Medicine and Health Sciences Commons^™

The Complementary Health Approaches For Pain Survey (Chaps): Validity Testing And Characteristics Of A Rural Population With Pain, Termeh Feinberg, Dina L. Jones, Christa Lilly, Amna Umer, Kim Innes

Faculty & Staff Scholarship

Objectives

Little is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS).

Design

Following pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10–12 minutes to com- plete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Trans- theoretical Model (TTM) underpinning to …

Ssaw: A New Sequence Similarity Analysis Method Based On The Stationary Discrete Wavelet Transform, Jie Lin, Donald Adjeroh, Bing-Hua Jiang, Yue Jiang

Faculty & Staff Scholarship

Background: Alignment-free sequence similarity analysis methods often lead to significant savings in computational time over alignment-based counterparts.

Results: Anewalignment-freesequencesimilarityanalysismethod,calledSSAWisproposed.SSAWstandsfor Sequence Similarity Analysis using the Stationary Discrete Wavelet Transform (SDWT). It extracts k-mers from a sequence, then maps each k-mer to a complex number field. Then, the series of complex numbers formed are transformed into feature vectors using the stationary discrete wavelet transform. After these steps, the original sequence is turned into a feature vector with numeric values, which can then be used for clustering and/or classification.

Conclusions: Usingtwodifferenttypesofapplications,namely,clusteringandclassification,wecomparedSSAW against the the-state-of-the-art alignment free sequence analysis methods. SSAW demonstrates competitive or …

Subclinical Atherosclerosis, Cardiovascular Health, And Disease Risk: Is There A Case For The Cardiovascular Health Index In The Primary Prevention Population?, Sarah S. Singh, Courtney S. Pilkerton, Carl D. Shrader Jr, Stephanie J. Frisbee

Faculty & Staff Scholarship

Background: Current primary prevention guidelines for cardiovascular disease (CVD) prioritize risk identification, risk stratification using clinical and risk scores, and risk reduction with lifestyle interventions and pharmacotherapy. Subclinical atherosclerosis is an early indicator of atherosclerotic burden and its timely recognition can slow or prevent progression to CVD. Thus, individuals with subclinical atherosclerosis are a priority for primary prevention. This study takes a practical approach to answering a challenge commonly faced by primary care practitioners: in patients with no known CVD, how can individuals likely to have subclinical atherosclerosis be easily identified using existing clinical data and/or information provided by the …

Possible Bite-Induced Abscess And Osteomyelitis In Lufengosaurus (Dinosauria: Sauropodomorph) From The Lower Jurassic Of The Yimen Basin, China, Lida Xing, Bruce M. Rothschild, Patrick S. Randolph-Quinney, Yi Wang, Alexander H. Parkinson, Hao Ran

Faculty & Staff Scholarship

We report an osseous abnormality on a specimen of the sauropod dinosaur Lufengosaurus huenei from the Fengjiahe Formation in Yuxi Basin, China. A gross pathological defect occurs on the right third rib, which was subjected to micro-computed tomographic imaging as an aid in diagnosis. The analysis of pathological characteristics and the shape of the abnormality is incompatible with impact or healed trauma, such as a common rib fracture, and instead suggests focal penetration of the rib, possibly due to a failed predator attack. The identification of characteristics based on gross morphology and internal micro-morphology presented by the specimen, suggests an …

Brief Report: Exercise And Blood Pressure In Older Adults—An Updated Look, George A. Kelley, Kristi S. Kelley

Faculty & Staff Scholarship

Background/Objectives. Raised blood pressure is a major problem in older adults. Using a random-effects model, a recent meta- analysis reported statistically significant reductions in both resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) as a result of aerobic, resistance, and combined aerobic and resistance exercise in adults ≥65 years. To provide more objective information regarding this nonpharmacologic approach, this study applied more robust methods to this data. Design. Meta-analysis of 41 randomized controlled trials representing 96 groups (52 exercise; 44 control). Setting. Any location where a randomized controlled trial could be conducted. Participants. Adults ≥65 years. Intervention. Trials …

Brief Report: Exercise And Anxiety In Adults With Arthritis And Other Rheumatic Diseases: Support For Evidential Value, George A. Kelley, Kristi S. Kelley, Leigh F. Callahan

Faculty & Staff Scholarship

Objective. Given the high prevalence of anxiety in adults with arthritis and other rheumatic diseases (AORD) and the subsequent need for interventions to reduce anxiety, this brief report sought to determine if evidential value exists to support the role of exercise for reducing anxiety in adults with AORD. Methods. Utilizing data from a prior meta-analysis, a recently developed approach, P- curve, was used to determine evidential value by assessing for publication bias and p-hacking. Binomial tests as well as the more robust Stouffer’s test were used to examine for evidential value. To examine the influence of selected studies on p-curve …

Effects Of Mantra Meditation Versus Music Listening On Knee Pain, Function, And Related Outcomes In Older Adults With Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (Rct), Kim Innes, Terry Kit Selfe, Sahiti Kandati, Sijin Wen, Zenzi Huysmans

Faculty & Staff Scholarship

Objective. Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA. Methods. Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included …

Three-Dimensional Imaging Of Kndy Neurons In The Mammalian Brain Using Optical Tissue Clearing And Multiple-Label Immunocytochemistry, Aleisha M. Moore, Kathryn A. Lucas, Robert L. Goodman, Lique M. Coolen, Michael N. Lehman

Faculty & Staff Scholarship

Kisspeptin/Neurokinin B/Dynorphin (KNDy) neurons of the arcuate nucleus (ARC) play a key role in the regulation of fertility. The ability to detect features of KNDy neurons that are essential for fertility may require three-dimensional (3D) imaging of the complete population. Recently developed protocols for optical tissue clearing permits 3D imaging of neuronal populations in un-sectioned brains. However, these techniques have largely been described in the mouse brain. We report 3D imaging of the KNDy cell population in the whole rat brain and sheep hypothalamus using immunolabelling and modification of a solvent-based clearing protocol, iDISCO. This study expands the use of …

Macrophage Sensing Of Single- Walled Carbon Nanotubes Via Toll- Like Receptors, Sourav P. Mukherjee, Olesja Bondarenko, Pekka Kohonen, Fernando T. Andon, Tana Brzicova, Isabel Gessner, Sanjay Mathur, Massimo Bottini, Paolo Calligari, Lorenzo Stella, Elena Kisin, Anna Shvedova, Reija Autio, Heli Salminen-Mankonen, Ritta Lahesmaa, Bengt Fadeel

Faculty & Staff Scholarship

Carbon-based nanomaterials including carbon nanotubes (CNTs) have been shown to trigger

inflammation. However, how these materials are ‘sensed’ by immune cells is not known. Here we compared the effects of two carbon-based nanomaterials, single-walled CNTs (SWCNTs) and graphene oxide (GO), on primary human monocyte-derived macrophages. Genome-wide transcriptomics assessment was performed at sub-cytotoxic doses. Pathway analysis of the microarray data revealed pronounced effects on chemokine-encoding genes in macrophages exposed to SWCNTs, but not in response to GO, and these results were validated by multiplex array-based cytokine and chemokine profiling. Conditioned medium from SWCNT-exposed cells acted as a chemoattractant for dendritic cells. …

Perfluoroalkyl Substances And Kidney Function In Chronic Kidney Disease, Anemia, And Diabetes, Baqiyyah N. Conway, Ashley N. Badders, Tina Costacou, John M. Arthur, Kim E. Innes

Faculty & Staff Scholarship

Background: Anemia often complicates chronic kidney disease (CKD), leading to insufficient tissue oxygenation and hypoxic injury, the factor thought to underlie progression from CKD to renal failure. Perfluorocarbons are potent oxygen transporters used in organ preservation and synthetic blood development. Data are scarce on their relationship with kidney function, especially in diabetes where anemia and hypoxia are more prevalent. We investigated the relationship of perfluoroalkyl acids (PFAS) with kidney function and variation by diabetes and anemia status.

Methods: Data on 53,650 adults (5,210 with diabetes) were obtained from the C8 Health Project. CKD was defined as an estimated glomerular filtration …

Discerning Suicide In Drug Intoxication Deaths: Paucity And Primacy Of Suicide Notes And Psychiatric History, Ian Rh Rockett, Eric D. Caine, Hilary S. Connery, Gail D'Onofrio, David J. Gunnell, Ted R. Miller, Kurt B. Nolte, Mark S. Kaplan, Nestor D. Kapusta, Christa L. Lilly, Lewis S. Nelson, Sandra L. Putnam, Steven Stack, Peeter Varnik, Lynne R. Webster, Haomiao Jia

Faculty & Staff Scholarship

Objective

A paucity of corroborative psychological and psychiatric evidence may be inhibiting detec- tion of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods.

Methods

This observational multilevel (individual/county), multivariable study employed a general- ized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System …

Novel Caries Loci In Children And Adults Implicated By Genome-Wide Analysis Of Families, Manika Govil, Nandita Mukhopadhyay, Daniel E. Weeks, Eleanor Feingold, John R. Shaffer, Steven M. Levy, Alexandre R. Vieira, Rebecca L. Slayton, Daniel W. Mcneil, Robert J. Weyant, Richard J. Crout, Mary L. Marazita

Faculty & Staff Scholarship

Background: Dental caries is a common chronic disease among children and adults alike, posing a substantial health burden. Caries is affected by multiple genetic and environmental factors, and prior studies have found that a substantial proportion of caries susceptibility is genetically inherited.

Methods: To identify such genetic factors, we conducted a genome-wide linkage scan in 464 extended families with 2616 individuals from Iowa, Pennsylvania and West Virginia for three dental caries phenotypes: (1) PRIM: dichotomized as zero versus one or more affected primary teeth, (2) QTOT1: age-adjusted quantitative caries measure for both primary and permanent dentitions including pre-cavitated lesions, and …

Metabolic And Transcriptional Modules Independently Diversify Plasma Cell Lifespan And Function, Wing Y. Lam, Arijita Jash, Cong-Hui Yao, Lucas D'Souza, Rachel Wong, Ryan M. Nunley, Gordon P. Meares, Gary J. Patti, Deepta Bhattacharya

Faculty & Staff Scholarship

Plasma cell survival and the consequent duration of immunity vary widely with infection or vaccination. Using fluorescent glucose analog uptake, we defined multiple developmentally independent mouse plasma cell populations with varying life- spans. Long-lived plasma cells imported more fluo- rescent glucose analog, expressed higher surface levels of the amino acid transporter CD98, and had more autophagosome mass than did short-lived cells. Low amino acid concentrations triggered re- ductions in both antibody secretion and mitochon- drial respiration, especially by short-lived plasma cells. To explain these observations, we found that glutamine was used for both mitochondrial respira- tion and anaplerotic reactions, yielding …

Menstrual Cycle And The Temporal Discrimination Threshold, Eavan M. Mc Govern, Emer O'Connor, Ines Beiser, Laura Williams, John Butler, Brendan Quinlivan, Shruti Narasimham, Rebecca Beck, Richard B. Reilly, Sean O'Riordan, Michael Hutchinson

Articles

The temporal discrimination threshold (TDT) is a proposed pre-clinical biomarker (endophenotype) for adult onset isolated focal dystonia (AOIFD). Age- and sex-related effects on temporal discrimination demonstrate that women, before the age of 40 years, have faster temporal discrimination than men but their TDTs worsen with age at almost three times the rate of men. Thus after 40 years the TDT in women is progressively worse than in men. AOIFD is an increasingly female-predominant disorder after the age of 40; it is not clear whether this age-related sexually-dimorphic difference observed for both the TDT and sex ratio at disease onset in …

Regulation Of Radioactive Fracking Waste, Elizabeth Ann Glass Geltman, Nichole Leclair

Publications and Research

Natural gas extracted form shale reached record production totals in 2015 in the United States and the US Energy Information Administration (EIA) forecasts natural gas production will continue to increase. Wastes from shale gas extraction can contain the radioactive isotopes radium-226 (Ra-226) and radium-228 (Ra-228), which decay further into radon (Rn). Exposure to radon, a form of naturally occurring radioactive materials (NORM), is the leading cause of lung cancer in the United States, after smoking. This article explores how states handle the disposal of technologically enhanced naturally occurring radioactive materials (TENORM) and/or NORM waste from oil and gas operations to …

Photoluminescence Mechanism And Applications Of Zn-Doped Carbon Dots, Quan Xu, Wei Cai, Miaoran Zhang, Yingchun Ye, Yeqing Li, Lipeng Zhang, Yongjian Guo, Zhiqiang Yu, Siyu Li, Xun Lin, Yusheng Chen, Yan Lou, Jason Street, Meng Xu

Faculty & Staff Scholarship

Heteroatom-doped carbon dots (CDs) with excellent optical characteristics and negligible toxicity have emerged in many applications including bioimaging, biosensing, photocatalysis, and photothermal therapy. The metal-doping of CDs using various heteroatoms results in an enhancement of the photophysics but also imparts them with multifunctionality. However, unlike nonmetal doping, typical metal doping results in low fluorescence quantum yields (QYs), and an unclear photoluminescence mechanism. In this contribution, we detail results concerning zinc doped CDs (Zn-CDs) with QYs of up to 35%. The zinc ion charges serve as a surface passivating agent and prevent the aggregation of graphene p–p stacking, leading to an …

Spontaneous Dna Damage To The Nuclear Genome Promotes Senescence, T Redox Imbalance And Aging, Andria R. Robinson, Matthew J. Yousefzadeh, Tania A. Rozgaja, Jin Wang, Xuesen Li, Jeremy S. Tilstra, Chelsea H. Feldman, Siobhan Q. Gregg, Caroline H. Johnson, Erin M. Skoda, Marie-Celine Frantz, Harris Bell-Temin, Hannah Pope-Varsalona, Aditi U. Gurkar, Luigi A. Nasto, Rena A.S. Robinson, Heike Fuhrmann-Stroissnigg, Jolanta Czerwinska, Sara J. Mcgowan, Nadiezhda Cantu-Madellin, Jamie B. Harris, Salony Maniar, Mark A. Ross, Christy E. Trussoni, Nicholas F. Larusso, Eugenia Cifuentes-Pagano, Patrick J. Pagano, Barbara Tudek, Nam V. Vo, Lora H. Rigatti, Patricia L. Opresko, Donna B. Stolz, Simon C. Watkins, Christin E. Burd, Claudette M. St, Croix, Gary Siuzdak, Nathan A. Yates, Paul D. Robbins, Yinsheng Wang, Peter Wipf, Eric E. Kelley, Laura J. Neidernhofer

Faculty & Staff Scholarship

Accumulation of senescent cells over time contributes to aging and age-related diseases. However, what drives senescence in vivo is not clear. Here we used a genetic approach to determine if spontaneous nuclear DNA damage is sufficient to initiate senescence in mammals. Ercc1-/Δ mice with reduced expression of ERCC1-XPF endonuclease have impaired capacity to repair the nuclear genome. Ercc1-/Δ mice accumulated spontaneous, oxidative DNA damage more rapidly than wild-type (WT) mice. As a consequence, senescent cells accumulated more rapidly in Ercc1-/Δ mice compared to repair-competent animals. However, the levels of DNA damage and senescent cells in Ercc1-/Δ mice never exceeded that …

Self-Reported Vs. Measured Height, Weight, And Bmi In Young Adults, Melissa D. Olfert, Makenzie L. Barr, Camille M. Charlier, Oluremi A. Famodu, Wenjun Zhou, Anne E. Mathews, Carol Byrd-Bredbenner, Sarah E. Colby

Faculty & Staff Scholarship

Self-reported height and weight, if accurate, provide a simple and economical method to track changes in body weight over time. Literature suggests adults tend to under-report their own weight and that the gap between self-reported weight and actual weight increases with obesity. This study investigates the extent of discrepancy in self-reported height, weight, and subsequent Body Mass Index (BMI) versus actual measurements in young adults. Physically measured and self-reported height and weight were taken from 1562 students. Male students marginally overestimated height, while females were closer to target. Males, on average, closely self-reported weight. Self-reported anthropometrics remained statistically correlated to …

Lead In The Environment, Msn Module, Dawn Blue

Q2S Enhancing Pedagogy

Module for MSN program in toxicology on lead in the environment.

Integrated Analysis Of The Value Of Wetland Services In Coastal Adaptation; Methodology And Case Study Of Hampton-Seabrook Estuary, New Hampshire, Paul Kirshen, Semra Aytur, David M. Burdick, Diane Foster, Tom Lippmann, Ellen Douglas, Sydney Nick, Chris Watson

Jackson Estuarine Laboratory

The present impacts from coastal storms and high tides grow significantly over time due to SLR even over the relatively short period to 2060. Hydrodynamic model simulations of storm surge with and without sea level rise scenarios show that although flooding and inundation increases with increasing subtidal forcing and higher sea level, dissipation of the tide and storm surge in the estuary channel somewhat limits the maximum inundation that might otherwise be expected in the back marsh areas. The estuary is dominated by high marsh, which lies high in the intertidal zone and by 2060 it will convert to mostly …

Investigation Of Wavenumber Calibration For Raman Spectroscopy Using A Polymer Reference, Dongyue Liu, Hugh Byrne, Luke O'Neill, Bryan M. Hennelly

Conference papers

Raman spectroscopy is an optical technique that can be used to evaluate the biomolecular composition of tissue and cell samples in a real-time and non-invasive manner. Subtle differences between datasets of spectra obtained from related cell groups can be identified using multivariate statistical algorithms. Such techniques are highly sensitive to small errors, however, and, therefore, the classification sensitivity of Raman spectroscopy can be significantly impacted by miscalibration of the optical system due to small misalignments of the optical elements and/or variation in ambient temperature. Wavenumber calibration is often achieved by recording the spectrum from a wavenumber reference standard, such as …

Towards Using A Physio-Cognitive Model In Tutoring For Psychomotor Tasks., Jong W. Kim, Chris Dancy, Robert A. Sottilare

Faculty Conference Papers and Presentations

We report our exploratory research of psychomotor task training in intelligent tutoring systems (ITSs) that are generally limited to tutoring in the desktop learning environment where the learner acquires cognitively oriented knowledge and skills. It is necessary to support computer-guided training in a psychomotor task domain that is beyond the desktop environment. In this study, we seek to extend the current capability of GIFT (Generalized Intelligent Frame-work for Tutoring) to address these psychomotor task training needs. Our ap-proach is to utilize heterogeneous sensor data to identify physical motions through acceleration data from a smartphone and to monitor respiratory activity through …

Protection Of Triplet Excited State Materials From Oxygen Quenching And Photooxidation In Optical Sensing Applications, Mikhail Filatov

Books/Book chapters

No abstract provided.

Graduate Admissions Recruitment Project, Kevin Anderson, Chiemela Dike, Yixin Du, Arvinder Kaur, Amanda Popp, Huizhong Yang

School of Professional Studies

In this project, several comparison schools were interviewed and disclosed to have used search lists to find candidates. The organizations that have valuable search lists which may be of good use for the School of Professional Studies include Educational Testing Service (ETS) and the Graduate Management Admission Council (GMAC). By choosing criteria such as demographics, location, academic performance, educational history provided by search lists, we believe there are many quality candidates for SPS programs. However, as we further investigated the functionality and cost-efficiency or return of investment of GRE search list, we spotted many uncertainties and few solid and successful …

Tolle Lege Works Published In 2018, Mcquade Library

Bibliographies

Compiled Tolle Lege bibliography of works published by members of the Merrimack College Community in 2018. Works include journal articles, books, book chapters, conference presentations and posters, and more.

Worcester Center For Crafts: A Transition To Online Sales, Monica Gow, Carly Branconnier, Srilatha Prodduturi, Ekaterina Shusharina, Alberta Yamoah

School of Professional Studies

The Clark University School of Professional Studies created a capstone team consisting of Monica Gow, Carly Branconnier, Iana Matkovskaia, Srilatha Prodduturi, Ekaterina Shusharina, and Alberta Yamoah to assist Worcester Center for Crafts (WCC) with the launch of their new online store. Worcester Center for Crafts wanted to showcase their beautiful American handmade crafts on an online platform, Shopify, in order to increase their sales and expand their market reach. The capstone team created a charter that outlined the scope of the project and what the team would deliver to WCC by the end of the project. The team agreed to …

Systematic Review And Meta-Analysis: Tuberculosis, Tnfα Inhibitors, And Crohn's Disease, Brent L. Cao

Honors Undergraduate Theses

Inflammation is often a protective reaction against harmful foreign agents. However, in many disease conditions, the mechanisms behind the inflammatory response are poorly understood. Often times, the inflammation causes adverse effects, such as joint pain, abdominal pain, fever, fatigue, and loss of appetite. Thus, many treatments aim to inhibit the inflammatory response in order to control adverse symptoms. Such treatments include TNFα inhibitors. However, a major risk associated with drugs inhibiting tumor necrosis factor alpha (TNFα) is serious infection, including tuberculosis (TB).

Anti-TNFα therapy is used to treat patients with Crohn’s disease, for which the risk of tuberculosis may be …

Audubon Data Project Final Report, Askhat Beygenov, Valinur Kutlambetov, Shrikant Patel, Phoebe Roberts, Ulfat Sayyed, Shriram Sivaraman

School of Professional Studies

The Audubon Data Project was initiated as a Clark University Capstone project. The project’s client, Mass Audubon’s Shaping the Future of Your Community program, had identified a need to improve their data management methods and make better use of their data. The Capstone team, composed of Clark University graduate students, met with the client regularly to review the current state of the data and potential improvements to be made. The process began with a data review. During the review we worked with the client to explicitly define the purposes and requirements of the data, the current process for updating and …

Towards A Physio-Cognitive Model Of Slow-Breathing, Chris Dancy

Faculty Conference Papers and Presentations

How may controlled breathing be beneficial, or detrimental to behavior? Computational process models are useful to specify the potential mechanisms that lead to behavioral adaptation during different breathing exercises. We present a physio-cognitive model of slow breathing implemented within a hybrid cognitive architecture, ACT-R/Φ. Comparisons to data from an experiment indicate that the physiological mechanisms are operating in a manner that is consistent with actual human function. The presented computational model provides predictions of ways that controlled breathing interacts with mechanisms of arousal to mediate cognitive behavior. The increasing use of breathing techniques to counteract effects of stressors makes it …

Risk Behaviors And Hiv Care Continuum Outcomes Among Criminal Justice-Involved Hiv-Infected Transgender Women And Cisgender Men: Data From The Seek, Test, Treat, And Retain Harmonization Initiative., Curt G Beckwith, Irene Kuo, Rob J Fredericksen, Lauren Brinkley-Rubinstein, William E Cunningham, Sandra A Springer, Kelsey B Loeliger, Julie Franks, Katerina Christopoulos, Jennifer Lorvick, Shoshana Y Kahana, Rebekah Young, David W Seal, Chad Zawitz, Joseph A Delaney, Heidi M Crane, Mary L Biggs

Epidemiology Faculty Publications

BACKGROUND: Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system.

METHODS: To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine …