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2021

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Full-Text Articles in Medicine and Health Sciences

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala May 2021

Identifying Opportunities For Implementing Home Blood Pressure Monitoring In Newly Diagnosed Or Worsening Hypertension At A Family Health Clinic, Catherine Liikala

Doctor of Nursing Practice Final Manuscripts

Abstract

The literature is clear that the diagnosis, treatment, and plan of care for hypertension in adults should rely, at least in part, on ambulatory blood pressure. Using in-office blood pressures alone risks inaccurate measurements and can result in inappropriate treatments. Many clinics, however, do not adhere to this recommendation and will fall back on clinic readings which puts the patient at risk of mismanaged hypertension and polypharmacy. This project was formulated to identify the extent to which hypertensive patients were diagnosed and managed without the use of home blood pressure monitoring in a small local community clinic. This …


Tanden Art-Making As Contemplative Practice, Rumi Ito May 2021

Tanden Art-Making As Contemplative Practice, Rumi Ito

Expressive Therapies Dissertations

The art-based study, focused on painting with black ink on paper and video documentation, explores the relationship between artistic expression and contemplative breathing with a particular focus on tanden, a unique concept of such Asian cultures as Chinese, Korean and Japanese. There were three research questions: “How can tanden influence one’s physical movements in the art-making process?” and “Can contemplative breathing with a focus on tanden influence the quality of expression in one’s art-making? If so, what are the influences and implications for art therapy?”

The research suggested five bodily sensations common to all participants: inhaling and exhaling, relaxing, …


Music As A Gateway To Healing Speech Disorders And Mental Health Holistically In The Patient With Aphasia: A Literature Review, Susan Warren May 2021

Music As A Gateway To Healing Speech Disorders And Mental Health Holistically In The Patient With Aphasia: A Literature Review, Susan Warren

Expressive Therapies Capstone Theses

People with some types of post-stroke aphasia often experience depression as well as loss of speech. Music therapy has unique properties that allow it to be used therapeutically to treat both speech impairment and depression yet it is rarely used to treat both disorders. This literature review seeks to examine the underlying causes for this discrepancy, review methods used by practitioners to treat both disorders and suggest future directions for additional research and implications for the treatment of patients with aphasia who have both language impairment and depression.


Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice May 2021

Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice

Expressive Therapies Capstone Theses

Pregnant people in the United States (US) face myriad barriers to resource accessibility when seeking support, including financial gatekeeping, discrimination, and cis-gendering of the process. Commodification of prenatal support is exhaustive and contributes to a growing exclusivity of traditionally accessible interventions designed to reduce stress, anxiety, and depression, and to promote positive fetal outcomes and parent-child bond. Mindfulness-based interventions are particularly appropriate for reducing stress, anxiety, and depression in pregnancy. Mindfulness-based interventions are intersectional, accessible means of pregnancy and childbirth support with evidence-based outcomes of positive birth experiences and results. Mindfulness is defined as nonjudgmental awareness of the present moment. …


Advocating For Neuro-Informed Music Therapy For Ptsd In Diverse Populations, A Literature Review, Shanell A. Percy May 2021

Advocating For Neuro-Informed Music Therapy For Ptsd In Diverse Populations, A Literature Review, Shanell A. Percy

Expressive Therapies Capstone Theses

Research indicates that music positively affects the brain, health, and wellness and continues to be researched for its effectiveness in treating PTSD. Traumatic memories are stored in the brain structures of the limbic system. Music has been shown to affect these brain structures, giving prospect to its use through music psychotherapy interventions as an effective treatment for PTSD. This review of music therapy literature assesses the effects of music on the brain, identifies current models for treating PTSD with music therapy, and considers culturally informed approaches to treatment. A widely known gap in the research of evidenced-based studies of music …


Community Art For Rebuilding College Communities Following The Covid-19 Pandemic: A Literature Review, Amber Haney May 2021

Community Art For Rebuilding College Communities Following The Covid-19 Pandemic: A Literature Review, Amber Haney

Expressive Therapies Capstone Theses

This paper is an examination of arts-based community engagement projects as a way to creatively engage, support, and endorse healing in college communities. This paper was written with consideration for potential long-term impacts on college students, individually and collectively, as a result of the COVID-19 pandemic. Throughout this paper, college student mental health trends in the United States are addressed and existing community engagement projects that center around community, healing, and resilience are examined. This paper argues that art therapy practices that are meant to advance societal healing can occur outside of the traditional, clinical individual or group therapy session …


Using Paper Theatres As An Expressive Arts Therapy Method: Activating Imaginal Worlds In Community Arts Practice, Silvina S. Ibanez May 2021

Using Paper Theatres As An Expressive Arts Therapy Method: Activating Imaginal Worlds In Community Arts Practice, Silvina S. Ibanez

Expressive Therapies Capstone Theses

Paper theatres are an artistic form that became widely popular in 19th century Europe. Also known as toy theatre and model theatre, a paper theatre has a small build-your-own proscenium and pre-cut paper characters that can be manipulated. Different styles of paper theatre can be found in several cultures.

In contemporary art, the use of paper theatres in several modalities led to an exploration of whether such theatres also could be used as an art therapy method. Research was conducted into expressive art therapy principles, Jungian perspectives, and recent studies in neurosciences. The studies included in the literature review confirmed …


How Art Therapy Can Ethically Address Symptoms Of Trauma With Asylum Seekers And Refugees, A Literature Review, Lydia Klauck May 2021

How Art Therapy Can Ethically Address Symptoms Of Trauma With Asylum Seekers And Refugees, A Literature Review, Lydia Klauck

Expressive Therapies Capstone Theses

Asylum seekers at the Southern border of the United States of America have experienced a number of complex traumas due to premigration experiences in their country of origin as well as anti-immigration laws that cause further oppression and discrimination. The intention of this capstone thesis is to examine how art therapy can ethically address the symptoms of trauma seen in asylum seekers and refugees in the United States. This literature review looked at arts-based and qualitative studies conducted in other countries as well as literature about trauma-informed treatment within the psychotherapy field in order to address the gap in the …


Exploring The Therapeutic Relationship As A Central Focus Through Expressive Arts Therapy In Oncology, Akshata Parekh May 2021

Exploring The Therapeutic Relationship As A Central Focus Through Expressive Arts Therapy In Oncology, Akshata Parekh

Expressive Therapies Capstone Theses

The treatment for cancer can be physically, mentally, emotionally and socially challenging. These treatments have side effects like physical body pain, hair loss, changes in weight, energy, nausea and more. These physical changes impact the social, mental and emotional well-being of the patient and makes this journey of the life-threating prognosis of cancer very tough to confront. Expressive arts therapy provides a safe space for the patients to address their mental health concerns as a result of this treatment. The Capstone Thesis Project explored expressive arts therapy interventions with 95 patients through single or multiple sessions while going through their …


Nothing To Lose: A Literature Review On Combating Anti-Fat Bias Through Expressive Therapies, Katlyn Tracy May 2021

Nothing To Lose: A Literature Review On Combating Anti-Fat Bias Through Expressive Therapies, Katlyn Tracy

Expressive Therapies Capstone Theses

Anti-fat bias exists and is a pervasive and often overlooked form of oppression that significantly harms the mental health of fat people. Similar to other forms of oppression, anti-fat bias remains perpetuated through ideology, enforced institutionally through discriminatory practices, and enacted through interpersonal harassment. There is growing interest in exploring not only the mental health impacts of anti-fat bias, but also the development of effective therapeutic interventions to support fat people impacted by it. However, research on therapeutic strategies for combating this issue remains scarce. The field of Expressive Therapies, with its range of creative modalities and focus on engaging …


Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans May 2021

Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans

Expressive Therapies Capstone Theses

The process of hospitalization and the environment of a typical psychiatric hospital is often counter-therapeutic. To challenge this problem, clinicians may introduce the concept of psychological containment. To elaborate, being hospitalized anywhere can be disorienting, frightening and even traumatic. This problem is only further exacerbated in psychiatric hospitals where patients may be disorganized, manic, or struggling with psychosis. Furthermore, psychological containment is essentially the ability for psychiatric patients to prevent their intense emotions from effecting others negatively, and to act with resiliency when other patients are unable to contain their own disruptive behaviors. This paper utilizes both an initial literature …


Language As The Medium: A Literature Review. Harnessing The Prolific Power Of Dramatic Language As A Therapeutic Tool In Drama Therapy, Edward Freeman May 2021

Language As The Medium: A Literature Review. Harnessing The Prolific Power Of Dramatic Language As A Therapeutic Tool In Drama Therapy, Edward Freeman

Expressive Therapies Capstone Theses

Language in and of the theatre, with its palate of variegated writing styles and playwrights from throughout time, has the potential to be harnessed, focused, and systematized for use as a therapeutic tool within drama therapy – the field’s artistic medium. Drama therapy could benefit from having a specific medium germane to its artform which has the potential to provide practitioners with a common resource and means of communication, assessment, diagnosis, and treatment planning, as well as align the field with other creative arts therapies. Language encompasses all forms of human communication – speaking, writing, signing, gesturing, expressing facially – …


Benefits Of Creative Therapies With Adoption And Complex Trauma: A Literature Review, Rosellen Boucher May 2021

Benefits Of Creative Therapies With Adoption And Complex Trauma: A Literature Review, Rosellen Boucher

Expressive Therapies Capstone Theses

This literature review explores the history of modern adoption and the effects on the adopted from a developmental, emotional, and behavioral standpoint. The review aims at addressing these specific needs through the use of art therapy. To become better acquainted with the concept, the history of modern adoption, as it pertains to the United States, is summarized with three subcategories as a focus points: domestic, international, and the foster care system. Building off of the history is a reflection on the past research surrounding adoption by considering adverse childhood experiences, complex trauma, attachment, and identity formation as it relates. Legislation …


Bringing The Body Into Art Therapy: The Use Of Touch And Body Awareness In Creative Healing, Janna Corsetti May 2021

Bringing The Body Into Art Therapy: The Use Of Touch And Body Awareness In Creative Healing, Janna Corsetti

Expressive Therapies Capstone Theses

The focus on the use of healing touch and body awareness in art therapy is critically lacking. Despite the research supporting the use of body-oriented techniques in clinical therapy, there is little research related to this use specifically in art therapy. Research reveals that healing touch and body awareness can be instrumental in healing trauma, if done with the proper training and boundaries in place. The first form of attachment and comfort for children is that of touch. Therefore, it is imperative to acknowledge the power of touch and body awareness when healing from traumatic experiences. The purpose of this …


Self-Compassion Integrated Art Therapy For Mothers During A Pandemic, Shannon Dover May 2021

Self-Compassion Integrated Art Therapy For Mothers During A Pandemic, Shannon Dover

Expressive Therapies Capstone Theses

This thesis reviews literature related to parental mental health and the novel coronavirus (COVID-19). COVID-19 is a collective trauma in which individuals experience the trauma differently depending on race, gender, and class. Women’s experience of living during COVID-19 related to changes in the workplace, caretaking, and more. The pandemic influenced parents and notably mothers with increased stress, depression, grief, and anxiety. The practice of self-compassion reduces shame and self-criticism which are common experiences during parenting and trauma. Self-compassion and art therapy can aid in resiliency and make living during COVID-19 more comfortable. With a literature review, results yield the following …


Exploring The Usefulness Of Mindfulness Practices Through Zoom Meetings In Reducing Anxiety And/Or Stress Of Adults With Learning And Developmental Disabilities During The Covid-19 Pandemic, Thatiane Abra May 2021

Exploring The Usefulness Of Mindfulness Practices Through Zoom Meetings In Reducing Anxiety And/Or Stress Of Adults With Learning And Developmental Disabilities During The Covid-19 Pandemic, Thatiane Abra

Expressive Therapies Capstone Theses

This thesis explored which mindfulness meditations or mindfulness practices could be beneficial in the online sessions, the extent to which adults with learning and developmental disabilities could learn the practices remotely, and how stress and anxiety disorders could be reduced through online mindfulness interventions. Furthermore, it was also necessary to address the online sessions as the only mental health treatment possibility during the Coronavirus pandemic for the clients observed and the benefits and limitations of these interventions. Additionally, the importance of structure and routine for this population, the multi-modal structure of the interventions, and how attunement plays an important role …


Storytelling As An Expressive Arts Therapy Intervention With Children Via Telehealth, Sidney Marie Joines May 2021

Storytelling As An Expressive Arts Therapy Intervention With Children Via Telehealth, Sidney Marie Joines

Expressive Therapies Capstone Theses

As an expressive arts therapist in training working in the midst of a global pandemic, I sought to develop a creative, safe, accessible, and effective intervention for children via telehealth during a time of great uncertainty. Coronavirus 2019 has had a massive impact on mental and physical health and disrupted the lives of billions across the globe; the pandemic also forced mental health professionals to online formats. I found a significant lack of literature around expressive arts therapy via telehealth. Through considering theoretical approaches from cinematherapy, narrative therapy, metaphor therapy, play therapy, and expressive arts therapy, I developed an eight-week …


Exploring Tactile Art-Making With Deafblind Students And Their Families: An Opportunity For Creative Play, Alice Rodgers May 2021

Exploring Tactile Art-Making With Deafblind Students And Their Families: An Opportunity For Creative Play, Alice Rodgers

Expressive Therapies Capstone Theses

The impact of a deafblind diagnosis on an individual’s mental health and the well-being of the family involved can be profound. However, current research and available literature for the mental health treatment and therapy practices of deafblind persons and their families is limited (Kyzar et al., 2016; “WFDB Global Report 2018,” n.d.). This thesis used the Leeds Family Psychology and Therapy Service principles (Leeds FPTS) and the Expressive Therapies Continuum with established deafblind teaching strategies to facilitate an original arts-based community project entitled: “Things We Like.” This project provided an opportunity for deafblind students (ages three to 22) and their …


"It's The Way You Sing It": Translating Music Therapy For Isolated Older Adults Affected By Covid-19 To The Television Screen, Eunice Wong May 2021

"It's The Way You Sing It": Translating Music Therapy For Isolated Older Adults Affected By Covid-19 To The Television Screen, Eunice Wong

Expressive Therapies Capstone Theses

The current Covid-19 pandemic has increased the likelihood of loneliness and social isolation among older adults due to the restrictions on movement and visitations in care facilities. Loneliness and social isolation have consistently been identified as risk factors for poor mental and physical health in older people. Meanwhile, a growing number of older adults are utilizing technological resources to enhance their interpersonal relationships and overall quality of life. In the winter of 2020/2021, an innovative music therapy-informed television program was designed and produced for isolated older adults in need of mental and emotional support. This project, produced jointly by a …


Characterizing The Gene Regulatory Network Required To Specify The Excitatory Neurotransmitter Phenotype Of V0v Spinal Interneurons, Amber Kellie Woodard May 2021

Characterizing The Gene Regulatory Network Required To Specify The Excitatory Neurotransmitter Phenotype Of V0v Spinal Interneurons, Amber Kellie Woodard

Theses - ALL

The majority of neurons within the spinal cord are interneurons. Interneurons make important connections with other cells that allow signals to be relayed between the brain and the rest of the body, and aid in functions such as locomotion. One key functional characteristic of interneurons is the neurotransmitter that they use to communicate with other cells. Interneurons that use GABA or glycine neurotransmitters to communicate have an inhibitory phenotype, while interneurons that use glutamate neurotransmitters have an excitatory neurotransmitter phenotype. Without the correct neurotransmitter phenotype, connections within the central nervous system will malfunction. It is therefore important to understand how …


Utilizing Post Graduate Residency Program In New Graduate Nurse Practitioners To Improve Clinical Outcomes, Lashaunda Jethro May 2021

Utilizing Post Graduate Residency Program In New Graduate Nurse Practitioners To Improve Clinical Outcomes, Lashaunda Jethro

Doctor of Nursing Practice Final Manuscripts

Utilizing Post Graduate Residency Program in New Graduate Nurse Practitioners to Improve Clinical Outcomes.

by LaShaunda R Jethro

The Advanced Practice Registered Nurse (APRN) role across the continuum of patient care continues to evolve, and the APRN continues to play a significant part in sustaining the current healthcare system and controlling the rising incidence of mortality and medical cost. While a substantial amount of evidence demonstrates that Nurse Practitioners (NPs) are expert healthcare providers, some studies also report that many new NPs fail to be confident in their capability to undertake the NP role and attend to increasing patient loads. …


Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling May 2021

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …


Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza May 2021

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …


Tissue Reaction To Novel Customized Calcium Silicate Cement Based Dental Implants. A Pilot Study In The Dog, Amir Fakhrzadeh, Mohammad A. Saghiri, Steven M. Morgano, Andrew Sullivan May 2021

Tissue Reaction To Novel Customized Calcium Silicate Cement Based Dental Implants. A Pilot Study In The Dog, Amir Fakhrzadeh, Mohammad A. Saghiri, Steven M. Morgano, Andrew Sullivan

All Dugoni School of Dentistry Faculty Articles

Objectives: The purpose of this study was to determine the level of periodontal tissue regeneration in a canine model following post-extraction placement of an implant molded from a composite material made from extracted tooth dentin and a calcium silicate cement (CSC) material. The investigation used autologous dentin in conjunction with a CSC material to form a composite implant designed for immediate tooth replacement. Methods: Two (2) beagles had a periodontal and radiographic examination performed to rule out any pre-treatment inflammation, significant periodontal disease, or mobility. Then, ination eleven (11) teeth were extracted and polyvinyl siloxane molds were made to fabricate …


The Impact Of Poverty And Neighborhood Characterstics On The Mental Health And Parent-Child Closeness In The Black Community: The Protective Role Of Black Cultural Strengths, Brandon Davis Hollie May 2021

The Impact Of Poverty And Neighborhood Characterstics On The Mental Health And Parent-Child Closeness In The Black Community: The Protective Role Of Black Cultural Strengths, Brandon Davis Hollie

Dissertations - ALL

Poverty and negative neighborhood characteristics can be detrimental to the mental health wellbeing of Black people. Yet, there is a lack of understanding of how, why, and for whom such factors impact the mental of the Black community. Using a sample of 1654 Black families from the Fragile Family and Child Wellbeing Study I investigated two models. First, I examined the path from poverty to depression, anxiety, and tested Black cultural strengths, religiosity and neighborhood cohesion as moderators. Second, I examined the path from poverty to parent-child closeness and tested Black cultural strengths, social ties and extended family as moderators. …


The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer May 2021

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …


Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet May 2021

Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet

Dissertations

Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a …


Transitioning From Onsite To Online Psychotherapy Visits During The Covid-19 Crisis, Michael Angello Negron, Dnp May 2021

Transitioning From Onsite To Online Psychotherapy Visits During The Covid-19 Crisis, Michael Angello Negron, Dnp

Doctor of Nursing Practice Final Manuscripts

Background: On March 19, 2020, the governor of the State of California, Gavin Newsom, issued executive stay-at-home order due to the coronavirus disease (COVID-19) pandemic (State of California, 2020). In a private psychiatric practice in southern California treating patients with anxiety and depression, psychotherapy treatment was abruptly affected by that order. The purpose of this project was to transition from onsite to online psychotherapy visits to ensure the continuity of care and facilitate patients’ progress in dealing with mental illnesses during the COVID-19 crisis.

Aims: The proposed solution to the problem of decreased access to care during the pandemic was …


Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James May 2021

Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James

Doctor of Nursing Practice Final Manuscripts

Background: Adolescent obesity is a serious health concern with increased worldwide prevalence. Excess weight gain can affect adolescent’s physical and emotional health. The adolescent with excess weight can involve acute and chronic long-term health complications that continue into adulthood.

Methods: Health care providers screened for overweight and obese adolescents during annual physicals and follow-up visits. Thirty adolescents at the 85th - 95th percentile and above on the growth chart received a pre and post clinical-screening questionnaire for eating behaviors and exercise. Individualized education with parent involvement and motivational interviewing (MI) was implemented with monthly follow-ups for 4 months.

Findings: Data …


Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller May 2021

Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Forty percent of the US population ages 20-39 are categorized as obese,

their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults.

Aims of Service Change: This evidence-based project proposal aims to provide a toolkit …