Medicine and Health Sciences Commons^™

Surface Keratin 1, A Tumor-Selective Peptide Target In Human Triple-Negative Breast Cancer, Shih-Jing Yao, Farideh Amirrad, Elmira Ziaei, Azam Saghaeidehkordi, Moom R. Roosan, Kiumars Shamloo, Ajay Sharma, Rachita K. Sumbria, Surya M. Nauli, Christopher G. Bunick, Kamaljit Kaur

Pharmacy Faculty Articles and Research

Targeting drugs to cancer cells via overexpressed cell-surface receptors has emerged as an effective therapeutic strategy for several cancers. However, identifying cell-surface receptors that allow selective uptake of targeting ligands by cancer cells—while sparing normal cells—remains a challenge, especially for triple-negative breast cancer (TNBC), which lacks a well-defined receptor for targeted delivery. In this study, immunohistochemical (IHC) analysis revealed that human TNBC patient tissues have significantly higher levels of keratin 1 (K1) compared to normal breast tissues. Among TNBC tissues, grade 3 tumors showed significantly higher (threefold) K1 expression compared to grade 2 tumors. We analyzed human TNBC and normal …

Teaching Pathographies Of Mental Illness, Nathan Carlin, Angela Gomez, Margarita Ortiz

Faculty and Staff Publications

This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin's Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the difference that can make.

Understanding Rural Schools’ Capacity To Learn About Evidence-Based Practices That Promote Youth Mental Health: A Comparative Case Study, Savannah Hobbs, Elaine S. Belansky, Nick Cutforth, Cynthia Hazel

The Rural Educator

Amid growing student mental health concerns, numerous evidence-based practices (EBPs) exist to promote student mental health, but most rural schools do not have these practices in place. Little is known about the organizational capacity of rural schools to learn about and select youth mental health EBPs, or the role research intermediaries can play to support these processes. In this study, 11 middle school staff from three rural school districts participated in surveys and semi-structured interviews to provide information on how schools learn about and select mental health EBPs, related barriers and facilitators, and the role of intermediary support. A semi-structured …

Alfred Russel Wallace Notes 37. What About Wallace On Vaccination . . . ?, Charles H. Smith

Faculty/Staff Personal Papers

Best known for his natural history studies on evolution and biogeography, Alfred Russel Wallace (1823−1913) had a significant second career as a social critic. One of his most controversial stances was his position on (smallpox) vaccination. Anti-vaxxers of the present frequently bring up his name as a resource for their side, but the situation is not so easily reducible to that.

Nsu Kpcom Link - Summer 2025 - Volume 4.2, Nova Southeastern University

NSU Florida Link Newsletter

No abstract provided.

A Case Report Of Disseminated Intravascular Coagulation After Intrauterine Fetal Demise., Gabrielle A Agcaoili, Kyriaki V Schooley, Elizabeth Johnson-Gray, Vincent Relli-Dempsey, Greeshma Allareddy

Women’s Health Articles

Disseminated intravascular coagulation (DIC) is a rare, life-threatening complication of pregnancy in which a hypercoagulable state develops secondary to the contact of tissue factor with circulating blood and causes widespread abnormal clotting. This pathological process disrupts normal blood flow, which can cause multi-organ dysfunction and is associated with very high maternal morbidity and mortality. Occurring in two phases, DIC begins with overactive clotting, which leads to the formation of blood clots within the vessels, and ultimately, the overactive clotting process uses up the body's stores of platelets and clotting factors. The most common obstetric cause of DIC is placental abruption, …

The Formation Mechanism Of Irrational Online Comments From The Perspective Of Dual Systems Theory, Xuefen Wang, Lei Guo, Liyan Chang, Zejiao Jiang

Journal of Scientific Information Research

[Purpose/significance] To explore the internal formation mechanism of unplanned irrational online comments is of great significance to promote the governance of cyberspace and the control of user behavior.

[Method/process] Based on the dual-system theory, the study constructed a model for the formation mechanism of irrational online comments, and revealed how online disinhibition and the spiral of silence affect individual internal states to stimulate irrational comments through empirical analysis.

[Result/conclusion] Research reveals that: compared to mild irrational comments, aggressive irrational comments are more likely to be unplanned behaviors, the cognitive-emotional preoccupation with online comments is the main driving factor for irrational …

A Link Prediction Model For Knowledge Graph Completion Of Traditional Chinese Medicine Cases, Qifeng Lou, Dongmei Mu, Shutong Wang, Lili Huang

Journal of Scientific Information Research

[Purpose/significance] To propose a link prediction model for completing the knowledge graph of Chinese medicine cases, aiming to fill in the missing information in the knowledge graph,reveal the potential unknown associations,and promote the construction of a more comprehensive and detailed knowledge graph of Chinese medicine cases.

[Method/process] Medical cases in the field of TCM asthma were collected and integrated to construct a knowledge graph of TCM asthma diagnosis and treatment. By introducing Dropout regularization and Batch Normalization techniques into the RotatE model, an improved ERDBN model is proposed and applied to the task of refining the asthma diagnosis and treatment …

Evaluating The Predictive Value Of Basc-3 Anxiety Scale And Working Memory Index Scores For Clinically Significant Test Anxiety: A Comprehensive Analysis Of Non-Classifiable Cases, Des'tiana S. Williams

Electronic Theses and Dissertations

This dissertation will explore how test anxiety (TA) affects working memory (WM) and whether certain factors can help predict higher levels of test anxiety. Anxiety has been defined as a common experience that can show up in various forms—like general worry, social fears, panic attacks, and specific phobias (APA, 2022). It was described as often triggering our natural “fight-or-flight” response, which can impact our ability to focus, think clearly, and remember things. For students, test anxiety has been especially challenging, affecting how they perform in high-stakes academic settings. Using data from a university based psychological assessment center, this study will …

Issue 14: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 14

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health.

Topics: Original Study Summaries: stereotactic body radiotherapy, surveillance over surgery for small pulmonary subsolid nodules, EBUS-TBNA sample acquisition and handling, Systolic arterial pressure targets in shock, stroke risk after AF, methotrexate versus prednisone, corticosteroid use in community-acquired …

Utilizing Pharmacogenomics To Improve Students' Self-Perception On The Interprofessional Competencies Of Roles And Responsibilities, And Teams And Teamwork, Amanda Brown, Moom R. Roosan, Robert Goldsteen, Scott D. Ochs, Reza Taheri

Pharmacy Faculty Articles and Research

Introduction

Pharmacogenomics (PGx) is an emerging discipline with the potential to revolutionize personalized medicine, but its successful implementation requires interprofessional collaboration. To address this need, a virtual interprofessional education (IPE) session was designed for student pharmacists and medical students to engage in a case-based learning experience.

Objective

The primary objective was to develop and implement an IPE activity focused on a patient case requiring PGx-guided dual antiplatelet therapy and to assess students' perceptions of two Interprofessional Education Collaborative (IPEC) Version 3 Core Competencies. A secondary objective was to identify key lessons from the session.

Methods

Pharmacist and physician faculty collaboratively …

Recruitment And Retention Of Intensive Care Unit Survivors In Follow-Up Studies: A Systematic Review, Beverley Ewens, Vivien Kemp, Yvonne Middlewick, Amanda Towell-Barnard, Lisa Whitehead

Research outputs 2022 to 2026

Background: Engaging intensive care unit survivors in research is challenging. Studies have reported recruitment and attrition rates; details are lacking on retention strategies and attrition. Objective: The aim of this study was to explore barriers and enablers to recruitment and retention in research of people post intensive care discharge. Methods: A convergent mixed-method review using the Joanna Briggs Institute (JBI) methodology considered studies that reported on recruitment, retention, and attrition rates of adult post–intensive care survivors in longitudinal studies. CINAHL Ultimate (CINAHL+), PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Scopus, Proquest Health, and Medical Collection were searched in March 2024 using …

The Effect Of Oral Colchicine And Vitamin K1 On Bone Metabolism In Patients With Diabetes Mellitus: A Post-Hoc Analysis Of A 2 × 2 Factorial Randomized Controlled Trial With 18F-Sodium Fluoride Positron Emission Tomography, Jamie W. Bellinge, Marc Sim, Roslyn J. Francis, Sing Ching Lee, Dick C. Chan, Christian M. Girgis, Gerald F. Watts, Joshua R. Lewis, Carl J. Schultz

Research outputs 2022 to 2026

Purpose: Diabetes mellitus (DM) confers an increased risk of fracture. Fracture risk stratification techniques are imperfect, and preventative therapies are sparse. We aimed to describe features associated with a dysfunctional bone metabolism determined by 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) in patients with DM and test the effects of vitamin K1 and colchicine therapy on vertebral 18F-NaF activity. Methods: This is a post-hoc analysis of a 2 × 2 factorial randomized double-blind placebo-controlled trial. Participants aged 50–80 with DM underwent 18F-NaF PET/CT imaging at baseline, 3 months of therapy with vitamin K1 (10mg/daily) or placebo, and colchicine (0.5 mg/day) …

A Perspective Or Review Based Entirely On Low-Quality Evidence Is Simply An Opinion, Matthew S. Tenan, Sophia Nimphius

Research outputs 2022 to 2026

No abstract provided.

Navigating Child Oral Health In Western Australia: A Caregiver's Perspective, Lesley Andrew, Elizabeth Wenden, Mohamed Estai, Ruth Wallace

Research outputs 2022 to 2026

Background: Early childhood caries (ECC) is the most common chronic health condition among Australian preschool-aged children. Untreated, ECC can affect children's physical and emotional health and future social opportunities. ECC is largely preventable through primary caregivers' correct understanding of oral health promoting diets, oral hygiene practices and dental service engagement. The study aim is to explore Western Australian (WA) primary caregivers' child oral health knowledge, experience and practices. The Fisher-Owens socioecological model of child oral health was applied across the study to structure and interpret the findings across the complex, interactive sociocultural influences on child oral health. Methods: The mixed-methods …

Understanding Perceptions, Attitudes And Experiences Of Nursing Students During Clinical Placement In Primary Health Care Settings – A Scoping Review, Debbie Procter, Kylie Mccullough, Debbie Massey, Karen Strickland

Research outputs 2022 to 2026

Aims: Critically analyse literature on undergraduate nursing students' perceptions, attitudes and experiences during Primary Health Care (PHC) placements and identify factors influencing their satisfaction. These insights may improve educational outcomes, shape career intentions and address workforce shortages. Background: Global nursing shortage, driven by increased demands and high attrition, impacts healthcare worldwide. Australia faces projected shortfalls of 79,473 nurses by 2035, significantly in PHC. Attributing factors include remuneration disparities, inadequate training/mentorship and limited career pathways. Strengthening the PHC nursing workforce is crucial, with undergraduate nursing students providing an important workforce pipeline. Design/Method: Scoping Review protocol was registered using Joanna Briggs Institute's …

Translating Advocacy Into Action: Exploring Oncology Healthcare Professionals’ Awareness And Use Of The Clinical Oncology Society Of Australia Position Statement On Exercise In Cancer Care, Jack Dalla Via, Francesca Cehic, Carolyn J. Peddle-Mcintyre, Christopher R. Andrew, David Mizrahi, Yvonne Zissiadis, Nigel A. Spry, Robert U. Newton, Mary A. Kennedy

Research outputs 2022 to 2026

Purpose: The Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care encourages all healthcare professionals to discuss, recommend, and refer people with cancer to exercise; however, use of these recommendations in practice is unknown. Methods: Oncology healthcare professionals working in Australia were invited to complete a cross-sectional online survey that assessed contextual factors that influence implementation of COSA exercise guidance in cancer care, based on the Consolidated Framework for Implementation Research. Results: We received 133 survey responses. Most were women (74%), nurses (35%), or oncologists (26%), involved in cancer care for > 10 years (63%), and in …

A Cross-Sectional Examination Of Missed Infection Control Practices Among Nurses In The Jordanian Hospitals, Muhammad Ahmed Alshyyab, Rania Ali Albsoul, Gerard Fitzgerald, Diana Arabiat

Research outputs 2022 to 2026

Background: Missed infection control practices may negatively impact quality healthcare and patient safety in acute health care settings. Hence, more research is urgently needed especially in Arab countries. To investigate the elements and reasons of missed infection control activities among nurses in Jordan. The sociodemographic correlates with missed infection control activities were also examined. Methods: A cross sectional design was utilized in this study. A convenience sample of 960 nurses from seven hospitals in the North of Jordan was used. The Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey was employed to collect the data. Data were analyzed using …

Exercise Effects On Symptoms Of Depression And Anxiety Vary By Patient, Clinical, And Intervention Characteristics In Cancer Survivors: Results From Pooled Analyses Of Individual Participant Data Of 26 Rcts, Marlou Floor Kenkhuis, Meike Doorenbos, Isa H. Mast, Neil K. Aaronson, Marc Van Beurden, Martin Bohus, Kerry S. Courneya, Amanda J. Daley, Daniel A. Galvão, Martine M. Goedendorp, Wim H. Van Harten, Sandi C. Hayes, Anouk E. Hiensch, Melinda L. Irwin, Marie José Kersten, Hans Knoop, Anne M. May, Alex Mcconnachie, Willem Van Mechelen, Nanette Mutrie, Robert U. Newton, Frans Nollet, Hester S. Oldenburg, Martina E. Schmidt, Kathryn H. Schmitz, Karl Heinz Schulz, Dennis R. Taaffe

Research outputs 2022 to 2026

Purpose: This study aimed to investigate whether socio-demographic, clinical, and intervention-related variables moderate the effects of exercise on depression and anxiety symptoms in cancer survivors. Methods: Data from 26 RCTs in the POLARIS database were analyzed using a one-step individual participant data (IPD) meta-analytic approach with linear mixed models to assess exercise effects on depression and anxiety symptoms (z-scores). Interaction terms were added to these models to explore moderators. Results are presented as betas (corresponding to Cohen’s d effect size). Results: Albeit statistically significant, exercise demonstrated negligible effects on symptoms of depression (β = − 0.11; 95% CI = − …

Foundations And Strategic Vision Of The Canadian Translational Geroscience Network, Guy Hajj-Boutros, Andréa Faust, John Muscedere, Perry Kim, Gilles Gouspillou, Lea Harrington, James L. Kirkland, George A. Kuchel, Jeremy Van Raamsdonk, R. Jane Rylett, Chantal Autexier, Louis R. Lapierre, Michael Kobor, Mohammad Auais, Ann Beliën, Jeroen Aerssens, George Sutphin, Kenneth Rockwood, Alexandra Papaioannou, Marc Sim, Jamie Justice, Nancy Mayo, Gustavo Duque

Research outputs 2022 to 2026

Geroscience is an emerging interdisciplinary field that explores the biological connections between aging and the development of chronic diseases, with the ultimate goal of identifying interventions to extend healthspan and delay age-related conditions. Recognizing the growing importance of this field, the Canadian Translational Geroscience Network (geroscience.ca) was officially launched during a conference held in Montreal on September 5-6, 2024. Building on the momentum of successful Geroscience meetings in Toronto and Montreal in 2023, this milestone event marked a transformative step forward for geroscience in Canada. This event brought together key stakeholders, including the Canadian Frailty Network (CFN), the Canadian Institutes …

Models Of Care For Indigenous Children In Rural And Remote Settings: A Global Scoping Review, Joseph Freeman, Thomas Stubbs, Verity Chadwick, Anita Pickard, Tuguy Esgin, Elizabeth J. Elliott, Alexandra Martiniuk

Research outputs 2022 to 2026

Indigenous communities internationally have demonstrated remarkable strength despite significant challenges. Health disparities among Indigenous peoples persist due to historical injustices and ongoing racial discrimination, not inherent vulnerabilities. Disparities are rooted in a legacy of colonisation, systemic exclusion, and socio-economic inequities impacting access to healthcare, education, and employment. Preliminary searches show limited literature on models of care for remote living Indigenous children. This review aimed to identify internationally, effective models of care for Indigenous children in rural and remote areas. A scoping review was conducted, analysing literature on models of care for remote Indigenous children. This study followed the JBI’s Scoping …

Rural Cancer Survivors' Perceived Delays In Seeking Medical Attention, Diagnosis And Treatment: Findings From A Large Qualitative Study, Alyssa Taglieri-Sclocchi, Ingrid Bindicsova, Susannah K. Ayre, Michael Ireland, Sonja March, Fiona Crawford-Williams, Suzanne Chambers, Jeff Dunn, Belinda C. Goodwin, Elizabeth A. Johnston

Research outputs 2022 to 2026

Aims: To investigate rural cancer survivors' self-reported reasons for perceived delays in initial cancer detection and treatment. Methods: Within a cohort study, adult cancer survivors who had travelled > 50 km for cancer care, staying at subsidised accommodation lodges in city centres in Queensland, Australia, were invited to complete a structured interview on perceived delays in: (i) seeking medical attention, (ii) receiving their diagnosis and (iii) commencing treatment. Content analysis was used to map self-reported reasons for perceived delays at each step, which were then categorised based on the perceived source: (i) personal, (ii) healthcare professional, (iii) healthcare system or (iv) …

The Therapeutic Potential Of Butyrate And Lauric Acid In Modulating Glial And Neuronal Activity In Alzheimer’S Disease, Rathnayaka Mudiyanselage Uththara Sachinthanie Senarath, Lotta E. Oikari, Prashant Bharadwaj, Vijay Jayasena, Ralph N. Martins, Wanakulasuriya Mary Ann Dipika Binosha Fernando

Research outputs 2022 to 2026

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder marked by amyloid-β plaque accumulation, tau tangles, and extensive neuroinflammation. Neuroinflammation, driven by glial cells like microglia and astrocytes, plays a critical role in AD progression. Initially, these cells provide protective functions, such as debris clearance and neurotrophic support. However, as AD progresses, chronic activation of these cells exacerbates inflammation, contributing to synaptic dysfunction, neuronal loss, and cognitive decline. Microglia release pro-inflammatory cytokines and reactive oxygen species (ROS), while astrocytes undergo reactive astrogliosis, further impairing neuronal health. This maladaptive response from glial cells significantly accelerates disease pathology. Current AD treatments primarily aim …

A Child With Severe Pneumonia Cannot Feed, Causing Malnutrition: Exploring Health Worker And Caregiver Perspectives And Practices For Mitigating Malnutrition Among Children With Severe Pneumonia, A Case Of Uganda, Damalie Nalwanga, Robert Opoka, Andrew Sentoogo Ssemata, Lawrence Kakooza, Andrew Kiggwe, Victor Musiime, Sarah Kiguli

Paediatrics and Child Health, East Africa

Background: Severe pneumonia remains the leading cause of morbidity and mortality among children worldwide. Severe pneumonia causes death during hospitalization, and survivors are prone to malnutrition after discharge from the hospital. The World Health Organization and United Nations International Children’s Fund recommend ‘continued’ feeding following a severe pneumonia illness without specific recommendations on nutritional support. This recommendation could influence health workers’ and caregivers’ nutritional practices. This study aimed to explore the perspectives and practices of health workers and caregivers for mitigating malnutrition among children with severe pneumonia.

Methods: We conducted a cross-sectional qualitative study between June and November 2021 among …

Investment In Family Medicine To Improve Health Outcomes In Sub-Saharan Africa, Sunanda C. Ray, Mpundu Makasa, Innocent Besigye, Jacob Shabani, Martha Makwero

Family Medicine, East Africa

Family physicians (FPs), as educators, capacity builders and clinical governance leaders of primary care (PC) teams, work to make them more effective and responsive to the needs of their patients. Various strategies are required to raise the profile of Family Medicine (FM) to ensure stronger representation in health sector planning and policy development for advocacy on behalf of the communities they serve. An illustration is given of the need for FP leaders to become equal partners in the National Surgical, Obstetric and Anaesthesia Planning process to ensure safer surgery at district hospitals and to address unmet surgical needs. Integrating FM …

Sociodemographic Influences On Substance Use In Psychosis In An African Cohort, Megan L. Campbell, Raymond Odokonyero, Dickens Akena, Melkam Alemayehu, Lukoye Atwoli, Lori B. Chibnik, Bizu Gelaye, Stella Gichuru, Symon M. Kariuki, Karestan C. Koenen

Internal Medicine, East Africa

Background: Substance use is common among individuals with psychotic disorders, but limited research exists on the variations in substance use across countries in Africa. This study aims to investigate the frequency of alcohol, tobacco, cannabis, and khat consumption in individuals with bipolar disorder (BD) and schizophrenia (SCZ) across four African countries: South Africa, Ethiopia, Kenya, and Uganda.

Methods: We utilized data from the Neuropsychiatric Genetics of African Populations-Psychosis project, a large case-control study which will soon have genetic data on over 42,000 participants, half with psychosis. Information on substance use was collected using the Alcohol, Smoking and Substance Involvement Screening …

Creating Space For Social Justice Discussions – How We Made The Uncomfortable Comfortable, Emilie Keeton, Msod, Jacqueline Hill, Bridgette Jones

Presentations

Current models of graduate medical education and faculty development have been described as inadequate for teaching, learning, and dialoguing about race and racism in medicine. We created the “Not-So Journal Club” (NSJC) to provide opportunities to review articles and discuss current events and social justice issues. Respondents reported planning to discuss with colleagues, make change to professional behaviors, and requested actions they could take to spur change. NSJC model appears to be effective to engage faculty in meaningful conversations about race and racism in medicine.

Telogen Effluvium And Anesthesia Considerations: A Case Report., Elizabeth Johnson-Gray, Samantha A Currier, Hanen Fernandez, Matt Brown, Matthias Franzen

Ambulatory and Primary Care Articles

Telogen effluvium is a form of non-scarring hair loss characterized by premature shedding of hair. Pathophysiologically, telogen effluvium occurs when a significant number of hair follicles prematurely enter the telogen phase, resulting in excessive shedding. The exact mechanism is unclear, but it is believed to involve alterations in the hair follicle's growth cycle, possibly mediated by illness, infection, major surgery, low protein intake, or hormonal changes. Some medications can also be linked to this disease, such as beta blockers, carbamazepine, and vitamin A. When affected hairs are in the resting phase, noticeable hair shedding occurs. Our patient was a 61-year-old …

Cardiovascular Manifestations Of Pseudoxanthoma Elasticum., Aimee Willett, Vivek V Jasti, Sean M Muir, Jay Anderson

Ambulatory and Primary Care Articles

Pseudoxanthoma elasticum (PXE) is a rare systemic disorder of elastic fibers. The most common manifestations include characteristic papules and ocular angioid streaks. Cardiovascular complications include peripheral arterial disease, hypertension, premature coronary artery disease, and cerebrovascular disease. These associations are secondary to dystrophic elastic fibers, resulting in the calcification of small- to medium-sized arteries. We present the case of a 22-year-old otherwise healthy female patient diagnosed with PXE following a biopsy of a neck lesion. Ophthalmologic evaluation revealed characteristic angioid streaks. The patient also reported early satiety and leg cramping, which prompted referral to gastroenterology and cardiology. Further investigation raised concern …

A Descriptive Bibliometric Study Of Cera Publication Dissemination, Authorship, And Citation Rates., Bryce A Ringwald, Jennifer L Middleton

Medical Education Articles

BACKGROUND AND OBJECTIVES: Barriers to performing family medicine research include funding, infrastructure, and mentorship shortages. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created in 2011 to address these issues. This study explores the scope and impact of CERA-related publications in family medicine.

METHODS: We performed a descriptive bibliometric study of CERA-related publications from 2011 to 2023. Articles were sourced from Medline (PubMed), SCOPUS, and the CERA website. Data analysis focused on publication type, authors, CERA survey type, and citation rates.

RESULTS: From a total of 231 articles retrieved via initial searches and 166 from the CERA …