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Articles 61 - 90 of 443

Full-Text Articles in Medical Humanities

Anesthesia And Pain Management In Conflict-Affected Regions: Addressing Global Health Barriers To Access And Quality Of Care​, Naeel Uddin, Sierra Brown, Maria Easler, Ayanda Mkhize, Marwa Hamdam, Chandu Goli, Lauren Draper Feb 2025

Anesthesia And Pain Management In Conflict-Affected Regions: Addressing Global Health Barriers To Access And Quality Of Care​, Naeel Uddin, Sierra Brown, Maria Easler, Ayanda Mkhize, Marwa Hamdam, Chandu Goli, Lauren Draper

Annual Research Symposium

This poster examines how to deliver safe, effective anesthesia and pain control in areas with limited resources and ongoing security threats. Focusing on portable technology, ketamine-based protocols, and telemedicine, we highlight ethical considerations, training needs, and global collaborations. Our findings outline a pathway to reduce suffering and improve surgical outcomes in vulnerable populations by addressing challenges unique to conflict settings.


Wellness Literature Review - 2024, Bidhu Sharma, Martin Huecker, Brian A. Ferguson Feb 2025

Wellness Literature Review - 2024, Bidhu Sharma, Martin Huecker, Brian A. Ferguson

Journal of Wellness

Introduction: The Journal of Wellness has moved to a single calendar year editorial review of wellness literature. This annual review includes studies published in 2024.

Methods: Authors conducted a PubMed and Google Scholar keyword search, narrowing results to interventional studies / clinical trials in humans.

Literature in Review: We conducted a thematic review of a selection of relevant papers from the literature search. COVID-19 crisis has exacerbated the rate of burnout and impacted well-being of healthcare providers. Need for intervention in this area has arisen significantly since the pandemic. Post pandemic, working conditions have been normalized to some extent, however, …


Life After, John C. Lyden Jan 2025

Life After, John C. Lyden

Journal of Religion & Film

This is a film review of Life After (2025), directed by Reid Davenport.


El Uso De Las Prácticas Curativas No Occidentales En Lugar De Y Dentro De La Cultura Biomédica, Lynda Gulledge Jan 2025

El Uso De Las Prácticas Curativas No Occidentales En Lugar De Y Dentro De La Cultura Biomédica, Lynda Gulledge

World Languages and Cultures Senior Capstones

This paper explores the difficulties that the Hispanic community faces when accessing healthcare in the United States, which emphasizes the use of biomedical culture. Topics such as cultural and linguistic barriers, past and present healthcare policies, and the use of non-Western medical practices are examined. Furthermore, this paper explores the history and use of curanderismo as an accessible and culturally appropriate form of healthcare. Lastly, the integration and acknowledgement of curanderismo in biomedical culture is explored and encouraged in order to create a more holistic healthcare experience for the Hispanic community.


Vaccines And Publics: A Variety Of Engagement Experiences, David H. Lee Jan 2025

Vaccines And Publics: A Variety Of Engagement Experiences, David H. Lee

Publications and Research

This chapter is about some of the sites and scenes where members of the public are exposed to (and engage in) vaccination discourse. To preview, after a brief introduction, we begin with messaging models of communication, followed by the move from messaging to engagement. Next, case examples of public engagement with vaccines are introduced, from pandemic influenza preparedness in the U.S., to polio eradication initiatives in India, and then to COVID-19 public engagement events in England. Settings of public engagement are noted, including online, in churches and museums. Then, there’s a section about communication and public participation, seen as either …


Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi Jan 2025

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …


Toward A Decolonial Digitality: On Seb Franklin's The Digitally Disposed, Travis Alexander Jan 2025

Toward A Decolonial Digitality: On Seb Franklin's The Digitally Disposed, Travis Alexander

English Faculty Publications

[Introduction] If the long hot summer of 2020 marked a season of racial reckoning, it was also—now visible in retrospect—a moment for processing with the relation between digital technologies and power. 8:46 after all names not only an event, a murder, but the title of a short digital film. A film, moreover, that has found decisively counterposed audiences in its ongoing afterlives. A forensics of police violence, on the one hand, 8:46 also avails, in the shadier corners of the dark web, the pleasures of a snuff film. In this way, 8:46 is emblematic of a broader, and, perhaps, terminal …


Perceived Obligations Of Older Partners In Living-Apart-Together Relationships, Allison M. Martin, Timothy S. Killian Jan 2025

Perceived Obligations Of Older Partners In Living-Apart-Together Relationships, Allison M. Martin, Timothy S. Killian

Discovery, The Student Journal of Dale Bumpers College of Agricultural, Food and Life Sciences

Older and middle-aged adults are increasingly in Living-Apart-Together (LAT) relationships characterized by committed romantic relationships without marriage and cohabitation. Because of assumptions that older adults will receive family caregiving as they grow older and need caregiving, it is not clear how people are likely to perceive obligations to provide caregiving assistance. As adults move into old age and incidence rates of Alzheimer’s Disease or Related Dementia (ADRD) increase, questions about the availability of family members to provide needed assistance are complicated by LAT relationships. The purpose of this study was to examine perceived obligations to provide assistance to older adults …


Exploring Psychological Implications Of The Contemporary Lung Transplant, Isaac C. Machar Jan 2025

Exploring Psychological Implications Of The Contemporary Lung Transplant, Isaac C. Machar

Williams Honors College, Honors Research Projects

Since its inception in 1963 at the University of Mississippi Medical Center, more than 50,000 lung transplant procedures have been performed. During its 50-year anniversary, 2023 saw just over 3,000 lung transplants performed in the United Sates. However, as this procedure continues to increase in execution each year, it is critical that the psychological implications of this procedure are explored. In this paper, I hope to develop an understanding of the psychological background of contemporary lung transplantation. Reviewing the lung and double lung transplant, the goal is to apply biopsychology principles to the field. Background information about transplant science is …


Sexual And Reproductive Health Access Among Racial/Ethnic Minority College Students, Srithanvi Pasunuri Jan 2025

Sexual And Reproductive Health Access Among Racial/Ethnic Minority College Students, Srithanvi Pasunuri

Honors Undergraduate Theses

Sexual and reproductive health (SRH) is critical for individual well-being, yet significant disparities in access persist among racial and ethnic minority college students in the United States. These inequities, driven by systemic barriers such as financial constraints, cultural stigmas, and inadequate campus resources, contribute to higher rates of unintended pregnancies, sexually transmitted infections (STIs), and poor health outcomes within these populations. This systematic review aims to identify and synthesize existing literature on the barriers to SRH access for racial and ethnic minority college students, explore how cultural, social, and institutional factors influence service utilization, and assess interventions proven effective in …


Exploring Patient-Provider Communication In Indian American Populations: A Scoping Review, Pranav S. Nadella Jan 2025

Exploring Patient-Provider Communication In Indian American Populations: A Scoping Review, Pranav S. Nadella

Honors Undergraduate Theses

Effective provider-patient communication directly influences patient satisfaction, treatment adherence, and health outcomes, yet the unique experiences of Indian Americans—one of the fastest-growing U.S. populations—remain underexplored in communication research. This scoping review, following Joanna Briggs Institute guidelines, systematically mapped the existing literature on provider-patient communication involving Indian Americans. Eleven studies met inclusion criteria, with data extracted on methods, populations, and seven coded aspects related to communication.

Findings revealed a narrow focus on first-generation immigrants and women, leaving men’s experiences and second-generation voices largely unexamined. Communication was shaped by language discordance, cultural stigma, family involvement, trust dynamics, and health literacy. No studies …


Addressing Barriers In The Primary Prevention Of Hypertension In Black People, Makalah Pierre Rn Bsn Jan 2025

Addressing Barriers In The Primary Prevention Of Hypertension In Black People, Makalah Pierre Rn Bsn

Honors Undergraduate Theses

Hypertension is a significant health concern among minority groups, and the black population is most at risk (Abrahamowicz et al., 2023). The black population experience higher prevalence rates of hypertension compared to other racial groups and are more likely to experience hypertension-related problems, including cardiovascular disease (CVD) and chronic kidney disease (CKD).  This literature review explores various nursing interventions aimed at preventing hypertension within this population. In this review, the term “black people or persons” is a broad term used to describe both African Americans and people of Afro-Caribbean decent. This includes various backgrounds such as Haitian, Jamaican, or otherwise …


Unmasking The Nexus Of Race, Ethnicity, And Health: An Intersectional Analysis Of The Epistemology Of Race In Medicine, Medical Curricula, And Health Disparities, Antoinette Leonard-Jean Charles Jan 2025

Unmasking The Nexus Of Race, Ethnicity, And Health: An Intersectional Analysis Of The Epistemology Of Race In Medicine, Medical Curricula, And Health Disparities, Antoinette Leonard-Jean Charles

Antioch University Dissertations & Theses

The persistent health disparities faced by Black, Indigenous, and People of Color (BIPOC) in the United States are deeply rooted in systemic racism embedded within medical education and clinical practice. Historical acceptance of racial supremacy in the United States has shaped both the foundations and continued practices of medical education, leading to entrenched biases that affect healthcare delivery and patient outcomes. This dissertation critically examines the intersection of race, education, and health by analyzing how historical and contemporary understandings of race and ethnicity shape medical curricula, healthcare practices, and patient care. Through the integration of Critical Race Theory (CRT), Social …


Exploring Lgbtq+ Competency In Healthcare, Jordan Whiteman Jan 2025

Exploring Lgbtq+ Competency In Healthcare, Jordan Whiteman

Honors College Theses

Marginalized groups such as the LGBTQ+ community are known to face healthcare disparities that negatively affect their process of navigating healthcare systems. This project explores the perceived lack of representation and understanding of the LGBTQ+ community within healthcare settings, exposing the deficits in knowledge for unique challenges and inequalities these patients may face. By viewing the literature, a myriad of complications faced by LGBTQ+ people in clinical settings can be identified. They possess a generalized feeling of mistrust towards the healthcare system. Healthcare staff overall describe low confidence with caring for this demographic. Heteronormativity’s presence in the field of healthcare …


A Worker's Struggle, Sakan Binte Imran, Shadman Mahmood Khan Pathan Jan 2025

A Worker's Struggle, Sakan Binte Imran, Shadman Mahmood Khan Pathan

Electrical & Computer Engineering Faculty Publications

[Introduction] The casualty department at Sir Salimullah Medical College Mitford Hospital was crowded, as it always was. The air smelled of antiseptics, and hurried footsteps echoed through the narrow corridors. It was another day of internship, and I had just finished checking on a patient when a nurse called me over.

“There’s a new case in Trauma. Factory worker. Severe hand injury.”

I hurried over and found a man sitting on the examination table. His face was pale, and his forehead was glistening with sweat. His right hand was wrapped in a blood-soaked cloth. His left hand trembled as he …


Minds, Made Up Or Malleable? Covert Commands At The Eclipse Of Vaccine Communications, David H. Lee Jan 2025

Minds, Made Up Or Malleable? Covert Commands At The Eclipse Of Vaccine Communications, David H. Lee

Publications and Research

Abstract: Although millions have died from SARS-CoV-2 illness, COVID vaccines are credited with stemming the tide. Vaccinations and boosters significantly decrease the incidence of severe illness and death (even if they don’t usually prevent COVID-19 infection). Despite the success of global vaccination efforts, frequent reports of vaccine hesitance and refusal suggest that public health communications need improvement.

The chapter begins by acknowledging adverse events associated with COVID vaccination, including rare cases of anaphylaxis, GBS, and myocarditis. An inoculation-theoretic rationale is offered for this admission of vaccine risks: just as immune defenses mount when organisms are exposed to pathogens, so too …


The Ethical Contributions Of Nudges To Healthcare, Ian Doherty Dec 2024

The Ethical Contributions Of Nudges To Healthcare, Ian Doherty

Electronic Theses and Dissertations

“The Ethical Contributions of Nudges to Healthcare” examines the ethical use, implications, and rationale for using nudges in healthcare. The use of nudges in healthcare are being empirically examined. This leaves much to be examined from the ethical perspective. To examine the ethical perspective, the dissertation lays out how nudges interact with and enhance the biomedical principles of autonomy and beneficence. The dissertation then turns to clinical ethics. Nudges, more specifically the framing effect, are paired with trust in the patient-physician relationship to discern how best to aid a patient in his or her medical decision-making. The dissertation then investigates …


The Living Document, Camilla Lyckblad Dec 2024

The Living Document, Camilla Lyckblad

Proceedings from the Document Academy

This physical interactive art piece of thesis research in progress aims to deepen comprehension of information behavior in clinical contexts, where the contemporary medical record, with its increasing digital properties such as open record access for patients, can be viewed as an entity that both listens and influences. The art piece sheds light on the complex dynamics of truth within clinical environments, where patients and healthcare professionals might selectively disclose or withhold information, aiming to protect both patient, clinician and the information itself. Set within a small, dimly lit room, the exhibit features eight aged medical records, each inscribed with …


The Challenge Of Regulating Pharmaceutical Clinical Trials In The 21st Century With A Focus On Guatemala, Alejandro Cerón, Antonio Ricafort, Carter Saccocio, Maria Delmonte, Jordan Vasquez, Amarri Bishop, Julia Atwood, Addison Bucsko, Jordan Lewis, Alexandra Welch, Itzael Garcia, Ella Wald, Selena Johnson, Crystal Jin, Talya Riciputi, Lindsey Speer, Vanessa Udo-Obong, Soren Engberg, Tessa Lindstrom Dec 2024

The Challenge Of Regulating Pharmaceutical Clinical Trials In The 21st Century With A Focus On Guatemala, Alejandro Cerón, Antonio Ricafort, Carter Saccocio, Maria Delmonte, Jordan Vasquez, Amarri Bishop, Julia Atwood, Addison Bucsko, Jordan Lewis, Alexandra Welch, Itzael Garcia, Ella Wald, Selena Johnson, Crystal Jin, Talya Riciputi, Lindsey Speer, Vanessa Udo-Obong, Soren Engberg, Tessa Lindstrom

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students and instructor of the "Right to Health in Theory and Practice" class taught in the fall of 2024 at the University of Denver. The report was prepared for the Vice Ministry of Health Regulation, Surveillance and Control of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: What can a country like Guatemala do to regulate international pharmaceutical clinical trials in the context of research commercialization? In other words, the work was guided by three important elements. First, the regulatory aspect of clinical trials. Second, …


Caracterización Lingüístico-Discursiva De Los Mecanismos De Despersonalización Y Posicionamiento Del Autor En El Género Médico Ficha Clínica, David Sanchez-Jimenez, Paulina Meza Nov 2024

Caracterización Lingüístico-Discursiva De Los Mecanismos De Despersonalización Y Posicionamiento Del Autor En El Género Médico Ficha Clínica, David Sanchez-Jimenez, Paulina Meza

Publications and Research

El dominio de géneros especializados es una competencia que representa gran dificultad para los estudiantes en formación. Su falta de dominio puede impedir o retrasar el proceso de enculturación de un individuo en una comunidad. Para formar adecuadamente a los estudiantes en las prácticas discursivas disciplinares, son necesarios datos empíricos sobre las características lingüístico-discursivas de los textos que deben producir. El objetivo de esta investigación cualitativa es describir los recursos lingüístico-discursivos de despersonalización y posicionamiento del autor en el género médico Ficha clínica. El corpus está constituido por 52 Fichas clínicas producidas por estudiantes de medicina de una universidad chilena. …


Implementing Online Educational Modules To Introduce Specialty Disability Care To Students In Undergraduate Nursing Programs, Keegan Brunner, Molly Helton Oct 2024

Implementing Online Educational Modules To Introduce Specialty Disability Care To Students In Undergraduate Nursing Programs, Keegan Brunner, Molly Helton

James Madison Undergraduate Research Journal (JMURJ)

In 2016, 1 in 4 adults reported living with a disability in the United States; however, few nursing schools include education about how to best care for these individuals in their curricula. Studies have found that when nurses and other healthcare workers have better attitudes toward patients with disabilities, it leads to better health outcomes. The literature suggests that education and exposure are the most effective ways to increase positive attitudes toward disabled communities. This study offered Equity Access modules titled “Disability and Healthcare” and “Accessibility” developed by Duquesne University to pre-professional health students planning on pursuing Nursing degrees at …


Challenges Of Conceptualizing, Creating, And Researching The History Of South Louisiana Hospitals, Chandler D. Smith, Jennifer K. Lloyd Oct 2024

Challenges Of Conceptualizing, Creating, And Researching The History Of South Louisiana Hospitals, Chandler D. Smith, Jennifer K. Lloyd

Library Faculty Publications

Objective: To create a resource guide on closed and relocated historical hospitals in the southern region of Louisiana, documenting rural and urban hospitals with their address, years open, interesting facts, and photographs if available.

Methods: A reference question about a historical hospital in the area prompted the idea, as when doing research for information about the hospital, it was more challenging than initially thought it would be to find photos and other information. Information was collected from a wide range of sources such as directories, newspaper and magazine articles, government reports, etc. Using this information, we have built a public …


Demographic Characteristics, Perinatal Smoking Patterns, And Risk For Neonatal Health Complications Among Pregnant Smokers In The United States Who Begin Using Electronic Cigarettes During Pregnancy: A Descriptive Study Using Population-Based Surveillance Data., Hui Nian, Rachel Odland, Samantha Mindlin, Lin Ammar, Hilary Tindle, Angela M Miller, Kelli K Ryckman, Ethan Xie, Tina V Hartert, Brittney M Snyder, Steven M Brunwasser, Pingsheng Wu Oct 2024

Demographic Characteristics, Perinatal Smoking Patterns, And Risk For Neonatal Health Complications Among Pregnant Smokers In The United States Who Begin Using Electronic Cigarettes During Pregnancy: A Descriptive Study Using Population-Based Surveillance Data., Hui Nian, Rachel Odland, Samantha Mindlin, Lin Ammar, Hilary Tindle, Angela M Miller, Kelli K Ryckman, Ethan Xie, Tina V Hartert, Brittney M Snyder, Steven M Brunwasser, Pingsheng Wu

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: Health agencies have called for research evaluating e-cigarette (EC) use in supporting prenatal smoking cessation. This study aimed to describe (1) the characteristics of smokers who begin using electronic cigarettes (ECs) during pregnancy, (2) how frequently smokers reduce or eliminate pre- and post-natal combustible cigarette (CC) use, and (3) the risk for neonatal health complications among smokers who initiate ECs during pregnancy.

AIMS AND METHODS: Pregnant women using CCs exclusively during prepregnancy, who participated in a U.S. surveillance study, were classified by their reported late-pregnancy smoking behavior as CC-exclusive users, EC initiators, or quitters. EC initiators were further subclassified …


Finding The Right Mentor & Maintaining The Relationship Through Key Conversations, Adebisi Alli, Ankita Sagar, Eliza Lo Chin, Paulina Awuah-Saadiq, Susan Thompson Hingle Oct 2024

Finding The Right Mentor & Maintaining The Relationship Through Key Conversations, Adebisi Alli, Ankita Sagar, Eliza Lo Chin, Paulina Awuah-Saadiq, Susan Thompson Hingle

Journal of Wellness

No abstract provided.


Advances In Biomedical Research And Treatments: What Is Acceptable?, Michael L. Clancy, Khalid M. Iskandarani, Mitchell C. Mccrea Oct 2024

Advances In Biomedical Research And Treatments: What Is Acceptable?, Michael L. Clancy, Khalid M. Iskandarani, Mitchell C. Mccrea

Journal of Health Ethics

This study investigated the technology acceptance (TA) of twenty-first century biomedical treatments by adults in the United States. A new TA instrument was created, using five distinct levels: (1) Healing and Prevention, (2) Replacement Organs, (3) Enhancements-Medical, (4) Enhancements-Discretionary, and (5) Transhumans. An on-line survey produced 353 usable responses, which showed distinct patterns for each of five biomedical treatment levels. There was clear support for Levels 1–3, but very strong opposition to Levels 4–5. The TA finding draws the line between which human interventions are acceptable versus others that should be prohibited through public policies and medical guidelines.


Residency Reflections, Naleen Patel Md Oct 2024

Residency Reflections, Naleen Patel Md

Journal of Wellness

No abstract provided.


Reviving Hysteria: The Nineteenth Century At The End Of The Twentieth, Christina Quintana Sep 2024

Reviving Hysteria: The Nineteenth Century At The End Of The Twentieth, Christina Quintana

Dissertations, Theses, and Capstone Projects

This dissertation explores popular and medical representations of female madness in two time periods: the late nineteenth and late twentieth centuries. I argue that 1990s American culture produced an abundance of texts, images, and narratives that revitalized the iconography and medical discourses of late nineteenth-century hysteria. Analyzing popular texts, films, and cultural touchstones of the 1990s, I explore how Victorian ideas about women’s minds—such as the inherent feebleness of the female brain and nervous system; the fatalistic, life-altering effects of female puberty; the association between hysteria and deviant female sexuality; and the implicit racialization of hysteria and female madness more …


Baby Dust: A Narrative Analysis Of Infertility Journeys On Youtube, Patricia Carrillo Aug 2024

Baby Dust: A Narrative Analysis Of Infertility Journeys On Youtube, Patricia Carrillo

Electronic Theses and Dissertations

Infertility is a distressing experience for those diagnosed and often exacerbated by engagement with biomedical treatments. This thesis is an exploration of infertility “journeys” posted on YouTube. Through a narrative analysis of 8 YouTube channels, several key themes were identified, specifically embodiment of the infertility label, barriers to treatment, and agency. This work uses the mindful body framework to look at how the individual body, social body, and body politic shape and reinforce these themes in the context of biomedical infertility treatment. These findings suggest infertility is a dynamic and distressing experience but by engaging in the narrative process, through …


The Bench To Community Initiative: Community-Based Participatory Research Model For Translating Research Discoveries Into Community Solutions, Jazma L. Tapia, Abigail Lopez, D. Bing Turner, Tonya Fairley, Tiah Tomlin-Harris, Maggie Hawkins, Pastor Rhonda Holbert, Lindsey S. Treviño, Dede K. Teteh-Brooks Aug 2024

The Bench To Community Initiative: Community-Based Participatory Research Model For Translating Research Discoveries Into Community Solutions, Jazma L. Tapia, Abigail Lopez, D. Bing Turner, Tonya Fairley, Tiah Tomlin-Harris, Maggie Hawkins, Pastor Rhonda Holbert, Lindsey S. Treviño, Dede K. Teteh-Brooks

Health Sciences and Kinesiology Faculty Articles

Methods: Community-based participatory research (CBPR) is an effective methodology for translating research findings from academia to community interventions. The Bench to Community Initiative (BCI), a CBPR program, builds on prior research to engage stakeholders across multiple disciplines with the goal of disseminating interventions to reduce breast cancer disparities and improve quality of life of Black communities.

The BCI program was established to understand sociocultural determinants of personal care product use, evaluate the biological impact of endocrine disrupting chemicals, and develop community interventions. The three pillars of the program include research, outreach and engagement as well as advocacy activities. The research …


Analyzing The Message Complexity, Signal Words, And Readability Of Medical Tourism Warning Messages, Alicia Mason, Sakshi Bhati Aug 2024

Analyzing The Message Complexity, Signal Words, And Readability Of Medical Tourism Warning Messages, Alicia Mason, Sakshi Bhati

Faculty Submissions

Medical tourists are deemed to be a vulnerable patient population because they often have limited knowledge of the specialized health care treatment and services they seek. They are also frequently unfamiliar with the medical tourism physicians, providers, and facilitators with whom they interact. As a result, travel, biomedical, and procedural risks are often difficult to define and estimate. This analysis uses computer-automated technology to analyze the risk and warning messages distributed by government and private medical associations to medical tourists. Results show these messages are often complex and highly textual with little visual graphic elements. The messages frequently lack key …