Medicine and Health Sciences Commons^™

Racial And Ethnic Disparities In Hospital Practices That Support Breastfeeding In The United States, Jane Lazar Tucker

Open Access Dissertations

Breastfeeding is the optimal form of infant nutrition and has many health benefits for mothers as well as infants (CDC, 2022a; Victora et al., 2016). Though rates of breastfeeding have improved in recent years, disparities in breastfeeding persist among Black and Hispanic women compared to White women (Beauregard et al., 2019; Chiang et al., 2021), despite similar intentions to breastfeed across all racial/ethnic groups (Hamner et al., 2021). Hospital practices that support breastfeeding, such as the baby being placed skin-to-skin immediately after delivery or staying in the room with the mother throughout the hospital stay, are known to predict breastfeeding …

Development Of An Order Set To Improve Consistency Of Blood Glucose Monitoring For Hospitalized Patients On Enteral Feeding, Kristen Calebaugh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Development of an Order set to Improve Consistency of Blood Glucose Monitoring for Adult Hospitalized Patients on Enteral Feeding

Kristen Calebaugh, BSN, RN

Background

Hospitalized patients often require artificial nutrition through either enteral feeding, placing the patient at risk for glucose alterations related to physiological responses of nutritional metabolism. Historically, there has been no standard of care or consistency aligning tube feedings times with point of care blood glucose testing. Without a standardized order set to guide blood glucose monitoring orders, patients on artificial nutrition may experience undetected hypo or hyperglycemia or inadequate glycemic control, which can cause adverse …

A Multidisciplinary Approach To Identify Postoperative Delirium In Geriatric Patients Using A Brain Health Screening Tool, Ashlyn Mccartney

Graduate Theses, Dissertations, and Problem Reports (ETD)

Postoperative delirium (POD) is a common occurrence, effecting nearly 61% of the surgical population recovering from anesthesia. POD increases risk of morbidity and mortality leading to prolonged hospital length of stay by 0.8 to 7.3 days and increased costs by $1,551 to $23,698 (Masharaf et al., 2022; Sethi, 2021). An academic medical center in northern West Virginia (WV) lacks a structured practice/protocol to identify high risk patients and assess POD. An evidence-based solution was developed based on the PICO question: Does a multidisciplinary approach to perianesthetic care utilizing a brain health screening tool, compared to lack of a screening tool, …

Multidisciplinary Approach To Injury Rehabilitation: The D1 College Athlete Perspective, Lindsey Leatherman

Graduate Theses, Dissertations, and Problem Reports (ETD)

Sport injuries continue to be unavoidable disruptions in student-athletes’ athletic careers with over 200,000 injuries estimated to be reported each year in college sport (Kerr et al., 2015). Researchers continue to emphasize the importance of an interprofessional approach to rehabilitation to help athletes manage the adverse psychological and emotional reactions to injury (Appaneal et al., 2009; Gervis et al., 2020; Putukian, 2016). The purpose of this study was to extend and replicate the research of Clement and Arvinen-Barrow (2021) by incorporating perspectives of Division I US student-athletes. The current study describes 321 NCAA Division I collegiate athletes’ experiences of receiving …

Project Quiet: A Quality Improvement Initiative To Reduce Noise Pollution During Anesthesia Induction And Emergence, James Christopher Woods

Graduate Theses, Dissertations, and Problem Reports (ETD)

Problem: Excessive intraoperative noise puts anesthesia providers at risk for errors that could negatively impact patient morbidity and mortality. Distractions from excessive noise experienced during the “critical phases” of anesthesia present a risk to patient safety and need to be reduced or eliminated. Anecdotally, reports from anesthesia staff at a large academic medical center confirmed that noise pollution during induction and emergence significantly impacted the performance of critical anesthesia tasks. Objective: The goal of this quality improvement (QI) project was to implement a series of interventions designed to reduce noise pollution during induction and emergence, and to reduce …

Interactions Between Myeloid Cells And Neutrophil Extracellular Traps In Pancreatic Ductal Adenocarcinoma, Hillary Gabrielle Pratt

Graduate Theses, Dissertations, and Problem Reports (ETD)

The 5-year-survival rate for pancreatic ductal adenocarcinoma (PDAC) is only 12% due in part to a lack of therapeutic strategies that target the pathophysiology of the disease. The only known curative therapy is surgical resection of the PDAC tumor, but only 20% of patients are eligible at the time of presentation. To improve outcomes for patients, new therapeutic options are needed. The PDAC tumor microenvironment (TME) is uniquely fibrotic and hypoxic, which is in part driven by the immune cell composition in the TME. Myeloid cells are a prominent immune infiltrate within the PDAC TME, so these cells have been …

Evaluating Outcomes Post-Adoption Of Reck Solution For Total Shoulder Arthroplasties: A Retrospective Quality Analysis, Benjamin Levi Tillis

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Evaluating Outcomes Post-adoption of RECK Solution for Total Shoulder Arthroplasties: A Retrospective Quality Analysis

Benjamin Tillis

Introduction: Local infiltration analgesia (LIA) has become an integral part of postoperative pain relief for West Virginia University (WVU) Medicine’s total joint arthroplasty procedures. However, not all LIAs are the same. Liposomal bupivacaine has a unique mechanism of delivery which could potentially lead to longer lasting effects. Ropivacaine, epinephrine, clonidine, and ketorolac (RECK) solution offers a multimodal approach to enhancing the duration of effect for the LIA. In 2022, WVU Medicine switched from liposomal bupivacaine to the RECK solution for total joint …

Pilot Quality Improvement Project To Update Surgeon Preference Cards Of A Community Hospital's Orthopedic Service, Jessica R. Mitchell

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Implementation of a Pilot Quality Improvement Project to Update Surgeon Preference Cards

of a Community Hospital’s Orthopedic Service

Jessica R. Mitchell

Problem Statement: Over time, surgeons change preferences for surgical equipment, and their preference cards need updating. Failure to update preference cards leads to impaired staff communication, opening of unnecessary equipment, excess waste, increased cost to patients and facilities, and potential threats to patient safety.

Background: Members of the orthopedic surgical team in a community hospital in suburban West Virginia wanted to establish a process to regularly update outdated surgeon preference cards (SPC) for several common orthopedic procedures. The …

The Impact Of Occupational Therapy In Lactation Services, Sarah Adrienne Mcaninch

Graduate Theses, Dissertations, and Problem Reports (ETD)

Many benefits to breastfeeding exist for both mothers and infants, yet exclusive breastfeeding rates remain low across the nation. These benefits include decreased chance of infections for infants, low infant mortality, and decreased chances of breast and ovarian cancers for mothers (Binns et al., 2016; CDC, 2023). Education strategies have recently become imperative for health organizations to help mothers sustain their ability to breastfeed within the recommended six-month timeframe. Current literature on education supports that women who receive education at some point in their lactation journey are more likely to reach the six-month period and have more confidence in their …

Relationships Between Cognitive And Physical Performance And Readiness In Military Populations, Lina Ochoa

Theses and Dissertations--Rehabilitation Sciences

Military missions and operations expose warfighters to stressful and demanding situations and dynamic environments. These situations and environments require that warfighters have optimal performance in several dimensions of human performance, such as cognitive and physical performance. Military readiness is the potential these military units or personnel have to successfully deploy and sustain assigned operational missions worldwide. Military readiness is essential for increased physical and cognitive performance, ensuring augmented individual and unit effectiveness, lethality, and national security. The primary challenge is understanding and finding ways to measure and assess the cognitive, behavioral, and physical performance effects of complex and challenging environments …

Do Pediatric Patients That Receive Dexmedetomidine As Premedication Experience Less Emergence Delirium Than Pediatric Patients That Receive Midazolam As Premedication?, Shelby Mccloud

Theses, Dissertations and Capstones

Title: Do pediatric patients that receive dexmedetomidine as premedication experience less emergence delirium than pediatric patients that receive midazolam as premedication?

Problem Statement: Midazolam remains the current choice within the practice for premedication in the prevention of emergence delirium, however as research continues there could possibly be a gap between the research and current practice. Throughout the practice of pediatric anesthesia most providers choose to premedicate with midazolam while there may be a more beneficial option of dexmedetomidine.

Results: The study found a significant variance in the incidence of emergence delirium among pediatric patients, ranging from 18.1% to 89%, depending …

Percutaneous Management Of Pelvic Fluid Collections: A 10-Year Series, Chidumebi Alim

Yale Medicine Thesis Digital Library

ABSTRACTTitle: Percutaneous Management of Pelvic Fluid Collections: A 10-Year Series Authors: Chidumebi Alim, BSc1; Chinenye Okafor, MBBS, MPH2; Joshua Cornman-Homonoff, MD3

1Yale School of Medicine, New Haven, CT2Department of Neurology, Yale School of Medicine, New Haven, CT 3Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT

Percutaneous image-guided drainage has emerged as the preferred treatment for infected and symptomatic fluid collections of adequate size, particularly those in the pelvis. Despite this, the optimal approach to catheter placement and management remains unknown. The purpose of this study was to retrospectively evaluate a large …

Influence Of Human And Viral Il-6 On Kshv Infection In Human Tonsil Lymphocytes, Wajd Zakir

Pharmaceutical Sciences (MS) Theses

Infection of B cells by the lymphotropic gamma-herpesvirus Kaposi sarcoma-associated herpesvirus (KSHV) causes Multicentric Castleman Disease, Primary Effusion Lymphoma, and the newly-identified inflammatory syndrome designated KICS. Despite proven connections to lymphoproliferative disorders, little is known about how KSHV invades the human immune system or the early events governing infection in B lymphocytes. IL-6 signaling plays a critical role in KSHV-mediated disease, where elevated hIL-6 levels are positively associated with KSHV viral load and disease progression. This dynamic is even more complex due to the co-existence of human IL-6 (hIL6) and KSHV-encoded viral IL-6 (vIL6) in these diseases. Although the impact …

A Comprehensive And Comparative Examination Of Healthcare Data Breaches: Assessing Security, Privacy, And Performance, Mohammed Al Kinoon

Graduate Thesis and Dissertation 2023-2024

The healthcare sector is pivotal, offering life-saving services and enhancing well-being and community life quality, especially with the transition from paper-based to digital electronic health records (EHR). While improving efficiency and patient safety, this digital shift has also made healthcare a prime target for cybercriminals. The sector's sensitive data, including personal identification information, treatment records, and SSNs, are valuable for illegal financial gains. The resultant data breaches, increased by interconnected systems, cyber threats, and insider vulnerabilities, present ongoing and complex challenges. In this dissertation, we tackle a multi-faceted examination of these challenges. We conducted a detailed analysis of healthcare data …

An Exploration Of Medical Mistrust In Urban African American Adolescents With High Risk Asthma, Meghna Shukla

Wayne State University Dissertations

Problem: Little is known about the relationship between medical mistrust and health outcomes in adolescents, particularly minority adolescents with chronic illness. There is also a paucity in knowledge on the relationship between caregivers’ trust or mistrust in a provider and if this is similar or dissimilar in their adolescent’s beliefs. To address this critical gap in research, this study aims to explore medical mistrust in AA adolescents with high-risk asthma and their caregivers. Asthma is currently the leading pediatric chronic respiratory condition in the United States, with a reported 60% had uncontrolled asthma symptoms. Asthma disproportionately affects urban, disadvantaged, minority …

Neuroimmune Response And Neurodegeneration In Adolescent Rats Following Binge Alcohol Exposure, Catherine Van Doorn

Theses and Dissertations--Pharmacy

Studies of adolescent drinking show a distinct prevalence of binge drinking, including at extreme levels, and this type of drinking has been identified as increasing risk of developing an Alcohol Use Disorder (AUD). Additionally, females suffer greater levels of harm from binge drinking and AUD and in an abbreviated timeline compared to males. Neuroimmune reactivity, specifically with microglial reactivity following binge drinking, may influence the sex differences seen in negative alcohol-related health disparities.

The first set of experiments sought to examine a marker of microglial reactivity, TSPO, in adolescent females and males and found the sexes displayed different temporal and …

Understanding Social Dynamics In Toxic Conversations And Public Health Intervention Acceptance On Social Media, Ana Aleksandric

Computer Science and Engineering Dissertations - Archive

Social media is now central to daily life, offering users a space to share content and opinions. However, these platforms also facilitate the spread of hate speech and misinformation, which can negatively impact public health. This dissertation develops methodologies to analyze social media data for insights that could inform health interventions. The research first examines user responses to toxic content, focusing on behavioral and emotional reactions, as well as group dynamics and bystander effects in toxic interactions. Another key focus is public opinion toward health interventions, particularly COVID-19 vaccination, using geolocated posts and analyzing factors such as race, ethnicity, and …

Clinical Characteristics And Outcomes Of Patients With Idiopathic Intracranial Hypertension In East Africa: A Retrospective Cross-Sectional Study, Zian Muikamba

Master of Internal Medicine

Introduction; Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by elevated intracranial cerebrospinal fluid (CSF) pressure without demonstratable evident causes. The mechanisms leading to a particular predilection for women of childbearing age who are overweight and obese or who have recent rapid weight changes remain imprecisely described. The Modified Dandy criteria is used for diagnosis and includes-clinical symptoms, papilledema, lumbar puncture (LP) opening pressure, and neuroimaging. If undiagnosed, it can progress to disabling irreversible visual loss. Weight loss is useful in addition to medical therapy in treating the condition. Data in Sub-Saharan Africa is scarce.

Methods; This study described …

Mandatory Second Opinion To Reduce Caesarean Section Rate Among Low-Risk Pregnant Women At A Private Tertiary Hospital: An Analysis Using Who Robson Classification., Gregory Ntiyakunze

Master of Obstetrics and Gynecology

v> The caesarean section rate has increased globally, even among low-risk obstetric deliveries. Consequently, mothers and babies are exposed to potential complications associated with caesarean sections. Therefore, the World Health Organization has introduced measures to reduce unnecessary caesarean sections, including a globally accepted classification system for all deliveries Robson's system and recommended safe non-medical interventions, such as mandatory second opinions prior to caesarean sections

Knowledge And Perception Of Hand Hygiene And Associated Factors Among Final Year Medical And Nursing Students In Dar Es Salaam Tanzania, Anthony Baltazary Ngowi

Master of Obstetrics and Gynecology

Hand hygiene, when practiced correctly and consistently is a simple and effective

method to prevent healthcare associated infections. These infections are acquired during a patients’ hospital stay and pose a major worldwide public health problem. The knowledge and practices related to hand hygiene among health workers need to be instilled early on during their training to develop a culture of correct and consistent practice. Existing literature has explored hand hygiene among health workers but very few studies have looked at it amongst medical and nursing students, who are the healthcare workers of tomorrow. This study aimed to assess hand hygiene …

Challenges In Post Graduate General Surgery Training In Tanzania: A Trainee’S Perspective, Shabbir Adamjee

Master of Surgery

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General Surgery residency training is a complex vigorous program which includes long working hours and complex surgical cases, in order to develop and attain the knowledge and the skills the trainee needs by the end of the program. Worldwide, general surgery programs have high attrition rates and residents have identified challenges which may be work related, related to social wellbeing and/or the residency program structure. Tanzania has public and private institutions providing general surgery residency training and although most have a quality assessment program the data is not readily available. Each institution has its personalized curriculum with its unique …

Microbial Profile And Antimicrobial Resistance Patterns Of Surgical Intra-Abdominal Infections At A Tertiary Hospital In Tanzania A Retrospective Cross-Sectional Study, Abduel Julius Kitua

Master of Surgery

v>

Among infections of surgical importance, intra-abdominal infections prevail among the most common in surgical patients with considerable morbidity and mortality. The ever-rising microbial resistance to commonly available antibiotics and geographical variations in microbial profile and resistance patterns poses a challenge to the management of these surgical infections of abdominal origin. The aim of this study was to evaluate microbiological characteristics and antibiotic susceptibility of isolates from intra-abdominal infections at a tertiary hospital in Tanzania and how these influence early treatment outcomes.

Factors Associated With Antiretroviral Drug Resistance Mutations Among Plhiv Failing To Achieve Virological Suppression On Second Line Treatment In Tanzania., Mabula M. Mabelele

Master of Internal Medicine

v> Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV/AIDS) is a major public health problem affecting an estimated 38.4 million people globally, with the (54%) of them being from the Eastern and Southern African regions. Despite progress in the availability of multiple classes of antiretroviral drugs and early initiation of treatment with cART, many patients still fail therapy in the first and second-line regimens due to drug resistance driven by continuous acquisition of drug resistance mutation (DRMs). DRMs are high among adults failing treatment regimens, ranging between 50-97%.

Ordinal Logistic Regression Exploring The Influence Of Admission And Discharge Policies On Resident Departures From Assisted Living Facilities, Samson Ebai Awoh

Graduate Research Theses & Dissertations

This study examines the influence of admission and discharge policies on the number of resident move-outs from assisted living facilities (ALFs). Using a cross-sectional quantitative design, data from the 2010 National Survey of Residential Care Facilities (NSRCF) were analyzed to explore the relationship between these policies and resident departures. The study controlled for various facility factors, including facility size, occupancy rate, chain ownership, ownership type, years in operation, Medicaid certification, number of resident deaths, number of RNs, LPNs or LVNs, and aides employed by the facility, meal policies, and the percentage of residents aged 85 or older. The significance level …

ผลของการฝึกพลัยโอเมตริกร่วมกับการจำกัดการไหลเวียนเลือดที่มีต่อพลังกล้ามเนื้อและความสามารถทางกีฬาฟันดาบสากลในนักกีฬาฟันดาบมือสมัครเล่น, นวินทร์ สุนทรเกตุ

Chulalongkorn University Theses and Dissertations (Chula ETD)

การศึกษาวิจัยนี้มีวัตถุประสงค์เพื่อศึกษาและเปรียบเทียบผลของการฝึกพลัยโอเมตริก และการฝึกพลัยโอเมตริกร่วมกับการจำกัดการไหลเวียนเลือด ที่มีต่อสมรรถภาพทางกีฬาฟันดาบสากล พลังกล้ามเนื้อ ความสามารถในการใช้พลังงานแบบแอโรบิกและแอนแอโรบิก รวมถึงการทรงตัวในนักกีฬาฟันดาบสากลสมัครเล่น กลุ่มตัวอย่างเป็นนักกีฬาฟันดาบสากลอายุเฉลี่ย 21.3 ± 3 ปี จำนวน 46 คน แบ่งออกเป็น 3 กลุ่ม ได้แก่ 1) กลุ่มควบคุม (CON) จำนวน 14 คน 2) กลุ่มฝึกพลัยโอเมตริก (PLY) จำนวน 16 คน และ 3) กลุ่มฝึกพลัยโอเมตริกร่วมกับการจำกัดการไหลเวียนเลือด (PLY+BFR) จำนวน 16 คน ทั้งสามกลุ่มได้รับการฝึกฟันดาบ 3 วันต่อสัปดาห์ โดยมีการควบคุมปริมาณการฝึกฟันดาบแบ่งเป็นการฝึกการเคลื่อนไหว การฝึกทักษะ และการฝึกแข่งขัน รวมระยะเวลาการฝึกฟันดาบ 1.5 - 2 ชั่วโมงต่อวัน กลุ่ม PLY และ PLY+BFR มีการฝึกเสริมด้วยการฝึกพลัยโอเมตริก 2 วันต่อสัปดาห์ ฝึก 4 ท่าในแต่ละวัน ซึ่งเป็นท่าฝึกที่เน้นการเคลื่อนไหวในแนวนอน (horizontal motion) เพื่อจำลองการเคลื่อนไหวในกีฬาฟันดาบ ในขณะฝึกพลัยโอเมตริกกลุ่ม PLY+BFR จะใส่อุปกรณ์เพื่อจำกัดการไหลเวียนเลือดแดงบริเวณส่วนต้นของรยางค์ล่างทั้ง 2 ข้าง และใช้แรงดันในการจำกัดการไหลเวียนเลือดที่ 60 เปอร์เซ็นต์ของแรงดันที่หลอดเลือดแดงถูกปิดกั้น (arterial occlusion pressure) ก่อนและหลังการฝึก ทุกกลุ่มได้รับการประเมินตัวแปรด้านสรีรวิทยาการออกกำลังกาย ประกอบด้วย ข้อมูลสรีรวิทยาทั่วไปและองค์ประกอบร่างกาย สมรรถภาพทางแอโรบิก สมรรถภาพทางกีฬาฟันดาบ พลังกล้ามเนื้อเชิงทักษะ ความแข็งแรงของกล้ามเนื้อ ระบบประสาทกล้ามเนื้อ และการทรงตัว การวิเคราะห์ข้อมูลเปรียบเทียบใช้การทดสอบความแปรปรวนแบบผสม 2x3 (กลุ่ม x เวลา) และเปรียบเทียบความแตกต่างระหว่างกลุ่มโดยใช้วิธีการทดสอบของแอลเอสดี (LSD) ภายหลังการฝึก 8 สัปดาห์ พบว่า ทั้งกลุ่ม PLY และ PLY+BFR มีการพัฒนาพลังกล้ามเนื้อเชิงทักษะ ความแข็งแรง …

A Comparative Analysis Of Costs Associated With Assisted Reproductive Technology; Invitro Fertilization Of Singleton, Twin, And Multiple Gestations Compared To Non-Invitro Fertilization Singleton Gestations, Ruth Arthur-Asmah

MUSC Theses and Dissertations

This study examines IVF and non-IVF costs associated with prenatal, delivery, and postpartum care using claims data from Merative MarketScan Commercial and Encounter data from 2018-2020 to understand the costs associated with respective IVF singleton, twin, and multiple gestations, as compared to non-IVF singleton gestations. These patients identified as females at birth, were continuously enrolled in private insurance, and have not experienced termination of pregnancy. The Student T-test was performed on continuous variables, and logistic regression was performed on binary variables with the overall outcome variables being cost, IVF, and non-IVF, controlling for age. The cost data was gamma log …

A Case Study In Program Evaluation, Alyssa Osborne

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

As a result of a Methicillin-Resistant Staphylococcus Aureus (MRSA) outbreak at a local high school, the Lexington Fayette County Health Department (LFCHD) has been tasked with developing a program to ensure timely reporting of actions taken in the event of a MRSA outbreak or disease outbreak of similar nature (1). This program evaluation is guided by the CDC’s 6-step program evaluation framework (2), which was used to inform this assessment.

Evaluation Of Public Radon Messaging In Kentucky As Compared To Three Other States, Abigail Knapp

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Radon poses a large health risk to those exposed to it, as it is an invisible, odorless, carcinogenic gas. Kentucky has high ambient levels of radon, but public awareness remains low as tobacco has been publicized as the main cause of lung cancer. As Kentucky has the highest incidence of lung and bronchial cancers in the United States, we aimed to examine the state’s health department radon page to see if it has sufficient information to warn residents about radon and provide resources. We reviewed the current Kentucky public messaging, radon rates, testing rates, and legislation compared to Ohio, Washington, …

Exploring The Effects Of Art Therapy Interventions On Self-Evaluations Of Food Addiction: A Randomized Control Study, Dawn Fiacco

Art Therapy | Doctoral Dissertations

Processed sugar is highly addictive and associated with chronic diseases such as obesity, type 2 diabetes, heart disease, and cancer. Often, people know that eating processed sugar has negative health consequences but continue to do so, possibly for emotional reasons. The gap between knowledge and behavior makes treating eating issues difficult. Art therapy is a nonverbal modality and could possibly circumvent usual rationalizations, making it an effective way to bridge the cognitive and emotional aspects of problematic eating. This randomized control, mixed methods study was conducted to examine whether a 7-week art directive program could help people with self-identified problematic …

Intuition And Insight In Art Therapy, Samantha Mach

Art Therapy | Doctoral Dissertations

The main goal of this research is to explore the unconscious phenomena of Intuition and Insight in art therapy. I define Intuition as knowledge that has been there all along and Insight as an inner sense of knowing and a space of no-thought. It is my belief that these unconscious processes lay at the heart of art and art-making and may therefore strengthen the therapeutic process. In order to investigate this hypothesis, I turned to the phenomenological analysis of qualitative interviews and found that seven themes emerged from the data collected: Prologue, Untethered, Interrelatedness, Deliverance, Concede, Divulge, Art as Allied, …