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Articles 241 - 270 of 2417
Full-Text Articles in Medicine and Health Sciences
Improving Patient Outcomes Post-Discharge: Implementing Evidence-Based Discharge Planning For High-Risk Mental Health And Substance Use Disorder Populations, Margaret Phillips
Improving Patient Outcomes Post-Discharge: Implementing Evidence-Based Discharge Planning For High-Risk Mental Health And Substance Use Disorder Populations, Margaret Phillips
Doctor of Nursing Practice Projects
A significant gap in standardized discharge procedures was identified at a nonprofit, community-based clinic serving male residential patients with substance use disorder (SUD) and co-occurring mental health conditions. The lack of a standardized discharge process led to poor follow-up appointment adherence, poor medication adherence and increased risk of relapse. This quality improvement (QI) project aimed to address these issues through the implementation of a cross-departmental discharge process that produced tailored Individualized Discharge Plans (IDP) or each patient, using the Donabedian and Kotter’s 8-Step Change models as guiding frameworks. Data were collected using custom-built tracking tools over two four-week periods, pre- …
The Role Of Neuroscience In Mental Health Management Within The Adhd Population, Kadi Rae Smith
The Role Of Neuroscience In Mental Health Management Within The Adhd Population, Kadi Rae Smith
University Honors Theses
Neuroscience-based educational interventions play a role in the management of Attention Deficit Hyperactive Disorder (ADHD), including the regulation of ADHD-correlated depression and anxiety. Existing research shows that elevated rates of depression correspond to anxiety within the ADHD community; approximately 8.83% of the global population. Social ostracization and isolation are established contributors to depression and anxiety which are commonly comorbid with ADHD. The need exists for further investigation of the beneficial impact that an accurate, biological understanding of how the brain works has on the mental health of the ADHD population, and by extension their families, education systems, and medical industries. …
Enhancing Mental Health Through Mind-Body Exercises In Sedentary Students: A Systematic Review With An Indonesian Perspective, Izmi Alya Khairunnisa, Aditya Denny Pratama
Enhancing Mental Health Through Mind-Body Exercises In Sedentary Students: A Systematic Review With An Indonesian Perspective, Izmi Alya Khairunnisa, Aditya Denny Pratama
Jurnal Sosial Humaniora Terapan
Sedentary Behavior (SB) among students is associated with increased risks of depression, anxiety, stress, and weakened immune function. According to the WHO, SB contributes to approximately two million deaths each year. This systematic literature review aims to evaluate the effectiveness of mind-body exercises in improving mental health outcomes—specifically stress reduction, anxiety management, and emotional regulation—among students with sedentary lifestyles. Using the PRISMA framework, 2,201 articles were identified from databases including Scopus, PubMed, and ProQuest, with six studies meeting the inclusion criteria. The review found that mind-body exercises such as yoga, tai chi, and pilates significantly reduce stress and anxiety, enhance …
Exploring The Connection Between Mental Health Stigma, Social-Emotional Risk, And Help-Seeking Behaviors Among High School Students, Dorie Ross
USF Tampa Graduate Theses and Dissertations
Throughout the United States, the rate of adolescents experiencing mental health-related challenges continues to rise, impacting their social-emotional well-being. Despite increasing concerns, the majority of adolescents do not seek treatment for mental health problems. One barrier contributing to a lack of help-seeking behaviors is mental health stigma. Furthermore, for students who have sought help for such concerns, there is a lack of consensus on whom high school students turn to for support when seeking help. The current study utilized quantitative methodology in the form of Structural Equation Modeling to examine the complex relationship between social-emotional risk, perceptions of mental health …
Social Exclusion And Mental Health Of Youths Affected By Parental Hiv/Aids In China: Based On A Serial Mediating Model, Jiaojiao Wan, Lili Ji, Zheqian Wang, Junfeng Zhao, Xiaoming Li
Social Exclusion And Mental Health Of Youths Affected By Parental Hiv/Aids In China: Based On A Serial Mediating Model, Jiaojiao Wan, Lili Ji, Zheqian Wang, Junfeng Zhao, Xiaoming Li
Faculty Publications
The mental health of youth living with patients with HIV needs focused attention. The primary source of psychological distress they experience may stem from social exclusion. Therefore, the current study was designed to explore the relationship between social exclusion and mental health among youths affected by parental HIV/AIDS in rural China.
Methods
297 youths affected by parental HIV/AIDS were recruited to completed questionnaires of social exclusion, perceived stress, future orientation and mental health. The bootstrap method was used to examine the mediation effects.
Results
It showed that: (1) the social exclusion (M = 32.48, SD = 15.25) significantly and …
Prevalence And Associated Factors Of Mental And Substance Use Problems Among Adults In Kenya: A Community-Based Cross-Sectional Study, Patrick Nzivo Mwangala, Anita Kerubo, Millicent Makandi, Rachel Odhiambo, Amina Abubakar
Prevalence And Associated Factors Of Mental And Substance Use Problems Among Adults In Kenya: A Community-Based Cross-Sectional Study, Patrick Nzivo Mwangala, Anita Kerubo, Millicent Makandi, Rachel Odhiambo, Amina Abubakar
Institute for Human Development, East Africa
Data on the burden and determinants of mental and substance use problems among women in urban and rural informal settlements in Kenya is sparse, thus limiting preventive and treatment efforts in these areas. To bridge the gap, we (a) determined the prevalence of depressive, anxiety and post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use problems among women compared to their spouses and (b) examined the correlates of these outcomes. Data collection for this cross-sectional survey was conducted in 2022 in Mombasa, Kwale and Nairobi counties in Kenya. A total of 1528 adults (1048 women) took part. The 9-Item …
Extending The Psychometric Properties Of The Arabic Rcmas In Jordanian Children Aged 7–16: Considering Gender And Age Invariances, Mohammad A. Al Jabery, Ebenezer Afrifa-Yamoah, Sara Farid Khalaf, Diana H. Arabiat
Extending The Psychometric Properties Of The Arabic Rcmas In Jordanian Children Aged 7–16: Considering Gender And Age Invariances, Mohammad A. Al Jabery, Ebenezer Afrifa-Yamoah, Sara Farid Khalaf, Diana H. Arabiat
Research outputs 2022 to 2026
Background: There are diverse gender and age-based differences in levels of anxiety between boys and girls. Establishing the validity of such assessments entails inquiry on the construct validity and measurement invariance of tools. This study examined the psychometric properties of the Arabic version of the Revised Children's Manifest Anxiety Scale (RCMAS) to assess its suitability for measuring child anxiety and its equivalence across genders and ages. Methods: A cross-sectional design was employed to examine the generalizability of the measure's structure. The study was conducted between November 2021 and January 2022. A sample of 178 children (86 boys and 92 girls), …
Stress And Burnout: Is There A ‘Happily Ever After’?, Margaret S. Gingrich D.D.S.
Stress And Burnout: Is There A ‘Happily Ever After’?, Margaret S. Gingrich D.D.S.
The Journal of the Michigan Dental Association
Executive Summary Dental professionals experience significant stress and burnout due to high patient expectations, challenging patients, employee management issues, and insurance complexities. Dr. Margaret Gingrich outlines Christina Maslach's six stages of burnout, from the honeymoon phase to reduced personal accomplishment. Recovery requires intentional rest following the "rule of 42" - dedicating 42% of daily time to various forms of rest, including physical, emotional, sensory, mental, spiritual, social, and creative restoration. Key strategies involve setting boundaries, saying no, taking breaks, seeking social support, and, when necessary, terminating problematic patient relationships. The Michigan Dental Association and American Dental Association provide wellness resources, …
Getting Help When The Going Gets Tough, Michelle C. Dziurgot D.D.S.
Getting Help When The Going Gets Tough, Michelle C. Dziurgot D.D.S.
The Journal of the Michigan Dental Association
In her editorial, Dr. Dziurgot emphasizes the importance of emotional support and mental health resources for dentists. She shares her own experiences of turning to family in tough times and offers practical alternatives for those without such support. Strategies include journaling, creative expression, and seeking professional counseling through programs like the MDA Member Assistance Program and ADA Talkspace. She encourages open dialogue and mutual support within the dental community.
Residential Factors Associated With Mental Health In United States Veterans, Air Force Military, And Air Force Employees, Andrew J. Hoisington, Christopher A. Stamper, Molly Penzenik, Meredith Reitter, Elizabeth J. Kovacs, Nazanin H. Bahraini, Lisa A. Brenner
Residential Factors Associated With Mental Health In United States Veterans, Air Force Military, And Air Force Employees, Andrew J. Hoisington, Christopher A. Stamper, Molly Penzenik, Meredith Reitter, Elizabeth J. Kovacs, Nazanin H. Bahraini, Lisa A. Brenner
Faculty Publications
Individuals in Westernized countries spend most of their time indoors. However, exploration of residential building factors that may influence occupants’ mental health is limited in scientific literature. The purpose of this study was to explore investigator's perceived areas of importance in residences to mental health via survey methods. To that end, we administered the Housing, Occupancy, Materials, and Environment (HOME) survey to assess factors that may influence mental health to those working in the United States (US) Air Force (n = 230) or past military members, US Veterans (n = 180). Self-reported mental health surveys were also administered to the …
Development Of An Age-Appropriate Household Dysfunction Measure And Its Concurrent Validity With Multiple Outcomes Among Middle School Adolescents In Southeast Texas, Sumaita Choudhury, Timothy J Walker, Emily T Hébert, Christine M Markham, Ross Shegog, Robert C Addy, Melissa F Peskin
Development Of An Age-Appropriate Household Dysfunction Measure And Its Concurrent Validity With Multiple Outcomes Among Middle School Adolescents In Southeast Texas, Sumaita Choudhury, Timothy J Walker, Emily T Hébert, Christine M Markham, Ross Shegog, Robert C Addy, Melissa F Peskin
Faculty, Staff and Student Publications
Existing adverse childhood experience (ACE) measures include a limited number of household dysfunction (HD) items and the use of adult-oriented language that is not always appropriate for middle schoolers. We developed an age-appropriate 10-item HD measure informed by previously validated ACE measures and tested its concurrent validity with dating violence (DV) perpetration, lifetime substance use, and mental health outcomes among middle schoolers in Southeast Texas. This cross-sectional study used the baseline data from a DV prevention intervention program for sixth graders (N = 126), Me & You Tech. Baseline data were collected from March 2023 to April 2023. To …
Optimizing Psychiatric Care Through Pharmacogenomics: An Evidence-Based Program To Increase Multi-Gene Pharmacogenomic Testing And Provider Competence In Mental Health Settings, Marc Boulanger
Doctor of Nursing Practice Final Manuscripts
Objective: This scholarly project aimed to enhance psychiatric providers' competency, confidence, and knowledge in the PHASER pharmacogenomic (PGx) testing program at the VA San Diego Healthcare System.
Background: PGx testing enhances psychiatric care by enabling precise medication management tailored to a patient’s genetic profile, improving treatment effectiveness and reducing adverse drug reactions. Despite demonstrated clinical utility, adoption of PGx remains limited due to provider knowledge gaps. This project addresses these gaps through targeted education.
Methods: Two educational modules, developed with input from the PHASER site-lead, aimed to enhance provider knowledge and confidence in PGx. Module one introduced the PHASER program …
Nurse-Led Medication Reconciliation Protocol In The Adult Outpatient Mental Health Setting, Grace Gu
Nurse-Led Medication Reconciliation Protocol In The Adult Outpatient Mental Health Setting, Grace Gu
Doctor of Nursing Practice Final Project Abstract
This scholarly project implemented a medication reconciliation protocol within the adult outpatient mental health clinic setting. The protocol aimed to increase the medication reconciliation rate from 55% to 60% within three months by May 2025, as well as improve the perception of medication reconciliation among nursing staff. The project was implemented within an outpatient mental health clinic, part of a local community mental health center in Austin, Texas. Patients often see multiple healthcare providers, leading to risks of polypharmacy. This can lead to adverse reactions, medication interactions, and hospitalizations. A flowsheet protocol was created to help guide nursing staff on …
Staff Education To Improve Patient Outcomes And Treatment Compliance Through Use Of Motivational Interviewing In The Mental Health Setting, Rachel Nardi
Walden Dissertations and Doctoral Studies
Summary: Treatment noncompliance is a significant problem within the realm of mental health care. Recurrent noncompliance increases symptom severity, the likelihood of a crisis, and the burden placed on mental health care resources. Motivational interviewing (MI) is an evidence-based practice (EBP) demonstrated through extensive research to positively affect patient outcomes. Teaching MI to mental health care providers is one option organizational leaders can choose to address treatment noncompliance. In order for MI to become standard nursing practice, a method of education must be developed and implemented. This necessitates the identification of effective education delivery methods. A staff education project was …
The Cost Of Accommodative Burdens: Prevalence & Impact On Deaf And Hard Of Hearing Individuals, Lorelei Becktel
The Cost Of Accommodative Burdens: Prevalence & Impact On Deaf And Hard Of Hearing Individuals, Lorelei Becktel
Undergraduate University Honors Capstones
This exploratory qualitative study (n=8) investigated the mental health effects of lack of reciprocity in accommodation and the resulting accommodative burden on deaf and hard of hearing individuals. Lack of reciprocity occurs when the split of the burden for communication accommodations falls significantly more on the deaf or hard of hearing individual. The resulting accommodative burden occurs when deaf and hard of hearing individuals adapt to make communication easier for hearing people at a level that is uncomfortable, unwanted, and/or detrimental to their needs. Effects, determined by participant responses, were examined via semi-structured interviews and analyzed via thematic analysis. Relationships …
A Description Of Mental Health Policies In Ohio Secondary Schools, Laura L. Harris, Molly Rowe
A Description Of Mental Health Policies In Ohio Secondary Schools, Laura L. Harris, Molly Rowe
Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association
OBJECTIVE To compare secondary school mental health policies implemented for the student body with those implemented for student athletes.
Evaluating Scheduling Tool To Improve Behavioral Health Counseling Scheduling Rates On Same Day Of Referral, Edward Delesky, Md, Oluwatoni Okuboyejo, Md, Elizabeth Franko, Md, Nwamaka Amobi, Md, Ronak Ahir, Md
Evaluating Scheduling Tool To Improve Behavioral Health Counseling Scheduling Rates On Same Day Of Referral, Edward Delesky, Md, Oluwatoni Okuboyejo, Md, Elizabeth Franko, Md, Nwamaka Amobi, Md, Ronak Ahir, Md
Health Equity and Quality Improvement (HEQI) Summit
Background
- Studies suggest 1 in 5 adults in the US suffer from mental illness, with up to 46% of Philadelphia residents reporting poor mental health.
- Care integration beginning with primary care physician evaluation and management is becoming more common.
- Behavioral health counseling (BHC), provided by a primary physician and trained psychologist, is vital in management of mental health conditions.
- Studies suggest same-day scheduling of follow up appointments improves treatment adherence.
- Goal: improve BHC scheduling rates on same-day of initial referral across two practice teams
Improving The Quality Of Veteran Health Care By Optimizing Va Integrated Primary Care: 20 Years And Beyond Of The Center For Integrated Healthcare, Jennifer S. Funderburk, Robyn Shepardson, Gregory Beehler, Kyle Possemato, Kristen Perry, Christina Shook, Jessica Martin, Katherine Dollar
Improving The Quality Of Veteran Health Care By Optimizing Va Integrated Primary Care: 20 Years And Beyond Of The Center For Integrated Healthcare, Jennifer S. Funderburk, Robyn Shepardson, Gregory Beehler, Kyle Possemato, Kristen Perry, Christina Shook, Jessica Martin, Katherine Dollar
The Journal of Integrated Primary Care
Primary care patients often present with mental and behavioral health concerns, such as depression or insomnia, leaving medical teams scrambling. To help fill this gap and increase access to care while aligning with patient preferences, a new service delivery model of integrated care, characterized by embedding behavioral health providers within medical teams, was embraced in a grassroots effort, with the VA being one of the first healthcare systems to implement it throughout all primary care settings. A common challenge to grassroot efforts is the lack of research establishing effectiveness and identifying ways to optimize the innovation’s impact. Innovative VA leaders …
Empowering Schools: Suicide Prevention Education For School Nurses, Navjot K. Singh
Empowering Schools: Suicide Prevention Education For School Nurses, Navjot K. Singh
Doctor of Nursing Practice (DNP) Projects
Background: Suicide among adolescents and youth is a serious public health issue that requires immediate intervention to reduce ideation and death. The increasing rate of suicide among children and adolescents has a profound effect on families, friends, and the community.
Problem: Suicide among school aged children and adolescents can create significant challenges for school nurses, who are often the first contact for students who recognize suicidal ideation and mental health crises. This issue is particularly significant for the Alameda school nurses in California, as they play a significant role in identifying and supporting students in a crisis.
Methods: A …
Burnout And Self-Efficacy: Exploring The Rewards And Challenges Faced By Crisis Counselors Working In Emergency Department Settings, Ellen Dotas
Dissertations, 2020-current
This dissertation explores burnout and self-efficacy in counselors who work with clients in crisis in emergency department settings. Mental health and emergency departments are two areas that tend to report higher levels of burnout than are reported in other occupational fields. While much research has been done on the topics of burnout and self-efficacy, limited information is available about counselors who work in these crisis roles. This dissertation follows a three-manuscript format and includes a conceptual, qualitative, and quantitative manuscript. The conceptual manuscript explores the nature of the crisis assessment itself, focusing on the area of risk assessment. The qualitative …
Exploring The Relationship Between Diet And Mental Health, Emory Layne
Exploring The Relationship Between Diet And Mental Health, Emory Layne
Honors Theses
Dietary patterns in Western societies have shifted over the past century due to the rise of food manufacturing and technological advancements. Ultra-processed foods now account for approximately half of the daily energy intake in high-income countries. Similarly, the national mental health crisis emerged in the 21st century and worsened after the COVID-19 pandemic. The changes in diet have impacted the gut microbiome, which interacts with the brain through the bidirectional gut-brain axis. Research suggests the concept of the gut-brain axis is a principal indicator of diet’s impact on mental health. However, this area of research is still emerging and requires …
The Impact Of The Mediterranean Diet On Depression: A Narrative Review, Emma Kate Schaaf
The Impact Of The Mediterranean Diet On Depression: A Narrative Review, Emma Kate Schaaf
Honors Theses
Background. The Western diet has extensive negative ramifications on physical health and emotional well-being. The Mediterranean diet, widely regarded as one of the healthiest eating patterns in the world, may have the ability to improve psychological conditions. This study aims to examine existing research from randomized control trials (RCTs) on the association between depression prevalence and the Mediterranean diet.
Methods. The following review was conducted using PRISMA guidelines and the Google Scholar and PsycInfo databases. The criteria for inclusion were that studies: 1) were randomized control trials (RCTs) examining the Mediterranean diet; 2) included samples of adults (i.e., > 18 years …
Policy To Decrease Attrition Rates Amongst Mental Health Nurses, Ashley E. Burnett
Policy To Decrease Attrition Rates Amongst Mental Health Nurses, Ashley E. Burnett
Doctor of Nursing Practice Final Project Abstract
The high attrition rate among mental health nurses in the United States presents a critical challenge, leading to increased operational costs, workforce shortages, and compromised patient care. This policy proposal seeks to address the issue of mental health nurse turnover by offering a structured approach to enhancing job contentment and dealing with stress factors within the workplace. In line with the purpose of the study, quantitative and qualitative data from workforce surveys, peer-reviewed literature, and policy evaluations are combined to determine common retention strategies. Findings indicate that mentorship programs, competitive salaries, flexible scheduling, and workplace support systems significantly reduce burnout …
Exploring The Relationship Between Disability And Stress: A Preliminary Study, Katie Mcclyman
Exploring The Relationship Between Disability And Stress: A Preliminary Study, Katie Mcclyman
Undergraduate University Honors Capstones
Mental health issues can become disabling, and living with a disability in an ableist world can cause mental health struggles. This project explores what aspects of living with a disability generate stress. This project is a survey that gathered data through a two-questionnaire survey of disabled college-aged students. The need for a project like this came from the fact that there is not substantial research from the field of psychology done on disabled people and the relationship between disability and stress. The results of this study found that the more disability impact increases, so does disability related stress. This means …
Podcasts In Mental, Physical, Or Combined Health Interventions For Adults: Scoping Review, Elizabeth M. Dascombe, Philip J. Morgan, Ryan J. Drew, Casey P. Regan, Gabrielle Turner-Mcgrievy, Myles D. Young
Podcasts In Mental, Physical, Or Combined Health Interventions For Adults: Scoping Review, Elizabeth M. Dascombe, Philip J. Morgan, Ryan J. Drew, Casey P. Regan, Gabrielle Turner-Mcgrievy, Myles D. Young
Faculty Publications
Background:
The increasing prevalence of poor mental and physical health in adults is a global health concern. Given the scope of this problem, scalable and effective treatment interventions are needed. While podcasts (online digital audio files) are becoming more popular, the extent of podcast use in mental, physical, or combined health interventions has not been reviewed.
Objective:
This scoping review primarily aims to summarize the available evidence regarding the use of podcasts in health promotion interventions. A series of 5 research questions was designed to systematically review and accurately represent podcast use in current research interventions.
Methods:
We conducted a …
Lawyers, Trauma, And Professional Well-Being: How The Legal Community Takes Back Its Mental Health, Brenda D. Gibson
Lawyers, Trauma, And Professional Well-Being: How The Legal Community Takes Back Its Mental Health, Brenda D. Gibson
Arkansas Law Review
Accompanying a notable shift in the legal academy to being more attentive to our students’ mental health, there must be an equal (or even greater) shift to focusing on trauma, mental health, and well-being in the broader profession. Significantly, trauma and its effects are compounded when combined with the challenges faced by underrepresented populations within the profession. To date, these challenges have been greeted by an ad hoc, piecemeal reaction to stress and trauma,10 which only inhibits wellness in the profession. Part I explores the current literature in both the humanities and the legal profession, beginning with a brief discussion …
Neighborhood Change As A Social Determinant Of Health: Assessing Associations With Mental Health And Psychosocial Attitudes Among Resident Clusters, Christopher Williams, Nathaniel Woodard, Charlene Kuo
Neighborhood Change As A Social Determinant Of Health: Assessing Associations With Mental Health And Psychosocial Attitudes Among Resident Clusters, Christopher Williams, Nathaniel Woodard, Charlene Kuo
Advances in Clinical Medical Research and Healthcare Delivery
Neighborhood change (NC) can be understood as a social determinant of health with direct psychosocial and economic impacts. Our objective was to define resident groups’ perceptions of NC and self-rated mental health in a community experiencing an intense form of NC known as gentrification. We conducted a cross-sectional study using random and convenience sampling. Our measures included a combination of scales and indexes that were used for conducting bivariate and cluster analyses. Our study included 143 responses from Phase II. Two of the three groups or clusters were statistically different in mental health and perceptions of NC impacts on community …
The Impact Of Maternal Mental Health On Child Development, Jessica White
The Impact Of Maternal Mental Health On Child Development, Jessica White
Nursing | Student Research Posters
No abstract provided.
Eos Wellness Center: Rethinking Inpatient Mental Health Facility Design, Emily Simms
Eos Wellness Center: Rethinking Inpatient Mental Health Facility Design, Emily Simms
Bachelor of Architecture Theses - 5th Year
The design of mental health facilities significantly impacts patient outcomes, especially for individuals with depression. Environmental factors such as lighting, thermal comfort, and access to nature influence mental health. This research explores how architectural design can reduce self-harm incidents and enhance recovery outcomes for patients with depression. The project hypothesizes that synchronizing light patterns and thermal comfort with patients’ circadian rhythms will reduce self-harm incidents and improve recovery. The problem established in the research is that disruptions to circadian rhythms increase the risk of depression, PTSD, and anxiety by 30% (Burns et al., 2022). Suicide is also the second leading …
An Educational Intervention: Knowledge Acquisition Of Perimenopausal Mental Health Symptoms And Treatment Options For Women Aged 35 Years Plus, Allison M. Hopps
An Educational Intervention: Knowledge Acquisition Of Perimenopausal Mental Health Symptoms And Treatment Options For Women Aged 35 Years Plus, Allison M. Hopps
Doctor of Nursing Practice Scholarly Projects
Perimenopause is a span of four to six years preceding menopause when estrogen levels decline. Up to 40% of women experience depression during the perimenopause transition. Hormone replacement therapy (HRT) can be an effective treatment for depressive symptoms during perimenopause, but many healthcare practitioners prescribe antidepressants instead of HRT for the management of mood-related symptoms. Perimenopausal depression is associated with the progression of chronic conditions such as cardiovascular disease, diabetes, and dyslipidemia. The general population, including women and healthcare providers, lacks the education and awareness surrounding perimenopause symptoms and treatment. This project educated women between ages 35 to 55 on …