Open Access. Powered by Scholars. Published by Universities.®

Digital Commons Network™

Open Access. Powered by Scholars. Published by Universities.®

Discipline
Institution
Keyword
Publication Year
Publication
Publication Type
File Type

Articles 106831 - 106860 of 743160

Full-Text Articles in Entire DC Network

Re-Localizing Writing Assessment: Sites Of Knowledge Mobilization., Charlotte Asmuth May 2022

Re-Localizing Writing Assessment: Sites Of Knowledge Mobilization., Charlotte Asmuth

Electronic Theses and Dissertations

For decades, writing assessment theorists have subscribed to the principle of localism––the belief that assessments should be designed with local contexts in mind and administered by local actors. Although this belief has ensured the validity of assessments in writing programs, it has also led to a tendency to treat assessment as a stable practice that is bound to a particular location, thus ignoring what happens when assessment knowledge and methods developed in one location travel to another distant location (as they do for campus assessment initiatives). To that end, this project traces how assessment knowledge is transformed as it travels …


Kurt Vonnegut, Modernity, And The Self: A Guide To The Good Life., Josh Simpson May 2022

Kurt Vonnegut, Modernity, And The Self: A Guide To The Good Life., Josh Simpson

Electronic Theses and Dissertations

What are people for? This is a question Kurt Vonnegut raises in his first novel, 1952’s Player Piano. Over five decades later, when he concludes a career with 2005’s A Man Without a Country, he is still asking, “What is life all about?” (66). These are the central questions for Vonnegut, and his novels, short stories, essays, interviews, correspondence, and commencement addresses offer a singular, life-long attempt at an answer. In this dissertation I offer a reading of Vonnegut not just as a writer concerned with philosophical questions, but rather, on a deeper, more personal level, as a …


Spectroscopic Measurements Of Meibum Compositional, Structural, And Functional Relationships To Elucidate The Role Of Meibum In Dry Eye., Anthony Chigozie Ewurum May 2022

Spectroscopic Measurements Of Meibum Compositional, Structural, And Functional Relationships To Elucidate The Role Of Meibum In Dry Eye., Anthony Chigozie Ewurum

Electronic Theses and Dissertations

The major aim of my dissertation was to investigate the etiology of dry eye disease which affects about 7 million people in the United States, causing symptoms that can lead to visual disturbance. Correlation between dry eye and an abnormal lipid layer of the tear film has been found. Tear film lipids originate mostly from the meibomian glands. Cholesteryl ester (CE) and Wax ester (WE) lipids make up most of the human meibum lipidome and the CE/WE ratio has been shown to decrease in patients with meibomian gland dysfunction. Model studies using synthetic CE and WE, although providing some insight, …


Etracellular Vesicles From Lactobacillus Rhamnosus Gg Protect Against Alcohol-Induced Liver Injury Through Suppression Of Intestinal Mir 194 And Subsequent Activation Of Fxr In Mice., Mengwei Jiang May 2022

Etracellular Vesicles From Lactobacillus Rhamnosus Gg Protect Against Alcohol-Induced Liver Injury Through Suppression Of Intestinal Mir 194 And Subsequent Activation Of Fxr In Mice., Mengwei Jiang

Electronic Theses and Dissertations

Numerous studies have reported the efficacy of probiotics for alcohol-associated liver disease (ALD). These studies indicate a strong interest among the scientific and medical communities in identifying alternative or adjunctive approaches for ALD, for which there is no effective or widely accepted therapeutic option. However, in-depth molecular knowledge on how probiotics render their effects is lacking. Patients with ALD often have increased hepatic bile acids (BAs), which can be toxic and are an important causative factor in liver injury and hepatocyte death. BAs are released into the intestines and serve not only as a “detergent” to promote fat absorption, but …


Genomic Tools And Models For Investigating The Role Of Germline Diversity In Mouse Antibody Repertoire Development., Justin T. Kos May 2022

Genomic Tools And Models For Investigating The Role Of Germline Diversity In Mouse Antibody Repertoire Development., Justin T. Kos

Electronic Theses and Dissertations

Given the diversity and complexity within immunoglobulin (IG) loci, effective mouse models first require characterization of intra-strain differences and construction of high-quality reference assemblies for IG loci in several representative strains. To understand light chain germline diversity across biomedically significant mouse strains, we profiled the expressed IGK and IGL repertoires of 18 commonly used laboratory mouse strains using AIRR-seq. Across strains, we observed germline IGKV sequences shared by three different IGK haplotypes and a more conserved IGLV germline repertoire among common laboratory strains. Pacific Biosciences (PacBio) Single-Molecule Real-Time (SMRT) sequencing was used to sequence and assemble bacterial artificial chromosomes (BAC) …


The Role Of Obesity In Macrophage-Mediated Mechanisms Promoting Early-Onset Colon Cancer., Katharina Marietta Scheurlen May 2022

The Role Of Obesity In Macrophage-Mediated Mechanisms Promoting Early-Onset Colon Cancer., Katharina Marietta Scheurlen

Electronic Theses and Dissertations

Early-onset colon cancer (EOCC) is a leading cause of cancer death among people younger than 50 years of age in the United States and is associated with metabolic dysfunction and obesity. Anti-inflammatory tumor-associated macrophages (TAM) and low Peroxisome Proliferator Activated Receptor Gamma (PPARγ) gene expression in colon cancer (CC) tissue promote tumor progression and decreased patient survival. Obesity-related hormones, such as leptin and adiponectin, have the potential to affect gene expression in TAM to promote CC progression and thereby link obesity and EOCC. The aim of this project was to identify target genes in human CC and to investigate the …


Definitions And Depictions Of Rhetorical Practice In Medieval English Fürstenspiegel., Joseph Ethan Blaine Sharp May 2022

Definitions And Depictions Of Rhetorical Practice In Medieval English Fürstenspiegel., Joseph Ethan Blaine Sharp

Electronic Theses and Dissertations

This dissertation examines how medieval authors defined rhetoric and depicted rhetorical practice in medieval English Fürstenspiegel. It begins by analyzing how the field of medieval rhetorical historiography has overlooked the Fürstenspiegel as a rhetorical genre due to its overt reliance on meta-rhetorical handbook genres as the objects of its analysis. This dissertation challenges traditional narratives that positions medieval rhetoric as a primarily academic discipline divorced from political practice by engaging in horizontal reading practices that examine the broader culture of medieval rhetorical practice alongside the definitions of rhetoric found in medieval English Fürstenspiegel. In so doing, this dissertation …


Coping Flexibility And Academic Resilience Among Low-Ses College Students., Benjamin J. Calebs May 2022

Coping Flexibility And Academic Resilience Among Low-Ses College Students., Benjamin J. Calebs

Electronic Theses and Dissertations

College students coming from a background of poverty may experience academic impairment due to their experiences of chronic economic adversity. However, despite the stressors associated with poverty and the potential deleterious consequences of this form of adversity, many low-socioeconomic status (low-SES) college students show high academic achievement. One predictor of resilient outcomes that has been studied outside of academic contexts is coping flexibility, the ability to use a range of different coping behaviors to meet the demands of different stressful situations. Coping flexibility has been found to be positively associated with psychological adjustment in a variety of populations, yet it …


“I Think It's Male Privilege”: A Qualitative Study Of Personal, Behavioral, And Socio-Environmental Factors Influencing High Risk Sexual Behavior And Hiv Transmission Among Heterosexual Adult Males In Ghana., Nana Ama Aya Erzuah Bullock May 2022

“I Think It's Male Privilege”: A Qualitative Study Of Personal, Behavioral, And Socio-Environmental Factors Influencing High Risk Sexual Behavior And Hiv Transmission Among Heterosexual Adult Males In Ghana., Nana Ama Aya Erzuah Bullock

Electronic Theses and Dissertations

There are roughly 340,000 adults and children living with HIV. Despite the progress in the global response and the lowing of infections, HIV rates in Ghana remain stable. Cultural and societal norms that exist at a given time and place influence masculine socialization and behavior. These norms promote heterosexual men’s engagement in high-risk sexual behaviors which result in HIV infections. Factors such as HIV knowledge, risk perception, male condom use, HIV testing, and counseling which minimize the risk of HIV, are also influenced by these norms. Men have been identified as assets and advocates for behavior change and social responsibility …


The Role Of Accuracy In Children’S Judgments Of Experts’ Knowledge., Allison J. Williams May 2022

The Role Of Accuracy In Children’S Judgments Of Experts’ Knowledge., Allison J. Williams

Electronic Theses and Dissertations

Children prefer to trust people with expertise and people who are accurate. Because experts make mistakes and give incorrect information (e.g., predictions and diagnoses), this dissertation explores children’s judgments of knowledge for experts who provide inaccurate information. Across two studies, 6- to 9-years-olds (N = 160) were introduced to two experts in different domains (doctor and mechanic) and rated how much each expert knows about their relevant domain. Then, over four consecutive trials, participants heard one expert give inaccurate answers to easy questions in their domain. After each trial, children explained why they believed the expert gave inaccurate answers …


As Above, So Below: Magical Poetics And Queer Alchemy & A Planetary Spell.., Robert Eric Shoemaker May 2022

As Above, So Below: Magical Poetics And Queer Alchemy & A Planetary Spell.., Robert Eric Shoemaker

Electronic Theses and Dissertations

"Words have power": no more obvious statement has perhaps ever been made in an essay. However, the nature of that power is quite complicated, with a long and contentious history. I think of poetry as magic. Poetry is magical in the sense that it has ineffable qualities to it that enable readers to experience new thoughts and feelings when experiencing poetry, but when I say magic I mean that I think of poetry as actual, practical magic. As I will argue, poetry has magical qualities to it regardless of who is weaving the words, while intentional use of a self-aware …


High-Probability Tasks And Task Completion Rates Of Students With Emotional And Behavioral Disorders., Amy R Hall May 2022

High-Probability Tasks And Task Completion Rates Of Students With Emotional And Behavioral Disorders., Amy R Hall

Electronic Theses and Dissertations

This dissertation is an investigation into the effects of high-probability tasks on the task completion rates of three students diagnosed with an emotional and behavioral disorder. It begins with a close look into best practices verses common practices, examines students supports currently available in schools, and highlights gaps present in today’s educational system for students who exhibit significant challenging behaviors. The dissertation reviews literature available on the topic of high-probability tasks as a logical solution to combating gaps in behavior support and describes methodology used to investigate the strategy and its effects. It closes by presenting data, conclusions, implications, and …


Plant-Pollinator Communities Responsive To Local And Landscape Level Factors In Grassland Restorations., Aaron Sexton May 2022

Plant-Pollinator Communities Responsive To Local And Landscape Level Factors In Grassland Restorations., Aaron Sexton

Electronic Theses and Dissertations

As humans continue to degrade natural ecosystems via greenhouse gas emissions and habitat destruction, many species are being pushed to the brink of extinction. In hopes to offset this degradation, habitat restoration attempts to restore ecosystem function to an improved state resembling intact, remnant values. This is a difficult, but important, undertaking with factors to consider at multiple spatial and temporal scales. The restoration and conservation of pollinator communities has garnered heightened attention because of the valuable ecosystem services they provide. This dissertation investigates the local and landscape level factors of grassland restorations that influence plant-pollinator communities. I used a …


Cannabinoids And Retinal Fibrotic Disorders., Lucy June Sloan May 2022

Cannabinoids And Retinal Fibrotic Disorders., Lucy June Sloan

Electronic Theses and Dissertations

Retinal fibrosis is detrimental to vision. Retinal pigment epithelial (RPE) cells contribute to several retinal fibrotic diseases. Upon exposure to TGF-β, a key fibrotic cytokine, RPE cells trans-differentiate to myofibroblasts marked by the integration of α-SMA fibers into F-actin stress fibers, which confer strong contractility. Myofibroblasts produce and contract the collagen-rich fibrotic scar and disrupt retinal architecture. In this study, we investigated the in vitro effects of the putative endocannabinoid compound N-oleoyl dopamine (OLDA) on TGF-β2 induced porcine RPE cell contraction and α-SMA expression. Using an in vitro collagen matrix contraction assay, we found that OLDA inhibited TGF-β2 induced contraction …


Particulate Hexavalent Chromium Inhibits Homologous Recombination Repair By Targeting Rad51 Paralogs In Human Lung Fibroblasts., Aggie R. Williams May 2022

Particulate Hexavalent Chromium Inhibits Homologous Recombination Repair By Targeting Rad51 Paralogs In Human Lung Fibroblasts., Aggie R. Williams

Electronic Theses and Dissertations

Hexavalent Chromium [Cr(VI)] is a known human lung carcinogen and general health hazard. The mechanism of carcinogenesis remains poorly understood, but chromosome instability (CIN) is the major theory in its carcinogenic mechanism. Homologous recombination (HR) repair is a DNA repair pathway that prevents CIN by repairing DNA double-strand breaks. RAD51, a key mediator protein of HR repair, along with the RAD51 paralogs (RAD51B, C, D, XRCC2, and 3) are required for HR repair. During HR, RAD51 loads and forms a helical nucleoprotein filament structure to promote DNA strand exchange and stimulate pairing activity of DNA. Cr(VI) exposures have been shown …


Contemporary Blackface Theatre: Exploring Split Second From An Authentic Black Lens To Combat White Stereotypes., Lamar Alonzo Hardy May 2022

Contemporary Blackface Theatre: Exploring Split Second From An Authentic Black Lens To Combat White Stereotypes., Lamar Alonzo Hardy

Electronic Theses and Dissertations

This MFA thesis defines Contemporary Blackface Theatre as exemplified in Dennis McIntyre’s Split Second, which was produced in Fall 2021 by the Department of Theatre Arts at the University of Louisville. Cast as Val Johnson, I aimed to find the truth within a Black character created from the white playwright’s limited perspective. In addition to an analysis of Split Second, my study of Contemporary Blackface Theatre examines the racist ideologies from F.M. Alexander’s point of view on black people and how I create truthfulness in my own black body. I detail how I used the Black Acting Methods: …


Black Women Burdening: The Process Of "Unburdening" Realism In Dennis Mcintyre's Split Second., Brandi L. Threatt May 2022

Black Women Burdening: The Process Of "Unburdening" Realism In Dennis Mcintyre's Split Second., Brandi L. Threatt

Electronic Theses and Dissertations

Black women who dramatize reality can experience a transference of burdens if realistic plays reflect their lived experiences. Burdens affect truthful character development and impact the mental, emotional, physical, social and spiritual well-being of Black actresses. This thesis will use the Fall 2021 University of Louisville production of Dennis McIntyre’s Split Second as a case study. Gender and Race studies along with an auto-ethnographic research approach will be used to examine how my portrayal of Alea in Split Second contributed to Black Woman Burdening, a phrase I created to examine how Black fatigue can negatively and specifically affect Black women …


The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley May 2022

The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley

Electronic Theses and Dissertations

This study investigated the cortical-striatal networks of verbal fluency declines in 6-month, post-operative, deep brain stimulation Parkinson’s Disease patients. Nine Parkinson’s disease participants with implanted STN or GPi DBS systems were recruited for this study. Verbal fluency data was obtained from each patient preoperatively and 6- months post implantation. The stimulation-based volume of tissue activated area (VTA) of each target site (STN or GPi) was analyzed using Lead-DBS and Lead-Group. The white matter tracks intersecting each patient’s VTA, terminating in the pre-SMA, SMA, caudate nucleus, and anterior cingulate were investigated and correlated with verbal fluency declines. We found statistically significant …


Meat The Future., Xin Chen May 2022

Meat The Future., Xin Chen

Electronic Theses and Dissertations

This research focuses on the subtle relationship between human life, the environment, and other animals that we live among every day. Under the mainstream social background of capitalism and a commodity economy, animals are the victims of constant consumption and exploitation. However, meat is a basic substance for human nourishment, especially in certain cultures. As a result, meat becomes an important part of the commodity economy in capitalist societies, wherein the supply must be filled to accommodate society’s demand. This research formed an exhibition using glass and ceramic artwork using a playfully satirical tone to offer a crucial alternative: how …


Automatic Testing Of Organic Strain Gauge Tactile Sensors., Brian P. Goulet May 2022

Automatic Testing Of Organic Strain Gauge Tactile Sensors., Brian P. Goulet

Electronic Theses and Dissertations

Human-Robot Interaction is a developing field of science, that is posed to augment everything we do in life. Skin sensors that can detect touch, temperature, distance, and other physical interaction parameters at the human-robot interface are very important to enhancing the collaboration between humans and machines. As such, these sensors must be efficiently tested and characterized to give accurate feedback from the sensor to the robot. The objective of this work is to create a diversified software testing suite that removes as much human intervention as possible. The tests and methodology discussed here provide multiple realistic scenarios that the sensors …


Putting Colorism On Trial Intraracial Colorism And Its Impact On Crime Trajectory Among African Americans., Shaderica Ta'shawn Sibley May 2022

Putting Colorism On Trial Intraracial Colorism And Its Impact On Crime Trajectory Among African Americans., Shaderica Ta'shawn Sibley

Electronic Theses and Dissertations

This study examines the impact of experiences of colorism on the crime trajectory of African Americans. It is qualitative in nature and utilizes semi-structured interviews with incarcerated African American people. As previous research has shown the painful impact of colorism on its victims, this study ultimately seeks to unearth if that pain translates into crime commission and trajectory. The primary purpose of this research is to contribute to the existing body of research that seeks to support “colorism healing” in the African American community. If this indicates that colorism contributes to crime trajectory, such an outcome would have practical implications: …


Acoustofluidic Delivery Of Gene Editing Compounds For Improved Immunotherapy Processing., Riyakumari K. Patel May 2022

Acoustofluidic Delivery Of Gene Editing Compounds For Improved Immunotherapy Processing., Riyakumari K. Patel

Electronic Theses and Dissertations

Cell-based immunotherapies are a new generation of “living-drug” treatments for cancer and other diseases. Chimeric antigen receptor (CAR) T-cell cancer therapy has shown promising results in lymphoma and B-cell malignancies. Currently, there are six FDA-approved CAR-T drugs on the market, and all of them use viral transfection for reprogramming. While viral transfection is effective, there are safety concerns due to inconsistent transfection that limit the use of CAR-T therapy. Current non-viral transfection techniques generally have lower transfection efficiency than viral transfection. Additionally, these techniques can be toxic, time-consuming, non-transportable, and expensive. To address these limitations, a novel 3D printed acoustofluidic …


Using Stock And Flow Modeling To Address Knowledge Gaps In Marine Plastic Pollution Data, Daniel P. Martin May 2022

Using Stock And Flow Modeling To Address Knowledge Gaps In Marine Plastic Pollution Data, Daniel P. Martin

OES Theses and Dissertations

As plastic becomes a ubiquitous part of society, its growth outpaces waste disposal infrastructure and enters the environment as physical and chemical pollution. Plastic can also erode during the use cycle and reach the environment without any chance of being arrested by collection efforts. Plastic is a hazard to many parts of the earth’s life support system but there are many knowledge gaps regarding the processes by which plastic moves through the use cycle and environment. In particular, the ocean is generally regarded as a sink for plastic out of which it is difficult to escape, but plastic can sink …


Mycobacteriosis Of Striped Bass (Morone Saxatilis) In Virginia Tributaries Of The Chesapeake Bay, Joshua S. Mcgilly May 2022

Mycobacteriosis Of Striped Bass (Morone Saxatilis) In Virginia Tributaries Of The Chesapeake Bay, Joshua S. Mcgilly

Biological Sciences Theses & Dissertations

Mycobacteriosis was first documented in Chesapeake Bay striped bass (Morone saxatilis) in 1997 after fish exhibited emaciation and skin lesions. Since it was first identified, studies of mycobacteriosis in the mainstem of the Chesapeake Bay (2003-2007) and the Rappahannock River (2005-2012) have shown high disease prevalence and disease-associated mortality. Until this study, no current prevalence data existed from the Rappahannock River, and no published prevalence data existed for the James River, leaving a gap in our understanding of this disease in major Chesapeake Bay tributaries. We began gathering mycobacteriosis prevalence data from an existing survey collecting striped bass …


Di•As•Po•Ra: Displaced, Not Erased., Betty Álvarez May 2022

Di•As•Po•Ra: Displaced, Not Erased., Betty Álvarez

Electronic Theses and Dissertations

This thesis is based on my artistic endeavors and research founded in my culture, family, the history of the United States government’s intervention in El Salvador, and the current political climate Latin Americans face today in the United States. I work within multiple mediums to resurrect pieces of my culture that are being forgotten or left behind due to assimilation. I accomplish this through revisiting and reinterpreting traditions. I aim to bring awareness of the Latin experience in a racially divided United States through artistic expression and my own personal experiences. My works are made to feel whimsical and playful, …


Dental Morphology In A Juvenile Mammal From The Late Cretaceous Of South America: Tooth Eruption And Development., Kayla E Newton May 2022

Dental Morphology In A Juvenile Mammal From The Late Cretaceous Of South America: Tooth Eruption And Development., Kayla E Newton

Electronic Theses and Dissertations

Meridiolestids are a diverse and distinct clade of Cretaceous–Miocene South American dryolestoid mammals ranging in size from small shrew-sized insectivores to large dog- sized omnivores. Cronopio dentiacutus from the Cenomanian La Buitrera locality, Rio Negro Province, Argentina (Candeleros Fm.) is the oldest and best known of them, represented by skull material and associated jaws. A juvenile skull as attributed to Cronopio dentiacutus, based on tooth size and morphology, was collected from the type locality. The specimen includes the skull and both articulated lower jaws. The fossil is poorly ossified and partially flattened; CT scanning reveals most of the dentition …


Alleviation Of Atopic Dermatitis Symptoms By Implementation Of Standard And Alternative Treatments, Nika Sayvongsa May 2022

Alleviation Of Atopic Dermatitis Symptoms By Implementation Of Standard And Alternative Treatments, Nika Sayvongsa

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Atopic Dermatitis (AD) is a chronic dermatological disease caused by a combination of hereditary and environmental factors. This is a common condition that is primarily diagnosed among children, but can persist throughout adulthood. Twenty peer-reviewed articles are analyzed in this expanded literature review. Various methods were implemented throughout these studies, including randomized, double-blind, placebo-controlled, and single-blind studies; all of the studies shared the objective of evaluating AD alleviation with the use of either standard treatment modalities or alternative/ complementary therapies.


Teaching Empathy: A Precursor To Accepting Diversity, Karen Viers May 2022

Teaching Empathy: A Precursor To Accepting Diversity, Karen Viers

Undergraduate Honors Theses

Robert Kennedy once said, “The purpose of life is to contribute in some way to making things better.” This statement inspired the author to question how prosocial behavior and the acceptance of diversity can be encouraged and is the driving force behind the following undergraduate thesis. Research tells us that Theory of Mind (ToM) and Affective Perspective Taking (APT) are essential components in a stepwise progression to learning empathy and can be taught to children ages five to seven. These elements are essential to developing an empathetic foundation that leads to healthier relationships, reduces bullying, and encourages the acceptance of …


Simulating Polistes Dominulus Nest-Building Heuristics With Deterministic And Markovian Properties, Benjamin Pottinger May 2022

Simulating Polistes Dominulus Nest-Building Heuristics With Deterministic And Markovian Properties, Benjamin Pottinger

Undergraduate Honors Theses

European Paper Wasps (Polistes dominula) are social insects that build round, symmetrical nests. Current models indicate that these wasps develop colonies by following simple heuristics based on nest stimuli. Computer simulations can model wasp behavior to imitate natural nest building. This research investigated various building heuristics through a novel Markov-based simulation. The simulation used a hexagonal grid to build cells based on the building rule supplied to the agent. Nest data was compared with natural data and through visual inspection. Larger nests were found to be less compact for the rules simulated.


Covid-19 In Tennessee: Lessons Learned And A Tool For The Future, Allen Archer, Randy Wykoff, Megan Quinn May 2022

Covid-19 In Tennessee: Lessons Learned And A Tool For The Future, Allen Archer, Randy Wykoff, Megan Quinn

Undergraduate Honors Theses

Background: In late 2019, the SARS-CoV-2 virus was identified in Wuhan, China. Within a matter of weeks, the virus spread to the United States and many other countries around the world. By March 5, 2020, the first case of COVID-19 (the disease caused by the SARS-CoV-2 virus) was identified in the state of Tennessee, and the first known COVID-19 associated death in the state followed on March 20, 2020. In 2020 alone, there were 514,922 confirmed cases and 6,760 COVID-19 attributed deaths in the state of Tennessee. It is important to understand, however, that confirmed COVID-19 deaths do not accurately …