Medicine and Health Sciences Commons^™

When The Therapist Is An Algorithm: Understanding Autism Spectrum Students’ Acceptance Of Generative Ai As A Mental Well-Being Tool Through The Technological Acceptance Model, Jossy P. George, Peter Muttungal, Benny Jeyekumar Davidson, Nishi Priya

Northeast Journal of Complex Systems (NEJCS)

This study examines the psychological and technological factors of the acceptance and emotional well-being of 349 college students with autism who use generative artificial intelligence tools as sources of psychological and emotional support. Grounded on the model of Technology Acceptance Model (TAM), the research studies relationships among perceived empathy, perceived usefulness, ease of use, emotional trust, continuance intention, and overall well-being. Structural equation modelling found that the perceived empathy was a significant predictor of ease of use and usefulness, while emotional trust and continuance intention proved to be significant predictors of emotional well-being. To reinforce these results, predictive modelling performed …

Cognitive Predictors Of Functional Recovery After Traumatic Brain Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

This study examined whether the Brief Test of Adult Cognition by Telephone (BTACT), administered during acute rehabilitation, improved the prediction of 5-year functional outcomes after traumatic brain injury (TBI) beyond standard demographic and injury-severity variables. Data were obtained from the Traumatic Brain Injury Model Systems (TBIMS) National Database (N = 6,880; enrolled 2017 onward). Missing data were handled using multiple imputation (20 datasets). Hierarchical multiple regressions were conducted with the Functional Independence Measure (FIM) and the Glasgow Outcome Scale–Extended (GOS-E) as outcome measures. Demographics (age, sex, education, race) were entered in Block 1, injury severity indicators (post-traumatic amnesia [PTA] duration, …

Self-Esteem Development And Emotional And Behavioral Disorders, Bahaa Al Ghraibeh

Archives of Assessment Psychology

Self-esteem is a fundamental psychological construct that develops across the lifespan and influences academic, social, emotional, and behavioral functioning. Research consistently links healthy self-esteem with positive developmental outcomes, including improved educational achievement, stronger interpersonal relationships, and better mental health. At the same time, emotional and behavioral disorders (EBD) are associated with persistent emotional, behavioral, academic, and social difficulties that can interfere with healthy self-development. This paper reviews the developmental trajectory of self-esteem from early childhood through adulthood and examines how the experiences commonly associated with EBD may negatively affect that trajectory. The review discusses how children begin forming self-esteem at …

Prior Traumatic Brain Injury As A Predictor Of Cognitive Deficits After Moderate-To-Severe Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

Prior traumatic brain injuries (TBIs) are common among individuals who later sustain a moderate-to-severe TBI (msTBI), and cumulative injury models suggest repeated TBIs may worsen long-term cognitive outcomes. This study tested whether prior TBI history independently contributes to cognitive performance one year after an index msTBI beyond demographic and injury-severity factors. Data were drawn from the Traumatic Brain Injury Model Systems National Database (N = 6,880 enrolled since 2017). 2,773 participants completed the Brief Test of Adult Cognition by Telephone at one-year follow-up. Hierarchical regression models evaluated whether prior TBI history accounted for incremental variance in overall cognitive status and …

Poor Compliance With Private Nursing And Midwifery Practice Guidelines In Urban Settings In Uganda, Dan Muramuzi, Edson Atwine, Barbara Okiror, Mercy Muwema, Christine Nimwesiga, Laban Muteebwa

School of Nursing & Midwifery, East Africa

Background: Optimal compliance with private practice guidelines is one of the core components of quality improvement in nursing and midwifery professions. Private nursing and midwifery practice guidelines in Uganda were introduced in 2019. However, little has been documented about compliance with these guidelines, despite playing a crucial role in ensuring safe nursing and midwifery practice and maintenance of professional standards.  We assessed the compliance with private nursing and midwifery practice guidelines of Uganda (2019) and explored barriers to optimal compliance with these guidelines in private health facilities licensed by the Uganda Nursing and Midwifery Council (UNMC) in Kampala Metropolitan …

Finding Happiness In "The Orange", Malachi Myers

Student Work

"Everything in the world, no matter how ordinary, is better when shared with friends.

Posting about ­­­­­­­­finding joy in the everyday from In All Things, an online hub that offers insight into maintaining and faithful and orthodox  Reformed Christian worldview while fearlessly engaging in  every aspect of contemporary life – until all is made new.

Finding Happiness in "The Orange"

Accepts: Advancing Communication Competence And Equitable Practices When Training Students, Imani Smith, Jamie Mayer, Tertia Jeppson

Honors Capstones

This project aims to collaboratively create an online, interactive experiential learning program to enhance students’ communication skills when engaging with adults who have cognitive-communication disabilities (CCD). Effective communication is vital for patient-centered care, yet training often lacks contributions from those with lived experience. Using a community-based participatory research framework, this pilot study centers on a needs assessment through focus groups  involving adults with CCD (n=4-8 participants). Initial pilot work will involve structured discussions to examine views on communication barriers and strategies. Data will be analyzed qualitatively to identify main themes that guide program development. Early findings are expected to emphasize …

Knowledge, Attitudes, And Practices Among Hepatitis B Patients In Jakarta, Indonesia: A Cross-Sectional Study, Hashem S. Arkok, Tri Yunis Miko Wahyono, Nurhayati Adnan Prihartono, Dipo Aldila

Kesmas

Hepatitis B remains a major public health problem in Indonesia. This study assessed the knowledge, attitudes, and practices (KAP) of hepatitis B patients in Jakarta to identify gaps in prevention and control and to explore relationships among KAP components. A cross-sectional study was conducted among 128 patients at a government hospital in South Jakarta, using a structured questionnaire that collected demographic information and assessed knowledge, attitudes, and practices regarding hepatitis B transmission and prevention. Despite moderate knowledge levels, major gaps remained. Only a small proportion (10.9%) correctly identified common symptoms, transmission routes (10.2%), and possible complications (18.8%). Misconceptions about transmission …

Development And Validation Of An Indonesian Questionnaire For Assessing Paracetamol Self-Medication Knowledge, Attitude, And Practice, Widyana Sagita Putri, Rani Sauriasari, Priharika Septyowati

Kesmas

Paracetamol is a widely used over-the-counter medicine for self-medication and is often perceived as completely safe. However, inappropriate use may result in hepatotoxicity and other adverse effects, particularly at high doses. This study aimed to develop and validate a questionnaire to assess the general Indonesian population’s knowledge, attitude, and practice (KAP) regarding paracetamol self-medication. The validation procedure consisted of three stages: content, face, and construct validation. Three experts assessed the relevance of the items using the Content Validity Index, and five respondents were interviewed to assess the linguistic clarity and comprehensibility of the questions. Construct validity and reliability were assessed …

Determinants Of Musculoskeletal Disorder In Formal And Informal Workers In Indonesia, Herlina J. El-Matury, Nabila Syahlan, Mohd Rafee B. Baharuddin

Kesmas

Musculoskeletal disorders (MSDs) are a leading cause of disability globally and are strongly influenced by occupational conditions. Evidence comparing MSD risk between formal and informal workers remains limited, particularly in developing countries. This study examined the association between individual and job-related factors with MSD symptoms among formal and informal workers in Indonesia. A cross-sectional study was conducted among 1,089 workers in North Sumatra Province, Indonesia, from August 2024 to December 2025. Participants were recruited using stratified convenience sampling from both the formal (office and health workers) and informal (drivers, traders, and farmers) sectors. MSD symptoms were assessed using the Nordic …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

The Feasibility Of Long-Term Care Within Indonesia’S National Health Insurance Scheme: A Qualitative Study, Atikah Adyas, Wan Aisyiah Baros, Khaterina Kristina Manurung, Dedy Revelino, Dewi Susanna, Vetty Yulianty, Anita Pebrina Lubis, Arum Atmawikarta, Iis Sinsin Nuryasini, Ahmad Jet Alamin

Kesmas

The rising prevalence of chronic diseases and disabilities, along with the aging of the population, has reduced individual independence and increased the demand for long-term care (LTC). This study aimed to assess the feasibility of integrating home healthcare services into Indonesia’s National Health Insurance (NHI) scheme. A qualitative study using purposive sampling was conducted in Bandar Lampung, Yogyakarta, and Jakarta, Indonesia, selected based on disease burden, proportion of older adults, and regional development. Data was collected through in-depth interviews, focus group discussions, and observation between August and September 2024, involving 68 informants, including regulators, community members, and health facility staff. …

Factors Associated With Public Health Centers’ Achievement Of Health Service Target In Yahukimo District, Highland Papua Province, Indonesia, Emaus Heluka, Venty Suryanti, Indasah Indasah, Prima Dewi Kusumawati

Kesmas

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health …

Gastrointestinal Symptoms After Sport-Related Concussion: Prevalence And Patterns In A Multi-Cohort Analysis, Emma Finnegan, Ed Daly, Katherine J. Hunzinger, Lisa Ryan

Department of Exercise Science Faculty Papers

Background/Objectives: Concussions occur across all sports globally; however, inconsistent symptom recognition continues to challenge diagnosis, management, and recovery. Although concussion effects extend beyond neurological dysfunction, gastrointestinal (GI) symptoms remain insufficiently captured within current assessment frameworks and may influence athletes’ fuelling choices and food tolerance during recovery. This study aimed to describe the prevalence and patterns of GI symptoms reported among athletes with a history of concussion and to explore whether symptom prevalence and burden differed by sex and country. Methods: A total of 401 adult athletes (225 males; mean age 32.4 ± 11.3 years) with a history of concussion were …

A Comparison Between Carlin And Dna Typewriter In Crispr-Mediated Lineage Tracing, Fengshuo Liu, Xiang Zhang, Yipeng Yang

Faculty, Staff and Students Publications

Background: CARLIN and DNA Typewriter are two major breakthroughs in CRISPR-based lineage tracing technology. It is essential to understand the potential and performance of these methods in lineage tracing, which provides important guidance on experimental design.

Results: In this study, we systematically compare these two strategies using a unified stochastic simulation framework with known ground-truth lineages. By explicitly modeling CRISPR editing dynamics, barcode evolution, and cell division processes, the framework enables quantitative benchmarking of lineage reconstruction accuracy across diverse experimental parameter regimes. Both methods are evaluated using multiple accuracy metrics, including Robinson-Foulds accuracy and triplet accuracy, allowing a comprehensive assessment …

Toxitarget: A Multi-Omics Database For Toxicant-Responsive Molecular Targets, Ravindra Kumar, Tianyi Fu, Prashant Kumar Kuntala, Benpeng Miao, Shuhua Fu, Daofeng Li, Frederick L Tyson, Marisa S Bartolomei, Cheryl L Walker, Ting Wang, Bo A Zhang

Faculty, Staff and Students Publications

Environmental toxicant exposures can induce widespread alterations in both the transcriptome and epigenome of mammals, and directly contribute to the increased risk of various diseases, including cardiovascular disorders, cancer, and neurological disorders. To evaluate how early-life toxicants produce long-term impacts on the transcriptome and epigenome in mice, the Toxicant Exposures and Responses by Genomic and Epigenomic Regulators of Transcription II (TaRGET II) Consortium generated a landmark resource comprising 3607 multi-omics datasets from longitudinal studies in mice. The molecular changes in responding to distinct environmental toxicants, including arsenic (As), lead (Pb), bisphenol A (BPA), tributyltin (TBT), di-2-ethylhexyl phthalate (DEHP), dioxin (TCDD), …

Correction: Misregulated Alternative Splicing In Endometriosis: A Role For Aberrant Mrna Variants In Endometriotic Cell Growth, Venkata Naga Goutham Davuluri, Michelle Dias, Roxanna Llinas, Neha Kamath, Pooja Popli, Shannon M Hawkins, Chandrakant Tayade, Elise T Courtois, Hari Krishna Yalamanchili, Ramakrishna Kommagani

Faculty, Staff and Students Publications

This corrects the article "Misregulated alternative splicing in endometriosis: a role for aberrant mRNA variants in endometriotic cell growth", 149.

Resilience And Social Support On Depression Risk For Chronic Obstructive Pulmonary Disease Patients In South Tangerang, Indonesia, Adhityawarman Menaldi, Sali Rahadi Asih, Farah Ainul Mardhiyyah

Kesmas

Chronic obstructive pulmonary disease (COPD) is a major public health concern with psychosocial impacts, such as reduced resilience and depression. This study examined the moderating role of perceived social support on the relationship between resilience and depression among individuals diagnosed with COPD in South Tangerang, Indonesia. A quantitative cross-sectional study was conducted between January and February 2024 using self-administered questionnaires. Participants were adult patients with clinically diagnosed COPD, recruited from all public health centers (PHC) in South Tangerang. A total of 125 participants met the inclusion criteria and were included in the analysis. Participants had a mean age of 41.46±15.69 …

Environmental Contamination Of Methicillin-Resistant Staphylococcus Aureus And Vancomycin-Resistant Enterococcus In Primary Care Clinics: Implications For Occupational Safety, Subki Ahmad, Normah Awang, Ermie Abdull Hamid, Anuar Ithnin, Nurul Farahana Kamaludin, Noraizah Muhd Nor

Kesmas

Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) are major contributors to healthcare-associated infection, yet data from primary care clinics remain limited. This study assessed environmental contamination in eight clinics in the Klang Valley, Malaysia, and evaluated associated environmental factors. Samples were collected from environmental surfaces and equipment in Medical Officer and Patient Treatment Rooms, then cultured and tested for antimicrobial susceptibility. Environmental parameters, including temperature, relative humidity, air movement, and room density, were measured. Data were analyzed using Kruskal–Wallis, Mann–Whitney, and multiple linear regression analyses. MRSA was detected on 19.8% of environmental surfaces (patient treatment beds (47.3%) and side …

Assessing Impact Of Heat Waves On Pregnancy And Lactation Amidst Climate Change: A Scoping Review., Susan Anyango, Grace Nakate

School of Nursing & Midwifery, East Africa

Background: The escalation of heat waves, attributed to climate change, represents a global public health concern, with pregnant
and lactating women identified as particularly vulnerable due to Physiological and hormonal changes.

Aim: To review the existing research on the effects of heat waves on pregnancy and lactation, identifying potential health risks and outcomes.

Methods: A structured search across PubMed, Scopus, Web of Science, and Google Scholar was conducted using terms related
to heat waves, pregnancy, lactation, and climate change. Inclusion criteria focused on peer-reviewed empirical
studies in English.

Results: Heat waves are linked to increased risks of preterm labor, low …

Descriptive Qualitative Study Of Nursing Students' Perceptions And Behaviors During Student-Led Class Sessions In Uganda, Proscovia Nakaye, Veronica Nakkonde, Mercy Muwema, Grace Nakate

School of Nursing & Midwifery, East Africa

Introduction: Student-led class sessions are a pedagogical approach where students actively engage in the learning process, influencing content, activities, and pace. This method fosters independent learning, communication skills, and teamwork. While some studies have shown the effectiveness of student-led sessions, nursing students often exhibit challenges, such as inattention and negative attitudes, affecting the quality of learning and patient care. Understanding nursing students' perceptions and behaviors in this context is essential for improving nursing education.

Methods: This descriptive qualitative study aimed to explore nursing students' perceptions and behaviors during student-led class sessions at Uganda Christian University. Sixteen direct-entry nursing students …

Prevalence Of Teenage Pregnancy And Associated Factors Among Adolescent Girls In Bobi Subcounty, Northern Uganda., Grace Auma, Margaret Alioru, Geoffrey Kaujju, Grace Nakate

School of Nursing & Midwifery, East Africa

Methodology: A Cross-sectional study design. A survey was conducted among 4893 married girls aged 15-19 years using quantitative methods. Quantitative data was collected through the structured questionnaire, which was administered, data was collected and entered in EPI-INFO 2020 software, and was cleaned and analyzed using STATA version 15.0. Binary logistic regression was done to examine the factors independently associated with teenage pregnancy. A multistage sampling technique was used.

Results: Our study showed that the prevalence of teenage pregnancy in Bobi Sub-County, Omoro District, is high at 27.5%. Significant Factors contributing to the likelihood of teenage pregnancy included those …

Misconduct Among Nurses And Midwives: A Retrospective Descriptive Study Of Cases Handled At The Uganda Nurses And Midwives Council From 2017 To 2021, Barbara Okiror, Christine Nimwesiga, Patience Muwanguzi, Tom Ngabirano, Mercy Muwema

School of Nursing & Midwifery, East Africa

Background: Media reports on the misconduct of nurses and midwives, including cases of fake credentials, drug theft, and incompetence, are on the rise. However, there are no published studies currently addressing this issue in Uganda. Therefore, to inform effective regulation of the profession, we analysed the misconduct cases involving nurses and midwives reported to the Uganda Nurses and Midwives Council between 2017 and 2021.

Methods: The study retrospectively described misconduct cases received and handled at UNMC from 2017 to 2021 and their outcomes. Following total population sampling, data were extracted from case files and then input into a …

Structures And Processes Of Critical Care Nursing Practice: Insights From Four Ugandan Intensive Care Units, Dominic Ogwal Savio, Edrisa Ssemwanga, Winter Patrick, Lameck Ssemogerere, Cliff Aliga

School of Nursing & Midwifery, East Africa

No abstract provided.

Characteristics Of People Who Inject Drugs Approached For Injection Assistance In Rural Kentucky, April Young, Ryli Hockensmith, Preston T Tolbert, Susan Westneat, Peter Vickerman, Jack Stone, Hilary L Surratt, Kayo Fujimoto, Hannah K Knudsen, Rachel Vickers-Smith, Katherine L Thompson, Laura Fanucchi, Julia Kollitz, Jennifer R Havens, Melvin D Livingston

Faculty, Staff and Student Publications

Objective: This study aims to understand the characteristics of people who inject drugs approached by others for injection assistance.

Method: Peer-referral and outreach were used to recruit rural adults who recently injected drugs in Appalachian Kentucky (n=435). Interviewer-administered questionnaires elicited data on participant characteristics and injection assistance. Descriptive statistics and generalized estimating equations clustered on peer-referral recruitment chain were used for analysis.

Results: Nearly one-third (30.1%) reported others had come to them for injection assistance. People approached for assistance were slightly younger (prevalence ratio [PR]: 0.91, 95% confidence interval [CI]: 0.85-0.99) but otherwise, demographically similar to their counterparts. Those approached …

Does Patient History Influence Capsular Contracture? An Exploratory Analysis With Machine Learning, Thomas M. Johnstone, Daniel Najafali, Jennifer K. Shaw, Justin M. Camacho, Chancellor Johnstone, Rahim S. Nazerali, Gordon K. Lee

Faculty Publications

Background: Capsular contracture (CC) is a frequent and distressing complication of breast augmentation and reconstruction. Although numerous patient-, surgical-, and implant-related risk factors have been proposed, reliable population-level predictors remain inconsistent across studies. This study evaluates whether administrative medical history, as encoded by ICD and CPT codes, contains sufficient predictive signal to identify patients at risk for CC using machine learning. Methods: Patients were queried from the MerativeTM MarketScan® Research Databases from 2003 to 2017 with CPT codes for implant-based breast reconstruction and augmentation. ICD codes were then used to identify all events and conditions of a patient’s history. Hyperparameter-tuned …

Associations Among Pork Intake, Weight-Loss, And Diet Quality Outcomes In A Commercial Weight-Management Program, Ana M Palacios, Grace Anderson, Beate Henschel, Alexandra M Lee, Kelli M Richardson, Chelsie Parker, Stephanie L Dickinson, Jing X Kersey, David B Allison, Gary D Foster, Michelle I Cardel

Faculty, Staff and Students Publications

Background: Pork is a common source of high-quality protein. However, it is typically recommended in moderation due to its saturated fat content, especially as its role in weight management, weight-loss (WL) programs, and overall diet quality is not well understood. This study aimed to identify associations among pork intake, WL, and diet quality among adults with overweight or obesity participating in a weight management program (WMP).

Methods: This secondary analysis used data from a 6-month randomized controlled trial (NCT05648344) evaluating the effectiveness of a WMP on diet quality. Data were collected through online surveys and the Automated Self-Administered …

Frame-Wise Multi-Echo Distortion Correction For Superior Functional Mri, Andrew N Van, David F Montez, Timothy O Laumann, Philip N Cho, Vahdeta Suljic, Noah J Baden, Nadeshka Ramirez-Perez, Kristen M Scheidter, Julia S Monk, Forrest I Whiting, Babatunde Adeyemo, Roselyne J Chauvin, Samuel R Krimmel, Athanasia Metoki, Aishwarya Rajesh, Jarod L Roland, Anxu Wang, Aristeidis Sotiras, Joshua S Shimony, Benjamin P Kay, Scott A Marek, Evan M Gordon, Nico U F Dosenbach, Et Al.

2020-Current year OA Pubs

Functional MRI (fMRI) data are severely distorted by magnetic field (B0) inhomogeneities, which currently must be corrected using separately acquired field map data. However, changes in the head position of a participant across fMRI frames cause changes in the B0 field, preventing accurate correction of geometric distortions. Movement during field map acquisitions corrupts field maps, preventing distortion correction altogether. In this study, we use multi-echo (ME) fMRI data to dynamically sample and correct for magnetic field image distortions caused by head motion. Our distortion correction pipeline, MEDIC (Multi-Echo DIstortion Correction), leverages magnetic field inhomogeneity information found in the difference between …

When Lupus Begins In The Heart: New-Onset Lupus Perimyocarditis Presenting As Acute Dilated Cardiomyopathy, Ripudaman Singh, Cesar Gutierrez

Research Symposium

Background: Acute decompensated dilated cardiomyopathy (DCM) in a middle-aged patient without traditional cardiovascular risk factors presents a diagnostic and therapeutic challenge. While acute coronary syndrome (ACS) and pulmonary embolism must be rapidly excluded, a systematic evaluation is required to identify less common etiologies. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease commonly presenting as pericarditis. Lupus myocarditis is a life-threatening complication with high morbidity and mortality that can present as DCM. Presentation of previously undiagnosed SLE as heart failure with reduced ejection fraction due to DCM is rare and occasionally reported. We describe a case of new-onset SLE initially …

Acquired Left Ventricular Noncompaction Physiology In Lupus Myocarditis: An Unclassified Cardiomyopathy Phenotype, Ripudaman Singh, Eduardo D. Flores Md, Facc

Research Symposium

Background: Left ventricular noncompaction (LVNC) is a rare structural abnormality of the left ventricular myocardium, characterized by prominent trabeculations and deep intertrabecular recesses due to incomplete compaction during embryogenesis. Clinical presentation is highly variable, ranging from asymptomatic cases to arrhythmias, thromboembolism, heart failure, and sudden cardiac death. Diagnosis is primarily imaging-based, with transthoracic echocardiography (TTE) using the Jenni criteria as standard. These criteria include excessive apical or midventricular trabeculations with a noncompacted-to-compacted ratio >2:1 at end-systole, a thin compacted epicardial layer (≤8.1 mm), and color Doppler flow within the recesses. When echocardiography is inconclusive, cardiovascular magnetic resonance (CMR) is recommended. …