Impact of COVID on Racial & Ethnic Minorities

Like I’ve mentioned in a few of my previous posts, this pandemic has brought on a lot of changes for everyone– but there is variation in how COVID-19 has impacted different groups of people. The experience of racial and ethnic minorities during this pandemic has been very different from other groups and is reflective of health outcomes that often exist for minorities in the U.S.

COVID-19

In New York City, the death rates for Black/African American individuals is much higher due to the virus, than it is for other racial/ethnic groups (1). The chart below shows the disproportionality of the effects of COVID on the population of African American individuals in a few states. 

Compared to the total state population, the majority of patients affected by COVID are African American (2).

These disparities exist not only during this pandemic, but in healthcare in general:

Reasons for the Disparity

People who belong to racial or ethnic minority groups experience the health care system differently than others– many of the existing disparities in society lead to poorer health outcomes, as well as greater vulnerability to viruses and other illnesses. Many minority groups live in heavily populated areas or live in households with multiple generations, where social distancing might not be possible (1). Many work hourly, so health benefits are not part of the package and health services become difficult to access (2). There is also a much higher population of racial and ethnic minorities in jails, prisons, etc. which are again, places that increase the risk of spread of viruses and other illnesses (1).

Also, because of the social distancing measures that have to be taken because of the pandemic, there has been a decrease in quality of care for patients who don’t speak English (4). Before, interpreters/translators could be present in person during a patient’s visit, which makes it much easier to translate and understand the patient’s concerns and symptoms. Now, a lot of interpreters have to work over the phone and it’s possible that a lot of information is getting lost in translation because it’s just harder to have a conversation and understand each other that way.

While the pandemic has affected everyone in one way or another, it has not affected everyone equally. The social determinants of health that I talked about in my first blog, in addition to factors such as racism, geographic location, and poverty, play a large part in deciding how an individual is affected. Unfortunately, the same level and quality of healthcare are not available to every person. Moving towards a system that addresses these disparities and provides excellent health care to each patient will involve first resolving the inequalities that exist in health care delivery in general and access to healthier food, exercise, etc. Additionally, training healthcare providers to better understand cultural differences and barriers to care could improve health outcomes for minority groups (3).

257,136 thoughts on “Impact of COVID on Racial & Ethnic Minorities

  1. Crenolanib
    Total symptom burden was found to be low. Patients with ‘very severe’ COPD had the greatest symptom burden, followed by those with ‘severe’, ‘moderate’, and ‘mild’ COPD. Symptom burden was higher for psychological symptoms, with a mean score of 1.60 compared to the physical symptoms (mean=0.87).

    Patients with COPD experience a remarkably high number of symptoms, and si

    Reply

  2. https://glassfortune.com/
    pada permainan taruhan online termasuk di permainan taruhan judi slots online tentulah banyak pemain mesti menyediakan modal. tiap permainan yang benar-benar memakai uang asli jadi mensyaratkan banyak pemain buat dapat menyediakan modal berbentuk uang asli juga. di dalam masalah tersebut anda menjadi pemain mesti arif cari tahu serta mendalami bagaimanakah cara atau perihal yang penting anda melakukan buat dapat mematikan untuk m

    Reply

  3. 출장 스웨디시
    안마는 우리몸의 신진대사를 능력을 올려주고 몸속 노폐물을 체외로 배출시켜 몸을 건강하게 만들어 주는 중요한 치료법이자 예방법 입니다.

    이러한 안마치료의 효과로는

    1. 통증완화

    일상생활에서 경험하듯이 아픈곳을 주무르거나 손으로 누르면 해당 부위에 혈액순환이 원활해지고, 근육이 이완 되면서 아픈부위의 통증이 완화됩니다.

    특히

    Reply

  4. PD-1/PD-L1 signaling pathway
    Hypogonadism contributes to limb skeletal muscle atrophy by increasing rates of muscle protein breakdown. Androgen depletion increases markers of the autophagy protein breakdown pathway in the limb muscle that persist throughout the diurnal cycle. However, the regulatory signals underpinning the increase in autophagy markers remain ill-defined. The purpose of this study was to characterize changes to autopha

    Reply

  5. BLU-222
    85 (0.74-0.98) and 0.91 (0.79-1.05) comparing with the gefitinib and erlotinib groups, respectively. The median (95% CI) TTNT were 10.9 (10.4-11.2), 11.7 (11.3-12.1), 13.4 (12.5-14.3) months for those receiving gefitinib, erlotinib, and afatinib, respectively (p<0.001). The hazard ratios (95% CI) for the afatinib group were 0.79 (0.70-0.88) and 0.89 (0.79-1.00) comparing with the gefitinib and erlotinib groups, respectiv

    Reply

  6. this website
    Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategi

    Reply

  7. reinrassiger deutscher schäferhund
    German Shepherd Dog Care

    German Shepherds require early socialization as well as consistent training to become well-behaved. They must be stimulated mentally in order to avoid boredness and destructive behavior.

    Several inherited diseases cause recurring vomiting or diarrhea in German Sh

    Reply

  8. selleck chemicals
    Nonnormal distributed data would be analyzed using Kruskal-Wallis test, followed by Mann-Whitney test with P less then 0.05 being performed. Results The gap between teeth in the T2 group was greater compared to T1 group (P = 0.00). However, there was a significant decrease of HSP-70 and MMP-8 expression in T2 group compared to T1 group in the tensile and compressive sides. Conclusion LLLT intervention during orthodontic treatment coul

    Reply

  9. click the next internet site
    The Comfiest Sectional Couches

    A lot of the sectional couches on our list are adjustable, consisting of seat depth, chaise setup and seemingly limitless material choices. Walsh suggests picking plush, textured fabrics for comfort and performance-grade materials if you have kids or pets.

    The Internet-famous Kova sectional from In

    Reply

  10. robotic vacuum cleaner sale
    Smart Vacuum Cleaner Features

    Picking a vacuum cleaner with the right features can be a wise investment in peace and tranquility. Some models include limits that you can place around the entryways to prevent the robot from entering certain areas of your home.

    Clean the dust b

    Reply

  11. check details
    0.05]) by enzyme-linked immunosorbent assays (ELISAs) and demonstrated that the levels of these targets were elevated in the OVX group but reduced in the TBD-treatment group. Collectively, our results suggest that the interventional effects of TBD on OVX rats are likely to be associated with the down regulation of VDR. Our findings enhance our molecular understanding of the interventional effects of TBD on PMOP and wi

    Reply

  12. Selleck Fluoxetine
    63 and a recovery rate above 84%. Thus, our platform offers new opportunities and benefits for biomarker, diagnostic, prognostic, and therapeutic research.Breast cancer is the most common malignant disease among women worldwide. Nowadays, combined therapy against several therapeutic targets is becoming a promising treatment to enhance the survival rate of the patients with some lethal subtypes, and also propos

    Reply

  13. check details
    Over two billion people around the world suffer from anemia. Majority of populations are using dietary supplements and herbal medicines for the management of the anemic conditions. Many polyherbal formulations such as RaktavardhakKadha (RK), are available in the Indian market as a nutritional supplement and herbal-based medicine for anemia.

    The present study is aimed

    Reply

  14. robotic vacuum cleaner sale
    Automated Vacuum Cleaner

    Robotic vacuum cleaners are an excellent option for those looking to avoid muscle strains from kneeling down to sweep or mop. They can be customized with features like no-go zones or virtual barriers that keep the robots from getting into dog poop or broken glass.

    <br

    Reply

  15. sirpiglenastat datasheet
    In conclusion, 26.9 nm citrate-coated AgNPs are capable of gaining access to the brain of mice and causing electric conductivity and relative permittivity damage along with a high degree of cellular toxicity in the brain tissue. Therefore, the present study highlights, for the first time, the adverse effects of the citrate-coated AgNPs to the brain of mice and raises the concern of their probable neu

    Reply

  16. selleck chemical
    The incidence of Neonatal Abstinence Syndrome (NAS) continues to rise and there remains a critical need to develop non-pharmacological interventions for managing opioid withdrawal in newborns. Objective physiologic markers of opioid withdrawal in the newborn remain elusive. Optimal treatment strategies for improving short-term clinical outcomes and promoting healthy neurobehavioral development have yet to be defin

    Reply

  17. 토토사이트 순위
    토토사이트는 많은 사람들이 스포츠나 카지노 게임을 즐기기 위해 찾는 주요 플랫폼입니다. 하지만 수많은 사이트 중에서 안전하고 믿을 수 있는 곳을 선택하는 것은 쉬운 일이 아닙니다. 다수의 사설 토토사이트가 존재하는 가운데, 먹튀나 부정행위가 발생하는 경우도 많아 사용자들이 더욱 신중을 기하게 됩니다.

    이 글에서는 안전한 토토사이트를 찾기 위한 가이드와 함께 최근의 토토사이트 순위 및 추천 리스트를 제공합니다. 또한, 토토사이트 커뮤니티에서 공유되는 정보와 리뷰를 통해 믿을 수 있는 사이트를 선별하는 방법을 안내하고자 합니다. 메이저 토토사이트와 먹튀검증의 중요성도 다루어, 사용자들이 안전하게 즐길 수 있는 환경을 만드는 데 도움을 주겠습니다.

    Reply

  18. selleckchem
    Epidemiologic and genomic studies have progressively improved our understanding of the causation of hypertension and the complex relationship with diet and environment. The majority of mendelian forms of syndromic hypotension and HTN have all been linked to mutations in genes whose encoded proteins regulate salt-water balance in the kidney, supporting the primacy of the kidneys in BP regulation. There are o

    Reply

  19. untreated adhd in adults
    Treating ADHD With Stimulant Medication

    Stimulant medications such as methylphenidate (Ritalin and Concerta) and amphetamines that are in the form of Lisdexamfetamine (Adderall and Vyvanse) help people focus and control their impulses. Atomoxetine is a non-stimulant drug that increases brain neurotransmit

    Reply

  20. buy SRPIN340
    Comparative anatomy studies of the skull of archosaurs provide insights on the mechanisms of evolution for the morphologically and functionally diverse species of crocodiles and birds. One of the key attributes of skull evolution is the anatomical changes associated with the physical arrangement of cranial bones. Here, we compare the changes in anatomical organization and modularity of the skull of extinct and extant

    Reply

  21. wyciszanie ścian
    Cisza w domu to marzenie wielu z nas, szczególnie w dzisiejszym, pełnym hałasu świecie. W dobie intensywnego życia, pełnego zgiełku ulic, sąsiadów oraz różnorodnych dźwięków z zewnątrz, warto zastanowić się, jak stworzyć przytulne i spokojne miejsce, w którym można naprawdę odpocząć. Wyciszanie ścian to jedno z najskuteczniejszych rozwiązań, które pozwoli na cieszenie się harmonią i ciszą w naszych wnętrzach.

    <b

    Reply

  22. 네이버 아이디 구매
    오늘날과 같이 급변하는 블로깅 환경에서 적합한 블로깅 플랫폼은 필수적입니다. 한국의 지배적인 검색 엔진이자 콘텐츠 플랫폼인 네이버는 더 많은 청중에게 다가가고자 하는 블로거에게 풍부한 가능성을 제시합니다. 그러나 네이버 계정을 설정하는 과정은 신규 이민자에게는 어리둥절할 수 있습니다. 자신의 심오한 아이디어를 표현하고자 하는 지식인부터 고객과 의미 있는 관계를 형성하고자 하는 열정적인 카페 주인에 이르기까지, 네이버 계정 획득은 블로그 열망을 실현하는 데 중요한 역할을 합니다.

    이 가이드에서는 네이버 계정 구매의 뉘앙스를 철저히 조사하여 간단한 프로세스에 대한 귀중한 통찰력과 전문가의 조언을 제공합니다. 공들여 수집한 정보를 통해 네이버 블로고스피어에 진입하고 인식 가능한 틈새 시장을 개척하는 데 필요한 확신을

    Reply

  23. Daurisoline in vivo
    and intracranial hemorrhage. Although not as sensitive in the detection of isolated skull fractures, t-fbMRI can be used to monitor pathologies implicated in TBI patients while minimizing radiation exposure from traditional surveillance imaging.Over a quarter of a century ago, the formulation of the “at risk mental state” and operational criteria to prospectively identify individuals at “clinical” or “ultra

    Reply

  24. Selleck Tigecycline
    675 USD, p = 0.0001). Very strong positive correlations were observed between SJR and JIF and between ES and h-index. All the journals in the h-index and ES first quartiles were hybrid-OA journals. Conclusion Based on these results, we recommend the use of SJR and ES together to evaluate journals in clinical allergy and immunology. Although there is a wide APC gap between all-OA and hybrid-OA journals, all j

    Reply

  25. AMG193
    They are especially useful for drugs where penetration of cell membranes is essential. Inhaled delivery of liposomal drug solutions can therefore facilitate direct access to macrophages in the lung where the infecting NTM may reside. A range of liposomal drugs are currently being evaluated in respiratory diseases.Personalised medicine, an essential component of modern thoracic oncology, has been evolving continuously ever si

    Reply

  26. TGFbeta inhibitor
    On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1mm nodal deposit were independently associated with higher rates of nodal relapse.

    Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2

    Reply

  27. 債務重組費用
    在今天快節奏的地球儀,管理資金偶爾會感到壓倒性特別是什麼時候出現意外的情況會導致債務那是難以控制。是否是由於意外的醫療費用,任務損失或計劃不佳這當然是金融的很多人找到自己努力解決似乎無法克服的債務。但,您會發現收回安全的途徑那是經濟包括特定的自願安排(IVA),債務減免請求(DRO)和破產。這篇有益的文章將探索這些選擇,提供清晰度和指導對於任何人尋找開始這當然是新鮮的。

    一個人自願安排(IVA)簡直就是合約這當然是正式的一個人和他們的債權人允許他們償還一部分與債務結束了一個小組持續時間,通常是五年。這種安排在法律上具有約束力會奉獻更好的方法這當然是有組織的債務在保護同時這個人債權人的進一步適當行動。列表鑰匙好處IVA是它允許人們保留其資產,例如例如

    Reply

  28. https://www.selleckchem.com/products/azd1656.html
    The specific microenvironment that cells reside in fundamentally impacts their broader function in tissues and organs. At its core, this microenvironment is composed of precise arrangements of cells that encourage homotypic and heterotypic cell-cell interactions, biochemical signaling through soluble factors like cytokines, hormones, and autocrine, endocrine, or paracrine secretions

    Reply

  29. full report
    ADHD Treatment For Adults

    ADHD symptoms can interfere with relationships, school and work. Fortunately, several treatments are available.

    Medications are effective in reducing ADHD symptoms. Long-acting stimulant medication provides once-a-day doses that boost compliance while reducing side effects.

    <br

    Reply

  30. 小說

    – 滿級大佬真的不想當綠茶了 – 满级大佬真的不想当绿茶了

    漫畫 – 與你相戀到生命盡頭 – 与你相恋到生命尽头

    第234章 功和

    木紅羽揶揄一聲道:“我苟不出宮,又哪樣能見兔顧犬湘王太子這麼無人問津的形制呢?諸侯,謬誤親兄弟,歸根到底是隔了一層腹部,就算是打響夫貴妻榮,也輪不到你夫外僑。”

    霜元星堅持道:“你窮想說什麼?!”

    木紅羽勾脣嘲笑道:“沒什麼,我獨嫌有人居心欺悔老好人罷了。湘王太子,你一點一滴爲秦王府效忠,篤,可你卻不理解,秦王皇儲連不費吹灰之力的事,都不甘爲你做。他對你啊,平生就不過詐騙。”

    霜元星戒備的看向木紅羽,外心中明晰木紅羽縱使想挑撥他與霜非臣裡邊的涉嫌。

    <

    Reply

  31. thor311
    bila anda memanglah berminat untuk bermain perjudian slots online, karena itu semestinya anda ketahui jika ada cara-cara dan ada banyak trick yang benar-benar dapat anda pakai. salah satunya ada dianjurkan tidak untuk simpel terikut emosi. banyak salah satunya yang kalah dan tidak berhasil dalam perjudian slots karena mereka terambil emosi. selaku pemain sebaiknya anda memang tidaklah melaksanakan itu sebab bakal ada rugi besar yang dapat anda peroleh.

    Reply

  32. SPOP-i-6lc
    All samples amplifying a product in the com1 assay also amplified a product in the htpAB and IS1111 assays. A total of 17/58 (29%) packets were positive with all three genes, 4/58 (7%) were positive with two genes (IS1111 and htpAB) and 4/58 (7%) were positive with the IS1111 gene only. Coxiella burnetii DNA was five times more likely to be found in offal than skeletal muscle meat samples. All meat samples in which C.

    Reply

  33. 1,4-Diaminobutane order
    Buscopan is used to treat stomach cramps including those resulting from irritable bowel syndrome, bladder cramps, and pain related to menstruation. Its pregnancy category is determined as C. It has been shown in experimental animal studies that the drug has a negative effect on the embryo, but sufficient and well-controlled studies have not been conducted in humans. The aim of this

    Reply

  34. find more
    These findings do not offer support for the biological plausibility of the epidemiological associations reported.Cotton is cheap, easily available and widely used as surgical material. Therefore, cotton would be good raw material to design a scaffold for tissue engineering applications. In this work, the gelatin-coated microfibrous paper scaffold was fabricated successfully by a papermaking process. Microf

    Reply

  35. learn more
    The improvement remained stable during the 12-month post-operative follow-up. The motor function tests correlated with each other and with ADL.

    A 3-month follow-up period after shunt surgery is adequate to show improvement in motor tasks, and a positive outcome will last for at least 12months. A shunt-responsive dysfunction of upper limb motor performance plays a major role in ADL

    Reply

  36. 債務重組邊間好
    在我們內部世界這當然是快節奏的挑戰可能出乎意料地出現很多人經歷債務困住。幸運的是,你可以找到有效的技術只需幫助瀏覽這一景觀這當然是動盪。這篇簡短的文章將探索三個關鍵選擇:特定的自願安排(IVA),債務減免產品(DRP)和破產。每個提供方法那是獨家獲得財務穩定和滿意度。

    一個人自願安排(IVA)只是正式協定那允許訪客以一種方式控制他們的債務這當然是結構。根據這種安排,債務人利用其債權人創建還款計劃那是量身定制利用他們的財務困境。通常持續3至5年,IVA允許個人產生還款可以每月有能力負擔得起防禦債權人騷擾。剩下的不安全的債務傾向於出院,啟用人們重新開始沒有成功結論後,過去的貨幣錯誤負擔關於IVA。

    債務減免計劃(DRP)提供替代方法專注於與債權人的談判話雖如此。此方法啟用人們查找定居點由於他們債務那可能是少於量那是全部的

    Reply

  37. kann man legal einen führerschein kaufen
    What You Need to Know Before You Buy a Buy EU Driving License

    It’s thrilling to drive on roads you have never seen before when you are in a foreign country. However, it is important to be aware of the rules to avoid issues with your vehicle.

    The European driving licenses are widely recognized acr

    Reply

  38. D609
    s will need to be included (250 in each arm). Trial status The protocol approved by the health authorities in Spain (Spanish Agency for Medicines and Health Products “AEMPS”) and the Ethics and Research Committee of Cantabria (CEIm Cantabria) corresponds to version 1.1 of April 2, 2020. Currently, recruitment has not yet started, with the start scheduled for the second week of May 2020. Trial registration Eudra CT number 2020-00

    Reply

  39. see more
    Intrahepatic cholangiocarcinoma (ICC) has over the last 10years become the focus of increasing concern largely due to its rising incidence and high mortality rates worldwide. Microcystin-leucine-arginine (MC-LR) has been reported to be carcinogenic, but there are no data on the linkage between MC-LR and ICC. This study aimed to explore whether the content levels of MC-LR in the tumour tissues of ICC patients be associated

    Reply

  40. seo優化
    在電流中數字時代,搜索引擎營銷(SEO)已經變成了必不可少的部分企業在線促銷。隨著競爭的加強,許多公司有開始尋求專業SEO服務提升他們的排名搜尋引擎例如尤其是在市場上例如香港,SEO不只是技術,但此外中的一個重要方面談到流行業務。

    香港SEO提供各種優化服務,例如利基研究,內容優化和反向連接構建。這些服務被設計為幫助企業改善他們的網站並吸引更多潛在客戶。通過專業的SEO優化,公司可以有效地提高品牌知名度並得到Google的較高排名搜索引擎結果,從而增加網站流量。

    適用於個人渴望查找SEO,參加相關課程或教學是一個好選擇。這些課程通常涵蓋必不可少的SEO的原理,工具使用,關鍵字分析還有其他內容。是否是自我研究或註冊該程序,掌握SEO技能可能帶來長期好處個人和

    Reply

  41. Eprosartan datasheet
    Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, dee

    Reply

  42. führerschein kaufen in deutschland
    How to Buy a Driving License in Germany

    You are able to exchange the license for a German driving licence if the license was issued by a member state of the EU/EEA, or a country that has an agreement of reciprocity. Otherwise, you must take a theory and a practical driving test (fees vary).

    <

    Reply

  43. hoki311
    memperoleh banyak sekali bonus dari suatu taruhan pastinya menjadi salah satunya sumber keuntungan dan penerimaan dalam taruhan. bila kamu sukses memperoleh bonus pastilah ini menjadi salah satunya keuntungan tambahan dalam penempatan taruhan. tergolong dalam masalah ini bonus free spin. bonus ini memungkinnya taruhan tanpa ada modal buat sejumlah perputaran slots online terunggul indonesia.

    memperoleh bonus free spin mesti sung

    Reply

  44. BMS-794833 clinical trial
    Higher cognitive abilities predicted more optimal trajectories in peer acceptance (odds ratio 1.03 [95% confidence interval = 1.01-1.05]), friendships (1.03 [1.00-1.05]), and peer problems (1.06 [1.04-1.09]). In addition, good parent-infant relationships predicted lower peer problem trajectories (1.61 [1.03-2.50]).

    Early cognitive deficits may underlie persistent

    Reply

  45. robotic vacuum cleaner on sale
    Best Automatic Vacuum Cleaner Robots

    Robot vacuums employ navigational tools such as sensors, lasers and cameras to map your space and effectively clean while keeping clear of obstacles. Some can even self-empty their own dustbins and mop!

    Many are connected to digital voice assistants or apps that allow for hands-free cleaning. Certain models come wi

    Reply

  46. MEK inhibitor
    Therefore, ozone exposure could not be performed for this virus. Nonetheless, this study provides great insight for the efficacy of ozone as an air treatment for the control of nosocomial influenza A outbreaks.The first aim of this study is to investigate the role of the EU Blue Card programme implemented in 2012 in Germany. In particular, we aim to explore the impact on the participation in cultural activities of first-generation

    Reply

  47. check details
    space acquired from the generative model. Features of the enzymatic reaction are embedded into the fixed-dimensional vector, and it is possible to express structural changes of enzymatic reactions comprehensively. The technique also involves differential-evolution-based reaction selection to design feasible candidate pathways and pathway scoring using neural-network-based reaction-possibility prediction.

    Reply

  48. deutscher schäferhund kaufen schweiz
    Where to Buy German Shepherd Puppies

    German Shepherds are excellent service dogs for police, military and other governmental agencies. They are intelligent, loyal, and guardian. They are also extremely active and require lots of exercise and stimulation.

    Their natural defense me

    Reply

  49. buy colombian cocaine
    COLOMBIA — Almost 20 many years after Pablo Escobar and also other drug cartels were wiped out by police, Colombia is still battling to recover by the economic and even social damage made by the drug war. Many people are still doing work to pay off debts that have accumulated over decades of government problem and bloodshed. Others have lost a new family member or perhaps a friend to drug vio

    Reply

  50. SB239063 purchase
    To assess the association of baseline uric acid levels and their changes from baseline to Year 1 with the risk of type 2 diabetes.

    This study cohort included 9471 subjects without a history of diabetes at baseline. The incident diabetes was diagnosed according to the American Diabetes Association standard.

    During a mean follow-up of 2

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *