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Full-Text Articles in Medicine and Health Sciences

The Effect Of Three Foot Orthoses On Plantar Pressure Under The First Metatarsophalangeal Joint Of Pes Planus Foot Type During Standing And Slow Running, Lacey Ann Nordsiden Apr 2007

The Effect Of Three Foot Orthoses On Plantar Pressure Under The First Metatarsophalangeal Joint Of Pes Planus Foot Type During Standing And Slow Running, Lacey Ann Nordsiden

Human Movement Studies & Special Education Theses & Dissertations

The purpose of this study was to examine the effect of three different foot orthoses on plantar pressure under the first metatarsophalangeal joint during standing and slow running. Twenty physically active participants, 12 males (19.7±1.3 years, 181.5±6.3cm, 83.6±12.3kg) and 8 females (20.8±1.5 years, 172.7±11.2cm, 69.9±14.2kg) with navicular drop greater than 10mm, no history of surgery to the lower extremity, and no history of pain or injury to the 1st metatarsophalangeal joint in the past six months volunteered for the study. Each subject performed standing and slow running tasks with four different orthosis conditions: no orthosis, metatarsal dome, U-shaped orthosis, and …


Food Facilities, Food Service Workers And The Flow Of Food: Food-Borne Illnesses In Taiwan's Preschools, Shu-Chen Lin Mar 2007

Food Facilities, Food Service Workers And The Flow Of Food: Food-Borne Illnesses In Taiwan's Preschools, Shu-Chen Lin

Graduate Student Dissertations, Theses, Capstones, and Portfolios

This study examined food-borne illnesses in Taiwan's preschools which are a major cause of personal distress and preventable death. They are of particular concern in preschools as very young children are highly susceptible to food-borne illnesses. Previous studies that comprehensively investigated the factors impacting food-borne illnesses in Taiwan were not found in the literature. The development of a universal food safety model is necessary as a means to measure relevant constructs. Application of the model should be able to prevent the occurrence of food-borne illnesses in organizations. This explanatory (correlational) study examined the relationships among food facilities, food service workers, …


The Role Of Bone Marrow Derived Cells In A Model Of Hepatic Regeneration, Maria Mazzeo Mar 2007

The Role Of Bone Marrow Derived Cells In A Model Of Hepatic Regeneration, Maria Mazzeo

Yale Medicine Thesis Digital Library

To examine the relationship between liver injury and the appearance of bone marrow derived hepatic cells we performed sex-mismatched bone marrow transplants in mice, with subsequent liver injury. Co-labeling for a marker of donor bone marrow origin and a marker of liver epithelial phenotype allowed us to identify rare marrow-derived hepatocytes at various time points following liver damage. The number of marrow-derived hepatocytes was low, however, and did not allow us to determine if liver-specific injury upregulated this process from baseline. We conclude that while marrow-derived hepatocytes are found, the low level of occurrence in this study makes it impossible …


Binge Eating, Emotion Regulation, And Cognitive Resources, Jennifer A. Tucker Mar 2007

Binge Eating, Emotion Regulation, And Cognitive Resources, Jennifer A. Tucker

Loma Linda University Electronic Theses, Dissertations & Projects

Research has shown that individuals with binge eating disorder (BED) have difficulty coping with negative emotions, although no research to date has directly investigated emotion regulation and binge eating. In the current study individuals with varying amounts of BED characteristics were measured for accuracy on a computerized task involving attention and working memory. Subsequent to the task, participants were given three self-report measures: the Eating Disorder Examination Questionnaire (EDEQ-I; Fairbum & Celio, 2004), the Positive and Negative Affect Schedule (PANAS; Watson, Clark & Tellgen, 1988), and the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003). It was hypothesized that in …


The Association Between Lifestyle Factors And Inflammatory Markers, Kerry Ann Stonebrook Mar 2007

The Association Between Lifestyle Factors And Inflammatory Markers, Kerry Ann Stonebrook

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States. While smoking, high blood pressure, and elevated cholesterol levels are established risk factors for CVD, inflammation is being evaluated as a potential independent risk factor. A key cytokine regulator of the inflammatory response, interleukin-1 (IL-1), has emerged as playing a particularly important role at the genetic level in determining the degree to which the inflammation pathway is turned on. How an individual’s genetic make-up affects inflammation, CVD risk, and response to lifestyle intervention is an area of research that is in …


A Composite Cognition Instrument For Nursing Care Of Combat Casualties, Patricia Frohock Hanes Phd, Msn, Maed, Rn Feb 2007

A Composite Cognition Instrument For Nursing Care Of Combat Casualties, Patricia Frohock Hanes Phd, Msn, Maed, Rn

Dissertations

In the course of caring for military and civilian combat casualties, military nurses must make rapid, accurate decisions. When developing methods to teach nurses essential content for combat casualty care, it is important to understand the cognitive and learning processes involved in acquiring that knowledge. Measures to examine how military nurses think and learn have significance, especially when applied to the high-stress, high-stakes practice arena of combat causality care. Use of these measures in evaluating educational strategies will help answer the need for better deployment readiness for military nurses. The purpose of this study is to develop an instrument to …


Intellectual Property, The Pharmaceutical Industry And Neglected Diseases: An Analysis Of The Effects Of The Current Patent System On Access To Medication, And A Consideration Of Alternative Legal And Non-Legal Solutions, Mohamed A. Elmaazi Feb 2007

Intellectual Property, The Pharmaceutical Industry And Neglected Diseases: An Analysis Of The Effects Of The Current Patent System On Access To Medication, And A Consideration Of Alternative Legal And Non-Legal Solutions, Mohamed A. Elmaazi

Archived Theses and Dissertations

No abstract provided.


Neurophysiologic And Behavioral Measures Of Phonetic Perception In Adult Second Language Speakers Of Spanish, Jaden D. Hellewell Jan 2007

Neurophysiologic And Behavioral Measures Of Phonetic Perception In Adult Second Language Speakers Of Spanish, Jaden D. Hellewell

Theses and Dissertations

Infants 6-8 months old are able to identify nearly every speech sound contrast on which they have been tested, regardless of whether that contrast represents an across-category (two different phonemes) phonetic change in their native language or not. A child's ability to identify non-native consonant contrasts greatly diminishes by 11-12 months of age. The present study examined speech sound discrimination in three groups of listeners. Adult second language (L2) listeners of Spanish were compared with native English listeners with no knowledge of Spanish and native Mexican listeners to determine if they would show the ability to discriminate phonetic distinctions that …


A Member Of The Novel Fikk Family Of Plasmodium Falciparum Putative Protein Kinases Exhibits Diacylglycerol Kinase Activity And Is Exported To The Host Erythrocyte, David Floyd Curtis Jan 2007

A Member Of The Novel Fikk Family Of Plasmodium Falciparum Putative Protein Kinases Exhibits Diacylglycerol Kinase Activity And Is Exported To The Host Erythrocyte, David Floyd Curtis

Electronic Theses and Dissertations

Plasmodium falciparum is one of four species known to cause malaria in humans and is the species that is associated with the most virulent form of the disease. Malaria causes nearly two million deaths each year, many of these occurring among children in under-developed countries of the world. One reason for this is the prevalence of drug resistant strains of malaria that mitigate the efficacy of existing drugs. Hence, the identification of a new generation of pharmacological agents for malaria is extremely urgent. The recent identification of a group of novel protein kinases within the Plasmodium falciparum genome has provided …


Giving Dentistry A Hand: Occupational Therapy Msd Prevention In Dentistry, Andrea Bilotti Jan 2007

Giving Dentistry A Hand: Occupational Therapy Msd Prevention In Dentistry, Andrea Bilotti

Occupational Therapy Capstones

Musculoskeletal disorders (MSDs) pose a significant threat to the dental profession. There are many risk factors inherent in the tasks of dental professionals that could lead to MSDs. A literature review from professional literature, journal articles, and professional websites was used to determine the various risk factors and types of MSDs that occur in the dental profession; best practices in MSD prevention in the dental field; and the role of occupational therapy ergonomic intervention in the dental field. The information has a solid foundation in Malcolm Knowles' theory of Andragogy.

To gather real life information, visits to a dental office …


Mlck/Actin Interaction In The Contracting A7r5 Cell And Vascular Smooth Muscle, Sean Eric Thatcher Jan 2007

Mlck/Actin Interaction In The Contracting A7r5 Cell And Vascular Smooth Muscle, Sean Eric Thatcher

Theses, Dissertations and Capstones

Myosin light chain kinase (MLCK) is an enzyme that phosphorylates the serine-19 residue on myosin regulatory light chains (MLCs) which serves to activate the Mg2+-ATPase of myosin. This catalytic activity is thought to be the primary role of MLCK; however, it has recently been suggested that MLCK’s actin binding and bundling properties may also be of importance in smooth muscle contraction. In the absence of calcium and calmodulin (CaM), MLCK will bundle actin filaments with its N-terminus. During calcium influx and subsequent CaM activation, MLCK binding to actin decreases resulting in unbundling of actin filaments and allows myosin and actin …


The Effect Of High-Fidelity Manikin-Based Human Patient Simulation On Educational Outcomes In Advanced Cardiovascular Life Support Courses, David L. Rodgers Jan 2007

The Effect Of High-Fidelity Manikin-Based Human Patient Simulation On Educational Outcomes In Advanced Cardiovascular Life Support Courses, David L. Rodgers

Theses, Dissertations and Capstones

The use of high-fidelity manikin-based simulation has been studied in many healthcare education areas. However, the use of this education technology in the American Heart Association Advanced Cardiovascular Life Support (ACLS) course has not been well examined in the literature, despite this education program being one of the most widely taught standardized medical courses in the United States. This study examined high fidelity manikin-based simulation versus low-fidelity manikin-based simulation in the context of an actual ACLS course. Four outcomes were measured: learning outcomes as judged by an expert rater panel reviewing videos of subjects performing a simulated cardiac arrest event …


Risk Management Practices Of Collegiate Athletic Trainers: An Examination Of Policies And Procedures, Ericka Point Zimmerman Jan 2007

Risk Management Practices Of Collegiate Athletic Trainers: An Examination Of Policies And Procedures, Ericka Point Zimmerman

Theses, Dissertations and Capstones

The purpose of this study was to identify and describe (a) risk management practices of collegiate athletic trainers, (b) perceived risk management practices important to the collegiate athletic trainer, (c) risk management responsibilities of the head athletic trainer, and (d) resources utilized by collegiate athletic trainers in the development of a risk management plan. Risk management practices were divided into 13 categories: (a) periodic review, (b) consultation, (c) periodic in-services of policies, (d) periodic inservices for personnel, (e) methods for insuring against loss, (f) participation and consent of athletes, (g) emergencies, (h) care and treatment of injuries and conditions, (i) …


Shear Stress Induced Mtor Signaling In Cultured A7r5 Aortic Smooth Muscle Cell Line, Sriram Prasad Mupparaju Jan 2007

Shear Stress Induced Mtor Signaling In Cultured A7r5 Aortic Smooth Muscle Cell Line, Sriram Prasad Mupparaju

Theses, Dissertations and Capstones

Vascular intervention procedures such as balloon angioplasty and stent implantation lead to denudation of endothelium exposing the underlying smooth muscle layer to effects of blood shear stress. The effect of shear stress on smooth muscle cell signaling has not been studied in depth. In this study, we examined time dependent changes in activation of Akt, mTOR and p70S6k related signaling in response to orbital shear stress on cultured A7r5 cells. A7r5 cells cultured to subconfluence on 150mm culture dishes were subjected to orbital shear of 9.8dynes/cm 2 for zero, 5 min, 15 min, 30 min, 1h, 4h and 24h. The …


Chronic Acetaminophen Treatment Influences Indices Of Reactive Oxygen Species Accumulation In The Aging Fisher 344 X Brown Norway Rat Aorta, Sarath Meduru Jan 2007

Chronic Acetaminophen Treatment Influences Indices Of Reactive Oxygen Species Accumulation In The Aging Fisher 344 X Brown Norway Rat Aorta, Sarath Meduru

Theses, Dissertations and Capstones

We have previously reported that aging in the Fisher 344 X Brown Norway (FBN) rat aorta is characterized by increased levels of ROS and alterations in cell signaling. Acetaminophen was found to scavenge free radicals in recent ischemia-reperfusion studies. Here we examined if chronic treatment with a therapeutic dose of acetaminophen attenuates age-associated increase in aortic ROS accumulation and signaling. FBN rats (27 month old; n=8) were subjected to 6 months of treatment with a therapeutic dose of acetaminophen (30mg/kg/day), with age-matched untreated FBN rats as controls. Protein oxidation levels were altered in control and treated aortae compared to aortae …


The Expression And Function Of Ppar And Hif-1 In Human Melanoma, Caroline Mills Jan 2007

The Expression And Function Of Ppar And Hif-1 In Human Melanoma, Caroline Mills

Theses, Dissertations and Capstones

The first part of my dissertation focuses on the expression and function of PPARs in human melanoma. I found that the A375 cells were significantly growth inhibited in response to PGJ2 and troglitazone treatment. HEMn-LP showed significant growth inhibition in response to troglitazone. I found that PPARγ and PPARδ mRNA is present in both the SK-Mel 28 and A375 cells. The relative level of PPARα mRNA expression is highest in SK-Mel 28 cells, ~3 fold higher relative to both the normal human melanocytes and A375 cells. PPARγ protein was ~50% higher in both SK-Mel 28 and A375 cells relative to …


The Relationship Between Leadership Styles And Organizational Culture Withinschools Of Nursing, Debra K. Vankovich Mullins Jan 2007

The Relationship Between Leadership Styles And Organizational Culture Withinschools Of Nursing, Debra K. Vankovich Mullins

Theses, Dissertations and Capstones

The purpose of this study was to investigate the relationship between leadership styles and organizational culture within schools of nursing. A non-probability convenience sample (N=149) of subjects was obtained from BSN schools of nursing within the Southern Regional Education Board geographical area. Three data collection tools were utilized including a demographic questionnaire; the Multi-factor Leadership Questionnaire (Bass & Avolio) which measures transformational, transactional, and laissez-faire leadership styles; and the Organizational Culture Assessment Inventory (Cameron & Quinn) which measures four culture types including clan, market, adhocracy and hierarchy cultures. A descriptive – correlational design was used. Inferential statistics utilized included multiple …


The Influence Of College Students’ Perception Of Parental (Or Primary Caregiver) Expectations On Coping Behavior And Adjustment In Early Adulthood, Jessica Smith Jan 2007

The Influence Of College Students’ Perception Of Parental (Or Primary Caregiver) Expectations On Coping Behavior And Adjustment In Early Adulthood, Jessica Smith

Theses, Dissertations and Capstones

While some research has examined how parental expectations affect educational achievement, there is very little known about how parental expectations affect the development of coping skills and adaptive and maladaptive psychosocial functions. Participants were asked to complete a measure of their abilities in academics, sports, leadership, honesty, responsibilities, among other things. Then, they completed a measure of what they perceived their parents’ expectations of those areas were. Lastly, they completed the Behavioral Assessment System for Children-College Self Report of Personality form as a measure of adaptive and maladaptive functioning. The goals of this study are to investigate 1) if participants' …


Investigation Of Environmental Microorganisms Associated With The Intrinsic Microbial Contamination Of An Alcohol-Free Mouthwash, Michelle D. Trickett Jan 2007

Investigation Of Environmental Microorganisms Associated With The Intrinsic Microbial Contamination Of An Alcohol-Free Mouthwash, Michelle D. Trickett

Theses, Dissertations and Capstones

The United States Pharmacopoeia (USP) Microbial Limits Test and Preservative Effectiveness Test were validated and completed on an alcohol-free mouthwash using standard USP recommended microorganisms and selected organisms isolated from the manufacturing environment. The microbial limits test using environmental isolates was found equivalent to the USP Microbial Limits Test currently used for release of the product. The preservative effectiveness test was performed to determine the efficacy of the parabens system against environmental isolates compared to those recommended in the USP test. In both tests Pseudomonas aeruginosa isolates exhibited resistance to the preservative system. All other isolates failed to grow after …


Aging Influences Multiple Indices Of Oxidative Stress In The Heart Of The Fischer 344/Nnia X Brown Norway/Binia Rat, Shinichi Asano Jan 2007

Aging Influences Multiple Indices Of Oxidative Stress In The Heart Of The Fischer 344/Nnia X Brown Norway/Binia Rat, Shinichi Asano

Theses, Dissertations and Capstones

Here we report the influence of aging on multiple markers of oxidativenitrosative stress in the heart of adult (6-month), aged (30-month) and very aged (36- month) Fischer 344/NNiaHSd X Brown Norway/BiNia (F344/NXBN) rats. Compared to 6 month old rat hearts, indices of oxidative (superoxide anion (–O2 ·), 4-hyrdoxy-2- nonenal (4-HNE)) and nitrosative (protein nitrotyrosylation) stress were 34.1 ± 28.1%, 186 ± 28.1% and 94 ± 5.8% higher, respectively, in 36-month hearts and these findings were highly correlated with increases in left ventricular wall thickness (r>0.669; r>0.710 and p<0.01, respectively). Regression analysis showed that increases in cardiac oxidative-nitrosative stress with aging were significantly correlated with changes in the expression and/or regulation of proteins involved in transcriptional (NF-κB) activities, signaling (mitogen activated protein kinases along with Src), apoptotic ( Bcl-2, Traf-2), and cellular stress (HSPs). These results suggest that the aging F344/NXBN heart may be highly suited for unraveling the molecular events that lead to age-associated alterations in cardiac oxidative stress.


Perceptions Of Preceptor Training In The Dietetic Supervised Practice Experience, Mary Kathryn Gould Jan 2007

Perceptions Of Preceptor Training In The Dietetic Supervised Practice Experience, Mary Kathryn Gould

Theses, Dissertations and Capstones

Preceptors are critical in the education of dietetic students and over the years, interest in preceptor training has grown. As a result, the American Dietetic Association recently established a task force to develop and implement a Preceptor Training Certificate Program. There is, however, limited information with regard to formal preceptor training currently being offered by dietetic internships and the affect it may have on programs. Because of the lack of knowledge concerning this topic, a qualitative collective case study was conducted at three university-based dietetic internships with the intent of adding to the body of knowledge regarding formal preceptor training …


Lean And Obese Zucker Rats Exhibit Different Patterns Of P70s6kinase Regulation In The Tibialis Anterior Muscle In Response To High Force Muscle Contraction, Anjaiah Katta Jan 2007

Lean And Obese Zucker Rats Exhibit Different Patterns Of P70s6kinase Regulation In The Tibialis Anterior Muscle In Response To High Force Muscle Contraction, Anjaiah Katta

Theses, Dissertations and Capstones

Increased muscle loading results in phosphorylation of the 70 kDa ribosomal S6 kinase (p70s6k) signaling pathway and this event strongly correlates with degree of muscle adaptation following resistance exercise. Here, we compared the basal and contraction- induced phosphorylation of p70s6k, Akt and mTOR in tibialis anterior muscles of lean and obese Zucker rats. Immunoblotting demonstrated differences in level of basal p70S6k phosphorylation (Thr 389) in the normal and diabetic TA. HFES had an increase in p70S6k (Thr389) phosphorylation at 0-, 1- and 3-hr in lean TA and only at 3-hr in obese TA. mTOR (Ser 2448) Phosphorylation was elevated in …


Stigma Perceived By Persons With Human Immunodeficiency Virus Attending The Infectious Diseases Clinic Of Centre Hospitalier Universitaire De Fann In Dakar, Senegal, Nana Akua Asafu-Agyei Jan 2007

Stigma Perceived By Persons With Human Immunodeficiency Virus Attending The Infectious Diseases Clinic Of Centre Hospitalier Universitaire De Fann In Dakar, Senegal, Nana Akua Asafu-Agyei

Yale Medicine Thesis Digital Library

Human Immunodeficiency Virus (HIV)-associated stigma is pervasive throughout the world. This stigma affects the ability of HIV-positive individuals to cope with their illness and it also affects behaviors around sexual practices, disclosure to others and the use of healthcare. The purpose of the research project was to examine the experience of internalized stigma among HIV-positive persons and their perceptions of stigmatizing attitudes in the community. The study also examined disclosure of HIV serostatus and identified factors contributing to disclosure and stigma in Senegal, a low prevalence Muslim country in West Africa. A cross-sectional study was conducted at Centre Hospitalier Universitaire …


Physical Characteristics Of An Individual: The Identification Of Biomarkers For Biological Age Determination, Michelle Alvarez Jan 2007

Physical Characteristics Of An Individual: The Identification Of Biomarkers For Biological Age Determination, Michelle Alvarez

Electronic Theses and Dissertations

It is now a matter of routine for the forensic scientist to obtain the genetic profile of an individual from DNA recovered from a biological stain deposited at a crime scene. Potential contributors of the stain must either be known to investigators (i.e. a developed suspect) or the questioned profile must be searched against a database of DNA profiles such as those maintained in the CODIS National DNA database. However, in those instances where there is no developed suspect and no match is obtained after interrogation of appropriate DNA databases, the DNA profile per se presently provides no meaningful information …


Retrocyclin Rc-101 Overcomes Cationic Mutations On The Heptad Repeat 2 Of Hiv-1 Gp41, Christopher Fuhrman Jan 2007

Retrocyclin Rc-101 Overcomes Cationic Mutations On The Heptad Repeat 2 Of Hiv-1 Gp41, Christopher Fuhrman

Electronic Theses and Dissertations

Retrocyclin RC-101, a θ-defensin with lectin-like properties, potently inhibits infection by many HIV-1 subtypes by binding to the heptad repeat (HR)-2 region of gp41 and preventing six-helix bundle formation. In the present study, we used in silico computational exploration to identify residues of HR2 that interacted with RC-101 and then analyzed the HIV-1 Sequence Database at LANL for residue variations in the HR1 and HR2 segments that could plausibly impart in vivo resistance. Docking RC-101 to gp41 peptides in silico confirmed its strong preference for HR2 over HR1, and implicated residues crucial for its ability to bind HR2. We mutagenized …


A Pilot Study To Screen Fall Risk In Adult Health Care Employees, Patricia Borboa, Emily Hansen, Jessica Hoeft, Alicia Holzer Jan 2007

A Pilot Study To Screen Fall Risk In Adult Health Care Employees, Patricia Borboa, Emily Hansen, Jessica Hoeft, Alicia Holzer

Physical Therapy Scholarly Projects

Background and Purpose: Due to the increasing age of the working population, falls are becoming an escalating problem especially in the healthcare industry. The purpose of this research study is to develop a cost effective quick screen to determine fall risk in healthcare employees. Our overall goal is to take the results gained from this pilot study and apply them on a larger scale in hopes of preventing falls thus decreasing dollars spent by companies on work injury.

Subjects: Volunteers from a local Health Care System. Inclusion criteria: permanent employees, over the age of 20, without an assistive device. A …


The Energy Club: A Diabetes Prevention Project For Monterey Elementary School, Peggy Ann Scoggin Jan 2007

The Energy Club: A Diabetes Prevention Project For Monterey Elementary School, Peggy Ann Scoggin

Theses Digitization Project

The Monterey School Diabetes Prevention Project's (MSDPP) ENERGY Club is a pilot project for school-based health prevention curriculum targeting students with risk factors for diabetes. ENERGY is an acronym for Exercise 'n Eating Right is Good for You.


Levels Of Subjective Quality Of Life Among Adults With Psychotic Disorders Formerly In Foster Care: Compared To A Matched Sample, Rosa Arias, Flora Irene Dharmaraj Jan 2007

Levels Of Subjective Quality Of Life Among Adults With Psychotic Disorders Formerly In Foster Care: Compared To A Matched Sample, Rosa Arias, Flora Irene Dharmaraj

Theses Digitization Project

The purpose of this study was to explore whether or not adults with psychotic disorders, who were formerly in foster care, are more likely to report a lesser quality of life as compared to a matched sample with no history of foster care.


An Administrator's Guide To Implementing Effective Dual Immersion Programs, Melanie Dawn Mcgrath Jan 2007

An Administrator's Guide To Implementing Effective Dual Immersion Programs, Melanie Dawn Mcgrath

Theses Digitization Project

This project fills a void in the area of dual immersion program implementation. Although there are general guidelines that exist, there is a paucity of specific guidelines that explicitly delineate the implementation of these critical components in the current accountability climate. We need to move beyond general categories and tailor them to the unique needs program models within situated contexts.


Development Of A Vascular Diagnostics Center At Downtown Hospital: A Feasibility Study, Roland Jason Fargo Jan 2007

Development Of A Vascular Diagnostics Center At Downtown Hospital: A Feasibility Study, Roland Jason Fargo

Theses Digitization Project

The scope of this analysis encompasses the feasibility of establishing a vascular diagnostics laboratory at Downtown hospital.