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2017

Public Health and Community Nursing

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Full-Text Articles in Medicine and Health Sciences

Inpatient Hospice Home: A Needs Assessment And Business Plan, Stacey Middleton Dec 2017

Inpatient Hospice Home: A Needs Assessment And Business Plan, Stacey Middleton

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Stacey Middleton

There are two constants that every person can count on in life, being born and dying. No amount of research is required, and there is no need to challenge the inevitable. When a child is born, people celebrate and congratulate the new parents and their family. When a person dies, people are saddened by the loss of a friend and loved one. Death comes to all and is either, fast and unexpected or a slow drawn out process. Every dying patient deserves to die with dignity, be free from pain, and …


Improving Adherence To Mental Health Treatment In A Low-Income Clinic, Janice G. Gandy Dec 2017

Improving Adherence To Mental Health Treatment In A Low-Income Clinic, Janice G. Gandy

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

The increasing prevalence of mental illness in the United States presents significant challenges for primary care providers in low-income settings. Integrated Behavioral Health (IBH) programs have resulted in improved general health for low-income participants; however, managing appointment adherence, in which the patient attends appointment as scheduled, is particularly challenging. The purpose of this pilot project was to implement bundled interventions at a low-income primary care clinic to improve patient adherence to behavioral health treatment. The bundle of interventions included: 1) educational interventions emphasizing the benefits of IBH care 2) warm patient handoffs between the primary care provider to a behavioral …


Exploring Perceptions And Experiences With Resources Among Rural Alzheimer's Dementia Family Caregivers In The Midwest, Rita M. Million Dec 2017

Exploring Perceptions And Experiences With Resources Among Rural Alzheimer's Dementia Family Caregivers In The Midwest, Rita M. Million

Theses & Dissertations

Exploring PERCEPTIONS AND EXPERIENCES WITH RESOURCES AMONG RURAL Alzheimer’s Dementia Family Caregivers in the Midwest

Rita M. Million

University of Nebraska, 2017

Supervisor: Karen Schumacher, Ph.D., RN

Background. Despite vast amounts of research on informal caregiving in the Alzheimer’s dementia (AD) population, research on the experience and perceptions of rural caregivers is limited. A better understanding of rural caregivers’ knowledge, use, and nonuse of resources is essential to offset the impact of caregiving. Purpose. This study explored Alzheimer’s dementia family caregivers’ experiences and perceptions with resources in rural Midwest communities. Design. A descriptive qualitative approach with one-time semi-structured interviews was …


Lost In Translation, Daniel Pena Dec 2017

Lost In Translation, Daniel Pena

Master's Projects and Capstones

At the conclusion of a patient’s hospitalization the Registered Nurse (RN) will review all discharge instructions in the patients room in their preferred language. Plan time for the discharge and facilitate a calm quiet environment, such as the patient’s room with the door closed, if possible. Get the discharge instructions printed out in their preferred language and a set for yourself in English would be best so you are able to review the instructions line by line with them. When the patients medical team, such as but not limited to, medical doctors, pharmacists, physical therapists, and social work have completed …


Data Aggregation Reporting Tool For Implementation In Home Health Fall Reduction Program, Jose Alberto Cruz Dec 2017

Data Aggregation Reporting Tool For Implementation In Home Health Fall Reduction Program, Jose Alberto Cruz

Master's Projects and Capstones

Abstract

Falls are a major preventable problem in healthcare that affects people of all ages but disproportionately affects the frail and elderly. Fall reduction programs play a significant role in reducing falls and fall related injuries and are a critical component in Home Health settings. This project takes place in a home health and hospice services agency. The purpose of the project consisted of aggregating fall data for benchmarking metrics to bring the agency’s Fall Reduction Program closer to compliance with state and national fall prevention guidelines. Two hundred and three fall event reports were analyzed and a problem arose …


Improving Early Sepsis Identification On Inpatient Units, Yee Yang Dec 2017

Improving Early Sepsis Identification On Inpatient Units, Yee Yang

Master's Projects and Capstones

Sepsis is a serious complication caused by an overwhelming immune response to infection that affect millions of people worldwide each year. Sepsis is a time sensitive illness that requires early identification and quick interventions to improve patient outcomes. This quality improvement project includes a team of clinical nurse leader (CNL) students and gathering information on the nursing compliance of the sepsis protocol at a large metropolitan hospital. The observations on different inpatient units and chart review conducted at the large metropolitan hospital led to increased awareness of gaps that prolong the identification of sepsis among patients; also to the creation …


Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan Dec 2017

Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan

Asian/Pacific Island Nursing Journal

Cervical cancer remains commonly diagnosed in Vietnamese American women. Despite efforts to increase cervical cancer screening among Vietnamese American women, participation rates are persistently lower than the national goal. The objective of this study is to explore beliefs of Vietnamese American women about cervical cancer, cervical cancer screening, and cancer prevention vaccines. A qualitative descriptive investigation captured group perceptions about meaning and beliefs of cervical cancer, screening, and cancer prevention vaccines, and participants’ stories using a community-based participatory research approach.

Forty Vietnamese American women were recruited from the Portland, Oregon metropolitan area into four focus groups. Using a process of …


Openpediatrics: Integrating Technology Into Pediatric Healthcare Education, Marisa Albert Dec 2017

Openpediatrics: Integrating Technology Into Pediatric Healthcare Education, Marisa Albert

Senior Honors Projects

In contemporary times, the dissemination of knowledge across specialties has become convenient through the use of computer technology and the internet. Technology has been integrated into educational systems worldwide and has become invaluable in the advancement of healthcare. Nursing practice and education has utilized modern technology as a resource for continuing education such as through the use of online RN-BSN programs and sharing improvements in healthcare practice. A great part of a nursing student’s education is understanding the importance of a nurse’s professional commitment to lifelong learning by utilizing critical thinking skills to support evidence-based practice to improve standards of …


Effect Of Socioeconomic Disadvantage, Remoteness And Indigenous Status On Hospital Usage For Western Australian Preterm Infants Under 12 Months Of Age: A Population-Based Data Linkage Study, Natalie A. Strobel, Sue Peter, Kimberley E. Mcauley, Daniel R. Mcaullay, Rhonda Marriott, Karen M. Edmond Dec 2017

Effect Of Socioeconomic Disadvantage, Remoteness And Indigenous Status On Hospital Usage For Western Australian Preterm Infants Under 12 Months Of Age: A Population-Based Data Linkage Study, Natalie A. Strobel, Sue Peter, Kimberley E. Mcauley, Daniel R. Mcaullay, Rhonda Marriott, Karen M. Edmond

Research outputs 2014 to 2021

Objectives:

Our primary objective was to determine the incidence of hospital admission and emergency department presentation in Indigenous and non-Indigenous preterm infants aged postdischarge from birth admission to 11 months in Western Australia. Secondary objectives were to assess incidence in the poorest infants from remote areas and to determine the primary causes of hospital usage in preterm infants.

Design:

Prospective population-based linked data set.

Setting and participants:

All preterm babies born in Western Australia during 2010 and 2011.

Main outcome measures:

All-cause hospitalisations and emergency department presentations.

Results:

There were 6.9% (4211/61 254) preterm infants, 13.1% (433/3311) Indigenous …


Improving Hpv Vaccination Series Initiation Rates And Compliance Among Indigent Women In South Texas, Ages 19-26, Through Provider Recommendation And Additional Clinic Funding: A Quality Improvement Project, Lacey Cudd Dec 2017

Improving Hpv Vaccination Series Initiation Rates And Compliance Among Indigent Women In South Texas, Ages 19-26, Through Provider Recommendation And Additional Clinic Funding: A Quality Improvement Project, Lacey Cudd

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase human papillomavirus vaccination series initiation rates among indigent women, ages 19-26, at a clinic in South Texas. The human papillomavirus is a sexually transmitted infection that has been associated with multiple types of cancers. Each year, approximately 6.2 million cases of the human papillomavirus infection are diagnosed; as many as 75% of all new infections occur among females 18-26 years of age. The human papillomavirus vaccination has a high efficacy in regards to cancer prevention, preventing as many as 76% of cancers with only one dose. The project included educating …


A Quality Improvement Initiative To Increase Statin Therapy Adherence Among Patients With Diabetes Aged 65 Years And Older, Kelly Nunemaker Dec 2017

A Quality Improvement Initiative To Increase Statin Therapy Adherence Among Patients With Diabetes Aged 65 Years And Older, Kelly Nunemaker

Doctor of Nursing Practice

The purpose of this project was to improve statin therapy adherence among diabetic patients aged 65 and older treated at a small family practice clinic in western San Antonio. Additionally, the project aimed to decrease LDL cholesterol (LDL-C) levels in this patient population as recommended to 70 mg/dl or less. Diabetic patients are more likely to die from a cardiac event than patients without diabetes. Statin therapy is an important factor in lowering cholesterol, which reduces the patient’s risk for atherosclerosis. Educating patients aged 65 and older about the role of statin therapy in preventing cardiovascular events, stroke, and vascular …


Self-Management As A Mediator Of The Relationship Between Social Support And Health Outcomes Of African American Adults With Type 2 Diabetes., Tariq N. Al-Dwaikat Dec 2017

Self-Management As A Mediator Of The Relationship Between Social Support And Health Outcomes Of African American Adults With Type 2 Diabetes., Tariq N. Al-Dwaikat

Electronic Theses and Dissertations

Type 2 diabetes (T2D) is often associated with serious complications. African American adults have higher rates of diabetes-related complications than other ethnicities. Diabetes self-management reduces the risk of developing biological and psychological symptoms. Social support promotes positive behavior change and self-management that leads to improved biobehavioral and psychosocial outcomes. Few studies explored the relationship between social support dimensions and self-management behaviors, diabetes biomarkers, and psychosocial outcomes of African American adults with T2D. The purpose of this dissertation was to examine the relationships of various dimensions of social support with self-management behaviors and diabetes biomarkers and psychosocial outcomes of African American …


The Relationship Of Religion, Religiosity, And Parental Communication In The Sexual Behaviors Of Filipinos Aged 18-25 Years In The United States And The Philippines, Ivy C. Tuason, Racidon Bernarte, Fanglong Dong Nov 2017

The Relationship Of Religion, Religiosity, And Parental Communication In The Sexual Behaviors Of Filipinos Aged 18-25 Years In The United States And The Philippines, Ivy C. Tuason, Racidon Bernarte, Fanglong Dong

Asian/Pacific Island Nursing Journal

This cross-sectional survey research aims to explore and compare the relationship of religion, religiosity, and parental communication to the sexual behaviors of Filipinos aged 18-25 years in the United States and the Philippines. The Duke University Religion Index and Parent-Teen Sexual Risk Communication Scale-III was used to measure religiosity and parental communication. There were 130 participants living in the United States and 247 living in the Philippines included in this study. Among respondents from the Philippines, low levels of parental communication were associated with an increased report for the lack of condom use during the last intercourse. Catholics had a …


Impact Of Hpv Education On Knowledge, Perception, And Cultural Influence Among African American Parents, Christina Lattner, Christina Lattner Nov 2017

Impact Of Hpv Education On Knowledge, Perception, And Cultural Influence Among African American Parents, Christina Lattner, Christina Lattner

Grace Peterson Nursing Research Colloquium

Abstract

Background: Infection with human papillomavirus (HPV), the sexually transmitted virus that causes cervical and penial cancer can be prevented. An effective vaccine has been approved for both boys and girls since 2006. Despite recommendation from the Center of Disease Control, vaccination initiation and completion rates among African American adolescents in the United States are lower than average in the nation.

Objectives: The purpose of this descriptive survey study was to identify African-American parents’ knowledge and perceptions of sexually transmitted HPV infection and the HPV vaccination. The secondary objective was to use a single-group pre-test post-test research design to …


College Students, Experiences On Smart Phone Technology Usage: A Qualitative Content Analysis Study, Fatemeh Jafarzadeh-Kenarsari, Parand Pourghane Nov 2017

College Students, Experiences On Smart Phone Technology Usage: A Qualitative Content Analysis Study, Fatemeh Jafarzadeh-Kenarsari, Parand Pourghane

The Qualitative Report

Besides many benefits of the cell phone technology, numerous arguments are raised on the different and important negative effects of such a technology. This qualitative content analysis study explored the common usages of smart phone technology, its challenges, and benefits among Iranian college students. Participants were 32 bachelor degree students who were recruited using purposive sampling method with maximum variation. Data were collected through 11 individual semi-structured interviews and 3 focus group discussions (5-8 students in each group). Data analysis was done based on a conventional content analysis approach. Data analysis resulted in 3 main themes and 12 sub-themes. The …


Mālama Nā Makua I Nā Keiki Me Ka Hānō: Native Hawaiian Parents Caring For Their Children With Asthma, May K. Kealoha, Merle Kataoka-Yahiro Oct 2017

Mālama Nā Makua I Nā Keiki Me Ka Hānō: Native Hawaiian Parents Caring For Their Children With Asthma, May K. Kealoha, Merle Kataoka-Yahiro

Asian/Pacific Island Nursing Journal

Native Hawaiian children have the highest prevalence rate of asthma among all ethnicities in the State of Hawai‘i. Literature is limited regarding native Hawaiian parents’ perception and experience caring for their children with asthma. The purpose of this study is to explore contemporary native Hawaiian parents’ perspective and experience of caring for their children with asthma in the context of uncertainty. We applied a descriptive qualitative approach by means of directed content analysis using focus groups. Directed content analysis applied Mishel’s Uncertainty in Illness Theory to guide data collection, organization, and analysis. We found that parents’ personal stories about their …


A Retrospective Analysis Of Nursing Students' Clinical Experience In An All-Male Maximum Security Prison., Mary T. Bouchaud, Madeline Brooks, Beth Ann Swan Oct 2017

A Retrospective Analysis Of Nursing Students' Clinical Experience In An All-Male Maximum Security Prison., Mary T. Bouchaud, Madeline Brooks, Beth Ann Swan

College of Nursing Faculty Papers & Presentations

Prisons provide an ideal learning experience to prepare prelicensure students with the knowledge and skill set needed for practice in the 21st century. Beginning descriptive evidence demonstrates that correctional health is an innovative community resource to educate nursing students in today's changing model of health care delivery and practice. This article shares results from a retrospective analysis of the perceptions and experiences of nursing students during their community clinical rotation in an all-male maximum security prison.


Unrecognized Epidemic Kills Farmers, M. Susan Jones, Deborah B. Reed, Matthew L. Hunt Oct 2017

Unrecognized Epidemic Kills Farmers, M. Susan Jones, Deborah B. Reed, Matthew L. Hunt

Nursing Faculty Publications

No abstract provided.


Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance Sep 2017

Perceived Knowledge And Perceptions Of Palliative Care Among Advanced Practice Cardiac Providers, Jordan Vance

Doctoral Dissertations and Projects

Providers of healthcare have continued to focus on addressing patients’ chronic health outcomes. When understanding how to manage chronic disease, there remains many opportunities in facilitation of better management. With such a wide range of individuals who suffer with a chronic condition, better management to address this population is essential. Palliative care aids in accomplishing this task. It was seen that there was a lack of education in relation to palliative care, with perceptions that continued to be a barrier to the utilization of the service. Due to the lack in education, the strongest barrier to palliative care service utilization …


Practice Matters: Red Flags In Evaluating Adult Abdominal Pain, Mary Branstetter Dnp, Dawn Garrett-Wright Phd Aug 2017

Practice Matters: Red Flags In Evaluating Adult Abdominal Pain, Mary Branstetter Dnp, Dawn Garrett-Wright Phd

International Journal of Faith Community Nursing

Abstract

Acute abdominal pain is the leading cause of presentation to an emergency department in the United States. Over 5.6 million annual visits have been reported for abdominal pain and represent 18% of emergency department visits and 1.5% of all office-based visits. Acute abdominal pain can be described as visceral, somatic, or neuropathic in origin. Faith community nurses have tools, such as OLDCARTS, to take a good history in order to make sound decisions regarding patient referral to a higher level of care. Identifying red flags for abdominal emergencies and awareness of signs and symptoms of colon cancer allow faith …


Exploration And Description Of Faith Community Nurses’ Documentation Practices And Perceived Documentation Barriers., Susan M. Dyess, Donna M. Callaghan, Andra S. Opalinski Dr. Aug 2017

Exploration And Description Of Faith Community Nurses’ Documentation Practices And Perceived Documentation Barriers., Susan M. Dyess, Donna M. Callaghan, Andra S. Opalinski Dr.

International Journal of Faith Community Nursing

Purpose: Documentation within Faith Community Nursing is an expected aspect of the professional specialty but is under-studied. Findings in previously published studies suggest there is a lack of consistent documentation practices among FCNs. Therefore, the aim of this research study was to explore and describe documentation practices of FCNs, and identify the perceived barriers to documentation.

Methodology: This mixed methods research had both qualitative and quantitative components. The qualitative inquiry involved three live focus groups and three telephonic key informant interviews (n = 28). Conventional content analysis was used to examine all qualitative data. The quantitative inquiry involved a survey …


General Nutrition Knowledge And Perceived Stress In A Rural Female Faith Community, Lori Alexander, M. Laurie Branstetter Dnp Aug 2017

General Nutrition Knowledge And Perceived Stress In A Rural Female Faith Community, Lori Alexander, M. Laurie Branstetter Dnp

International Journal of Faith Community Nursing

In rural America, high rates of obesity are influenced by a lack of education and limited community resources. The purpose of this study was to assess the effect of an educational intervention on recommended nutrition and body mass index knowledge and to describe the perceived stress in a rural female faith community. A quantitative quasi-experimental pre-test post-test research design was used. English speaking female participants (N=49) 18 years of age and older from two rural community churches received an educational intervention based on the Health Belief Model. Participants completed a demographic survey, self-reported height and weight, general nutrition …


Sexual Harassment At Work Place: Are You Safe?, Anila Naveed, Ambreen Tharani, Nasreen Alwani Aug 2017

Sexual Harassment At Work Place: Are You Safe?, Anila Naveed, Ambreen Tharani, Nasreen Alwani

Ambreen Tharani

In today's world women are increasingly participating in the realm of work force, yet they are facing many obstacles in their way. Sexual harassment is one of those obstacles. Sexual harassment at work place is prevalent in every society. It could happen to anyone but women are the targeted victims. Sexual harassment is considered as a traumatic event and the victim may end up in having physical and mental sufferings that hinders a person to work effectively. At an organisational level this may result in decrease work effectiveness, decreased work productivity, high absenteeism, high turnover, and low staff morale. Hence …


Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic Aug 2017

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …


Rates Of Autoimmune Disease Increasing In Women, Rosa De La Cotera Aug 2017

Rates Of Autoimmune Disease Increasing In Women, Rosa De La Cotera

Grace Peterson Nursing Research Colloquium

Abstract

Autoimmune disorders (AD) are a group of highly disabling pathological conditions that are growing at an alarming rate affecting approximately 8% of the population. These disorders occur more frequently in women, as 78% of those diagnosed are women. Little conclusive research has been conducted as to determine why there is a tremendous sex disparity when looking at the rates. Due to the overall poor health that results from these disorders, there is an increase in the societal burden in terms of health care costs, loss of work productivity and reduced quality of life. The aim of this integrative literature …


Racial Microaggressions Within The Field Of Nursing, Theresa Farris, Elizabeth Hartman, Young-Me Lee Aug 2017

Racial Microaggressions Within The Field Of Nursing, Theresa Farris, Elizabeth Hartman, Young-Me Lee

Grace Peterson Nursing Research Colloquium

Racial microaggressions (RM) have transitioned into a subtle form of contemporary racism and are potentially involved within our communication as healthcare providers. Though cultural competency is addressed within nursing education, this RM phenomenon continues to happen in everyday discourse and can occur with little or no awareness on the part of Caucasians. The aim of this study was to gain a better understanding of how RMs against African Americans exist within the field of nursing and how their underlying discrimination increases the marginalization of this community. A detailed search was conducted using CINAHL, PsycInfo and ProQuest databases using the keywords: …


Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan Aug 2017

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education …


Barriers To Advance Directives, Anna Malia Connor Ticknor Aug 2017

Barriers To Advance Directives, Anna Malia Connor Ticknor

Grace Peterson Nursing Research Colloquium

Abstract

Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of …


Food Insecurity And Its Impact On Health Status Among Homeless Individuals: An Integrative Literature Review, Jacqueline Munyasya Aug 2017

Food Insecurity And Its Impact On Health Status Among Homeless Individuals: An Integrative Literature Review, Jacqueline Munyasya

Grace Peterson Nursing Research Colloquium

FOOD INSECURITY AND ITS IMPACT ON HEALTH STATUS AMONG HOMELESS INDIVIDUALS:

AN INTEGRATIVE REVIEW

Jacqueline Munyasya

Faculty Sponsor: Dr. Shannon Simonovich

Background: Food insecurity is a serious problem in the United States and the number of people affected by food insecurity in the United States has risen dramatically in recent years. The homeless population is disproportionately affected. The combination of homelessness and food insecurity is a problem has the combined effect that is extremely costly to the public and the overall health of the population. As nurses, we will encounter these populations and treat them in both community and acute …


Evaluating The Role Of Community Advisory Boards: With Persons Who Inject Drugs In Photovoice Research, Nicole Pallas Aug 2017

Evaluating The Role Of Community Advisory Boards: With Persons Who Inject Drugs In Photovoice Research, Nicole Pallas

Grace Peterson Nursing Research Colloquium

Background: The use of community advisory boards (CABs) is a source of leadership in community-based participatory research (CBPR); however, not all researchers have incorporated CABs, and others have restricted CAB involvement for feasibility purposes. Although there is literature about utilizing CABs in a variety of CBPR studies, less is known about the challenges and successes of working with persons who inject drugs (PWIDs) as CAB members in photovoice methodology, as well as their perceptions throughout the process.

Objectives: The purpose of this qualitative study was to investigate the role CABs play in photovoice research while determining PWIDs’ capacity to fulfill …