Public Health Commons^™

The Role Of Intermittent Preventive Treatment For Malaria In Saving Lives And Promoting Drug Resistance, Carrie Manore

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

A Stochastic Epidemiological Model Of The Response Of American Chestnut Populations To Fungal Blight, Kelsey Lieberman, Rebecca Rouleau, Anita Davelos Baines, Martin Allen

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

How I Learned To Communicate My Inner Life With Asperger’S: Ted Talk Annotated Resource List, Meghan Rice

Undergraduate Research Award

No abstract provided.

Healthcare Outcomes And Resource Utilization Associated With Neonatal Hypoglycemia: Analysis Of Data From The Hcup Kid’S Inpatient Database, Brook T. Alemu

Health Services Research Dissertations

Neonatal hypoglycemia is the most common metabolic abnormality in infants and is associated with neurological damage and death. The risk of developing hypoglycemia among infants born from diabetic mothers is even higher. Although much work has been performed addressing issues for treatment and care, research related to neonatal hypoglycemia has been focused on the clinical or individual level risk factors. Contextual risk factors such as hospital characteristics, neighborhood economic status, and regional variations were not considered in earlier studies. Additionally, although healthcare resources utilization of hypoglycemia has been adequately addressed in the adult population, this topic has not been studied …

Dietary Inflammatory Index And Colorectal Cancer Risk – A Meta-Analysis, Nitin Shivappa, Justyna Godos, James R. Hébert, Michael David Wirth, Gabriele Piuri, Attilio Speciani, Giuseppe Grosso

Faculty Publications

Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus …

Challenges In Modeling Complexity Of Neglected Tropical Diseases: A Review Of Dynamics Of Visceral Leishmaniasis In Resource Limited Settings, Swati Debroy, Olivia F. Prosper, Austin Mishoe, Anuj Mubayi

Mathematics Faculty Publications

Objectives: Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects …

Prevalence And Trends In Transmitted And Acquired Antiretroviral Drug Resistance, Washington, Dc, 1999-2014., Annette M Aldous, Amanda D Castel, David M Parenti

Epidemiology Faculty Publications

Background

Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC.

Methods

We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, …

Trends In The Environmental Health Job Market For New Graduates, Jason W. Marion, Timothy J. Murphy Phd, Anne Marie Zimeri Phd

EKU Faculty and Staff Scholarship

The question of whether the job market can support future graduates of environmental health programs remains an important and difficult question for environmental health programs, current and prospective students, parents, and other stakeholders. Our previous report using 2014 data from the U.S. Bureau of Labor Statistics demonstrated anticipated growth and higher than average pay in the profession through at least 2022 for baccalaureate degree holders (Marion & Sinde, 2015). Growth in the profession does not necessarily translate into job availability if the market is saturated with job candidates. While university programs produce graduates, local health departments (LHDs) have suffered tremendous …

Lyme Disease And Youtube™: A Cross-Sectional Study Of Video Contents, Corey H. Basch, Lindsay A. Mullican, Kwanza D. Boone, Jingjing Yin, Alyssa Berdnik, Marina E. Eremeeva, Isaac Chun-Hai Fung

Environmental Health Sciences: Faculty Publications

Objectives: Lyme disease is the most common tick-borne disease. People seek health information on Lyme disease from YouTubeTM videos. In this study, we investigated if the contents of Lyme disease-related YouTubeTM videos varied by their sources.

Methods: Most viewed English YouTubeTM videos (n = 100) were identified and manually coded for contents and sources.

Results: Within the sample, 40 videos were consumer-generated, 31 were internet-based news, 16 were professional, and 13 were TV news. Compared with consumer-generated videos, TV news videos were more likely to mention celebrities (odds ratio [OR], 10.57; 95% confidence interval [CI], 2.13–52.58), prevention of Lyme disease …

Level Of Exposure Of Childhood Tuberculosis With Adult Pulmonary Tuberculosis Household Contacts, Al Asyary, Tris Eryando, Purwantyastuti Purwantyastuti, Purnawan Junadi, Carol Clark, Edwin Van Teijlingen

Kesmas

Tuberkulosis paru (TB) pada anak kian menjadi masalah kesehatan global yang masih terlupakan seiring dengan peningkatan proporsi TB di Indonesia. Penularan penyakit ini di populasi umum seringkali berdampak pada anak, terlebih ketika kontak TB terjadi di rumah tangga. Penelitian ini bertujuan untuk memperoleh faktor protektif sehingga anak tetap sehat meskipun memiliki kontak dengan penderita TB dewasa serumah. Penelitian ini dilakukan dengan pendekatan kasus kontrol pada 132 responden anak yang berasal dari delapan rumah sakit rujukan dan beberapa puskesmas di Provinsi Daerah Istimewa Yogyakarta. Penelitian dilakukan dalam periode Januari hingga Desember 2014 yang hasilnya dianalisis dengan uji bivariat (kai kuadrat) dan …

Influence Of Quality Of Work Life Towards Psychological Well-Being And Turnover Intention Of Nurses And Midwives In Hospital, Indra Wahju Hardjanti, Aryo Dewanto, Noermijati Noermijati

Kesmas

Selama ini perawat telah dilatih untuk memberikan perawatan pasien dan meningkatkan kualitas hidup pasien, namun kualitas kehidupan kerja dan psychological well-being mereka sendiri terabaikan. Rendahnya kualitas kehidupan kerja perawat di rumah sakit menyebabkan tingginya keinginan pindah kerja perawat. Tingginya angka keinginan pindah kerja perawat dan bidan di Rumah Sakit X Malang merupakan masalah yang memerlukan perhatian dari manajemen rumah sakit agar tidak menjadi menyebabkan rendahnya mutu pelayanan kesehatan di rumah sakit. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas kehidupan kerja, psychological well-being, dan keinginan pindah kerja perawat dan bidan di rumah sakit. Penelitian ini menggunakan desain penelitian kuantitatif korelasional …

Risk Differences Between Elderly Men And Women Toward Doctor-Diagnosed Diabetes Mellitus In Urban Areas In Indonesia: 2013 National Basic Health Research Data, Meiwita Budiharsana

Kesmas

Diabetes melitus (DM) adalah salah satu penyakit tidak menular yang paling umum di Indonesia. DM disebabkan berbagai faktor risiko. Peningkatan prevalensi DM salah satunya disebabkan oleh perubahan gaya hidup di perkotaan. Penelitian ini bertujuan untuk menguji perbedaan prevalensi DM yang didiagnosis dokter pada laki-laki dan perempuan usia 15 tahun keatas yang tinggal di daerah perkotaan di Indonesia. Analisis menggunakan data sekunder Riset Kesehatan Dasar (Riskesdas) 2013 dengan desain studi potong lintang. Total sampel sebanyak 333.731 responden. Metode analisis menggunakan regresi logistik ganda. Hasil menunjukkan bahwa DM yang didiagnosis dokter pada laki-laki dan perempuan usia 15-39 tahun di perkotaan tidak berbeda. …

Bancroftian Filariasis Transmission Parameters After The Fifth Year Of Filiariasis Mass Drug Administration In Pekalongan City, Tutik Ida Rosanti, Sugeng Juwono Mardihusodo, Wayan Artama

Kesmas

Penelitian ini bertujuan untuk mengukur parameter parasitologi (microfilaria rate, kepadatan mikrofilaria), parameter imunologi (antigen prevalence) dan parameter entomologi (infection rate dan infective rate) pada tahun kelima pelaksanaan mass drug administration di Kelurahan Pabean Kota Pekalongan. Penelitian ini merupakan penelitian observasional dengan pendekatan potong lintang yang dilaksanakan pada bulan Juli sampai dengan Agustus 2015 di Kelurahan Pabean Kota Pekalongan. Microfilaria rate dan kepadatan mikrofilaria ditentukan dengan pemeriksaan darah jari pada 313 responden. Antigen prevalence ditentukan dengan mengukur antigen beredar menggunakan metode immunochromatographic test (ICT) Wuchereria bancrofti. Incective rate dan infection rate diukur dengan cara menemukan larva cacing filaria pada nyamuk hasil …

Provision Of Informed Consent Towards The Level Of Anxiety In Pre-Operative Patients At Mamuju District Public Hospital, Imelda Appulembang

Kesmas

Tindakan pembedahan merupakan salah satu tindakan medis yang dapat mendatangkan stressor sehingga menimbulkan kecemasan pada pasien. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian informed consent terhadap tingkat kecemasan pada pasien pra-operasi di Rumah Sakit Umum Daerah (RSUD) Mamuju. Populasi pada penelitian ini adalah pasien pra-operasi. Sampel ditentukan dengan menggunakan pendekatan accidental sampling sehingga diperoleh sampel sebanyak 32 orang. Jenis penelitian ini adalah penelitian kuantitatif dengan menggunakan metode quasi experimental design melalui pendekatan non-equivalent time sample design yang dianalisis dengan menggunakan uji statistik Wilcoxon. Hasil penelitian menunjukkan bahwa terdapat pengaruh pemberian informed consent terhadap tingkat kecemasan pasien. Dapat disimpulkan pemberian informed …

Effects Of Contraceptive Use On Productivity Of Women Labor At Pt. Bomar Makassar Industrial Area, Masni Mappajanci, Andi Misnawati, Darmawansyah Darmawansyah

Kesmas

Produktivitas kerja potensial pada kelangsungan hidup perusahaan. Penggunaan kontrasepsi dapat memengaruhi fisiologi setiap perempuan, sehingga dapat memengaruhi aktivitas sehari-hari dan akan berdampak terhadap produktivitas tenaga kerja. Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan alat kontrasepsi terhadap produktivitas tenaga kerja perempuan dengan mengontrol usia, pendidikan dan motivasi kerja. Penelitian dengan rancangan potong lintang melibatkan 71 pekerja perempuan PT Bomar Makassar yang telah menikah. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner pada bulan Mei sampai Juni 2015, kemudian dianalisis secara univariat, bivariat, dan multivariat. Hasil penelitian menunjukkan bahwa terdapat pengaruh penggunaan alat kontrasepsi terhadap produktivitas kerja setelah dikontrol dengan variabel usia (nilai …

Influence Of Scaling Up Nutrition Education Towards Knowledge And Attitude Of Students At Santa Elisabeth Medan School Of Health Sciences, Rani Gartika Holivia Silalahi, Yesschi Anggraeni Tambunan

Kesmas

Tingginya angka pernikahan pada usia remaja yang disertai dengan rendahnya pengetahuan tentang pola asuh merupakan salah satu pemicu terjadinya masalah gizi. Remaja merupakan orang tua masa depan. Tujuan penelitian ini untuk mengetahui pengaruh pendidikan 1.000 hari pertama kehidupan terhadap pengetahuan dan sikap mahasiswi Sekolah Tinggi Ilmu Kesehatan Santa Elisabeth Medan tahun 2016. Penelitian ini menggunakan kuasi eksperimental dengan desain one group pre- dan post test. Metode pengambilan sampel dengan metode purposive sampling sebanyak 115 mahasiswi tingkat III program studi Diploma III Kebidanan. Pendidikan dilakukan di kelas sebanyak 4 kali dalam 2 minggu dengan menggunakan metode mengajar dan diskusi. Penelitian ini …

The Profile And Determinant Factors Of Quality Of Life In Patients With Diabetic Neuropathy, Rizaldy Taslim Pinzon, Kadek Sinthia Grahita Adnyana, Marta Lisnawati Zalukhu

Kesmas

Neuropati merupakan salah satu komplikasi tersering pada diabetes melitus (DM). Neuropati dapat memengaruhi kualitas hidup, derajat kesehatan, maupun tingkat ekonomi. Oleh karena itu, penting untuk mengetahui kualitas hidup pasien DM dengan neuropati beserta dampak yang ditimbulkannya terlebih dahulu agar mendapatkan penanganan yang tepat demi meningkatkan kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui profil kualitas hidup pasien DM dengan neuropati. Penelitian ini merupakan studi observasional menggunakan Short Form 8 (SF-8) Health Survey Standard Indonesia terhadap pasien diabetes melitus dengan neuropati yang diambil secara konsekutif pada bulan Maret hingga Agustus 2016 di Poli Saraf Rumah Sakit Bethesda, Yogyakarta. Terdapat 57 subjek …

The Relationship Of Plasma Trans Fatty Acids With Dietary Inflammatory Index Among Us Adults, Mohsen Mazidi, Hong-Kai Gao, Nitin Shivappa, Michael David Wirth, James R. Hébert, Andre Pascal Kengne

Faculty Publications

Background: It has been suggested that trans fatty acids (TFAs) play an important role in cardiovascular diseases. We investigated the association between plasma TFAs and the dietary inflammatory index (DII) ™ in US adults.

Methods: National Health and Nutrition Examination Survey (NHANES) participants with data on plasma TFAs measured from 1999 to 2010 were included. Energy-adjusted-DII ™ (E-DII ™) expressed per 1000 kcal was calculated from 24-h dietary recalls. All statistical analyses accounted for the survey design and sample weights.

Results: Of the 5446 eligible participants, 46.8% (n = 2550) were men. The mean age of the population was 47.1 …

Marketing Strategy Of School Of Professional Studies In China, Jiahui Liu, Jing Wang, Shuo An, Wengxing Wang, Yiwei Wang

School of Professional Studies

Chinese students are the most visible international presence at many universities across the United States, and the number continues to grow. Since 2010, The number of graduate students studying abroad has entered the period in which the increase has been declining. Under the circumstance of the weak global economy and high cost of education, the administration needs to attract the attention of Chinese students. In the process of competing for applicants, how to develop marketing strategies to attract students’ eyeballs has become an important means of trying to increase school income through Chinese students. The marketing strategy mentioned in this …

A Comparison Of Outdoor Bioaerosol And Particulate Measurements In Las Vegas, Tanviben Yogeshkumar Patel

UNLV Theses, Dissertations, Professional Papers, and Capstones

The urbanization of the Las Vegas Valley has turned the desert into a green oasis by introducing many non-native plant species, some of which are allergenic. Outdoor bioaerosols consist of microorganisms, pollen, spores, and other agents that could cause infections or affect the health of humans. Studies have suggested that exposure to bioaerosols through inhalation can lead to various human health risks. Typically, one monitoring station is established per city to obtain pollen and mold counts for an entire metropolitan area, and the site may not be representative of community exposures. The objective of this study was to measure and …

Bayesian Model Averaging With Change Points To Assess The Impact Of Vaccination And Public Health Interventions., Esra Kürüm, Joshua L Warren, Cynthia Schuck-Paim, Roger Lustig, Joseph A Lewnard, Rodrigo Fuentes, Christian A W Bruhn, Robert J Taylor, Lone Simonsen, Daniel M Weinberger

Global Health Faculty Publications

Background: Pneumococcal conjugate vaccines (PCVs) prevent invasive pneumococcal disease and pneumonia. However, some low-and middle-income countries have yet to introduce PCV into their immunization programs due, in part, to lack of certainty about the potential impact. Assessing PCV benefits is challenging because specific data on pneumococcal disease are often lacking, and it can be difficult to separate the effects of factors other than the vaccine that could also affect pneumococcal disease rates.

Methods: We assess PCV impact by combining Bayesian model averaging with change-point models to estimate the timing and magnitude of vaccine-associated changes, while controlling for seasonality and other …

Socioeconomic Status, Air Quality And Geographic Variation In Emergency Room Visits For Acute Bronchitis On The California Central Coast, Sean Lang-Brown, Heather W. Starnes, Gary B. Hughes

Symposium

IMPORTANCE: Analysis of geospatial variation in acute bronchitis due to socioeconomic and environmental factors can allow the efficient delivery of resources to populations most at risk.

OBJECTIVE: We sought to determine if small scale variation in socioeconomic factors and emergency room (ER) visits for acute bronchitis are associated in small cities or rural communities. We also modeled the effects of air quality on daily rates of ER visits for acute bronchitis in the context of socioeconomic factors to investigate modifying relationships.

DESIGN, SETTING, AND PARTICIPANTS: We examined ER visits for acute bronchitis in San Luis Obispo and Santa Barbara counties …

Mixture Models For Undiagnosed Prevalent Disease And Interval-Censored Incident Disease: Applications To A Cohort Assembled From Electronic Health Records., Li C Cheung, Qing Pan, Noorie Hyun, Mark Schiffman, Barbara Fetterman, Philip E Castle, Thomas Lorey, Hormuzd A Katki

Epidemiology Faculty Publications

For cost-effectiveness and efficiency, many large-scale general-purpose cohort studies are being assembled within large health-care providers who use electronic health records. Two key features of such data are that incident disease is interval-censored between irregular visits and there can be pre-existing (prevalent) disease. Because prevalent disease is not always immediately diagnosed, some disease diagnosed at later visits are actually undiagnosed prevalent disease. We consider prevalent disease as a point mass at time zero for clinical applications where there is no interest in time of prevalent disease onset. We demonstrate that the naive Kaplan-Meier cumulative risk estimator underestimates risks at early …

Higher Education Capacity Building In Water Resources Engineering And Management To Support Achieving The Sustainable Development Goal For Water In Pakistan, Steven J. Burian, Mercedes Ward, Tariq Banuri, M. Aslam Chaudhry, Sajjad Ahmad, Bakhshal Lashari, Rasool Bux Mahar, Davey Stevenson, Jim Vanderslice, Kamran Ansari, Munir Babar, Abdul Latif Qureshi

Civil and Environmental Engineering and Construction Faculty Research

Achieving the Sustainable Development Goals requires a multi‐pronged approach, with a key element being the development of a trained Community of Practice to sustain the advances in the relevant sectors. The engagement of higher education as a catalyst in the development and capacity building of the next generation of professionals and citizens comprising the Community of Practice is essential to meet the challenges of poverty, climate change, and clean water and to sustain those advances past 2030. This paper describes a capacity building program funded by the United States Agency for International Development to partner the University of Utah, in …

Analysis Of A Potential A(H7n9) Influenza Pandemic Outbreak In The U.S., Walter A. Silva Sotillo

USF Tampa Graduate Theses and Dissertations

This dissertation presents a collection of manuscripts that describe development of models and model implementation to analyze impact of potential A(H7N9) pandemic influenza outbreak in the U.S. Though this virus is still only animal-to-human transmittable, it has potential to become human-to-human transmittable and trigger a pandemic. This work is motivated by the negative impact on human lives that this virus has already caused in China, and is intended to support public health officials in preparing to protect U.S. population from a potential outbreak of pandemic scale.

An agent-based (AB) simulation model is used to replicate the social dynamics of the …

Influence Of Environmental Parameters On Mold Sampling Results, Benjamin Fishman

USF Tampa Graduate Theses and Dissertations

Mold is a type of fungus present in nearly all environments. Mold thrives under several environmental parameters such as high humidity and an adequate food source. A professional, such as an industrial hygienist, can measure mold in indoor and outdoor environments. Industrial hygienists commonly use a cascade impactor with a culture plate to capture air within a sampling area. While collecting air samples, environmental parameters such as temperature, humidity, and carbon dioxide are recorded. A laboratory then cultures and analyzes the samples, identifying the types and amounts of viable mold found in the sampling area.

In this study, a data …

Safety Of Induced Sputum Collection In Children Hospitalized With Severe Or Very Severe Pneumonia., Andrea N Deluca, Laura L Hammitt, Julia Kim, Melissa M Higdon, Henry C Baggett, Daniel E Park, +Several Additional Authors

Epidemiology Faculty Publications

Background.: Induced sputum (IS) may provide diagnostic information about the etiology of pneumonia. The safety of this procedure across a heterogeneous population with severe pneumonia in low- and middle-income countries has not been described.

Methods.: IS specimens were obtained as part a 7-country study of the etiology of severe and very severe pneumonia in hospitalized childrenbefore, during, and after the procedure to record oxygen requirement, oxygen saturation, respiratory rate, consciousness level, and other evidence of clinical deterioration. Criteria for IS contraindications were predefined and serious adverse events (SAEs) were reported to ethics committees and a central safety monitor.

Results.: A …

Data Management And Data Quality In Perch, A Large International Case-Control Study Of Severe Childhood Pneumonia., Nora L Watson, Christine Prosperi, Amanda J Driscoll, Melissa M Higdon, Daniel E Park, Megan Sanza, Andrea N Deluca, Juliet O Awori, Doli Goswami, Emily Hammond, Lokman Hossain, Catherine Johnson, Alice Kamau, Locadiah Kuwanda, David P Moore, Omid Neyzari, Uma Onwuchekwa, David Parker, Patranuch Sapchookul

Epidemiology Faculty Publications

The Pneumonia Etiology Research for Child Health (PERCH) study is the largest multicountry etiology study of pediatric pneumonia undertaken in the past 3 decades. The study enrolled 4232 hospitalized cases and 5325 controls over 2 years across 9 research sites in 7 countries in Africa and Asia. The volume and complexity of data collection in PERCH presented considerable logistical and technical challenges. The project chose an internet-based data entry system to allow real-time access to the data, enabling the project to monitor and clean incoming data and perform preliminary analyses throughout the study. To ensure high-quality data, the project developed …

Colonization Density Of The Upper Respiratory Tract As A Predictor Of Pneumonia-Haemophilus Influenzae, Moraxella Catarrhalis, Staphylococcus Aureus, And Pneumocystis Jirovecii., Daniel E Park, Henry C Baggett, Stephen R C Howie, Qiyuan Shi, Nora L Watson, W Abdullah Brooks, Perch Study Group

Epidemiology Faculty Publications

Background.

There is limited information on the association between colonization density of upper respiratory tract colonizers and pathogen-specific pneumonia. We assessed this association for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. Methods.

In 7 low- and middle-income countries, nasopharyngeal/oropharyngeal swabs from children with severe pneumonia and age-frequency matched community controls were tested using quantitative polymerase chain reaction (PCR). Differences in median colonization density were evaluated using the Wilcoxon rank-sum test. Density cutoffs were determined using receiver operating characteristic curves. Cases with a pathogen identified from lung aspirate culture or PCR, pleural fluid culture or …

Microscopic Analysis And Quality Assessment Of Induced Sputum From Children With Pneumonia In The Perch Study., David R Murdoch, Susan C Morpeth, Laura L Hammitt, Amanda J Driscoll, Daniel E Park, +Several Additional Authors

Epidemiology Faculty Publications

Background.

It is standard practice for laboratories to assess the cellular quality of expectorated sputum specimens to check that they originated from the lower respiratory tract. The presence of low numbers of squamous epithelial cells (SECs) and high numbers of polymorphonuclear (PMN) cells are regarded as indicative of a lower respiratory tract specimen. However, these quality ratings have never been evaluated for induced sputum specimens from children with suspected pneumonia. Methods.

We evaluated induced sputum Gram stain smears and cultures from hospitalized children aged 1–59 months enrolled in a large study of community-acquired pneumonia. We hypothesized that a specimen representative …