JCU > Research Portfolio > A/Prof Stephanie Topp

About

Dr. Stephanie Topp is an A/Prof. in Global Health and Development in the College of Public Health, Medical and Veterinary Sciences and an Associate Research Fellow at the Nossal Institute for Global Health, University of Melbourne. She has 15 years’ experience working as a health systems practitioner and researcher in low-income settings, including PNG, India, South Africa and Zambia. She has a Masters in International Public Health (University of Sydney); a MPhil Development Studies (Oxford University), and a PhD in Global Health (University Melbourne).

Steph is the Associate Editor for Health Systems with BMJ Global Health and a member of the Board of Directors for Health Systems Global. She is chair of the 8th Global Symposium of Health Systems Research (HSR2024) and immediate past-chair of the Health Systems Global thematic working group on social science research (SHAPES). Steph is a regular contributer to the International Health Policies Blog and a member of the Australian Institute for Tropical Health and Medicine and the Anton Breinl Centre for Health Systems Strengthening. She was previously a Visiting Assistant Professor in the Health Care Organization and Policy unit, School of Public Health, University of Alabama in Birmingham (UAB). Steph previously held a Career Development Fellowship with the Hot North Collaboration, and holds a current NHMRC Early Leadership Investigator fellowship.

Steph's research has been widely cited and has informed multiple government and multi-lateral policy frameworks and recommendations

BLOGS and MEDIA

Nov 2022: CAPHIA Press Release: CAPHIA 2022 Award Winners Announced
Aug 2022: Global Health Matters Podcast (WHO TDR): Global Health Career Paths: Learn, Mentor, Practice, Repeat.
Jun 2022: Public Health Association of Australia - CDC Corner: Questions of scope and governance: A northern Queensland perspective on the proposed Centre for Disease Control. Blog.
Jun 2022: WHO-SYSTAC Initiative & University of Geneva: Webinar - Health Systems Resilience: Framing Debates and Latest Evidence
Jul 2022: Health Policy and Planning Blog: Health Policy and Planning’s Top 10 Articles Contributing to the 2021 Impact Factor [Edelman [...] Topp SM (2021) Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context]
Dec 2021: Bloomberg Press: Omicron, Delta pave the wave for a new super variant Panel Discussion with Anja Trivedi, Bloomberg Opinion Columnist.
Aug 2021: Health Policy and Planning Blog: Health Policy and Planning’s Top 10 Articles Contributing to the 2020 Impact Factor. [Sriram, Topp et al (2018) 10 Best Resources on Power in Health Policy and Systems in Low- and Middle-Income Countries]
Apr 2021: Bloomberg Press: COVID isn't over, and the next wave may be worse. Interview with David Fickling, 31 Mar 2021.
Jul 2020: Health Systems Governance Collaborative Webinar - Towards Equity, Full Agency and Greater Cultural Awareness. Part of the Building the Reset initiative.
Jul 2020: CRC NA Press Release: The Northern Australia health service delivery situational analysis report is the first pan-northern assessment of issues and priorities for health service delivery.
Feb 2020: International Health Politices: Power and politics: the case for linking resilience to health system governance.
Jan 2019: Health Policy and Planning Blog: Top 10 Altmetric & Downloaded papers 2018 [Sriram, Topp et al (2018) 10 Best Resources on Power in Health Policy and Systems in Low- and Middle-Income Countries]
Dec 2018: nam AIDSMap: Ten reasons people stop attending HIV care in Zambia
Dec 2018: International Health Policies: Social Science Researchers' Musings on Power and Health Systems.
Oct 2018: Health Systems Global Blogs: Revisiting Power and Global Health: Looking ahead to HSR2018 in Liverpool
Aug 2018: JCU Brighter: Buying power: What's trendy for international health donors.

Teaching

TM5502: Tropical Public Health (Level 5; TSV)
TM5552: Global Health and Development (Level 5; TSV)
TM5578: Emerging Public Health Threats (Level 5; TSV)
TM5600: Introduction to One Health (Level 5; TSV)

Interests

Professional

Board of Directors, Health Systems Global (2020 - 2024)
Member: WHO Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN)
Associate Editor, Health Systems: BMJ Global Health (2016-ongoing)
Expert Reviewer: UK National Institute for Health Research (NIHR) Evaluation, Trials and Studies Coordinating Centre (2014-ongoing)
External Advisory Group: Optimizing Momentum Toward Sustainable Epidemic Control program, ICAP at Columbia (2017-2020)
Co-Chair: Social Sciences Thematic Working Group, Health Systems Global (2017-2021)
Expert Panel: STOP TB Key & Vulnerable Population Guides / and Guides to Effective Case Finding (2015-2018)
Publication Mentor (2018): WHO Alliance for Health Systems and Policy Research - Women in Publication mentorship scheme

Research

Health Systems
Human Resources for Health
Governance & Accountability

Teaching

Global health
Health policy
Health systems

Experience

2020 to 2022 - Consultant, World Health Organization (Townsville / Geneva)
2019 - Associate Professor, James Cook University (Townsville)
2017 to 2019 - Consultant, University of North Carolina (UNC) (Townsville / Malawi)
2015 to 2018 - Senior Lecturer, James Cook University (Townsville)
2017 - Consultant, World Health Organisation (Townsville / Myanmar)
2012 to 2015 - Visiting Assistant Professor, University of Alabama (Birmingham) (Zambia)
2008 to 2010 - Program Manager, Centre for Infectious Disease Research in Zambia (Zambia)

Research Disciplines

Socio-Economic Objectives

Honours

Awards

2022 - Individual Teaching Excellence Award, Council of Academic Public Health Institutions of Australasia (CAPHIA)
2020 - Overall Discipline Winner, Award for Research Excellence, Public Health and Tropical Medicine
2020 - Deans Awards for Teaching Excellence, and Subject Excellence, for Global Health and Development, College of Public Health Medical and Vet Sciences, James Cook University
2019 - QLD Young Tall Poppy Award
2019 - Overall College Winner, Early Career Researcher Excellence, College of Public Health Medical and Vet Sciences, James Cook University
2018 - (Primary Investigator) JCU Rising Star Award - $15,000
2018 - (Co-Investigator) Learning & Teaching Grant - $9814 - Embedding Career Development in Post Graduate Public Health
2017 - (Co-Investigator) Learning & Teaching Grant - $9500 - Mapping the Post Graduate Journey
2017 - (Co-Investigator) Learning & Teaching Grant - $2650 - External Peer Review of Teaching, TM5502 Tropical Public Health
2017 - (Co-Investigator) Learning & Teaching Grant - $9857 - Transforming Assessment Practices In Public Health
2017 - (Lead) Research Consultancy - USD50,000 - WHO Myanmar, Development of Health Workforce Strategy 2018-2021
2004 to 2006 - NSW Rhodes Scholar

Fellowships

2020 to 2025 - NHMRC Investigator Award (EL) ($561,000)
2019 - Hot North Career Development Fellowship ($90,000)
2013 - Emerging Voices for Global Health, Institute for Tropical Medicine (ITM), Antwerp.
2011 to 2012 - Doctoral Fellowship, Population Council Zambia
2007 to 2008 - HIVCorps Fellow, Centre for Infectious Disease Research in Zambia

Memberships

2012 to 2020 - Health Systems Global
2008 to 2020 - International AIDS Society

Publications

These are the most recent publications associated with this author. To see a detailed profile of all publications stored at JCU, visit ResearchOnline@JCU. Hover over Altmetrics badges to see social impact.

Journal Articles

Bolton Moore C, Pry J, Mukumbwawenechanya M, Eshun-Wilson I, Topp S, Mwamba C, Roy M, Sohn H, Dowdy D, Padian N, Holmes C, Geng E and Sikazwe I (2022) A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia. PLOS Global Public Health, 2 (8).
Dawes N and Topp S (2022) Challenges to managing quality of care in northern Queensland residential aged care facilities. Social Sciences and Humanities Open, 6.
Dawes N and Topp S (2022) A qualitative study of senior management perspectives on the leadership skills required in regional and rural Australian residential aged care facilities. BMC Health Services Research, 22.
Dawes N and Topp S (2022) Senior manager leadership competencies for quality residential aged care: an Australian industry perspective. BMC Health Services Research, 22.
Edelman A, Taylor J, Ovseiko P, Larkins S and Topp S (2022) The population health role of academic health centres: a multiple-case exploratory study in Australia and England. Health Policy, 126. pp. 1051-1061
Haakenstad A, Irvine C, Knight M, Bintz C, Aravkin A, Zheng P, Gupta V, Abrigo M, Abushouk A, Adebayo O, Agarwal G, Alahdab F, Al-Aly Z, Alam K, Alanzi T, Alcalde-Rabanal J, Alipour V, Alvis-Guzman N, Amit A, Andrei C, Andrei T, Antonio C, Arabloo J, Aremu O, Ayanore M, Banach M, Barnighausen T, Barthelemy C, Bayati M, Benzian H, Berman A, Bienhoff K, Bijani A, Bikbov B, Biondi A, Boloor A, Busse R, Butt Z, Camera L, Campos-Nonato I, Cardenas R, Carvalho F, Chansa C, Chattu S, Chattu V, Chu D, Dai X, Dandona L, Dandona R, Dangel W, Daryani A, De Neve J, Dhimal M, Dipeolu I, Djalalinia S, Do H, Doshi C, Doshmangir L, Ehsani-Chimeh E, El Tantawi M, Fernandes E, Fischer F, Foigt N, Fomenkov A, Foroutan M, Fukumoto T, Fullman N, Gad M, Ghadiri K, Ghafourifard M, Ghashghaee A, Glucksman T, Goudarzi H, Das Gupta R, Hamadeh R, Hamidi S, Haro J, Hasanpoor E, Hay S, Hegazy M, Heibati B, Henry N, Hole M, Hossain N, Househ M, Ilesanmi O, Imani-Nasab M, Irvani S, Islam S, Jahani M, Joshi A, Kalhor R, Kayode G, Khalid N, Khatab K, Kisa A, Kochhar S, Krishan K, Defo B, Lal D, Lami F, Larsson A, Leasher J, LeGrand K, Lim L, Mahotra N, Majeed A, Maleki A, Manjunatha N, Massenburg B, Mestrovic T, Mini G, Mirica A, Mirrakhimov E, Mohammad Y, Mohammed S, Mokdad A, Morrison S, Naghavi M, Ndwandwe D, Negoi I, Negoi R, Ngunjiri J, Nguyen C, Nigatu Y, Onwujekwe O, Ortega-Altamirano D, Otstavnov N, Otstavnov S, Owolabi M, Pakhare A, Pepito V, Perico N, Pham H, Pigott D, Pokhrel K, Rabiee M, Rabiee N, Rahimi-Movaghar V, Rawaf D, Rawaf S, Rawal L, Remuzzi G, Renzaho A, Resnikoff S, Rezaei N, Rezapour A, Rickard J, Roever L, Sahu M, Samy A, Sanabria J, Santric-Milicevic M, Saraswathy S, Seedat S, Senthilkumaran S, Servan-Mori E, Shaikh M, Sheikh A, Silva D, Stein C, Stein D, Titova M, Topp S, Tovani-Palone M, Ullah S, Unnikrishnan B, Vacante M, Valdez P, Vasankari T, Venketasubramanian N, Vlassov V, Vos T, Yearwood J, Yonemoto N, Younis M, Yu C, Zadey S, Bin Zaman S, Zerfu T, Zhang Z, Ziapour A, Zodpey S, Lim S, Murray C and Lozano R (2022) Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 399 (10341). pp. 2129-2154
Mirzoev T, Topp S, Afifi R, Fadlallah R, Obi F and Gilson L (2022) Conceptual framework for systemic capacity strengthening for health policy and systems research. BMJ Global Health, 7 (8).
Mwamba C, Beres L, Topp S, Mukamba N, Simbeza S, Sikombe K, Mody A, Geng E, Holmes C, Kennedy C, Sikazwe I, Denison J and Bolton Moore C (2022) 'I need time to start antiretroviral therapy': understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia. Annals of Medicine, 54 (1). pp. 830-836
Nkem A, Topp S, Devine S, Li W and Ogaji D (2022) The impact of oil industry-related social exclusion on community wellbeing and health in African countries. Frontiers in Public Health, 10.
Rajan R and Topp S (2022) Accountability mechanisms of inquiries and investigations into Australian governments’ responses to the COVID-19 pandemic. Australian and New Zealand Journal of Public Health, 46 (4). pp. 488-494
Schaaf M, Boydell V, Topp S, Iyer A, Sen G and Askew I (2022) A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Global Health, 7. pp. 1-15
Topp S, Tully J, Cummins R, Graham V, Yashadhana A, Elliott L and Taylor S (2022) Rhetoric, reality and racism: the governance of Aboriginal and Torres Strait Islander Health Workers in a state government health service in Australia. International Journal of Health Policy and Management, 11 (12). pp. 2951-2963

More: ResearchOnline@JCU stores 110+ research outputs authored by A/Prof Stephanie Topp from 2010 onwards.

Current Funding

Current and recent Research Funding to JCU is shown by funding source and project.

CRC for Developing Northern Australia - Grant

Progressing health equity through strengthening the Aboriginal and Torres Strait Islander Health Workforce

Indicative Funding: $2,352,530 over 3 years (administered by TAAHC)
Summary: This collaborative TAAHC project aims to build on QH led Health Equity Strategies and plans within each of the partner HHSs in nQ through co-designed Aboriginal and Torres Strait Islander health workforce plans to strengthen recruitment, retention and career pathways for Aboriginal and Torres Strait Islander staff (clinical and non-clinical) within HHSs, and also strengthening the capacity of non-Indigenous staff to work respectfully with Aboriginal and Torres Strait Islander colleagues.
Investigators: Sarah Larkins, Stephanie Topp, Catrina Felton-Busch, Shaun Solomon and Bonnie Eklom (College of Medicine & Dentistry, College of Public Health, Medical & Vet Sciences, JCU Murtupuni Centre for Rural & Remote Health and Tropical Australian Academic Health Centre Limited)
Keywords: Health workforce; Aboriginal and Torres Strait Islander; Capacity strengthening; Health equity; First Nations health workforce; Rural, regional and remote

CRC for Developing Northern Australia Scheme - Projects

Integrating Health Care Planning for Health and Prosperity in North Queensland.

Indicative Funding: $750,000 over 3 years, in partnership with Tropical Australian Academic Health Centre Limited ($330,000)
Summary: Improving health and prosperity across Northern Australia is constrained by planning silos and limited creativity in models-of-care. North Queensland (NQ) has a unique opportunity to unite health industry partners and improve efficiencies and effectiveness in service delivery. Building on findings from our Health Situational Analysis we will co-create integrated systems for mapping population need, health services and workforce, prioritising areas for action. This work brings together key public and private health system partners across North Queensland, including Hospital and Health Services, Primary Health Networks and the Community Controlled Health Sector to take a regional approach to strengthening the integration of care and place-based planning of workforce and service implementation in North Queensland. The organizational recognition of the Tropical Australian Academic Health Centre (TAAHC) streamlines these relationships. We will work with all TAAHC partners, plus QAIHC and WQPHN to take a regional approach in NQ, whilst working with expert technical reference group members from NT and WA to ensure shared learning across the north. Then, working closely with service providers and consumers we will facilitate place-based planning and design, implement and evaluate new models-of-care that will optimise health and economic outcomes, consumer and workforce satisfaction.
Investigators: Sarah Larkins, Stephanie Topp, Alex Edelman, Nishila Moodley, Edward Strivens and Maxine Whittaker (College of Medicine & Dentistry, College of Public Health, Medical & Vet Sciences and Cairns & Hinterland Hospital & Health Service)
Keywords: place -based planning; Rural Health Services; Health Workforce; integrated care; rural and remote; Health Equity

National Health & Medical Research Council - Investigator Grants

Health system governance and tuberculosis control in the Torres Strait: an institutional analysis

Indicative Funding: $561,800 over 5 years
Summary: Using institutional analysis, the project will address a gap in knowledge regarding the nature and robustness of health system governance for tuberculosis (TB) control in the Torres Strait Protected Zone. The Torres Strait Protected Zone is an area of strategic public health importance due to high rates of TB and multi-drug resistant TB and proximity to Papua New Guinea where the disease is endemic. The project will identify and characterise the role(s) of different stakeholders and evaluate the formal and informal rules that drive TB-related decisions in this unique cross-border region. In doing so, it will deliver critical insights into the resilience and adaptive capacity of health system responses to TB, and produce recommendations to strengthen governance capabilities to counter existing and emerging communicable disease threats.
Investigators: Stephanie Topp (College of Public Health and Medical & Vet Sciences)

Canadian Institutes of Health Research - Global Health: Planning and Dissemination Grant

The impact of emergency care workforce policy on health equity: a comparative analysis

Indicative Funding: $5,124 over 1 year
Summary: The purpose of this proposal is to develop a cross-country comparative research study on the linkages between emergency care workforce policy and health equity. The activities sponsored by this grant will facilitate the development of a comparative study to be submitted to the Canadian Institutes of Health Research on multi-stakeholder perspectives on the impact of emergency care workforce policy on health equity in Canada, Australia, Rwanda, and South Africa. This proposal uniquely brings together a team with complimentary skills in health policy and systems research, emergency medicine and epidemiology, perspectives that are each essential to unpacking emergency care workforce policy.
Investigators: Veena Sriram, Riyad Abu-Laban, Simon Pulfrey, Stephanie Topp, Heike Geduld and Menelas Nkeshimana (The University of British Columbia, College of Public Health, Medical & Vet Sciences, University of Cape Town and University Teaching Hospital Rwanda)
Keywords: Health Workforce; Health Policy; Emergency Care; Health Equity

Tropical Australian Academic Health Centre Limited - Contract Research

North Queensland Aboriginal and Torres Strait Islander Sexually Transmissable Infections Action Plan 2016-2021 - Synthesis of Key Learnings.

Indicative Funding: $75,074 over 1 year
Summary: The project will undertake a synthesis of key learnings of the North Queensland Aboriginal and Torres Strait Islander Sexually Transmissible Infections (STIs) Action Plan 2016-2021and related initiatives and available evidence base to inform the development, through place-based, co-design processes, of sustainable sexual health models to manage the risk of STIs to First Nations people in Northern Queensland. The project will also undertake an epidemiological analysis of STIs in Northern Queensland and develop an an evaluation framework that can be applied to the development, implementation and evaluation of sustainable sexual health models to manage the risk of STIs to First Nations people in Northern Queensland.
Investigators: Stephanie Topp (College of Public Health and Medical & Vet Sciences)
Keywords: Aboriginal and Torres Strait Islander Health; Resilience; Culture; Wellbeing

Menzies School of Health Research - HOT NORTH - Project Grant

Who?s steering the ship? A case comparison of the governance of Aboriginal and Torres Strait Islander Health Workers across Northern Australia

Indicative Funding: $36,500 over 2 years
Summary: Using a qualitative cross-case design, this project will expand on current Queensland-based work to address this gap in knowledge by exploring the governance arrangements that shape the work practices of A&TSIHW across both Queensland and the Northern Territory. Continuing the first systematic work relating to A&TSIHW governance carried out in Queensland as part of a 2019 with Hot North support, this project will: a) extend the project scope and characterize both the formal and informal rules and norms that influence A&TSIHW roles in the Top End Health Service of the NT, and b) through cross-case analysis of QLD and NT data, develop new insights into the influence of different geographic, social and administrative structures on A&TSIHW performance. The outcomes are expected to support efforts to strengthen Indigenous health workforce planning across Northern Australia.
Investigators: Stephanie Topp in collaboration with Josslyn Tully and Sean Taylor (College of Public Health, Medical & Vet Sciences, Torres & Cape Hospital & Health Service and Top End Health Service)
Keywords: Aboriginal and Torres Strait Islander He; Health Systems; Remote and Rural; Health Workforce; Governance; Northern Australia

The Global Fund - Contract Research

Allocative efficiency modelling to support National TB programs

Indicative Funding: $191,260 over 4 years
Summary: Tuberculosis (TB) has now been unequivocally identified as the world's leading infectious killer, with global control failing to make significant inroads into the huge burden of disease. TB in Australia is driven by this huge global burden, with around 60% of all TB cases occurring in our region and nearly 90% of Australia's cases occurring in the overseas born. Our group has an established track record of undertaking country-level simulations to better understand TB epidemiology and predict the effectiveness of programmatic interventions in the local context. These applications are linked to a program of theoretical and epidemiological research to improve understanding of TB transmission and strengthen model underpinnings. Recently, we have been working to develop our model into a flexible and robust platform by using principles of software engineering, including object-oriented and modular programming. This approach allows rapid adaptation of our tool ("AuTuMN") to new objectives without the need to modify many of the constituent modules. In this project, we will extend the AuTuMN structures to undertake country implementations in up to six additional countries, funded by The Global Fund Against AIDS, Malaria and tuberculosis (TGF). These countries are: Myanmar Timor L'este The Kingdom of Bhutan Cambodia The Philippines Sri Lanka This RFAF is an indicative budget, as airfares and other direct costs will only be paid upon submission of receipts. Additionally, TGF produces contracts in US dollar amounts so amounts below are subject to change. Which of the above countries elect to undertake this work has not yet been determineJCU will administer the grant but University of Melbourne and Monash University will send invoices for work undertaken as part of this grant.
Investigators: Emma McBryde, R Ragonnet, Nhut Tan Doan, James Trauer and Stephanie Topp in collaboration with Ross McLeod, Damon Eisen, Jennifer Ho, Tanya Diefenbach-Elstob, Kathryn Snow and Bosco Ho (Australian Institute of Tropical Health & Medicine, The University of Melbourne, Monash University, College of Public Health, Medical & Vet Sciences, College of Medicine & Dentistry and Queensland Health)
Keywords: Tuberculosis; mathematical modelling; international health; disease simulation

Menzies School of Health Research - HOT NORTH Fellowship

Rhetoric to Reality: how the governance of Aboriginal and Torres Strait Islander Health Workers impacts chronic disease prevention and care in Northern Australia

Indicative Funding: $90,709 over 1 year
Summary: This project will explore the governance arrangements that shape the work practices of Aboriginal and Torres Strait Islander Health Workers (A&TSIHW) in two government services in far North Queensland and the Northern Territory respectively. As the first systematic work relating to A&TSIHW governance the project aims to characterize both the formal and informal rules and norms that influence A&TSIHW roles, and develop new insights into the influence of different geographic, social and administrative structures on A&TSIHW performance. The outcomes are expected to support efforts to strengthen Indigenous health workforce planning across Northern Australia.
Investigators: Stephanie Topp (College of Public Health and Medical & Vet Sciences)
Keywords: Aboriginal and Torres Strait Islander He; Health Systems; Remote and rural health areas; Governance; Accountability

Supervision

Advisory Accreditation: I can be on your Advisory Panel as a Primary or Secondary Advisor.

These Higher Degree Research projects are either current or by students who have completed their studies within the past 5 years at JCU. Linked titles show theses available within ResearchOnline@JCU.

Current

The Engagement and Participation of Faith based Organizations in the Health System Reforms in Soloman Islands (PhD , Secondary Advisor)
Evaluating the impact of hospital pharmacists on a health equity agenda in a regional Australian setting - more than just the medicines. (PhD , Secondary Advisor)
An Investigation on the Impacts of Social Exclusion on the Health and Well-being of Niger Delta Communities in Nigeria (PhD , Primary Advisor/AM/Adv)
Variance in Policy Adoption in the Pacific: The case for Context-Specific NCD Prevention and Control Measures and the role of the NCD Best Buys (PhD , Primary Advisor)
Strengthening community empowerment approaches to Aedes species mosquito management in a high-income country setting: comparative case studies within Queensland, Australia. (PhD , Primary Advisor)

Completed

Senior manager leadership competencies to promote and protect Australian residential aged care quality of care (2022, PhD , Primary Advisor)
Medicalised childbirth: variation in care and drivers of maternal health service provision in Queensland, Australia (2021, PhD , Secondary Advisor)
The role of academic health centres in improving population health: a multiple-case study in Australia and England (2021, PhD , Primary Advisor)
Disparities in experiences of access to care for Australians with mental health conditions (2020, PhD , Secondary Advisor)

Collaboration

The map shows research collaborations by institution from the past 7 years.
Note: Map points are indicative of the countries or states that institutions are associated with.