 2019 (COVID-19) pandemic, telehealth was rarely used for breast cancer management at tertiary care centers. We sought to examine patient satisfaction, experiences, preferences, and perceived effectiveness and technical quality of telehealth visits in follow-up patients receiving routine outpatient care in the breast medical oncology practice at The University of Texas MD Anderson Cancer Center.

Methods: We administered a survey to 60 follow-up patients for a duration of 9 months (January 5, 2021 to October 27, 2021) who had at least one telehealth consultation during the COVID-19 pandemic, from April 10, 2020 to October 21, 2021. …

Disability, Urban Influence, And Covid-19 Financial Hardships: Findings From A Predominantly Rural Sample, Mackenzie Brewer, Jodien Johnson, Kyra Davidson, Carson Mencken

Journal of Rural Social Sciences

This study examined the financial impacts of the early COVID-19 pandemic among households with children and compared outcomes based on disability status and urban influence. Survey data were collected in fall 2020 by the Urban Institute from mostly rural households participating in the Meals-to-You program, which delivered food to eligible households with children in the U.S. due to school closures. Relative risk contingency analysis and multivariate logistic regression were used to assess financial hardship from the pandemic. Sampled households reporting at least one member with a disability had greater odds of food insecurity, delaying purchases, depleting savings, and difficulty paying …

Act With Cf: A Randomized Trial Of Acceptance And Commitment Therapy Vs Supportive Psychotherapy For Adults With Cystic Fibrosis, C. Virginia O'Hayer, Patrick J. Smith, Christopher F. Drescher, Heather Bruschwein, Chelsi N. Nurse, Hallie M. Kushner, Krista Ingle, Michael J. Stephen, Jeffrey B. Hoag

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: Psychological distress, including anxiety and depression, is common among adults with CF, associating with poor quality of life, lung function, and healthcare utilization. This 3-year, multi-site, telehealth-delivered randomized trial sought to determine whether Acceptance and Commitment Therapy (ACT with CF) is superior to supportive psychotherapy (SP), in improving psychological functioning for adults with CF.

METHODS: One hundred twenty-four adults with CF and elevated anxiety and/or depressive symptoms were recruited coincident with the first COVID lockdown, from Thomas Jefferson University Hospitals, University of Virginia, Augusta University, Duke University Medical Center, and social media. Participants were randomized to 6 weeks of …

Conceptions Of Latinos And Latinas About The Grieving Process And Associate Concepts Of Dying, Death, Bereavement, And Loss: A Covid-19-Post-Pandemic Case Study, Rosario Garcia Ortiz

Dissertations

The purpose of this study was to recognize the grieving process and the related concepts of Latinos who lost a loved one to the COVID-19 pandemic. Death and dying have been studied in the United States, with limited studies focusing on the Latino culture. The COVID-19 pandemic was a devastating experience for the world and continues to be studied for understanding and lessons in the aftermath. This research included four participants from the Latino culture who lost a loved one during the COVID-19 pandemic. An inductive approach and data analysis were used to form theoretical constructs. Three main categories were …

Knowledge “Hiding And Seeking” During The Pandemic: Who Really Wins In The New Normal?, Kim-Lim Tan, Ivy S. H. Hii, Chuen Kong Kevin Cheong

Research Collection Lee Kong Chian School Of Business

PurposeThe recent COVID-19 pandemic caused a severe economic downturn. Employees working in these organisations face employment uncertainty. The pandemic disrupted their daily routines, and it added a layer of complexity to the already resource-constrained environment. During these times, employees would conserve their resources to maintain competitiveness, one of which is knowledge hiding. While economic activities are resuming, the appearance of new variants could mean the transition towards endemicity could be put on hold. Hence, there is a need to rethink the behaviour of employees as they would have elevated levels of anxiety towards resuming daily work activities. Therefore, this study …

Trends And Disparities In Coronary Artery Disease And Obesity-Related Mortality In The United States From 1999-2022, Mushood Ahmed, Hira Javaid, Aimen Shafiq, Zain Ali Nadeem, Areeba Ahsan, Abdullah Nofal, Raheel Ahmed, Mahboob Alam, Marat Fudim, Gregg C Fonarow, Mamas A Mamas

Faculty, Staff and Students Publications

BACKGROUND: Almost half of the US adult population has obesity, which predisposes to atherosclerosis and can lead to poor prognosis in coronary artery disease (CAD). We aim to identify CAD and obesity-related mortality trends among adults in the United States stratified by age, sex, race and geographical location.

METHODS: The CDC-WONDER database was used to extract death certificate data for adults aged ≥ 25 years. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were described by calculating annual percent change (APC) and the average APC (AAPC) in the rates using Joinpoint …

In And Out Of The Silence: Connecting Waiting Worship With Transformative Care, Neil E. Cantrall, Scot Headley, Catherine Parry, Jim Wilkins-Luton

International Christian Community of Teacher Educators Journal

This essay offers an in-depth view into the transformative care experienced by four educators who found community and soul care through regular, online meetings framed around the Quaker tradition of silent, unprogrammed worship. The four colleagues were initially brought together through participation in a doctoral program, and began meeting online when the COVID-19 pandemic shifted the program’s traditional face-to-face summer residency to a virtual format. They formed solid bonds and found deep meaning through the soul care provided by the weekly meetings. As a result, the group found that the transformative care provided for each other began to naturally overflow …

Nurses Take The Lead: Creating Gender Responsive Global Health, Hoi Shan Fokeladeh, Annette Kennedy, Elizabeth A. Madigan, Wanda Montalvo, Bongi Cristabel Sibanda, Cecilia Sironi

Sigma Global Initiatives

90% of nurses and midwives are women. Gender bias has led to underinvestment in nursing and the full potential of nurses not being used. Nurses experience high rates of violence and abuse and during the COVID-19 pandemic have suffered psychological distress, a lack of protection, and burnout. The event will raise the visibility of the work of nurses in creating gender responsive global health by exploring the importance of nurse leadership and full and effective participation in global health decision-making; safe and decent work and fair pay for nurses; and the contribution of nurses in responding to the COVID-19 pandemic.

Prescription Practices, Anti-Psychotics, And Covid-19: An Intersectional Examination Of The Long-Term Care Home Setting In Canada, Olivia Ramos

Dalhousie Journal of Legal Studies

Public discourse and concern over the state of long-term care homes in Canada has been ongoing over the last two decades. One of the main sources of these concerns is the off-label prescription of anti-psychotic medications to long-term care home residents. Off-label use of pharmaceuticals is common and can be beneficial in certain contexts, however, there is a risk of anti-psychotics being used as an inappropriate means of managing patients chemically in the long-term care home setting. This paper engages in three lines of inquiry: first, the regulatory landscape of on and off-label prescription in Canada; second, the off-label use …

University Students Speak Out: Suggestions To Improve The Move To Emergency Remote Education, Pauline Howes, Justine E. Pettigrew

Faculty Articles

The 2020 COVID-19 crisis forced universities to make a dramatic shift to emergency remote education (ERE). While the urgency of the pandemic is gone, schools continue implementing ERE, but more often on a short-notice, short-term basis in response to various situations. This research examines students’ suggestions for improving university transitions to ERE and applies them to post-pandemic use of ERE. Qualitative thematic analysis was used to analyze responses to an open-ended survey question answered by 2,751 students at a large Southeastern U.S. university. Responses identified main concerns as Grades and Grading (38%), Better University and Instructor Preparation (23%), Improved Learning …

Impacts Of The Covid-19 Pandemic On Intimate Partner Violence And Child Maltreatment Services In Rural Northwest North Carolina, Elisabeth G. Galphin, Adam Hege, Amy Dellinger Page

Journal of Appalachian Health

The current study examined the impact of the COVID-19 pandemic on IPV and child maltreatment services in rural northwestern North Carolina. Qualitative interviews were conducted with eight professionals representing six service organizations across four counties. The findings highlighted challenges these agencies faced throughout the pandemic, new risks for the clients served, and positive outcomes. In addition, it has been a useful learning experience as public health and social service agencies learn to serve their communities more effectively moving forward. This is especially relevant for rural communities, as it has put public health preparedness at the forefront.

Refereed Research - Religiosity And Sociality As Sources Of Resilience For Women Subsistence Entrepreneurs During The Pandemic, Rozina Akther

Subsistence Marketplaces

This study examines challenges faced by subsistence women entrepreneurs during COVID-19, the crisis of 2020, and their resilience in addressing the circumstances. The results of qualitative interviews with 13 subsistence marketplace women entrepreneurs in Bangladesh are presented in this article. In the current study, two themes are found to best capture the experiences and resilience of women business owners in the subsistence marketplaces. Furthermore, the study provides important insights from informant interviews, showing how women business owners navigate their operations during a pandemic. It highlights attributes such as relational strength and faith in a higher power that contribute to their …

Evaluation With Structural Equation Modeling Of Variables Affecting Health-Seeking Behaviors During The Covid-19 Pandemic In İstanbul, Türkiye, Pinar Atali, Seyhan Hidiroğlu, Ali̇can Sarisaltik, Melda Karavuş

Turkish Journal of Medical Sciences

Background/aim: The relation between the demographic characteristics of individuals and their health-seeking behaviors was presented and the effects of health cognitions, healthy lifestyle behaviors, and coronavirus fear levels on health-seeking behaviors during the COVID-19 pandemic were examined.Materials and methods: This descriptive survey study was conducted in the Tuzla District of İstanbul, Türkiye, between March and June 2021. Results: From analysis of the 391 participants, 60.0% were females, 27.1% were between 31 and 40 years of age, 47.0% were healthcare professionals, and the perceived socioeconomic status of 50.9% was above average. According to the results, the women exhibited more health-seeking behavior …

Modern Band Music Teachers' Adoption Of A Community Music Ethos In Online Teaching During The Covid-19 Pandemic, Bryan Powell, Gareth Dylan Smith, Warren Gramm, David Knapp

Visions of Research in Music Education

At intersections of popular music education, music technology, and community music practices, music teachers in the United States adapted to teaching and learning during the COVID-19 pandemic, specifically from March 2020 to March 2021. The purpose of this research was to better understand the perspectives of modern band teachers regarding the opportunities and challenges of teaching music during the pandemic. The researchers interviewed four teachers who taught modern band (popular music) in public schools in geographically and demographically distinct parts of the US and found that each educator adopted a community music ethos in the online environment. An analysis of …

Understanding The Role Of Perceived Racial Discrimination On Adolescent Mental Health During The Covid-19 Pandemic, Jill V. Klosky, Delia Lang, Briana Woods-Jaeger, Julie Gazmararian

Journal of the Georgia Public Health Association

Abstract

Background: Adolescent mental health declined during the COVID-19 pandemic. Racial discrimination, which may negatively affect adolescent mental health, has increased. This study sought to understand whether pre-pandemic reports of racial discrimination predicted changes in adolescent depression, anxiety, and self-esteem from before to during the COVID-19 pandemic.

Methods: Two online surveys were administered at two public high schools in semi-rural, north-central Georgia; one in Spring 2020, just before the closing of public schools due to COVID-19; the other to the same students in Fall 2020.

Results: Most participants were White (62%) and the majority (88%), reported the same or better …

Pandemic Perspectives From Detained Youth During Covid-19: Bridging The Knowledge Gap For Future Safeguards., April Mcneill-Johnson, Zuri Hudson, Brittany Moore, Dumebi Okocha, Megha Ramaswamy, Kimberly Randell

Manuscripts, Articles, Book Chapters and Other Papers

Despite the worsening health disparities among youth in detention during the COVID-19 pandemic, there has been minimal exploration into the pandemic experiences of detained youth and opportunities for pandemic mitigation. This paper analyzes the perspectives of youth in detention on the pandemic, including the effect of the pandemic on their detention experience and their perceptions about COVID-19 vaccination. The study used purposive sampling to recruit 16 participants (aged 14-17 years) from two juvenile detention centers in the urban Midwest. We conducted semi-structured interviews and analyzed verbatim transcripts using a hybrid deductive-inductive approach and thematic analysis. Four themes emerged: 1) personal …

Disclosure Patterns Of Opioid Use Disorders In Perinatal Care During The Opioid Epidemic On X From 2019 To 2021: Thematic Analysis, Dezhi Wu, Minnie Ng, Saborny Sen Gupta, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Youyou Tao, Yang Ren, Peiyin Hung, Shan Qiao, Jiajia Zhang, Jennifer Fillo, Xiaoming Li, Constance Guille, Kacey Eichelberger, Bankole Olatosi

Publications

BACKGROUND: In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known …

Human Epidemiology And Response To Sars-Cov-2 (Heros): Objectives, Design, And Enrollment Results Of A 12-City Remote Observational Surveillance Study Of Households With Children, Using Direct-To-Participant Methods, Patricia C Fulkerson, Katherine Rivera-Spoljaric, Et Al.

2020-Current year OA Pubs

The Human Epidemiology and Response to SARS-CoV-2 (HEROS) Study is a prospective, multicity, 6-month incidence study conducted from May 2020 to February 2021. The objectives were to identify risk factors for SARS-CoV-2 infection and household transmission among children and people with asthma and allergic diseases, and to use the host nasal transcriptome sampled longitudinally to understand infection risk and sequelae at the molecular level. To overcome challenges of clinical study implementation due to the coronavirus pandemic, this surveillance study used direct-to-participant methods to remotely enroll and prospectively follow eligible children who are participants in other National Institutes of Health-funded pediatric …

Teacher Retention Challenges: What We Learned Before And After Covid-19, Brenda Morton, Edd., Joel Maresh Edd

Northwest Journal of Teacher Education

The COVID-19 pandemic exacerbated the already elevated stress levels among teachers, leading to contemplation of leaving the profession. As educators were compelled to transition to online teacher, they suddenly found themselves immersed in the households of their students, an entirely novel experience. This newfound proximity granted teachers insight into various aspects of the students’ lives, including family dynamics, home environments, levels of household stress, and the accessibility of essential resources. In addition to the teaching duties, educators were tasked with the development of online curricula, the acquisition of online learning resources, and providing support to parents and families during a …

How Have Occupational Therapy Services Been Delivered During The Covid-19 Pandemic?, Hulya Yucel, Selen Aydoner

Internet Journal of Allied Health Sciences and Practice

The provision of traditional healthcare services has encountered obstacles due to the Coronavirus Disease-2019 (COVID-19) pandemic. The inability of healthcare professionals and clients to survive the pandemic and the inadequacy of personal protective equipment have created uncertainties regarding the appropriate practices for addressing individuals' health conditions. Furthermore, the field of rehabilitation, including occupational therapy, has experienced changes in the delivery of traditional practices. Therefore, this review aimed to examine occupational therapy services delivered during the COVID-19 pandemic. As a result of the literature review, the most commonly provided services by occupational therapists during COVID-19 were discussed and a total of …

Parallel Electrophysiological Abnormalities Due To Covid-19 Infection And To Alzheimer’S Disease And Related Dementia, Yang Jiang, Jennifer Neal, Pradoldej Sompol, Görsev Yener, Xianghong Arakaki, Christopher M. Norris, Francesca R. Farina, Agustin Ibanez, Susanna Lopez, Abdulhakim Al-Ezzi, Voyko Kavcic, Bahar Güntekin, Claudio Babiloni, Mihály Hajós

Neurology Faculty Publications

Many coronavirus disease 2019 (COVID-19) positive individuals exhibit abnormal electroencephalographic (EEG) activity reflecting “brain fog” and mild cognitive impairments even months after the acute phase of infection. Resting-state EEG abnormalities include EEG slowing (reduced alpha rhythm; increased slow waves) and epileptiform activity. An expert panel conducted a systematic review to present compelling evidence that cognitive deficits due to COVID-19 and to Alzheimer’s disease and related dementia (ADRD) are driven by overlapping pathologies and neurophysiological abnormalities. EEG abnormalities seen in COVID-19 patients resemble those observed in early stages of neurodegenerative diseases, particularly ADRD. It is proposed that similar EEG abnormalities in …

Shared Trauma: An Evolutionary Model Concept Analysis In Light Of Covid-19, April Hutto, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Beverly Baliko Phd, Rn, Pmhnp-Bc

Publications

Shared trauma (ST) is a term historically applied to social work experiences, but other healthcare professionals (HCP) also experience ST. With the occurrence of COVID-19, ST has impacted HCP globally and has led to new discoveries and more questions regarding its scope, impact and duration. This article aims to explore the concept of ST applied to nurses in light of COVID-19 using the Rogers and Knafl Evolutionary Model for Concept Analysis. Further examination and evolution of ‘shared trauma’, particularly during COVID-19, has led to the development of an adapted model to explore the implications of ST on health-related outcomes for …

Vaccine Decision-Making Among Pregnant Women: A Protocol For A Cross-Sectional Mixed-Method Study In Brazil, Ghana, Kenya And Pakistan, Jessica Schue, Prachi Singh, Berhaun Fesshaye, Emily Miller, Shanelle Quinn, Ruth Karron, Renato Souza, Maria Laura Costa, Ferdinand Okwaro, Marleen Temmerman

Centre of Excellence in Women and Child Health

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited …

Meeting The Challenge Of Covid-19: Innovation And Adaptation In Services For Expectant And Parenting Youth In Baltimore, Margo Candelaria, Corey Shdaimah, Jenny Afkinich, Yan (Stella) Zhu

Journal of Human Services: Training, Research, and Practice

To explore perspectives on COVID-19’s impact on access to services for expectant and parenting youth (EPY), qualitative interviews were conducted with seven service providers and two parents. Open coding resulted in three overarching themes. 1. Creativity and adaptation: pride regarding ability to devise necessary modifications. 2. New and ongoing networks: inter-agency collaboration, provider-parent relationships, and parent networks offered material and social support. 3. Communication: varied strategies helped maintain and initiate EPY engagement. In under-resourced environments where providers and EPY must be creative due to scarcity, COVID-19 required that respondents draw on existing networks and strategies to cope with new challenges.

Emotional Overeating And Eating Motives During Covid-19 In Polish Women: Intergroup Comparison Among Participants In Various Body Mass Index Categories, Adriana Modrzejewska, Justyna Modrzejewska, Kamila Czepczor-Bernat, Julia Wyszomirska

Baltic Journal of Health and Physical Activity

Introduction: Taking into account the situation of the COVID-19 pandemic and the ac-companying lockdown resulting in increased negative emotions, it is interesting to learn about eating motives and behaviors and check their intensity. The aim of this study was to investigate the differences between Polish women in various body mass index categories in terms of eating motives and emotional overeating during the COVID-19 pandemic. Material and methods: This study sample comprised 1,447 women (M_age = 31.34 ± 11.05; M_BMI = 23.79 ± 4.59). The research used the following tools: the Eating Motivation Survey, the Emotional Overeating Questionnaire, and …