Nutrition Commons^™

Nutritional & Colorectal Health, Tariq A. Alam, Brittany R. Rice, Sara B. Police

Journal of Pharmacology & Nutritional Sciences

Kentucky has the highest incidence and mortality rate of all site cancers, and Kentuckians residing in the Appalachian region often have worse outcomes, where cancer is a leading cause of death. Focusing on colorectal cancer (CRC) specifically, Kentucky ranks first nationwide for incidence (50 cases per 100,000 people) and fifth for mortality (about 17 deaths per 100,000 people). The Kentucky Colon Cancer Screening Program increased screening rates and reduced mortality since its launch. Yet, CRC remains a leading cause of death for Kentuckians. Risk factors for CRC include increasing age as well as a history of inflammatory bowel disease (IBD) …

Cultivating Carrots, Community, And Health-Conscious Children: Investigating The Effects Of Community Garden Implementation On Nutrition Attitudes Of Elementary Students In The Los Angeles Unified School District, Hannah Michele Tiedemann

Scripps Senior Theses

Growing up in an urban food desert can significantly affect children's development, health, and well-being (Jencks et al., 1990; Leventhal et al., 2000). Compared to their more affluent peers, youth living in low-socioeconomic urban neighborhoods are at greater risk of experiencing poor-quality diets, food insecurity, unhealthy body weights, and mental health problems (Duncan et al., 1997; Sampson et al., 1997). Moreover, children living in food-insecure households are more likely to consume calorically dense diets high in trans fat and added sugar, putting them at risk for poor health, childhood obesity, and chronic, diet-related diseases as adults (Nielsen et al., 2002). …

การเกิดภาวะพหุสัณฐานทางพันธุกรรมของยีนในวิถีวิตามินดีและความเสี่ยงต่อภาวะออทิซึมสเปกตรัมในประชากรไทย, ชาญณรงค์ แซ่ฉั่ว

Chulalongkorn University Theses and Dissertations (Chula ETD)

กลุ่มอาการออทิซึมสเปกตรัม (Autism spectrum disorder; ASD) เป็นปัญหาสุขภาพระดับโลกที่สำคัญ โดยพบว่ามีความชุกของโรคที่เพิ่มสูงขึ้น อย่างไรก็ตามสาเหตุและกลไกในการเกิดภาวะออทิซึมสเปกตรัมยังไม่ทราบแน่ชัดอาจเกี่ยวข้องกับปัจจัยด้านพันธุกรรมและสิ่งแวดล้อม โดยปัจจุบันมีรายงานถึงบทบาทของวิตามินกับภาวะออทิซึมสเปกตรัม วัตถุประสงค์ของการศึกษานี้คือศึกษาการเกิดภาวะพหุสัณฐานทางพันธุกรรมของยีนในวิถีเมทาบอลิกของวิตามินดีและความเสี่ยงต่อการเกิดภาวะออทิซึมสเปกตรัมและระดับความรุนแรงของโรคในเด็กไทย การศึกษานี้มีจำนวนอาสาสมัคร 276 ราย โดยเป็นกลุ่มเด็กที่มีภาวะออทิซึมสเปกตรัม 169 ราย และกลุ่มควบคุมเป็นเด็กที่ไม่มีโรคทางระบบประสาท 107 ราย ซึ่งได้ทำการตรวจวิเคราะห์ภาวะพหุสัณฐานทางพันธุกรรมของยีน CYP2R1, CYP27B1, GC และ VDR โดยเทคนิค TaqMan-based real-time Polymerase Chain Reaction (PCR) และตรวจวิเคราะห์ระดับวิตามินดีในกระแสเลือดโดยใช้เทคนิค Chemiluminescence Immunoassay (CLIA) โดยเด็กที่พบภาวะออทิซึมสเปกตรัมจะได้รับการตรวจระดับความรุนแรงของภาวะออทิซึมสเปกตรัมด้วย Childhood Autism Rating Scale, 2nd Edition (CARS2) โดยผลที่ได้จากการศึกษาพบว่า การเกิดภาวะพหุสัณฐานทางพันธุกรรมของยีน CYP2R1, CYP27B1, VDR และ GC (rs4588) ไม่มีความสัมพันธ์กับการเกิดภาวะออทิซึมสเปกตรัมและความรุนแรงของอาการออทิซึมสเปกตรัม อย่างไรก็ตามการศึกษาชี้ให้เห็นว่า การเกิดภาวะพหุสัณฐานทางพันธุกรรมของยีน GC (rs7041 (A>C)) มีความสัมพันธ์อย่างมีนัยสำคัญกับความเสี่ยงที่เพิ่มขึ้นต่อการเกิดภาวะออทิซึมสเปกตรัมและความรุนแรงของอาการออทิซึมสเปกตรัมด้วย โดยเฉพาะอย่างยิ่งบุคคลที่มีการขาดระดับวิตามินดีร่วมด้วย นอกจากนี้ผลศึกษาพบว่าไอโซฟอร์มของ GC1s และ GC1s-GC1s ฟีโนไทป์มีความสัมพันธ์อย่างมีนัยสำคัญกับความเสี่ยงต่อการเกิดภาวะออทิซึมสเปกตรัมตลอดจนความรุนแรงของอาการออทิซึมสเปกตรัม โดยสรุปการศึกษาวิจัยในครั้งนี้ชี้ให้เห็นว่า การเกิดภาวะพหุสัณฐานทางพันธุกรรมของยีน GC (rs7041 (A>C)) และไอโซฟอร์ม GC1s อาจเป็นตัวบ่งชี้ทางพันธุกรรมที่สามารถช่วยในการประเมินความเสี่ยงต่อการเกิดภาวะออทิซึมสเปกตรัมและความรุนแรงของอาการออทิซึมสเปกตรัมในเด็กไทยได้ในอนาคต อย่างไรก็ตามการศึกษาในอนาคตควรศึกษาในกลุ่มประชากรที่ใหญ่ขึ้นเพื่อยืนยันผลการศึกษาวิจัยครั้งนี้

A Systematic Review Of Marketing Practices Used In Online Grocery Shopping: Implications For Wic Online Ordering, Leslie Hodges, Caitlin M. Lowery, Priyanka Patel, Joleen Mcinnis, Qi Zhang

Community & Environmental Health Faculty Publications

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer …

The Passion For Eating Well, Samira Fallah, John Marsh, Wei Chen

Business

The Dr. Yum Project, founded by Dr. Nimali Fernando, is a non-profit organization committed to facilitating healthy eating for families. The idea was seeded when, working at pediatric clinics, Dr. Fernando witnessed the alarming rise of childhood obesity and observed children experiencing health issues linked to poor dietary habits. In pursuit of the Dr. Yum Project’s mission, numerous initiatives have been undertaken, with one of the most significant being the development of the Preschool Food Adventure curriculum. In recent years, this curriculum has achieved considerable success and has been actively promoted to various schools. Dr. Fernando holds an optimistic outlook, …

Dietitians’ Self-Efficacy For Implementation Strategies And Evidence-Based Practice Guideline Implementation Behaviors: A Mixed Methods Study, Lisa Moloney

Graduate Research Theses & Dissertations

Background: Evidence-based practice (EBP) guidelines are valuable tools that can help promote the implementation of research into practice. Implementation of EBP guidelines can improve the standardization and quality of healthcare, but unfortunately, they are not routinely used in daily practice. Evidence-based practice is a core component of nutrition and dietetics practice, yet little is known about registered dietitian nutritionists’ (RDNs’) implementation of EBP guidelines. Purpose: The purpose of this study was to investigate RDNs’ reported self-efficacy for using implementation strategies and their reported implementation behaviors for EBP guidelines. Methods: An explanatory mixed methods study guided by the Theory of Planned …

The Impact Of Sugar Sweetened Beverages (Ssbs) Taxes On Consumption And Health Outcomes In Latinx Youth Residing In Los Angeles County, Jacquelyn Campos-Araujo

Pitzer Senior Theses

This proposed research study aims to investigate whether the implementation of sugar-sweetened beverage (SSB) taxes will lead to reduced consumption and improved health outcomes in the Latinx youth population residing in Los Angeles County. The study will utilize a mixed-methods design, including a baseline survey and health examination, the implementation of SSB taxes, and a follow-up survey and health examination. The expected results suggest a statistically significant reduction in SSB consumption and improved glycemic control following the implementation of the SSB taxation intervention. However, I predict a slight decrease in the number of participants with dental caries, indicating that further …

Kidney Stones And Energy Drinks: A Literature Review, Donovan D. Bentz

Schultz-Werth Award Papers

Kidney stones are common, painful, and expensive to treat. Several factors play a role in the development of stones, particularly the consumption of sugars such as fructose. As such, the consumption of sugary energy drinks contributes to the development of kidney stones. However, there is a lack of understanding behind the mechanism of kidney stone development and the role energy drinks play in stone development. This review analyzes the mechanism of kidney stone development and the effect energy drink consumption has on stone development. Here, we also detail the dietary roles calcium, oxalate, ascorbic acid, and animal protein have on …

Increasing Efficiency Of Finishing Beef Production: Strategies To Optimize Starch Digestion, Improve Flake Quality, And Reduce Methane Emissions, Ronald J. Trotta

Theses and Dissertations--Animal and Food Sciences

To continue to meet the demands of increasing food production and environmental sustainability, new strategies are needed to enhance the efficiency of finishing cattle production. A review of the literature identified several nutritional and physiological constraints that limit the ability for cattle to digest starch and absorb glucose from the small intestine. Comparative sequencing analyses revealed a missing region of the sucrase-isomaltase protein which could affect the capacity for starch digestion in cattle. Post-flaking sampling and handling recommendations were generated based on a series of experiments to improve estimates of starch availability and flaking consistency for commercial feedlots and laboratories. …

Maize, Fish, And Leafy Greens: Agricultural Diversity In Rural Zambia, Claire Gillespie

NUTR/GLST 498b: Global Research Experiences in Nutrition and Health

In Zambia, where 40% of children are stunted, there is limited interest in farming among primary school children as they consider their future. As grocery stores replace open-air markets, access to indigenous foods will become more difficult. Although 73 different types of foods were found in open-air markets, Zambian diets tend to be monotonous. Maize is the staple food and maize-based foods such as nshima are consumed daily, perpetuating low nutritional intake. Increasing crop diversity can increase balanced diets in Zambian school children and better support a growing population.

Running From Malnutrition: Zambian Children And Growth In The Eastern And Southern Provinces, Cole Murphy

NUTR/GLST 498b: Global Research Experiences in Nutrition and Health

Although malnutrition rates remain high in Zambia, there are limited data for primary school children on factors that contribute to poor growth. This study was designed to examine one factor rarely considered in research about stunting, i.e., energy expenditure among primary school children and its contribution to short stature. § §Historically, stunting has been a major public health issue in much of sub-Saharan Africa and continues to yield severe consequences for physical and mental development throughout the lifespan (Iversen et al., 2022). §Both household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa (Gassara et al., …

Letter From The Dean, Jean-Francois Meullenet

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

No abstract provided.

Discovery: The Student Journal Of Dale Bumpers College Of Agricultural, Food And Life Sciences - Volume 24 2023, Several Authors

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

No abstract provided.

Letter From The Faculty Editor, Beth Kegley

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

No abstract provided.

Effects Of Time-Restricted Feeding And Whey Protein Isolate Supplementation On Dietary Intake, Mood, And Sleep In A 12-Week Randomized Controlled Trial, Sydney E. Boudrey, Aubree L. Hawley

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Obesity affects adults in the United States, leading to chronic diseases and reduced well-being. Time-Restricted Feeding (TRF) is a type of dietary intervention lacking current data regarding the effectiveness on facets of well-being. This study’s objective was to determine the effect of time-restricted feeding supplemented with whey protein isolate on food intake, sleep, and mood in overweight or obese adults. Nineteen participants were randomly assigned to the control or experimental group: 1) control, TRF, and 2) experimental, TRF with whey protein supplementation. Participants followed the assigned dietary intervention for 12 weeks. Every 4 weeks (baseline, week 4, week 8, and …

Rice Biomass Response To Various Phosphorus Fertilizers In A Phosphorus-Deficient Soil Under Simulated Furrow-Irrigation, Jonathan B. Brye, Kristofor R. Brye, Diego Della Lunga

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Wastewater-recovered phosphorus (P), in the form of the mineral struvite (MgNH4PO4∙6H2O), may provide a sustainable alternative to decreasing rock-phosphate reserves. Struvite can be generated via precipitation methods, potentially reducing the amount of P runoff to aquatic ecosystems. The objective of this greenhouse tub study was to evaluate the effects of chemically and electrochemically precipitated struvite (CPST and ECST, respectively) on aboveground plant response in a hybrid rice cultivar grown using furrow-irrigation compared to other common fertilizer-P sources [i.e., triple super phosphate (TSP) and diammonium phosphate (DAP)] using three replications of fertilizer treatment in a P-deficient silt loam (Typic Glossaqualfs). Aboveground …

Fostering Infant And Toddler Music Competence At The Jean Tyson Child Development Study Center, Ellen Mathews, Laura Herold, Shelley Mcnally, Donia Timby

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

This paper presents a creative research project that introduced musical instruments in an outdoor setting to infants and toddlers ages 0-to-3 years old. It was grounded in research suggesting that music plays a vital component in expanding development in the early childhood years, helping to promote learning across many domains. This project began with a survey distributed to 7 infant and toddler classroom educators, after which responses were analyzed for themes regarding perceived infant interests. Subsequent observations were conducted to evaluate the best fit for the implementation of an outdoor experiential music space. Based on the findings, a developmentally appropriate …

Effects Of Cyclic Heat Stress On The Acute Inflammatory Response In Broilers, Alessandro J. Rocchi, Chrysta N. Beck, Jossie M. Santamaria, Gisela F. Erf

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Heat stress (HS) is a growing concern in broiler production. Little is known regarding the effect of HS on immune function. To examine the effects of HS on innate immunity, the local- and systemic-inflammatory responses to lipopolysaccharide (LPS) were examined in Cobb 500 male broiler chicks reared under thermoneutral (TN) or cyclic HS conditions. Beginning at four days of age, HS birds were subjected to 35 °C from 8:00 a.m. to 10:00 p.m. and TN temperatures from 10:00 p.m. to 8:00 a.m. At 37 days of age, four groups of broilers were formed: LPS-TN (8 broilers), phosphate-buffered saline (PBS)-TN (4 …

An Inclusive Playground For Infant And Toddler Development, Amanda M. Swartz, Jacquelyn D. Wiersma-Mosley, Donia Timby, Shelley Mcnally, Caitlyn Daniel

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

The purpose of this project was to help children reach more developmental goals and to make outdoor play at the Jean Tyson Child Development Study Center more inclusive for all children. Children gain many developmental goals from playing outside and being exposed to other environments as compared to just being inside the classroom. Outdoor play should be as inclusive as indoor play and offer many different activities and outlets, just as the indoor classroom does. The implementation of this service-learning creative project was to add more versatility to the outdoor area at the University of Arkansas Jean Tyson Child Development …

Validation Of A Diagnostic Marker For Primocane-Fruiting In Blackberry, Isabella Vaughn, Alexander Silva, Carmen Johns, Lacy Nelson, Margaret Worthington

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Typical blackberries (Rubus subgenus Rubus) have perennial crowns and roots and biennial canes. The first-year canes (primocanes) are usually vegetative, while second-year canes (floricanes) produce fruit. Primocane-fruiting blackberries produce fruit on first-year canes and are desirable to growers because they potentially allow for a longer harvest season in temperate regions and enable production in tropical areas where no natural chill hours are accumulated. The development of molecular markers for desirable traits can potentially increase efficiency in blackberry breeding. However, to date, there are no diagnostic molecular markers for economically important traits in blackberries. Primocane-fruiting is recessively inherited, and tetraploid blackberries …

Obesity During Adolescence And Feeding Practices During Infancy: Cross-Sectional Study, Reem Sharaf-Alddin, Radhia Almathkoori, Hara Kostakis, Ahmed N. Albatineh, Abdullah Al-Taiar, Muge Akpinar-Elci

Community & Environmental Health Faculty Publications

Background: Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East.

Aims: To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy.

Methods: This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure …

The Role That Diet And Lifestyle Factor Plays In An Increased Risk For Cardiovascular Disease In Asians And Pacific Islanders, Ethan Caragan

Nursing | Student Research Posters

Cardiovascular disease is the leading global cause of mortality, often resulting in heart attacks and strokes due to obstructed blood flow to vital organs. The risk of these events is influenced by dietary choices, smoking, and physical activity. Despite preventative measures, the impact of diet and lifestyle on cardiovascular health varies across ethnic groups. This thesis aims to evaluate how variations in dietary traditions and lifestyle among Asians and Pacific Islanders contribute to increased or decreased cardiovascular disease risks compared to other racial groups. The study focuses on the dietary and lifestyle factors of Asian Americans and Pacific Islanders in …

An Analysis On How Housing Status Influences The Gut-Brain-Axis For Populations In And Around The Skid Row Area Of Los Angeles, California, Mauricio Guzman

Pitzer Senior Theses

Over recent years, the “microbiota-gut-brain axis” (MGBA) has garnered significant attention in the scientific community. Specifically, perturbations of the MGBA via stress and dietary intake have been linked to a wide-range of diseases including gastrointestinal diseases, metabolic diseases, mood disorders, and cognitive diseases. However, most studies have been solely conducted on mice models and have yet to consider the more complex, intricate systems that impact the human body. In addition, researchers have yet to consider the populations who may be most susceptible to chronic stress and negative dietary outcomes. Drawing from the fields of medical sociology, non-invasive human biology, and …

Examining The Utility Of A Kentucky Fcs Cooperative Extension Curriculum On Community Members’ Healthy And Sustainable Diet-Related Behaviors, Catharine Pickford

Theses and Dissertations--Nutrition and Food Systems

Experts recommend individuals adopt healthy and sustainable dietary behaviors to improve human and environmental health. The objective of this study was to pilot a sustainable eating Family and Consumer Sciences (FCS) Cooperative Extension curriculum and evaluate the effectiveness of the lesson series by measuring participants’ changes in knowledge, perceptions, and intentions towards healthy and sustainable dietary behaviors as well as overall satisfaction with lessons. A five-lesson sustainable eating curriculum was developed with topics focused on: reducing food waste; eating more seasonal, local plant-based foods; varying protein sources; maintaining energy balance; and consuming fewer highly processed and packaged foods. To assess …

Relationships Between Behavior, Energy Metabolites, And Corticosterone In Black-Legged Kittiwake (Rissa Tridactyla) Nestlings, Sierra Pete

Master’s Theses

Birds can cope with energy-shifting challenges by redirecting energy and behavior to maintain energetic homeostasis. Nestlings allocate energy to support their rapid growth and developmental period; thus, their challenges and the subsequent energetic demands can be much different than an adult. At a baseline level, energy is constantly shifting in response to regularly occurring challenges; however, more substantial challenges can initiate the production of glucocorticoid hormones. In birds, the main glucocorticoid is corticosterone. Corticosterone is believed to aid in energy homeostasis by redirecting energy metabolite mobilization. Energy metabolites are intermediaries or end products of cellular metabolism, thus, metabolites like glucose …

Alzheimer’S Disease Genetics And Short-Chain Fatty Acid Treatment In Studies Of The Murine Gut Microbiome, Diana Zajac

Theses and Dissertations--Physiology

Elucidating the relationship of the gut microbiome in Alzheimer's Disease (AD) risk and pathogenesis is an area of intense interest. Since 60 to 80% of AD risk is related to genetics and APOE alleles represent the most impactful genetic risk factors for AD, their mechanism(s) of action are under intense scrutiny.

First, I conducted a study on APOE targeted replacement mice to investigate the impact of APOE alleles on the murine gut microbiome. The relative abundance of bacteria from the family Ruminococacceae and related genera increased with APOE2 status. The relative abundance of the class Erysipelotrichia increased with APOE4 status, …

Risk Of Low Energy Availability, Disordered Eating, And Menstrual Dysfunction In Female Collegiate Runners, Leah Louise Dambacher

All Master's Theses

Collegiate female distance runners may be at risk for low energy availability (LEA) due to increased exercise energy expenditure with or without decreased energy intake. Furthermore, this population has increased risk of disordered eating (DE), which can lead to LEA and negative health consequences, such as menstrual dysfunction (MD). Purpose: The purpose of this study was to: 1) investigate risk of LEA and DE and 2) compare DE, training volume, and weight dissatisfaction among female collegiate runners athletes at risk vs not at risk for LEA. Methods: Female runners (n = 287) who competed on an NCAA Division …

Impact Of The Washington State Covid-19 Lockdown On 5-10-Year-Ol School-Aged Children Residing In Kitties County, Peyton Rondeau

All Master's Theses

Background: The Washington State COVID-19 lockdown and subsequent school closures brought increased dependency on parents to provide nutritious meals and opportunities for physical activity for their children.

Purpose: The aim of this study was to describe the impacts of the Washington State COVID-19 lockdown on the dietary, physical activity, and screen time habits of children ages 5-10-years-old residing in Kittitas County.

Methods: A researcher-developed Qualtrics survey was created and validated via the Index of Item Objective Congruence. The survey was administered to parents via Facebook, using local Kittitas County Facebook groups.

Results: Most parents identified that the Washington lockdown negatively …

I2n: Image To Nutrients, A Sensor Guided Semi-Automated Tool For Annotation Of Images For Nutrition Analysis Of Eating Episodes, Tonmoy Ghosh, Megan A Mccrory, Tyson Marden, Janine Higgins, Alex Kojo Anderson, Christabel Ampong Domfe, Wenyan Jia, Benny Lo, Gary Frost, Matilda Steiner-Asiedu, Tom Baranowski, Mingui Sun, Edward Sazonov

Children’s Nutrition Research Center Staff Publications

Introduction: Dietary assessment is important for understanding nutritional status. Traditional methods of monitoring food intake through self-report such as diet diaries, 24-hour dietary recall, and food frequency questionnaires may be subject to errors and can be time-consuming for the user.

Methods: This paper presents a semi-automatic dietary assessment tool we developed - a desktop application called Image to Nutrients (I2N) - to process sensor-detected eating events and images captured during these eating events by a wearable sensor. I2N has the capacity to offer multiple food and nutrient databases (e.g., USDA-SR, FNDDS, USDA Global Branded Food Products Database) for annotating eating …

Small Bowel Obstruction In Postpartum Vaginal Delivery Due To Prior Abdominal Adhesions Case Report, Liubin Yang, Lydia Kao

Children’s Nutrition Research Center Staff Publications

Intestinal obstruction rarely occurs after uncomplicated vaginal deliveries. Here, we present a case of a multiparous woman with a history of prior appendectomy presenting with generalized, nonspecific abdominal pain that was out of proportion to exam findings. Initial abdominal X-ray was nonspecific, and subsequent computed tomography (CT) abdomen showed closed small bowel obstruction requiring surgical repair. We present a case of intestinal obstruction occurring within 24 hours of uncomplicated vaginal delivery with a risk factor of a prior appendectomy surgery and the use of CT abdomen and pelvis to expedite diagnose.