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Analytical, Diagnostic and Therapeutic Techniques and Equipment

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Best Screening: Introducing The Neonatal Assessment Visual European Grid To Nicus In Tennessee, Gabrielle Sledge Apr 2024

Best Screening: Introducing The Neonatal Assessment Visual European Grid To Nicus In Tennessee, Gabrielle Sledge

OTD Capstone Projects

Blind Early Services Tennessee (BEST) is an early intervention agency that serves children ages 0-5 with visual impairments across Tennessee. BEST serves over 200 children and families across the state offering early intervention (BEST Start), parent empowerment (BEST Advocate), and family support (BEST Together) programming. The purpose of this project was to assist in the implementation of an early identification initiative (BEST Screening) using the Neonatal Assessment Visual European Grid (NAVEG). The NAVEG is a newborn vision screening shown to identify neurological risk for visual impairments. The long-term goal of this program is to promote the screening and early identification …


From Heel To Toe: Investigating Plantar Fasciitis Causes, Diagnosis, And Treatment Strategies, Breanna Littlejohn Jan 2024

From Heel To Toe: Investigating Plantar Fasciitis Causes, Diagnosis, And Treatment Strategies, Breanna Littlejohn

Undergraduate Honors Theses

This presentation informs plantar fasciitis patients. The cause of plantar fasciitis is multifactorial but most cases result from overuse stress. The cause of plantar fasciitis is multifactorial but most cases result from overuse stress. The classic presentation is of sharp localized pain at the heel. In some cases, a heel spur may be found. This presentation explains how exercise can improve plantar fasciitis. Reviewing risk factors will help you identify and manage plantar fasciitis when undergoing treatment. Understanding plantar fasciitis is crucial as it is a common and painful condition affecting the bottom of the foot. This inflammation of the …


Using Noninvasive Calibrated Cuff Plethysmography To Observe The Effects Of Cold-Water Immersion On Arterial Compliance, Rita M. Grigorian Dec 2023

Using Noninvasive Calibrated Cuff Plethysmography To Observe The Effects Of Cold-Water Immersion On Arterial Compliance, Rita M. Grigorian

Biomedical Engineering: Graduate Reports and Projects

As the prevalence of cardiovascular diseases continues to exponentially grow in populations across the globe, the necessity of determining underlying factors, effective methods of diagnoses, and universally available preventive measures also grows. Early detection of endothelial dysfunction, a proven precursor of cardiovascular diseases, can be extremely impactful in encouraging preventative measures and early intervention before medical conditions become chronic. In recent years, ice plunging, a form of cryotherapy involving full body immersion in cold water, has gained popularity within circles of fitness and health practitioners, gaining the interest of people of all backgrounds. Certain parallels observed between the human physiological …


Art Of Aging – A Portraiture Study, Alaina Mann Dec 2023

Art Of Aging – A Portraiture Study, Alaina Mann

Theses/Capstones/Creative Projects

The process of aging can be viewed through different lenses within our society. In the past, scientists and medical professionals performed various studies to better understand and analyze different facets of aging, medicine, and health in general. Historically the arts have reflected multiple aspects of medicine and treatments while more recently, the arts have been used in a research capacity to provide different ways to represent illness, suffering, and care. This study used art-based research methods and portraiture to gather qualitative observations on the older populations within our community. Data collected included drawings, a field journal, and interviews. This study …


Nanocellulose Based Foams For Low-Cost Disposable Medical Applications, Dominic Kugell Aug 2023

Nanocellulose Based Foams For Low-Cost Disposable Medical Applications, Dominic Kugell

Electronic Theses and Dissertations

Polyurethane foams have been a staple material for their use in medical positioners, such as post-surgery elevation pillows as well as specific tailored positioners for their use during surgery. Polyurethane foams are preferred because of their lower cost compared to other petroleum derived foams, their versatility, and suitable mechanical properties. However, the environmental impact, including both cost and perception, of these foams is immense. Therefore, alternatives are being explored with biopolymers emerging as a promising class of materials. Cellulose is one such polymer that has recently demonstrated desirable properties. In this study, cellulose nanofibrils (CNF), a household foaming agent, and …


Examining Benefits Of Early Intervention In Cases Of Pediatric Chronic Hypoxia, Kendra Stefan Jun 2023

Examining Benefits Of Early Intervention In Cases Of Pediatric Chronic Hypoxia, Kendra Stefan

University Honors Theses

There is a strong foundation of evidence and consensus in the literature that hypoxia has adverse impacts on brain function. Recent research has broadened the field in two directions. One is the treatment for acute hypoxic injuries, and the second is regarding the accumulative impact of intermittent or chronic hypoxia. Historically, in cases of acute hypoxia, action is taken to remedy the source of hypoxia. Physical and cognitive rehabilitation has typically been provided as needed depending on the severity of the injury. While cases of intermittent or chronic hypoxia may not demonstrate an acute urgency for treatment and rehabilitation, current …


The Relationships Among Proprioception, Balance, And Cognitive Perception Of Body Awareness In College Students, Courtney Helmick May 2023

The Relationships Among Proprioception, Balance, And Cognitive Perception Of Body Awareness In College Students, Courtney Helmick

Honors College Theses

Introduction: Proprioception is an important physiological function that is essential for activities of daily living as well as exercise and sport performance. Integration of proprioceptive signals plays a key role in both static and dynamic balance. Previously, researchers have assessed the relationship between balance and proprioception, however, the effect of cognitive perception of body awareness has not previously been included in this research. The aim of this pilot study was to explore the relationships among lower extremity proprioception, dynamic balance, and cognitive perception of body awareness in college students.

Methods: Nineteen apparently healthy college students (age 21.26 ± 1.10 years, …


Comparison Of A Dynamic Ankle Orthosis To A Walking Boot For Preserving Ankle Joint Motion And Reducing Tibial Bone Load And Strain, Perri Johnson Jr. Dec 2022

Comparison Of A Dynamic Ankle Orthosis To A Walking Boot For Preserving Ankle Joint Motion And Reducing Tibial Bone Load And Strain, Perri Johnson Jr.

Theses and Dissertations (ETD)

Tibial stress fractures are a common overuse injury accounting for 21.9 – 69% of stress fractures among runners and 24 – 51.2% of stress fractures in military cadets. Current treatment involves wearing a walking boot for 3 – 12 weeks, which limits ankle motion and causes lower limb muscle atrophy. A Dynamic Ankle Orthosis (DAO) provided a distractive force that offloaded the ankle and retained sagittal ankle excursion during walking. It remains unclear how tibial loading is affected by a walking boot or the DAO. This thesis presents a feasibility study confirming the offloading effects of the DAO on tibial …


To Develop A Clinically Friendly Multi-Segment Kinematic And Kinetic Foot Model And Test It On Pre-/Post-Hto Patients With Medial Knee Osteoarthritis And Knee Varus, Songlin Zhu Jun 2022

To Develop A Clinically Friendly Multi-Segment Kinematic And Kinetic Foot Model And Test It On Pre-/Post-Hto Patients With Medial Knee Osteoarthritis And Knee Varus, Songlin Zhu

Electronic Thesis and Dissertation Repository

This study aims to develop a clinically useful multi-segment foot model that will enable the analysis of foot kinematics and kinetics in an optical motion capture laboratory setting. This study will also test the new multi-segment foot model on patients with knee osteoarthritis and varus knee alignment that is corrected by high tibial osteotomy (HTO). The multi-segment foot model divides the foot into four functional segments: the hindfoot, midfoot, forefoot and hallux. An X-Z-Y-Cardan angle rotation convention was used to determine intersegmental dorsi/plantar flexion, inversion/eversion, and internal/external rotation. Joint moments, joint powers and medio-longitudinal arch (MLA) height/length ratio were also …


Early Detection Of Atypical Motor And Neurobehavior Of Infants At Risk Secondary To Opioid Exposure: A Prospective Study, Kara Boynewicz May 2022

Early Detection Of Atypical Motor And Neurobehavior Of Infants At Risk Secondary To Opioid Exposure: A Prospective Study, Kara Boynewicz

Electronic Theses and Dissertations

Prenatal opioid exposure has been studied in relation to infants' medical outcomes. However, large gaps exist in the literature supporting early identification of atypical neurobehavior and motor development of infants with prenatal opioid exposure. The purpose of the study was to investigate whether prenatal opioid exposure has a negative influence on a newborn infant’s neurobehavior and motor development to aid in the early identification of potential delays. Using a prospective quasi experimental design, infants motor development using the Test of Infant Motor Performance (TIMP) and neurobehavior using the NICU Neonatal Network Scale (NNNS) was assessed on 58 infants in a …


Comparative Kinematic Gait Analysis In Adults With Multiple Disabilities, Lauren Rumbalski Apr 2022

Comparative Kinematic Gait Analysis In Adults With Multiple Disabilities, Lauren Rumbalski

Undergraduate Honors Thesis Projects

The purpose of this research is to identify abnormal gait parameters or patterns amongst young adults with multiple disabilities enrolled in a work transition program sponsored by a public-school system. Gait disorders are commonly seen in individuals with neurologic disorders, with significant research in children with autism. Gait disorders have been linked with fall and injury risk, with significant research in elderly populations. Gait analysis technology can be used to identify gait characteristics in populations that are abnormal or contribute to gait disorders. In an observational design, students from the transitional program promoted by Westerville City Schools, housed on Otterbein …


Comparison Of Landing Biomechanics Between Different Competitive Levels Of Irish Dance, Jade Shields Jan 2022

Comparison Of Landing Biomechanics Between Different Competitive Levels Of Irish Dance, Jade Shields

West Chester University Master’s Theses

Abstract

Objectives: To determine differences in lower limb landing biomechanics and lower extremity function scale scores between champion levels, in young female Irish dancers.

Design: Cross-sectional.

Setting: McDade-Cara School of Irish Dance

Participants: 12 Open Champion (OC) level female Irish dancers (11.9 ± 3.37 years) and 9 Preliminary Champion (PC) Irish dancers (13.5 ± 3.37 years) performed the landing error scoring system test (LESS), and completed the lower extremity functional scale (LEFS) and a descriptive data questionnaire

Main outcome measures: LESS scoring sheet and LEFS PRO

Results: No significant differences found between OC and PC levels on …


Characterization, Implementation, And Impact Of Low Stimulation Precautions In Acute Neurological Injury, Alexis Kurek Jun 2021

Characterization, Implementation, And Impact Of Low Stimulation Precautions In Acute Neurological Injury, Alexis Kurek

Dissertations

Recommendations provided by clinical and professional organizations that encourage providing patients with a low stimulation environment following acquired brain injury are prevalent but supported by expert opinion only. Such recommendations are based on extrapolation of what is known about physiological response to environmental stimuli, however such findings are not specific to the patients with acquired brain injury. Recommendations for low stimulation environments lack guidance for their application and implementation of precautions, and there have been no studies investigating their effectiveness at improving clinical outcomes.

The objective of this study is to determine what patient characteristics are associated with prescription of …


Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans May 2021

Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans

Expressive Therapies Capstone Theses

The process of hospitalization and the environment of a typical psychiatric hospital is often counter-therapeutic. To challenge this problem, clinicians may introduce the concept of psychological containment. To elaborate, being hospitalized anywhere can be disorienting, frightening and even traumatic. This problem is only further exacerbated in psychiatric hospitals where patients may be disorganized, manic, or struggling with psychosis. Furthermore, psychological containment is essentially the ability for psychiatric patients to prevent their intense emotions from effecting others negatively, and to act with resiliency when other patients are unable to contain their own disruptive behaviors. This paper utilizes both an initial literature …


Exploring The Usefulness Of Mindfulness Practices Through Zoom Meetings In Reducing Anxiety And/Or Stress Of Adults With Learning And Developmental Disabilities During The Covid-19 Pandemic, Thatiane Abra May 2021

Exploring The Usefulness Of Mindfulness Practices Through Zoom Meetings In Reducing Anxiety And/Or Stress Of Adults With Learning And Developmental Disabilities During The Covid-19 Pandemic, Thatiane Abra

Expressive Therapies Capstone Theses

This thesis explored which mindfulness meditations or mindfulness practices could be beneficial in the online sessions, the extent to which adults with learning and developmental disabilities could learn the practices remotely, and how stress and anxiety disorders could be reduced through online mindfulness interventions. Furthermore, it was also necessary to address the online sessions as the only mental health treatment possibility during the Coronavirus pandemic for the clients observed and the benefits and limitations of these interventions. Additionally, the importance of structure and routine for this population, the multi-modal structure of the interventions, and how attunement plays an important role …


The Therapeutic Benefits Of Attunement Through Lindy Hop, Sarah Trowbridge May 2021

The Therapeutic Benefits Of Attunement Through Lindy Hop, Sarah Trowbridge

Expressive Therapies Capstone Theses

Dance/movement therapy (DMT) was developed as a tool to aide in therapeutic healing. A foundational aspect of DMT is attunement, the emotional/kinesthetic connection between two people that allows for meaningful and healing bonds to emerge. Lindy Hop is a partnered dance that fosters an environment of attunement, as it is accessed both subconsciously and consciously. This research explores Lindy Hop as a possible method of therapeutic treatment. The literature indicates the physiological need for attunement and how safety plays a key role in strengthening senses of self-identity, nervous system development, and worldview. Four experienced Lindy Hoppers were recruited to engage …


Dance/Movement Therapy In Response To Continuous Race-Based Trauma, Aliesha Bryan May 2021

Dance/Movement Therapy In Response To Continuous Race-Based Trauma, Aliesha Bryan

Dance/Movement Therapy Theses

Trauma is concomitant with a lack of safety; as such, where there is a threat to safety, there is likely to be trauma. Afrodescendants living in the United States, through an ongoing lack of human regard, are often powerless to ensure their safety, and are regularly subjected to continuous, race-based trauma. Racism is deeply embedded in the nation’s institutions as well as in every relationship, and this deeply pervasive and penetrating ideology influences strongly how individuals of any race interact with others. Race-based aggression, from micro- to macro-, has a profound and continuously traumatizing effect on Afrodescendants, with similarly profound …


Predicting Dissatisfaction With Total Knee Arthroplasty, Joseph S. Munn Jan 2021

Predicting Dissatisfaction With Total Knee Arthroplasty, Joseph S. Munn

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a common and effective treatment for end-stage osteoarthritis. However, approximately 20% of patients are consistently found to be dissatisfied or unsure of their satisfaction with their TKA at 1-year post-surgery. Two strategies for reducing dissatisfaction have appeared in the literature. The first aims to reduce the number of dissatisfied patients who will undergo surgery by identifying patients likely to be dissatisfied pre-surgery. The second aims to implement interventions that improve patient satisfaction by generating realistic expectations for outcomes and by association improving met expectations scores. It may be possible to improve the performance of these …


Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm Jan 2021

Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm

DNP Projects

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project …


Pinch Span And Force: Normative Data, Requirements For Functional Tasks And Life Roles, And The Influence Of Carpometacarpal Joint Osteoarthritis, Nancy Hock Jun 2020

Pinch Span And Force: Normative Data, Requirements For Functional Tasks And Life Roles, And The Influence Of Carpometacarpal Joint Osteoarthritis, Nancy Hock

Dissertations

The three studies that form this dissertation build knowledge related to functional pinch. Study 1 provides normative data for the Baseline® 5-Position Hydraulic Pinch Meter, which may be used in clinical practice. The data collected in this study demonstrate the relationship between lateral pinch strength and age and reveal that strength decreases with age in both males and females. Through examination of the lateral pinch force produced at the 5 different pinch spans, it was found that the strongest lateral pinch strength was produced at 4-5 cm of pinch span. This information can be used by clinicians as they modify …


Assessment Of Antebrachial And Carpal Muscle Activity During Smartphone Use: Is “Selfie Wrist” A Real Phenomenon?, Monica Stacy May 2020

Assessment Of Antebrachial And Carpal Muscle Activity During Smartphone Use: Is “Selfie Wrist” A Real Phenomenon?, Monica Stacy

Honors Theses

Reports in the media by celebrities have sparked an interest in a phenomenon being called “selfie-wrist,” in which smartphone users develop symptoms traditionally associated with carpal tunnel syndrome (CTS). There has been no research to date which investigates the claims of “selfie wrist.” The primary aim of this study was to address the validity of “selfie wrist” claims. The secondary aim of this study was to further investigate the effects of texting on musculoskeletal health, taking into account the differences between texting one-handed versus two-handed, and the effect of using a grip device while texting.

The experiment consisted of an …


Champ's Triathlon Training Program, Rachael Sollman Apr 2020

Champ's Triathlon Training Program, Rachael Sollman

OTD Capstone Projects

Champ's Triathlon Training Program was created to provide an adaptive fitness opportunity to the community of Nashville, TN. This program was specifically targeting children 8 to 15 years old diagnosed with Down's Syndrome and Cerebral Palsy, Gross Motor Function Classification Scale levels I, II, and III. Champ's Triathlon Training Program was an extension of the Champ's Tri My Best Triathlon hosted by a team of therapists and Vanderbilt's Pediatric Clinic, including Kelley Newman. The program aimed to increase the participants' strength, flexibility, and endurance through triathlon related activities such as running/walking, swimming, and biking. Outcomes of the program were to …


Physical Therapy With Adjunct Therapies In Patients With Chronic Pain And Disability Post-Motor Vehicle Accidents, Lakshmi Subramanian Apr 2020

Physical Therapy With Adjunct Therapies In Patients With Chronic Pain And Disability Post-Motor Vehicle Accidents, Lakshmi Subramanian

Dissertations and Theses

This project is a thorough literature review of studies concerning physical therapy interventions in conjunction with adjunct treatments for patients post-motor vehicle accidents focused on the therapy’s efficacy as related to functional outcome measures. Physical therapy is frequently treatment of choice for patients after minor motor vehicle accidents. However, most patients seek concomitant therapies like acupuncture, chiropractic, epidural steroid injection, and psychological counselling. This paper seeks to gather data on the efficacy of different treatment modalities when used in conjunction with each other. Often patients are traumatised or develop anxiety about driving requiring counselling and therapy. The vast majority of …


Vestibular Function And Sports-Related Concussion: An Exploratory Investigation Of The Consequences Of Sports Related Concussion On Vestibular Function And Outcomes, Carolina Quintana Jan 2020

Vestibular Function And Sports-Related Concussion: An Exploratory Investigation Of The Consequences Of Sports Related Concussion On Vestibular Function And Outcomes, Carolina Quintana

Theses and Dissertations--Rehabilitation Sciences

Sports-related concussions (SRC), or mild traumatic brain injuries that occur as a result of sports or athletic participation, are said to affect approximately 300,000 young adults and 1.4 million youth athletes in the United States on an annual basis. SRC create a significant burden on the health care system by generating an estimated $60 billion dollars in direct and indirect costs in 2000. In addition to the financial burden these injuries create, they additionally impose both short- and long-term effects for those effected and their overall health. Among the many effects of concussions are physical signs as symptoms such as …


Socioeconomic Status's Impact On The Experience Of Loneliness, Tessa Samuels Jun 2019

Socioeconomic Status's Impact On The Experience Of Loneliness, Tessa Samuels

Sociology & Anthropology Theses

Loneliness is a feeling that is nearly universal, yet some people are more vulnerable to prolonged exposures of the experience of loneliness. Due to the subjective nature of loneliness, there is minimal literature on loneliness without the variable of social isolation (Hawkley et al. 2008, Ryan et al. 2008, Kearns et al. 2015, Lee and Ishii-Kuntz 1987) or social capital (Benner and Wang 2014, Andersson 1998, Ryan et al. 2008, Kearns et al. 2015) involved. There are numerous variables that impact loneliness. One must consider age — there has been solid gerontology research that reveals that elderly people are less …


The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava May 2019

The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava

Evidence-Based Practice Project Reports

The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, …


Innovative Care Of Individuals In The Athletic Training Room: A Case Series, Kathryn E. Young May 2019

Innovative Care Of Individuals In The Athletic Training Room: A Case Series, Kathryn E. Young

Senior Honors Projects, 2010-2019

This work follows three unique cases of athletic injuries and/or injuries in patients. These cases were selected because of the innovative nature of the rehabilitation process conducted by the sports medicine team via the athletic training room or the unique nature of the injury/case.

The first is a concussion sustained from a motor vehicle accident in a collegiate female thrower. This is unique because it’s a non-sport related concussion handled as an athletic trainer would handle a sports related concussion. It also demonstrates a new unique protocol for concussion management.

The second case is a patient with two complete anterior …


Different Effects Of Static And Vibrating Foam Rollers On Ankle Plantar Flexion Flexibility And Neuromuscular Activation, Brianna G. Mazzei Apr 2019

Different Effects Of Static And Vibrating Foam Rollers On Ankle Plantar Flexion Flexibility And Neuromuscular Activation, Brianna G. Mazzei

Honors College Theses

The relatively new implementation of vibration into foam rollers was developed in response to the positive feedback of whole-body vibration treatment and foam rolling therapy. The purpose of the study is to research the changes in range of motion and myoelectric activity of the ankle dorsiflexors in female NCAA Division I swimmers when using a vibrating foam roller in comparison to a static foam roller. Combining the self-myofascial release with the increased blood flow and muscle temperature exerted from vibration could possibly enhance the effects of foam-rolling treatment. The different effects of ankle flexibility and motor unit activation after static …


Evidence And Interventions For Children With Handwriting Deficits, Josephine Hatch Apr 2019

Evidence And Interventions For Children With Handwriting Deficits, Josephine Hatch

Thinking Matters Symposium Archive

The purpose of this project was to determine effective interventions shown to increase fine motor skills in children who experience handwriting deficits related to ADD/ADHD or other attention deficits. The project was prepared for a pediatric outpatient OT at Hasbro Children’s Hospital. The information was found via the USM databases through specific search terms and parameters.
This work is significant because many OTs and teachers are working with children who have deficits in handwriting and fine motor abilities. There needs to be additional research conducted specifically with children who have ADD/ADHD and exhibit fine motor and handwriting deficits.
The research …


Experiences Of Veterans With Ptsd And Sud In An Outpatient Setting, Andrew Breault, Hannah Shifflett-Kohler Apr 2019

Experiences Of Veterans With Ptsd And Sud In An Outpatient Setting, Andrew Breault, Hannah Shifflett-Kohler

Thinking Matters Symposium Archive

In 2014, there were approximately 7.9 million adults in the United States with co-occurring Post Traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUD) (SAMHSA, 2014). Of the veterans who served in the conflicts in Iraq and Afghanistan alone, 30% of those in SUD treatment also meet the criteria for PTSD (Seal et al, 2008, pp. 476). Furthermore, statistics show that about 20 Veterans in the United States complete suicide daily (Spiva, 2019, p. 8). The Department of Veterans Affairs is urgently seeking successful approaches to addressing the high incidence of suicides among all veterans along with the low retention …