Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons™

Open Access. Powered by Scholars. Published by Universities.®

Public Health Education and Promotion

Institution
Keyword
Publication Year
Publication
Publication Type
File Type

Articles 5731 - 5760 of 7978

Full-Text Articles in Medicine and Health Sciences

Patient Empathy & Effects On Health Outcomes, Erin Elizabeth Schliesman Jan 2016

Patient Empathy & Effects On Health Outcomes, Erin Elizabeth Schliesman

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this paper is to examine the relationship between physician empathy and healthcare outcomes for patients. The main points of focus will be how empathy is defined in a healthcare setting, the effects empathy has on health and healing of patients, particularly the empathetic relationship between the physicians and patients and finally how empathy can be better incorporated into healthcare settings.

Go to article

Cultural Influences On The Weight, Diet, And Physical Activity Of Pregnant Immigrant Latinas, Martha Eugenia Dominguez Jan 2016

Cultural Influences On The Weight, Diet, And Physical Activity Of Pregnant Immigrant Latinas, Martha Eugenia Dominguez

Walden Dissertations and Doctoral Studies

The problem addressed in this phenomenological study is how culture and acculturation can potentially influence gestational weight during pregnancy, leading to overweight and obesity among immigrant Latinas. To understand the possible influence of culture and acculturation on the diet, exercise, and weight of pregnant immigrant Latinas, the experiences of immigrant Latinas who had undergone a pregnancy in Mexico and were pregnant in California were examined. The ecological model theory was applied as a framework for exploring the participants' experiences regarding nutrition, physical activity, and weight gain. Semistructured interviews with 10 qualified participants were conducted. Data analysis entailed an inductive approach …

Go to article

Type 2 Diabetes Prevention And Management In A Primary Care Clinic Setting, Ada Nwachuku Nwachuku Jan 2016

Type 2 Diabetes Prevention And Management In A Primary Care Clinic Setting, Ada Nwachuku Nwachuku

Walden Dissertations and Doctoral Studies

Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the …

Go to article

Risk Factors Associated With Severe Acute Respiratory Infections Cases, Ryan Gatdula Ortiguerra Jan 2016

Risk Factors Associated With Severe Acute Respiratory Infections Cases, Ryan Gatdula Ortiguerra

Walden Dissertations and Doctoral Studies

The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age …

Go to article

Influences Of Peer Pressure And Relationship Knowledge On Sexual Behaviors Of Hispanic/Latino Youth, Richard Velez Jan 2016

Influences Of Peer Pressure And Relationship Knowledge On Sexual Behaviors Of Hispanic/Latino Youth, Richard Velez

Walden Dissertations and Doctoral Studies

Numerous studies have shown a rising HIV/AIDS epidemic among U.S. Hispanics/Latinos. Risky sexual behavior, alcohol, drug abuse, and sociodemographics contribute to Hispanics/Latinos' elevated risk for contracting HIV and other STDs. There is a need for additional research to understand the combination of factors associated with HIV and other STD infection among Hispanic/Latino youth. Based on social cognitive theory, this study examined the influences of peer pressure and relationship knowledge on risky sexual behavior among Hispanic/Latino young adults as measured by the Peer Pressure Inventory (PPI), the Teenage Research Unlimited Survey (TRU), and the Youth Risk Behavior Survey (YRBS). A group …

Go to article

Association Between Haart And Metabolic Syndrome Components Among Hiv-Positive Adults In Southeastern Nigeria, Bridget Okiemute Amechi Jan 2016

Association Between Haart And Metabolic Syndrome Components Among Hiv-Positive Adults In Southeastern Nigeria, Bridget Okiemute Amechi

Walden Dissertations and Doctoral Studies

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, …

Go to article

Understanding Caregivers' Perceptions Of Childhood Immunization, Oliver Anyabolu Jan 2016

Understanding Caregivers' Perceptions Of Childhood Immunization, Oliver Anyabolu

Walden Dissertations and Doctoral Studies

Low immunization in Nigeria is associated with high prevalence of childhood diseases. The purpose of this qualitative phenomenological study was to describe caregivers' perceptions of routine immunization of their children ages 24 to 36 months. Caregivers' attitudes, cultural beliefs, and knowledge regarding immunization were examined. The health belief model was used to guide study. Interviews were conducted with 5 caregivers of fully immunized and 5 caregivers of partially and nonimmunized children. Digital recordings were analyzed using NVivo 10 to identify themes and subthemes. Attitudes of caregivers with fully immunized children included both perceived barriers (distance to health center, lack of …

Go to article

Fall Safety Bundle, Baili Denise Campbell Jan 2016

Fall Safety Bundle, Baili Denise Campbell

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services (CMS) report thousands of falls in hospitals each year. The CMS does not reimburse hospitals for fall related injuries, costing the hospital system organization for which this DNP project was designed millions of dollars each year. Framed within the Iowa model of evidence-based practice and using a team approach, the purpose of this project was to develop an evidence-based (EB) fall safety bundle for use by nursing staff and a curriculum to educate staff on prevention strategies. The components of the EB fall bundle kit were approved by the stakeholder committee. Evaluation of …

Go to article

Perceptions Of Emergency Preparedness Among Immigrant Hispanics Living In Oklahoma City, Oklahoma, Rebekah Doyle Jan 2016

Perceptions Of Emergency Preparedness Among Immigrant Hispanics Living In Oklahoma City, Oklahoma, Rebekah Doyle

Walden Dissertations and Doctoral Studies

Tornadoes are occurring with increased frequency in Oklahoma. Emergency preparedness planning is essential to decreasing individuals' risks of injury or death from a tornado. Research on immigrant Hispanics' knowledge and perceptions of emergency preparedness is limited. The purpose of this study was to explore the perceptions and lived experiences of immigrant Hispanics who had experienced a tornado or other crisis weather conditions in Oklahoma during spring of 2013. The research questions explored their perceived risk for injury and knowledge of tornado preparedness planning. The health belief model provided the theoretical underpinnings for this qualitative phenomenological study. Semi structured interviews were …

Go to article

Beliefs Among Mothers Of Adolescent Females On Cervical Cancer Vaccination, Aja Rochelle Gardner Jan 2016

Beliefs Among Mothers Of Adolescent Females On Cervical Cancer Vaccination, Aja Rochelle Gardner

Walden Dissertations and Doctoral Studies

Hispanic and African American women are infected with sexually transmitted diseases more often than are Caucasian women. This racial disparity is also seen in the incidence of human papillomavirus (HPV) and cervical cancer. The medical connection between HPV and cervical cancer is often unknown or misunderstood among women. This study addressed the beliefs and subsequent health decisions of minority parents regarding whether to get their daughters vaccinated against HPV. The theoretical framework for this study was Rosenstock's health belief model (HBM). The specific study design used was Husserl and Heidegher's theory on Phenomenology. This qualitative study utilized focus groups containing …

Go to article

Factors Affecting Body Mass Index Levels In African American Women Living In North Carolina, Padmini Shanti Kirpalani Jan 2016

Factors Affecting Body Mass Index Levels In African American Women Living In North Carolina, Padmini Shanti Kirpalani

Walden Dissertations and Doctoral Studies

The prevalence of obesity has doubled over the past 25 years in the United States, particularly in North Carolina. Obesity is influenced by biological, social, and environmental factors; its prevalence has been found to be higher among African American women and other racial ethnic minorities. Guided by the social ecological model, the purpose of this cross sectional study was to examine the relationship of the psycho-social, psycho-behavioral factors, and body mass index levels (BMI) in African American women living in North Carolina versus their Hispanic American and European American counterparts. A logistic regression model using secondary data from the Behavioral …

Go to article

The Experience Of Survivorship: Quality Of Life For African American Breast Cancer Survivors, Angela L. Grimmett Jan 2016

The Experience Of Survivorship: Quality Of Life For African American Breast Cancer Survivors, Angela L. Grimmett

Walden Dissertations and Doctoral Studies

African American breast cancer survivors are at a greater risk of experiencing disparities in mortality, treatment, and quality of life. The purpose of this phenomenological study was to explore the impact that breast cancer had on the quality of life of African American breast cancer survivors from a psychosocial, physical, spiritual, and economic perspective. Face-to-face, in-depth interviews were conducted with 9 volunteers who met the eligibility criteria of being breast cancer survivors of African American decent. The sample of survivors ranged in ages 45 to 80 and was between 6 to 30 years postdiagnosis. Giorgi's phenomenological method was used to …

Go to article

Experiences Of Chronic Disease Self-Management Program Leaders, Laketa Monique Hillman Jan 2016

Experiences Of Chronic Disease Self-Management Program Leaders, Laketa Monique Hillman

Walden Dissertations and Doctoral Studies

Chronic conditions are public health threats. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based disease management program that addresses personal self-management of chronic conditions. The CDSMP involves peer trainers who instruct and assist with chronic disease preventive measures. Although disease management demonstrates promise to improving patient self-maintenance, previous researchers have not evaluated how the program affects program leaders. The purpose of this study was to discover how self-help leaders feel about the CDSM program. The overarching research question asked about perspectives that self-help leaders had toward the program. Through a narrative qualitative approach, the perceptions of peer leaders were …

Go to article

Strategies Ontario Hospital Administrators Apply To Generate Non-Government Revenue To Remain Sustainable, Frank Pieter Martien Naus Jan 2016

Strategies Ontario Hospital Administrators Apply To Generate Non-Government Revenue To Remain Sustainable, Frank Pieter Martien Naus

Walden Dissertations and Doctoral Studies

Health care administrators in Ontario want to transform health care with a focus on improving efficiency and quality of care, yet they pay little attention to increasing revenue. The purpose of this qualitative case study was to explore strategies Ontario hospital administrators apply to generate nongovernment revenue to remain sustainable. The target study population consisted of 2 chief executive officers and 2 chief financial officers at Ontario academic research hospitals. The conceptual framework for this study included radical organizational change theory supported by complexity leadership theory, and grounded in an evidence-based approach. The researcher conducted open-ended semi-structured interviews and made …

Go to article

Community And Patient-Centered Medical Home In The Care Of Chronically Ill Patients, Victor A. Carrillo Jan 2016

Community And Patient-Centered Medical Home In The Care Of Chronically Ill Patients, Victor A. Carrillo

Walden Dissertations and Doctoral Studies

Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the …

Go to article

Perceptions Of Immunizations As Health Prevention Among Female Mexican Immigrants In Oklahoma, Jennifer Doyle Jan 2016

Perceptions Of Immunizations As Health Prevention Among Female Mexican Immigrants In Oklahoma, Jennifer Doyle

Walden Dissertations and Doctoral Studies

Research on health prevention behaviors of Mexican immigrant mothers regarding immunizations has been limited. As of 2014, Hispanics or Latinos comprised 9.6% of the population of the state of Oklahoma and were the largest minority group within Oklahoma. This minority population has continued to grow at a rapid rate in Oklahoma. The purpose of this study was to explore the perceptions of immunizations held by Mexican immigrants who are mothers residing in Oklahoma. The aim of this study was to identify their perceived risk of contracting a vaccine-preventable disease if not immunized and knowledge of immunizations as a health prevention …

Go to article

Attitudes And Beliefs Towards Prostate Cancer Screenings And Diagnosis Among Zimbabwean Physicians, Adoniah Mavura Mukona Jan 2016

Attitudes And Beliefs Towards Prostate Cancer Screenings And Diagnosis Among Zimbabwean Physicians, Adoniah Mavura Mukona

Walden Dissertations and Doctoral Studies

Zimbabwean men at risk of developing prostate cancer (PC) are diagnosed late or not at all. A cross sectional, quantitative study was done in Zimbabwe to establish physicians' attitudes and beliefs towards PC screening and diagnosis. Descriptive statistics were obtained to determine physicians' beliefs and attitudes using the Physician Attitudes and Beliefs Questionnaire Survey. The instrument incorporated validated instruments, the Burns' Cancer Belief Scale and Physician Survey on Prostate Cancer Screening, and demographic questions to measure specific independent variables, potentially influencing attitudes and beliefs. Means and standard deviations were conducted for continuous variables for beliefs and attitudes, and frequencies and …

Go to article

Risk Factors And Outcomes For Bloodstream Infections Among Patients With Skin Infections, Michael Rybak Rybak Jan 2016

Risk Factors And Outcomes For Bloodstream Infections Among Patients With Skin Infections, Michael Rybak Rybak

Walden Dissertations and Doctoral Studies

Acute bacterial skin and skin structure infections (ABSSSI) are common infections within the local community, and they result in higher morbidity and health care costs. While risk factors for skin and soft tissue infections have been previously evaluated, risk factors associated with secondary bloodstream infections (BSI) has not been investigated, especially in an intercity patient population with limited health care resources. In this case control investigation, 392 patients consisting of 196 cases (ABSSSI + BSI) and 196 controls (ABSSSI) were investigated to determine risk for BSI. Both sociodemographic and underlying conditions were evaluated. According to bivariate analysis of cases and …

Go to article

Risk Of Alzheimer's Disease Among Older Hispanic/Latinos With Diabetes, Kathy Bianco Jan 2016

Risk Of Alzheimer's Disease Among Older Hispanic/Latinos With Diabetes, Kathy Bianco

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is the 6th leading cause of death in older Americans. Currently there is no cure for AD, and even though the specific cause is unknown, diabetes mellitus type 2 (DM2) is regarded as a risk factor. Hispanics have a higher incidence of DM2 and possibly AD. I chose a life course theoretical model for this quantitative cross-sectional study to illuminate the variables most pertinent to a pathway from good health to poor health. The variables chosen were hypertension (HTN), obesity, smoking, stroke, dyslipidemia, and lower educational attainment. The research questions were used to examine biologic, metabolic, sociologic, …

Go to article

Influence Of Teacher Participation On Student Fitness And Student Participation In Physical Education, Whitney Morris Jan 2016

Influence Of Teacher Participation On Student Fitness And Student Participation In Physical Education, Whitney Morris

Walden Dissertations and Doctoral Studies

Physical activity plays a key role in the health of children. Childhood obesity is increasing in the United States, and children are spending less time being physically active. Active participation by a physical education (PE) teacher in physical activities has been suggested as a means of promoting student fitness. The purpose of this quasi-experimental quantitative study was to determine whether modeling of physical activity by a PE teacher would increase student participation and physical fitness. Bandura's social learning theory provided the theoretical framework for the study. Participants included 311 4th and 5th grade elementary students enrolled in physical education classes. …

Go to article

Impact Of Medicare And Medicaid Beneficiaries With Selected Conditions On Emergency Department Utilization, John K. Amoh Jan 2016

Impact Of Medicare And Medicaid Beneficiaries With Selected Conditions On Emergency Department Utilization, John K. Amoh

Walden Dissertations and Doctoral Studies

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 …

Go to article

Effect Of Reduced-Fee Dental Hygiene Treatment And Oral Health Perceptions Among Socioeconomically Deprived Persons, Janeime Necole Asbury Jan 2016

Effect Of Reduced-Fee Dental Hygiene Treatment And Oral Health Perceptions Among Socioeconomically Deprived Persons, Janeime Necole Asbury

Walden Dissertations and Doctoral Studies

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges …

Go to article

Gestational Age, Birth Weight, And Incidence Of Adult Type 2 Diabetes Among Southeast Alaska Natives, Renee Elaine Crawford Jan 2016

Gestational Age, Birth Weight, And Incidence Of Adult Type 2 Diabetes Among Southeast Alaska Natives, Renee Elaine Crawford

Walden Dissertations and Doctoral Studies

American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design …

Go to article

Self-Efficacy And Self-Management Assessments On Hispanic Patients With Diabetes, Yesenia Dejesus Jan 2016

Self-Efficacy And Self-Management Assessments On Hispanic Patients With Diabetes, Yesenia Dejesus

Walden Dissertations and Doctoral Studies

Hispanics are at increased risk for diabetes and are 40% more likely to die from the condition than are non-Hispanic Caucasians. The purpose of this project was to determine the effects of diabetes education conducted in Spanish by bilingual staff on the self-management and self-efficacy of a sample of 50 volunteer adult Hispanic clinic patients with diabetes. The education intervention incorporated the American Diabetes Association's Diabetes Self-Management Education program materials. Bandura's self-efficacy theory was selected as the theoretical support for the project that relied on self-management education of the patients to improve their self-efficacy to undertake the interventions necessary to …

Go to article

Wellness Intervention As A Quality Of Life Predictor In Mentally Ill Veterans, Tosha Lashon Ellis Jan 2016

Wellness Intervention As A Quality Of Life Predictor In Mentally Ill Veterans, Tosha Lashon Ellis

Walden Dissertations and Doctoral Studies

Veterans with serious mental illness (SMI) are at high risk of developing conditions such as insulin resistance, obesity, and smoking, which may lead to chronic medical problems. As a result, the morbidity and mortality of people with SMI are high compared to the general population. It appears that integrated care improves the wellbeing of veterans; however, there is a gap in the literature on wellness-based interventions for veterans with SMI. The purpose of this cross-sectional study was to evaluate the association between a wellness intervention for veterans and their perceived quality of life (QOL). Social cognitive theory was the theoretical …

Go to article

The Lived Experiences Of Hiv+ Community Health Workers Serving Hiv+ Clients, Phronie Lynn Jackson Jan 2016

The Lived Experiences Of Hiv+ Community Health Workers Serving Hiv+ Clients, Phronie Lynn Jackson

Walden Dissertations and Doctoral Studies

Numerous studies have focused on the effectiveness of community health worker (CHW) programs in producing positive health behaviors and health outcomes for the clients CHWs serve; however, there has been a gap in the literature regarding how the health of HIV + CHWs is impacted by their jobs. A phenomenological design was used to gain insight into the lived experiences of HIV+ CHWs (HIVCHW) who provided services to HIV positive clients. Fifteen HIVCHW were recruited using criteria and snowball techniques. Data were collected via audio recorded personal interviews regarding respondents' perceptions of their work and how it impacted their own …

Go to article

Heroes Or Victims: The Lived Experiences Of Women On Female Genital Mutilation/Cutting In Northwestern Nigeria, Sarah Kasham Philips Jan 2016

Heroes Or Victims: The Lived Experiences Of Women On Female Genital Mutilation/Cutting In Northwestern Nigeria, Sarah Kasham Philips

Walden Dissertations and Doctoral Studies

The custom of female genital mutilation/cutting (FGM/C) is a traditional practice inimical to women's health with profound implications. There is a gap in the literature on the lived experiences of women who have undergone FGM/C and their statuses within their communities. Guided by the social cognitive theory and the ecological model, this qualitative study aimed at explicating the attitudes and perceptions of women in the northwest region of Nigeria towards the practice of FGM/C, to illuminate how the women view themselves in their society and the inspiration for the continued practice of FGM/C. Interview and observation data were gathered from …

Go to article

Health Care Provider Perceptions Of High Blood Pressure Screening For Asymptomatic African American Teens, Juanita Braxton Jan 2016

Health Care Provider Perceptions Of High Blood Pressure Screening For Asymptomatic African American Teens, Juanita Braxton

Walden Dissertations and Doctoral Studies

Health care provider perceptions of typical practices play a significant role in evaluating the efficacy of screening and diagnosis of teen high blood pressure in African Americans. African American adults are more likely to develop high blood pressure than are any other ethnic group; however, there is a gap in the literature concerning high blood pressure in teens. Approximately 1 to 5 of every 100 children has high blood pressure. This purpose of this phenomenological study was to explore the perspectives of health care providers on high blood pressure screening and diagnosis of African American asymptomatic teens. The health belief …

Go to article

The Relationship Between Health Risk And Workplace Productivity In Saudi Arabia, Sarah Lorraine Hayman Jan 2016

The Relationship Between Health Risk And Workplace Productivity In Saudi Arabia, Sarah Lorraine Hayman

Walden Dissertations and Doctoral Studies

Rising worldwide rates of noncommunicable diseases (NCDs) in the Middle East, principally Saudi Arabia, have put an increasing load on the health system and employers. Middle Eastern organizations have been slow to develop targeted health programs, which include an emphasis on employee productivity. The purpose of this study was to determine the relationship, if any, between employee lifestyle and workplace productivity. Productivity is the amount of work produced based on the time and cost required to do so. The underlying theoretical foundations of this research were the socioecological health model and the human capital model. The quantitative, ex post facto …

Go to article

Perception Of Nutrition And Utilization Of Healthy Food Ideas When Making Food Choices., Judy Pilgrim-Hector Jan 2016

Perception Of Nutrition And Utilization Of Healthy Food Ideas When Making Food Choices., Judy Pilgrim-Hector

Walden Dissertations and Doctoral Studies

The availability of nutrition information is an important aspect of health care and equally important is access to cultural and theoretical nutrition evidence to increase awareness on ways to manage a diet in ethnic communities. The problem was the shortage of culturally appropriate nutrition data to educate Caribbean immigrants. The purpose of the study was to acquire culturally profound nutrition information on Caribbean immigrants' distinctive philosophical perception on nutrition and food choices. A phenomenological approach was used to examine ways in which the participants integrate nutrition facts when making food choices. The theory of reasoned action was the main conceptual …

Go to article

First Prev Next Last