Medicine and Health Sciences Commons^™

Understanding Barriers To Fresh Produce Consumption In Detroit, Riley Ann Macdonald, Kalyyanee Ganesh Nanaaware, Jeff Lu, Derek Zahnleuter, Heather Sun, Sara Naessig, Aminah Bharadia, Eric A. Mcgrath

Medical Student Research Symposium

Title: Understanding Barriers to Fresh Produce Consumption in Detroit

Abstract:

Background Information:

Detroit has barriers to fresh produce consumption and poor health outcomes related to diet, which necessitate further study. We aim to investigate these barriers by understanding current consumption practices of fresh produce, and provide evidence for future solutions to combat these barriers.

Methods:

Surveys were distributed at two urban garden locations (Wayne State University School of Medicine Medical Student Garden and Wayne Pediatrics Garden) in Midtown, Detroit, to patrons (n=34) receiving fresh produce between March-October 2024. Surveys screened for demographics, transportation, what produce patrons took, if they …

Opioid Vs. Money Choice Preference Patterns In Regular Heroin Users, Amolak S. Jhand, Mark Greenwald

Medical Student Research Symposium

About two-thirds of people treated for opioid use disorder (OUD) return to opioid use within the first-year post-treatment, and about 10% report use while on agonist therapy. Understanding determinants of opioid-seeking is vital to reducing recurrence and its risks. We assessed individual differences in effortful choices between opioid and money amounts, modeling real-world choices.

Our lab conducted studies in which regular heroin-users were stabilized on buprenorphine to suppress withdrawal. Within experimental sessions, the participant could choose repeatedly across 12 trials between units of hydromorphone (HYD, 1 or 2 mg IM) vs. money ($2 or $4); HYD and money amounts differed …

Factors Affecting Length Of Stay In Pediatric Orthopedic Surgical Patients, Neeti Gandra, Elika Ridelman Phd, Michelle Coughlin Md, Christina Shanti Md

Medical Student Research Symposium

Background: Length of stay is calculated by the Center for Medicaid and Medicare services based on different patient variables. This study aims to identify and understand which factors affect hospital stays in pediatric orthopedic surgery patients to create strategies to reduce length of stay and refine length of stay predictions for these patients.

Methods: We conducted a retrospective chart review of 288 pediatric orthopedic patients admitted to the hospital from January 2018 to December 2021. All 288 patients met inclusion criteria. Data were collected and analyzed.

Results: Of the 288 patients included in the study, the average expected length of …

Cracking The Code: Enhancing Sdoh Documentation With Icd-10-Cm Z Codes, Neha Chava, Saachi Mittal, Sujit Prasad

Medical Student Research Symposium

Introduction:

Social determinants of health (SDOH) have a large impact on health outcomes with the World Health Organization (WHO) estimating that SDOH accounts for nearly 30-55% of patient health outcomes. Addressing SDOH especially in primary care clinics can lead to reduced barriers to care and improvement in health outcomes. At WSUSOM, there is curricular emphasis on gaining knowledge of SDOH, but this does not always translate to clinical practice. Currently, ICD-10-CM Z Codes are being used to report SDOH and other factors influencing patients’ health status. We would like to investigate how SDOH is currently being documented and create an …

Two-Year Outcomes Of Bleb Needling Following Primary Glaucoma Filtering Surgery In Primary Open Angle Glaucoma, Sruti Ramamoorthy, Timothy Page, Matthew Mello, Maryam Ashrafkhorasani Md, Vaama Patel Md, Gilbert Xue Do, Mohamed Haidar Do, Bryan Turco Md, Karim Dirani Md, Vivian Rajeswaren Md, Faisal Ridha Al-Timimi Md, Mark Juzych Md, Bret Hughes Md

Medical Student Research Symposium

Two-year Outcomes of Bleb Needling Following Primary Glaucoma Filtering Surgery in Primary Open Angle Glaucoma

Authors: Maryam Ashrafkhorasani MD¹, Vaama Patel MD², Gilbert Xue DO³, Mohamed Haidar DO³, Bryan Turco MD⁴, Sruti Ramamoorthy BS¹, Matthew Mello BS¹, Timothy Page BA¹, Karim Dirani MD¹, Vivian Rajeswaren MD¹, Faisal Ridha Al-Timimi MD⁵, Mark Juzych MD¹, Bret Hughes MD¹

1. Kresge Eye Institute, Wayne State University, Detroit, MI, USA
2. Vanderbilt University, Nashville, TN, USA
3. Ascension Macomb Oakland Hospital, …

Canary In The Carpal Tunnel: A Pilot Study Of The Value Of The Screening For Amyloidosis In Carpal Tunnel Syndrome, Trevor Ruesch, Nevil Khurana, Logan Hansen Md, Katiya Barkho, Julia Malewicz, Charles Day Md

Medical Student Research Symposium

Introduction/Purpose:

Transthyretin amyloidosis occurs in two forms, hereditary transthyretin amyloidosis (hATTR), and wild-type ATTR (wtATTR)². Amyloidosis can result in restrictive cardiomyopathy presenting as heart failure with preserved ejection fraction (HFpEF)⁴. A growing body of evidence demonstrates that amyloidosis may be underdiagnosed and can be caught earlier in the disease course⁵. The proteins causing amyloidosis can also deposit into various tissues including the carpal tunnel leading to carpal tunnel syndrome ².

In this pilot study, we propose that early detection of amyloid via a biopsy of the transverse carpal ligament or tenosynovium in the …

Stopping The Cirrhosis: An International Review Of Hep C Screening In Prisons And Jails From 2004-2023, Anastasia Sahu Bs, Jack Spurlock Ba, Mhs, Eliza Beal Md

Medical Student Research Symposium

Background: As of 2023, HCV prevalence in state prisons in the United States was 9 times higher than the general population¹. Without treatment, 20% of people with HCV will develop cirrhosis, and some estimate that 70% of hepatocellular carcinoma (HCC) cases arise from cirrhosis or advanced fibrosis². Despite the high prevalence in prisons, the US does not have nationally standardized Hep C screening in correctional facilities. The goal of this study is to investigate different models of existing programs in prisons internationally. Understanding these models will inform Hep C screening in US prisons on a state …

Assessing Platelet Counts As Predictors Of Vasospasm And Discharge Outcomes In Aneurysmal Subarachnoid Hemorrhage, Alexander Weiss M.S., B.S., B.A., Jared C. Reese M.D., Pouya Entezami M.D., M.S.

Medical Student Research Symposium

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries a 21.9% 30-day case fatality rate, largely due to complications from cerebral vasospasm (CVS), which can lead to delayed cerebral ischemia (DCI). Despite extensive research, the best predictive biomarkers for vasospasm remain unclear. This study evaluates whether variations in platelet count predict vasospasm and patient outcomes in aSAH.

Methods: A retrospective cohort study included 297 aSAH patients from the Henry Ford Health System electronic medical records. Inclusion criteria required an aSAH diagnosis, hospital admission within 24–48 hours of symptom onset, transcranial Doppler (TCD) data, daily platelet count, and modified Rankin scale (mRS) …

Assessing The Efficacy Of Amniotic Bladder Therapy For Female Sexual Dysfunction In Patients With Radiation Cystitis, Kyle P. O'Hollaren, Aron Liaw M.D., Steven Lucas M.D., Nivedita Dhar M.D.

Medical Student Research Symposium

Introduction and Objectives: Female sexual dysfunction (FSD) and radiation cystitis (RC) are complications of pelvic radiation with limited treatment options. Both conditions result from radiation-induced inflammation and scarring of pelvic organs, leading to symptoms such as dysuria in RC and dyspareunia in FSD, with significant impacts on quality of life. Amniotic Bladder Therapy (ABT), which we have previously demonstrated improves symptoms of RC through immunomodulatory and anti-fibrotic effects, may also offer therapeutic potential for FSD. In this study, we assessed the efficacy of intra-detrusor micronized amniotic membrane (AM) injections on FSD symptoms in patients with concomitant RC, using the …

Machine Learning To Predict The Severity Score Of Trauma Pediatric Patients, Ashley Frei Bs, Elika Ridelman Phd, Rebecca Adams Bs

Medical Student Research Symposium

Background

Many scoring systems currently exist to predict severity and mortality among trauma patients. However, controversy remains over the validity of these scoring systems in pediatrics and their use in guiding treatment. Additionally, many of these tools utilize variables that can only be collected days after admission, prohibiting predictions from being determined in the immediate hours following the trauma. The goal of this study is to develop an appropriate scoring system utilizing variables collected in the pre-hospital setting and on admission of a trauma pediatric patient that could be used to help determine the minimal necessary level of care for …

Budesonide For Engraftment Fever Prophylaxis Following Autologous Vs. Allogeneic Hematopoietic Stem Cell Transplantation: An Interim Analysis, Swathi Srikantan, Shatha Farhan

Medical Student Research Symposium

Background: Engraftment Syndrome (ES), an inflammatory process involving fever and rash, has been observed to be a frequent complication following autologous hematopoietic stem cell transplantation (HSCT); however, there is limited data on its incidence after allogeneic HSCT. Studies by Betticher et al. and others have illustrated the role of steroids in reducing ES. Due to a lack of randomized trials exploring prophylactic measures, we conducted a prospective study to establish whether there is a difference between autologous vs. allogeneic groups with respect to budesonide prophylaxis and reduction of ES.

Methods: This randomized trial is based on 56 patients who received …

Identifying And Supporting Struggling Radiology Residents: A Comprehensive Approach To Enhance Academic And Clinical Competence, Clara M. Melhem, Younes Motii, Arif Musa Md, Alicia Mccartney Do, Scotty Mckay Md, Bana Bazerbashi Md

Medical Student Research Symposium

No abstract provided.

What You See Is What You Get: Improved Patient Outcomes With Anterograde Endoscopic Versus Open Carpal Tunnel Release, Christian J. Hausner, Alex Lindahl, Meet Patel, Tobin Smith, Jack Franchino, Shems Hamdan, Rahul Bodapati, Jonathan Albrecht, Zachary Chen, Charles Day

Medical Student Research Symposium

Introduction: Carpal tunnel syndrome, a common neuropathy caused by median nerve compression, impairs hand function and quality of life. While retrograde endoscopic carpal tunnel release (CTR) comparisons with open CTR has been extensively studied, limited research has been conducted on anterograde endoscopic CTR, which provides proximal-to-distal visualization of the transverse carpal ligament. This study aimed to compare Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Upper Extremity (UE) scores between open and anterograde endoscopic CTR over one year.

Methods: Patients were identified through a retrospective chart review of surgery schedules for hand and wrist surgeons affiliated with a …

Perspective Of Adolescents With Migraine: A Survey Based Study, Cameron Bear, Kevin Chau, Julie Waineo, Jasmine Policherla, Lalitha Sivaswamy

Medical Student Research Symposium

Introduction

Pediatric migraine, the leading cause of years lived with disability among adolescents, affects 62% of this population, making it a widespread and debilitating disorder. Numerous studies highlight the link between increased patient engagement and improved health outcomes. However, pediatric engagement presents unique challenges, including ethical considerations, the patient's capacity for clinical decision-making, and parental preferences. This study seeks to guide physicians in prioritizing the assessment and enhancement of patient involvement and health literacy in the management of pediatric migraine.

Methods

Children aged 12–19 years with a confirmed diagnosis of migraine were recruited from the headache clinic at Children’s Hospital …

Pulling The Trigger On Patient Care: A Comparison Of Asc And Hopd Settings For Trigger Finger Release, Carinne M. Jarvis, Nooraldin Kamalaldin, Hunter Cohn, Meet S. Patel, Charles S. Day

Medical Student Research Symposium

Introduction

There is an increased focus on balancing cost-effectiveness with positive patient outcomes. Trigger finger release (TFR) offers an opportunity to compare its value in a hospital outpatient department (HOPD) versus an ambulatory surgical center (ASC). We hypothesized that TFR performed in an ASC provides greater value.

Methods

Time-Driven Activity-Based Costing (TDABC) was used to collect cost data for each procedure. Steps in the patient care pathway were timed, and costs were categorized as:

• Direct Variable: Staff salaries, supplies

• Direct Fixed: Facility, utilities

• Indirect: Administration, marketing

Changes in PROMIS Pain Interference (PI) and Upper Extremity (UE) from pre-operative to three …

Low, Current, And Persistent Poverty Area Residence And Social Risks Among Black Cancer Survivors, Leane S. Kuo, Theresa A. Hastert

Medical Student Research Symposium

Background: Persistent area-level poverty may contribute to long-term social and economic disinvestment and fewer health promoting resources even compared with current area-level poverty. This may contribute to unmet social needs, which are associated with adverse health outcomes. This study examines associations between living in persistent (vs. current and low) poverty areas and prevalence of social needs among African American cancer survivors.

Methods: We utilized data from 3,650 participants in the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults were invited to participate if they were ages 20-79 at diagnosis with breast, colorectal, lung, prostate, or endometrial cancer (ages …

Synergistic Surgical Strategies: A Comparative Analysis Of Combined Carpal Tunnel And Trigger Finger Release, Diana Kernen Ba, Clayton Kramm Bs, Meet Patel Bs, Trae Hill Bs, Carter Dunaway Bs, Charles S. Day Md, Mba

Medical Student Research Symposium

Introduction:

Since 1980, U.S. healthcare spending has outpaced GDP growth, while lagging outcomes, highlighting the need to evaluate cost-effectiveness of treating Trigger Finger Release (TFR) and Carpal Tunnel Release (CTR) simultaneously or sequentially.

Methods:

36 Patients were recruited: 12 CTR and 12 TFR patients comprised the sequential cohort, while 12 patients who underwent simultaneous CTR and TFR comprised the simultaneous cohort. Costs were calculated utilizing time-dependent activity-based costing (TDABC), activity-based costing (ABC), and insurance claims data. Procedural times were tracked and multiplied by personnel per-minute salaries to determine direct variable labor costs. Direct variable costs for supplies and direct fixed …

Characterizing Kmt2d In Endometrial Cancer, Katherine R. Davanzo

Medical Student Research Symposium

Endometrial cancer is rising in incidence in the United States, notably among premenopausal women. This increase and the trend of delayed childbearing warrant the need for further advancement in fertility-sparing treatment for endometrial cancer. A gene left widely unexplored in its possible clinical utility as a target for fertility-sparing treatment is KMT2D, a lysine-specific methyltransferase and tumor suppressor. Preliminary gene set enrichment analysis on a 12Z endometriotic epithelial cell line identified TIMP3 as a gene that is possibly regulated by KMT2D expression. TIMP3 encodes an irreversible inhibitor of matrix metalloproteinases (MMPs), a well-recognized class of proteins as contributing to the …

Skin Of Color Representation In Biologic Advertisements For Psoriasis And Psoriatic Arthritis, Grace Doakes, Sydney Martin, Melissa Baithey, Julia Riley, Kelsey Flood, Rithu Srikantha

Medical Student Research Symposium

Skin of color (SoC) patients with psoriasis experience more severe disease, lower quality of life, and increased psoriasis-related hospitalizations compared to non-SoC counterparts (1-2). SoC patients with psoriasis demonstrate decreased familiarity with biologic medications (3-4) , which could lead to undertreatment and greater disease burden. In light of previous findings indicating inadequate SoC representation in dermatologic direct-to-consumer (DTC) advertising, we compared skin tone representation in patient-facing materials for 13 biologics FDA-approved for psoriasis and psoriatic arthritis (PsA) on pharmaceutical DTC advertising websites from July 20, 2023 to August 20, 2023. Images of 331 people, excluding videos, were analyzed via Fitzpatrick …

Enhancing Patient Education: Evaluating The Efficacy Of A Video-Based Diagnostic Tool For Hand And Wrist Conditions, Carinne M. Jarvis, Hunter Cohn, Kate Workman, Mary Zylinski, Alexander Sonaglia, Youssef Salama, Charles S. Day

Medical Student Research Symposium

Introduction

Improving patient understanding of health conditions before consultations can enhance readiness, comprehension, adherence, and outcomes. This study evaluates whether a physician-designed interactive video helps patients self-diagnose one of thirteen common hand and wrist conditions before consulting a specialist. Developed collaboratively with hand specialists and patients, the video guides users through a structured decision-making process to identify their condition. We hypothesize that patients who utilize the video-based diagnostic tool prior to their appointment will be more likely to correctly identify their diagnosis.

Methods

Fifty-six patients were randomized into control and experimental groups. The control group selected a diagnosis from a …

Sexual And Reproductive Healthcare Perceptions Among Arab-American Women: Implications For Gynecological Health Outcomes, Munna Hazime, Kaitlyn Zablock, Whitney Bowyer, Natalie Ahmad Mateju, Andrew Markowitz

Medical Student Research Symposium

This literature review analyzes the sexual and reproductive healthcare perceptions of Arab-American (AA) women living in the United States and how this impacts the prevalence of gynecological diseases. Sexual health is viewed promiscuously within the AA population and is generally reduced to the physical act of intercourse. It is considered either an agent of sexual desire or a means to reproduce. This dichotomy overlooks aspects of gynecological health within a broader framework. This attitude is evident in the minimal utilization of preventative screenings and increased rates of sexually transmitted infections (STIs) and gynecological cancers. Consequently, this narrow view of sexual …

The Role Of Churches In Enhancing Cancer Screening Adherence: A Focus On Faith-Based Health Literacy Among African American Women, Miranda I. Goodson, Genevieve Murray

Medical Student Research Symposium

Background: It is estimated that cancer is the second leading cause of death for African American women in the United States. One study revealed that Black women have a 1 in 3 chance of developing cancer with a 1 in 6 chance of mortality. Research has shown a lower breast cancer screening adherence among women in cultural minorities and faith-based communities. The importance of spirituality and religion as an influential factor on Black community members’ beliefs about health and medicine must be considered as churches are pillars of social support within Black American communities.

Methods: A search for studies about …

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders, Hazem Alata, Hussein Bazzi, Saleh Al-Juburi, Angie Achkar, Liam Browning, Nicole Oska, Adam Chaban, Arash Javanbakht

Medical Student Research Symposium

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders

Introduction:

Substance use disorders (SUD) among Middle Eastern and North African (MENA) populations remain largely understudied, despite evidence of high prevalence rates and lower rates of treatment engagement. Unique cultural conceptualizations and beliefs surrounding substance use disorders may perpetuate stigma, further contributing to disparities in access to and utilization of treatment services. This study aims to explore the attitudes and perspectives of individuals from MENA communities regarding substance use disorders, with the goal of identifying and addressing barriers to treatment.

Methods:

An anonymous bilingual Qualtrics survey was administered, gathering responses from …

Gap Analysis Of The Surgical Clerkships Experience According To The 2022 And 2023 Aamc Gq Survey, Madelyn N. Moretti, Suhas Nagappala, Michael Nunu, Neha Iska, Yeonju Kim, Jason Booza

Medical Student Research Symposium

BACKGROUND: Surgery remains a male-dominated field, and mediating factors for this discrepancy remain ill-defined. Little research has explored the experience of female medical students in surgical clerkships, which can exert strong influence over career choice. This study investigates whether disparities in clerkship experiences contribute to this gender gap.

METHODS: US medical students were surveyed on a variety of measures, including clerkship experiences, via the 2022 and 2023 AAMC GQ surveys. Differences in response pattern between male and female students were analyzed with chi-squared tests.

RESULTS: In surgical clerkships, female students reported less physician oversight when performing histories (2022: 79.60% vs …

Is There A Difference In Effectiveness Between Nonoperative Treatments For Modified Garcia-Elias Scapholunate Ligament Injuries Stages 1 And 2?, Michelle Yi, Minie Zhang, Lucas Kopp, Charles S. Day

Medical Student Research Symposium

Introduction

Scapholunate interosseous ligament (SLIL) injuries result from falling on an outstretched hand. Studies have assessed the effectiveness of non-operative treatments, but none has compared different non-operative treatments. We analyze the effectiveness of casting and bracing/splinting based on patient reported outcomes (PRO).

Methods

Chart review was conducted on 1150 possible SLIL injury patients from 5 orthopaedic hand surgeons from a Midwestern, tertiary-care academic hospital system between 2021 and 2024. Two patient cohorts were divided based on treatment. PROs obtained were PROMIS Upper Extremity (UE) and Pain Interference (PI) pre-treatment and 2-3 months after. Patient improvement was calculated as difference between …

Understanding Adolescent Fear Extinction: Identifying Profiles And Connections To Anxiety, Jovan Jande, Clara Zundel, Samantha Ely, Sneha Bhargava, Carmen Carpenter, Reem Tamimi, Leah Gowatch, Mackenna Shampine, Emilie-Clare O'Mara, Jennifer Losiowski, Christine Lewis, Alaina Jaster, Shravya Chanamolu, Hilary A. Marusak

Medical Student Research Symposium

Anxiety disorders, the most prevalent mental health conditions, often emerge during adolescence. Core features include difficulties in regulating or extinguishing learned fear. However, compared to adults, less is known about fear extinction and its relationship with anxiety in youth. Most studies rely on group-level averages of single fear indicators, such as skin conductance responses (SCR) or self-reported fear, which may overlook individual variation, introduce bias, and miss critical manifestations like behavioral avoidance. Using a validated Pavlovian fear extinction paradigm, we applied k-means clustering to identify distinct fear extinction profiles in adolescents, examining their reliability and validity in relation to conditioned …

How The Conflicts In The Middle East Affect The Mental Health Of Arab American Medical Students, Samar Ghassan Chehab, Abeer Wael Abukamil, Sabrina Khan, Jennifer Mendez, Rima Charara

Medical Student Research Symposium

Background and Relevance

Medical school students represent a vulnerable population frequently experiencing mental health disorders such as chronic stress and anxiety (Dederichs et al., 2021). The unstable political climate in the Middle East may contribute to worsening mental health among the population of Arab American medical students. Helplessness regarding unfolding political events and perceptions from peers often deter students from accessing already limited mental health resources (Mental Health America, 2021).

Design and Methods

An anonymous survey distributed to Arab American medical students in Michigan evaluated the impact of recent events in the Middle East on their well-being. The Future Anxiety …

Implications Of Glyphosate-Based Herbicides On The Female Reproductive System And Reproductive Outcomes, Alexandra Stone, Olivia G. Camp Ms, David Bai Md, Awoniyi Awonuga, Husam M. Abu-Soud

Medical Student Research Symposium

Background

Glyphosate-based herbicides (GBHs) are the most widely used herbicides in the United States, accounting for 19% of estimated global use. Although the Environmental Protection Agency has reaffirmed that the active ingredient glyphosate (GLY) is safe for humans, recent studies on exposure have suggested an association with cancer, metabolic disorders, endocrine disruption and infertility, and Alzheimer’s and Parkinson’s disease. Recently, we have shown that GLY exposure deteriorates metaphase II oocyte quality through zinc deficiency, ROS accumulation, and chromosome disruption. In this work, we review the mechanisms of GLY toxicity in the female reproductive tract and discuss the potential clinical implications …

Androgen Hormones Regulate The Production On The Pain-Inducing Inflammatory Molecule Il-1Β In A Mouse Model Of Inflammatory Pain, Hariharan Ramakrishnan, Geoffroy Laumet, Jaewon Sim

Medical Student Research Symposium

Chronic pain prevalence varies between sexes with a higher incidence and duration reported in women compared to men. This disparity suggests that biological factors, such as sexual hormones, may influence pain perception and development. Among the key players in pain mechanisms, interleukin-1 beta (IL-1β), an inflammatory molecule, has been identified to activate neurons involved in pain sensation. This study explores the hypothesis that sexual hormones, particularly androgens, regulate IL-1β production in inflamed tissues, thereby influencing pain responses. To investigate this, we induced inflammatory pain in male and female mice using Complete Freund’s Adjuvant (CFA), injected into the hind paw. To …

Methods For A Bioengineered 3d Human Brain-Like Tissue Model Of Neuro-Regeneration After Traumatic Brain Injury, Marly Coe, Sydni Rosenfeld, Celia Byrne, Volha Liaudanskaya, David Kaplan

Medical Student Research Symposium

Traumatic brain injury (TBI) causes permanent cell death and can lead to long-term cognitive dysfunction, with no available treatments to repair the damaged brain tissue. Methods to track and understand TBI in humans are severely limited by the inaccessibility of living brain tissue, creating a need for in vitro model systems to study cellular mechanisms of degeneration and regeneration following injury. Here we describe methods to establish a 3D human brain tissue model, consisting of a silk-collagen composite scaffold seeded with human neurons, astrocytes, and microglia, to study neuro-regeneration after TBI. Step-by-step fabrication, injury, and analytical assessments of the 3D …