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Articles 391 - 420 of 559

Full-Text Articles in Other Public Health

Smoking Trends Among U.S. Latinos, 1998–2013: The Impact Of Immigrant Arrival Cohort, Georgiana Bostean, Annie Ro, Nancy L. Fleischer Mar 2017

Smoking Trends Among U.S. Latinos, 1998–2013: The Impact Of Immigrant Arrival Cohort, Georgiana Bostean, Annie Ro, Nancy L. Fleischer

Sociology Faculty Articles and Research

Few studies examine nativity disparities in smoking in the U.S., thus a major gap remains in understanding whether immigrant Latinos’ smoking prevalence is stable, converging, or diverging, compared with U.S.-born Latinos. This study aimed to disentangle the roles of period changes, duration of U.S. residence, and immigrant arrival cohort in explaining the gap in smoking prevalence between foreign-born and U.S.-born Latinos. Using repeated cross-sectional data spanning 1998–2013 (U.S. National Health Interview Survey), regressions predicted current smoking among foreign-born and U.S.-born Latino men and women (n = 12,492). We contrasted findings from conventional regression analyses that simply include period and duration …


The Scoping Review Method: Mapping The Literature In “Structural Change” Public Health Interventions, Rosie Hanneke, Yuka Asada, Lisa D. Lieberman, Leah Christina Neubauer, Michael C. Fagan Feb 2017

The Scoping Review Method: Mapping The Literature In “Structural Change” Public Health Interventions, Rosie Hanneke, Yuka Asada, Lisa D. Lieberman, Leah Christina Neubauer, Michael C. Fagan

Department of Public Health Scholarship and Creative Works

This case discusses how we used scoping review methodology to map the literature in an emergent area of research, “structural change” public health interventions. Scoping reviews are similar to systematic reviews in both scale and rigor; both of these literature review methodologies are comprehensive approaches to reviewing the literature on a topic. However, while a systematic review attempts to answer a specific, targeted research question, a scoping review is designed to map and categorize all of the literature on a broad topic. For this reason, it is an excellent method to employ in emergent research areas, in which researchers have …


Expanding Intersectionality Praxis: Informing Culturally-Responsive Programming For Black And Latino Gay And Bisexual Young Men, Justin T. Brown Feb 2017

Expanding Intersectionality Praxis: Informing Culturally-Responsive Programming For Black And Latino Gay And Bisexual Young Men, Justin T. Brown

Dissertations, Theses, and Capstone Projects

Black/Latino gay/bisexual young men face a multitude of health disparities caused by various determinants of health. However, despite the awareness of the gaps, health intervention research rarely explores the impact of current health intervention strategies on Black/Latino gay/bisexual young men’s overall health and well-being. Traditional health interventions are deficit-based, health condition-specific, and often limited in their cultural-specificity. As health-related fields move toward holistic, evidence-based practices, new primary prevention approaches need to emerge. Using qualitative investigation strategies, this study included primary analysis of participatory workshop artifacts, and secondary analysis of survey and focus group data. This study identified critical factors necessary …


E-Cigarette Specialty Retailers: Data To Assess The Association Between Retail Environment And Student E-Cigarette Use, Georgiana Bostean, Catherine M. Crespi, Patsornkarn Vorapharuek, William J. Mccarthy Jan 2017

E-Cigarette Specialty Retailers: Data To Assess The Association Between Retail Environment And Student E-Cigarette Use, Georgiana Bostean, Catherine M. Crespi, Patsornkarn Vorapharuek, William J. Mccarthy

Sociology Faculty Articles and Research

The retail environment is a major social determinant of health, yet little is known about the e-cigarette specialty retailer environment. The e-cigarette specialty retail environment may be associated with e-cigarette use by middle and high school students, an issue that was addressed in a recent article entitled, “E-cigarette use among students and e-cigarette specialty retailer presence near schools,” by Bostean and colleagues (G. Bostean, C.M. Crespi, P. Vorapharuek, W.J. McCarthy, 2016). We present data relating to e-cigarette specialty retailers in Orange County, California. We describe the data collection method (including the search methodology to identify e-cigarette specialty retailers), present descriptive …


Detroit Food Metrics Report 2017, Alex B. Hill, Amy Kuras Jan 2017

Detroit Food Metrics Report 2017, Alex B. Hill, Amy Kuras

Urban Studies and Planning Faculty Research Publications

This report provides a snapshot of data and information on Detroit’s food system as well as trends over time. The report includes a broad range of programs and initiatives that local organizations, the Detroit Food Policy Council, and the City of Detroit are undertaking to address food insecurity, increase healthy food access and awareness, and support a more sustainable and just food system.


The Indirect Consequences Of Expanded Off-Label Promotion, Patricia J. Zettler Jan 2017

The Indirect Consequences Of Expanded Off-Label Promotion, Patricia J. Zettler

Faculty Publications By Year

The U.S. Food and Drug Administration’s (FDA) policies have been a battleground for litigation about First Amendment protections for commercial speech. In the last five years, the FDA’s position that “off-label” promotion of approved prescription drugs—when a manufacturer promotes a drug for a use for which the FDA has not approved it—leads to violations of the Federal Food, Drug, and Cosmetic Act has been subject to successful legal challenges. Although the merits of these off-label promotion decisions are well traversed in the literature, this Article explores the potential indirect consequences of recently-recognized protections for off-label promotion. This Article demonstrates that—as …


Learning And Working Together: Invoking Systems’ Change Through Inter-Organizational Collaborative Principles And A Learning Community Framework, Brandon Hey Jan 2017

Learning And Working Together: Invoking Systems’ Change Through Inter-Organizational Collaborative Principles And A Learning Community Framework, Brandon Hey

Theses and Dissertations (Comprehensive)

Local communities face significant challenges such as increased inequality, immigration, and global climate change. In order to address these challenges whole cities have to innovate and learn together. In this thesis, I introduce the Learning Community (LC) model, a new way of collaborating and creating collective impact that emphasizes learning, alongside collective impact, as a central strategy to addressing complex social challenges. In a LC, members value the continuous pursuit of knowledge, feedback, and experimentation as well as the flow of information and resources between academic institutions and practice groups. The value of learning is built into key structures …


Palynological Investigation Of Mummified Human Remains, Karl Reinhard, Marina Milanello Do Amaral, Nicole Wall Jan 2017

Palynological Investigation Of Mummified Human Remains, Karl Reinhard, Marina Milanello Do Amaral, Nicole Wall

Karl Reinhard Publications

Pollen analysis was applied to a mummified homicide victim in Nebraska, U.S.A., to determine the location of death. A control sample showed the normal ambient pollen in the garage crime scene. Ambient windborne types, common in the air of the region, dominated the control. Internal samples were analyzed from the sacrum, intestine, and diaphragm. Microfossils were recovered from the rehydrated intestine lumen. The intestinal sample was dominated by Brassica (broccoli). The sacrum sample was high in dietary types but with a showing of ambient types. The pollen from the diaphragm was dominated by ambient pollen similar to the control samples. …


Pseudoscorpions Of The Family Cheiridiidae (Arachnida: Pseudoscorpiones) Recovered From Burial Sediments At Pachacamac (500–1,500ce), Peru, Johnica J. Morrow, Livia Taylor, Lauren Peck, Christian Elowsky, Lawrence Stewart Owens, Peter Eeckout, Karl Reinhard Jan 2017

Pseudoscorpions Of The Family Cheiridiidae (Arachnida: Pseudoscorpiones) Recovered From Burial Sediments At Pachacamac (500–1,500ce), Peru, Johnica J. Morrow, Livia Taylor, Lauren Peck, Christian Elowsky, Lawrence Stewart Owens, Peter Eeckout, Karl Reinhard

Karl Reinhard Publications

Fragmented remains of pseudoscorpions belonging to the family Cheiridiidae (Arachnida, Pseudoscorpiones) were recovered from Ychsma polity (c. AD 1000–1475) burial sediments from Pachacamac, Peru. Sediments from 21 burials were examined following rehydration in 0.5% trisodium phosphate for 48 h and subsequent screening through a 250 lm mesh. Materials larger than 250 lm were surveyed for the presence of arthropods. A total of two samples contained pseudoscorpion fragments, which were collected and quantified to determine the minimal number of pseudoscorpions present per gram of each sample. Following quantification, pseudoscorpion specimens were imaged utilizing confocal laser scanning microscopy (CLSM) to assist with …


Poison In Pink, Sydney V. Cook Jan 2017

Poison In Pink, Sydney V. Cook

Graduate Student Theses, Dissertations, & Professional Papers

Humans slather, spray, mist, and cleanse their bodies with personal care products like lotion, hairspray, cologne, and shampoo every day. Our cupboards are stocked full of them, but few of us understand what is in those jars and bottles. We trust that if it’s on the shelf at the store, it’s safe. However, this is not always the case, and many personal care products contain chemicals that are harmful to human and environmental health.

My multi-disciplinary Environmental Studies thesis project combines evidenced-based research, interviews, nonfiction narrative, and science communication to create part of a book manuscript intended to educate general …


Stroke Outreach In The Lao Community, Noor A. Dythavon Dec 2016

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …


Mental Health Workout: Lifting Stigma, Jeremy Bambery Dec 2016

Mental Health Workout: Lifting Stigma, Jeremy Bambery

Master's Projects and Capstones

Mental illness affects one out of every five Americans between the ages 13-18, and it is estimated that two-thirds of these individuals will not seek treatment due to the stigma associated with having a mental illness or mental health issue (National Alliance on Mental Illness). Access to information and the ability to talk openly without fear will aid in creating a stigma free future. The goal of this project is to supply high school students in the San Francisco Bay Area with information regarding the stigma associated with mental health and mental illness via videos that will be used as …


Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond Nov 2016

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …


Give A Man A Fish: A Narrative Approach To A Case Study Of Soup Kitchens In The Wentworth Community, Evelyn Shen Oct 2016

Give A Man A Fish: A Narrative Approach To A Case Study Of Soup Kitchens In The Wentworth Community, Evelyn Shen

Independent Study Project (ISP) Collection

This study uses a narrative approach to explore the role of soup kitchens in the predominantly Coloured and English-speaking Wentworth community. Many of the community’s churches1 and non-profit organizations host soup kitchens regularly, rotating so that there is a meal available each day of the week.

Qualitative data was gathered through volunteering with the soup kitchens as a participant observer and having conversations and open-ended interviews with soup kitchen guests and hosts. Institutional context was provided by interviews with the Convener of the War Room and the Ward Councillor, and representatives of three non-profits in the community. In order to …


Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske Oct 2016

Emergency Medical Services And Public Policy In Durban, Kwazulu-Natal, John Buyske

Independent Study Project (ISP) Collection

This project seeks to explore the realities of the emergency medical system in the Durban area, particularly relative to government policy. It contextualizes its findings within the literature on public policy. Data for the project was collected via nine in-depth interviews with various professionals working in the field of emergency medical services, as well as a survey of fourteen citizens conducted in the peri-urban township of Cato Manor. This data was analyzed using qualitative methods. While every participant had different views and a different perspective on emergency services, some recurring themes and trends became evident, allowing for conclusions to be …


Assessing The Archaeoparasitological Potential Of Quids As A Source Material For Immunodiagnostic Analyses, Johnica J. Morrow, Karl Reinhard Oct 2016

Assessing The Archaeoparasitological Potential Of Quids As A Source Material For Immunodiagnostic Analyses, Johnica J. Morrow, Karl Reinhard

Karl Reinhard Publications

In the present study, quids from La Cueva de los Muertos Chiquitos (CMC) were subjected to ELISA tests for 2 protozoan parasites, Toxoplasma gondii (n=45) and Trypanosoma cruzi (n=43). The people who occupied CMC, the Loma San Gabriel, lived throughout much of present-day Durango and Zacatecas in Mexico. The known pathoecology of these people puts them into at-risk categories for the transmission of T. gondii and T. cruzi. Human antibodies created in response to these 2 parasites can be detected in modern saliva using ELISA kits intended for use with human serum. For these reasons, quids were reconstituted and …


Prehistoric Pathoecology As Represented By Parasites Of A Mummy From The Peruaçu Valley, Brazil, Karl Reinhard, Adauto Araújo Oct 2016

Prehistoric Pathoecology As Represented By Parasites Of A Mummy From The Peruaçu Valley, Brazil, Karl Reinhard, Adauto Araújo

Karl Reinhard Publications

Paleopathologists have begun exploring the pathoecology of parasitic diseases in relation to diet and environment. We are summarizing the parasitological findings from a mummy in the site of Lapa do Boquete, a Brazilian cave in the state of Minas Gerais. These findings in context of the archaeology of the site provided insights into the pathoecology of disease transmission in cave and rockshelter environments. We are presenting a description of the site followed by the evidence of hookworm, intestinal fluke, and Trypanosoma infection with resulting Chagas disease in the mummy discovered in the cave. These findings are used to reconstruct the …


Temporal And Spatial Distribution Of Enterobius Vermicularis (Nematoda: Oxyuridae) In The Prehistoric Americas, Karl J. Reinhard, Adauto Araújo, Johnica J. Morrow Sep 2016

Temporal And Spatial Distribution Of Enterobius Vermicularis (Nematoda: Oxyuridae) In The Prehistoric Americas, Karl J. Reinhard, Adauto Araújo, Johnica J. Morrow

Karl Reinhard Publications

Investigations of Enterobius sp. infection in prehistory have produced a body of data that can be used to evaluate the geographic distribution of infection through time in the Americas. Regional variations in prevalence are evident. In North America, 119 pinworm positive samples were found in 1,112 samples from 28 sites with a prevalence of 10.7%. Almost all of the positive samples came from agricultural sites. From Brazil, 0 pinworm positive samples were found in 325 samples from 7 sites. For the Andes region, 22 pinworm positive samples were found in 411 samples from 26 sites for a prevalence of 5.3%. …


Farm Animal Welfare And Human Health, Alan M. Goldberg Sep 2016

Farm Animal Welfare And Human Health, Alan M. Goldberg

Agribusiness Collection

The paper examines the relationship between farm animal welfare, industrial farm animal production, and human health consequences. The data suggest that when the animal welfare of land-based farm animals is compromised, there are resulting significant negative human health consequences due to environmental degradation, the use of non-therapeutic levels of antibiotics for growth promotion, and the consequences of intensification. This paper accepts that even if meat and fish consumption is reduced, meat and fish will be part of the diet of the future. Industrial production modified from the current intensified systems will still be required to feed the world in 2050 …


Cleaning Puparia For Forensic Analysis, Leon G. Higley, Tierney R. Brosius, Karl Reinhard, David Carter Sep 2016

Cleaning Puparia For Forensic Analysis, Leon G. Higley, Tierney R. Brosius, Karl Reinhard, David Carter

Karl Reinhard Publications

We tested procedures for removing adipocere from insect samples to allow identification. An acceptable procedure was determined: (i) Samples were sorted in petri dishes with 75% alcohol to remove any larvae, adult insects, or other soft-bodied material. (ii) Samples of up to 24 puparia were placed in a vial with 15 mL of 95% acetone, capped, and vortexed for a total of 30–90 sec in 10- to 15-sec bursts. This step removed large masses of adipocere or soil from specimen. (iii) Specimens were removed from acetone and placed in a vial of 15 mL of 2% potassium hydroxide (KOH) and …


Strategic Community Healthcare Management, Stephanie Penrod Aug 2016

Strategic Community Healthcare Management, Stephanie Penrod

Master's Projects and Capstones

Federally Qualified Health Centers(FQHC) and Community Health Centers are growing with the Affordable Care Act. This paper introduces literature that supports the need for Community Health Centers and management of low income patients with chronic illnesses. This paper also reviews the fieldwork experience at a FQHC. It reviews the goals, project, methods and findings of the fieldwork. This paper also elaborates on the scope of the project and a quality improvement report for the FQHC in observation. It discusses the future potential implementation of the recommendations and the benefits for both employees and patients. This paper concludes with follow up …


Cryptosporidium Parvum Among Coprolites From La Cueva De Los Muertos Chiquitos (600–800 Ce), Rio Zape Valley, Durango, Mexico, Johnica J. Morrow, Karl Reinhard Aug 2016

Cryptosporidium Parvum Among Coprolites From La Cueva De Los Muertos Chiquitos (600–800 Ce), Rio Zape Valley, Durango, Mexico, Johnica J. Morrow, Karl Reinhard

Karl Reinhard Publications

In the present study, 90 coprolites from La Cueva de los Muertos Chiquitos (CMC) were subjected to enzyme-linked immunosorbent assay (ELISA) tests for 3 diarrhea-inducing protozoan parasites, Entamoeba histolytica, Giardia duodenalis, and Cryptosporidium parvum, to determine whether these parasites were present among the people who utilized this cave 1,200–1,400 yr ago. These people, the Loma San Gabriel, developed as a culture out of the Archaic Los Caracoles population and lived throughout much of present-day Durango and Zacatecas in Mexico. The Loma San Gabriel persisted through a mixed subsistence strategy of hunting-gathering and agricultural production. The results of …


Commencement Program 2016, Loma Linda University Jun 2016

Commencement Program 2016, Loma Linda University

Commencement Programs

CONTENTS

1 | Message from the President

3 | 2016 Events of Commencement

5 | The Academic Procession

7 | Significance of Academic Regalia

9 | The Good Samaritan

10 | University History Highlights

12 | Loma Linda University Song - "Healing Love"

13 | The Speakers

21 | The University Honorees

36 | The School Honorees

56 | The President's Award Recipients

66 | The Program

  • School of Medicine, 67
  • School of Pharmacy, 90
  • School of Dentistry, 98
  • School of Allied Health Professions - Allied Health Studies, Cardiopulmonary Sciences, Clinical Laboratory Science, Health Informatics and Information Management, Nutrition and …


Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu May 2016

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …


Oil & Gas Drilling In National Parks, Elizabeth Ann Glass Geltman Jan 2016

Oil & Gas Drilling In National Parks, Elizabeth Ann Glass Geltman

Publications and Research

While a great deal of public attention addresses the Halliburton loophole of the Energy Policy Act of 2005 and Bureau of Land Management efforts to regulate hydraulic fracturing on public lands, less attention has been paid to the National Park Service “9B Regulations,” which provide a national regulatory framework governing the exercise of nonfederal oil and gas rights in national parks. This article begins with a review of law pertaining to oil and gas drilling in national parks. The article examines the tension in striking a balance between environmental protection, conservation of national lands and achieving energy independence, including National …


The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris Jan 2016

The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris

Pharmacy Faculty Articles and Research

Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.

Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …


Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski Jan 2016

Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski

Department of Sociology: Faculty Publications

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people’s access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes—at its heart— decolonization, while also utilizing the “best …


Heath And The Homeless Population Of Missoula: “Housing First” As A Solution, Marissa S. Ginnett Jan 2016

Heath And The Homeless Population Of Missoula: “Housing First” As A Solution, Marissa S. Ginnett

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Missoula, Montana has an extremely high rate of homelessness at .75% of the population (compared to other large cities, Seattle, Washington at .23% and Los Angeles, California at .32%). This is due to there not being much done to help chronically inebriated homeless individuals. All are turned away from Missoula's overnight shelters if they are not sober. For an inebriated homeless person, the jail and the hospital are the only two places where they can stay the night. Through comparison to other cities, such as Seattle, Washington, I have identified that Missoula needs a wet housing program. Wet housing provides …


Making Health A Priority: Constrained Choices At The Grocery Store, Christy F. Brady Jan 2016

Making Health A Priority: Constrained Choices At The Grocery Store, Christy F. Brady

Theses and Dissertations--Sociology

Mounting evidence of the deleterious health effects of poor diet, obesity, and correlated conditions underscore the need to understand how social factors influence food choices. A variety of factors contribute to the diets that Americans consume including limited time, limited income, lack of cooking skills, food deserts, and cheap, convenient foods in abundant portions in grocery stores and restaurants. These contextual factors serve as constraints that impact an individual’s ability to prioritize health when shopping for food. Using the three paper dissertation format, this project will utilize a Constrained Choice Theory (CCT) framework to investigate sociodemographic trends in priorities in …


Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright Jan 2016

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …