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Articles 3301 - 3330 of 22956

Full-Text Articles in Social and Behavioral Sciences

Developing A New Tool For Early Detection Of The Nutritional And Health Risk Factors Of Urban Workers’ Productivity, Hildagardis Meliyani Erista Nai, Arimbi Karunia Estri, Christina Ririn Widianti Feb 2023

Developing A New Tool For Early Detection Of The Nutritional And Health Risk Factors Of Urban Workers’ Productivity, Hildagardis Meliyani Erista Nai, Arimbi Karunia Estri, Christina Ririn Widianti

Kesmas

Nutrition and health play vital roles in work productivity. This study aimed to develop a risk self-assessment tool called Early Detection of the Nutritional and Health Risk Factors on the productivity of urban workers. This study was conducted in two stages: 1) the development of the tool to determine the nutritional and health risk factors that affect productivity based on literature reviews and scoring systems and 2) the testing of validity and reliability. Finally, the tool contained 63 items, including 28 items on nutritional risk factors and 35 on health risk factors. The validity of the tool was assessed using …


Obesity And Asthma Risk In Indonesian Adults: Findings From The 2018 Indonesia Basic Health Research, Hoirun Nisa Feb 2023

Obesity And Asthma Risk In Indonesian Adults: Findings From The 2018 Indonesia Basic Health Research, Hoirun Nisa

Kesmas

Obesity and asthma are both global public health challenges. Mounting evidence suggests that obesity may increase asthma risk in adults; however, the association by sex remains uncertain. This study examined the association of obesity with asthma risk in Indonesian adult men and women. Data were obtained from the 2018 Indonesia Basic Health Research. The analysis included 299,837 men and 333,218 women aged ≥18 years. Asthma was identified by the self-report of a doctor’s diagnosis. Obesity was defined as a body mass index ≥30 kg/m2. A logistic regression was used for data analysis. Asthma prevalence was 2.7% (2.5% in men and …


Maternal And Child Health Handbook Utilization, Quantity And Quality Of Antenatal Services, And Maternal Emergency Rates In Padang City In 2022, Rena Afri Ningsih, Yusrawati Yusrawati, Joserizal Serudji Feb 2023

Maternal And Child Health Handbook Utilization, Quantity And Quality Of Antenatal Services, And Maternal Emergency Rates In Padang City In 2022, Rena Afri Ningsih, Yusrawati Yusrawati, Joserizal Serudji

Kesmas

This study analyzed the relationship between the utilization of the Indonesian Ministry of Health’s Maternal and Child Health Handbook and the quantity and quality of antenatal care to maternal emergency levels. This study applied mixed methods with a consecutive sampling technique and included 108 mothers undergoing maternal emergencies at a central general hospital (quantitative) and eight mothers, seven midwives, and five cadres at primary health cares (qualitative) as informants. The result showed a relationship between the utilization of the Maternal and Child Health Care Handbook (p-value = 0.043), the quantity of antenatal care (p-value


Students Arts Participation Increases Stem Motivation Via Self-Efficacy, Stephen M. Dahlem Feb 2023

Students Arts Participation Increases Stem Motivation Via Self-Efficacy, Stephen M. Dahlem

The Transdisciplinary STEAM+ Journal

This work found that there exists a correlation between student motivation in science, technology, engineering and mathematics (STEM) and student participation in the arts during high school with self-efficacy being a mediator. STEM is an important component of student success from a broad, national, perspective, as well as from a domain-specific point of view. The results of this work may provide aid to teachers, parents, administrators, and even students seeking to find ways to increase student motivation and performance in the STEM subjects. Additionally, this work may be of interest to advocates of the arts. This quantitative correlational study was …


Challenge-Based Learning & Steam Curriculum, Diana Lockwood Feb 2023

Challenge-Based Learning & Steam Curriculum, Diana Lockwood

The Transdisciplinary STEAM+ Journal

STEAM education is being integrated into elementary schools as a way to engage more students in creativity, hands-on learning, and problem-based learning also referred to as Challenge-Based-Learning (CBL). This article focuses on elementary educators’ curriculum design for STEAM and presenting students with open-ended questions phrased as a challenge as a way to raise student interest and achievement (DeJarnette, 2018; Hunter-Doniger, 2018). When students received challenges to solve, they felt more open to sharing their ideas since there was more than one potential right answer (DeJarnette, 2018; Drake, 2012). When implementing CBL, teachers act as facilitators using a constructivist approach as …


Factors Affecting Presence And Occupancy Of Marabou Storks (Leptoptilos Crumeniferus) At Abattoirs And Slaughter Slabs Near Jinja, Uganda, Elena Arroway Feb 2023

Factors Affecting Presence And Occupancy Of Marabou Storks (Leptoptilos Crumeniferus) At Abattoirs And Slaughter Slabs Near Jinja, Uganda, Elena Arroway

DU Undergraduate Research Journal Archive

This study examined the factors affecting the presence and occupancy of marabou storks at abattoirs and slaughter slabs near Jinja, Uganda. The average number of storks per unit area was compared across different areas within one large abattoir, including an analysis of the presence of free food, human disturbance, and other scavenging birds (pied crow, piapiac, spur-winged lapwing, and cattle egrets). Occupancy across two abattoirs and one slaughter slab was compared and related to the number of animals slaughtered daily at the facility. Direct observations at abattoirs and slaughter slabs were conducted for ten minutes with five minutes between observations. …


The Trade Impact Of Economic Integration Agreements, Byungyul Park, John C. Beghin Feb 2023

The Trade Impact Of Economic Integration Agreements, Byungyul Park, John C. Beghin

Cornhusker Economics

A year ago, Cornhusker Economics reported on the substantial trade integration that has been taking place globally in recent decades (see Beghin, 2022). With this proliferation of Economic Integration Agreements (EIAs) through regional and bilateral trade agreements and customs unions since the 1990s, many economists have investigated the effect of these agreements on merchandise trade. Early investigations struggled to find robust findings. They reached two opposite conclusions, with an eventual rejoinder on their limitations. Some investigations found statistically insignificant or negligible effects of EIAs on trade flows. Other investigations found significant effects, sometimes negative, of EIAs on trade. See Park …


Marine Ecological Protection And Restoration: International Agendas And China Action, Ke Duan, Zhengyan Liu, Shengkang Liang, Yanbin Li, Dongliang Lu Feb 2023

Marine Ecological Protection And Restoration: International Agendas And China Action, Ke Duan, Zhengyan Liu, Shengkang Liang, Yanbin Li, Dongliang Lu

Bulletin of Chinese Academy of Sciences (Chinese Version)

International conventions and initiatives can promote collective action against global crises, and strengthen the efforts of countries to take concerted actions. This study summarizes the important international agendas related to marine ecological conservation and restoration, and analyzes China's policy mechanism in recent years. It believes that the policies in China and international documents are synergistic and effective in jointly strengthening efforts to respond to the global crisis. This study also puts forward some countermeasures and suggestions for China to build a detailed regional marine ecological map, strengthen ecological corridor restoration, improve scientific and technological support systems, and promote international cooperation …


Practice Of Building Biomedical Innovation Highland In The United States And Its Enlightenment To China, Xiaoling Ma Feb 2023

Practice Of Building Biomedical Innovation Highland In The United States And Its Enlightenment To China, Xiaoling Ma

Bulletin of Chinese Academy of Sciences (Chinese Version)

The modern pharmaceutical industry began with the large-scale production of chemical drugs. With the radical innovation of basic sciences, such as life science, biomedicine has become the focus of the pharmaceutical industry, with broad prospects. Since World War II, the U.S. government, enterprises and scientific community have cultivated the biomedical industry and scientific foundation, created an environment for innovation, established an effective life science innovation system, and gradually become the innovation highland of biomedicine in the world. Building a biomedical innovation highland is an important part of China to become the world science center. China can learn from U.S. experience …


Characteristics Analysis And Inspiration Of The Us Brain Initiative, Mian Zu, Ying Wang, Wei Liu, Zexi Xin, Lei Wang Feb 2023

Characteristics Analysis And Inspiration Of The Us Brain Initiative, Mian Zu, Ying Wang, Wei Liu, Zexi Xin, Lei Wang

Bulletin of Chinese Academy of Sciences (Chinese Version)

Major countries have launched brain initiatives for competition, aiming to gain strategic priority in the area of brain ultimate frontier for human being in the course of recognizing nature. The US BRAIN Initiative is a scientific project comparable to the Human Genome Project in scale and potential impact. Accelerating the development and application of new technologies and tools is the driving force for the US BRAIN Initiative, which takes the lead in race owing to its realistic and innovative development mode. This study briefly reviews the implementation progress, the strategic reports and research achievements of the US BRAIN Initiative, and …


The Santa Clara, 2023-02-17, Santa Clara University Feb 2023

The Santa Clara, 2023-02-17, Santa Clara University

The Santa Clara

No abstract provided.


Workforce Trends To Watch In 2023, Cheryl A. Burkhart-Kriesel Feb 2023

Workforce Trends To Watch In 2023, Cheryl A. Burkhart-Kriesel

Cornhusker Economics

The rise of quiet quitters, digital nomads, and shaky employee trust are some of the major workforce trends that need watching in 2023, according to a recent article published by the Harvard Business School. Coupled with an uncertain economy and a tight labor market, business owners can view these potential trends as either challenges that pull their business down or opportunities that offer a competitive advantage. To leverage these toward business growth and increased productivity, it takes an understanding of how these trends emerged and how they could be an asset in an ever-changing business environment.

Covers: quiet quitters, digital …


Timing And Magnitude Of Drought Impacts On Carbon Uptake Across A Grassland Biome, Andrew Felton, Gregory R. Goldsmith Feb 2023

Timing And Magnitude Of Drought Impacts On Carbon Uptake Across A Grassland Biome, Andrew Felton, Gregory R. Goldsmith

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Although drought is known to negatively impact grassland functioning, the timing and magnitude of these impacts within a growing season remains unresolved. Previous small-scale assessments indicate grasslands may only respond to drought during narrow periods within a year; however, large-scale assessments are now needed to uncover the general patterns and determinants of this timing. We combined remote sensing datasets of gross primary productivity and weather to assess the timing and magnitude of grassland responses to drought at 5 km2 temporal resolution across two expansive ecoregions of the western US Great Plains biome: the C4-dominated shortgrass steppe and …


Clinical Outcomes Of A Large-Scale, Partnership-Based Regional Food Prescription Program: Results Of A Quasi-Experimental Study, Nalini Ranjit, Jennifer N Aiyer, Jack D Toups, Esther Liew, Kenia Way, Henry Shelton Brown, John Wesley Mcwhorter, Shreela V Sharma Feb 2023

Clinical Outcomes Of A Large-Scale, Partnership-Based Regional Food Prescription Program: Results Of A Quasi-Experimental Study, Nalini Ranjit, Jennifer N Aiyer, Jack D Toups, Esther Liew, Kenia Way, Henry Shelton Brown, John Wesley Mcwhorter, Shreela V Sharma

Faculty, Staff and Student Publications

BACKGROUND: Food prescription programs are gaining interest from funders, policy makers, and healthcare payers as a way to provide value-based care. A small body of research suggests that such programs effectively impact health outcomes; however, the quality of existing studies is variable, and most studies use small samples. This study attempts to address these gaps by utilizing a quasi-experimental design with non-equivalent controls, to evaluate clinical outcomes among participants enrolled in a food prescription program implemented at scale.

METHODS: We completed a secondary analysis of participant enrollment and utilization data collected between May 2018 and March 2021, by the Houston …


Household Food Security In The Mountain West, 2021, Zachary Walusek, Corryn Richardson, Issac Hernandez-Alcaraz, Annie Vong, Caitlin J. Saladino, William E. Brown Jr. Feb 2023

Household Food Security In The Mountain West, 2021, Zachary Walusek, Corryn Richardson, Issac Hernandez-Alcaraz, Annie Vong, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines data on household food security published by the United States Department of Agriculture. We examine the prevalence of household food insecurity and very low food security in Mountain West states (Arizona, Colorado, Nevada, New Mexico, and Utah) and the United States national average for comparative analysis.


College Of Natural Sciences Newsletter, November 2022 - January 2023, College Of Natural Sciences Feb 2023

College Of Natural Sciences Newsletter, November 2022 - January 2023, College Of Natural Sciences

College of Natural Sciences Newsletters and Reports

Volme 3, Issue 7

Page 1 Dean's Message
Page 2 Awards & Recognition
Page 3 Sioux Falls Middle School Visit
Page 4 Bio-Micro Day of Scholars
Page 5 GIS Day at USGS EROS
Page 6 Indigenous People's Festival, & Visiting Jack's Imagination Lab
Page 7 Media Coverage of CNS, & Research Highlights from Geography & Geospatial Sciences
Page 8 Media Coverage of CNS. cont.
Page 9 Open PRAIRIE Data
Page 10 Recent Publications from CNS
Page 11 Recent Publications from CNS. cont.
Page 12 CNS Holiday Snapshots
Page 13 & 14 Fall 2022 Dean's List
Page 12-14 Fall 2022 Outreach …


Assessment Of Variable Rate Nitrogen Application On Rice Cultivars Using Remote Sensing, Rush Matthew Evans Feb 2023

Assessment Of Variable Rate Nitrogen Application On Rice Cultivars Using Remote Sensing, Rush Matthew Evans

Student Theses and Dissertations

Application of the right time and amount of fertilizer N is challenging in rice fertilization because crop N supply is highly variable in the field. Research plots were established at four research plot fields and one commercial field in Arkansas. Independent variables included six nitrogen (N) application rates (0, 67, 101, 134.5, 168, and 202 kg N ha-1), multiple rice cultivars, and five locations. The response variable was 24 vegetative indices values using high spatio-temporal multispectral and thermal imagery obtained from an Unmanned Aerial Vehicle (UAV). The 134 and 168 kg N ha-1 rates were identified as the control group …


Rising Interest Rates: What They Mean For You And The Economy, Timothy Meyer Feb 2023

Rising Interest Rates: What They Mean For You And The Economy, Timothy Meyer

Cornhusker Economics

Discusses rising interest rates what they mean for agricultural workers and the economy.


Bridging The Cultural Divide: A Single Case Study Exploring Connections Between Multi-Cultural Education, Identity, Self-Esteem And Leadership, Amy Britton Feb 2023

Bridging The Cultural Divide: A Single Case Study Exploring Connections Between Multi-Cultural Education, Identity, Self-Esteem And Leadership, Amy Britton

Journal of Multicultural Affairs

This qualitative single case study explores connections between multicultural education, identity development, self-esteem, and leadership. The study focuses on the lived experiences of a lifelong learner, educator, and leader in higher education with the pseudonym, Rachel. The interview with Rachel traced how she experiences diversity within her academic experiences as a learner and her professional experiences as an educator and leader.


The Emerging Scholars Issue: Insights On Teaching And Leading Through Reshaping Policy And Practice, Lakia M. Scott, Taylor D. Bunn Feb 2023

The Emerging Scholars Issue: Insights On Teaching And Leading Through Reshaping Policy And Practice, Lakia M. Scott, Taylor D. Bunn

Journal of Multicultural Affairs

The Emerging Scholars program began at the 2019 Texas-NAME conference with five graduate students, four of which were enrolled in a doctoral program. Students participated in preconference workshops on establishing a research agenda, understanding academia and higher education institutions, and creating a network as an education researcher. Since its inception, the program has continued introducing students to collaborations and publication opportunities through Texas-NAME. This special issue provides doctoral students (some of whom have since graduated) with an opportunity to be single-authors in their scholar. Organized in three distinct sections, readers will be exposed to research and policy briefs and critical …


Sport And Mental Health Performance Optimization In An Adolescent Gymnast: A Case Evaluation, Davy Phrathep, Brad C. Donohue, Brenna N. Renn, John Mercer Dr., Daniel N. Allen Feb 2023

Sport And Mental Health Performance Optimization In An Adolescent Gymnast: A Case Evaluation, Davy Phrathep, Brad C. Donohue, Brenna N. Renn, John Mercer Dr., Daniel N. Allen

Psychology Faculty Research

The Optimum Performance Program in Sports (TOPPS) is a multi-component, sport-specific Family Behavior Therapy that has demonstrated improved sport performance, relationships, and mental health outcomes in adult and adolescent athletes with, and without, diagnosed mental health disorders in clinical trials. The current case trial demonstrates successful implementation of a novel component of TOPPS (i.e., talk aloud optimal sport performance imagery leading to dream mapping) in a biracial Latina and White adolescent gymnast without a mental health diagnosis. The participant demonstrated significant improvements from baseline to both post-treatment and 3-month follow-up in severity of mental health functioning, factors interfering with sports …


Riverine Commons And Institute Framework Plan, Community Design Center Feb 2023

Riverine Commons And Institute Framework Plan, Community Design Center

Community Design Center Project Reports

The nonprofit Watershed Conservation Resource Center is restoring a 98-acre riparian wetland landscape near downtown Fayetteville as a River Commons and Institute. The Framework Plan combines watershed restoration with architecture and urban design to house a river education center, a visitor interpretive center, walking trails, passive recreation facilities including bird watching and canoeing, and outdoor heritage exhibitions. The Plan operates at the intersection of anthropology, ecology, and design in developing a lasting and robust riverine knowledge fund across space and time.


Bringing Back Former Vegans And Vegetarians: An Obstacle Analysis, Jo Anderson, Coni Arévalo Feb 2023

Bringing Back Former Vegans And Vegetarians: An Obstacle Analysis, Jo Anderson, Coni Arévalo

Diet

People have a variety of motivations for switching to plant-based diets, yet not all people who begin the transition to a vegan or vegetarian (collectively called veg*n) diet maintain it long-term. In fact, Faunalytics’ study of current and former veg*ns (2014) found that the number of lapsed (former) vegans and vegetarians in the United States far surpasses the number of current veg*ns, and most who lapse do so within a year. Are these people the low-hanging fruit for diet advocates? They could be—there are many of them and they’re clearly at least somewhat willing to go veg*n, so maybe more …


Effects Of Body Composition On Weight-Bearing Staging In Firefighters: Based On Linear, Pls Regression Model Analysis, Hongye Li Feb 2023

Effects Of Body Composition On Weight-Bearing Staging In Firefighters: Based On Linear, Pls Regression Model Analysis, Hongye Li

International Journal of Physical Activity and Health

Firefighters are often exposed to traumatic events such as high temperatures, heavy fumes, and toxic gases during rescue services. The challenges require firefighters to have a higher level of physical performance compared to a typical person. In urbanized settings, weight-bearing staging is a necessary skill for firefighters. Currently, research has found a positive correlation between firefighter body composition and occupational activity performance. This study aims to examine effects of body composition on the weight-bearing staging performance of firefighters, providing guidance for firefighters' daily training routines. Participants were 47 male firefighters in Yangjiang City, Guangdong Province (age: 25.2 ± 3.9; height: …


Cover Crop Planting Practices Determine Their Performance In The U.S. Corn Belt, Katja Koehler-Cole, Roger W. Elmore, Humberto Blanco-Canqui, Charles A. Francis, Charles A. Shapiro, Christopher A. Proctor, Sabrina J. Ruis, Suat Irmak, Derek M. Heeren Feb 2023

Cover Crop Planting Practices Determine Their Performance In The U.S. Corn Belt, Katja Koehler-Cole, Roger W. Elmore, Humberto Blanco-Canqui, Charles A. Francis, Charles A. Shapiro, Christopher A. Proctor, Sabrina J. Ruis, Suat Irmak, Derek M. Heeren

Nebraska Cooperative Extension: Faculty and Staff Publications

Cover crop growing periods in the western United States Corn Belt could be extended by planting earlier. We evaluated both pre-harvest broadcast interseeding and post-harvest drilling of the following cover crops: (a) cereal rye (Secale cereale L.) [RYE]; (b) a mix of rye + legumes + brassicas [MIX1], (c) a mix of rye + oat [Avena sativa L.] + legumes + brassicas (MIX2), (d) legumes [LEGU]) and (e) a no cover crop control. These were tested in continuous corn (Zea mays L.) [corn–corn] and soybean [Glycine max (L.) Merr.]–corn systems [soybean–corn] at three sites in Nebraska …


Dendritic Spine Density And Morphology In The Dorsolateral Striatum Following A High Fat Diet, Tikva Nabatian Feb 2023

Dendritic Spine Density And Morphology In The Dorsolateral Striatum Following A High Fat Diet, Tikva Nabatian

Dissertations, Theses, and Capstone Projects

Obesity rates have been dramatically rising in recent years and in 2017-2018 more than 42% of adults in the United States were obese. Obesity is associated with numerous health problems, including cardiovascular disease, stroke, insulin resistance, and type II diabetes. The prevalence of highly palatable and calorically dense foods high in fats and sugars is a significant factor in the increase in obesity rates. Many suggest that palatable food affects the brain in ways similar to drugs of abuse, reinforcing the consumption of highly palatable foods in the same way drugs reinforce drug use. While numerous weight loss programs and …


Civil Society Organizations Serving Children In Vietnam: Opportunities And Constraints Working With Government Agencies, Trang P. Kelly Feb 2023

Civil Society Organizations Serving Children In Vietnam: Opportunities And Constraints Working With Government Agencies, Trang P. Kelly

Dissertations, Theses, and Capstone Projects

When Vietnamese civil society organization (CSO) administrators manage their relationships with government authorities to ensure children receive social services, they operate under Vietnam’s complex political, socioeconomic, and cultural constraints in environments where the Vietnamese government employs soft power to control CSOs and their donors. This study adds to the literature on the nature of CSO in Vietnam. It details the current imbalance of power between state-sponsored organizations (SSOs) and non-SSOs and provides an updated view of how Vietnamese non-SSOs mix social, economic, and political roles as employers and advocates.

Combining a qualitative exploratory and interpretative case study, I address a …


Sit Less, Move More: A National Study Of Physical-Activity Behavior And Cancer, Stella O. Nwogugu Feb 2023

Sit Less, Move More: A National Study Of Physical-Activity Behavior And Cancer, Stella O. Nwogugu

Dissertations, Theses, and Capstone Projects

Background: Physical activity is associated with lower risks of cancer, the second leading cause of death among Americans. Yet, sedentary behavior is the prevailing lifestyle for about 80% of American adults. Additionally, cancer survivors remain significantly inactive, even though physical activity has been shown to decrease risk of cancer and cancer recurrence, improve tolerance of cancer therapy, and reduce mortality. This research explores the relative impact of personal agency, social support, and key demographic variables on physical-activity behavior for a national sample of adults as well as how these relationships differ for cancer survivors and their counterparts.

Methods: Using the …


Biological Correlates Of The Effects Of Auricular Point Acupressure On Pain, Chao Hsing Yeh, Nada Lukkahatai, Xinran Huang, Hulin Wu, Hongyu Wang, Jingyu Zhang, Xinyi Sun, Thomas J Smith Feb 2023

Biological Correlates Of The Effects Of Auricular Point Acupressure On Pain, Chao Hsing Yeh, Nada Lukkahatai, Xinran Huang, Hulin Wu, Hongyu Wang, Jingyu Zhang, Xinyi Sun, Thomas J Smith

Faculty, Staff and Student Publications

BACKGROUND: To identify candidate inflammatory biomarkers for the underlying mechanism of auricular point acupressure (APA) on pain relief and examine the correlations among pain intensity, interference, and inflammatory biomarkers.

DESIGN: This is a secondary data analysis.

METHODS: Data on inflammatory biomarkers collected via blood samples and patient self-reported pain intensity and interference from three pilot studies (chronic low back pain, n = 61; arthralgia related to aromatase inhibitors, n = 20; and chemotherapy-induced neuropathy, n = 15) were integrated and analyzed. This paper reports the results based on within-subject treatment effects (change in scores from pre- to post-APA intervention) for …


Effects Of Continuous Exercise On Physiological Indexes Among Middle-Aged And Elderly Chronic Patients In Northwest China, Niu Jianzhuang, Niu Zhen, Ren Xiangyu, Yu Xuemei, Gao Nina, Shao Nina, Zhang Chengyi Feb 2023

Effects Of Continuous Exercise On Physiological Indexes Among Middle-Aged And Elderly Chronic Patients In Northwest China, Niu Jianzhuang, Niu Zhen, Ren Xiangyu, Yu Xuemei, Gao Nina, Shao Nina, Zhang Chengyi

International Journal of Physical Activity and Health

With the increase of aging population, accompanied by a series of aging problems, the study showed that the probability of chronic disease in the elderly population is 92.1%, and further research shows that the probability of having two or more chronic diseases is 70.0%. Therefore, understanding of the distribution and spatial-temporal variation trend of risk factors related to chronic diseases can provide scientific basis for the formulation of policies and intervention strategies for the prevention and treatment of chronic diseases. It is of urgent practical significance to improve the quality of life of the elderly and reduce the social medical …