Epidemiology Commons^™

Pterygium Recurrence And Corneal Stabilization Point After Pterygium Excision Using The Controlled Partial Avulsion Fibrin Glue Technique, Mohd Radzi Hilmi, Khairidzan Mohd Kamal, Mohd Zulfaezal Che Azemin

Makara Journal of Health Research

Background: This study aimed to evaluate the pterygium recurrence rate and corneal stabilization point after pterygium excision via the controlled partial avulsion fibrin glue technique using multiple corneal parameters.

Methods: One hundred eyes of 100 patients who had undergone primary pterygium excision surgery via the controlled partial avulsion fibrin glue technique were retrospectively reviewed. Corneal stabilization points were determined over four follow-up sessions (i.e., the 1st, 3rd, 6th, and 12th months after surgery) based on changes in Simulated-K, corneal irregularity measurement, shape factor, and toric mean keratometry. Post-operative courses were followed for 12 months after surgery. Recurrence was …

Effects Of L-Fucose Supplementation On The Viability Of Cancer Cell Lines, Muhammad Alif Mazlan, Afzan Mat Yusof, Muhammad Lokman Md Isa

Makara Journal of Health Research

Background: Fucose is a deoxyhexose sugar. While the biological roles of L-fucose remain unclear, the sugar is known to accelerate the malignant potential of cancer cells. Therefore, this study aimed to evaluate the viability pattern of human cancer and normal cell lines treated with fucose.

Methods: The human gingival fibroblast (HGF-1), colorectal adenocarcinoma (HT-29) and skin malignant melanoma (A375) cell lines were cultured and treated with fucose at three concentrations of 1, 5, and 10 mg/ml. Cell viability was then measured using (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed using Statistical Package for the Social …

Health-Related Quality Of Life And Work Ability Of Smallholder Rice Farm Workers In San Jose, Occidental Mindoro, Philippines, Artemio Morado Gonzales Jr, Ryan Mark Aloro Ambong, Leoniel Salibio Bais, Lendon Perez Macaspac

Makara Journal of Health Research

Background: Health is an integral form of human capital that can positively influence agricultural worker productivity in the physical, mental, and social domains. Poor health usually represents a burden to farm workers because a failure to meet scheduled tasks on the farm can later affect the dependents who rely on it for food nourishment and sustained livelihood. This study aims to determine the association between health and the work capabilities of smallholder rice farm workers in San Jose, Occidental Mindoro, Philippines.

Methods: A cross sectional study was conducted among 100 farm workers. The SF-36 (HRQoL) and Work Ability …

Perceived Need And Utilization Of Dental Health Care Services In Indonesia: A Secondary Analysis Using The National Socioeconomic Data, Normaliza Ab Malik, Robbykha Rosalien, Nadine Khalissya, Iwany Amalliah Badruddin, Diah Ayu Maharani

Makara Journal of Health Research

Background: Perceived needs and utilization of oral health services are important to ensure improvements in oral health outcomes and to allocate resources for the continuous provision of the services. This study aimed to determine the factors influencing the perceived needs and utilization of oral health services in Indonesia.

Methods: Secondary data from the 2013 Indonesian National Socioeconomic Survey (n = 260,925) was used. Descriptive analysis and logistic regression were employed to describe the relationship between perceived needs and utilization of oral health services.

Results: The proportions of Indonesians who had a perceived need for oral health services and …

Organizational Empowerment Among Nursing Faculty In The Northwestern Region Of Saudi Arabia, Salman Hamdan Alsaqri, Eddieson Pasay-An, Liza Villacorte, Fredezwinda Madjid, Carmencita Pacis, Ahmad Khalil Ahmad Al-Sadi

Makara Journal of Health Research

Background: This study aimed to determine the differences in the workplace empowerment of nursing faculty as it relates to their demographic information.

Methods: A comparative cross-sectional study was conducted among 65 nurse educators at the College of Nursing, University of Hail, Saudi Arabia. The data were collected through a survey questionnaire between January and March 2019.

Results: Significant differences were found regarding gender and opportunity (p < 0.017), support (p < 0.020), resources (p < 0.022), job activities scale (JAS; p < 0.005), organizational relationship scale (ORS; p < 0.011), and marital status on resources (p < 0.031). In comparison, gender to information and all of the other demographic variables such as marital status (except resources), years of experience, age, nationality, educational qualifications, and specialization were found insignificant to opportunity, support, resources, information, JAS, and ORS, where all of their p-values were more than 0.05.

Conclusion: Male nursing faculty were found to be more empowered in terms of opportunity, support, resources, JAS, and …

Effect Of The Sims Program On Oral Hygiene Levels Of 5–6-Year-Old Children In The Kampar District, Malaysia: A Cluster-Randomized Controlled Trial, Nurul Hayati Anwar, Nor Azlida Mohd Nor, Zamros Yuzadi Mohd Yusof

Makara Journal of Health Research

Background: This study evaluated the effect of the “Senyuman Indah Milik Semua” program (SIMSP) versus the existing preschool oral healthcare program (POHP) on children’s oral health and parents’ oral health literacy (OHL) in Kampar district, Malaysia.

Methods: This was a cluster-randomized, matched pair, examiner-blind, controlled trial. Using computer-generated random tables, 14 preschools were allocated to the SIMSP intervention over 6 months and another 14 were allocated to the POHP, which was concealed at the cluster level. Healthy 5–6-year-old children and parents who understood the Malay language were recruited. The SIMSP was comprised of preschool visits by dental …

Association Between Sociodemographic Factors And Estrogen Receptor-Positive, Progesterone Receptor-Positive Breast Cancer Subtypes: A Cross-Sectional Study, Vinodkumar Mugada, Raj Kiran Kolakota, Varsha Mahato

Makara Journal of Health Research

Background: The presence of risk factors have a high risk of developing breast cancer. Our study aimed to find an association between sociodemographic factors and the risk of estrogen receptor (ER)-positive, progesterone receptor (PR)-positive breast cancer among women.

Methods: A cross-sectional study was conducted on 200 women with breast cancer. Association between sociodemographic factors and hormone receptor subtypes of breast cancer was found using the Chi-square test. Multiple logistic regression analysis was used to know the strong predictors of hormone receptor subtypes.

Results: The mean age was 50.08 (10.67) years. Comorbidities had a statistically significant association with …

Ua3/10/3 Convocation, Timothy Caboni

WKU Administration Documents

Convocation speech given by WKU president Timothy Caboni regarding COVID-19, diversity, student recruitment, enrollment, retention and graduation; budget, and economic growth.

Housing Stability And Diabetes Among People Living In New York City Public Housing, Sungwoo Lim, Sze Yan Liu, Melanie H. Jacobson, Eugenie Poirot, Aldo Crossa, Sean Locke, Jennifer Brite, Elizabeth Hamby, Zinzi Bailey, Stephanie Farquhar

Department of Public Health Scholarship and Creative Works

Public housing provides affordable housing and, potentially, housing stability for low-income families. Housing stability may be associated with lower incidence or prevalence and better management of a range of health conditions through many mechanisms. We aimed to test the hypotheses that public housing residency is associated with both housing stability and reduced risk of diabetes incidence, and the relationship between public housing and diabetes risk varies by levels of housing stability. Using 2004-16 World Trade Center Health Registry data, we compared outcomes (housing stability measured by sequence analysis of addresses, self-reported diabetes diagnoses) between 730 New York City public housing …

Pre-Testing Of The Who’S Educational Video: “How To Protect Yourself Against Covid-19”, Hilyatul Fadliyah, Manendra Muhtar, Munih Munih, Sylviasari Risgiantini, Weny Wulandary, Hadi Pratomo

Kesmas

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a public health emergency in many countries, including Indonesia. The World Health Organization (WHO) released an educational video, entitled "How to Protect Yourself Against COVID-19", which explained how to prevent the spread of COVID-19. This study is a qualitative study that aims to pre-test this video, based on the Information, Education, Communication (IEC) theory, by analyzing teenagers’ perceptions of the video. The design used was a Rapid Assessment Procedure (RAP), and the data were collected by conducting in-depth interviews with participants, through …

Impact Of Lockdown In India: A Case Study Comparing Kanataka With International Model, Stelvin Sebastian, Aby Paul, Jeeva Joseph, Joel Joby, Sanjo Saijan, Jobin Kunjumon Vilapurathu

Kesmas

The COVID-19 was declared a pandemic and a global health emergency by WHO, prompting various countries to implement early and stringent social distancing protocols through lockdown, to flatten the epidemic curve. The objective of the present study was to assess the impacts and effectiveness of the lockdown protocol in Karnataka and Punjab, compared with the implementation of this method in Australia and the UK. This study involved the collection of data from different authorized databases, in two phases. The first phase included the time starting with the first-reported index case through the 14th day after the declaration of lockdown, for …

Review Of Trial Therapies And Treatment For Covid-19: Lessons For Indonesia, Halma Zahro Mukhlida, Hilma Hasro Maulida, Gunanti Khairunnisa, Margaretha Josephine Mantrono, Risky Kusuma Hartono, Rindu Rindu, Eka R W Purnamasari, Rizky Fajar Meirawan

Kesmas

The infectious disease from Coronavirus Disease 2019, or COVID-19, has quickly spread world-wide since 2019. Therapies for managing COVID-19 have yet to be confirmed as medication for the severe sickness that the disease may cause. This study aimed to review the previous research of the efficacy of trial therapy and treatment to the patients in the hospital with COVID-19. Using PRISMA guidelines as a method for conducting a systematic literature review, a total of 67 articles were collected from several online journal databases. Various therapies were found that are effective in the treatment and management of COVID-19. In accordance with …

Whims (Washing Hands, Immunity Boost, Masking & Social Distancing), Srinivasan Ragothaman

Creative Work

This is a shot poem about preventing the spread of Covid-19. It pleads general public to wear masks, wash hands, social distance, and boost immunity. It is set to a popular tune in Hindi - Dil Ke Jharoke Mein.

Efek Obesitas Dengan Risiko Kejadian Penyakit Asma Pada Perempuan Usia Produktif Di Indonesia, Arief Maulana, Nurhayati A. Prihartono, Yovsyah Yovsyah

Jurnal Epidemiologi Kesehatan Indonesia

Penelitian mengenai hubungan obesitas dengan risiko kejadian penyakit asma sudah banyak dilakukan namun masih jarang dilakukan penelitian yang mengambil sampel perempuan usia produktif (15-64 tahun). Tujuan penelitian ini adalah untuk mengevaluasi hubungan obesitas dalam menyebabkan asma pada perempuan usia produktif (15-64 tahun). Penelitian ini menggunakan data bersumber dari Indonesian Family Life Survey 5 (IFLS-5) tahun 2014 dengan desain penelitian cross sectional. Sampel yang dianalisis pada penelitian ini berjumlah 15.654 setelah memenuhi kriteria inklusi dan eksklusi. Data sampel dianalisis dengan menggunakan uji regresi logistik untuk mengetahui besar risiko obesitas dalam menyebabkan asma. Hasil penelitian didapatkan prevalensi asma sebesar 2,91%. Hasil analisis …

Stres Kerja Perawat Meningkatkan Gejala Sindrom Pramenstruasi Di Rumah Sakit X Bekasi, Ratih Yulianingsih, Yenita Agus, Maftuhah Maftuhah

Jurnal Epidemiologi Kesehatan Indonesia

Profesi perawat berisiko terhadap stres kerja yang dapat mencetuskan sindrom pramenstruasi. Sindrom pramenstruasi yang terjadi ketika perawat bekerja akan berdampak pada penurunan produktivitas dan risiko terjadinya kecelakaan kerja, maka kondisi tersebut akan membahayakan pasien. Tujuan penelitian ini adalah untuk mengetahui tingkat stres kerja perawat, sindrom pramenstruasi, dan hubungan stres kerja perawat dengan sindrom pramenstruasi. Penelitian ini menggunakan studi potong lintang. Sampel penelitian terdiri dari 160 perawat dalam usia subur di Rumah Sakit (RS) X Bekasi dan sebanyak 12 perawat termasuk ke dalam kriteria ekslusi penelitian yakni mengonsumsi kontrasespi oral atau menderita sindrom polikistik ovarium. Stres kerja perawat dibagi dalam 8 …

Hubungan Preeklamsia Dengan Kejadian Bblr Di Rsu Kabupaten Tangerang Tahun 2018, Astrisa Faadhillah, Helda Helda

Jurnal Epidemiologi Kesehatan Indonesia

Berat badan lahir rendah didefinisikan oleh World Health Organization. sebagai berat saat lahir kurang dari 2500 gram. Bayi dengan berat badan lahir rendah (BBLR) meningkatkan angka kesakitan dan kematian dua kali lipat dibandingkan dengan bayi yang lahir dengan berat badan 2500 gram atau lebih. Berat lahir rendah menjadi masalah kesehatan masyarakat berkelanjutan secara signifikan dan global dikaitkan dengan serangkaian konsekuensi jangka pendek dan jangka panjang. Faktor resiko utama yang berhubungan dengan tingginya kejadian BBLR adalah faktor demografi, penyakit kronis sebelum hamil, status gizi ibu hamil, komplikasi dalam kehamilan, dan status pemeriksaan kehamilan. Metode yang digunakan dalam penelitian ini adalah cross …

Karakteristik Ibu Melahirkan Sectio Caesaria Peserta Jaminan Kesehatan Nasional Di Rumah Sakit Profit X Di Sekitar Jakarta, Trisna Budy Widjayanti

Jurnal Epidemiologi Kesehatan Indonesia

Program Jaminan Kesehatan Nasional (JKN) memudahkan akses ibu melahirkan Sectio Caesaria (SC) di RS. Dalam tahun 2014-2017 persalinan SC menempati urutan 10 jumlah kasus dan klaim tertinggi. WHO menetapkan angka optimum SC sebesar 15% sebagai salah satu standar kualitas pelayanan persalinan ibu. Tujuan penelitian ini untukmengidentifikasi karakteristik sosial ekonomi dan klinis dari ibu yang melahirkan SC yang berhubungan dengan penggunaan JKN di Rumah Sakit Profit (RSP) X di sekitar Jakarta. Penelitian menggunakan desain Cross Sectional dengan total sampel sebanyak 385 ibu melahirkan SC yang diambil dari rekam medis pada periode januari 1- 31 Desember 2018. Karakteristik sosial ekonomi dan klinis …

Studi Tinjauan Pustaka: Risiko Kejadian Kanker Paru Pada Penderita Tuberkulosis Paru., Fariha Ramadhaniah, Syahrizal Syarif

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia merupakan satu dari lima negara di dunia dengan insiden kasus TB yang tinggi, sementara itu kanker paru di Indonesia merupakan kasus keganasan utama yang paling sering terjadi. Untuk melihat gambaran risiko kejadian kanker paru diantara penderita TB paru, dilakukan studi tinjauan pustaka pada sepuluh jurnal yang dipublikasikan melalui Pubmed pada tahun 2009-2019. Kriteria inklusi dalam pemilihan jurnal yaitu TB paru sebagai faktor risiko dan kanker paru primer sebagai outcome, sedangkan kriteria ekslusi adalah jurnal yang merupakan tinjauan pustaka sistematis, skrining, diagnosis, dan evaluasi hasil pengobatan yang berkaitan dengan infeksi TB dan kanker paru. Analisis deskriptif menunjukan subjek sebagian …

How Much Can Mexican Healthcare Providers Learn About Breastfeeding Through A Semi-Virtual Training? A Propensity Score Matching Analysis, Mireya Vilar-Compte, Rafael Pérez-Escamilla, Meztli Moncada, Diana Flores

Department of Public Health Scholarship and Creative Works

Background: Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Methods: Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered …

We Are Not Alone In Trying To Be Alone, Patricia C. Lopes

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Certain diseases, like colds, tend not to stop us. A paracetamol here, an ibuprofen there, and we are on the go. That is, until we, as a species, are faced with a virus that not only spreads through social contact, but has an estimated reproductive number of 2 to 2.5 and potentially kills 3–4% of those infected (WHO, 2020). To reduce transmission probability of COVID-19, governmental agencies around the world have recommended or enforced measures to decrease social contact; early evidence suggests these measures produce the intended effect (Kucharski et al., 2020).

Costs Of Maternity Leave To Support Breastfeeding; Brazil, Ghana And Mexico, Mireya Vilar-Compte, Graciela M. Teruel, Diana Flores-Peregrina, Grace J. Carroll, Gabriela S. Buccini, Rafael Perez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given …

Identifying The Weak Foundation Of Public Health Resilience Fornational Disaster Policy In Indonesia’S Mid-Term Developmentagenda 2015–2019: A Policy Content Analysis, Gita Miranda Warsito, Meiwita Budiharsana, Sharyn Burns

Kesmas

Indonesia is one of the most susceptible nations toward natural disasters in the world. Since 1992, approximately 37 tsunami incidents have occurred inIndonesia, with at least 1,244 cases of natural disasters during 2018. Despite the overwhelming impact of disasters on Indonesia, Public Health Resilience,as an approach to disaster countermeasures, has been poorly elaborated in Indonesia’s development agenda (National Mid-term Development Plan (NMDP),or Rencana Pembangunan Jangka Menengah Nasional (RPJMN), 2015 - 2019). By utilizing the method of policy content analysis, this study aimed to analyzethe policy background of Public Health Resilience against disasters in the NMDP 2015 - 2019 and National …

Benson's Relaxation Therapy And Sleep Quality Among Elderlyat A Social Institution In Inakaka, Indonesia, Nur Baharia Marasabessy, Lucky Herawati, Irhamdi Achmad

Kesmas

Serious sleep disturbances among elderlies include attention or memory disorders, depression and often fall. A quasi experimental study design with pre-posttest with control group was performed to determine effect of Benson’s relaxation therapy on sleep quality among the elderly, and influences of sex, age anddisease suffered differences. Of a total of 46 elderlies from a Social Institute in Ambon, 29 were taken for the treatment group and 19 for the control group.The treatment group was interfered with Benson’s breathing relaxation for 14 days. Sleep quality was measured using Pittsburg sleep quality index form. Datawere analyzed using independent t-test and multivariate …

Effects Of Climbing Choice, Demographic, And Climate On Walking Behavior, Febriani Fajar Ekawati, Frank Francis Eves

Kesmas

Walking is a public health recommendation to increase physical activity. Although walking for transport is associated with health benefits, it is frequently avoided when a mechanized alternative is available and when the weather or individuals’ available resources are unfavorable. The present quasi-experimental study used chosen walking speed to estimate the use of resources by pedestrians and investigated 730 pedestrians’ behavior when approaching a choice point between a short stair and a ramp at an exit from a university campus toward the local train station on six separate days. Results revealed that individuals who climbed the stairs walked faster than those …

Religious Leader’S Support Toward Individual At Risk Ofhiv/Aids To Attend Voluntary Counselling And Testing Service, Imelda Februati Ester Manurung, Chatarina Umbul Wahyuni, Ari Probandari

Kesmas

Religious leader is a figure who is believed to have the gift of healing. A person with illness will follow any advice the religious leader gives for his/her recovery.Based on the phenomenon, religious leader is a potential local figure to give support for individuals at risk of human immunodeficiency virus (HIV) andacquired immune deficiency syndrome (AIDS). This study aimed to determine factors related to religious leader’s support toward individuals at risk of HIV andAIDS to attend voluntary counselling and testing (VCT) service. This study was an observational analytical with cross-sectional design. The population of thisstudy was religious leader in Kupang …

Myths About Menstrual Personal Hygiene Among Female Adolescents, Tyas Diah Palupi, Terry Y.R. Pristya, Randy Novirsa

Kesmas

Poor personal hygiene during menstruation among adolescents can lead to urinary tract infection, reproductive tract infection, and skin irritation. This studyaimed to determine the relationship between belief in myths and personal hygiene during menstruation. Cross-sectional quantitative study was conductedusing a sample of 119 10th grade female students from Tangerang 13 State Senior High School selected through purposive sampling. Logistic regressionanalysis was used in this study to determine the relationship between myths and personal hygiene after age of menarche, attitude, socioeconomic status,information, and maternal education were controlled. In the bivariate selection, modeling was completed by entering confounding and interaction variablesthen reducing …

Adaptation And Validation Of The Tamil (Sri Lanka) Version Ofthe Montreal Cognitive Assessment, Pethirupillai Amal Dinesh Coonghe, Pushpa Fonseka, Sampasivamoorthy Sivayogan, Ajantha Keshavaraj, Rahul Malhotra, Truls Ostbye

Kesmas

The study aimed to develop the Tamil (Sri Lanka) version of the Montreal Cognitive Assessment (MoCA) and investigate its reliability and validity as a briefscreening tool for mild cognitive impairment (MCI). Tamil-speaking Sri Lankan elderly with normal cognition and MCI were recruited from a neurology clinic.Adaptation of the English MoCA to the Tamil (Sri Lanka) involved context-specific content modification and translation. The content validity, reliability, sensitivity,and specificity of the tool were evaluated. Study participants were 184 older adults, comprising 85 with normal cognition and 99 neurologist-diagnosed MCI.The tool had high internal consistency (Cronbach's alpha = 0.83). Receiver operating characteristic curve …

Adverse Effect Of Aerosol Pesticide On Lung Dysfunction Amongpaddy Farmers In Purworejo, Central Java, Indonesia, Fajaria Nurcandra, Renti Mahkota, Tri Yunis Miko Wahyono

Kesmas

The World Health Organization estimated that chronic obstructive pulmonary disease (COPD) will be the highest non-communicable disease worldwide by2030, and pesticide exposure is one of major risk factors. This study aimed to determine effect of pesticide exposure on lung dysfunction among paddyfarmers. A case-control study was performed on April - May 2016 in Purworejo. The case group comprised 66 farmers suffering from lung dysfunction during2015 based on medical records, while the control group comprised 59 neighboring farmers showing normal lung function. Both case and control groups weretested using a spirometer and COPD assessment test (CAT) questionnaire. Logistic regression analysis of …

Correlation Of Knowledge And Beliefs To Adherence With Antibiotic Use In Adult Patients At A Private Hospital In Sidoarjo, Muhammad Hasan Wattiheluw, Fauna Herawati, Setiasih Setiasih, Rika Yulia

Kesmas

Infectious diseases are one of the top ten causes of death in the world. Antibiotic therapy is administered for infectious diseases, but if bacteria are exposed to antibiotics continuously, then the bacteria are able to adapt to the medication, thereby resulting in antibiotic resistance. This condition results in an increase in mortality, long hospitalization period, and increased cost of antibiotic therapy and health services. Adherence to using antibiotics may be influenced by knowledge and beliefs about them. This study aimed to understand correlation between knowledge and belief with adherence to antibiotic use at a private hospital in Sidoarjo. This cross-sectional …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …