Digital Commons Network^™

Bridging The Gut And The Heart-Exploring Pathophysiology, Risk Factors, And Therapeutic Implications Of Cardiovascular Disease In Inflammatory Bowel Disease, Diana Othon-Martinez, Sylvia Valeria Peña-Muñoz, Margarita Riojas-Barrett, Genesis Vidales-López, Josué Moisés Sánchez Guzmán, Lukasz Kwapisz

School of Medicine Publications

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic systemic immune dysregulated disorder affecting the gastrointestinal tract that often has extraintestinal manifestations. Limited data exist on the cardiovascular (CV) implications of IBD, but a higher prevalence of CV disease (CVD) has been observed compared to the general population, resulting in increased mortality risk. This review examines the pathophysiology and risk factors linking IBD to CVD, highlighting several key mechanisms: The “lipid paradox” in active IBD, arterial stiffness and endothelial dysfunction, proinflammatory cytokine activity, gut microbiota dysbiosis, and drug-induced myocardiopathy. The main findings include information about IBD …

Cannabidiol And Beta-Caryophyllene: Chronic Inflammatory Pain, Mohammed Alnoud, Mohammad Hussain, Jose Rios, Emmanuel Franco, Justin D. Mills, Joshua Nwose, Maria Sophia Malbas, Hiram L. Garcia, Sophia Leslie, Manish Tripathi, Khalid Benamar

School of Medicine Publications

While chronic pain is challenging to manage, it always co-exists with depression. Currently, chronic pain and depression are usually treated separately with distinct approaches, yet effectiveness remains elusive. Consequently, the development of integrated therapeutic strategies for pain while addressing depression is a high public health priority and unmet need that affects millions of people. This study aims to determine if the combination of the two phytocannabinoids Beta-Caryophyllene (BCP) and cannabidiol (CBD) is effective for chronic pain while simultaneously showing antidepressant effects. We used a chronic inflammatory pain model (Complete Freund's Adjuvant, CFA) and a battery of pain and depression-like behavior …

A Narrative Review On Artificial Intelligence In Neurosurgery: Ethical Challenges And Implementation Considerations, Tirath Patel, Hamza Yousuf Ibrahim, Fathimathul Henna, Fatima Nasir, Abbas Hussain, Rahma Naveed, Aziz Ur Rehman, Syeda Ramish Zehra Kazmi, Bhum Daishik Patel, Nikhilesh Anand

School of Medicine Publications

Introduction: Artificial intelligence (AI) is revolutionizing neurosurgery by enhancing diagnostic precision, surgical planning, and postoperative management. However, its integration raises ethical concerns related to bias, privacy, accountability, and the potential dehumanization of healthcare. This review focuses on navigating these challenges while maximizing AI's potential in improving patient care.

Methodology: A narrative review was conducted by identifying studies from PubMed, Cochrane Library, and Google Scholar databases. The search utilized the following keywords: "artificial intelligence," "neurosurgery," "machine learning," "data privacy," "robotic surgery," "ethics," and "bias." The review primarily focused on issues of dataset bias, data privacy, and the need for transparency and …

Human Alveolar Macrophage Function Is Impaired In Tuberculosis Contacts With Diabetes, Léanie Kleynhans, Carine Kunsevi-Kilola, Happy Tshivhula, Tariq Webber, Alana Keyser, Nicole Prins, Candice I. Snyders, Ayanda Shabangu, Virginie Rozot, Blanca I. Restrepo

School of Medicine Publications

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Individuals with type 2 diabetes (T2D) are at increased risk of developing active TB, tend to present with more severe disease and experience adverse treatment outcomes compared to individuals without T2D co-morbidity. However, the underlying mechanisms responsible for increased susceptibility of patients with T2D to TB remain poorly understood.

Methods: We performed bronchoscopies and collected bronchoalveolar lavage fluid (BAL) from TB contacts with and without T2D in South Africa and obtained paired human alveolar macrophages (HAMs) and monocyte-derived macrophages (MDMs) for transcriptomic, epigenetic and functional assays.

Findings: Following …

Exploring Bone Oncology In A Medically Underserved Area: A Retrospective Cohort Of Bone Metastases And Malignant Bone Neoplasia In The Rio Grande Valley, Blake C. Martin, Juan Carlos Lopez Alvarenga, Michael Sander

School of Medicine Publications

Objectives: The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation sought to evaluate the demographic and clinical characteristics linked to bone metastases and primary malignant bone neoplasms (PMBNs) in patients from the RGV and to compare the frequency of these conditions with the US general population.

Methods: This was a retrospective chart review in which data were gathered from the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018 to September 4, 2024. Various statistical analyses …

Genetic Variations In Extracellular Matrix Degradation Pathways Linking To Major Depressive Disorder: Evidence From A Large-Scale Genetic Association Study, Halliru Zailani, Daniel Tzu-Li Chen, Sheng-Che Lin, Jia-Hau Lee, Mei-Ling Li, Jane Pei-Chen Chang, Kuan-Pin Su

BioMedicine

Dysregulation of extracellular matrix (ECM) degradation pathways has been increasingly implicated in major depressive disorder (MDD), yet its genetic basis remains unclear. This study investigated the relationship between ECM-related genetic polymorphisms and MDD susceptibility. In a case-control study, we analyzed 317 MDD patients and 1,268 sexmatched controls from the Taiwan Biobank (TWB). Genomic DNA was analyzed using the Affymetrix TWB array, targeting single nucleotide polymorphisms (SNPs) in 140 ECM degradation genes (Reactome database). Full-model association tests identified significant SNPs, validated with 5,000 max(T) permutations and adjusted via logistic regression for age, body mass index, education level, and marital status. We …

Neuroprotection Of Paeoniflorin As Antidepressant Candidate, Yuh-Fung Chen, Yi-Jui Chen, Jai-Sing Yang, Min-Min Lee, Huei-Yann Tsai

BioMedicine

Background: Depression is one of the common mental disorders worldwide, and currently used antidepressants have undesirable effects; therefore, the development of new antidepressants without side effects is urgently needed. Paeoniflorin (PF) exhibits various pharmacological activities, including anti-inflammatory, antioxidant, and neuroprotective effects. NMDA receptors in the hippocampus play a vital role in the pathophysiology of depression. Due to the scarcity of reports on the neuroprotection of PF on NMDA-induced excitotoxicity in the hippocampus, the present study aims to investigate the effects of PF on NMDA-mediated EPSP and calcium influx in the hippocampus to evaluate the potential of PF as an antidepressant. …

Prophylactic Effect Of Omega-3 Polyunsaturated Fatty Acids Monotherapy In Preventing Recurrent Major Depressive Disorder: A Randomized Controlled Trial, Ikbal Andrian Malau, Cheng-Ho Chang, Wei-Jen Chen, Wen-Chun Liu, Halliru Zailani, Hsien-Feng Liao, Jane Pei-Chen Chang, Wei-Che Chiu, Kuan-Pin Su

BioMedicine

Background: Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have demonstrated efficacy as adjunctive treatment for MDD. In fact, fewer studies assessed the prophylactic properties of n-3 PUFAs as monotherapy on the recurrence of MDD.

Aims: This study aimed to assess the prophylactic effect of n-3 PUFAs monotherapy against recurrent MDD.

Methods: We conducted a 6-month randomized controlled trial to assess the prophylactic effect of n-3 in preventing recurrent MDD. We assigned 60 remitted MDD patients to the n-3 group (n = 30) and placebo (n = 30). Furthermore, we assessed the difference in depression severity and MDD recurrence based on the …

Tai Chi For Cardiovascular Wellness: Integrating An Ancient Practice Into Modern Therapeutic Approaches, Chun-Han Cheng, Wen-Rui Hao, Huan-Yuan Chen, Po-Yuan Chen, Ju-Chi Liu, Tzu-Hurng Cheng

BioMedicine

Tai Chi, a traditional Chinese martial art characterized by gentle, fluid movements and deep breathing, has gained increasing recognition for its cardiovascular health benefits. This study investigated the integration of Tai Chi into contemporary cardiovascular health practices, focusing on its physiological and psychological effects. The slow, controlled movements characteristic of Tai Chi contribute to enhanced cardiovascular fitness, decreased blood pressure, and improved vascular function, while simultaneously alleviating stress and fostering emotional well-being. Through a review of clinical studies and trials, this study underscores the efficacy of Tai Chi in cardiovascular rehabilitation programs and its accessibility as a community-based intervention. Additionally, …

Circadian Rhythms And Neuroendocrine Dysregulation In Adhd: Therapeutic Insights From Omega-3 Fatty Acids, Ayesha Zafar Iqbal, Patricia Marest Suwindi, Sunny Yin-Shan Chen, Lindsay Liang-Tien Cho, Kuan-Pin Su, Jane Pei-Chen Chang

BioMedicine

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition often accompanied by circadian rhythm disturbances, particularly delayed sleep phase. These involve superchiasmatic nucleus (SCN) dysregulation, altered melatonin secretion, and hypothalamic–pituitary–adrenal (HPA) axis activity, which may be exacerbated by artificial light exposure. Genetic studies further implicate circadian mechanisms, linking ADHD with polymorphisms in clock genes such as PER and CLOCK.

Nutraceuticals, particularly omega-3 polyunsaturated fatty acids (n-3 PUFAs), have been proposed as modulators of circadian rhythms. N-3 PUFAs are essential for brain health and may influence melatonin synthesis and sleep–wake regulation. Preclinical and clinical findings suggest that supplementation can improve cognitive …

The Integrative Role Of Melatonin In Psychiatric Disorders: A Systematic Review Of Evidence From Circadian Biology, Lifestyle Medicine, And Psychoneuroimmunology, Ho Bao Chau Le, Kollawat Somsri, Thansita Bhunyakarnjanarat, Nattiya Hirankarn, Asada Leelahavanichkul

BioMedicine

Melatonin, a hormone produced by the pineal gland, is known for regulating circadian rhythms and has emerging therapeutic potential in psychiatric disorders. This systematic review examines evidence from clinical and preclinical studies to assess melatonin’s efficacy in the following conditions: depression, anxiety, bipolar disorder, and schizophrenia. Beyond its role in circadian regulation, melatonin exhibits antioxidative, anti-inflammatory, and immunomodulatory properties, which intersect with nutrition, lifestyle medicine, and psychoneuroimmunology (PNI).

The review finds that melatonin improves sleep quality, restores circadian balance, and modulates stress-related neuroimmune pathways. It also supports neuroplasticity and reduces oxidative stress, contributing to resilience against psychosocial and environmental stressors. …

From Rhythm To Resilience: The Interplay Of Circadian Rhythm, Melatonin, Lifestyle, Nutrition In Psychoneuroimmunology (Pni), Jane Pei-Chen Chang, Kuan-Pin Su

BioMedicine

Emerging evidence reveals that circadian rhythm, melatonin signaling, nutrition, and inflammation are intricately intertwined in shaping both mental and physical health. Circadian disruptions and lifestyle imbalances contribute to neuroinflammation, mood dysregulation, and cardiometabolic dysfunction, as seen in attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), metabolic syndrome,and cardiovascular diseases. This special issue highlights interdisciplinary research that integrates circadian biology, nutrition, and psychoneuroimmunology (PNI) toward personalized and preventive psychiatry. Featured studies explore circadian and melatonin mechanisms in ADHD and MDD, the therapeutic and prophylactic potential of omega-3 polyunsaturated fatty acids (n-3 PUFAs), the neuroprotective potentical of paeoniflorin, and the role of extracellular …

Climate And Non-Genetic Effects On Goat Milk Quality And Casein Prediction Using Machine Learning, Ibrahima Mahamane Abdourhamane, Dilek Arsoy

The Thai Journal of Veterinary Medicine

Milk quality is becoming more and more crucial for farmers with the increasing use of component-based pricing systems in the sector. This study aimed to investigate the effects of climate-related and non-genetic factors on goat milk quality on the island of Northern Cyprus and to predict casein content using machine learning techniques. An analysis was performed on 21,695 goat milk samples collected between 2012 and 2018. Somatic cell count (SCC), standard plate count (SPC), and key milk components such as protein, casein, lactose, and fat were evaluated for different seasons, regions, farm sizes, and raw milk types. Five machine learning …

Disclosing That Which Has Been Made Invisible: Collective Ontological Inquiry With Vanessa Machado De Oliveira, Dorothy Cococinno Ladybugboss, Aiden Cinnamon Tea, And Aiden Senior, Raphael Borges, Witneiris Constanzo, Samantha Encarnacion, Kaley Klapisch, Carolyne J. White

Turning Toward Being: The Journal of Ontological Inquiry in Education

An unconventional and collaboratively written text begun as a Book Review that expands into a hybrid Book Review-Notes From The Field-Article as we sought to do justice to our encounter with three provocative books that elicit ontological inquiry inside and outside our classrooms, inquiry that challenges us, confuses us, confronts us to unlearn and loosen the grip of ontological constraints we were thrown into within modernity and our embeddedness within the everyday life. Our reading of these books elicits much needed hope for the precarious times we are living through with this earth.

One Individual’S Culmination Is Another’S Abyss: The Matter Of Mattering, Lou Agosta

Turning Toward Being: The Journal of Ontological Inquiry in Education

One individual’s culmination is another’s new beginning and yet another’s abyss. The abyss is nihilism. The challenge of such a Big Idea as The Culmination (the event, not the title of Robert Pippin’s book) is to weave the hermeneutic tapestry of the meaning of Being (Sein) as disclosed in poetry, aesthetics, and the life-world, while coaxing the lumbering Hegelian camel of German Idealism through the eye of the narrow needle of Dasein’s (Heideggerian) finitude. The world and entanglement are disclosed in a nondiscursive (preconceptual) manner as mattering. The way forward in philosophy lies through innovations in “mattering”—not a conceptual sense …

Receiving Requirements And Aesthetic Experience In The Sarcastic Narrative Discourse: What Is Read And Seen "Sawalef Khatera" By Ahmed Al-Fahid , And "Selfie" By Khalaf Al-Harbi, Alma Saleh Hasan Alzahrani

UB Journal for Humanities

This research discusses the requirements for receiving the sarcastic narrative discourse in the modern Saudi narration, comparing between what is read and what is seen, by focusing on the qualitative characteristics of the discourse, It aims to keep pace with the march of Saudi creativity towards maturity in its various manifestations. Irony is the art of receiving, it requires tools other than reading, and satirical writing calls for satirical reading, and this leads to the methodological tool of research, which is what reading theories provide means of revealing the requirements for receiving sarcastic discourse. This research aims to highlight the …

The Principles And Directives Contained In The Sunnah Of The Prophet To Protect Societies From Epidemics, Maria Bassam Mohammed Abdel Rahman

UB Journal for Humanities

This research was titled (The Principles and Directives Contained in the Prophet’s Sunnah to Protect Communities from Epidemics), with the aim of deriving the principles contained in the Prophet’s texts to prevent epidemics and prevent their spread, and to explain the means of the Prophet’s Sunnah in facing the challenges of limiting the spread of epidemics. The prophetic texts and an inventory of the hadiths in which the topic of epidemics was mentioned, then classified, described and analyzed in the light of the prophetic context. The study concluded that the prophetic Sunnah included important principles and means to limit the …

The Tort Responsibility For Damages To The Humanoid Robot: A Comparative Study Between The Civil Law And The Provisions Of Islamic Jurisprudence, Mohamed Hamdan Abdeen Asran

UB Journal for Humanities

The robot is one of the most prominent manifestations of the development of industrial intelligence, as it has entered into many fields such as civil service, medicine, industry, education, domestic and military service, and others. Which raises many legal problems and obstacles Such as defining the concept of a robot and the extent to which it enjoys a legal personality, and what is the legal and sharia basis on which we can found the responsibility of the robot. Can we attribute this responsibility to the theory of defective products, the theory of the responsible human representative, the theory of the …

A Certainty-Weighted, Belief-Based Model Of Political Attitudes: A Bayesian Analysis Of American Public Attitudes Toward The Affordable Care Act, Gabriel Miao Li, Josh Pasek, Jon A. Krosnick

Communication Faculty Articles and Research

This study proposes a novel, certainty-weighted account of the process by which political beliefs shape political attitudes. Building upon expectancy-value frameworks, this paper introduces belief certainty as a moderator of belief impact. A Bayesian partial-pooling approach is used to test a model positing how beliefs about what the Patient Protection and Affordable Care Act does and does not do relate to overall attitudes toward the law. This analytic method manages the complexity of multiple potentially correlated beliefs and evaluations by imposing a structural constraint to avoid multicollinearity and enable accurate estimation of parameters. Data from a nationally representative sample survey …

Pengaruh Aerobic Low Impact Exercise Terhadap Fungsi Kognitif Lansia Dengan Risiko Demensia Di Sasana Tresna Werdha Cibubur Tahun 2025, Nur Achirda, Liza Laela Abida, Kania Annisa Zahra

Jurnal Fisioterapi Terapan Indonesia

Background: Entering old age, the elderly often face various problems, one of which is impaired cognitive function. Some factors that influence the decline in cognitive abilities in the elderly include gender, education level, occupation, nutritional status, and comorbidities that can interfere with the nervous system, such as dementia and Alzheimer's disease. The problem of dementia in the elderly is an important concern that requires effective prevention and treatment. Dementia in the elderly can include several aspects, such as orientation, registration, attention and calculation, memory, and language. Physiotherapy has an important role in maintaining and improving body movement function, so that …

State Of California Cannabis Reporting, University Of Mississippi – National Center For Cannabis Research And Education

California

No abstract provided.

Implementing Phq-2 In An Outpatient Mental Health Practice, Krishona Poignard

Doctor of Nursing Practice Projects

Depression remains widely underidentified in outpatient behavioral health settings, where variable screening practices limit early recognition and appropriate treatment. This quality improvement project addressed this gap by standardizing screening through targeted clinician education. The purpose was to improve clinician confidence and adherence to validated tools, specifically the Patient Health Questionnaire-2 (PHQ-2) and, when indicated, the Patient Health Questionnaire-9 (PHQ-9). The project aimed to increase consistent tool use through an evidence-based educational intervention guided by Lewin’s Change Theory and the Iowa Implementation for Sustainability Framework. A quasi-experimental, single-group pretest–posttest design was employed with licensed clinical staff, including licensed social workers (LSWs), …

The Two Hungers: Food Security, Morality, And Cash Transfer Policies For Canela Apanjekra People In Indigenous Central Brazil, Bruno Nogueira Guimarães

Tipití: Journal of the Society for the Anthropology of Lowland South America

This article examines how the Canela Apanjekra (Porquinhos Indigenous Land, Maranhão, Brazil) engage with conditional cash transfer policies aimed at combating hunger—especially the Bolsa Família Program—and how these policies are interpreted through Indigenous moral economy. Drawing on long-term ethnographic research (2011–2019) and a household survey conducted in 2019, it argues that “hunger” is not a unitary condition measurable solely through individual consumption, but a relational and ecological experience shaped by obligations to share, by shame/respect (paham), and by shifting conditions of subsistence. The analysis develops the notion of “two hungers”: in the village, hunger is commonly articulated as …

Clark County Deputy Marshals Association And Raymundo Enriquez V. Clark County, A Political Subdivision Of The State Of Nevada; And The Eighth Judicial District Court Of The State Of Nevada, In And For The County Of Clark, 141 Nev. Adv. Op. 49 (Oct. 23, 2025), Adrienne Jack-Sands

Nevada Supreme Court Summaries

CLARK COUNTY DEPUTY MARSHALS ARE COURT EMPLOYEES, NOT PART OF A LAW ENFORCEMENT AGENCY EMPLOYED WITHIN THE EXECUTIVE DEPARTMENT

Simulation Of Stress, Deformation, And Vibration In Unlubricated Ball Bearings At Varying Rotational Speeds, Billy Dwiki, Moh. Hartono

Journal of Mechanical Engineering Science and Technology (JMEST)

Bearings are critical components in rotating machinery, and their performance is highly influenced by operational factors such as rotational speed, load, and lubrication. This study aims to analyze the deformation, stress, and dynamic behavior of SAE 52100 bearings under dry operating conditions at various rotational speeds, as well as to propose mitigation strategies for high-speed industrial applications. A finite element simulation was conducted using ANSYS R19.2 to evaluate the total deformation, equivalent elastic strain, Von Mises stress, and vibrational characteristics of a 6204-type SAE 52100 bearing. The simulations were performed across a speed range of 600 to 2000 RPM under …

Workplace Violence In The Ed As A Global Phenomenon: Literature Review, Katelyn George, Julie Kientz Elting

Biennial Convention (CONV)

Purpose: This presentation reviews the literature to explore the experience of workplace violence towards healthcare workers from patients/families in the emergency department as a global phenomenon.

Background: Attention to workplace violence (WPV) in emergency departments (ED) by patients or families toward healthcare workers in the US has been increasing (Carey & Hendricks, 2023; Doehring et al., 2024; McLaughlin & Khemthong, 2024). Since EDs are a point of entry to care, WPV can be exacerbated due to the fast-paced and unpredictable environment (McLaughlin & Khemthong, 2024). Patients are commonly admitted experiencing pain, substance use issues, and mental health crises which may …

The Matter Of Production And Forms Of Sharing: Transformations Of Food Economies In Lowland South America, Clarice Cohn, Diego Madi Dias, Adriana Athila

Tipití: Journal of the Society for the Anthropology of Lowland South America

This special issue of Tipití presents a critical examination of ‘food economies’ and their transformations within Indigenous communities in Lowland South America. Stemming from seminal ideas in its Anthropology that directly or indirectly discuss ‘food’ (and much of what goes along with it), this edited volume focuses on the materiality of relations as a strategic lens for understanding contemporary Indigenous lives and their transformations, according to how they are perceived by Indigenous peoples themselves and others such as health care professionals and the state. The articles explore how Indigenous foodways—from acquisition to consumption, including sharing and distribution—reveal key aspects …

Fermentative Processes Of The Agricultural Food System In The Upper Rio Negro: Ethnographic Notes On Feminine Knowledge, Intention, And Agency In The Production Of Fermented Beverages, Lorena França

Tipití: Journal of the Society for the Anthropology of Lowland South America

This article examines the fermentative processes at the core of the agricultural food system of the Upper Rio Negro, northwestern Amazon, highlighting women’s technical and social agency in the production of fermented beverages such as caxiri. Based on ethnographic fieldwork conducted among Baniwa and Tukano families between 2018 and 2019, the study explores how fermentation constitutes not merely a biochemical transformation of matter but a sociotechnical language through which women express intention, alliance, and distinction. The paper analyzes in detail two cases of caxiri preparation, showing how women’s manipulation of manioc, tubers, saliva, and utensils configures embodied knowledge transmitted …

El Sistema Nainu De Agricultura Familiar: Semillas De La Memoria Social Y De La Autonomía Alimentaria En Gunayala (Panamá), Lenín Alfonso Morales, Geodisio Castillo, Diego Madi Dias

Tipití: Journal of the Society for the Anthropology of Lowland South America

La presente investigación examina el sistema agroforestal familiar (nainu) del pueblo gunadule como un tejido de resistencia social, espiritual y ecológica frente a los procesos históricos y actuales de desposesión territorial y colapso climático. A partir de un enfoque etnográfico basado en métodos participativos y epistemologías indígenas, se analizan las prácticas, conocimientos y relaciones que sostienen la autonomía alimentaria y la regeneración del territorio en Gunayala. El estudio documenta los impactos de la transferencia tecnológica, la expansión de semillas híbridas y transgénicas, identificados como amenazas centrales para la continuidad de los cultivos tradicionales y la salvaguardia de semillas …

Reducing Emergency Department To Medical Icu Boarding Times: Implementing A Standardized Escalation Protocol At A Large Medical Center Hospital, Taylor A. Robbins-Ethridge

Doctor of Nursing Practice Final Project Abstract

Prolonged emergency department (ED) boarding of critically ill patients awaiting transfer to the medical intensive care unit (MICU) delays access to definitive care and is associated with increased mortality and longer hospital stays. This quality improvement project aimed to reduce ED boarding times for MICU patients by implementing the Bed Ready in 30: Just Say Yes escalation protocol. The Plan–Do–Study–Act (PDSA) framework guided the implementation of a structured escalation process to standardize nurse-to-nurse communication once a MICU bed was marked as ready in the electronic health record. A pre–post observational study was used to evaluate the intervention using electronic health …