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2020

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Full-Text Articles in Medicine and Health Sciences

Donor Age Effects On The Proliferative And Chondrogenic/Osteogenic Differentiation Performance Of Equine Bone Marrow- And Adipose Tissue Derived Mesenchymal Stem Cells In Culture, Jasmin Bagge Jan 2020

Donor Age Effects On The Proliferative And Chondrogenic/Osteogenic Differentiation Performance Of Equine Bone Marrow- And Adipose Tissue Derived Mesenchymal Stem Cells In Culture, Jasmin Bagge

Theses and Dissertations--Veterinary Science

Orthopedic injuries are a major cause of lameness and morbidity in horses. Bone marrow (BM)- and adipose tissue (AT) derived mesenchymal stem cells (MSCs) have shown potential to facilitate the repair of orthopedic injuries and are being used increasingly in veterinary clinics. Presently, the use of MSCs as a therapy for equine patients is most commonly applied as autologous transplants, using BM- and AT-MSCs harvested from the patient shortly after the time of injury. Cell-based therapies are therefore delayed to enable primary cell numbers to be expanded in culture. Of concern, however, are human and rodent studies that have shown …


Host-Parasite Interaction In Horses: Mucosal Responses To Naturally Acquired Cyathostomin Infections And Anthelmintic Treatment, Ashley Elaine Steuer Jan 2020

Host-Parasite Interaction In Horses: Mucosal Responses To Naturally Acquired Cyathostomin Infections And Anthelmintic Treatment, Ashley Elaine Steuer

Theses and Dissertations--Veterinary Science

Cyathostomins are ubiquitous parasites in equids. In rare cases, cyathostomins lead to a generalized typhlocolitis and death. In healthy horses, local reactions are noted to the mucosal larvae; however, the mechanisms and importance of these reactions have not been elucidated. It has been hypothesized that anthelmintics can alter these reactions. Currently, three drug classes are approved for use in horses against cyathostomins; while all products target the adults, only two products are labeled as larvicidal. Adulticidal therapy is implicated in triggering the typhlocolitis, however, current evidence is contradictory. There is also conjecture that the larvicidal drugs can increase the risk …


Comparative Chondrogenesis Of Interzone And Anlagen Cells In Equine Skeletal Development, Chanhee Mok Jan 2020

Comparative Chondrogenesis Of Interzone And Anlagen Cells In Equine Skeletal Development, Chanhee Mok

Theses and Dissertations--Veterinary Science

At the presumptive sites of future synovial joints during mammalian skeletogenesis, articular cartilage develops from interzone located between the cartilaginous anlagen of bones. Thus, two types of cartilaginous tissues differentiate in close proximity. While anlagen cartilage is transient, progressing through endochondral ossification to form bones, articular cartilage is stable and functions throughout life to facilitate both low friction movement and load distribution. Despite important life-long functional properties, articular cartilage has a very limited intrinsic ability to repair structural defects. On the other hand, structural lesions in bones generally heal well by forming a cartilaginous callus and recapitulating endochondral ossification to …


Stress And Cancer Treatment: How A Family’S Adaptability And Cohesion Affects Financial Stress, Emily Marie Johnson Jan 2020

Stress And Cancer Treatment: How A Family’S Adaptability And Cohesion Affects Financial Stress, Emily Marie Johnson

Theses and Dissertations--Family Sciences

According to the American Cancer Society (2019), it is estimated that 1,762,450 new cancer diagnoses occurred in 2019 in the United States. Currently, cancer remains one of the leading causes of death worldwide (American Cancer Society, 2019). As cancer affects the family, roles within the family will shift (e.g., transitioning to a caregiving relationship), causing each family member to adapt. With the costs of cancer steadily increasing, this potentially leaves a devastating impact on the family. When considering family function in terms of Family Systems, John Rolland created the Family Systems Illness Model to explain how families adapt to an …


An Educational Pilot Intervention To Increase Environmental Health Literacy Among Rural Kentucky Youth Attending Summer Camp, Ashley Rose Mattingly Jan 2020

An Educational Pilot Intervention To Increase Environmental Health Literacy Among Rural Kentucky Youth Attending Summer Camp, Ashley Rose Mattingly

Theses and Dissertations--Nutrition and Food Systems

Risk factors, including exposure to environmental pollutants, poor dietary and overall health outcomes, and low environmental health literacy (EHL), place the rural Appalachian youth population at increased risk for chronic diseases. Implementation of nutrition and pollution curriculum into two week-long summer day camps for youth ages 5-12 years that focus around healthy lifestyles and environmental stewardship has the potential to increase health protective action in this community. This research utilized qualitative interviews of 30 Kids on the Creek Camp attendees to determine the efficacy of the implementation of an active learning lesson to increase EHL by explaining the link between …


Appetite-Regulating Hormones In Energy Compensation With Exercise, Jack Moreland Jan 2020

Appetite-Regulating Hormones In Energy Compensation With Exercise, Jack Moreland

Theses and Dissertations--Nutrition and Food Systems

Background: The appetite-regulating hormones may influence compensatory increases in energy intake with exercise, although this causal relationship has been difficult to prove in a longitudinal trial.

Methods: 37 participants (29 female) aged 18 to 40 years performed aerobic exercise 6 days (6d), 2 days (2d), or 0 days per week for 12-weeks. Concentrations of ghrelin, leptin, glucagon-like peptide 1 (GLP-1), and insulin were assessed before (fasting, minute 0) and after a standardized meal at minute 15, 30, 45, 60, 90, 120, 150, and 180. Linear mixed-effects models were used to model the relationships between time point (12 weeks vs. baseline) …


Cardiac Effects Of Obesity During Pregnancy In C57bl/6j Mice, Kayla Lynn Dudick Jan 2020

Cardiac Effects Of Obesity During Pregnancy In C57bl/6j Mice, Kayla Lynn Dudick

Theses and Dissertations--Nutrition and Food Systems

Objective: Pregnancy requires profound cardiac and metabolic adaptation. Left ventricular (LV) mass is increased in response to pregnancy, but is not associated with cardiac damage. In contrast, obesity-mediated cardiac hypertrophy is pathological. Data from animal studies indicate dietary fatty acid composition may have a protective effect during states of extreme cardiac physiological adaptation. In contrast, aberrant cardiac metabolism is a hallmark of disease. Over a third of reproductive-age women in the United States are obese, but there is a paucity of data describing the effect of obesity on maternal cardiac adaptation to pregnancy. The objective of this study was to …


Is Postural Control During Unstable Sitting A Proxy Measure For Determinants Associated With Lumbar Stability?, Christian Larivière, Richard Preuss, Daniel Ludvig, Sharon M. Henry Jan 2020

Is Postural Control During Unstable Sitting A Proxy Measure For Determinants Associated With Lumbar Stability?, Christian Larivière, Richard Preuss, Daniel Ludvig, Sharon M. Henry

Études primaires

Abstract

The aim of this study was to test whether determinants associated with lumbar stability can predict performance during unstable sitting (trunk postural control - TPC). If confirmed, unstable sitting could be viewed as a proxy measure for these determinants. Wobbling chair motion was measured in 58 subjects with an inertial sensor, and six outcomes were computed (mean frequency and velocity, frequency dispersion, two variables from the sway density analysis and Lyapunov exponent - short interval) to represent TPC performance. Subjects also performed five other trunk neuromuscular tests to quantify the thickness of back and abdominal muscles and …


Theoretical Investigation Of The Low Frequency Fundamental Mechanism Of The Objective Occlusion Effect Induced By Bone-Conducted Stimulation, Kevin Carillo, Olivier Doutres, Franck Sgard Jan 2020

Theoretical Investigation Of The Low Frequency Fundamental Mechanism Of The Objective Occlusion Effect Induced By Bone-Conducted Stimulation, Kevin Carillo, Olivier Doutres, Franck Sgard

Études primaires

The objective occlusion effect induced by bone-conducted stimulation refers to the low frequency acoustic pressure increase that results from occluding the ear canal opening. This phenomenon is commonly interpreted as follows: the bone-conducted sound “leaks” through the earcanal opening and is “trapped” by the occlusion device. This instinctive interpretation misrepresents the fundamental mechanism of the occlusion effect related to the earcanal impedance increase and already highlighted by existing electro-acoustic models. However, these models simplify the earcanal wall vibration (i.e., the origin of the phenomenon) to a volume velocity source which, in the authors' opinion, (i) hinders an exhaustive comprehension of …


Augmenting Public Health Informatics Capacity To Better Manage Covid-19, Pascal Felix, Gulzar H. Shah Jan 2020

Augmenting Public Health Informatics Capacity To Better Manage Covid-19, Pascal Felix, Gulzar H. Shah

Eagles Talking About the Public’s Health

No abstract provided.


Physiological Effects During Aerobatic Flights On Science Astronaut Candidates, Pedro Llanos, Diego M. Garcia Jan 2020

Physiological Effects During Aerobatic Flights On Science Astronaut Candidates, Pedro Llanos, Diego M. Garcia

Publications

Spaceflight is considered the last frontier in terms of science, technology, and engineering. But it is also the next frontier in terms of human physiology and performance. After more than 200,000 years humans have evolved under earth’s gravity and atmospheric conditions, spaceflight poses environmental stresses for which human physiology is not adapted. Hypoxia, accelerations, and radiation are among such stressors, our research involves suborbital flights aiming to develop effective countermeasures in order to assure sustainable human space presence. The physiologic baseline of spaceflight participants is subject to great variability driven by age, gender, fitness, and metabolic reserve. The objective of …


Physiological Effects On Scientist Astronaut Candidates: Hypobaric Training Assessment, Pedro Llanos, Diego Garcia Jan 2020

Physiological Effects On Scientist Astronaut Candidates: Hypobaric Training Assessment, Pedro Llanos, Diego Garcia

Publications

This paper is addressed to expanding our understanding of the effects of hypoxia training on our bodies to better model its dynamics and leverage some of its implications and effects on human health. Hypoxia training is a recommended practice for military and civilian pilots that allow them to recognize their early hypoxia signs and symptoms, and Scientist Astronaut Candidates (SACs) who underwent hypobaric hypoxia (HH) exposure as part of a training activity for prospective suborbital flight applications. This observational-analytical study describes physiologic responses and symptoms experienced by a SAC group before, during and after HH exposure and proposes a model …


Medicina Tropical Y Su Proyeccion Actual: Un Breve Panorama [A Brief Overview: Tropical Medicine And Its Current Projection], Nathalie Chacon, Luis Alfonso Colmenares Suárez Jan 2020

Medicina Tropical Y Su Proyeccion Actual: Un Breve Panorama [A Brief Overview: Tropical Medicine And Its Current Projection], Nathalie Chacon, Luis Alfonso Colmenares Suárez

Physician Assistant Studies Faculty Publications

La rica tradición histórica y los importantes avances científicos de la Medicina Tropical (MT) han contribuido a su inmensa proyección actual. La literatura consultada así lo refleja. Esta investigación documental apuntó a esa misma dirección y buscó enriquecer el acervo bibliográfico al respecto. Mediante la lectura crítica de referencias y el método cualitativo de Huberman y Miles se estructuró una argumentación discursiva referente a la proyección actual de la MT a lo largo de las tres secciones de este trabajo: su origen histórico, su ulterior desarrollo, sus tendencias y perspectivas futuras. El médico escocés Patrick Manson (1844-1922), es considerado como …


Tratamiento De La Leishmaniasis Tegumentaria Americana Con Meglumina En Pacientes Con Inmunoterapia Previa [Treatment Of American Tegumentary Leishmaniasis With Meglu-Mine In Patients With Previous Immunotherapy], Pedro Navarro, Luis Alfonso Colmenares Suárez, Olinda Delgado, María Antonia De La Parte, Mariana Rivas, Romy Plaza, Ana G. Angulo, Nathalie Chacon Fonseca Jan 2020

Tratamiento De La Leishmaniasis Tegumentaria Americana Con Meglumina En Pacientes Con Inmunoterapia Previa [Treatment Of American Tegumentary Leishmaniasis With Meglu-Mine In Patients With Previous Immunotherapy], Pedro Navarro, Luis Alfonso Colmenares Suárez, Olinda Delgado, María Antonia De La Parte, Mariana Rivas, Romy Plaza, Ana G. Angulo, Nathalie Chacon Fonseca

Physician Assistant Studies Faculty Publications

El antimoniato de meglumina (AM) y la inmunoterapia (IMTP), son las opciones terapéuticas individuales más utilizadas en los pacientes con leishmaniasis tegumentaria americana (LTA) en nuestro medio. El objetivo de este trabajo fue evaluar la eficacia terapéutica del AM en pacientes con LTA e IMTP previa y cicatrización lenta de sus lesiones. Los pacientes se evaluaron en la Sección de Endemias Rurales del Instituto de Medicina Tropical (SER-IMT), entre el 01 de enero del año 2002 y el 31 de octubre del 2010. Se contó con la colaboración de la Sección de Inmunoparasitología del referido instituto (SIP-IMT). Se estudiaron 32 …


Know Before You Play: Associations Between Race, Education, And Hiv Susceptibility, Anfa Mohamed Diiriye Jan 2020

Know Before You Play: Associations Between Race, Education, And Hiv Susceptibility, Anfa Mohamed Diiriye

All Graduate Theses, Dissertations, and Other Capstone Projects

Black women are disproportionately affected by HIV in the United States. This paper analyzes the associations between race, education, and HIV susceptibility, furthering previous research to understand if educational attainment reduces HIV susceptibility and if reduction patterns are similar for Black and White women. The CDC’s National Survey of Family Growth 2015-2017 was used to analyze associations using binary logistic and multiple regression models. HIV susceptibility was operationalized through four measures: condom use, having a partner with concurrent sexual relationships, having had an STD, and age at first sex. Black women were not found to be significantly more susceptible to …


Epidemiology Of Colorectal Cancer Comorbidities And Stage At Diagnosis, Survival, And Second Primary Malignancies In Kentucky, 2003-2016, Nikita Leigh Vundi Jan 2020

Epidemiology Of Colorectal Cancer Comorbidities And Stage At Diagnosis, Survival, And Second Primary Malignancies In Kentucky, 2003-2016, Nikita Leigh Vundi

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

Background: Colorectal cancer (CRC) is the third most common type of cancer and the third most common cause of cancer death among men and women in the United States.1-3 The American Cancer Society estimates that there will be 147,950 new cases of CRC and 53,200 CRC related deaths in the U.S. for the year 2020.3 Kentucky CRC incidence for 2012-2016 was the highest in the nation, and the mortality rate for years 2013-2017 was ranked 5th in the nation.4-6 Risk factors for CRC include lifestyle factors, genetics, and disease status (comorbidities and treatment).2, 7 Diabetes has been …


Utilizing A Community-Based Doula Care Intervention To Reduce Race-Based Perinatal Health Inequities In Jefferson County, Kentucky, Brendan Mathews Jan 2020

Utilizing A Community-Based Doula Care Intervention To Reduce Race-Based Perinatal Health Inequities In Jefferson County, Kentucky, Brendan Mathews

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

Target Population and Need

The United States is currently the only industrialized nation in the world experiencing increasing rates of

pregnancy-related mortality.

1,2

Black women die at 3-4 times the rate of their white counterparts.

1-5

This disparity

is likely caused by the experience of systemic racism, which increases allostatic load and produces epigenetic

modifications linked to higher likelihood for poor birth outcomes. Biases perpetuated by health care providers

result in black women being less likely to receive quality healthcare and more likely to experience poor perinatal

1-7 to all pregnant women.

health outcomes.

The provision of doula-based care can …


The Impact Of Covid-19 On Worksite Wellness Programs, Marilyn S. Campbell Jan 2020

The Impact Of Covid-19 On Worksite Wellness Programs, Marilyn S. Campbell

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

Introduction: Worksite wellness programs are popular employer offerings as of the last few decades. The COVID-19 pandemic has caused major shifts in behavior since these programs have been implemented. The purpose of this study was to see how the pandemic has affected various offerings within a university worksite wellness program.

Methods: This study is a secondary analysis of a university worksite wellness program, and it compares participation in the various offerings in response to the COVID-19 pandemic by evaluating 2019 participation (pre-pandemic) to 2020 participation (including onset of the pandemic and after). This worksite wellness program, which is available to …


Utilizing A Formative Program Evaluation Approach And An Application Of Grounded Theory To Assess A Novel Harm Reduction Program, Dia Obonyo Jan 2020

Utilizing A Formative Program Evaluation Approach And An Application Of Grounded Theory To Assess A Novel Harm Reduction Program, Dia Obonyo

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

Formative program evaluation is conducted during development and early implementation to ensure a program is feasible, appropriate, and acceptable. The Harm Reduction Initiative (HRI), a program of KIRP, the Kentucky AIDS Drug Assistance (KADAP) Income Reinvestment Program, seeks to address some of the underlying causes of infectious disease vulnerability resulting from drug use by focusing on infectious disease testing and linkage to care among high risk individuals. The primary objective of the evaluation was to achieve the following aims: 1) characterize the need for the program, 2) clarify the theory and logic of the program, 3) inform implementation, and 4) …


Outcome Measures For Chronic Cough: A Literature Review, Sarah Campbell Jan 2020

Outcome Measures For Chronic Cough: A Literature Review, Sarah Campbell

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Background: Approximately 9-10 percent of adults experience chronic cough. Chronic cough is a cough that lasts greater than eight weeks, with significant impacts on an individual's quality-of-life in social, psychological, and physical domains. Current treatment is not successful for all patients, and a lack of validated outcome measures makes it challenging to determine the efficacy of experimental chronic cough interventions.

Aims: The purpose of this review is to determine the optimal protocols for outcome measures needed to ascertain the efficacy of chronic cough treatment.

Main contribution: Inconsistent correlations were found between objective and subjective outcome measures. The strongest outcome measure …


Promoting A Culture Of Civility Among Oncology Nurses In The Ambulatory Care Setting To Improve Patient Safety And Nurse Retention, Sheila Evans Jan 2020

Promoting A Culture Of Civility Among Oncology Nurses In The Ambulatory Care Setting To Improve Patient Safety And Nurse Retention, Sheila Evans

DNP Scholarly Projects

INTRODUCTION: Nurse incivility is a well-documented phenomenon discussed in the literature and woven into the nursing lexicon. Nurse incivility results in negative consequences for nurses, patients and organizations. Adding to its complexity is the fact that nurses may be unable to identify and address covert uncivil behaviors and lack an effective tactic to mitigate situations.

AVAILABLE KNOWLEDGE: The nursing literature describes the existence of nurse-to-nurse incivility and its correlation with negative outcomes. Regulatory bodies such as The Joint Commission (TJC) also recognize the adverse outcomes resulting from civility and issued two alerts addressing workplace behavior. Additionally, the American Nurses Association …


Using The Bedside Care Conference To Improve The Patient Experience, Eileen Keefe Jan 2020

Using The Bedside Care Conference To Improve The Patient Experience, Eileen Keefe

DNP Scholarly Projects

Abstract

Improving the patient experience of hospital care is a priority for nursing leaders. The terms patient satisfaction and patient experience have been used interchangeably to define the patient’s unique perspective on care quality and the impact of patient engagement on health outcomes. Patients and families experience suffering when their expectations are not congruent with their care in the hospital setting, and there are significant cost and financial implications for organizations that do not reach performance thresholds. Communication with nurses is highly correlated to overall patientsatisfaction in the Center for Medicare and Medicaid (CMS) Hospital Consumer Assessment of Providers and …


Creating Buy-In From Nurse Leaders To Implement Inpatient Education And Screening For Human Trafficking: A Quality Improvement Initiative, Andrea Macdonald Jan 2020

Creating Buy-In From Nurse Leaders To Implement Inpatient Education And Screening For Human Trafficking: A Quality Improvement Initiative, Andrea Macdonald

DNP Scholarly Projects

BACKGROUND: Human trafficking is an under-recognized healthcare issue affecting an

estimated 20 to 40 million individuals globally. Professional nursing organizations, healthcare

regulatory bodies and legislators have declared the need for education and screening practices. A

quality improvement initiative designed to create buy-in from nurse leaders to create and

implement education, screening and a protocol to guide care of human trafficking victims who

may present to inpatient and clinic settings at the organization was developed to bridge gaps in

knowledge and inform evidence-based practice.

METHODS: Literature review informed the development of an education intervention presented

to nurse leaders using multi-modal learning …


Integrating Yoga Into A Medication Assisted Treatment Program To Improve Retention, Linda Davidson Jan 2020

Integrating Yoga Into A Medication Assisted Treatment Program To Improve Retention, Linda Davidson

DNP Scholarly Projects

Background: In 2017, Health and Human Services declared the opioid epidemic a public health emergency (US Department of Health & Human Services, 2017). As a response, access to medication assisted treatment (MAT) programs was encouraged. In 2016, a community health center in Western North Carolina started a MAT program integrating buprenorphine treatment with behavioral health (BH) services. Data from May 2018 through May 2019 demonstrated retention in the MAT program ranged from 65-75% at a given time with behavioral health attendance under 50%.

Aims: The aim of this quality improvement project was to examine if integrating yoga, an …


Moving A Licensed Practical Nurse To A Registered Nurse In New Hampshire: A Health Policy Initiative, Vicki Gamez Jan 2020

Moving A Licensed Practical Nurse To A Registered Nurse In New Hampshire: A Health Policy Initiative, Vicki Gamez

DNP Scholarly Projects

Background: The United States is expected to experience a shortage of Registered Nurses (RN) due to a demand for more nurses to care for an aging population. Not only is there a current deficit in the number of RNs, but there is also a lack of ethnic and racial diversity among RNs. Licensed Practical Nurse (LPN) transition programs increase workforce mobility and allow LPNs to build upon their education and clinical experience as they transition to the RN roles. Therefore, the aim of this DNP project was to implement a health policy change initiative that addresses the barriers of workforce …


Improving Transitions In Care: Focus On The Revocation Of Conditional Discharge Process In New Hampshire, Stacy A. Sorrell Jan 2020

Improving Transitions In Care: Focus On The Revocation Of Conditional Discharge Process In New Hampshire, Stacy A. Sorrell

DNP Scholarly Projects

Background: At this time there is no standardized education for providers of New Hampshire Hospital addressing the Revocation of Conditional Discharge Process. Psychiatric patients in New Hampshire most at risk for harm to self or others are managed through Involuntary Commitment Orders. These orders are intended to support those most at risk of destabilization and treatment non-compliance. The Revocation of Conditional Discharge Process is one of the procedures used to re-hospitalize a patient whose care is managed through an Involuntary Commitment Order when needed. The psychiatric providers at New Hampshire Hospital must complete this last step in the revocation process, …


The Impact Of Income On Nutrition: A Case Study Of Northern Mozambique, Hunter Swanigan, Lawton Lanier Nalley Jan 2020

The Impact Of Income On Nutrition: A Case Study Of Northern Mozambique, Hunter Swanigan, Lawton Lanier Nalley

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

In 2017, Mozambique ranked as one of the least developed countries in the world by measures of health, education, and income. With a minimal annual income, purchasing adequate food to meet recommended levels of nutrients for a healthy diet is difficult, leaving 40% of the country undernourished. This study analyzed what foods are available during the dry months (hungry season) of May through October in the Nampula province of Mozambique to determine if it is possible to meet recommended levels of nutrients from purchasing and growing food. Three different levels of income were used to determine what percentage of the …


Nsu Sharks Rx_Winter 2020, Nova Southeastern University Jan 2020

Nsu Sharks Rx_Winter 2020, Nova Southeastern University

NSU Sharks Rx

Newsletter


The Impact Of The Nursing Shortage On The Quality Of Care Of Veterans, Brian Alexander Fainguersch Jan 2020

The Impact Of The Nursing Shortage On The Quality Of Care Of Veterans, Brian Alexander Fainguersch

Honors College Theses

No abstract provided.


Primary Causes And Risk Factors Leading To Nurse Burnout In The Healthcare Field, Alexa D'Angelo Jan 2020

Primary Causes And Risk Factors Leading To Nurse Burnout In The Healthcare Field, Alexa D'Angelo

Honors College Theses

Nurse burnout has become a growing issue among hospitals throughout the world. It is a subject that greatly effects both the mental and physical health of current and future nurses going into the field. This study explored the most popular and well-known causes and risk factors of nurse burnout throughout hospitals. Through the use of structured interviews, three participants were chosen with backgrounds in varying specialties. The interviews consisted of ten predetermined questions, with room for the participants to elaborate. Along with the interviews, data was gathered from current, up to date literature on the research topic of nurse burnout. …