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Urban Land-Based Healing: A Northern Intervention Strategy, Nicole Redvers, Melanie Nadeau, Donald Prince Jan 2023

Urban Land-Based Healing: A Northern Intervention Strategy, Nicole Redvers, Melanie Nadeau, Donald Prince

Indigenous Health Faculty Publications

Urban Indigenous populations face significant health and social disparities across Canada. With high rates of homelessness and substance abuse, there are often few options for urban Indigenous Peoples to access land-based healing programs despite the increasingly known and appreciated benefits. In May 2018, the first urban land-based healing camp opened in Yellowknife, Northwest Territories, Canada, one of the first to our knowledge in Canada or the United States. This camp may serve as a potential model for an Indigenous-led and Indigenous-based healing camp in an urban setting. We seek to present preliminary outcome data from the healing camp in a …


Centering Culture In The Treatment Of Opioid Use Disorder With American Indian And Alaska Native Communities: Contributions From A National Collaborative Board, Katherine A. Hirchack, Melanie Nadeau, Angel Vasquez, Alexandra Hernandez-Vallant, Kyle Smith, Cuong Pham, Karen Anderson Oliver, Paulette Baukol, Karen Lizzy, Raquel Shaffer, Jalene Herron, Aimee M. C. Campbell, Kamilla L. Venner Jan 2023

Centering Culture In The Treatment Of Opioid Use Disorder With American Indian And Alaska Native Communities: Contributions From A National Collaborative Board, Katherine A. Hirchack, Melanie Nadeau, Angel Vasquez, Alexandra Hernandez-Vallant, Kyle Smith, Cuong Pham, Karen Anderson Oliver, Paulette Baukol, Karen Lizzy, Raquel Shaffer, Jalene Herron, Aimee M. C. Campbell, Kamilla L. Venner

Indigenous Health Faculty Publications

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation …


January 27, 2023 Ereporter, University Of Alabama At Birmingham Jan 2023

January 27, 2023 Ereporter, University Of Alabama At Birmingham

eReporter (campus newsletter)

No abstract provided.


Leading Change: Generating Cultural Responsiveness And Competence In Nursing, Kerstin G. Hudgins Jan 2023

Leading Change: Generating Cultural Responsiveness And Competence In Nursing, Kerstin G. Hudgins

Dissertations

Culturally responsive teachings prepare students to support social justice, diversity, equity, and inclusion (DEI) in and beyond the classroom. Rising reports of culturally insensitive care and the reported challenges that nurses experience when caring for culturally diverse patients warrant the advancement of the intercultural readiness of nursing students. The study investigated the cultural content taught, encompassing LGBTQ+ health education, at the School of Nursing at a historically black college and university (HBCU) in the Southeastern United States. The participant selection involved purposeful sampling of various stakeholders engaged in interviews and focus groups, including faculty, nursing students, and nurse managers with …


Editorial: The Health Informatics Series: Evolving With A New Discipline, Marion J. Ball, Kathryn J. Hannah, Nhora Cortes-Comerer, Judith V. Douglas Jan 2023

Editorial: The Health Informatics Series: Evolving With A New Discipline, Marion J. Ball, Kathryn J. Hannah, Nhora Cortes-Comerer, Judith V. Douglas

Open Initiatives Grant Funded Publications-Archive

A brief history of the book series launched by Springer-Verlag in 1988 as Computers in Healthcare stands as a case study of its role in the development of informatics in medicine. Renamed Health Informatics in 1998, the series grew to include 121 titles as of September 2022, covering topics from dental informatics to ethics, from human factors to mobile health. An analysis of three titles now in their fifth editions reveals the evolution of content in the core disciplines of nursing informatics and health information management. Shifts in topics in the second editions of two landmark titles chart the history …


Safety Of Adenosine For The Treatment Of Supraventricular Tachycardia In Hospitalized Patients With Covid-19 Pneumonia, T. Zivan, Ramon L Ruiz, Alexandre Martinez, Behzad B. Pavri Jan 2023

Safety Of Adenosine For The Treatment Of Supraventricular Tachycardia In Hospitalized Patients With Covid-19 Pneumonia, T. Zivan, Ramon L Ruiz, Alexandre Martinez, Behzad B. Pavri

Department of Medicine Faculty Papers

Coronavirus disease 2019 (COVID-19) is associated with pulmonary involvement and cardiac arrhythmias, including supraventricular tachycardia (SVT). Adenosine is commonly used to treat SVT and is generally safe, but is rarely associated with bronchospasm. There are no data regarding the safety of adenosine use in patients with COVID-19 pneumonia and physicians may hesitate to use it in such patients. We surveyed resident physicians and cardiology attendings regarding their level of comfort in administering adenosine to hospitalized COVID-19 patients. We compared a study group of 42 COVID-19 hospitalized patients who received adenosine for SVT to a matched (for age, sex, and co-morbidities) …


The Visualization Of Orphadata Neurology Phenotypes, Daniel B. Hier, Raghu Yelugam, Michael D. Carrithers, Donald C. Wunsch Jan 2023

The Visualization Of Orphadata Neurology Phenotypes, Daniel B. Hier, Raghu Yelugam, Michael D. Carrithers, Donald C. Wunsch

Electrical and Computer Engineering Faculty Research & Creative Works

Disease Phenotypes Are Characterized by Signs (What a Physician Observes during the Examination of a Patient) and Symptoms (The Complaints of a Patient to a Physician). Large Repositories of Disease Phenotypes Are Accessible through the Online Mendelian Inheritance of Man, Human Phenotype Ontology, and Orpha data Initiatives. Many of the Diseases in These Datasets Are Neurologic. for Each Repository, the Phenotype of Neurologic Disease is Represented as a List of Concepts of Variable Length Where the Concepts Are Selected from a Restricted Ontology. Visualizations of These Concept Lists Are Not Provided. We Address This Limitation by using Subsumption to Reduce …


Kenyon Collegiate - January 27, 2023 Jan 2023

Kenyon Collegiate - January 27, 2023

Kenyon Collegiate

No abstract provided.


Discerning The Effect Of The Relationship Between Disclosure And Responsiveness On Depression, Anxiety, And Compassion Fatigue Among Veterinarians, Carrie Reif-Stice, Sarah Smith-Frigerio, Cheryl Auch Lawson, Steven Venette Jan 2023

Discerning The Effect Of The Relationship Between Disclosure And Responsiveness On Depression, Anxiety, And Compassion Fatigue Among Veterinarians, Carrie Reif-Stice, Sarah Smith-Frigerio, Cheryl Auch Lawson, Steven Venette

Faculty Publications

OBJECTIVE

Previous scholarship has posited that veterinarians experience more anxiety, depression, and compassion fatigue symptoms than the general population. Disclosure of psychological stressors, combined with positive responsiveness, may reduce psychological symptoms. The goal of this study was to test the relationships between disclosure, responsiveness, compassion fatigue, anxiety, and depression.

SAMPLE

230 veterinarians from a private Facebook online support group.

PROCEDURES

Veterinarians from a private Facebook online support group were administered a cross-sectional survey using established scales measuring disclosure, responsiveness, compassion fatigue, anxiety, and depression. All scales reported strong reliability and validity.

RESULTS

Pearson correlations and mediation models were used to …


Implicit Bias Mask: Two Sides To Every Story, Emily Smith, Mura Abdul-Nabi, Lukas Biel, Melissa Elmali, Joseph Mccormick Jan 2023

Implicit Bias Mask: Two Sides To Every Story, Emily Smith, Mura Abdul-Nabi, Lukas Biel, Melissa Elmali, Joseph Mccormick

Patient Education Projects

No abstract provided.


Implicit Bias Mask: Thinking Outside The Box Of "Physician Identity", Dana Josifoski, Sarah Bdeir, Farzad Baghaie, Joyce Li, Sujit Prasad, Kevin Cobty Jan 2023

Implicit Bias Mask: Thinking Outside The Box Of "Physician Identity", Dana Josifoski, Sarah Bdeir, Farzad Baghaie, Joyce Li, Sujit Prasad, Kevin Cobty

Patient Education Projects

No abstract provided.


Implicit Bias Mask: The Unity In Diversity Mask, Petar Martinovski, Anthony Bally, Nadeen Sukhon, Yousif Jafar, Sarah Chamdin, Manahil Shaikh Jan 2023

Implicit Bias Mask: The Unity In Diversity Mask, Petar Martinovski, Anthony Bally, Nadeen Sukhon, Yousif Jafar, Sarah Chamdin, Manahil Shaikh

Patient Education Projects

No abstract provided.


Implicit Bias Mask: Evil Eye, Sesilia Kammo, Hamza Ali, Alexander Eskandarian, Michael Wang, Sonja Klumpp, Swetha Reddy Jan 2023

Implicit Bias Mask: Evil Eye, Sesilia Kammo, Hamza Ali, Alexander Eskandarian, Michael Wang, Sonja Klumpp, Swetha Reddy

Patient Education Projects

No abstract provided.


Implicit Bias Mask: Our Journey Inside Out, Juwan Taylor, Salvatore Serra, Alexa Kalaj, Hannah Lee, Saleh Al-Juburi, Amrutha Kotlure Jan 2023

Implicit Bias Mask: Our Journey Inside Out, Juwan Taylor, Salvatore Serra, Alexa Kalaj, Hannah Lee, Saleh Al-Juburi, Amrutha Kotlure

Patient Education Projects

No abstract provided.


Implicit Bias Mask: (Gettin' The) Best Of Me, Julia Malewicz, Nasser Junedi, Kirsten Brinkmeier, Alisha Williams, Hovhannes Hayrapetyan, John Gallagher Jan 2023

Implicit Bias Mask: (Gettin' The) Best Of Me, Julia Malewicz, Nasser Junedi, Kirsten Brinkmeier, Alisha Williams, Hovhannes Hayrapetyan, John Gallagher

Patient Education Projects

No abstract provided.


Implicit Bias Mask: Internalizing The Medical Student Identity, Samantha Odeesho, Brennan Burrows, Nickolas Vinokurov, Gabriella Cascio, Sumeet Saini, Tiffany Chu Jan 2023

Implicit Bias Mask: Internalizing The Medical Student Identity, Samantha Odeesho, Brennan Burrows, Nickolas Vinokurov, Gabriella Cascio, Sumeet Saini, Tiffany Chu

Patient Education Projects

No abstract provided.


Implicit Bias Mask: The Value Of Time In Medical School, Markiesha Baines, Arifbillah Sarowar, Saachi Mittal, Meaghan Osborne, Karthik Babu Kolisetty, Connor Sakis Jan 2023

Implicit Bias Mask: The Value Of Time In Medical School, Markiesha Baines, Arifbillah Sarowar, Saachi Mittal, Meaghan Osborne, Karthik Babu Kolisetty, Connor Sakis

Patient Education Projects

No abstract provided.


Resetting The Rules On Trade And Gender? A Comparative Assessment Of Gender Approaches In Regional Trade Agreements In The Context Of A Possible Gender Protocol Under The African Continental Free Trade Area, Katrin Kuhlmann Jan 2023

Resetting The Rules On Trade And Gender? A Comparative Assessment Of Gender Approaches In Regional Trade Agreements In The Context Of A Possible Gender Protocol Under The African Continental Free Trade Area, Katrin Kuhlmann

Georgetown Law Faculty Publications and Other Works

At long last, gender and trade are together on the international agenda, with significant implications for women entrepreneurs and traders around the world. Alongside the landmark 2017 Joint Declaration on Trade and Women’s Empowerment, regional trade agreements (RTAs) have taken the lead on more tangible gender commitments. One such RTA is the African Continental Free Trade Area (AfCFTA), in which gender appears as an express priority alongside sustainable and inclusive socio-economic development. Yet, this is only a starting point. A gender-focused protocol has been proposed under the AfCFTA framework, representing a significant opportunity to reassess RTA provisions on gender and …


Implementation Of Mrsa Nasal Swabs As An Antimicrobial Stewardship Intervention To Decrease Anti-Mrsa Therapy In Covid-19 Infection, Alaina Dekerlegand, Emily Johnston, Britney Mellor, Melanie Rae Schrack, Catherine O’Neal Jan 2023

Implementation Of Mrsa Nasal Swabs As An Antimicrobial Stewardship Intervention To Decrease Anti-Mrsa Therapy In Covid-19 Infection, Alaina Dekerlegand, Emily Johnston, Britney Mellor, Melanie Rae Schrack, Catherine O’Neal

School of Medicine Faculty Publications

In the early stages of treating patients with SARS-CoV-2, limited information was available to guide antimicrobial stewardship interventions. The COVID-19 Task Force and Antimicrobial Stewardship Committee, at a 988-bed academic medical center, implemented the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) testing to assist with the de-escalation of anti-MRSA therapy in patients with suspected superimposed bacterial pneumonia in COVID-19. A retrospective study was conducted to evaluate the impact of MRSA nasal swab PCR testing on the rate of anti-MRSA therapy between 13 April 2020 and 26 July 2020. A total of 122 patients were included …


The Diamond, January 27, 2023, Dordt University Jan 2023

The Diamond, January 27, 2023, Dordt University

Dordt Diamond

  • Front Page: Remembering Emma Nibbelink; Progress Through Collaboration; East Campus Apartments to Get New Appliances
  • News: Increased Vandalism Prompts Mandatory Meeting; Goodbye Twosdays; Howard Wilson Retires
  • Feature: Swimming into the Future; Winter Storms Impact
  • Opinion: America's Health Literacy Crisis; Conservatives on Campus Need Coordination
  • Art & Entertainment: The 13-Year Sequel - Avatar: The Way of Water Film Review; Puss in Boots: The Last Wish; Beloved Video Game "The Last of Us" Turned into Live-Action TV; The Art of War; First High School Art Exhibit to Begin March 1st; New Sports Broadcasting Class …


A Framework To Predict Variability Characteristics In Building Load Profiles, Sam Moayedi, Andrew Parker, Kevin James, Xiaoyue Cheng, Michael Hempel, Hamid Sharif, Mahmoud A. Alahmad Jan 2023

A Framework To Predict Variability Characteristics In Building Load Profiles, Sam Moayedi, Andrew Parker, Kevin James, Xiaoyue Cheng, Michael Hempel, Hamid Sharif, Mahmoud A. Alahmad

Durham School of Architectural Engineering and Construction: Faculty Publications

The expansion of Advanced Metering Infrastructure (AMI) has provided building operators and researchers detailed information on building energy consumption. The majority of AMI systems, however, record data at relatively low resolutions of 15, 30, or 60 minutes, due to cost, storage and bandwidth limitations. Emerging applications in power flow analysis, Quasi-Static Time-Series Simulation (QSTS), smart grid integration and load matching, however, require data at higher resolutions. Short-term energy demand can deviate significantly from long-term averages, with an unknown magnitude and frequency when only low-resolution load profile data is available. This paper presents a novel data-driven approach to predict characteristics of …


Recognizing Operators’ Duties To Properly Select And Supervise Ai Agents – A (Better?) Tool For Algorithmic Accountability, Richard Zuroff Jan 2023

Recognizing Operators’ Duties To Properly Select And Supervise Ai Agents – A (Better?) Tool For Algorithmic Accountability, Richard Zuroff

Canadian Journal of Law and Technology

In November of 2020, the Privacy Commissioner of Canada proposed creating GDPR-inspired rights for decision subjects and allowing financial penalties for violations of those rights. Shortly afterward, the proposal to create a right to an explanation for algorithmic decisions was incorporated into Bill C-11, the Digital Charter Implementation Act. This commentary proposes that creating duties for operators to properly select and supervise artificial agents would be a complementary, and potentially more effective, accountability mechanism than creating a right to an explanation. These duties would be a natural extension of employers’ duties to properly select and retain human employees. Allowing victims …


If A Machine Could Talk, We Would Not Understand It: Canadian Innovation And The Copyright Act’S Tpm Interoperability Framework, Anthony D. Rosborough Jan 2023

If A Machine Could Talk, We Would Not Understand It: Canadian Innovation And The Copyright Act’S Tpm Interoperability Framework, Anthony D. Rosborough

Canadian Journal of Law and Technology

This analysis examines the legal implications of technological protection measures (‘‘TPMs”) under Canada’s Copyright Act. Through embedded computing systems and proprietary interfaces, TPMs are being used by original equipment manufacturers (‘‘OEMs”) of agricultural equipment to preclude reverse engineering and follow-on innovation. This has anti-competitive effects on Canada’s ‘‘shortline” agricultural equipment industry, which produces add-on or peripheral equipment used with OEM machinery. This requires interoperability between the interfaces, data formats, and physical connectors, which are often the subject of TPM control. Exceptions under the Act have provided little assistance to the shortline industry. The research question posed by this analysis is: …


Recalibrating Governance - Part Ii, Ishrat Husain Dr. Jan 2023

Recalibrating Governance - Part Ii, Ishrat Husain Dr.

Faculty Research - Newspaper and Magazine Articles

The frequent takeovers by military regimes and the consequential screening of hundreds of civil servants led to the subservience of the civil service to military rulers, erosion of the authority of the traditional institutions of governance and loss of initiative by the higher bureaucracy. Given the insecurity of service, the priority shifted from public service to maximizing personal interests by those in power. A glaring example of elites using public policy to promote their self-interest and undue accumulation of wealth at the expense of the poor of the population is the major preoccupation of all civil servants, military officials, media …


4d Lung Mri With High-Isotropic-Resolution Using Half-Spoke (Ute) And Full-Spoke 3d Radial Acquisition And Temporal Compressed Sensing Reconstruction, Can Wu, Guruprasad Krishnamoorthy, Victoria Yu, Ergys Subashi, Andreas Rimner, Ricardo Otazo Jan 2023

4d Lung Mri With High-Isotropic-Resolution Using Half-Spoke (Ute) And Full-Spoke 3d Radial Acquisition And Temporal Compressed Sensing Reconstruction, Can Wu, Guruprasad Krishnamoorthy, Victoria Yu, Ergys Subashi, Andreas Rimner, Ricardo Otazo

Faculty, Staff and Student Publications

Objective:

To develop a respiratory motion-resolved 4D MRI technique with high-isotropic-resolution (1.1 mm) using 3D radial sampling, camera-based respiratory motion sensing, and temporal compressed sensing reconstruction for lung cancer imaging.

Approach:

Free-breathing half- and full-spoke 3D golden-angle radial acquisitions were performed on eight healthy volunteers and eight patients with lung tumors of varying size. A back-and-forth k-space ordering between consecutive interleaves of the 3D radial acquisition was performed to minimize eddy current-related artifacts. Data were sorted into respiratory motion states using camera-based motion navigation and 4D images were reconstructed using temporal compressed sensing to reduce scan time. Normalized sharpness indices …


Monitoring And Modulating Diet And Gut Microbes To Enhance Response And Reduce Toxicity To Cancer Treatment, Anne Knisely, Yongwoo David Seo, Jennifer A Wargo, Manoj Chelvanambi Jan 2023

Monitoring And Modulating Diet And Gut Microbes To Enhance Response And Reduce Toxicity To Cancer Treatment, Anne Knisely, Yongwoo David Seo, Jennifer A Wargo, Manoj Chelvanambi

Faculty, Staff and Student Publications

The gut microbiome comprises a diverse array of microbial species that have been shown to dynamically modulate host immunity both locally and systemically, as well as contribute to tumorigenesis. In this review, we discuss the scientific evidence on the role that gut microbes and diet play in response and toxicity to cancer treatment. We highlight studies across multiple cancer cohorts that have shown an association between particular gut microbiome signatures and an improved response to immune checkpoint blockade, chemotherapy, and adoptive cell therapies, as well as the role of particular microbes in driving treatment-related toxicity and how the microbiome can …


Regenerative Agriculture - A Literature Review On The Practices And Mechanisms Used To Improve Soil Health, Ravjit Khangura, David Ferris, Cameron Wagg, Jamie Bowyer Jan 2023

Regenerative Agriculture - A Literature Review On The Practices And Mechanisms Used To Improve Soil Health, Ravjit Khangura, David Ferris, Cameron Wagg, Jamie Bowyer

Natural Resources Research Articles

Conventional farming practices can lead to soil degradation and a decline in productivity. Regenerative agriculture (RA) is purported by advocates as a solution to these issues that focuses on soil health and carbon sequestration. The fundamental principles of RA are to keep the soil covered, minimise soil disturbance, preserve living roots in the soil year round, increase species diversity, integrate livestock, and limit or eliminate the use of synthetic compounds (such as herbicides and fertilisers). The overall objectives are to rejuvenate the soil and land and provide environmental, economic, and social benefits to the wider community. Despite the purported benefits …


Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu Jan 2023

Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu

Nebraska Center for Virology: Faculty Publications

Membrane proteins expressed on the surface of enveloped viruses are conformational antigens readily recognized by B cells of the immune system. An effective vaccine would require the synthesis and delivery of these native conformational antigens in lipid membranes that preserve specific epitope structures. We have created an extracellular vesicle–based technology that allows viral membrane antigens to be selectively recruited onto the surface of WW domain–activated extracellular vesicles (WAEVs). Budding of WAEVs requires secretory carrier-associated membrane protein 3, which through its proline-proline-alanine-tyrosine motif interacts with WW domains to recruit fused viral membrane antigens onto WAEVs. Immunization with influenza and HIV viral …


Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu Jan 2023

Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu

Nebraska Center for Virology: Faculty Publications

Membrane proteins expressed on the surface of enveloped viruses are conformational antigens readily recognized by B cells of the immune system. An effective vaccine would require the synthesis and delivery of these native conformational antigens in lipid membranes that preserve specific epitope structures. We have created an extracellular vesicle–based technology that allows viral membrane antigens to be selectively recruited onto the surface of WW domain–activated extracellular vesicles (WAEVs). Budding of WAEVs requires secretory carrier-associated membrane protein 3, which through its proline-proline-alanine-tyrosine motif interacts with WW domains to recruit fused viral membrane antigens onto WAEVs. Immunization with influenza and HIV viral …


Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu Jan 2023

Displaying And Delivering Viral Membrane Antigens Via Ww Domain–Activated Extracellular Vesicles, Sengjin Choi, Zhiping Yang, Qiyu Wang, Zhi Qiao, Maoyun Sun, Joshua Wiggins, Shi-Hua Xiang, Quan Lu

School of Veterinary and Biomedical Sciences: Faculty Publications

Membrane proteins expressed on the surface of enveloped viruses are conformational antigens readily recognized by B cells of the immune system. An effective vaccine would require the synthesis and delivery of these native conformational antigens in lipid membranes that preserve specific epitope structures. We have created an extracellular vesicle–based technology that allows viral membrane antigens to be selectively recruited onto the surface of WW domain–activated extracellular vesicles (WAEVs). Budding of WAEVs requires secretory carrier-associated membrane protein 3, which through its proline-proline-alanine-tyrosine motif interacts with WW domains to recruit fused viral membrane antigens onto WAEVs. Immunization with influenza and HIV viral …