Open Access. Powered by Scholars. Published by Universities.®

Public Health Commons™

Open Access. Powered by Scholars. Published by Universities.®

2021

Discipline
Institution
Keyword
Publication
Publication Type
File Type

Articles 2851 - 2880 of 4752

Full-Text Articles in Public Health

2021-04-06_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services Apr 2021

2021-04-06_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …


2021-04-06_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services Apr 2021

2021-04-06_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …


2021-04-06_Michigandaily_Covidmap, Michigan Department Of Health & Human Services Apr 2021

2021-04-06_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …


Dietary Inflammatory Index Is Related To Heart Failure Risk And Cardiac Function: A Case-Control Study In Heart Failure Patients, Jalal Moludi, Nitin Shivappa Mbbs, Mph, Ph.D., Soghra Alisgharzadeh, James R. Hébert Scd, Mohammad Alizadeh Apr 2021

Dietary Inflammatory Index Is Related To Heart Failure Risk And Cardiac Function: A Case-Control Study In Heart Failure Patients, Jalal Moludi, Nitin Shivappa Mbbs, Mph, Ph.D., Soghra Alisgharzadeh, James R. Hébert Scd, Mohammad Alizadeh

Faculty Publications

Aims: Previous studies suggest that diet and inflammation are important risk factors for heart failure (HF); however, the associations remain unclear. The Dietary Inflammatory Index (DII®) was established to measure the inflammatory capacity of individuals' diet. This study aimed to explore the DII in HF subjects compared with controls. Methods and Results: We conducted a case–control (116 cases and 113 controls) study that recruited in the similar clinics. DII scores were calculated based on dietary intakes. N-Terminal pro-brain natriuretic peptide (NT-proBNP) levels and ejection fraction (EF) were assessed in both groups. In order to analyze DII scores with HF as …


2021-04-05_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …


2021-03-05_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services Apr 2021

2021-03-05_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services

Michigan COVID-19 Vaccine Data

The COVID Vaccine Dashboard page was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214-547150--,00.html.

Data is updated Monday through Saturday. Previously reported numbers of administered vaccine doses may change as new data are received. A possible lag in reporting vaccine doses will result in increases in numbers previously reported.

This report is created by the Michigan Department of Health and Human Services Division of Immunization from data reported to the Michigan Care Improvement Registry (MCIR).

The dashboard contained the tabs Vaccines Shipped, Distribution Trend, Doses Administered, Doses by Vaccine, Doses Metrics, Coverage, Coverage Metrics …


2021-04-05_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.


2021-04-05_Michigandaily_Covidmap, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …


2021-04-05_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …


2021-04-05_Michiganoverview_Covidcounts, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michiganoverview_Covidcounts, Michigan Department Of Health & Human Services

Michigan COVID-19 Confirmed Cases by Date of Onset Data

Data was downloaded as an Excel spreadsheet which appeared in the Public Use Datasets section under the Cumulative Data link of Michigan's Coronavirus webpage, under the url https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html.

Cases are aggregated by the date of onset of COVID-19 symptoms, if known, otherwise by laboratory specimen date if known, otherwise by case referral date. Deaths are aggregated by the date of death if known, otherwise by the last date of a change to the case status.


2021-04-05_Michiganoverview_Covidschooloutbreak, Michigan Department Of Health & Human Services Apr 2021

2021-04-05_Michiganoverview_Covidschooloutbreak, Michigan Department Of Health & Human Services

Michigan COVID-19 Outbreak Reports

The School Outbreak Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_102480---,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by local health departments. Data is updated every week.

In accordance with the Council of State and Territorial Epidemiologists’ outbreak definition, schools that have been found by their local health department to have two (2) or more COVID-19 cases who may have shared exposure at the school grounds and are not from the same household (with the exception of dorms and off-campus housing) are included. If your child’s school is …


Spatial Analysis Of Health Care Utilization Among Medicare Beneficiaries With Coal Workers’ Pneumoconiosis And Other Related Pneumoconiosis, Ahmed A. Arif, Claudio Owusu, Rajib Paul, Christopher M. Blanchette, Ripsi P. Patel, Tyrone F. Borders Apr 2021

Spatial Analysis Of Health Care Utilization Among Medicare Beneficiaries With Coal Workers’ Pneumoconiosis And Other Related Pneumoconiosis, Ahmed A. Arif, Claudio Owusu, Rajib Paul, Christopher M. Blanchette, Ripsi P. Patel, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

  • The states with the highest number of Medicare beneficiaries with coal workers’ pneumoconiosis (CWP) were Kentucky, West Virginia, Virginia, and Pennsylvania.
  • Significant clustering of health care utilization rates for Medicare beneficiaries with CWP was observed in the central Appalachian states of Kentucky, West Virginia, and Virginia.
  • Significant clustering of health care utilization rates for Medicare beneficiaries with Other Related Pneumoconiosis was observed in Appalachia and the southeast parts of Texas and Louisiana. This clustering merits additional research to understand underlying disease etiology.


Timing Of Term Elective Cesarean Section And Adverse Neonatal Outcomes: A Multi-Center Retrospective Cohort Study, Ayah Al Bizri, Nansi Boghossian, Anwar Nassar, Pascale Nakad, Dina Jaber, Rabih Chahine, Gaby Fallakha, Gjaotj Makhoul, Khalid Yunis Apr 2021

Timing Of Term Elective Cesarean Section And Adverse Neonatal Outcomes: A Multi-Center Retrospective Cohort Study, Ayah Al Bizri, Nansi Boghossian, Anwar Nassar, Pascale Nakad, Dina Jaber, Rabih Chahine, Gaby Fallakha, Gjaotj Makhoul, Khalid Yunis

Faculty Publications

Background Rate of cesarean section (CS), including elective CS has globally increased. Studies have found that term elective CS before 39 weeks of gestation is associated with increased risk of adverse respiratory outcomes.

Objective To determine the rate of elective CS and examine the association between timing of elective term CS and adverse neonatal outcomes in a large population of Lebanese women.

Methods A Multi-Center Study was conducted using data from the National Collaborative Perinatal Neonatal Network database. Simple and multivariable logistic regression models were used to examine the association between timing of term elective CS and adverse neonatal outcomes. …


To Preprint Or Not To Preprint, Forest W. Arnold, Kimberley A. Buckner, Alex Glynn, Jessica Petrey, Jose Bordon Apr 2021

To Preprint Or Not To Preprint, Forest W. Arnold, Kimberley A. Buckner, Alex Glynn, Jessica Petrey, Jose Bordon

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Economic Insecurity As A Risk Factor During The Covid-19 Pandemic, Klaus E. Cavalhieri Apr 2021

Economic Insecurity As A Risk Factor During The Covid-19 Pandemic, Klaus E. Cavalhieri

Journal of Health Disparities Research and Practice

The novel coronavirus disease 2019 (COVID-19) is currently spreading at a rapid rate worldwide. The current pandemic may have several adverse effects on overall psychological functioning and health behaviors. Economic insecurity, operationalized as financial strain and employment uncertainty, can be a significant risk factor for both psychological outcomes and compliance with shelter-in-place recommendations (i.e., health behaviors). One hundred and twenty four participants answered survey data on economic security, fear of COVID-19, health care system distrust, anxiety, well-being, and compliance with CDC recommendations to curb the spread of COVID-19 (i.e., health behaviors; CDC, 2020). Economic security was significantly associated with well-being, …


The Culture Factor: The Effects On Healthcare Decisions Among Guyanese Men, Harrynauth Persaud Apr 2021

The Culture Factor: The Effects On Healthcare Decisions Among Guyanese Men, Harrynauth Persaud

Journal of Health Disparities Research and Practice

Culture, religious beliefs, and ethnic customs, all play a role in how patients make healthcare decisions. As the racial and ethnic diversity continues to increase in the United States, so does the culture, religious beliefs, and customs. This research aims to explore the cultural and other influences on making healthcare decisions among Indo-Guyanese immigrant men. In-depth interviews were conducted among participants residing in the neighborhood areas of Queens, New York. Thorough qualitative analyses were performed on the data for which three major themes emerged. Family influences on health behaviors, the use of alternative medicines, and religious beliefs were found to …


An Opportunity To Partner With Community Organizations To Collect Data On Asian Americans, Victoria Wang, Karen Kim Apr 2021

An Opportunity To Partner With Community Organizations To Collect Data On Asian Americans, Victoria Wang, Karen Kim

Journal of Health Disparities Research and Practice

Background: There is a shortage of health data for Asian American (AA) populations. This shortfall may be improved through the involvement of AA-serving community-based organizations (CBOs).

Objectives: This study assesses the feasibility of and interest among CBOs in creating a AA community-based data registry.

Methods: Leaders of CBOs were interviewed to assess their current data collection framework and their attitudes towards a shared data registry.

Results: Qualitative analysis shows CBOs are active in data collection, find data to be instrumental to their mission, and are interested in contributing to a broader data registry.

Discussion: The inclusion …


Disparities In Access To After-Hours Care In The U.S.: A National Study, Kavita Mosalpuria, Fernando A. Wilson, Mohammad Siahpush Apr 2021

Disparities In Access To After-Hours Care In The U.S.: A National Study, Kavita Mosalpuria, Fernando A. Wilson, Mohammad Siahpush

Journal of Health Disparities Research and Practice

After-hours care provides timely access to continuity of care for chronic illnesses and episodic care for acute illness. Lack of timely access to primary care services is one of the main drivers of emergency department overuse. Our aim was to examine disparities in access to after-hours care based on race, income, geographic location, type of insurance, and health care setting. We used data from the 2010 Health Tracking Household Survey. Multivariable logistic regression was used to assess disparities in access to after-hours care. We found disparities by type of insurance, geographic location, and type of health care setting. People with …


2021-04-04_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services Apr 2021

2021-04-04_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …


2021-04-03_Michigandaily_Covidmap, Michigan Department Of Health & Human Services Apr 2021

2021-04-03_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …


2021-04-03_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services Apr 2021

2021-04-03_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …


2021-04-03_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services Apr 2021

2021-04-03_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …


Age And Sex Are Associated With The Plasma Lipidome: Findings From The Goldn Study, Emily Slade, Marguerite R. Irvin, Kevin Xie, Donna K. Arnett, Steven A. Claas, Tobias Kind, David W. Fardo, Gregory A. Graf Apr 2021

Age And Sex Are Associated With The Plasma Lipidome: Findings From The Goldn Study, Emily Slade, Marguerite R. Irvin, Kevin Xie, Donna K. Arnett, Steven A. Claas, Tobias Kind, David W. Fardo, Gregory A. Graf

Biostatistics Faculty Publications

Background
Developing an understanding of the biochemistry of aging in both sexes is critical for managing disease throughout the lifespan. Lipidomic associations with age and sex have been reported, but prior studies are limited by measurements in serum rather than plasma or by participants taking lipid-lowering medications.

Methods
Our study included lipidomic data from 980 participants aged 18–87 years old from the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN). Participants were off lipid-lowering medications for at least 4 weeks, and signal intensities of 413 known lipid species were measured in plasma. We examined linear age and sex associations with …


Socastee Interview, Participant #02, April 2, 2021, Jennifer Mokos, Jaime Mccauley Apr 2021

Socastee Interview, Participant #02, April 2, 2021, Jennifer Mokos, Jaime Mccauley

Flood Survivor Interviews

A community member of the Rosewood neighborhood in Socastee is interviewed by a CCU student.


Forward Together Update [Survey Reminder], April 2, 2021, University Of Northern Iowa Apr 2021

Forward Together Update [Survey Reminder], April 2, 2021, University Of Northern Iowa

UNI Response to COVID-19

A reminder to fill out the survey concerning on-campus vaccination clinics.


2021-04-02_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services Apr 2021

2021-04-02_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.


2021-04-02_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services Apr 2021

2021-04-02_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily.

Syndromic Surveillance System data is obtained from approximately 183 facilities participating in syndromic surveillance (132 Emergency Departments (ED), 51 Urgent Cares) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, triage notes, and clinical impression) for fever or …


2021-04-02_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services Apr 2021

2021-04-02_Michiganoverview_Covidvaccinestats, Michigan Department Of Health & Human Services

Michigan COVID-19 Vaccine Data

The COVID Vaccine Dashboard page was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214-547150--,00.html.

Data is updated Monday through Saturday. Previously reported numbers of administered vaccine doses may change as new data are received. A possible lag in reporting vaccine doses will result in increases in numbers previously reported.

This report is created by the Michigan Department of Health and Human Services Division of Immunization from data reported to the Michigan Care Improvement Registry (MCIR).

The dashboard contained the tabs Vaccines Shipped, Distribution Trend, Doses Administered, Doses by Vaccine, Doses Metrics, Coverage, Coverage Metrics …


2021-04-02_Michigandaily_Covidmap, Michigan Department Of Health & Human Services Apr 2021

2021-04-02_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …


Impact Of Covid-19 On Healthcare Labor Market In The United States: Lower Paid Workers Experienced Higher Vulnerability And Slower Recovery, Neeraj Bhandari, Kavita Batra, Soumya Upadhyay, Christopher Cochran Apr 2021

Impact Of Covid-19 On Healthcare Labor Market In The United States: Lower Paid Workers Experienced Higher Vulnerability And Slower Recovery, Neeraj Bhandari, Kavita Batra, Soumya Upadhyay, Christopher Cochran

Healthcare Administration and Policy Faculty Research

The resilience of the healthcare industry, often considered recession-proof, is being tested by the COVID-19 induced reductions in physical mobility and restrictions on elective and non-emergent medical procedures. We assess early COVID-19 effects on the dynamics of decline and recovery in healthcare labor markets in the United States. Descriptive analyses with monthly cross-sectional data on unemployment rates, employment, labor market entry/exit, and weekly work hours among healthcare workers in each healthcare industry and occupation, using the Current Population Survey from July 2019−2020 were performed. We found that unemployment rates increased dramatically for all healthcare industries, with the strongest early impacts …