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Articles 61 - 90 of 18903
Full-Text Articles in Business Administration, Management, and Operations
From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus
From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus
Patient Experience Journal
After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …
Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii
Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii
Patient Experience Journal
Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …
Pathways To Patient-Provider Conflict In Nigeria: A Structural Equation Model Of Expectations, Communication, Trust, And Organizational Constraints, Akaninyene O. Unaam, Christie Divine Akwaowo, Edidiong A. Unaam
Pathways To Patient-Provider Conflict In Nigeria: A Structural Equation Model Of Expectations, Communication, Trust, And Organizational Constraints, Akaninyene O. Unaam, Christie Divine Akwaowo, Edidiong A. Unaam
Patient Experience Journal
Objective: This study empirically investigated the drivers of patient-provider conflict and tested a conceptual model linking treatment expectations, communication, trust, and organizational constraints to conflict intensity in Nigerian tertiary care. Methods: A cross-sectional survey of 400 patients (response rate 82.3%) and 150 healthcare providers (response rate 71.2%) from three Nigerian tertiary hospitals was conducted using stratified random sampling. Validated, culturally adapted scales measured unrealistic treatment expectations, communication barriers, organizational constraints, trust, and conflict intensity. Data were analyzed using Structural Equation Modeling (SEM) with maximum likelihood estimation and bootstrapping for mediation testing. Multi-group confirmatory factor analysis established measurement invariance across samples. …
Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn
Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn
Patient Experience Journal
Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …
Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura
Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura
Patient Experience Journal
While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and …
From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding
From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding
Patient Experience Journal
This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, …
Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes
Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes
Patient Experience Journal
An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so the male perspective is largely missing from the literature. This narrative is an account of my personal journey of secondary infertility. Presenting a male perspective of infertility provides a point of view which is rarely explored and is about a topic which feels largely a societal taboo. I chart how infertility has changed me, what it has meant to me through my years of trying to come to …
When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster
When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster
Patient Experience Journal
Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it …
Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher
Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher
Patient Experience Journal
Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized …
Building Trust In The Absence Of Certainty: Community As Trust In Action, Jennifer A. Owens
Building Trust In The Absence Of Certainty: Community As Trust In Action, Jennifer A. Owens
Patient Experience Journal
This personal narrative explores how trust is experienced and sustained in the context of serious illness, where uncertainty is persistent and control is limited. Drawing on the lived experience of caregiving for a child with an undiagnosed congenital diaphragmatic hernia (CDH), this personal narrative examines how trust emerges not as a matter of belief or individual choice, but as something recognized through the actions of others.
Rebuilding Trust After Bondi Beach: Healing Patients, Protecting Caregivers, And The Sacred Work Of Care, Anne Marie Hadley
Rebuilding Trust After Bondi Beach: Healing Patients, Protecting Caregivers, And The Sacred Work Of Care, Anne Marie Hadley
Patient Experience Journal
The Bondi Beach tragedy of December 14, 2025 profoundly disrupted Australia's collective sense of safety, belonging, and trust. Beyond the immediate loss of life and injury, such events exert lasting impacts on healthcare systems and the people who work within them. This article explores how trust can be rebuilt not only for patients and communities, but also for caregivers themselves. Drawing on trauma-informed care, psychological safety, and human experience design, it examines the often-overlooked dimensions of staff safety, the essential role of pastoral care and chaplaincy, and the particular vulnerabilities experienced by faith-based caregivers during periods of social fracture and …
Supporting The Human Experience: Why Compassion Outperforms Empathy In Care Delivery, Katelyn Carey
Supporting The Human Experience: Why Compassion Outperforms Empathy In Care Delivery, Katelyn Carey
Patient Experience Journal
Healthcare professionals are often taught that empathy, defined as imagining oneself in the emotional experience of another, is essential to providing excellent care. Yet in high-stress, high-stakes clinical environments, the very tool given to increase patient and employee connection can contribute to disengagement, burnout, and diminished resiliency. This research review article examines the longstanding conflation of empathy and compassion in healthcare and argues that the distinction between the two is not merely semantic but critical to provider well-being and patient outcomes. Drawing on research from neuroscience, psychology, and communication studies, the piece outlines how emotional, perspective-taking empathy activates the brain's …
Racial Concordance And The Assumption Of Trust: Why Engagement Is Often Mistaken For Partnership In The Care Of Black Men, Samantha Faith Calhoun, Lacretia Carroll, Y'Esha Williams-Click, Kola Brown
Racial Concordance And The Assumption Of Trust: Why Engagement Is Often Mistaken For Partnership In The Care Of Black Men, Samantha Faith Calhoun, Lacretia Carroll, Y'Esha Williams-Click, Kola Brown
Patient Experience Journal
Race concordance between patients and clinicians is frequently promoted as a strategy to improve trust and engagement for Black men in healthcare. Evidence suggests that encounters with Black male clinicians often increase patient comfort and observable engagement; however, engagement alone does not necessarily reflect trust. Drawing on professional experience as a nurse and researcher working with Black men, and on prior research examining shared decision-making preferences among Black men with hypertension in the U.S. Mid-South, this Personal Narrative examines how race-concordant encounters may rely on presumed trust, leading clinicians to advance diagnosis and treatment planning without adequate co-construction of care. …
Building Or Breaking Trust In Healthcare Through Patient And Family Engagement In Research And Service Design: The Need For Authentic Engagement Practices, Lisa D. Hawke, Hajar Seiyad, Shoshana Hauer, Charlotte Munro, Natasha Y. Sheikhan
Building Or Breaking Trust In Healthcare Through Patient And Family Engagement In Research And Service Design: The Need For Authentic Engagement Practices, Lisa D. Hawke, Hajar Seiyad, Shoshana Hauer, Charlotte Munro, Natasha Y. Sheikhan
Patient Experience Journal
Trust in the healthcare system is an important driver of public health, but is sometimes lacking among individuals and communities. Patient and family engagement in research and service development is one proposed means of influencing trust. Patients and families can be engaged authentically and meaningfully as partners in the conduct of research and the development of healthcare services. When engagement is conducted following best practices, patients and families have the opportunity to build strong mutual relationships with project leads, hold a share of the power in the discipline, and exercise choice to influence the research and service development agenda. These …
Co-Designing Trust: Patient Experience, Relationships, And The Design Of Care, Toni Land
Co-Designing Trust: Patient Experience, Relationships, And The Design Of Care, Toni Land
Patient Experience Journal
Trust can have a positive or negative impact on patients, families, and community healthcare experience. Although important, it is often treated as something soft and intangible rather than something intentionally measured and designed. Currently, healthcare organizations collect and report patient experience data related to communication, courtesy, respect, and responsiveness. But these measures do not capture the specific behaviors that influence whether trust builds or whether it stalls. This commentary explores trust as a foundational behavioral and environmental element in healthcare and challenges that improving trust requires more than good intentions; it requires bringing voices to the table through co-design. Starting …
A Modern Playbook For Trust Across The Health Ecosystem, Erin O'Malley
A Modern Playbook For Trust Across The Health Ecosystem, Erin O'Malley
Patient Experience Journal
Public trust in health care delivery, public health, and biomedical innovation is at a historic low. While many place the blame on the COVID-19 pandemic and the proliferation of social media, the reality is that distrust is a deeply rooted structural challenge that has plagued the U.S. for centuries. It is tied to historical movements for medical freedom and centuries of systemic discrimination and earned mistrust among minoritized communities. Today, this crisis is compounded by a lack of shared values and facts and the rising dominance of tribal identity over objective science. The Coalition for Trust in Health & Science …
Healing The Social Covenant: Rebuilding Trust And Re-Humanizing Healthcare, Cynda Hylton Rushton
Healing The Social Covenant: Rebuilding Trust And Re-Humanizing Healthcare, Cynda Hylton Rushton
Patient Experience Journal
Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of …
Trust: Why A Commitment To Human Experience Matters, Jason A. Wolf
Trust: Why A Commitment To Human Experience Matters, Jason A. Wolf
Patient Experience Journal
Trust is one of the most essential elements in our overall human existence. It is a critical part of our human experience, one that reaches well beyond the boundaries of healthcare. Trust is the element that holds society together. It emerges in the relationship of one human being connecting with another human being, and it reaches to the engagements people have with organizations, institutions, and systems as well. Trust, while hard to hold, is ever present. It is a powerful force that guides our way of being, our interactions, our choices, even if we ourselves are not directly conscious of …
Foundations Of Project Management, Michael Daniel Sherwin
Foundations Of Project Management, Michael Daniel Sherwin
Open Education Materials
This book aims to equip readers with practical tools and strategies for managing people, resources, and tasks effectively. We include examples, case studies, references, and tools and templates. We encourage you to explore references and videos to deepen your understanding of project management. It is designed for everyone, not just those individuals seeking to be project managers. Whether you are supporting or leading projects, this course will provide a foundation for developing the skills needed to drive results within an organization.
Course: GRBU 638
Creative Commons Attribution
Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy
Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy
Master's Projects and Capstones
Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs.
Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.
Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …
The Startup: Critical Perspectives On Technology Entrepreneurship And Digital Labor, Kochav Koren
The Startup: Critical Perspectives On Technology Entrepreneurship And Digital Labor, Kochav Koren
All Duquesne Faculty Scholarship
Communication and media studies are rapidly reshaped by socio-technological forces within the framework of informational capitalism, where startups emerge as key drivers of the global creative economy. This study critically examines the global startup movement through political economy, classical sociology, and Southern perspectives to assess whether digital entrepreneurship fosters genuine, decentralized innovation or perpetuates speculative financialization and labor precarity. Employing a multi-layered theoretical framework—including Schumpeterian creative destruction, Marxist commodity fetishism, and Weberian charismatic authority—and qualitative fieldwork across North and Latin American tech hubs, the analysis reveals startups as network enterprises that both disrupt markets and reproduce structural inequalities. The findings …
Ai You Can Trust: Understanding The Role Of Structural Assurance And Situational Normality In The Use Of Generative Ai, Olushola Bunmi Abayomi
Ai You Can Trust: Understanding The Role Of Structural Assurance And Situational Normality In The Use Of Generative Ai, Olushola Bunmi Abayomi
Dissertations
The rapid growth of generative artificial intelligence (GenAI) has increased its use in productivity, content creation, and decision support; however, adoption depends on user trust, as GenAI performs tasks that are often associated with human judgment. Drawing on the Trust in Technology Model, this dissertation examines how structural assurance and situational normality influence Trust in GenAI, and how Trust in GenAI affects trusting intentions and users' willingness to depend on GenAI. Structural assurance and situational normality, captured through several factors, were modeled as antecedents of Trust in GenAI and, in turn, trusting intentions. The model was tested using survey-based experimental …
Identifying The Threshold: Using Regulatory Focus As A Predictor Of Ceo Adaptibility During Environmental Changes, George B. Constantine Iii
Identifying The Threshold: Using Regulatory Focus As A Predictor Of Ceo Adaptibility During Environmental Changes, George B. Constantine Iii
Dissertations
Building on research on CEO turnover and strategic leadership, this study examines how decision makers' regulatory focus shapes strategic decision-making and how this can contribute to performance decline, often resulting in CEO replacement. Drawing on regulatory focus theory, the study theorizes that measurable chronic regulatory focus attributes influence decision makers’ capacity to adapt to environmental change—conditions under which prior research suggests executives may become rigid and persist with established strategies. Despite its relevance for strategic adaptation, such chronic trait behavior has received limited attention in the current business literature. To address this gap, effectuation theory is integrated into a simulation-based …
The Evolution Of The Modern Library Brand: Transforming Community Engagement Into Sustainable Revenue, Slone Williams
The Evolution Of The Modern Library Brand: Transforming Community Engagement Into Sustainable Revenue, Slone Williams
Georgia Library Quarterly
This article examines the development of the Cobb Library Shop, an e-commerce initiative launched by the Cobb County Public Library to generate sustainable funding through brand engagement. Built on a modest startup budget, the shop integrates a multichannel sales strategy and leverages internal talent to create a scalable, community-centered retail model.
The project achieved a full return on investment within 14 days and continues to demonstrate steady revenue expansion. By combining entrepreneurial practices with public service values, this case study highlights how libraries can diversify funding streams, enhance community engagement, and establish a replicable model for revenue-generating library systems.
J Mich Dent Assoc August 2026
The Journal of the Michigan Dental Association
Each month, the Journal of the Michigan Dental Association delivers news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200-plus members. It remains the main publication reaching Michigan dentists and is available worldwide through ADA Commons.
The August 2026 (Volume 108, No. 8) issue of the Journal is published in print format to provide updates and insights for Michigan's oral health community and MDA members. Print editions occur every other month beginning with January.
The August 2026 issue of the Journal of the Michigan Dental Association explores clinical, professional, legal, leadership, and public …
Mda At Your Service: Updating Your Practice Roster With The Mda, Mda Membership Department Staff
Mda At Your Service: Updating Your Practice Roster With The Mda, Mda Membership Department Staff
The Journal of the Michigan Dental Association
This question-and-answer article provides practical guidance for MDA members on updating practice rosters, accessing continuing education opportunities, addressing staffing shortages through virtual assistants, and participating in the MDA LEAD Program. The article highlights available member resources and emphasizes professional development, workforce support, and leadership growth within organized dentistry.
The Back Page: A Toast To The Future: From Boomers To Gen Z Zoomers, George T. Goodis Dds, Gerald J. Halk Dds
The Back Page: A Toast To The Future: From Boomers To Gen Z Zoomers, George T. Goodis Dds, Gerald J. Halk Dds
The Journal of the Michigan Dental Association
This article highlights a leadership brunch that brought together multiple generations of dental leaders to encourage engagement in organized dentistry. The gathering emphasized mentorship, leadership development, and the transfer of institutional knowledge to younger dentists. Participants celebrated the future of the profession while discussing the importance of community involvement, leadership participation, and professional growth.
Exploring Factors Related To Retention Of Young Soccer Officials, Jacob K. Tingle, Lynn L. Ridinger, David J. Hancock, Joseph Foran, Lucas Ribeiro
Exploring Factors Related To Retention Of Young Soccer Officials, Jacob K. Tingle, Lynn L. Ridinger, David J. Hancock, Joseph Foran, Lucas Ribeiro
School of Business Faculty Research
Purpose/Rationale
The purpose of this study was to examine factors (needs and motivations) that contribute to retention of young soccer officials.
Design/Methodology/Approach
An online survey was distributed to soccer referees who received their first USSF officiating license as a juvenile.
Findings:
Correlational and regression analyses yielded five key findings: (1) Self-Determination Theory (SDT) principles are salient to retention; (2) Intrinsic Motivation and Sense of Community significantly impact retention; (3) variables across scales were highly correlated and had large effect sizes; (4) findings were similar across demographic variables; and (5) small increases to Relatedness and Choice had a large impact on …
Navigating The Dark Side: Emotional Labor's Impact On Hr Professionals' Wellness, Esmeralda Amelia Rendón
Navigating The Dark Side: Emotional Labor's Impact On Hr Professionals' Wellness, Esmeralda Amelia Rendón
Electronic Theses and Dissertations
This qualitative descriptive study was designed to document and describe how female-identifying human resource (HR) generalist practitioners serving as sole or primary employee relations practitioners in small- to medium-sized organizations across the United States experience and manage emotional labor in their roles, cope with its demands, and how these experiences impact their wellness and perceptions of organizational support. Despite the centrality of emotional labor (EL) in human resource professionals’ (HRPs) roles, little was known about how HRPs in these underresourced environments cope with these demands. Data were collected through semistructured virtual interviews with eight participants and analyzed using Braun and …
Religious Practice And Attitudes Toward Immigration And Racial Justice In America, Amya Douglas
Religious Practice And Attitudes Toward Immigration And Racial Justice In America, Amya Douglas
Graduate Theses and Dissertations (2019 - present)
This study aims to understand how Christians’ knowledge of Scripture and involvement in the church have an impact on their social-political views, specifically, racial justice and immigration. By using the survey responses from the 6th wave of the Baylor Religion Survey, more frequent church attendance and reading Scripture were correlated with a greater recognition of racism in terms of being against white supremacy and white nationalism, supporting racial justice when asked about racial gaps, and possessing greater support for immigrants. This study highlights the distinction between religious affiliation and religious practice, and it suggests that certain policy sentiments can be …