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Relationship Between The Experience Of Perceived And Physician Diagnosed Arthritis And The Presence Of Dsm-Iv Criteria-Based Major Depression (Mdd) Among Older, Ryan Neil Schmidt Dec 2013

Relationship Between The Experience Of Perceived And Physician Diagnosed Arthritis And The Presence Of Dsm-Iv Criteria-Based Major Depression (Mdd) Among Older, Ryan Neil Schmidt

Theses and Dissertations

BACKGROUND: The purpose of this study was to explore both positive screened MDD and the perception of being depressed (P) and the likelihood of either increasing if the patient suffered from arthritis (P/E), either perceived or evaluated by a physician. The study explored the univariate, bivariate, and multivariate relationships between MDD and depression (P) to better describe influencing characteristics and their prevalence, as related to MDD and depression (P).

METHODS: The study examined a cross section of patients 65 years and older (n=8,205) within the National Epidemiologic Survey on Alcohol Abuse and Alcoholism (NESARC) [2001-02] sponsored by the National Institute …


The Effect Of Cancer Cachexia Severity And Eccentric Muscle Contractions On Selected Myofiber Metabolic Properties In Mouse Skeletal Muscle, Joshua Earl Mangum Jan 2013

The Effect Of Cancer Cachexia Severity And Eccentric Muscle Contractions On Selected Myofiber Metabolic Properties In Mouse Skeletal Muscle, Joshua Earl Mangum

Theses and Dissertations

Cancer cachexia is a complex syndrome that induces skeletal muscle wasting and dysregulation of skeletal muscle metabolism. Alterations in area of myofibers and myofiber metabolic properties can significantly impact the function of skeletal muscle. The purpose of this study was to examine the effect of cachexia severity and resistance exercise training on frequency and area of selected myofiber metabolic characteristics during cachexia-induced myofiber atrophy. Male ApcMin/+ (Min) mice were studied during the progression of cachexia (16-20 weeks of age) and stratified into groups based on the severity of cachexia. For the second study, male Min mice performed resistance exercise (RE) …


Understanding The Early Stages Of Development Of A Global Health Partnership, Wendy Raquel Gonzalez Navarrete Jan 2013

Understanding The Early Stages Of Development Of A Global Health Partnership, Wendy Raquel Gonzalez Navarrete

Theses and Dissertations

Maternal and child undernutrition contributes to more than one-third of child deaths. Global Health Partnerships (GHP) have emerged as a response to undernutrition and other pressing health problems. GHPs promote joint decision-making among donors, multilateral agencies, and country partners. Despite their positive impact on health problems, GHPs have generated unintended negative effects on country partners. This study aimed to understand the factors, strategies, and processes conducive to the establishment of an effective GHP in the context of a cooperative regional effort to reduce undernutrition and improve maternal and child health in eight countries in Latin America, Regional Health Initiative (RHI). …


A Qualitative Study Of An Urban Community Garden: Creating Healthier Neighborhood Environments, Lauren Workman Jan 2013

A Qualitative Study Of An Urban Community Garden: Creating Healthier Neighborhood Environments, Lauren Workman

Theses and Dissertations

Neighborhoods influence population level health; the places where people live, work, and grow are an essential setting for health promotion interventions. In efforts to create healthier neighborhood environments, there is a movement to better understand neighborhood social characteristics. The neighborhood social environment potentially includes social relationships (including trust and cohesion), networks, norms, and the resources that may be generated from relationships. In addition, more work is needed to learn about how people may become engaged in neighborhood initiatives. Community gardens are a 1) potential strategy to promote health at community and individual levels 2) mechanism to involve community members in …


Prevention Of Skin Breakdown In The Pediatric Intensive Care Unit, Lydia H. Palmer Jan 2013

Prevention Of Skin Breakdown In The Pediatric Intensive Care Unit, Lydia H. Palmer

Theses and Dissertations

Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin …


A Critical Review Of Endometriosis Pathology, Brittany Lauren Cureton Jan 2013

A Critical Review Of Endometriosis Pathology, Brittany Lauren Cureton

Theses and Dissertations

Endometriosis is a complex, multifactorial, reproductive disorder present in approximately 10-15% of adult women between the ages of 25-35. This disorder occurs when endometrial glands and stroma grow ectopically on the surface of the ovaries, pelvic peritoneum, fallopian tubes, and the uterus. Endometriosis causes varying degrees of painful symptoms and infertility in infected individuals. Three main theories of endometrial accumulation attempt to explain the etiology of this elusive disease. There have been various staging of endometriosis symptoms that attempt to standardize classification as well as predict pain and infertility. Angiogenesis, necessary to the survival of endometrial tissue, along with immune …


Associations Between The Perceived And Built Food Environment, Timothy L. Barnes Jan 2013

Associations Between The Perceived And Built Food Environment, Timothy L. Barnes

Theses and Dissertations

Neighborhood food environments have been associated with dietary intake and obesity. Measures of the food environment have typically been characterized with geographic information systems (GIS)-based measures, however, the use of perception-based measures of the food environment have increased in frequency. Few studies have fully examined the relationship between perceptions and GIS-based measures of the food environment, especially considering the congruency between perceived and GIS-based presence of specific retail food outlets, nor the relationship between food outlets and perceived availability of healthy foods or fast food opportunities.

Telephone survey data from 705 residents in an eight-county region of South Carolina were …


Geographical Proximity To Health Facilities And Breast Cancer Morbidity And Mortality Among Women In South Carolina's Best Chance Network, Leepao Khang Jan 2013

Geographical Proximity To Health Facilities And Breast Cancer Morbidity And Mortality Among Women In South Carolina's Best Chance Network, Leepao Khang

Theses and Dissertations

Death rates for breast cancer have steadily decreased in women due to early detection, such as mammography, and improved treatments. Despite the benefit of mammography, many women are not up-to-date on screening and do not receive timely follow-up after abnormal mammogram finding. Breast cancer is a major contributor to morbidity and mortality among women in South Carolina. To reduce the disproportionate burden of breast cancer and cervical cancer among women in South Carolina, the South Carolina Best Chance Network (BCN) was established to provide service delivery and ensures timely and complete diagnostic follow-up and treatment initiation for underserved women.

The …


Environmental Pre-Conditioning Of Bacterial Populations And Communities To Extreme Acidity, Gabriel Joseph Swenson Jan 2013

Environmental Pre-Conditioning Of Bacterial Populations And Communities To Extreme Acidity, Gabriel Joseph Swenson

Theses and Dissertations

The ability of opportunistic enteric pathogens to cause disease is effected by their ability to survive the variable and lethal acidity of the mammalian host gastrointestinal milieu. In many of these pathogens, survival is conferred by an acid stress response (ASR). ASR is elicited when bacterial cells are pre-conditioned in sub-lethal acidity (pH 4-6) which induces rapid biochemical and physiological modifications and facilitates survival when extreme acidity (pH 1-3) is encountered. In Vibrio cholerae, the causative agent of the diarrheal disease Cholera, ASR was initially investigated in an effort to determine how this ubiquitous aquatic bacterium is capable of causing …


Race, Ethnicity, And Differential Perceptions Of Sexual Victimization (Assault), Kaleea Regina Lewis Jan 2013

Race, Ethnicity, And Differential Perceptions Of Sexual Victimization (Assault), Kaleea Regina Lewis

Theses and Dissertations

The purpose of this pilot study is to ascertain how a sample of female college students perceives a hypothetical victim of a fabricated sexual assault. Participant perceptions of the sexual assault were explored through three distinct parameters: (1) victim responsibility attributes, (2) levels of trauma suffered due to the experience, and (3) levels of social support. This study addressed the two following research questions: (1) how does the hypothetical sexual assault victim's race and ethnicity affect how the study parameters are assessed and (2) how do participants perceive a hypothetical sexual assault victim, when presented in different races and ethnicities, …


Mass Spectrometry And Tandem Mass Spectrometry Characterization Of Protein Patterns, Protein Markers And Whole Proteomes For Pathogenic Bacteria, Jennifer Intelicato-Young Jan 2013

Mass Spectrometry And Tandem Mass Spectrometry Characterization Of Protein Patterns, Protein Markers And Whole Proteomes For Pathogenic Bacteria, Jennifer Intelicato-Young

Theses and Dissertations

There have been many recent reviews published on MALDI-TOF MS (matrix assisted laser desorption/ionization time-of-flight) MS (mass spectrometry) for identification of bacteria particularly with relevance to clinical microbiology. MALDI-TOF MS is now a mature technique for bacterial identification with great promise. The purpose of this review is to put into perspective MALDI-TOF MS and other widely used mass spectrometry methods for characterization of proteins. MALDI-TOF MS is used for rapid determination of a mass pattern of proteins for bacterial characterization; these proteins

are generally not identified. Alternatively, after gel separation, MALDI TOF-TOF MSMS (tandem mass spectrometry) or on-line LC-ESI MS-MS …


The Reproductive Ecology Of Plethodontid Salamanders In The South Carolina Inner Coastal Plain, Heather Rena Oswald Jan 2013

The Reproductive Ecology Of Plethodontid Salamanders In The South Carolina Inner Coastal Plain, Heather Rena Oswald

Theses and Dissertations

Nest- site selection is a critical process in the life history of amphibians, directly influencing offspring survival and parental fitness. When and where an amphibian chooses to nest is strongly influenced by a range of environmental cues. We monitored plethodontid salamander breeding behavior in seepage wetlands in the South Carolina inner Coastal Plain. Seepage wetlands are ideal for monitoring semiaquatic salamander breeding, because they provide habitat for both larval and adult salamanders while having relatively predictable, constant water temperatures and presence year round. We observed the breeding phenology of three sympatric salamanders (Eurycea cirrigera, Desmognathus auriculatus, and Pseudotriton ruber) in …


Exploring African American And White 18-19 Year Old Males' Communication Experiences With Their Parents And Partners About Sex And Contraception, Charlotte Toole Galloway Jan 2013

Exploring African American And White 18-19 Year Old Males' Communication Experiences With Their Parents And Partners About Sex And Contraception, Charlotte Toole Galloway

Theses and Dissertations

Background: Increasing parent-child and partner communication about sex and contraception have been identified as protective factors that are amenable to change by teen pregnancy prevention programs.

Purpose and Methods: From June through July 2012, a total of six focus groups (N=30) were conducted with African American and White 18-19 year old males to retrospectively explore their communication experiences with parents and partners about sex and contraception, and their attitudes and beliefs about sex, pregnancy, and contraception.

Results: Most participants felt that parent-child sexual risk communication would be more effective when parents had a history of open communication and a good …


Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr. Jan 2013

Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr.

Theses and Dissertations

Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based …


Bioassay Guided Fractionation Of American Ginseng. A Hexane Fraction Of American Ginseng Suppresses Colitis And Associated Colon Cancer. Mechanism Of Action., Deepak Poudyal Jan 2013

Bioassay Guided Fractionation Of American Ginseng. A Hexane Fraction Of American Ginseng Suppresses Colitis And Associated Colon Cancer. Mechanism Of Action., Deepak Poudyal

Theses and Dissertations

Inflammatory Bowel Disease (IBD) [Ulcerative colitis (UC) and Crohn's Disease (CD)] is a group of chronic disorders of unknown etiology characterized by inflammation in the gastrointestinal tract associated with a high colon cancer risk. UC is characterized by periods of active disease ("flare-ups"), followed by periods when the disease is inactive ("remission"). The end result is an abnormal immune response with repeated episodes of colonic inflammation. Conventional treatment of UC by aminosalicylates, TNFα inhibitors, and steroids have modest effects, and come with a high risk of side effects including dyspeptic symptoms, gastric ulceration and sometimes hospitalization and deaths. Because of …


Impact Of Physical Activity In The Prevention Of Colorectal Cancer, Sarah Ashley Barnes Jan 2013

Impact Of Physical Activity In The Prevention Of Colorectal Cancer, Sarah Ashley Barnes

Theses and Dissertations

This review evaluates the current understanding of research on the impact of physical activity in the prevention of colorectal cancer. Current biological mechanisms implicated in physical activity and colorectal cancer risk reduction are blood glucose regulation, insulin sensitivity, leptin and adiponectin profiles, inflammation as well as secreted protein acidic and rich in cysteine (SPARC), an exercise induced myokine. Recent literature indicates that 30-60 minutes of moderate to vigorous activity a day is effective against colorectal cancer development, and there is convincing evidence of aerobic exercise as differently beneficial in recruiting mechanisms identified as preventative against colorectal cancer. This article provides …


Postnatal Depression In Mexico: Healthcare Provider Conceptualizations And Policies In The Public Health Sector, Jean Marie Sims Place Jan 2013

Postnatal Depression In Mexico: Healthcare Provider Conceptualizations And Policies In The Public Health Sector, Jean Marie Sims Place

Theses and Dissertations

Background: The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) highlight education and training for healthcare providers and the development of a policy framework as core strategies to address maternal mental health in low- and middle-income countries. This research critically examines these strategies with respect to postnatal depression in Mexico. The research 1) addresses how healthcare providers in Mexico conceptualize postnatal depression, and 2) assesses the policies that exist in Mexico regarding postnatal depression, which will inform the next steps for policy development. The research informs appropriate healthcare provider education and training, as well as the next …


A Novel Approach To The Design Of Selective Inhibitors For Cell Cycle Cyclin Dependent Kinases, Tracy Perkins Jan 2013

A Novel Approach To The Design Of Selective Inhibitors For Cell Cycle Cyclin Dependent Kinases, Tracy Perkins

Theses and Dissertations

CDK2/cyclin A and CDK4/cyclin D1 are proven targets for cancer drug discovery. The development of novel CDK inhibitors, with high selectivity, are being investigated by targeting the cyclin binding groove (CBG) located on the cyclin, the regulatory subunit of CDK. The CBG is a shallow area that is involved in signaling and the inhibition of cell cycle CDKs via endogenous tumor suppressors. Currently, non-peptidic inhibitors are being developed based on the recognition amino acid sequence, HAKRRLIF, of the C-terminal peptide sequence of the CDK inhibitor p21WAF1. Computational design and the utilization of non-natural amino acids are being proposed to identify …


Differential Effects Of The Great Recession On Minority Populations, Samuel Towne Jan 2013

Differential Effects Of The Great Recession On Minority Populations, Samuel Towne

Theses and Dissertations

Times of severe economic flux may burdend individuals at differing levels. The Great Recession affected individuals differently by racial group. Vulnerable individuals who may already be burdened by economic strains and health disparities may benefit from state policies that work to improve the health and health care access of individuals. Medicaid Generosity for parents or childless adults is associated with differences in individuals' health status and reporting forgone medical care. Individuals in states that have higher levels of Medicaid eligibility defined as eligibility in relation to the percent of the Federal Poverty Level report lower levels of poor or fair …


A Preliminary Study Exploring Racial Differences In Triage, Hospitalization Status, And Discharge Medication In An Emergency Department In Graniteville, Sc, Clare Pollock Jan 2013

A Preliminary Study Exploring Racial Differences In Triage, Hospitalization Status, And Discharge Medication In An Emergency Department In Graniteville, Sc, Clare Pollock

Theses and Dissertations

Purpose

This study seeks to identify any racial differences present in assigned triage scores, hospitalization status and discharge medications in a rural hospital likely experiencing a surge after a mass casualty incident involving chlorine gas as a result of a train derailment. Differences were examined between Non-Hispanic White and African American adults who were moderately ill and who presented to the emergency department of the closest hospital to the accident site within 24 hours of the incident.

Methods

Non-Hispanic White and African American adults who presented to the emergency department of the closest hospital to the accident site and who …


Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma Jan 2013

Food Environment And Birth Outcomes In South Carolina, Xiaoguang Ma

Theses and Dissertations

An increasing number of studies examined the association between neighborhood characteristics and birth outcomes. However, the results can be difficult to compare because of the variety of indicators used to characterize the neighborhood. As an important neighborhood characteristic, the food environment is associated with residents' nutrition status, diet quality, and related health outcomes. In addition, the food environment has been found to influence women's diet quality during pregnancy, which is a key factor in predicting birth outcomes. However to date, studies on food environment and birth outcomes are extremely limited.

This study examined the association between food environment (evaluated by …


Illness-Related Diabetes Social Support And Glycemic Control Among Middle Aged And Older Adults, Favel Leah Mondesir Jan 2013

Illness-Related Diabetes Social Support And Glycemic Control Among Middle Aged And Older Adults, Favel Leah Mondesir

Theses and Dissertations

Objective

The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC.

Methods

We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence …


Trophic Response To Polycyclic Aromatic Hydrocarbons And Copper In Tidal Flats Of North Inlet, South Carolina, Leslie Lynn Muggelberg Jan 2013

Trophic Response To Polycyclic Aromatic Hydrocarbons And Copper In Tidal Flats Of North Inlet, South Carolina, Leslie Lynn Muggelberg

Theses and Dissertations

The trophic link between benthic microalgae (BMA) and fiddler crabs is critical for the ecosystem functioning of estuaries and alterations in this linkage by anthropogenic activities could have cascading impacts on food webs and biogeochemical cycling in these sensitive habitats. Singular and interactive effects of two common pollutants in aquatic ecosystems, polycyclic aromatic hydrocarbons (PAHs) and copper (Cu), were investigated by exposing field collected sediment communities to the contaminants and measuring changes in BMA biomass and community composition in a bioassay design. The consequential impacts on the food web were then explored by examining the effects of PAHs and copper …


Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation And Measurement Issues In Rural Pakistan, Zaeem Haq Jan 2013

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation And Measurement Issues In Rural Pakistan, Zaeem Haq

Theses and Dissertations

Appropriate nutrition and psychosocial stimulation during the first three years of life can have long-lasting effects on a child's health and development. However, not all children in the world receive adequate nutrition and psychosocial stimulation during this period. There has been enormous interest in developing the evidence on the most effective ways of implementing and assessing early childhood development (ECD) promotion interventions in resource poor settings. Despite the interest, the integration of ECD interventions into pre-existing public health programs, and assessment of these interventions in extended family, rural household environment have not been addressed.

The dissertation research presented here was …


Fishing And Fish Consumption Patterns In The Gullah/Geechee Sea Island Population, Jamelle Heyward Ellis Jan 2013

Fishing And Fish Consumption Patterns In The Gullah/Geechee Sea Island Population, Jamelle Heyward Ellis

Theses and Dissertations

The Gullah/Geechee (G/G) people are descendants of West African slaves who remained in seclusion on the Sea Islands of South Carolina, North Carolina, Georgia, and Florida until the end of the Civil War in 1865. In addition to retaining their unique cultural language, they also remain largely a fishing subsistence population. Decades of urban development have reduced the G/G population's access to traditional fishing locations and have increased exposures to environmental contaminants in some bodies of water that are frequently fished by the G/G. Approximately 98.4% of SC rivers and streams and 77.6% of lakes have been assessed for aquatic …


Association Between Breastfeeding And Infant Growth: A Probable Reverse Causality, Shraddha Vyas Jan 2013

Association Between Breastfeeding And Infant Growth: A Probable Reverse Causality, Shraddha Vyas

Theses and Dissertations

Background: Much conflicting results exist in the association between breastfeeding and infant growth. One of these confusions is related to the temporal sequence between breastfeeding practice and infant growth.

Objective: This study aimed at examining the association and investigating a possible reverse causality between breastfeeding and infant growth.

Method: Infant Feeding Practices Survey II, a national longitudinal database with repeated measurements, following women prenatally and until one year postpartum (N=2914) was used. Mixed linear model assessed the impact of breastfeeding from the 2nd, 4th, 6th and 9th months on infant growth at the 3rd, 5th, 7th and 12th months, respectively. …


Insects As Indicators Of Environmental Stress, De Anna Estella Beasley Jan 2013

Insects As Indicators Of Environmental Stress, De Anna Estella Beasley

Theses and Dissertations

In the face of climate change-related events and anthropogenic disturbances, understanding the impacts of these events on species richness, abundance and distribution is important for us to mitigate biodiversity loss and better predict consequences for the environment and for human life. Insects are excellent models for understanding the consequences of environmental stress due to the sensitivity of their development and behavior. The overall focus of my dissertation research is the investigation of fluctuating asymmetry and oviposition behavior as indicators of environmental stress. My research includes a meta-analysis of published literature, and empirical research that was part of a collaborative initiative …


A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton Jan 2013

A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton

Theses and Dissertations

The often toxic work environment in which nurses practice contributes to decreased well-being, job dissatisfaction, and poor retention rates, while negatively impacting quality and patient safety. Most leadership programs and resources target nurses in formal leadership positions and are exclusive of the bedside nurse. The purpose of this research utilization project was to determine immediate and short-term outcomes of an educational leadership workshop for nurses, including intent to change the work environment and subsequent action to change the work environment. The goal was to develop, deliver, and evaluate an evidence-based educational intervention to empower nurses at all levels of care …


Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford Jan 2013

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford

Theses and Dissertations

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease characterized by symptoms of urinary urgency, frequency, bladder pain, and chronic pelvic pain in the absence of known pathology. Selection of appropriate treatments depended on the severity of the patient's symptoms and patient's preference. This review found that it is important for providers and patients to set realistic goals for symptom improvement when starting a new treatment.

The purposes of this project was to 1) conduct a substantive literature review on treatment guidelines for IC/PBS, 2) analyze the literature for comparing oral pharmacological interventions and behavioral interventions for IC/PBS, and 3) …


Examining The Relationships Between Religiosity, Spirituality, Internalized Homonegativity, And Sexual Risk Behaviors Among African-American Men Who Have Sex With Men: The Sexual Health In Faith Traditions (Shift) Study, Stacy Whichard Smallwood Jan 2013

Examining The Relationships Between Religiosity, Spirituality, Internalized Homonegativity, And Sexual Risk Behaviors Among African-American Men Who Have Sex With Men: The Sexual Health In Faith Traditions (Shift) Study, Stacy Whichard Smallwood

Theses and Dissertations

Background: African-American men who have sex with men (AAMSM) are at disproportionate risk for HIV infection. Although the disparities in infection rates between AAMSM and MSM of other groups have been well-documented, little is known about the factors that contribute to the disparity, particularly psychosocial factors. One such factor, internalized homonegativity (IH), has been identified as a potential predictor of AAMSM engagement in risky sexual behaviors. However, little has been known about the ways in which IH manifests itself in the lives of AAMSM, or the role that sociocultural institutions, such as African-American faith communities, play in the development of …