Diseases Commons^™

Telemedicine For Rheumatology Patients In Covid-19 Pandemic: Perspectives Of Patients, Muhammad Mehmood Riaz, Saad Bin Zafar Mahmood, Noreen Nasir

Section of Internal Medicine

Telemedicine use for patients with autoimmune rheumatic conditions during the pandemic mandates better characterization. We conducted a telephonic survey on patients who consulted rheumatologists remotely to determine their attitudes toward telemedicine. The study was conducted at Aga Khan University Hospital, a tertiary care hospital in Pakistan which is a lower-middle-income country. Descriptive analyses were performed. Fifty patients visited tele-rheumatology clinic, 35 (70.0%) were female with a mean (SD) age of 47.6 (18.1) years. Majority (27, 54.0%) learned about telemedicine from hospital website and outpatient clinic desk or helpline. Lack of examination was the biggest concern with teleconsultation (18, 22.2%). Most …

Neurofibromatosis Type 1 Has A Wide Spectrum Of Growth Hormone Excess, Fady Hannah-Shmouni, Giampaolo Trivellin, Pablo Beckers, Lefkothea P Karaviti, Maya Lodish, Christina Tatsi, Adekunle M Adesina, Fotini Adamidou, Gesthimani Mintziori, Jami L Josefson, Martha Quezado, Constantine A Stratakis

Faculty, Staff and Students Publications

Overgrowth due to growth hormone (GH) excess affects approximately 10% of patients with neurofibromatosis type 1 (NF1) and optic pathway glioma (OPG). Our aim is to describe the clinical, biochemical, pathological, and genetic features of GH excess in a retrospective case series of 10 children and adults with NF1 referred to a tertiary care clinical research center. Six children (median age = 4 years, range of 3−5 years), one 14-year-old adolescent, and three adults (median age = 42 years, range of 29−52 years) were diagnosed with NF1 and GH excess. GH excess was confirmed by the failure to suppress GH …

Covid-19 Newsletter (Vol. 114), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

Quadruped Gait And Regulation Of Apoptotic Factors In Tibiofemoral Joints Following Intra-Articular Rhprg4 Injection In Prg4 Null Mice, Daniel S. Yang, Edward E. Dickerson, Ling X. Zhang, Holly Richendrfer, Padmini N. Karamchedu, Gary A. Badger, Tannin A. Schmidt, Alger M. Fredericks, Khaled A. Elsaid, Gregory D. Jay

Pharmacy Faculty Articles and Research

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome leads to diarthrodial joint arthropathy and is caused by the absence of lubricin (proteoglycan 4—PRG4), a surface-active mucinous glycoprotein responsible for lubricating articular cartilage. In this study, mice lacking the orthologous gene Prg4 served as a model that recapitulates the destructive arthrosis that involves biofouling of cartilage by serum proteins in lieu of Prg4. This study hypothesized that Prg4-deficient mice would demonstrate a quadruped gait change and decreased markers of mitochondrial dyscrasia, following intra-articular injection of both hindlimbs with recombinant human PRG4 (rhPRG4). Prg4^−/− (N = 44) mice of both sexes were injected with rhPRG4 …

Variability Of Care And Access To Transplantation For Children With Biliary Atresia Who Need A Liver Replacement, Jean De Ville De Goyet, Toni Illhardt, Christophe Chardot, Peace N Dike, Ulrich Baumann, Katherine Brandt, Barbara E Wildhaber, Mikko Pakarinen, Fabrizio Di Francesco, Ekkehard Sturm, Marianna Cornet, Caroline Lemoine, Eva Doreen Pfister, Ana M Calinescu, Maria Hukkinen, Sanjiv Harpavat, Fabio Tuzzolino, Riccardo Superina

Faculty, Staff and Students Publications

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life …

Dronedarone For Atrial Fibrillation Prophylaxis In Patients Undergoing Open Heart Surgical Interventions: A Case Series, Jay D. Patel, Mrhaf Alsamman, Dewansh Goel, Sai Gudduru, Rakesh Prashad

Journal of Community Hospital Internal Medicine Perspectives

Atrial fibrillation (a-fib) is one of the most frequently encountered and studied arrhythmias in medicine. The presence of A-fib in the post-operative period of coronary artery bypass graft (CABG) surgery is of particular concern for clinicians as this presents risks of post-operative stroke, hospital readmission, or anticoagulation dilemmas depending on the patient’s comorbidities. In this case study, we present 5 patients who were treated with dronedarone prior to undergoing open heart procedures. We subsequently followed each patients clinical course paying close attention for any evidence of post-operative a-fib.

Public Policy And Religion In The Pandemic: U.S. Constitution And The First Amendment, Stephen Covell, Diane Riggs, Cameron Borg

Modules for Teaching Pandemic Response and Religion in the USA

The following teaching module is designed for high school and college level instructors who seek to teach a lesson on the impact the COVID-19 pandemic had on the relationship between church and state. The teaching module features a lesson plan, case studies, and assignments that can be incorporated as the instructor sees fit. This teaching module was created by Western Michigan University's Department of Comparative Religion.

The Use Of Mobility And Medication On Patient’S Perception Of Pain In Hospitalized Patients With Chronic Back Pain Benchmark Study, Katherine E. Zaske Merenda Mrs., Katherine Merenda

MSN Capstone Projects

According to Boss & Huether, twenty-nine percent of Americans have been diagnosed with chronic low back pain (CLBP). This pain can affect every part of their lives leading to lost wages and decreased quality of life. CLBP is an issue experienced by many hospitalized patients. These patients may not be able to mitigate their pain as they normally would due to safety protocols in hospital settings. Exercise or mobility has been shown to decrease a person’s perception of pain. The importance of exercise and mobility in a hospital setting to help decrease a patient’s perception of pain needs further research. …

An Imaging Biomarker Of Tumor-Infiltrating Lymphocytes To Risk-Stratify Patients With Hpv-Associated Oropharyngeal Cancer, Germán Corredor, Paula Toro, Can Koyuncu, Cheng Lu, Christina Buzzy, Kaustav Bera, Pingfu Fu, Mitra Mehrad, Kim A Ely, Mojgan Mokhtari, Kailin Yang, Deborah Chute, David J Adelstein, Lester D R Thompson, Justin A Bishop, Farhoud Faraji, Wade Thorstad, Patricia Castro, Vlad Sandulache, Shlomo A Koyfman, James S Lewis, Anant Madabhushi

Faculty, Staff and Students Publications

BACKGROUND: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has excellent control rates compared to nonvirally associated OPSCC. Multiple trials are actively testing whether de-escalation of treatment intensity for these patients can maintain oncologic equipoise while reducing treatment-related toxicity. We have developed OP-TIL, a biomarker that characterizes the spatial interplay between tumor-infiltrating lymphocytes (TILs) and surrounding cells in histology images. Herein, we sought to test whether OP-TIL can segregate stage I HPV-associated OPSCC patients into low-risk and high-risk groups and aid in patient selection for de-escalation clinical trials.

METHODS: Association between OP-TIL and patient outcome was explored on whole slide …

Obesogenic Environments And Cardiovascular Disease: A Path Analysis Using Us Nationally Representative Data, Fangqi Guo, Georgiana Bostean, Vincent Berardi, Alfredo J. Velasquez, Jennifer W. Robinette

Psychology Faculty Articles and Research

Introduction

People living in obesogenic environments, with limited access to healthful food outlets and exercise facilities, generally have poor health. Previous research suggests that behavioral risk factors and indicators of physiological functioning may mediate this link; however, no studies to date have had the requisite data to investigate multi-level behavioral and physiological risk factors simultaneously. The present study conducted serial and parallel mediation analyses to examine behavioral and physiological pathways explaining the association between environmental obesogenicity and cardiovascular disease (CVD).

Methods

This cross-sectional observational study used data from the 2012–2016 Health and Retirement Study, a representative survey of US older …

Racial Disparities In Prostate Cancer: A Complex Interplay Between Socioeconomic Inequities And Genomics, Dallin Lowder, Kinza Rizwan, Collin Mccoll, Alyssa Paparella, Michael Ittmann, Nicholas Mitsiades, Salma Kaochar

Faculty, Staff and Students Publications

The largest US cancer health disparity exists in prostate cancer, with Black men having more than a two-fold increased risk of dying from prostate cancer compared to all other races. This disparity is a result of a complex network of factors including socioeconomic status (SES), environmental exposures, and genetics/biology. Inequity in the US healthcare system has emerged as a major driver of disparity in prostate cancer outcomes and has raised concerns that the actual incidence rates may be higher than current estimates. However, emerging studies argue that equalizing healthcare access will not fully eliminate racial health disparities and highlight the …

Central Line Associated Blood Stream Infection Prevention With Use Of Disinfection Caps: A Scoping Review, Marianne E. Person, Jessica Biggs, Elizabeth Ross, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background Central lines provide lifesaving uses, but they also place the patient at risk for central line associated blood stream infections (CLABSI). Catheter location, length of stay, handwashing, dressing changes, and disinfection of ports before use are all factors to prevent CLABSIs, yet sometimes these measures are not enough. Disinfecting caps are another way to decrease central line infection, however not all hospitals use this method. This scoping review aims to compare CLABSI rates with and without the use of disinfecting caps for the duration of central line use in intensive care patients.

Methods From August 2019 to September 2021, …

Impact Of Spontaneous Breathing Trials On Reducing Ventilator-Associated Pneumonia In Adult Intubated Patients: A Scoping Review, Jireh R. Johnson Bsn, Rn, Hamzha Aysheh Bsn, Rn, Keianna Luckett Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background For ventilated patients in the intensive care unit, ventilator-associated pneumonia (VAP) is a major source of morbidity. It is difficult to diagnose due to many of the diagnostic criteria being subjective, its clinical signs that are broad, and its association with various respiratory disorders. Hospitals have developed varying ventilator bundles in expectation to prevent the incidence of Ventilator-associate pneumonia. We performed scoping review to determine the impact of spontaneous breathing trials (SBT) on reducing VAP.

Methods From August to November of 2021, using the MEDLINE, ScienceDirect, and Scopus databases and MeSH search terms, we identified over 20,000 articles containing …

Protocol For A Cluster Randomised Controlled Trial Of Secondary Distribution Of Hepatitis C Self-Testing Within The Context Of A House-To-House Hepatitis C Micro-Elimination Programme In Karachi, Pakistan, Sonjelle Shilton, Dania Ali, Alyia Hasnain, Adeel Abid, Jessica Markby, Muhammad S. Jamil, Niklas Luhmann, Pamela Nabeta, Stefano Ongarello, Saeed Hamid

Medical College Documents

Background: Globally, just 21% of the estimated 58 million people living with hepatitis C virus (HCV) know their status. Thus, there is considerable need to scale-up HCV testing if the World Health Organization (WHO) 2030 hepatitis elimination goals are to be achieved. HCV self-testing may assist with this; however, there are currently no data on the real-world impact of HCV self-testing. With an estimated 5% of the general population living with HCV, Pakistan has the second highest HCV burden in the world. This study aims to evaluate the acceptability and impact of home delivery of HCV self-testing for secondary distribution …

Envisioning Future Urinary Tract Infection Diagnostics, Robin Patel, Christopher R Polage, Jennifer Dien Bard, Larissa May, Francesca M Lee, Valeria Fabre, Mary K Hayden, Sarah D B Doernberg, David A Haake, Barbara W Trautner, Larissa Grigoryan, Ephraim L Tsalik, Kimberly E Hanson

Faculty, Staff and Students Publications

Urinary tract infections (UTIs) are among the most common bacterial infections in the United States and are a major driver of antibiotic use, both appropriate and inappropriate, across healthcare settings. Novel UTI diagnostics are a strategy that might enable better UTI treatment. Members of the Antibacterial Resistance Leadership Group Laboratory Center and the Infectious Diseases Society of America Diagnostics Committee convened to envision ideal future UTI diagnostics, with a view towards improving delivery of healthcare, patient outcomes and experiences, and antibiotic use, addressing which types of UTI diagnostics are needed and how companies might approach development of novel UTI diagnostics.

Perceptions Of Hypertension And Treatment Adherence In Impoverished Hypertensive Adults: A Qualitative Analysis, Sarah E. Hogg

Honors College Theses

Hypertension is a global public health crisis. It is the largest risk factor for cardiovascular disease, which is the leading cause of death globally (CDC, 2021). While it can be managed, there are additional barriers that hypertensive impoverished populations face in regards to hypertension management. The purpose of this study was to explore knowledge, attitudes, and perceptions of hypertension, and treatment adherence in impoverished hypertensive adults. Interviews were analyzed using thematic analysis, and were explained within the context of the health belief model. The results show that there was a lack of understanding of hypertension and its long term effects. …

Using Digital Storytelling To Assess Patient Experience With Management Of Diabetes In Everyday Life (Model) Study Intervention, Arati Joshi

Longitudinal Scholar's Project

African Americans are disproportionately affected by obesity-associated diabetes compared to their White counterparts. While social determinants of health may contribute to their poor health outcomes, studies have shown that pragmatic primary care-based interventions can be effective in improving the management of obesity-associated diabetes. The Management of Diabetes in Everyday Life (MODEL) is a pragmatic randomized comparative effectiveness trial of three approaches (health coaching, text-messaging, and enhanced usual care) to supporting medically underserved African American patients with uncontrolled diabetes in improving their self-care decisions. The purpose of this study is to assess the effect of the MODEL program participation on the …

The Parkinson's Wellness Project: An 8-Part Educational Video Series, Samantha L. Stevenson

OTD Capstone Projects

The Parkinson’s Wellness Project is an 8-part educational video series created by Samantha Stevenson, a student in Belmont University’s Doctorate Program in Occupational Therapy. Purpose: This project was created to benefit all persons with Parkinson’s disease (PD) and their care partners who attend Rocksteady Boxing (RSB) in Franklin/Nashville, TN. Methodology: The student conducted research to identify the salient issues experienced by people living with PD. The issues were then synthesized into 8 separate categories including the following: facial expression, mental health, sexual health, self-care, sleep, diet and nutrition, meditation, and postural alignment. Experts in the healthcare field produced specialized content …

Repurposing Probenecid For The Treatment Of Heart Failure (Re-Prosper-Hf): A Study Protocol For A Randomized Placebo-Controlled Clinical Trial, Jack Rubinstein, Nathan Robbins, Karen Evans, Gabrielle Foster, Kevin Mcconeghy, Toluwalope Onadeko, Julie Bunke, Melanie Parent, Xi Luo, Jacob Joseph, Wen-Chih Wu

Faculty, Staff and Student Publications

BACKGROUND: Improving contractility in heart failure with reduced ejection fraction (HFrEF) has resurfaced as a potential treatment goal. Inotropic therapy is now better understood through its underlying mechanism as opposed to the observed effect of increasing contractility. Calcitropes are a subgroup of inotropes that largely depend on the stimulation of adenylyl cyclase to transform ATP into cyclic adenosine monophosphate (cAMP). At least two clinically relevant calcitropes-istaroxime and probenecid-improve contractility through an increase in systolic intracellular calcium without activating cAMP production. Probenecid, which has been safely used clinically for decades in non-cardiac conditions, has recently been identified as an agonist of …

Predicted Gene Expression In Ancestrally Diverse Populations Leads To Discovery Of Susceptibility Loci For Lifestyle And Cardiometabolic Traits, Heather M Highland, Genevieve L Wojcik, Mariaelisa Graff, Katherine K Nishimura, Chani J Hodonsky, Antoine R Baldassari, Alanna C Cote, Iona Cheng, Christopher R Gignoux, Ran Tao, Yuqing Li, Eric Boerwinkle, Myriam Fornage, Jeffrey Haessler, Lucia A Hindorff, Yao Hu, Anne E Justice, Bridget M Lin, Danyu Lin, Daniel O Stram, Christopher A Haiman, Charles Kooperberg, Loic Le Marchand, Tara C Matise, Eimear E Kenny, Christopher S Carlson, Eli A Stahl, Christy L Avery, Kari E North, Jose Luis Ambite, Steven Buyske, Ruth J Loos, Ulrike Peters, Kristin L Young, Stephanie A Bien, Laura M Huckins

Faculty, Staff and Student Publications

One mechanism by which genetic factors influence complex traits and diseases is altering gene expression. Direct measurement of gene expression in relevant tissues is rarely tenable; however, genetically regulated gene expression (GReX) can be estimated using prediction models derived from large multi-omic datasets. These approaches have led to the discovery of many gene-trait associations, but whether models derived from predominantly European ancestry (EA) reference panels can map novel associations in ancestrally diverse populations remains unclear. We applied PrediXcan to impute GReX in 51,520 ancestrally diverse Population Architecture using Genomics and Epidemiology (PAGE) participants (35% African American, 45% Hispanic/Latino, 10% Asian, …

Recommendations For Providers To Improve Quality Of Care & Health Outcomes For Patients With Tick-Borne Diseases, Kayla G. Hugate, Jennifer Hall

Student Scholar Showcase

Background: Healthcare providers lack knowledge about tick-borne diseases related to recognition, diagnosis, treatments, and communication. With the number of ticks and types of tick-borne diseases increasing, it is vital that providers know how to effectively diagnose, manage and treat a TBD patient.

Methods: A mixed method survey was implemented in 2021 with persons diagnosed with a tick-borne disease to explore their experiences with diagnosis, management and treatment. The survey was posted on TBD social media pages and sent through email snowballing. Thematic analysis was used to code results from three open-ended questions.

Results: A total of 434 …

Post-Intensive Care Syndrome Prevention And Detection In Covid-19 Patients, Bethany Sloane Melega

Student Scholar Showcase

COVID-19 has impacts on patient health beyond the hospital. The trauma that patients, and families of patients, can experience during an admission to an intensive care unit (ICU) can last long after discharge from the ICU and the hospital in general. The psychological and physical impacts of ICU hospitalization can cause patients to experience Post Intensive Care Syndrome (PICS). PICS is the culmination of symptoms that persist after a critical illness that involve all aspects of a patient’s physical and mental well-being and can significantly affect family life and increase recovery time. Due to the strict personal-protective equipment (PPE) usage …

Covid-19 Newsletter (Vol. 113), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

Coronavirus Update 4-5-22, The Coronavirus Planning Team

University Briefings & Virtual Events

Based on current numbers and trends and in accordance with CDC guidance, we will recommend vaccination, but not require it, for the fall. Vaccination has been one component of our strategy, along with testing, tracing, isolation, quarantine, masking, hygiene and social distancing. We will continue to follow the way the virus evolves and listen to the advice of state and local health officials, and we will let you know over the summer as decisions are made on our testing, isolation and other strategies for the fall.

Interpersonal Communication In Eye Care: An Analysis Of Potential Impacts On Cataract Surgery Candidates’ Expectations And Behaviors, Amy Hellem, Sara Labelle, Cynthia Matossian, Paul Karpecki

Communication Faculty Articles and Research

Purpose: To identify cataract surgery candidates’ knowledge, beliefs, desires and emotions as they relate to cataract surgery generally as well as to their behavioral intent to adhere to a doctor-recommended pre-surgical ocular surface prep routine designed to improve refractive outcomes and prevent surgical complications.

Methods: This national, noninterventional, cross-sectional, mixed methods survey included 278 US adults ages 65 and older with no history of cataract surgery in either eye.

Results: Only 20% of participants said they want to have cataract surgery, and even fewer (8%) said they wish they could have cataract surgery right away. Fear was the predominant emotion …

Qualitative Data Analysis For Health Research: A Step-By-Step Example Of Phenomenological Interpretation, Sue Monaro, Janice Gullick, Sandra West

The Qualitative Report

Phenomenological studies have been critiqued when analytic activities and intersection with the underpinning philosophy lack clarity. This methodological discussion paper describes data analysis in hermeneutic interpretive phenomenology. Data management strategies (transcript preparation, coding, philosophy application, tabling/concept maps, and Microsoft Word) and data analysis processes (reduction, display, and conclusion drawing/verification) are illustrated. Deconstruction, reconstruction, and reorganisation of themes/subthemes using hierarchical heading styles to populate the navigation pane and philosophical tenets acted as analytic hooks. This paper has outlined data analysis in hermeneutic interpretive phenomenology, including the use of MS Word and its functionality, which was supported by other data display strategies …

Perceptions Of Weight Status And Energy Balance Behaviors Among Patients With Non-Alcoholic Fatty Liver Disease, Natalia I Heredia, Ruchi Gaba, Yan Liu, Shilpa Jain, Manasi Rungta, Manav Rungta, Hashem B El-Serag, Fasiha Kanwal, Aaron P Thrift, Maya Balakrishnan

Faculty, Staff and Students Publications

Weight loss through behavioral modification is central to treating non-alcoholic fatty liver disease (NAFLD). To achieve this, patients need to accurately self-perceive their health behaviors. We aimed to identify predictors of concordance between self-perception and objective measures of body weight, physical activity (PA) and dietary behaviors. We used data from the Harris County NAFLD Cohort, an ongoing prospective study in a regional safety-net healthcare system. Patients completed self-administered baseline questionnaires on demographics, diet, PA, and self-perceptions. We assessed concordance between actual and self-perceived body weight and energy-balance behaviors. Multivariable logistic regression identified predictors of concordance. Patients (n = 458; average …

Demographic And Regional Trends Of Mortality In Patients With Aortic Dissection In The United States, 1999 To 2019, Salik Nazir, Robert W Ariss, Abdul Mannan Khan Minhas, Rochell Issa, Erin D Michos, Yochai Birnbaum, George V Moukarbel, P Kasi Ramanathan, Hani Jneid

Faculty, Staff and Students Publications

Background Aortic dissection (AoD) is associated with high morbidity and mortality. However, the burden of AoD mortality is not well characterized, and contemporary data and mortality trends in different demographic and geographic subgroups have not been described. Methods and Results Trends in AoD mortality were assessed using a cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Crude and age-adjusted mortality rates (AAMR) per 1 million people with associated annual percent changes were determined. Joinpoint regression was used to assess trends in the overall sample and different demographic (sex, race and ethnicity, …

Discharge Care Bundle To Reduce Copd 30-Day Readmission Rates In A Hospital Acute Care Unit, Dao Vang

Student Scholarly Projects

Practice Problem: Chronic obstructive pulmonary disease (COPD) readmissions severely impact patients’ health, mortality, and quality of life and increase unnecessary healthcare use and spending. Utilization of a protocol and discharge care bundle to reduce the readmission rate for COPD patients is critical to combat the problem.

PICOT: The PICOT question that guided this project was in adult patients 65 years or older admitted to a hospital acute care unit for acute exacerbation of COPD (P), does a protocol and discharge care bundle (I) compared to no protocol and no discharge care bundle (C) reduce the 30-day hospital COPD readmission rate …

Why Aboriginal And Torres Strait Islander Australians Fall And Fracture: The Codesigned Study Of Indigenous Muscle And Bone Ageing (Simba) Protocol, Ayse Zengin, Cat Shore-Lorenti, Marc Sim, Louise Maple-Brown, Sharon Lee Brennan-Olsen, Joshua R. Lewis, Jennifer Ockwell, Troy Walker, David Scott, Peter Ebeling

Research outputs 2022 to 2026

OBJECTIVES: Aboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians. SETTING: All clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments …