SDG Report: Richard M. Fairbanks School of Public Health
SDG Report: Richard M. Fairbanks School of Public Health
Since 2012, the IU Richard M. Fairbanks School of Public Health (FSPH) has grown rapidly and become a significant supporter of health and wellbeing within Indiana and around the world. FSPH is committed to equitable health for all – recognizing the importance of the social and ecological determinants of health, the interconnectedness of human and planetary health, and the need for effective leadership and action to advance sustainable solutions to the world’s most urgent public health challenges. FSPH is accredited by the Council on Education for Public Health (CEPH) and the global Agency for Public Health Education Accreditation (APHEA). The School’s Master of Health Administration program is the only MHA program in Indiana accredited by the Commission on Accreditation of Healthcare Management Education (CAHME).
AMPATH program: SDGs 3, 4, 10, 16, and 17
The AMPATH program is a multi-faceted public health initiative born from a partnership between Indiana University and Moi University (Kenya). FSPH is engaged in identifying and helping Kenyans overcome social barriers to health. FSPH’s Dr. Bill Tierney leads the AMPATH Mexico program in collaboration with the Faculty of Medicine in Benemérita Universidad Autónoma de Puebla. The goal is to improve health and health care for those living in the low-resource communities around Puebla. Dr. Tierney, along with Dr. Gerardo Maupomé, are positioning FSPH to lead public health and research, contributing directly to SDG 3: Good Health and Wellbeing.The AMPATH program is a multi-faceted public health initiative born from a partnership between Indiana University and Moi University (Kenya). FSPH is engaged in identifying and helping Kenyans overcome social barriers to health. FSPH’s Dr. Bill Tierney leads the AMPATH Mexico program in collaboration with the Faculty of Medicine in Benemérita Universidad Autónoma de Puebla. The goal is to improve health and health care for those living in the low-resource communities around Puebla. Dr. Tierney, along with Dr. Gerardo Maupomé, are positioning FSPH to lead public health and research, contributing directly to SDG 3: Good Health and Wellbeing.
AMPATH places emphasis on quality education (SDG 4). By facilitating training and research, IU students (with a large proportion from FSPH) actively drive AMPATH’s delivery of holistic healthcare. In addition, students, residents and faculty from Kenya and Mexico spend time in Indianapolis and other consortium countries. FSPH has bolstered the training of medical students by providing in-person faculty teaching, long-distance teaching and consultation using FSPH’s ECHO (Extension for Community Healthcare Outcomes) model.
Aside from directly addressing healthcare needs on the ground, AMPATH also addresses North-South learning inequities through interinstitutional partnerships (SDG 10 Reducing inequality). FSPH has helped develop and implement AMPATH’s population health program, making AMPATH the first organization in Kenya to pilot its national health insurance program. FSPH and AMPATH work closely with the Kenyan government to help citizens overcome social barriers of health. FSPH is currently in the preliminary stages of replicating this program in Mexico.
Finally, AMPATH’s innovative healthcare model is rooted in mutually beneficial and respectful partnerships among numerous organizations and institutions, both private and public. Through this, FSPH actively engages in SDG 17: Partnerships for the Goals. By working towards a common goal, all involved members learn and grow in concert with others, which makes AMPATH a truly unique program.
Biostatistics Data Collection and Analysis: SDGs 3 & 17
Faculty from FSPH’s Department of Biostatistics and Health Data Science are actively involved in procuring, analyzing and providing biological data for healthcare and policymaking in collaboration with IeDEA – International epidemiology Databases to Evaluate AIDS – a non-profit global organization which aims to address HIV/AIDS. Dr. Constantin Yiannoutsos, professor of biostatistics, has played a major role in these activities. This has involved studies on matters including Pediatric HIV burden, and projections for global Pediatric ARV doses demand.
Dr. Gerardo Maupomé: SDGs 3, 10, 17
Dr. Gerardo Maupomé is a professor and associate dean of research in the Richard M. Fairbanks School of Public Health (FSPH) at Indiana University. He also has multiple adjunct/affiliated positions within IU, including the Indiana University Network Science Institute and in 2020, he became associate director of the community health partnerships (CHeP), with the Indiana Clinical and Translational Sciences Institute (CTSI). In addition, he is also the chief innovation officer for the IUPUI ECHO (Extension for Community Healthcare Outcomes) Center. See detailed showcase at https://international.iupui.edu/global-learning/iupui-sdgs/sdgs-iupui/index.html
Dr. Sarah Archer: SDGs 16 & 17
Dr. Sarah Archer is a humanitarian aid and public health subject matter expert contractor. Her work helps military personnel better understand civilian, international, intergovernmental, interagency, and non-government organizations’ functions; public health issues affecting civilians/non-combatants in complex humanitarian emergencies and natural disasters; and how to prevent and mitigate the effects of these emergencies on civilians/non-combatants, especially those in the most vulnerable population groups. She has worked in Asia, Africa, the Middle East, and various places in the USA. This work directly correlates with SDG 16: Peace, Justice and Strong Institutions, and SDG 17: Partnerships for the Goals.
Dr. Suzanne Babich: SDGs 3 & 17
Dr. Suzanne Babich is a professor and associate dean of global health in FSPH. She directs the interdisciplinary Doctoral Program in Global Health Leadership (DrPH). The goal of the program is to produce graduates with the motivation, knowledge, and skills to become top leaders committed to improving public health by advancing effective and sustainable solutions to the world’s most complex and urgent challenges.
Dr. Janie Benson: SDGs 3, 5 & 10
Dr. Janie Benson, a global health affiliated faculty, has provided strategic and technical leadership as vice president for research and evaluation for Ipas, a global non-profit organization focused on reducing unsafe abortion and advancing women’s reproductive rights. She developed and directed the organization’s programmatic M&E system and served as investigator/co-investigator for research in Ethiopia, Kenya, Malawi, Nigeria, Bolivia, Mexico, Peru, the US and other countries. Her specialty areas included improving abortion care quality and access, women’s and providers’ perspectives on abortion, costs of abortion care, postabortion contraceptive uptake, and health worker performance.
Dr. Silvia Bigatti: SDGs 3, 10 & 17
Dr. Silvia Bigatti examines the distinct psychological stress experienced by different populations and its negative physical and mental health outcomes. In studies focused on investigating health disparities in Indianapolis, she uses a community based participatory research framework. Her intervention research has focused on psychosocial interventions for fibromyalgia syndrome, advanced cancer, and adolescent resiliency training. Her research projects have included community-based breast cancer studies among Black women, cumulative disadvantage population studies, and community-based Latino youth depression and suicide research.
Dr. Justin Blackburn: SDGs 3, 10 & 17
Dr. Justin Blackburn is an associate professor of health policy and management (HPM), and the PhD program director for HPM. His research primarily involves leveraging large administrative data sets to evaluate public health policy and outcomes at the state, local, and national level. He is a frequent collaborator with state and local public health agencies and has applied methodologically innovative approaches to evaluate important public health topics including dental health services and outcomes, long-term care policy and outcomes, Medicaid and CHIP coverage, and measuring health care quality.
Dr. Sha Cao: SDG 3
Dr. Sha Cao’s current research areas include: 1) designing novel statistical learning tools for integration of multiple heterogeneous sources and/or types of biomedical data; 2) detecting the latent structures of high dimensional biomedical data; 3) studying the tissue microenvironment and interactions of its cell components.
Dr. Edward Chikwana: SDGs 3, 10 & 17
Dr. Edward Chikwana has worked in human health risk assessment in various capacities. In 2018, he worked as a risk assessment consultant at the Hoosier Environmental Council in Indianapolis, focusing on assessing human health risk associated with heavy metal contamination from coal ash waste generated at several Indiana coal-powered electricity generation stations. Additionally, he has been working at Corteva Agriscience as a human health risk assessor within the Crop Protection Regulatory Sciences group. He is a subject matter expert in risk-based dietary and non-dietary human exposure assessments, including higher tier approaches, to support registration of plant protection products across various geographies.
Dr. Kenneth Coburn: SDGs 3, 10 & 17
Dr. Kenneth Coburn is the president, CEO, and medical director of Health Quality Partners (HQP), a nonprofit research and development organization based in Pennsylvania, dedicated to improving population health outcomes through health care delivery redesign. HQP designs, tests, and spreads systems of advanced preventive care for vulnerable populations, especially chronically ill older adults, with robust evaluations demonstrating significant improvements in health outcomes and cost.
Dr. Michele Cote: SDGs 3 & 17
Dr. Michele Cote is a professor in the Department of Epidemiology. Her research focuses on genetic and molecular factors in female cancers that impact disease incidence or prognosis in underserved populations. Currently, she works as principal investigator of an NCI R01 to examine molecular alterations in high grade endometrial cancers and is actively engaged in analyzing data and biospecimens from African American women with benign breast disease (BBD) and subsequent invasive cancers. She has an extensive history of successful national and international research collaborations, in breast, endometrial, ovarian, and lung cancers.
Ms. Shandy Dearth: SDGs 3 & 17
Ms. Shandy Dearth, director of the Center for Public Health Practice, has spent most of her career focusing on infectious disease surveillance, emergency preparedness planning and response, and public health informatics. She is currently a member of her community's park advisory council and is a proponent of advocating for more public health resources in Indiana.
Dr. Brian Dixon: SDGs 3 & 17
Dr. Brian Dixon is a professor of epidemiology and global health. His research focuses on applying informatics methods and tools to improve population health in clinical as well as public health organizations. This leverages clinical and administrative data in electronic health records to improve population outcomes, better understand threats to public health as well as care delivery processes, examine public health business processes, and make population surveillance more efficient.
Dr. Thomas Duszynski: SDGs 3 & 10
Dr. Thomas Duszynski is a clinical assistant professor in the Department of Epidemiology. Dr. Duszynski’s research interests include infectious diseases and how they continue to shape the world and public health’s response. This is coupled with the rise of antimicrobial resistance and the resurgence of vaccine preventable diseases.
Dr. Ellen Einterz: SDGs 3 & 10
Dr. Ellen Einterz is a global health affiliated faculty member and has published articles on a range of topics including snakebite, malaria, international aid, neonatal tetanus, family planning, traditional uvulectomy, telemedicine, trachoma, and access to healthcare in underserved parts of the world. She is presently a clinic physician for the Marion County Public Health Department’s refugee program and maintains an adjunct affiliation with the Indiana University School of Medicine and Fairbanks School of Public Health.
Dr. Corinne Graffunder: SDGs 3 & 17
Dr. Corinne Graffunder joined the CDC Foundation in 2020 as the associate vice president for domestic non-infectious programs. She is responsible for the leadership, management and direction of the Foundation’s domestic non-infectious disease portfolio. The domestic NID portfolio ranges in scope and includes non-communicable diseases, injury prevention, birth defects and environmental health programs and projects impacting all 50 states, the US territories and tribal nations.
Dr. Marion Greene: SDGs 3 & 17
Dr. Marion Greene is a research assistant professor in the Department of Health Policy and Management. She conducts health-related research, primarily on behavioral health topics such as substance use and addiction, mental health, and suicide. Dr. Greene frequently collaborates with state agencies and community organizations on needs assessments and evaluations, utilizing both quantitative and qualitative methods.
Dr. Jiali Han: SDGs 3 & 17
Dr. Jiali Han is professor and chair of the Department of Epidemiology. Dr. Han leads genetic and molecular epidemiology studies of cancer etiology, prevention, outcome and global health. He leads international consortia on genetic susceptibility to keratinocyte carcinoma and the post-“genome-wide association study” collaborative effort on integrative and functional analysis of genetic variants associated with skin cancer. He has also played a leading role in international collaborative consortia on pigmentary traits, skin and lung cancers. Another area of his research interests is the opioid response-mediated addictive behavior of tanning bed usage.
Dr. Chris Harle: SDGs 3 & 17
Dr. Chris Harle’s research focuses on the design, adoption, use, and value of health information systems. His primary interest is in understanding how information technology-mediated communication tools affect consumer, patient, and healthcare provider decisions and behavior. He is also interested in developing research informatics infrastructure and service processes that support clinical and translational research.
Dr. Katy Ellis Hilts: SDGs 3 & 10
Dr. Katy Ellis Hilts is an assistant professor in the Department of Health Policy and Management. Her research involves assessing how policies and systems-level strategies influence organizational practices to improve scalable, sustainable implementation of evidence-based interventions, such as tobacco dependence treatment, within and across healthcare settings. Her current work leverages her training as a health services researcher and background in tobacco control to support efforts to train and assist pharmacists in integrating tobacco cessation services (including prescribing) into practice.
Dr. Kun Huang: SDG 3
Dr. Kun Huang’s research interests lie in translational bioinformatics, computational pathology, medical imaging, computational biology, integrative genomics tools for precision health, computer vision, and machine learning with applications in cancers and Alzheimer’s disease. He is focused on translating informatics tools to improve clinical practice and accelerate scientific discovery.
Dr. Emily Jackson: SDGs 3, 5 & 17
As senior medical advisor for quality of care at Ipas, a global non-profit organization focused on expanding access to safe abortion, contraception and reproductive rights, Dr. Emily Jackson maintained the organization’s evidence-based clinical guidance-The Clinical Updates in Reproductive Health-used in more than 30 countries to improve the quality of abortion and contraception care services.
Ms. Andrea Janota: SDGs 3, 10 & 17
Ms. Andrea Janota is the director of the IUPUI ECHO Center. The ECHO Center is an undertaking of Project ECHO, which stands for ‘Extension for Community Healthcare Outcomes’, and is based in the University of New Mexico. The ECHO model promotes community-based healthcare information dissemination. The idea is to create a community of physicians who can share their expertise with other specialists in order to create widespread knowledge of important health considerations in a community. This is done through short presentations, and case-based learning. At IUPUI, Ms. Janota and the Project ECHO team have devised the INPEP (Indiana Peer Education Program) ECHO which works in correctional facilities. Primarily, the people in correctional facilities learn how to promote health outcomes. Another ECHO project implemented by the FSPH team was centered around COVID-19 in nursing homes at the beginning of the pandemic.
Dr. Gift Kamanga: SDGs 3, 10 & 17
Dr. Gift Kamanga’s key technical expertise and research activities are in HIV and AIDS services, sexually transmitted infections, family planning, maternal/neonatal health, and HIV programming for key population groups.
Dr. Paige Klemme: SDGs 3 & 5
Dr. Paige Klemme is a project management specialist in the Department of Social and Behavioral Sciences. Her research focuses on the child welfare workforce, trauma responsive services, secondary traumatic stress, community engagement, and program evaluation. In addition to research, Dr. Klemme is a project management specialist for Healthy Beginnings at Home, a pilot program aimed at providing housing support and case management to pregnant women.
Dr. Lisa M. Koonin: SDG 3
Dr. Lisa M. Koonin is recognized as an international expert in emergency preparedness and response, especially for pandemic influenza response. She was the originator of private sector pandemic and emergency response programs at CDC and has extensive experience working with businesses and non-governmental organizations.
Dr. Patrick J. Loehrer: SDGs 3, 5, 10 & 17
Dr. Patrick J. Loehrer is an active clinical researcher and specialist in the treatment of a variety of cancers including testes, bladder, colon, pancreas and, most notably, thymic malignancies. His research on the drug, ifosfamide, led to its approval by the FDA. Also, his research related to thymic cancers has been recognized with the Exceptional Service Award of the Foundation for Thymic Research.
Dr. Erin Macey: SDGs 3, 5 & 17
Dr. Erin Macey is associated with the Grassroots MCH Initiative (#AskTheWomen) which builds the capacity of communities to enact systems change that improves the health of moms and babies. The Grassroots MCH Initiative trains and mentors women leaders who live and work in Indiana zip codes with persistently high infant mortality rates. Leaders use their understanding of the root causes behind these high rates, in collaboration with the support team, to build a community where every pregnancy and baby has the opportunity to thrive.
Dr. Egil Marstein; SDGs 3, 10 & 17
Dr. Egil Marstein is a professor of practice who focuses on global health funding and leadership issues as these relate to institutional contexts such as those associated with the World Health Organization, World Trade Organization, World Bank and others with a bona fide mandate to develop durable health systems.
Olena Mazurenko: SDGs 3 & 17
Dr. Olena Mazurenko is interested in understanding the potential that policies and health information technology (HIT) interventions hold to improve pain care and opioid prescribing, in particular, for millions of patients with chronic pain. In her policy studies, she reviewed various health policies related to opioid prescribing, including the Centers for Medicare & Medicaid's reimbursement policy tied to patient experience. More recently, she led an effort to assess the effects of the 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain on tapering among patients on long-term opioid therapy.
Dr. Nir Menachemi: SDGs 3, 8 & 17
Dr. Nir Menachemi’s interdisciplinary work focuses on health policy, medicine, and business. Since the start of the pandemic, he has been principal investigator on the Indiana SARS-CoV-2 Prevalence study, the only statewide random sample testing study in the US. The work generated new breakthrough knowledge about COVID-19 and generated statewide, national, and international media attention. As lead scientist on this project, he managed a multi-disciplinary team of epidemiologists, biostatisticians, public health, and infection disease experts.
Ms. Summer Miller: SDGS 3 & 17
Ms. Summer Miller’s experience in STD prevention spans five years and includes working at the local, state, and national levels.
Dr. Hongmei Nan: SDGs 3 & 17
Dr. Hongmei Nan is vice chair and professor in the Department of Global Health. With extensive training in epidemiology in China, South Korea, Japan and the US, she has more than 25 years of experience in conducting epidemiologic studies of cancer and other chronic diseases in different populations. In particular, she has extensive expertise in molecular epidemiologic studies of cancers, including colorectal and skin. Her recent research initiatives have focused on genetics-based colorectal cancer prevention; Metabolomic profiles, pigmentary traits and skin cancer; Mitochondrial DNA copy number; and global health.
Dr. Mabel Nangami: SDGs 3, 10 & 17
Dr. Mabel Nangami is a global health affiliated faculty member who currently serves as deputy project leader on the 1st Moi University research chair project in health systems research. She is the Co-PI on “How to Improve Access to Healthcare for Cross Border Communities in East Africa.” She is leading the investigation on the impacts of disease and treatment on household welfare in Kenya, the impact of nutrition programs for AMPATH patients on ARVs, and their ability and willingness to pay for family planning services.
Dr. Stjepan Oreskovic: SDGs 3, 10 & 17
Dr. Stjepan Oreskovic is the founder and director of the World Health Organization Collaborating Centre for HIV Strategic Information, working with experts, scholars, and policymakers from 111 countries and educating more than 2600 students in the course of the last 15 years. Professor Oreskovic is best known for his projects fostering innovative health care interventions in the area of tobacco control, obesity prevention, internet addiction and HIV surveillance.
Dr. Robert Roy: SDGs 3, 6, 12, 14 & 15
Dr. Robert Roy has been actively involved in the support of the global toxicology (and regulatory toxicology) efforts of many 3M divisions and business units. Some of these toxicologically-related activities include the placing, monitoring, and evaluation of both short-term and longer-term toxicity studies, developing detailed health hazard assessments for base chemicals, intermediates, and industrial and consumer products.
Dr. Lisa Staten: SDGs 3, 10 & 17
Dr. Lisa Staten is dedicated to improving health equity through community engagement. A great deal of her work has focused on chronic disease prevention using community-based participatory research methods. More recently, she shifted her focus to developing interventions that address the social determinants of health.
Dr. Cynthia Stone: SDGs 3, 10 & 17
Dr. Cynthia Stone is a professor in the Department of Health Policy and Management. Her research focuses on health impact assessment for political and project decision making, and community health needs assessment for health department accreditation and hospital compliance with ACA.
Dr. Heather Taylor: SDGs 3, 10 & 17
Dr. Heather Taylor is passionate about improving access to dental care and reducing oral health disparities among low-income adults and children.
Ms. Melissa Titus: SDGs 3 & 10
Ms. Melissa Titus is a lecturer in the Department of Epidemiology. Her research interests include outbreaks of infectious diseases, surveillance of infectious diseases, and working to improve the response of public health to those diseases.
Dr. David Townsend: SDGs 3, 10 & 17
Dr. David Townsend is a global health affiliated faculty member who coordinated the Corporate Council on Africa's AIDS Task Force and has served on the Baltimore City Commission on HIV/AIDS. His teaching experiences include Jessup maximum security prison, the Baltimore Police Academy, retirement communities, high schools, and middle schools.
Dr. Jack E. Turman, Jr.: SDGs 3, 10 & 17
Dr. Jack Turman is a professor in the Department of Social and Behavioral Sciences. He has dedicated his career to building community-based participatory programs that improve maternal and child health outcomes.
Dr. Elizabeth Umberfield: SDGs 3, 10 & 16
Dr. Elizabeth Umberfield’s research aims to amplify patients’ agency through informatics. This includes projects examining the regulations by which patients’ blood and tissue samples may be used for secondary uses; applying text processing to identify permissions within clinical consent forms; and extending the Informed Consent Ontology for machine-interpretation of clinical consent documents.
Dr. Joshua R. Vest: SDGs 3, 10, 16 & 17
Dr. Joshua R. Vest is a professor in the Department of Health Policy and Management, and director for the Center for Health Policy. He has a particular interest in effective public health information systems.
Dr. Chastity Walker: SDGs 3, 10 & 17
Dr. Chastity Walker is responsible for leading and coordinating the US Embassy Accra interagency health security portfolio, in partnership with the Government of Ghana and other GHSA donor countries. She is a recognized authority on GHSA, providing direct technical consultation and scientific guidance to US Missions, host country Ministries of Health, and key in-country stakeholders on the requirements of the International Health Regulations 2005 (IHR 2005).
Ms. Jenna Watkins: SDGs 3 & 10
Ms. Jenna Watkins is a program management specialist at the IUPUI ECHO Center.
Ms. Tess Weathers: SDGs 3 & 10
Ms. Tess Weathers is a research associate in the Department of Social and Behavioral Sciences and has worked to enhance public understanding and evidence-based engagement on health disparities through both public scholarship and her contribution to several collaborative research studies. In academic-community partnerships, she often serves as a bridge between scientists and non-scientists with the goal of educating and creating action for the public good. She applies her training in epidemiology to focus on the social conditions which contribute to health and illness, and she teaches an undergraduate course on the social determinants of health.
Dr. Jennifer Wessel: SDGs 3 & 10
Dr. Jennifer Wessel is an associate professor in the Department of Epidemiology. Her primary research area is cardiovascular genomic epidemiology. Her research involves identifying novel genomic risk factors for coronary heart disease and related outcomes, disease-gene associations for coronary heart disease pharmacologic endpoints, developing innovative public health interventions to promote healthy lifestyles through personalized interventions and risk communication based on individual’s genetic and lifestyle profiles, and developing epidemiologic and statistical methods for genomic data.
Dr. Jacqueline C. Wiltshire: SDGs 3, 10 & 17
Dr. Jacqueline Wiltshire’s research focuses on disparities in access to healthcare including healthcare affordability and the patient-provider relationship. Specifically, her objective is to elucidate the social ecological factors that underlie racial/ethnic disparities in healthcare access, especially among older adults.
Ms. Whitley Wynns: SDGs 3, 10 & 17
Ms. Whitley Wynns has experience working at the community-level to drive change to improve maternal and child health outcomes. She understands the need for better policies at the local, state and federal levels to create equitable systems for women and children, and improve pregnancy outcomes. Ms. Wynns also works on programs which prioritize sexual education policy reform.
Dr. Lisa Yazel: SDGs 3, 10 & 17
Dr. Yazel’s research interests focus on obesity and diabetes prevention, the health education specialist workforce, advocacy for public health/community health efforts, and program evaluation. Additionally, she is engaged in building sustainable partnerships at the grassroots level to increase access to healthy food for those in need.
Dr. Valerie A. Yeager: SDGs 3, 10 & 17
Dr. Yeager’s research focuses on the intersection of healthcare and public health systems including studies of nonprofit hospital community benefits, community health needs assessments (CHNAs), wrap-around service provision, and care coordination. Her research also expands into the public health services and systems field where she studies voluntary national accreditation of public health departments and workforce topics such as recruitment, retention, and training needs.
Dr. Faith Yego-Kosegi: SDGs 3, 5, 10 & 17
Dr. Faith Yego-Kosegi focuses on health policy and management with vast experience in developing and augmenting capacity of health systems and services. She is also co-chair for the Public Health and Primary Care working group at the Academic Model Providing Access to Healthcare (AMPATH). Dr. Yego-Kosegi’s research focuses on the areas of maternal and child health, innovative technologies to improve health outcomes, health systems research, disaster preparedness, food security, and climate change.
Jianjun Zhang: SDGs 3 & 17
Dr. Jianjun Zhang is a professor in the Epidemiology Department and is nationally recognized for his impactful research work in the identification and validation of proteomic, metabolomic, genetic, hormonal, and other biomarkers for the early detection of pancreatic cancer and the malignant progression of pancreatic cysts.