Plan Presentation The presented project can be summarized in the following PICOT question: In senior hospitalized patients, what is the effectiveness of increased patient education and participation with regular exercise/physical therapy versus current hospital fall prevention programs with limited exercise/physical therapy in promoting balance and stability thus minimizing falls and...
Introduction The purpose of this study was to examine the risk factors predicting asthma among adult foreign-born African Americans in California. I used a quantitative correlation approach to undertake the research. The associated variables included the dependent variable (asthma status), independent variables (tobacco smoking, alcohol use, education level, income level,...
Introduction Canada, as a developed nation, is currently experiencing an aging population in its demographics. It arises from low birth rates, good quality healthcare, and longer lifespan for its citizenry. Due to advancement in healthcare, more people are living longer than before, despite an increase in the number of chronic...
Item No. Action Alternatives (check one) Action Content for Item (quick notes / bullet points) Scott Little – e-mail Call Immediately Note to call w/in 2-3 days Email immediately Email w/in day Meet with ASAP Forward to:______________ Note to meet w/in 2-3 days Other (specify:__________) No response needed Email Jane...
Introduction Any company comes to a point when adjustments in the operational process become necessary to provide better customer satisfaction and employee engagement. Process improvement programs are vital elements of organizations’ development. Therefore, managers who care about the constant progress of their companies take care to apply the best improvement...
Introduction Change processes are inevitable in every sphere of life because change is crucial for development. Changes frequently become a problem due to the resistance of stakeholders and other obstacles. Change theories are supposed to empower the process of change and make it less painful for the parties involved. Thus,...
The healthcare organizations chosen for the review are the Institute of Electrical and Electronics Engineers (IEEE), the American Medical Informatics Association (AMIA), and the Health Information and Management Systems Society (HIMSS). The membership fees of IEEE depend on members’ countries of residence and the duration of membership. The fees for...
How does understanding the database design assist with information retrieval and analytics? Database design is a crucial aspect of working with databases (DBs), which refers to a complex of procedures aimed at creating a structure that will be used to store and manage end-user data. If the end-user realizes the...
Abstract This paper aims to investigate the relationship between asthma and smoking among African immigrants in California. The research problem is founded on the failure of many health studies to include African immigrants as a minority group in health studies that investigate the relationship between asthma and smoking. From this...
Introduction The main role of global medical industry is to provide quality, reliable, and affordable medical care services; in above light, world Health Organization (WHO), European Union, United Nation bodies, and different regional and national bodies have continued to support programs that improve medical care provision. Jointly, the above bodies...
What are the primary reason and the need to aggregate data in health care? Explain your answer with examples Data aggregation in health care means collecting many different types of information into one unified data asset. The primary reason for the practice is that it allows an organization, such as...
Roy Simpson Professional accomplishments Roy Simpson is an informatics pioneer who is the current Deputy President for the Cerner Corporation. He is also the Senior Executive for the Corporation. In the early 1970s, he worked as an assistant to a Chief Nursing Officer in a community-based hospital owned by a...
The points proposed to be discussed in the presentation address the idea of unity because all the sections relate to the thesis. It is important to discuss the necessity of the merger for HealthPartners, the situation of the strategic shift, and the impact observed as a result of the merger...
Forms of Medical Group Practice Nowadays, private physician practices are in decline. The major disadvantages of these practices include high risks associated with practice-management responsibility, financial risks, and problems with autonomy balance (Kash & Tan, 2016). Medical groups, in comparison, offer fewer risks and disadvantages. Some forms of group practice...
If lack of mental health awareness is related to the society’s acceptance of mental institutes, then raising mental health awareness among the Saudi society will make them accept AlAmal complex for mental health According to Jorm (1), failing to provide health literacy to the public may result into lack of...
HealthPartners merged with Park Nicollet Health Services in 2013, and the organization has undergone a significant strategic shift because of the merger (HealthPartners, 2014). The purpose of this project is to state what impact the strategic shift had on the progress of this non-profit health care provider. Thus, the focus...
Abstract The population of children affected by AD/HD has a range of behavioral challenges that are difficult to manage in a group or team environment. Therefore, many families suffer because they are placed under great stress to monitor their child’s hyperactivity and impulsive behavior constantly. The result of AD/HD is...
Define quality in health care and explain the key principles and characteristics of total quality management and continuous quality improvement in the health care context. In your answer include a brief discussion about how TQM and CQI approaches differ from industry, or business-based, quality management, and performance improvement methods. Refer...
What are the largest expense categories incurred by health care services organizations? America’s health care spending has increased at an alarming rate over the past few years. Cleverley, Cleverley, and Song (2010) note that government spending on health care has almost doubled in recent times compared to its spending in...
Introduction Training sessions are directed at improving a particular aspect of operations in an organization. Barnes Jewish Hospital needs changes to respond to the evolving environment of healthcare in the US, and to enhance the efficiency of work to adapt to the Affordable Healthcare Act requirements. It is critical to...
A Brief Description of Inpatient and Outpatient Settings Inpatient and outpatient services refer to analytical and therapeutic processes carried out on patients undergoing various forms and levels of treatment. Inpatient implies that the individual is admitted to the hospital where the diagnostic and therapeutic procedures are conducted to ensure the...
Houston Methodist is a leading healthcare institution in the United States (About Houston Methodist, 2016). The organization provides “a wide range of health services to more patients in the Greater Houston Area” (About Houston Methodist, 2016, para. 2). The hospital’s major centers are characterized by qualified members of staff. The...
Introduction Commitment in a team can be described as a sense of free-flowing excitement and passion, where members are willing to anything that is required to enable the team to succeed (Larson & LaFasto, 1989). To provide effective health care, teams of health care providers need to work together as...
Model Evaluation Improvement science models are often used to enhance quality and safety standards in healthcare settings (Ernst et al., 2010). Particularly, they are designed to integrate evidence-based improvement practices in service delivery processes through improvements in patient safety and service quality (Ernst et al., 2010). In this assignment, two...
In today’s world, organizations are expected to use the latest technologies to improve customer experiences. Leasing mobile devices instead of purchasing them allows organizations to cut their expenses while also enhancing the quality of services provided to customers. A Request for Proposal is a useful document that allows sharing the...
The steps involved in the process of project planning Post #1 The steps in planning a project starts with knowing the parameters. It is important to give you a framework based on reality and will allow a good starting point. If those involved know the requirements and resources, it is...
National Infrastructures Within the past decade, the US government has been focusing on the best approaches to transform the country’s healthcare sector. One of the strategies entails the use of modern technologies. This objective has led to the establishment of efficient Electronic Health Record (EHR) and Health Information Exchange (HIE)...
Introduction According to Bourke Health Service (n. d.), Bourke is located to the northwest of Sydney along the Darling River. is a town with a population of about 4000 people (Linke n.d). The area boasts of a health facility which is referred to as the Bourke Health service. This facility...
The present work contains a handout for patient education on diabetes management, which is meant for people with diabetes; also, their families and caregivers may be interested in it. The handout is predominantly devoted to helping the audience to educate themselves on the issue. Diabetes is a chronic health condition,...
Introduction to the Project Obesity is a serious public health concern in the United States that puts millions of children and adolescents at risk of having poor health. Despite the intentions to control and prevent this condition among the chosen population, its prevalence remains high, and certain improvements are expected...
The state of California is engaged in State Health Information Exchange (State HIE) program that is aimed at creating IT infrastructural solutions for meaningful, rapid, and secure exchange of patients’ health data across states. The state of California as a participant is responsible for the availability and adequate flow of...
Research Proposal HealthPartners merged with Park Nicollet Health Services of St. Louis Park in Minnesota in 2013 (HealthPartners, 2014). The leaders’ focus on the cooperation strategy is explained with references to expectations regarding the improvement of the delivery system and expansion of services in the community. The selected cooperation strategy...
Neuroplasticity is a term that describes the human brain’s ability to adjust its structure in response to various factors (Doidge, 2007). Neuroplasticity is an important adaptive mechanism that allows the human brain to learn new information and maintain its function in case of an injury or a disease, and it...
Problem Identification A patient’s safety is a worldwide priority in preventing medication errors before they lead to permanent or temporary harm, financial loss, psychological trauma to patients and health care providers, and death. As stated by Aronson (2009), a medication error is characterized by the incorrect performance of prescriptions, negligence,...
It is essential for the healthcare team to exercise effective communication. Professional nurses should strive to assist patients as much as they can. The comfort goals of a patient are very important and hence, it should be the focus of a nurse. Pain management for patients is usually the main...
There is no use denying the fact that people are different. Some of them have a talent for one activity while others can perform some other actions better. At the dawn of civilization, people started to perform the kinds of activities they could to the best and since that time...
Introduction HIV/AIDS prevention in Africa has been a matter of intense debate throughout decades. Admittedly, various social and cultural issues contribute to the spread of the infection in the region. Therefore, cultural settings should be taken into account while developing prevention programs. Pen-3 Model within the dimension of cultural empowerment...
Do you purchase or consume organic food? If yes, how did you first adopted a green organic lifestyle? I have been purchasing organic food since it became widely introduced to the market. I’ve had two friends who are avid supporters of the healthy lifestyle. One of them is also an...
Introduction The narration of a story, irrespective of whether it relates to other people or is about oneself, is the same across the world. The advancement of language in human life, both on a personal and evolutionary basis, leads to the intricate use of metaphors and features of speech. This...
Assessment The Agency Health Protection Agency, HPA, is an organisation that deals with people suffering from various diseases, including tuberculosis. Tuberculosis (TB) is a highly contagious disease that comes with different repercussions depending on individual cases (Larsen, 2012). It is treated with antibiotics and takes around six months before it...
Introduction Tiny, portable gadgets, such as pocket digital assistants (PDAs) and mobile phones, have been pushed on the mark in recent years. Mobile or ubiquitous computing and handy gadgets are changing the relations between computers and humans. There is an introduction of a new communication approach based on context. This...
Introduction Huntington’s disease is a rare disease that is hereditary. It is a neurodegenerative disease and is characterized by chorea, emotional disorder, and dementia. The disease was described first in 1872. Huntington’s disease or condition is an autosomal dominant trait. This means that an offspring of a carrier, regardless of...
Introduction The institutionalization of healthcare is a major source of ethical conflicts. When looking at ethics, we consider the question; what do we owe to the other person? Today, healthcare management is an arrangement among the following groups: consumers or the patients, the providers who are the physicians and other...
Abstract The human orgasm is an important part of the sexual experience. Researchers state that it reinforces the relevance of sex. According to most researchers, the function of orgasm is to reinforce sex by acting as positive feedback to allow procreation. In this research, I evaluated the prevalence of female...
Purpose Statement To inform my audience about healthy eating and the way they can benefit from it. The positive evaluation of the topic presupposes a persuasive element. Thesis Statement Healthy eating habits can significantly improve one’s health which means that they should be promoted. Introduction Attention Getter: We all know...
Introduction The complex cognitive frameworks within an individual subject the mind to various processes. Psychologists seek to explain human behavior based on these cognitive frameworks (Stahl & Goldstein, 2010). However, in-depth approaches to the study of mental processes gave rise to the concepts of neuroscience and neuroplasticity. The brain plays...
Study Summary The Study Objective The objective of the study was to determine the role of active smoking in the occurrence of breast cancer among women. Specifically, the study aimed at establishing the extent to which active smoking increases the risk of breast cancer among Canadian women. Primary Exposure and...
Calculating Measure of Association Case One When the data provided in the first case is sorted, the organization of both the vaccinated and autistic conditions is shown in this table. With Autism Without Autism Total Vaccinated 263 440,392 440,655 Non-Vaccinated 53 96,595 96,648 Total 316 536,987 537,303 Using this table,...
Out of all the small treats, one can offer to others or buy for oneself, candies have always been the most popular ones. Chocolate, fruit, or jelly, sweet or sour, soft or hard – there are so many types of this product that a lifetime is not enough to try...
There are multiple screening tests for colon cancer or colorectal cancer. According to the global systematic review of screening interventions and guidelines, there are three major tests including a colonoscopy, flexible sigmoidoscopy, and fecal occult blood test (FOBT) (Bénard, Barkun, Martel, & von Renteln, 2018). As the researchers note, there...
Would You Call This an Epidemic or An Outbreak? The situation described in the case study can be classified as an outbreak. An outbreak is a relatively small-scale occurrence of a disease in a well-defined community at numbers greater than expected for the area. The numbers of individuals affected by...
One of the most influential events that set a new trend not only for Epidemiology but for the lifestyles of millions of people around the world was the publishing of similar studies by Cuyler Hammond and Daniel Horn (1954) Richard Doll and Austin Hill (1956) which connected smoking and lung...
Louise Fresco (2009) presented her views on the challenges related to food production that can jeopardise the development of human societies. The TED speaker made several important points associated with the production of food, farmers’ perspectives and concerns, and the role food (and bread, in particular) plays in people’s life....
Eric Morgan (2018) aims at developing a framework to predict the flow of parasites from wild animals to domestic species in Kazakhstan and Botswana. The researcher examines the way parasites adapt to the changeable environment, as well as the migration of wild animals that is often unpredictable. The limitations of...
Alprazolam General Description Alprazolam is an anxiolytic agent, a triazolobenzodiazepine derivative that has sedative, anticonvulsant, and central muscle relaxant effect. The drug is marked by the anxiolytic activity that is expressed in the reduction of emotional stress, anxiety, and panic attacks, which is combined with a moderately pronounced hypnotic effect...
Risk Assessment What are the hazards and do they prevent ‘lone working’? Sodium acetate buffer- It is an irritant that can destroy the integrity of the skin as well as the lining of the gastrointestinal tract. Sodium acetate can also irritate the eyes and affect the sense of sight. A...
In the current study, the focus was placed on the characterization of gut structure changes in mouse models for Autism spectrum disorder and chronic obstructive pulmonary disease. Autism spectrum disorder (ASD) is defined as a developmental condition affecting behavior and communication. The disease implies a variation of symptoms and can...
Both Human Papillomavirus (HPV), a disease that can cause malignancies, and gonorrhea are sexually transmitted infections (STIs), which pinpoint to the fact that this patient’s partner may have these health issues as well. In order to properly communicate with the patient, it is essential to explain that these diseases are...
Hypothetical Case M. J. is a 54 years old male who was diagnosed with amyotrophic lateral sclerosis (ALS). Initially, he has experienced symptoms of limb weakness in his arms, which progressed to the lower part of his body. In addition, he has difficulty walking due to stiffness in his legs....
Clinical Experience Review My clinical experience includes diverse patient encounters. While practicing family medicine, I had an opportunity to observe some cases of hypertension, hyperlipidemia, diabetes, ADHD, COPD, STD’s, skin diseases, depression, anxiety, and chronic back pain among adult patients aged from 23 to 92. Moreover, I encountered children aged...
A 16-year old athlete developed hives and fainted on two separate occasions while running 2 hours after lunch. She had a tuna salad sandwich with celery. She has eaten the same type of sandwich since without symptoms, but not within 6 hours of running. The patient suffered from urticaria induced...
Risk Assessment on Allergens Case 1 In this case, the boy has hives and faints while running. Regarding the fact that these reactions are observed two hours after lunch but not six hours after eating, the diagnosis of food-dependent exercise-included anaphylaxis (FDEIA) may be given. It is an unusual reaction...
Overview The concern for an adult’s mental health in regards to suicide should begin at the age of sixty, as at this period the issue is the most prevalent. Additionally, Shaha, Bhatb, Zarate-Escuderoc, DeLeo, and Erlangsen (2016), conducted a study to determine suicide rates for adults aged from 60 to...
Summary The video Euthanasia considers the ethical issue from the point of view of the law, ethics, religion, and philosophy. It does not appear to take a stance, but it portrays euthanasia as a phenomenon that is unlikely to disappear. The film offers a comprehensive overview of various attitudes as...
The patient reported shortness of breath, right-sided chest pain, chills and fever, productive cough, and rust-colored mucus. His physical examination showed tachypnea, decreased breath sounds on the right, and coarse rhonchi through the right lung field. Additional Laboratory and Radiological Tests Chest X-ray – it will help see the problem...
Summary Rachel has a family history of breast cancer on her mother’s side and finds that she has a mutated breast cancer 1. She has two sisters, Lisa and Kristin, so it is suggested they be tested also. Rationale According to the latest regulation, I am not allowed to disclose...
Because AG’s body mass index is higher than 25, he is suffering from blurred vision and hypertension and has never had these complaints before, it is logical to assume that he has type 2 diabetes. However, it is recommended to complete a random blood sugar test and an oral glucose...
According to the individual’s history, the pathophysiology of the illness includes the reaction of the woman’s body to some irritant. She has become sensitive to something in the environment, which, as a rule, does not cause any uncommon response in the human body. In the current case, the possible disease...
Energy pathways and exercises that utilize them There are three major pathways for obtaining energy exploring both aerobic and anaerobic exercises. First of all, it is an ATP-PC system. One should realize the fact that the body needs a constant supply of ATP energy. Besides, for short and intense physical...
Evidence-Based Project: palliative care I have always been interested in investigating ways of improving the patients’ quality of life and their overall state. Especially, this is relevant to palliative care because I understand that these patients may be exposed to numerous health problems that are connected not only to their...
Wavelength Wavelength refers to the distance over which a wave repeats itself. A wavelength is normally determined by putting into consideration the distance between two corresponding points that have the same period. Wavelength is usually represented by the letter lambda (λ) whereas the meter is the SI unit that is...
General Purpose: To inform and raise awareness Specific Purpose: I want to inform my audience about the common myth about tap water being more harmful than bottled water. Thesis: Although bottled water is traditionally preferred to tap water because of its supposedly improved quality and its effective promotion, tap water,...
Overview of the Case Story Andrea Kennedy Yates “drowned her children on June 20, 2001” (Resnick, 2007, p. 3). According to experts, Yates suffered from depression and psychosis. The legal test for insanity known as the M’Naghten Rules was used during the case. The court eventually convicted Andrea Yates of...
Abstract It would not be wrong to claim that obesity starts from the cradle, follows the child through various growth phases, and may lead to many health complications in adulthood. Children must be provided with appropriate help to avoid health problems that may result due to overweight unconsciousness. This help...
Female genital mutilation is practiced by different tribes and cultures. It is used to ensure social and moral norms among girls, and it is believed that it symbolizes maturity. It is used to control women in many regions (Simister 247). Africa and the Middle East have recorded the highest number...
Savant syndrome is one of the most mysterious phenomena in the modern world. It represents the condition when the brain damage may reveal the hidden genius. The savant abilities are unique by their nature. The person expresses mastery in particular activities without the necessary knowledge or training. Stephen Wiltshire is...
Introduction Health-related issues concerning women and cancer are very sensitive. Cancer is curable when detected early, although many people still believe that it is a terminal disease. Various risk factors increase and expose individuals to contracting cancer. Although some of the risk factors are unavoidable, most of them are highly...
This review focuses on the barriers in Nursing associated with the introduction of Evidence-based Practice. Evidence-based practice is relatively a new concept that involves a change from the traditional practice. The human tendency is always to resist first to changes. The resistance is what this review proposes to consider as...
The physiological consequences and health risks of excess body weight Description of Concrete Experience I may not be overweight, but I have lived and interacted with people with excess body weight. My mum is one of the closest people to me who are overweight. Even though she is my role...
Research Summary Table: Urinary Tract Infections Author (year) Purpose Sample/Number of Participants Design Level of Evidence Findings Limitations Blanck, Donahue, Brentlinger, Stinger, & Polito (2014) To investigate a bundled approach to catheter care practices and clarify its impact on patients with UTI. Two groups (18 years of age or more)...
Robert Johnson is a 60-year-old man who is experiencing severe pain and numbness in his left leg. After tests and examinations, he went through spine surgery. During post-surgical procedures, the patient suddenly lost consciousness after complaining of chest pain. He is unresponsive to stimuli, his pulse is not palpable and...
The following chapter is created to illustrate the findings of the research paper in order to analyse and interpret the results. This chapter analyses the data through the regression analysis and descriptive statistics along with a model summary that can be used to determine the impact of the dependent variable...
Assessing While assessing decreased cardiac output, it is important to gather both objective and subjective data from the patient. Subjective data includes numerous symptoms, such as fatigue, anxiety and agitation, changes in mental condition (e.g., hyperactivity or confusion), fainting, and so on (de Souza et al., 2014). Objective data includes...
The first article under analysis – Care Seeking for Pain in Young Adults with Sickle Cell Disease – was authored by Jenerette, Brewer, and Ataga (2014). The first two are professional nurses while the last one is a doctor of medicine. The article is of recent publication and in circulation...
Communicable diseases The Department of Health of Miami, Florida has an epidemiology program. Its primary objectives are to monitor and investigate the cases of communicable population-based diseases and conditions. The monitoring is in place for a purpose to detect and address the conditions in time to prevent their development and...
Introduction Nowadays, many people suffer from hypertension and the inabilities to control the changes of their blood pressure. People have headaches and do not know the reasons for such pain. One of the possible options to check your blood pressure is to buy an automatic blood pressure monitor and use...
Explain the concept of professionalism about the “Gold Coats” “A large part of achieving recognition as a professional has to do with the way that you present yourself to others. It is a mindset that becomes easier to apply as you progress further and becomes an inspiration to others to...
Citation 1 Beliveau, Richard, and Denis Gingras. Green tea: prevention and treatment of cancer by nutraceuticals. Lancet 364.9439 (2004):1021-22. Print. Credibility This article was published in the Lancet, which is a resourceful scholarly source. Beliveau is a leading Ph.D. scholar in the field of cancer research at the University of...
Introduction In today’s competitive business scenario, it has become critical for organisations to give priority to customer service and satisfaction. Such priority is more crucial for the service industry such as health care. Due to increasing competition, private sector companies engaged in health care are forced to prioritise customer service....
Abstract The use of Electroencephalography (EEG) has become a core factor in determining the levels of aspect for growth and development in the management of mental health Over the years. Electroencephalography has been used by many health practitioners in the diagnosis of diverse brain conditions and ailments such as epilepsy,...
Introduction Any dysfunction in the frontal and the prefrontal cortex is assessed through numerous methods. One of the methods is the Wisconsin Card Sorting Task dubbed WCST. The Wisconsin Card Sorting Task test is a set-shifting neuropsychological test. Specifically, WCST is used to assess the human executive functioning (Monchi et...
How important is it to involve users and in what aspect(s) of the design or what stage of the selection process would you seek their involvement? Potential users of computers in a health care facility setting should be involved in all decisions regarding the introduction of computers in their workplace...
Introduction Assisted suicide denotes measures by which a person or a group of people assist another person to voluntary bring about his or her own death. It may also describe how a doctor helps a terminally ill person to die. Assisted suicide In many cultures, suicide has remained the best...
Speech and language disorders refer to disorders in communication that arise from difficulties in hearing, language development, speech, and fluency (Cook and Friend 46). Examples include stuttering, dysarthria, voice problems, language expression disorder, and phonological disorder. These disorders usually range from small problems of sound replacement to difficulty in comprehending...
“Disease Warriors” Documentary and Epidemiology Summary of the documentary “Disease Warriors” The episode Disease Warriors describes the work of healthcare professionals, trying to prevent the spread of contagious diseases and help patients who suffer from various illnesses such as AIDS. This film shows that vaccination can be the key to...
MHC Self-proteins from non-self proteins are viral that are distinguished by the major histocompatibility complex (MHC). This component is an important molecule involved in body immunity. The molecule signifies foreign molecules that may be present in the human body system. The paper intends to analyze the importance of MHC molecules...
Background of the problem “Overwhelming facts reveal that racial and cultural minority groups are more likely to receive poorer quality health care than white Americans, even when factors such as insurance status are controlled” (American College of Physicians 2010). As the country’s population continues to grow and diversify, the health...
Literature Review Electronic health record (EHR) is an application of information technology in the collection, storage, retrieval, and utilization of data derived from patients or the general population. Hayrinen, Saranto, and Nykanen (2008) define EHR as “a means of repository of patient data in a digital form, stored, and exchanged...
Bipolar Disorder In this paper, it is preliminarily asserted that, over recent times, there have been several debates regarding the intricacies of bipolar disorder (also called manic depressive disorder). It is further stated that, to a great extent, immense progress has been made in terms of treating this order. However,...
The Language Hemisphere Notably, there exists a dogmatic assumption that the left hemisphere controls language. Nevertheless, this is a gross oversimplification of the matter. In this case, the two hemispheres are involved in language processing (Banich, 2004). However, the left hemisphere has a relative advantage of performing the role than...
Market structure According to the US government report of 2007, the market structure for both the prescription drugs (brand-name drugs) and generic drugs are changing significantly. It notes that for the last four decades there, is a small increase, in demand, for prescription drugs due to the increasing use of...
Introduction Respiration is the process of exchanging gases between the environments and organisms during which the thoracic volume changes to develop a specific mechanism of pushing the air out of the trachea and pulling the next portion of the air in the trachea. The elements of the mechanism are expiration...