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Full-Text Articles in Medicine and Health Sciences

The Ethnobotany And Pharmacology Of Medicinal Plants For Caribbean Women’S Health, Ella Thomas Vardeman Jun 2025

The Ethnobotany And Pharmacology Of Medicinal Plants For Caribbean Women’S Health, Ella Thomas Vardeman

Dissertations, Theses, and Capstone Projects

Approximately 55% of the world’s population lives in cities, and the United Nations estimates that this number will rise to 68% by 2050. Urban ethnobotany, the study of people’s traditional knowledge and use of plants in cities, is increasingly important as people adapt their cultural traditions to changing environments. In New York City (NYC), there have been several urban ethnobotany investigations in collaboration with Caribbean immigrant groups. However, there has yet to be an ethnobotanical survey that documents and botanically authenticates the medicinal plants used in the Haitian community. Previous collaborative research with women from the Caribbean in NYC has …


Assessment Of Mental Wellbeing Programs In The Construction Industry, Evan James Olszak Jun 2025

Assessment Of Mental Wellbeing Programs In The Construction Industry, Evan James Olszak

Construction Management

Mental health problems are very prevalent within the construction industry, and there is not enough attention put towards the mental wellbeing of employees in the industry. The construction industry is ranked #2 for deaths by suicide, and #1 when mining and extraction are included (CDC, 2021). Previous research has been done to understand the severity of the issue, and some programs have been started to spread awareness and train employees. The issue arises in a lack of analysis of these programs. The programs that are being used are still in their infancy and require a comprehensive review to understand the …


Comparative Genotoxicological Analysis Of Occupational Pesticide Exposures: An Experimental Approach And Systematic Review, Moustafa Samy Sherif Jun 2025

Comparative Genotoxicological Analysis Of Occupational Pesticide Exposures: An Experimental Approach And Systematic Review, Moustafa Samy Sherif

Dissertations

This dissertation investigates the genotoxic and cytotoxic effects of pesticide exposure through three complementary research components: a systematic review of occupational pesticide exposure in Arab countries (AraSys), a systematic review on encapsulated versus conventional pesticide formulations (Encap-Sys), and experimental toxicological assessments of various pesticide formulations in human cell lines (Pyr-Ex). This experimental component includes cytotoxicity assays using propidium iodide and DNA damage assessments via alkaline comet assays in HL60 and HepG2 cell lines exposed to pyrethroid insecticides and glyphosate-based formulations.

The AraSys systematic review revealed a critical positive association between occupational pesticide exposure and DNA damage in agricultural workers in …


Associations Between Vitamin D Deficiency And Sociodemographic Factors, Lifestyle Behaviors, And Metabolic Conditions: A Cross-Sectional Study From The Hnnhs In Greece, Asmae Mohamad Sadek Jun 2025

Associations Between Vitamin D Deficiency And Sociodemographic Factors, Lifestyle Behaviors, And Metabolic Conditions: A Cross-Sectional Study From The Hnnhs In Greece, Asmae Mohamad Sadek

Theses

Vitamin D deficiency (VDD) is a widespread global health concern associated with various sociodemographic, lifestyle, dietary, and metabolic factors. While previous studies examined VDD in Greece, few provided a comprehensive analysis across multiple determinants using representative national data. This study aimed to assess the prevalence and predictors of VDD among Greek adults and to examine its associations with sociodemographic, dietary, behavioral, and metabolic variables using data from the Hellenic National Nutrition and Health Survey (HNNHS). A cross-sectional analysis was conducted among 978 adults (≥19 years) from the HNNHS. Serum 25-hydroxyvitamin D [25(OH)D] concentrations < 20 ng/mL were defined as deficient and ≥20 ng/mL as normal. The median age of participants was 40.2 years, and 62.0% were female. The overall prevalence of VDD was 46.0%, with the highest rate observed among adults aged ≥60 years (62.2%). VDD was significantly associated with older age (p < 0.001), retirement status (62.9% among retired; p < 0.001), low and sedentary physical activity (32.7% and 32.6% vs. 50.8% among highly active; p < 0.001), higher HDL (median 52.0 vs. 49.0 mg/dL among VDD vs Normal; p = 0.001), elevated serum calcium (median 9.4 vs. 9.2 mg/dL among VDD vs Normal; p = 0.020), and lower insulin levels (median 7.5 vs. 8.0 μIU/mL among VDD vs Normal; p = 0.044). Dietary intake (total energy and macronutrients) and body composition were not significantly associated with VDD. In the multivariate model, significant independent predictors of VDD included being retired (AOR = 2.383; 95% CI: 1.596–3.558; p < 0.001), having higher serum calcium levels (AOR = 1.563; 95% CI: 1.078–2.266; p = 0.019), and higher HDL levels (AOR = 1.016; 95% CI: 1.005–1.027; p = 0.001). Physical activity level was also a key determinant; participants classified as sedentary or low active had significantly higher odds of deficiency compared to highly active individuals (AOR = 0.468; 95% CI: 0.319–0.690; p < 0.001). This counterintuitive result may be influenced by factors such as increased indoor physical activity, and warrants further investigation. Dietary intake and body composition were not significantly associated with VDD. The findings underscore the importance of incorporating sociodemographic and lifestyle factors into prevention strategies. Interventions should particularly focus on older adults, retired individuals, even if they have higher HDL and calcium levels, and are physically active.


Analyzing “Sex Ed: The College Edition” - A Comprehensive Workshop Increasing Sexual Literacy On Cal Poly’S Campus, Merav Tzori Jun 2025

Analyzing “Sex Ed: The College Edition” - A Comprehensive Workshop Increasing Sexual Literacy On Cal Poly’S Campus, Merav Tzori

Kinesiology and Public Health

"Sex-Education: The College Edition", is a comprehensive and interactive workshop based on Cal Poly student data collected via survey. The workshop aimed to address sexual health knowledge and behavior gaps in the student population and provide sexual education about anatomy, barrier methods, contraception, STIs, and more. The following paper discusses the creation, execution, and efficacy of the workshop that was conducted with seven student groups.


Digesting The Details: How Cooking Shapes The Microbiome And Influences Obesity, Tracy Lieu Jun 2025

Digesting The Details: How Cooking Shapes The Microbiome And Influences Obesity, Tracy Lieu

University Honors Theses

Obesity is a growing global health concern linked to chronic diseases and changes in the gut microbiome. While diet is known to affect gut microbes, less attention has been given to how food processing methods, such as heating, fermentation, and cold processing, change food in ways that influence the gut microbiome and health. This thesis reviews research on how different cooking and preparation techniques affect the availability of nutrients for microbial fermentation and the resulting effects on microbial diversity and metabolism. The findings show that fermentation and cold processing are the most supportive of gut health. These methods help preserve …


The Effect Of Dietary Strawberry Supplementation On Glycemic Control Factors In Overweight And Obese Postmenopausal Women With At-Risk Diabetes Mellitus Pathogenesis, Jennifer Herrera Jun 2025

The Effect Of Dietary Strawberry Supplementation On Glycemic Control Factors In Overweight And Obese Postmenopausal Women With At-Risk Diabetes Mellitus Pathogenesis, Jennifer Herrera

Master's Theses

Glycemic control is directly related to type II diabetes mellitus (T2DM). As of 2023, 30.5 million Americans have T2DM, and this number only continues to increase exponentially across the world (“Facts & Figures,” n.d.). T2DM is only a precursor to fatal conditions including cardiovascular disease, the number one cause of death in the United States. Extensive research has revealed that strawberries, a high polyphenolic food, may pose positive effects on glycemic control biomarkers. This study aimed to investigate the effect of three servings of strawberries in the form of 39-g of freeze-dried strawberry powder (FDSP) for six weeks on glycemic …


The Impact Of Nicu Death On Bereaved Mothers, Jennie Terranova Jun 2025

The Impact Of Nicu Death On Bereaved Mothers, Jennie Terranova

University Honors Theses

Infant loss in the United States occurs 5.6 per 1,000 live births. This paper examines risk factors that contribute to neonatal death. Prematurity is a risk factor for NICU admission. A portion of premature babies receiving care in the NICU will die. The stressful nature of the NICU has been studied widely in journals. The impact of NICU death on hospital staff and bereaved parents has been studied less. Mortality studies suggest that bereaved mothers are at a high risk of dying within the first 5 years after their child has died. Despite the frequency of maternal death post-child loss, …


Examining Long-Term Care For Ncaa Student-Athletes: Improving Concussion Protocols And Healthcare, Sydney Watson Jun 2025

Examining Long-Term Care For Ncaa Student-Athletes: Improving Concussion Protocols And Healthcare, Sydney Watson

University Honors Theses

Sports-related concussions (SRC) are a significant issue in collegiate athletics, particularly in high-impact sports. While the National Collegiate Athletic Association (NCAA) has protocols for immediate injury management, they don't fully address the long-term effects retired athletes experience. This paper examines whether former NCAA athletes who suffered from SRC should receive more comprehensive concussion-related healthcare. Findings reveal that current NCAA measures, such as baseline assessments and return-to-play protocols, fall short in addressing the lasting physical, cognitive, and emotional challenges of student-athletes who suffered multiple SRC. Protocols and procedures set by professional leagues like the NFL and NHL highlight the NCAA's gaps …


Surveying Management Strategies For Pediatric Autoimmune Hepatitis, Lillie Baca Jun 2025

Surveying Management Strategies For Pediatric Autoimmune Hepatitis, Lillie Baca

University Honors Theses

Pediatric autoimmune hepatitis (PAIH) is a long-term condition that requires ongoing treatment and regular monitoring. It is characterized by its elevation of liver enzymes, interface hepatitis, and the specific presence of circulating autoantibodies. There is a general lack of consensus on appropriate measures of diagnostic criteria, treatment medication, and beneficial practices for monitoring the disease. The existing literature contains several subtle discrepancies that challenge a practitioner's judgement for care management of children with autoimmune hepatitis. This study is a retrospective chart review aimed at understanding the current diagnostics, treatment, and long-term management strategies of PAIH at a single center. Also, …


Assessing The Challenges Latin Immigrant Populations Face In Accessing Healthcare And Proposing Solutions To Improve Accessibility, Melina Khiabani Jun 2025

Assessing The Challenges Latin Immigrant Populations Face In Accessing Healthcare And Proposing Solutions To Improve Accessibility, Melina Khiabani

University Honors Theses

Access to healthcare is considered a basic human right, yet many Hispanic and Latin immigrant populations in the United States, especially those living in rural areas, face significant barriers that prevent them from receiving the care they need. These barriers include language differences, cultural misunderstandings, financial hardship, fear of legal consequences, and geographic isolation. This literature review explores the challenges that Hispanic/Latin immigrants aged 19-25 in rural areas encounter when trying to access healthcare, particularly preventative services.

Drawing from a wide range of existing research, this thesis identifies how policy restrictions, social determinants of health, and systemic discrimination contribute to …


Structure Vs Agency: The Intersectionality Of Race, Mental Health, And Homelessness, Jayley Martin Jun 2025

Structure Vs Agency: The Intersectionality Of Race, Mental Health, And Homelessness, Jayley Martin

University Honors Theses

This project investigates the intersectionality between race, mental health, and homelessness, emphasizing the dynamic interplay between structural factors and individual characteristics. Through an integrative literature review, the research addresses the question of how race, mental health, and homelessness are interconnected. The findings suggest a distinct relationship between untreated mental illness and an increased risk of homelessness, particularly among marginalized racial groups. In addition, some mental illnesses, such as anxiety and depression, have a higher incidence among those who face conflict due to racial discrimination. Structural components such as systemic racism in social services and healthcare practices significantly impact access to …


Penicillin: The Burdensome Physiology Of Β-Lactamase, Lena Uyen-Thi Ngo Jun 2025

Penicillin: The Burdensome Physiology Of Β-Lactamase, Lena Uyen-Thi Ngo

University Honors Theses

This thesis is a literature review investigating the effects of overusing penicillin and the nonadherence to proper treatment on the evolutionary changes in a bacterium's resistance. Drawing upon the history, present, and future of penicillin research, the examination analyzes how penicillin came to be, how bacteria developed their resistance, and how scientists are combating this issue. In doing so, the study investigates the historical timeline regarding the discovery of penicillin as an antibiotic. Furthermore, the review will examine the scientific changes within a bacterium's physiology to develop its antibiotic resistance. Finally, the review will delve into what scientists are currently …


A Comprehensive Literature Review Of Gender Differences In Perception And Response To Stress, Zoe M. Shankland Jun 2025

A Comprehensive Literature Review Of Gender Differences In Perception And Response To Stress, Zoe M. Shankland

University Honors Theses

It is well established that psychological stress, whether acute, chronic, or recurring, creates an imbalance in the body’s ability to regulate itself, leading to the potential for long-term disease. This paper looks at the possibility that women (anyone who identifies as a woman) experience more general mental stress than men (anyone who identifies as a man) due to women experiencing unique stressors under a patriarchal society. Men and women live different lives in modern society due to differing societal expectations and biological processes for women (menstruation, pregnancy, menopause). These extra feelings of stress may be tied to traditional gender roles …


Quantitative Analysis Using Mri Of Patients That Are High Risk For Pancreatic Cancer, Aqsa Tarik Jun 2025

Quantitative Analysis Using Mri Of Patients That Are High Risk For Pancreatic Cancer, Aqsa Tarik

University Honors Theses

Pancreatic ductal adenocarcinoma (PDAC) is a cancer that is detected in its later stages, causing its five-year survival rate of 2-9% (3). The majority of patients who develop PDAC unfortunately deal with a low survival rate due to the progression of the tumor in the body. Magnetic resonance imaging (MRI) can assess the structure of the tissue within organs in the body. These scans can also be used in order to detect and diagnose tumors, allowing them to be a generator of cancer biomarkers. PDAC isn’t distinguishable on conventional images, as the pancreas will appear normal, allowing the tumor progress …


Access To Healthcare For Rural Transgender Adults In The United States, Devon Smith Jun 2025

Access To Healthcare For Rural Transgender Adults In The United States, Devon Smith

University Honors Theses

Urban and rural healthcare differ significantly in the amount of facilities, providers and kinds of specialty care that are offered in each environment. The United States is split into urban and rural counties in any given region, and based on those population sizes, are the allocation of healthcare resources for residents. In rural areas in the U.S., transgender adults lack access to gender-affirming care and encounter a lack of gender-affirming care providers due to workforce shortages, discrimination, and a lack of cultural competency. To determine if these residents lacked access to care compared with their urban counterparts, I performed a …


In Vitro Evaluation Of A Novel Computationally Designed Anticancer Peptide In Ovarian Cancer Cell Models, Basma A. Shaala Jun 2025

In Vitro Evaluation Of A Novel Computationally Designed Anticancer Peptide In Ovarian Cancer Cell Models, Basma A. Shaala

Theses and Dissertations

Ovarian cancer remains one of the leading causes of cancer-related mortality among

women, highlighting the need for novel therapeutic agents with improved selectivity and

reduced toxicity. Anticancer peptides (ACPs) have emerged as promising candidates

due to their ability to selectively target cancer cells. In this study, the anticancer activity

of a computationally designed ACP was evaluated in vitro using the SKOV-3 ovarian

cancer cell line, with HEK cells employed as a non-cancerous control.

Cell viability was assessed using the MTT assay, and cytotoxicity was further confirmed

by the trypan blue exclusion method. Apoptosis and necrosis were analyzed using

Annexin V-FITC/Propidium …


The Games Kids Play: Determining Concussion Risk Of Playground Sports, Brynlee Morgan Jun 2025

The Games Kids Play: Determining Concussion Risk Of Playground Sports, Brynlee Morgan

Health, Human Performance and Recreation Undergraduate Honors Theses

Playground games play a very vital role in child development, but they have been shown to present significant risks of injury, particularly concussion injuries. Supervisors of playground games or recreational sports may lack comprehensive knowledge of concussion protocols, potentially resulting in undiagnosed pediatric concussion, which can be critical to the child’s long-term health. This study aims to identify which playground games or recreational sports pose the highest risk for injury, specifically concussions, and highlights the importance of concussion prevention training for all school personnel to minimize potential health risks for children. The methodology involved the identification of injuries from playground …


Leadership And Peer Support Of Surgeons Post-Adverse Event: A Phenomenological Study, Maxine E. Trent Jun 2025

Leadership And Peer Support Of Surgeons Post-Adverse Event: A Phenomenological Study, Maxine E. Trent

Electronic Theses and Dissertations

Abstract Surgeons are leaving the active practice of surgery and fewer physicians are pursuing surgical training, as a result the United States is predicted to have a shortage of surgeons until 2050. Surgery hosts a multitude of occupational stressors, one of which is interoperative adverse events and the subsequent experience of second victims. The literature indicates surgeons prefer psychological/emotional support from peers after interoperative adverse events. However, best practices for how to deliver peer and leadership support responses when surgeons experience second victims have not been established. This was a phenomenological qualitative study targeting practicing surgeons across the United States. …


Weight Recidivism Post-Bariatric Surgery: A Lifestyle Modifications Educational Intervention, Kimeshia N. Johnson Jun 2025

Weight Recidivism Post-Bariatric Surgery: A Lifestyle Modifications Educational Intervention, Kimeshia N. Johnson

Electronic Theses and Dissertations

Weight recidivism after bariatric surgery is a frustrating phenomenon for bariatric surgery patients and healthcare professionals. A 90-day lifestyle modification intervention for patients at least 18 months postsurgery was performed in the primary care setting to determine if a structured program could promote or maintain weight loss. The intervention aimed to investigate if participation in a structured lifestyle modification program would impact the body mass index of bariatric patients at least 18 months postsurgical intervention. In coordination with a nutritionist specializing in addiction and obesity education, a booklet detailing the guidelines for a 12-week program was provided to 41 bariatric …


Resonance, Jess D. Skyleson May 2025

Resonance, Jess D. Skyleson

Masters Theses

Resonance is a digital media installation intended to facilitate a deeper understanding of inter-connection within and between ourselves and others, and to depict how our voices live both within and beyond us. The exhibit is divided into two intertwining halves:

Externally, the piece involves creative communication between people, art mediums, and life experiences. This aspect includes the contributions of thirty patients, doctors, and caregivers who responded to one another’s artwork in a series of workshops led by the artist. Starting with the creative writing of patients, this was provided to a group of unrelated medical providers, who responded with visual …


The Interplay Of Accommodation And Oculomotor Vergence Within Young Adults With Binocularly Normal Vision And Typically-Occurring Convergence Insufficiency, Sebastian Fine May 2025

The Interplay Of Accommodation And Oculomotor Vergence Within Young Adults With Binocularly Normal Vision And Typically-Occurring Convergence Insufficiency, Sebastian Fine

Dissertations

Concerted binocular coordination evoking oculomotor and refractive responses to visual stimuli are essential to daily function. Oculomotor dysfunctions can inhibit binocular responses to visually-near stimuli and have high comorbidities to accommodative dysfunctions. Three visual cues for inward (convergent) and outward (divergent) oculomotor movements, when presented concertedly create natural-viewing conditions: disparity- the binocular difference in light cast onto the fovea due to differing ocular perspectives, blur- the acuity of a visual target which stimulates accommodation, and proximal- the perceived distance of a visual stimuli based on size.

This study aims to quantitatively investigate oculomotor vergence and accommodation performances between individuals with …


Investigating The Associations Of Cognitive Health, Health Behaviors, And Personality In Older Community-Dwelling Adults, Yan-Jhu Su May 2025

Investigating The Associations Of Cognitive Health, Health Behaviors, And Personality In Older Community-Dwelling Adults, Yan-Jhu Su

Graduate Doctoral Dissertations

Cognitive decline poses a significant public health challenge, with profound implications for aging populations. This dissertation investigates the associations between health behaviors, leisure activities, personality traits, and cognitive function in older U.S. adults, using data from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS). This work comprises three studies that explore both cross-sectional and longitudinal perspectives on cognitive aging.

Study 1 examines the complex interactions between personality traits, education, health behaviors, and cognitive function. The study is divided into two parts: Study 1a explores the role of health behaviors—smoking, alcohol use, and physical activity—as …


Gust, Stroll, Veil, Jungeun Park May 2025

Gust, Stroll, Veil, Jungeun Park

Masters Theses

I witness the unsettling and chaotic moments of everyday life:

blood clots in fried eggs, a dead rat on my porch, mites crawling on our skin . . .

These quiet tragedies exist with almost brutal indifference!

We eat, digest, excrete. We menstruate. We parasitize. We coexist.

I seek the intersection of repulsion and wonder in my daily experience and body sensations, visualizing unseen stimuli. I employ veil as a strategy. It conceals yet reveals. Sometimes, it acts as a transparent layer, sharpening what lies beneath. Other times, it blurs colors and forms, rendering them ambiguous. Veil transforms, entices, and …


From Industrial Building To Affordable Senior Housing: An Idea Book Beyond Code, Weiyi Ma May 2025

From Industrial Building To Affordable Senior Housing: An Idea Book Beyond Code, Weiyi Ma

Masters Theses

This thesis envisions a proposal to adaptively re-purpose Rhode Island’s extant industrial building stock into affordable housing tailored to the needs of its older and more vulnerable citizens. Architectural dignity, in terms of older citizens amidst this housing crisis, is the creation of living environments that honor their autonomy, comfort, and identity through design interventions that provide accessible, luminous, breathable, and socially enriching spaces, reaffirming their rightful place within the community. With humanistic care and logical rigor, it establishes a mathematical framework for assessment and execution, anchored in five criteria: light, air, space, accessibility, and livability, and presents itself in …


Of Dolls And Jewels : Keeping As A Strategy Of Care And Belonging, Yuqi Fan May 2025

Of Dolls And Jewels : Keeping As A Strategy Of Care And Belonging, Yuqi Fan

Masters Theses

In this thesis, I will discuss the psychology behind object attachment in the doll-keeping subculture by integrating doll language into contemporary jewelry. I researched the Chinese term “Pi” as an accurate way of explaining how doll-keepers are attached to their dolls. In this 21st century, the widespread use of social media and AI technologies have deepened people's reliance on virtual spaces, leading to emotional detachment in our society. Adopting the concept of “Pi” into contemporary jewelry, which encourages a shift in focus towards external objects, the practice of doll-keeping becomes a form of self-care that compensates for our current loneliness …


Prosthesis, Alexander A. Grosek May 2025

Prosthesis, Alexander A. Grosek

Masters Theses

This thesis explores the hospital as a prosthetic—a structural and spatial support for the human body in moments of vulnerability. Like a crutch or cast, the hospital temporarily supports patients in their transition from horizontal (infirm) to vertical (mobile), yet its architecture often fails to contribute meaningfully to that healing process. While clinical treatment is prioritized, the spatial, emotional, and sensory dimensions of care are neglected. What supports what becomes a central question: the building holds the body, but the body also gives meaning to the building. Their relationship is reciprocal.

Rather than proving that good design improves health—an idea …


Gradiance: A Mindfulness Intervention, Kip Geddes May 2025

Gradiance: A Mindfulness Intervention, Kip Geddes

Masters Theses

People in cities live life at a fast paced forward march that results in a mental state called ‘hurry sickness’. This prevents them from living in the moment, which often leads to a disconnection to those around them. Mindfulness techniques have been proven to increase people’s levels of happiness and openness to the people around them. However, many people are too busy to practice these methods. My thesis looks at ways for mindfulness to intervene into their established routines. Illumination has been shown to promote mental well-being, either in therapy lamps, or circadian rhythm based lighting; the liminal spaces that …


Field Journal: The Excluded Middle, Carrie E. Kouts May 2025

Field Journal: The Excluded Middle, Carrie E. Kouts

Masters Theses

What does it look like to engage with organisms and landscapes at the periphery of anthropocentric value structures? How does one break the internalized myth that the “built” environment is excluded from the natural world? When does a hyper-mobile and hyper-commodified society confront the exponential crisis of animal death? Within this series of journal entries, field notes, collection observations, weird prose, and sensory musings, one will find questions on the nature of being human and the complex narratives of care we encounter in a world shared with more-than-humans. Each handwritten vignette and photograph from daily life weaves a non-linear and …


The Portals: Jewelry As A Site Of Escape And Solace, Jung Ki Min May 2025

The Portals: Jewelry As A Site Of Escape And Solace, Jung Ki Min

Masters Theses

This thesis investigates jewelry as a medium for emotional escape and psychological refuge, offering multisensory alternative forms of escapism. Rooted in personal experiences of continuous change and instability, the work explores how imagined spaces—constructed through AI-generated and digitally assisted visuals and layered material processes—can serve as intimate sanctuaries. Drawing from psychological theories, surrealism, and escapism, the study positions jewelry as a portable interface that enables temporary retreat without full detachment from reality. The series of work, which integrates transparent acrylic, visual layering, and subtle dimensionality, materializes these imagined spaces into wearable forms. These pieces invite reflective engagement, allowing wearers to …