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2010

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Group B Streptococcus Intrapartum Prophylaxis Guidelines Adherence: A Perinatal Risk Management Issue, Lisa Hanson, Leona Vandevusse Apr 2010

Group B Streptococcus Intrapartum Prophylaxis Guidelines Adherence: A Perinatal Risk Management Issue, Lisa Hanson, Leona Vandevusse

College of Nursing Faculty Research and Publications

No abstract provided.


Paracoccidiomycosis And Hiv/Aids: A Common Problem In An Uncommon Location, Astrid Radermacher Do, Joseph L. Yozviak Do, Facp, Marcelo Gareca Md Apr 2010

Paracoccidiomycosis And Hiv/Aids: A Common Problem In An Uncommon Location, Astrid Radermacher Do, Joseph L. Yozviak Do, Facp, Marcelo Gareca Md

Department of Medicine

No abstract provided.


Effectiveness Of The Combat Operational Stress Control Training Program: Expectations Of The U.S. Marine Corps, Marek M. Sipko Apr 2010

Effectiveness Of The Combat Operational Stress Control Training Program: Expectations Of The U.S. Marine Corps, Marek M. Sipko

STEMPS Theses & Dissertations

This study evaluated the effectiveness of the U.S. Marine Corps combat operational stress preventive training program to determine whether the program meets the training effectiveness criteria of the Marine Corps. This evaluation entailed both qualitative and quantitative inquiries to answer the subject matter research questions.

The participants consisted of active duty and reserve Marines on active duty. For the purposes of the quantitative analysis, the researcher obtained a random sample of 480 Marines. Additionally, the researcher obtained a purposefully stratified qualitative sample of 12 active duty Marines consisting of four junior non-commissioned Marines, four staff non-commissioned officers, and four commissioned …


Chironian Spring/Summer 2010, New York Medical College Apr 2010

Chironian Spring/Summer 2010, New York Medical College

The Chironian

No abstract provided.


Toward An Applied Anthropology Of Gis: Spatial Analysis Of Adolescent Childbearing In Hillsborough And Pinellas Counties, Florida, Kathleen I. Maes Apr 2010

Toward An Applied Anthropology Of Gis: Spatial Analysis Of Adolescent Childbearing In Hillsborough And Pinellas Counties, Florida, Kathleen I. Maes

USF Tampa Graduate Theses and Dissertations

This work investigates births to white, African American and Hispanic adolescents in Hillsborough and Pinellas Counties, Florida, from 1992 to 1997 in two age groups - 13 to 17 year-olds and 18 to 19 year-olds - using spatial statistical techniques along with key informant interviews to provide insights into the utility of the research findings. The research developed a method for estimating the adolescent population in inter-census years, which was used to determine denominators for calculating teen birth rates. It also developed a composite deprivation index using socioeconomic indicators at the census block group level. The index provided context for …


Candida Albicans Adhesion And Biofilm Formation On Phosphated And Non-Phosphate Containing Poly(Methylmethacrylate) Polymers, Kathryn Elizabeth Ryan Apr 2010

Candida Albicans Adhesion And Biofilm Formation On Phosphated And Non-Phosphate Containing Poly(Methylmethacrylate) Polymers, Kathryn Elizabeth Ryan

Master's Theses (2009 -)

Denture-induced stomatitis is prevalent among prosthesis users, particularly the elderly and institutionalized where it has been estimated to be present in over 60-65% of denture wearers. Treatment of this clinical condition is problematic due to incomplete disinfection of the acrylic surface and rapid microbial re-colonization. Moreover, ingestion or aspiration of pathogens in denture plaque exposes the elderly and immunocompromised to unexpected infections.

Acrylic polymers have generally been used to replace missing teeth and periodontal tissues in edentulous or partially dentate patients. Currently, edentulous adults in the US population are common, with complete edentulism greater than 41% among Americans aged 65 …


Ecological Interactions Between Spiders And The Purple Pitcher Plant, Sarracenia Purpurea, Marc Aaron Milne Apr 2010

Ecological Interactions Between Spiders And The Purple Pitcher Plant, Sarracenia Purpurea, Marc Aaron Milne

Biological Sciences Theses & Dissertations

Spiders and harvestmen are commonly captured by or reside upon the carnivorous purple pitcher plant, Sarracenia purpurea. Although spiders and harvestmen are often known to be prey of S. purpurea, other ecological interactions between these arthropods and the plant are poorly understood. Studies were undertaken at three pitcher plant populations, two in Virginia and one in North Carolina, to assess the ecological relationships between spiders and harvestmen and S. purpurea. Multiple plots containing pitcher plants (treatment) and plots lacking pitcher plants (control) were created at these locations. Spiders and harvestmen were collected through five different techniques. Spatial, …


Today - March 31, 2010, Loma Linda University Mar 2010

Today - March 31, 2010, Loma Linda University

TODAY

Inside this issue:

-- Lifestyle and chronic diseases discussed at Healthy People 2010
-- Walter's Children's Charity Classic raises $200,000 for pediatric ophthalmology
-- Strengthening Hospital Adventiste d'Haiti
-- Pediatric RN residents celebrate with Drs. Clark and Seuss
-- Public health student speaks at One Young World Summit
-- The renewal of spiritual emphasis at Loma Linda University in the 1970s
-- LLU summer internship and management residency programs continue to shape the Adventist health care, business, and communication leaders of tomorrow
-- LLU prepares county environmental health departments
-- Children's Assessment Center combats the effects of sexual child abuse …


Who Guidelines For Antimicrobial Treatment In Children Admitted To Hospital In An Area Of Intense Plasmodium Falciparum Transmission: Prospective Study, Behzad Nadjm, Ben Amos, George Mtove, Jan Ostermann, Semkini Chonya, Hannah Wangai, Juma Kimera, Walii Msuya, Frank Mtei, Denise Dekker, Rajabu Malahiyo, Raimos Olomi, John A. Crump, Christopher J. M. Whitty, Hugh Reyburn Mar 2010

Who Guidelines For Antimicrobial Treatment In Children Admitted To Hospital In An Area Of Intense Plasmodium Falciparum Transmission: Prospective Study, Behzad Nadjm, Ben Amos, George Mtove, Jan Ostermann, Semkini Chonya, Hannah Wangai, Juma Kimera, Walii Msuya, Frank Mtei, Denise Dekker, Rajabu Malahiyo, Raimos Olomi, John A. Crump, Christopher J. M. Whitty, Hugh Reyburn

Faculty Publications

Objectives To assess the performance of WHO’s “Guidelines for care at the first-referral level in developing countries” in an area of intense malaria transmission and identify bacterial infections in children with and without malaria.

Design Prospective study.

Setting District hospital in Muheza, northeast Tanzania.

Participants Children aged 2 months to 13 years admitted to hospital for febrile illness.

Main outcome measures Sensitivity and specificity of WHO guidelines in diagnosing invasive bacterial disease; susceptibility of isolated organisms to recommended antimicrobials.

Results Over one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum …


Risk Factors Of Bronchial Ahtma In Children … A Hospital Based Study, Nadia A. Nasir, Mahmoud Shebab, Nebal Waill, Sadiq J. Alhammash, Muhi K. Aljanabi Mar 2010

Risk Factors Of Bronchial Ahtma In Children … A Hospital Based Study, Nadia A. Nasir, Mahmoud Shebab, Nebal Waill, Sadiq J. Alhammash, Muhi K. Aljanabi

Iraqi Postgraduate Medical Journal

ABSTRACT: BACKGROUND : Asthma is characterized by inflammation of the airways with intermittent bronchospasm. Bronchial asthma is an important cause of morbidity and mortality in childhood. There are many identifiable risk factors contributing to both the expression and persistence of asthma . OBJECTIVE: This study threw a light on some of the risk factors of bronchial asthma in childhood. PATIENTS AND METHODS: This study was performed to determine some of the risk factors of childhood asthma in 62 asthmatic children admitted to Children Welfare Teaching Hospital in Baghdad Medical City in the period from 1st February to 1st July 2007 …


Language Outcome After Left Anterior Temporal Lobectomy In Patients With Discordant Functional Magnetic Resonance Imaging And Intracarotid Sodium Amobarbital Testing Results, Julie K. Janecek Mar 2010

Language Outcome After Left Anterior Temporal Lobectomy In Patients With Discordant Functional Magnetic Resonance Imaging And Intracarotid Sodium Amobarbital Testing Results, Julie K. Janecek

Counselor Education and Counseling Psychology Research Exchange Conference

Language Outcome after Left Temporal Anterior Lobectomy in Patients with Discordant Functional Magnetic Resonance Imaging and Intracarotid Sodium Amobarbital Testing Results Rationale: Previous research has examined concordance rates between Wada and fMRI language lateralization indices (LIs) and has yielded variable results with limited post-surgical language outcome data. Therefore, additional evidence of the concurrent and predictive validity of fMRI LIs is needed. We will calculate Wada/fMRI LI concordance rates in the largest sample to date, investigate predictors of discordance and examine the ability of each procedure to predict language outcome in discordant cases. Methods: A consecutive series of 229 presurgical epilepsy …


Dibutyltin Activates Map Kinases In Human Natural Killer Cells, In Vitro, Sabah O. Odman-Ghazi, Abraham Abraha, Erica Taylor Isom, Margaret M. Whalen Mar 2010

Dibutyltin Activates Map Kinases In Human Natural Killer Cells, In Vitro, Sabah O. Odman-Ghazi, Abraham Abraha, Erica Taylor Isom, Margaret M. Whalen

Chemistry Faculty Research

Previous studies have shown that dibutyltin (DBT) interferes with the function of human natural killer (NK) cells, diminishing their capacity to destroy tumor cells, in vitro. DBT is a widespread environmental contaminant and has been found in human blood. As NK cells are our primary immune defense against tumor cells, it is important to understand the mechanism by which DBT interferes with their function. The current study examines the effects of DBT exposures on key enzymes in the signaling pathway that regulates NK responsiveness to tumor cells. These include several protein tyrosine kinases (PTKs), mitogen-activated protein kinases (MAPKs), and mitogen-activated …


Management Of Kawasaki Disease In Texas: Policy Implications, Alberto Coustasse, Doohee Lee, Cody Arvidson, Julius J. Larry Iii, Witold Migala Mar 2010

Management Of Kawasaki Disease In Texas: Policy Implications, Alberto Coustasse, Doohee Lee, Cody Arvidson, Julius J. Larry Iii, Witold Migala

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but KD has received little attention on its management from a policy perspective. The core objective of this paper is to review the literature, identify problems related to KD, and evaluate and offer some policy alternatives to effectively prevent and treat KD epidemiologically in Texas. Policy options suggested in this paper include, among others, (1) establishing a mandatory national KD registry system (along with active surveillance), (2) introducing sentinel providers, (3) requiring mandatory reporting of KD by hospitals, and (4) sponsoring policy KD research and practice.


Diagnosis Of Enteric Fever In The Emergency Department: A Retrospective Study From Pakistan., Uzma R. Khan, J. Razzak, Ali Faisal Saleem Dr, Adnan Ahmed, Sabeena Jalal Mar 2010

Diagnosis Of Enteric Fever In The Emergency Department: A Retrospective Study From Pakistan., Uzma R. Khan, J. Razzak, Ali Faisal Saleem Dr, Adnan Ahmed, Sabeena Jalal

Department of Emergency Medicine

Background:Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters.
Aims: The present study identifies the clinical and laboratory parameters predicting enteric fever in Patients visiting the emergency department of a tertiary care hospital in Pakistan.
Methods:This is a retrospective chart review of all adult Patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005).
Results:A total of 421 emergency department Patients were admitted to …


A Community-Based Study Of Factors Associated With Continuing Transmission Of Lymphatic Filariasis In Leogane, Haiti, Alexis Boyd, Kimberly Y. Won, Shannon K. Mcclintock, Catherine V. Donovan, Sandra J. Laney, Steven A. Williams, Nils Pilotte, Thomas G. Streit, Madsen V.E. Beau De Rochars, Patrick J. Lammie Mar 2010

A Community-Based Study Of Factors Associated With Continuing Transmission Of Lymphatic Filariasis In Leogane, Haiti, Alexis Boyd, Kimberly Y. Won, Shannon K. Mcclintock, Catherine V. Donovan, Sandra J. Laney, Steven A. Williams, Nils Pilotte, Thomas G. Streit, Madsen V.E. Beau De Rochars, Patrick J. Lammie

Biological Sciences: Faculty Publications

Seven rounds of mass drug administration (MDA) have been administered in Leogane, Haiti, an area hyperendemic for lymphatic filariasis (LF). Sentinel site surveys showed that the prevalence of microfilaremia was reduced to ,1% from levels as high as 15.5%, suggesting that transmission had been reduced. A separate 30-cluster survey of 2- to 4-year-old children was conducted to determine if MDA interrupted transmission. Antigen and antifilarial antibody prevalence were 14.3% and 19.7%, respectively. Follow-up surveys were done in 6 villages, including those selected for the cluster survey, to assess risk factors related to continued LF transmission and to pinpoint hotspots of …


Bone Marrow Stromal Cells Use Tgf-Β To Suppress Allergic Responses In A Mouse Model Of Ragweed-Induced Asthma, K. Nemeth, A. Keane-Myers, J. M. Brown, D. D. Metcalfe, J. D. Gorham Mar 2010

Bone Marrow Stromal Cells Use Tgf-Β To Suppress Allergic Responses In A Mouse Model Of Ragweed-Induced Asthma, K. Nemeth, A. Keane-Myers, J. M. Brown, D. D. Metcalfe, J. D. Gorham

Dartmouth Scholarship

Bone marrow stromal cells [BMSCs; also known as mesenchymal stem cells (MSCs)] effectively suppress inflammatory responses in acute graft-versus-host disease in humans and in a number of disease models in mice. Many of the studies concluded that BMSC- driven immunomodulation is mediated by the suppression of pro- inflammatory Th1 responses while rebalancing the Th1/Th2 ratio toward Th2. In this study, using a ragweed induced mouse asthma model, we studied if BMSCs could be beneficial in an allergic, Th2- dominant environment. When BMSCs were injected i.v. at the time of the antigen challenge, they protected the animals from the majority of …


March 22, 2010 Reporter, University Of Alabama At Birmingham Mar 2010

March 22, 2010 Reporter, University Of Alabama At Birmingham

eReporter (campus newsletter)

No abstract provided.


A Global Fight Against Buruli Ulcer Mar 2010

A Global Fight Against Buruli Ulcer

News Releases

No abstract provided.


Optimizing Vaccine Allocation At Different Points In Time During An Epidemic, Laura Matrajt, Ira M. Longini Jr. Mar 2010

Optimizing Vaccine Allocation At Different Points In Time During An Epidemic, Laura Matrajt, Ira M. Longini Jr.

UW Biostatistics Working Paper Series

For current pandemic influenza H1N1, vaccine production started in the early summer, and vaccination started in the fall. In most countries, by the time vaccination started, the second wave of H1N1 was already under way. With limited supplies of vaccine, it might be a good strategy to vaccinate the high-transmission groups earlier in the epidemic, but it might be a better use of resources to protect instead the high-risk groups later on. We develop a deterministic epidemic model with two age-groups (children and adults) and further subdivide each age group in low and high risk. We compare optimal vaccination strategies …


Risk Assessment Of Catch And Release, Rolf Erik Olsen, Tor Fredrik Næsje, Trygve Poppe, Lynne Sneddon, John Webb Mar 2010

Risk Assessment Of Catch And Release, Rolf Erik Olsen, Tor Fredrik Næsje, Trygve Poppe, Lynne Sneddon, John Webb

Aquaculture and Fisheries Collection

The report was produced during most of 2009, and gives a state of art overview of current knowledge on the effects of catch and release practices on these fish species’ welfare, using accessible and peer reviewed published literature as basis for the assessment. Anecdotic and non-published reports have been used to a limited extent as they are regarded as untested or containing unverified statements. The Panel on Animal Health and Welfare discussed the full report in a meeting on the 9th of December, and gave its support to the conclusions drawn by the ad hoc-group.

The report has concentrated on …


Climate Change, Environmental Justice, And Vulnerability: An Exploratory Spatial Analysis, Sacoby M. Wilson, Roland Richard, Lesley Joseph, Edith M. Williams Mar 2010

Climate Change, Environmental Justice, And Vulnerability: An Exploratory Spatial Analysis, Sacoby M. Wilson, Roland Richard, Lesley Joseph, Edith M. Williams

Faculty Publications

Research has demonstrated that vulnerable populations including disadvantaged populations of color live in areas that may place them at higher risk of exposure to social and environmental hazards. Due to climate change, these populations may experience worse health outcomes and environmental health disparities. The purpose of this project was to explore the use of Geographic Information Systems (GIS) to assess areas that may be vulnerable to climate change across the United States. We employed ArcGIS 9.3 to create vulnerability scores for areas across the country that may be that may be impacted by climate change at the county level in …


Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi Mar 2010

Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi

Pathology, East Africa

Background: Typhoid fever is a global health problem. The World Health Organization (WHO) estimates that the current annual global burden of typhoid is approximately 22 million new cases, 5% of which are fatal.

Methodology: To assess the trends in antibiotic resistance in 100 Salmonella enterica serovar Typhi strains were isolated from the blood of patients in Nairobi, Kenya, from 2004 to 2006. All isolates were tested against ampicilin, chloramphenic, nalidixic acid, ciprofloxacin, cotrimoxazole, cefuroxime, cefriaxone, amoxycillin/clavulanic acid, tetracycline and gentamycin. Susceptibility and resistance were determined using MIC and disk diffusion tests.

Results: From 2004 to 2006 a total of 100 …


Animal Health Matters, Russ Daly, David H. Zeman Mar 2010

Animal Health Matters, Russ Daly, David H. Zeman

Animal Health MATTERS Newsletter

[Page] 1- Iraqi Veterinarian Brings Veterinary-and Life-Experiences to ADRDL [Page] 2- Director's Message — Tomorrow’s Veterinarians and the NAVMEC [Page] 2- Veterinarians with Current USDA Accreditation: Note Program Changes [Page] 4- The Virology Section at SDSU’s ADRDL [Page] 5- Fish Health and Diagnostics Update Pieces and Parts [Page] 6- VSD Faculty Members Honored at SDSU Faculty Recognition Event [Page] 6- ADRDL Assists AIB in Bovine Tuberculosis Diagnostics [Page] 6- 2010 Bailey Herd Health Conference a Success [Page] 6- Faculty Members Attend “Animal Welfare in Veterinary Education and Research” Symposium [Page] 7- Calf Scours Submission Reminders [Page] 7- Calendar of Events


Impaired Antiviral Activity Of Interferon Alpha Against Hepatitis C Virus 2a In Huh-7 Cells With A Defective Jak-Stat Pathway, Sidhartha Hazari, Partha K. Chandra, Bret Poat, Sibnarayan Datta, Robert F. Garry, Timothy P. Foster, Gus Kousoulas, Takaji Wakita, Srikanta Dash Mar 2010

Impaired Antiviral Activity Of Interferon Alpha Against Hepatitis C Virus 2a In Huh-7 Cells With A Defective Jak-Stat Pathway, Sidhartha Hazari, Partha K. Chandra, Bret Poat, Sibnarayan Datta, Robert F. Garry, Timothy P. Foster, Gus Kousoulas, Takaji Wakita, Srikanta Dash

Faculty Publications

Background. The sustained virological response to interferon-alpha (IFN-) in individuals infected with hepatitis C virus (HCV) genotype 1 is only 50%, but is about 80% in patients infected with genotype 2-6 viruses. The molecular mechanisms explaining the differences in IFN- responsiveness between HCV 1 and other genotypes have not been elucidated. Results. Virus and host cellular factors contributing to IFN responsiveness were analyzed using a green fluorescence protein (GFP) based replication system of HCV 2a and Huh-7 cell clones that either possesses or lack a functional Jak-Stat pathway. The GFP gene was inserted into the C-terminal non-structural protein 5A of …


Quality Of Life, Hope, Social Support, And Self-Care In Heart Failure Patients, Karen A. Mcgurk Phd, Mn, Rn Mar 2010

Quality Of Life, Hope, Social Support, And Self-Care In Heart Failure Patients, Karen A. Mcgurk Phd, Mn, Rn

Dissertations

Heart failure is a significant, chronic health problem. Much is known about physiological factors related to this condition. Less is known about the psychosocial aspects that influence disease risk, progression, and treatment. The purpose of this study was to describe the relationships between quality of life, hope, social support, and self-care. A descriptive, correlational study was conducted. The participants were 65 heart failure patients who attended 2 military-based heart failure clinics. Quality of Life was measured using the Left Ventricular Dysfunction Questionnaire (LVD-36), Hope was measured using the Herth Hope Index (HUI), Social Support was measured using the Medical Outcomes …


Sbs General Campus Announcement 2010-03-12, Darren Johnson Mar 2010

Sbs General Campus Announcement 2010-03-12, Darren Johnson

Southampton Announcements and News

No abstract provided.


Evaluation Of Alternative Technologies To Supply Drinking Water To Marines In Forward Deployed Locations, Derek R. George Mar 2010

Evaluation Of Alternative Technologies To Supply Drinking Water To Marines In Forward Deployed Locations, Derek R. George

Theses and Dissertations

With recent increases, there are approximately 20,000 Marines deployed in the Helmand Province of Afghanistan. The cost of delivering bottled water to the troops is rapidly becoming unsustainable and convoys delivering bottled water are vulnerable to Improvised Explosive Devices (IEDs). Currently, raw water from indigenous sources, which has chemical and microbiological contaminants, is treated with reverse osmosis (RO), but only used for hygiene, with bottled water used for drinking. Due to the economic costs and risks to life of providing bottled water, decision-makers need to evaluate technology alternatives to treat raw water to supply safe drinking water. In this study, …


Gene Expression Patterns In Flea Vectors Of Yersinia Pestis, Wei Zhou Mar 2010

Gene Expression Patterns In Flea Vectors Of Yersinia Pestis, Wei Zhou

Theses and Dissertations

Plague bacteria (Yersinia pestis) are transmitted to susceptible mammals by fleas. At least 25 flea species found in North America have been identified as plague vectors. The most efficient flea vector is the Oriental rat flea Xenopsylla cheopis, while the cat flea Ctenocephalides felis is a poor vector. The factors that determine vector competence of different fleas are not known. The main obstacles that the bacteria must overcome in the flea gut are also unknown. Fleas' molecular responses to Y. pestis invading could be a determining factor to control the bacterial survival and growth. Good and poor …


High Volume Air Sampling For Viral Aerosols: A Comparative Approach, Casey W. Cooper Mar 2010

High Volume Air Sampling For Viral Aerosols: A Comparative Approach, Casey W. Cooper

Theses and Dissertations

The United States Air Force has high volume biological air sampling equipment available including the XMX/2L-MIL and DFU-1000. Neither system has been evaluated for effectiveness in the collection of viruses. Furthermore, decontamination methods have not been evaluated for these systems after use in sampling for a viral agent. MS2 bacteriophage was used as a surrogate virus. Aerosolized MS2 was released into a 12 m3 exposure chamber. High and moderate airborne concentrations of MS2 were evaluated. Low volume impingers were used for comparative purposes as well. Samples were analyzed using plaque assay and polymerase chain reaction (PCR). At high viral loads …


Microbes At A Non-Point Source Sub-Tropical Recreational Marine Beach And Their Implications On Human Health And Beach Monitoring Practices, Amir Mahmoud Abdelzaher Mar 2010

Microbes At A Non-Point Source Sub-Tropical Recreational Marine Beach And Their Implications On Human Health And Beach Monitoring Practices, Amir Mahmoud Abdelzaher

Open Access Dissertations

Swimming in ocean water, including beaches not impacted by known point sources of pollution, continues to pose a rising health concern. Studies which evaluate the relationship between indicator microbes, pathogens, and human health at recreational beaches are rare, especially at non-point beaches, although such studies are necessary for establishing criteria which would protect public health while minimizing economic burdens. The objective of this dissertation was to better understand the non-point source beach system, and hence determine possible directions that should be taken from a beach regulatory perspective in order to protect bather health and minimize economic burdens. This objective was …