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Articles 5161 - 5190 of 73648
Full-Text Articles in Entire DC Network
The Pulse, 1984, N7, Fall, Advocate Health - Midwest
The Pulse, 1984, N7, Fall, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.
The Pulse, 1985, N10, Autumn, Advocate Health - Midwest
The Pulse, 1985, N10, Autumn, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.
The Pulse, 1983, N3, Winter, Advocate Health - Midwest
The Pulse, 1983, N3, Winter, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.
Impaired Driving Among Rural Appalachian Women In The Year Following Incarceration, J. Matthew Webster, Megan F. Dickson, Shawn M. Jamison, Michele Staton
Impaired Driving Among Rural Appalachian Women In The Year Following Incarceration, J. Matthew Webster, Megan F. Dickson, Shawn M. Jamison, Michele Staton
Journal of Appalachian Health
Introduction: Despite the known risks associated with substance use following incarceration, no studies have examined substance-impaired driving as a post-incarceration health risk behavior in rural Appalachia.
Purpose: The present study examined differences by impaired driving following incarceration and identified predictors of impaired driving in sample of rural Appalachian women with a history of drug use and risky sex.
Methods: Women (N=340) from three rural Appalachian jails completed a baseline interview in jail and follow-up interviews at six and 12 months post-release. Interview questions included demographic characteristics and information on substance use risk, mental health, criminal legal system involvement, and impaired …
Investigating Suicide Risk Factors Among Appalachian West Virginian Adults, Erin D. Caswell, Angela M. Dyer, Summer D. Hartley, Caroline P. Groth, Mary Christensen, Sahiti K. Tulabandu, Bryce K. Weaver, Ruchi Bhandari
Investigating Suicide Risk Factors Among Appalachian West Virginian Adults, Erin D. Caswell, Angela M. Dyer, Summer D. Hartley, Caroline P. Groth, Mary Christensen, Sahiti K. Tulabandu, Bryce K. Weaver, Ruchi Bhandari
Journal of Appalachian Health
Introduction: Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services.
Purpose: This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian Region
Methods: Using 2021 Mountain …
Comparative Outcomes Following Randomization To A Pilot Facebook-Based Hiv Prevention Intervention Among Appalachian Women Involved In The Criminal Legal System, Megan F. Dickson, Erika Pike, Michele Staton
Comparative Outcomes Following Randomization To A Pilot Facebook-Based Hiv Prevention Intervention Among Appalachian Women Involved In The Criminal Legal System, Megan F. Dickson, Erika Pike, Michele Staton
Journal of Appalachian Health
Introduction: Rural Appalachian women who use drugs and are involved in the criminal legal system are at increased risk for health consequences (such as HIV/Hepatitis C). Service barriers throughout rural communities have prompted a need to examine the effectiveness of novel intervention delivery methods (e.g., social media).
Purpose: This study aims to determine if enhancing an existing HIV prevention intervention with additional modules delivered via Facebook improves service access by examining short-term outcomes among Appalachian women returning to the community following jail release.
Methods: Between 2019 and 2022, consenting women from two rural Appalachian jails were randomly selected, screened, interviewed, …
Heartbeat, 2004 December, Advocate Health - Midwest
Heartbeat, 2004 December, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.
Heartbeat, 2003 April, Advocate Health - Midwest
Heartbeat, 2003 April, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.
Heartbeat, 2002 February, Advocate Health - Midwest
Heartbeat, 2002 February, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.
Heartbeat, 2002 April, Advocate Health - Midwest
Heartbeat, 2002 April, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.
Heartbeat, 1996 September, Advocate Health - Midwest
Heartbeat, 1996 September, Advocate Health - Midwest
Historical Documents - Combined
Dreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.
Diagnostic Stewardship Cutoffs For Urinalysis Results Prior To Performing A Urine Culture: Analysis Of Data From A Healthcare System, Deborah Kupferwasser, Amy Y. Kang, Liz Chen, Holly K. Huse, Loren G. Miller
Diagnostic Stewardship Cutoffs For Urinalysis Results Prior To Performing A Urine Culture: Analysis Of Data From A Healthcare System, Deborah Kupferwasser, Amy Y. Kang, Liz Chen, Holly K. Huse, Loren G. Miller
Pharmacy Faculty Articles and Research
Background Urinary Tract Infections (UTIs) are commonly overdiagnosed. Some labs conduct urinalysis (UA) as a preliminary screening before proceeding to urine culture to reduce processing unnecessary samples. However, the optimal UA cutoffs for this diagnostic stewardship intervention are not well defined.
UA squamous epithelial cells were not graphed b/c the value crossed the diagonal at multiple points. Methods We performed a retrospective, cross-sectional analysis of urine studies performed from 2/1/21-1/31/23 at the Los Angeles County Department of Health Services (4 medical centers & 20 clinics). We examined patient encounters in which a UA was ordered synchronously with a urine culture. …
Assessment Of Risk Factor Prediction Using Machine Learning Techniques And Hybrid Approach Based On Soft Sets, Menaga A
Theses and Dissertations
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, and India reports a significantly high death rate due to its large population base and the increasing prevalence of non-communicable diseases. National statistics indicate that 20–27% of deaths in India are attributed to CVDs, with the proportion steadily rising over the years. Recognizing the urgency of early detection and risk prevention, the World Health Organization (WHO) introduced “The Global Action Plan for the Prevention and Control of Non-Communicable Diseases (2013–2020),” emphasizing early identification, risk reduction, and timely treatment. In this context, decision-making applications have gained importance across domains especially healthcare …
Safety Of Omadacycline Versus Standard-Of-Care Oral Antibiotic Treatment For Bone And Joint Infections: Interim Results From An Open-Label, Non- Inferiority, Randomized Controlled Trial, Amy Y. Kang, Guarina Garcia Delgado, Donna Phan Tran, Evelyn A. Flores, Vanessa Romo-Kozan, Isabel Payan, Loren G. Miller
Safety Of Omadacycline Versus Standard-Of-Care Oral Antibiotic Treatment For Bone And Joint Infections: Interim Results From An Open-Label, Non- Inferiority, Randomized Controlled Trial, Amy Y. Kang, Guarina Garcia Delgado, Donna Phan Tran, Evelyn A. Flores, Vanessa Romo-Kozan, Isabel Payan, Loren G. Miller
Pharmacy Faculty Articles and Research
Background
The incidence of bone and joint infections (BJIs) continues to increase, and existing oral BJI antibiotics have limitations. Omadacycline may be a potential treatment option for BJI treatment due to activity against doxycycline-resistant S. aureus and ESBL-producing Enterobacterales for which there are often no viable oral options. However, the safety of omadacycline in this setting is poorly defined.
Methods
We performed an open label, randomized, controlled clinical trial of adults with BJIs in the outpatient setting. Participants were randomized to omadacycline-containing regimen (omadacycline 300mg po daily) or Standard-of-Care (SOC) antibiotics. Adjunctive antibiotics were permitted in addition to omadacycline. Safety …
Understanding Vaccines: A 3d Animation And Print Materials For Clinical Trial Patients, Shannon Gregory
Understanding Vaccines: A 3d Animation And Print Materials For Clinical Trial Patients, Shannon Gregory
Theses
This project covers the importance of patient education, and the decisions that go into making patient facing materials. The topic of this piece is “Understanding Vaccines” and will explore several key aspects: what vaccines are, how they work, their important role in public health, and how to best communicate with patient audiences. Given the growing challenges in vaccine education, this piece will address common misconceptions and emphasize the importance of clear, accessible communication. The goal of this piece is to educate, but also to encourage individuals to make well-informed decisions regarding vaccination. The artwork created for this thesis was developed …
Emergency Room Utilization Rates Among Unhoused Patients Receiving Care At A Student-Led Free Clinic, Lindsey Torres, Tina Gustin
Emergency Room Utilization Rates Among Unhoused Patients Receiving Care At A Student-Led Free Clinic, Lindsey Torres, Tina Gustin
Graduate Student Government Association Research Conference
Purpose statement: The purpose of this activity is to allow the learner to recognize the impact of a student-led clinic aimed at caring for those living in homelessness by providing accessible primary care and minimizing barriers to reduce avoidable emergency room utilization.
Objectives:
- At the end of the presentation, learners will be able to discuss and demonstrate knowledge of outcomes related to emergency room visits when student-led clinics are implemented in their region.
- To identify the most common reasons persons living in homelessness present to the emergency room to expand services in future practice.
Background: Studies have determined that unhoused …
Hyperlipidemia, Acculturation, And Health Insurance Coverage In United States Foreign-Born Individuals, Debola Olayinka Ola
Hyperlipidemia, Acculturation, And Health Insurance Coverage In United States Foreign-Born Individuals, Debola Olayinka Ola
Walden Dissertations and Doctoral Studies
Hyperlipidemia is one of the modifiable risk factors for cardiovascular diseases (CVD), the leading cause of death among minority populations in the United States, including foreign-born people. Therefore, preventing and treating hyperlipidemia alongside other CVD risk factors is critical for avoiding CVD. Prior research examined disparities in health insurance coverage, length of stay, and blood cholesterol with mixed observations over time with new immigrants. This study aimed to determine if there was a statistically significant association between language spoken at home, length of stay in the United States, having health insurance coverage or none, and high cholesterol level status among …
Pediatric Immunization Program To Lessen The Lack Of Services In Rural Communities, Shannon London Nowiski
Pediatric Immunization Program To Lessen The Lack Of Services In Rural Communities, Shannon London Nowiski
Walden Dissertations and Doctoral Studies
The lack of resources in rural communities encourages new programs to improve outcomes in health and wellness. This project aimed to reduce the vaccination barriers of transportation and time by bringing vaccines to the children in the existing medical clinic. The purpose of this doctor of nursing practice project was the development of a sustainable vaccination program for rural communities. The practice-focused question was: Can a community team develop a sustainable plan to provide education and the provision of vaccines in a rural community? This included proposing clinical practice guidelines (CPGs) for providers regarding the education of patients, families, and …
Hyperlipidemia, Acculturation, And Health Insurance Coverage In United States Foreign-Born Individuals, Debola Olayinka Ola
Hyperlipidemia, Acculturation, And Health Insurance Coverage In United States Foreign-Born Individuals, Debola Olayinka Ola
Walden Dissertations and Doctoral Studies
Hyperlipidemia is one of the modifiable risk factors for cardiovascular diseases (CVD), the leading cause of death among minority populations in the United States, including foreign-born people. Therefore, preventing and treating hyperlipidemia alongside other CVD risk factors is critical for avoiding CVD. Prior research examined disparities in health insurance coverage, length of stay, and blood cholesterol with mixed observations over time with new immigrants. This study aimed to determine if there was a statistically significant association between language spoken at home, length of stay in the United States, having health insurance coverage or none, and high cholesterol level status among …
Staff Education To Increase Awareness And Readiness Of Clinicians To Use The Clinical Decision Support For Immunization (Cdsi) Tool, Lemlem Erketa Ejo
Staff Education To Increase Awareness And Readiness Of Clinicians To Use The Clinical Decision Support For Immunization (Cdsi) Tool, Lemlem Erketa Ejo
Walden Dissertations and Doctoral Studies
Accurate evaluation and forecasting of immunization and ensuring the right vaccines are administered at the right time are essential for the success of immunization programs. Interpreting the clinically written Advisory Committee on Immunization Practice (ACIP) recommendations by individual clinicians is time-consuming and complex, increasing the risk of misinterpretation, inconsistent practice, and inaccurate immunization evaluation and forecasting. Thus, the purpose of this project is to introduce clinicians at the selected project site to an evidence based clinical decision support tool and evaluate participants readiness to utilize the tool. Staff education on the clinical decision support for immunization (CDSi) tool was conducted …
Pediatric Immunization Program To Lessen The Lack Of Services In Rural Communities, Shannon London Nowiski
Pediatric Immunization Program To Lessen The Lack Of Services In Rural Communities, Shannon London Nowiski
Walden Dissertations and Doctoral Studies
The lack of resources in rural communities encourages new programs to improve outcomes in health and wellness. This project aimed to reduce the vaccination barriers of transportation and time by bringing vaccines to the children in the existing medical clinic. The purpose of this doctor of nursing practice project was the development of a sustainable vaccination program for rural communities. The practice-focused question was: Can a community team develop a sustainable plan to provide education and the provision of vaccines in a rural community? This included proposing clinical practice guidelines (CPGs) for providers regarding the education of patients, families, and …
Staff Education To Increase Awareness And Readiness Of Clinicians To Use The Clinical Decision Support For Immunization (Cdsi) Tool, Lemlem Erketa Ejo
Staff Education To Increase Awareness And Readiness Of Clinicians To Use The Clinical Decision Support For Immunization (Cdsi) Tool, Lemlem Erketa Ejo
Walden Dissertations and Doctoral Studies
Accurate evaluation and forecasting of immunization and ensuring the right vaccines are administered at the right time are essential for the success of immunization programs. Interpreting the clinically written Advisory Committee on Immunization Practice (ACIP) recommendations by individual clinicians is time-consuming and complex, increasing the risk of misinterpretation, inconsistent practice, and inaccurate immunization evaluation and forecasting. Thus, the purpose of this project is to introduce clinicians at the selected project site to an evidence based clinical decision support tool and evaluate participants readiness to utilize the tool. Staff education on the clinical decision support for immunization (CDSi) tool was conducted …
Development And Validation Of Natural Language Processing Algorithms In The Enact National Electronic Health Record Research Network, Yanshan Wang, Jordan Hilsman, Chenyu Li, Michele Morris, Paul M Heider, Sunyang Fu, Min Ji Kwak, Andrew Wen, Joseph R Applegate, Liwei Wang, Elmer Bernstam, Hongfang Liu, Jack Chang, Daniel R Harris, Alexandria Corbeau, Darren Henderson, John D Osborne, Richard E Kennedy, Nelly-Estefanie Garduno-Rapp, Justin F Rousseau, Chao Yan, You Chen, Mayur B Patel, Tyler J Murphy, Bradley A Malin, Chan Mi Park, Jungwei W Fan, Sunghwan Sohn, Sandeep Pagali, Yifan Peng, Aman Pathak, Yonghui Wu, Zongqi Xia, Salvatore Loguercio, Steven E Reis, Shyam Visweswaran
Development And Validation Of Natural Language Processing Algorithms In The Enact National Electronic Health Record Research Network, Yanshan Wang, Jordan Hilsman, Chenyu Li, Michele Morris, Paul M Heider, Sunyang Fu, Min Ji Kwak, Andrew Wen, Joseph R Applegate, Liwei Wang, Elmer Bernstam, Hongfang Liu, Jack Chang, Daniel R Harris, Alexandria Corbeau, Darren Henderson, John D Osborne, Richard E Kennedy, Nelly-Estefanie Garduno-Rapp, Justin F Rousseau, Chao Yan, You Chen, Mayur B Patel, Tyler J Murphy, Bradley A Malin, Chan Mi Park, Jungwei W Fan, Sunghwan Sohn, Sandeep Pagali, Yifan Peng, Aman Pathak, Yonghui Wu, Zongqi Xia, Salvatore Loguercio, Steven E Reis, Shyam Visweswaran
Faculty, Staff and Student Publications
Electronic health record (EHR) data are a rich and invaluable source of real-world clinical information, enabling detailed insights into patient populations, treatment outcomes, and healthcare practices. The availability of large volumes of EHR data are critical for advancing translational research and developing innovative technologies such as artificial intelligence. The Evolve to Next-Gen Accrual to Clinical Trials (ENACT) network, established in 2015 with funding from the National Center for Advancing Translational Sciences (NCATS), aims to accelerate translational research by democratizing access to EHR data for all Clinical and Translational Science Awards (CTSA) hub investigators. The present ENACT network provides access to …
Expanding Health Insurance For Formerly Incarcerated People, Benjamin Barsky, James R. Jolin, Meredith B. Rosenthal
Expanding Health Insurance For Formerly Incarcerated People, Benjamin Barsky, James R. Jolin, Meredith B. Rosenthal
Faculty Scholarship
No abstract provided.
Immuno-Bioinformatics Study Of Secondary Metabolites From Watercress Nasturtium Officinale As Immunostimulant In Whiteleg Shrimp Litopenaeus Vannamei By Targeting Peroxinectin And Scavenger Receptor Class B, Qurrota A’Yunin, Muhaimin Rifa’I, Maftuch Maftuch, Yoga Dwi Jatmiko, Muhammad Hermawan Widyananda, Triyanto Triyanto, Muhammad Tegar Handrianto
Immuno-Bioinformatics Study Of Secondary Metabolites From Watercress Nasturtium Officinale As Immunostimulant In Whiteleg Shrimp Litopenaeus Vannamei By Targeting Peroxinectin And Scavenger Receptor Class B, Qurrota A’Yunin, Muhaimin Rifa’I, Maftuch Maftuch, Yoga Dwi Jatmiko, Muhammad Hermawan Widyananda, Triyanto Triyanto, Muhammad Tegar Handrianto
Karbala International Journal of Modern Science
The viral disease affects the whiteleg shrimp (Litopenaeus vannamei) and causes losses. Immunostimulants are recognized as a more environmentally friendly approach to disease management and antimicrobial properties of aquatic organisms. Watercress (Nasturtium officinale) is an aquatic plant species that contains antioxidant properties that can protect the organism from disease and boost the immune system. Shrimp rely heavily on innate immunity to combat infectious agents due to their absence of adaptive immunity. Peroxinectin and scavenger receptor class B (SRB) play essential roles in the shrimp defense system. This research employs a bioinformatic to assess the immunostimulatory potential …
Minerals And Human Health: From Deficiency To Toxicity, Mohammed S. Razzaque, Sunil J. Wimalawansa
Minerals And Human Health: From Deficiency To Toxicity, Mohammed S. Razzaque, Sunil J. Wimalawansa
School of Medicine Publications
Minerals are essential nutrients that play critical roles in human health by regulating various physiological functions. Examples include bone development, enzyme function, nerve signaling, and the immune response. Both the deficiencies and toxicities of minerals can have significant health implications. Deficiencies in macrominerals such as calcium, magnesium, and phosphate can lead to osteoporosis (associated with falls and fractures), cardiovascular events, and neuromuscular dysfunction. Trace mineral deficiencies, such as iron and zinc. Selenium deficiency impairs oxygen transport, immune function, and antioxidant defenses, contributing to anemia, delaying wound healing, and increasing susceptibility to infectious diseases. Conversely, excessive intake of minerals can have …
Urine Proteomics Defines An Immune Checkpoint-Associated Nephritis Signature, James P Long, Shailbala Singh, Yanlan Dong, Cassian Yee, Jamie S Lin
Urine Proteomics Defines An Immune Checkpoint-Associated Nephritis Signature, James P Long, Shailbala Singh, Yanlan Dong, Cassian Yee, Jamie S Lin
Faculty, Staff and Student Publications
Immune checkpoint inhibitor (ICI) therapy is a cornerstone treatment for many cancers, but it can induce severe immunotoxicity, including acute interstitial nephritis (AIN). Currently, kidney biopsy is required to differentiate ICI-AIN from other causes of acute kidney injury (AKI). However, this invasive approach can lead to morbidity, delayed glucocorticoid treatment for patients with AIN, and unnecessarily prolonged suspension of ICI therapy in non-AIN patients. Delayed or incorrect diagnosis of ICI-AIN is particularly detrimental, as over 50% of patients are at risk of permanent renal damage. Thus, there is an urgent need for non-invasive biomarkers that can rapidly and accurately distinguish …
Review Of New Treatment Options For Toxoplasmosis, Kiley Roman
Review Of New Treatment Options For Toxoplasmosis, Kiley Roman
D.U.Quark
Toxoplasmosis is an infectious disease caused by the parasite, Toxoplasma Gondii. The parasite is often carried in cats and contaminated food and water. Toxoplasmosis is not serious most of the time but can be harmful to immunocompromised people, pregnant women, and their fetuses or babies. Treatments are commonly given to the immunocompromised. However, there are problems with the current treatments, in which they only treat active parasites and cannot remove the cysts created by disease progression. Due to the treatments’ inability to remove cysts, an infected person may not fully recover from the infection. This review evaluated the new …
Unveiling The Potential Of Generative Artificial Intelligence: A Multidimensional Journey Into The Future, Keng Boon Ooi, Alex Koohang, Eugene Cheng Xi Aw, Tat Huei Cham, Cihan Cobanoglu, Charles Dennis, Yogesh K. Dwivedi, Jun Jie Hew, Heather Linton Kelly, Laurie Hughes, Chieh Yu Lin, Anubhav Mishra, Ian Phau, Ramakrishnan Raman, Marianna Sigala, Yun Chia Tang, Lai Wan Wong, Garry Wei Han Tan
Unveiling The Potential Of Generative Artificial Intelligence: A Multidimensional Journey Into The Future, Keng Boon Ooi, Alex Koohang, Eugene Cheng Xi Aw, Tat Huei Cham, Cihan Cobanoglu, Charles Dennis, Yogesh K. Dwivedi, Jun Jie Hew, Heather Linton Kelly, Laurie Hughes, Chieh Yu Lin, Anubhav Mishra, Ian Phau, Ramakrishnan Raman, Marianna Sigala, Yun Chia Tang, Lai Wan Wong, Garry Wei Han Tan
Research outputs 2022 to 2026
Purpose: The launch of ChatGPT has brought the large language model (LLM)-based generative artificial intelligence (GAI) into the spotlight, triggering the interests of various stakeholders to seize the possible opportunities implicated by it. Nevertheless, there are also challenges that the stakeholders should observe when they are considering the potential of GAI. Given this backdrop, this study presents the viewpoints gathered from various subject experts on six identified areas. Design/methodology/approach: Through an expert-based approach, this paper gathers the viewpoints of various subject experts on the identified areas of tourism and hospitality, marketing, retailing, service operations, manufacturing and healthcare. Findings: The subject …
Water Security In The Wake Of Arizona V. Navajo Nation: How The President’S Emergency Powers Can Provide A Path Forward For The Navajo Nation, Kelly Bridges
University of Chicago Legal Forum
In 2023, the Supreme Court decided Arizona v. Navajo Nation, finding that the United States government does not have an affirmative duty to ensure the Navajo Nation’s water security. The decision offers the Navajo two paths forward for relief: the tribe can either litigate specific water rights claims in the Colorado River Basin or lobby the President and Congress to amend an 1868 treaty, the language of which served as the basis for the holding in Navajo Nation. These paths forward are not without problems. Litigating water rights claims is costly and time-intensive, sometimes taking decades to be decided. As …