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2013

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School Mental Health: Views Of Services Integration And Attitudes Toward Evidence-Based, Donna L. Burton Jan 2013

School Mental Health: Views Of Services Integration And Attitudes Toward Evidence-Based, Donna L. Burton

USF Tampa Graduate Theses and Dissertations

ABSTRACT

Purpose of the study. Through secondary data analysis of results from the School Mental Health Services Integration Survey (SMHSIS), this study describes indicators of school mental health integration preparedness, including role identification, willingness to engage in tasks associated with mental health services integration and implementation facilitators. The study also investigated the utility of a modified version of the Evidence-Based Practice Attitude Scale (EBPAS) for use with school staff.

Study rationale. With as many as 20% of children meeting criteria for mental disorders that cause impairment, the gaps in mental health services delivery to this special needs population are evident …


Referral Tracking Pilot And Referral Outcome Rates For The School Health Program In Panama, Jesica Eileen Candanedo Jan 2013

Referral Tracking Pilot And Referral Outcome Rates For The School Health Program In Panama, Jesica Eileen Candanedo

USF Tampa Graduate Theses and Dissertations

Background: The School Health Program (SHP) in the Republic of Panama includes preventive healthcare services delivery and referral issuing at elementary schools nationwide. Despite these early prevention efforts, a majority of referrals are apparently not achieving their desired outcome. This idea is supported by the SHP data showing preventable diseases on the rise. Thus, learning the outcome rates of particular referral outcomes may provide a basis for appropriately targeted action.

Methods: Three focus groups were conducted with health workers, medical records staff, and teachers, respectively. Following systems thinking and framework analysis, a pilot plan for referral tracking and referral outcome …


Cost Of Treatment Of Asthma Attacks In A Tertiary Level Healthcare Hospital In Panama, Nydia Flores Chiari Jan 2013

Cost Of Treatment Of Asthma Attacks In A Tertiary Level Healthcare Hospital In Panama, Nydia Flores Chiari

USF Tampa Graduate Theses and Dissertations

Asthma is a chronic respiratory disease characterized by inflammation of the airway and the presence of recurrent attacks (exacerbations) of breathlessness, wheezing, cough, chest tightness, or some combination of these symptoms. In the US, about 53% of people with asthma had an asthma attack in 2008, and 57% of these, were children. One in ten children (10%) had asthma in 2009, and boys were more likely than girls to have asthma. Internationally, the prevalence of asthma varies widely in different countries, but the disparity is narrowing due to rising prevalence in low and middle income countries. Unfortunately, we do not …


The Water Culture Beliefs Of Embera Communities And Maternal And Child Health In The Republic Of Panama, Ilenia Anneth Forero Jan 2013

The Water Culture Beliefs Of Embera Communities And Maternal And Child Health In The Republic Of Panama, Ilenia Anneth Forero

USF Tampa Graduate Theses and Dissertations

Water has cultural and spiritual values to indigenous people. These beliefs expose them to unsafe water sources and make them vulnerable to waterborne diseases. This background is not taken into account when countries write their water legislations, therefor imposing a management of water not readily accepted by them. The Embera group is one of the indigenous groups from the Republic of Panama, who have strong water beliefs. They live along the shore of rivers in houses built on high stilts away from urban areas. The purpose of this cross-sectional community based study is to describe through a survey the relation …


The Relationship Between Socioeconomic Status And Body Mass Index On Vitamin D Levels In African American Women With And Without Diabetes Living In Areas With Abundant Sunshine, Shani Vann Davis Jan 2013

The Relationship Between Socioeconomic Status And Body Mass Index On Vitamin D Levels In African American Women With And Without Diabetes Living In Areas With Abundant Sunshine, Shani Vann Davis

USF Tampa Graduate Theses and Dissertations

OBJECTIVE: To examine the relationships between socioeconomic status (SES), body mass index (BMI), and vitamin D levels in African American (AA) women living in areas with abundant sunshine; and to explore if diabetes moderates these relationships.

SIGNIFICANCE: More AA's live in poverty, and experience obesity, diabetes, and chronic disease compared to other groups. Eighty percent of AA women are overweight or obese, and rates of type 2 diabetes is highest in this group. Minority race, obesity, and diabetes increase risks for low vitamin D, and are associated with p

DESIGN AND METHOD: A cross-sectional descriptive research design was used to …


Virtual Screening For Inhibitors Of Anti-Apoptotic Proteins: Dck, Bcl-Xl, Mcl-1, Mdmx, And Mdm2, Courtney Jerome Du Boulay Jan 2013

Virtual Screening For Inhibitors Of Anti-Apoptotic Proteins: Dck, Bcl-Xl, Mcl-1, Mdmx, And Mdm2, Courtney Jerome Du Boulay

USF Tampa Graduate Theses and Dissertations

←Within this dissertation the topic of virtual screening is discussed with regard to three different cancer targets and also a brief introduction of the tools used in virtual screening. In Chapter 1, the reader will be introduced to virtual screening and the programs that are used in virtual screening. In Chapter 2, the first of three projects are discussed. This project consists of the work that was done to find inhibitors of the P53 binding domain of MDMX. In this project the mobility of residues within the binding site of MDMX are discussed and the ways in which we attempted …


Evaluation Of Pulmonary Risks Associated With Selected Occupations, Stephen Casey Harbison Jan 2013

Evaluation Of Pulmonary Risks Associated With Selected Occupations, Stephen Casey Harbison

USF Tampa Graduate Theses and Dissertations

Occupational health surveillance programs are designed to evaluate and reduce injury, illness, and deaths related to workplace hazards. In the state of Florida, there are numerous industries where workers are potentially exposed to airborne hazards from gases, vapors and dusts. Airborne occupational exposures to irritants, vesicants, and fibrogens have the potential to cause pulmonary function impairment if exposures are not properly controlled for high-level acute exposure as well as chronic exposure. For occupations that demand workers be exposed to substances known to be associated with pulmonary function impairment, respirators may be a principal method for exposure

control. OSHA requires pulmonary …


The Relationship Between High School Coaches' Beliefs About Sports Injury And Prevention Practice Readiness, Siwon Jang Jan 2013

The Relationship Between High School Coaches' Beliefs About Sports Injury And Prevention Practice Readiness, Siwon Jang

USF Tampa Graduate Theses and Dissertations

Although sports and other forms of physical activities are associated with numerous health benefits, adolescent sports injury has emerged as an important public health problem. As the most immediate caregivers for athletes, coaches are expected to play an important role in preventing and reducing injuries, -considering that sports medical staff, such as athletic trainers are not always available to care for athletes. However, research on coaches' beliefs and practices related to injury prevention has been limited to coaching competency issues, in which injury prevention is considered only one component. Therefore, the purpose of the study was to describe the coaches' …


Parent Distress In Life With A Child With Type 1 Diabetes, Lauren Nicole Johnson Jan 2013

Parent Distress In Life With A Child With Type 1 Diabetes, Lauren Nicole Johnson

USF Tampa Graduate Theses and Dissertations

Objective:

The purpose of this study was to highlight parent distress in diabetes, identify factors associated with distress and to show how public health and clinical professionals can assist parents in coping with their child's diabetes and living positively as a family unit.

Methods:

Parents of youth with diabetes (N = 41 qualitative, N = 332 quantitative) were engaged in focus groups, interviews, and survey research to understand their needs and stressors in life with a child with diabetes. Themes were examined in the qualitative data, and correlations and a regression model were run and analyzed from the quantitative data …


Exercise Barriers In Cancer Survivors: A Multi-Dimensional Approach, Morgan Lee Jan 2013

Exercise Barriers In Cancer Survivors: A Multi-Dimensional Approach, Morgan Lee

USF Tampa Graduate Theses and Dissertations

The population of cancer survivors is rapidly expanding, and promotion of health and quality of life for these individuals is a priority. Exercise confers numerous general and cancer–specific benefits, yet many cancer survivors are insufficiently active. Research on perceived exercise barriers in cancer survivors has been limited by methodological and conceptual problems. Recent research suggests barriers may be multi–dimensional, and different types of barriers may be salient depending on whether or not a person intends to engage in a given behavior. Global (i.e., abstract) barriers may be negatively associated with intention, while practical (i.e., concrete) barriers may be positively associated …


The Strong Black Woman, Depression, And Emotional Eating, Michelle Renee Offutt Jan 2013

The Strong Black Woman, Depression, And Emotional Eating, Michelle Renee Offutt

USF Tampa Graduate Theses and Dissertations

Abstract

Eighty percent of all black women are overweight or obese which can lead to greatly increased morbidity and mortality, increasing healthcare costs and loss of healthy years of life. While multiple factors may contribute to obesity in black women, the cultural persona of the Strong Black Woman (SBW), an ideology that promotes unflagging toughness and denial of self-needs, may be the basis for behaviors that contribute to steady state obesity in this group. The purpose of this study was to investigate the relationships between the SBW persona, depression, and emotional eating.

Two predominately black churches in Florida were approached …


Fertile Ground For A Social Movement: Social Capital In Direct Agriculture Marketing, Elizabeth A. Murray Jan 2013

Fertile Ground For A Social Movement: Social Capital In Direct Agriculture Marketing, Elizabeth A. Murray

USF Tampa Graduate Theses and Dissertations

Building from existing literature on anthropology of food, political economy of food and consumption, and social movement theory, I examine the direct agriculture network of Tampa Bay Florida through a mixed-method ethnography. The research consisted of one year of field-work, with 6 months and over 100 hours of active participant observation, open-ended interviews with eight local producers, and short surveys with 100 market patrons. This thesis is an analysis of the results of this rigorous qualitative and quantitative work and, perhaps more importantly, an account of my own personal struggles in joining the direct agriculture network and my ultimate commitment …


Evaluation Of Occupational Risk Factors For Nurses And Cnas: Analysis Of Florida Workers' Compensation Claims Database, Sheila Mohammed Jan 2013

Evaluation Of Occupational Risk Factors For Nurses And Cnas: Analysis Of Florida Workers' Compensation Claims Database, Sheila Mohammed

USF Tampa Graduate Theses and Dissertations

Musculoskeletal injuries lead to most claims even though needlestick injuries receive the most attention. In 2010, health expenditures in the United States neared $2.6 trillion. CNAs, orderlies, and attendants had the highest rates of musculoskeletal disorders of all occupations with an incidence of 249 per 10,000 compared to 34 per 10,000 for all workers. The financial burden of back injuries in the healthcare industry is estimated to add up to $20 billion annually. Data was extracted for cause of injury, nature of injury and body part injured. Extracted data was analyzed both descriptively and by logistic and linear regression using …


A Comparative Study: How Educational And Healthcare Preparedness Affected Marketization Of The Chinese And Indian Economies, Cindy Arjoon Jan 2013

A Comparative Study: How Educational And Healthcare Preparedness Affected Marketization Of The Chinese And Indian Economies, Cindy Arjoon

USF Tampa Graduate Theses and Dissertations

In this archival study, I explore reasons why India's economic takeoff into marketization in 1991 failed to meet the same success as China in 1979 when it made the same transition. I analyze the impact of education and healthcare on development and how investments in both sectors can yield significant returns privately and socially. The research in this paper seeks to answer the following question: Why was the Indian economy unable to meet the same success as China when developing a global, open market economy?

In order to answer this question, I begin by proving a solid relationship between education, …


"They Come, But They Don't Spend As Much Money": Livelihoods, Dietary Diversity, Food Security, And Nutritional Status In Two Roatan Communities In The Wake Of Global Crises In Food Prices And Finance, Racine Marcus Brown Jan 2013

"They Come, But They Don't Spend As Much Money": Livelihoods, Dietary Diversity, Food Security, And Nutritional Status In Two Roatan Communities In The Wake Of Global Crises In Food Prices And Finance, Racine Marcus Brown

USF Tampa Graduate Theses and Dissertations

ABSTRACT

This dissertation explores the associations between recent global crises in staple food prices and finance and the following aspects of life in two communities on the island of Roatàn, Islas de La Bahia (Bay Islands), Honduras: household livelihoods; food commoditization; dietary diversity; food security; and nutritional status. The aims of this study are: ) assess the geographic and economic source(s) of foods consumed by two different communities on Roatàn; b) discover how the most recent economic and food crises have affected foodways and nutrition on Roatàn; c) assess how these crises have affected economic growth of the tourism sector …


The Elimination Of Blindness: An Ethnographic Exploration Of The Fight Against Trachoma In Niger, Kelley Cosby Sams Jan 2013

The Elimination Of Blindness: An Ethnographic Exploration Of The Fight Against Trachoma In Niger, Kelley Cosby Sams

USF Tampa Graduate Theses and Dissertations

The goal of this study is to explore specialized and popular cultural models of trachoma, and the interaction between the trachoma elimination program and its target audience in one trachoma hyper-endemic intervention community. Eighty four million people worldwide, mainly children, are infected with active bacterial trachoma. For some, this will lead to painful and progressive corneal opacity and eventual blindness. The disease is most commonly spread by person-to-person contact or by flies, and affects very specific populations living in resource-poor areas such as rural Niger, which has one of the highest prevalence rates worldwide.

The World Health Organization formed an …


Phenotypic Characterization Of The Pancreatic-Derived Factor (Pander) Knockout Mouse On Pure C57bl/6 Background, Shari Moak Jan 2013

Phenotypic Characterization Of The Pancreatic-Derived Factor (Pander) Knockout Mouse On Pure C57bl/6 Background, Shari Moak

USF Tampa Graduate Theses and Dissertations

PANcreatic-DERived Factor (PANDER), or FAM3B, is a 235-amino acid protein strongly expressed within and secreted from the endocrine pancreas. Research surrounding PANDER has revealed a large role for the protein in maintaining glucose homeostasis, as evidenced by several Ad-PANDER overexpressing murine models, our lab's pancreas-specific PANDER transgenic overexpressor, and most recently our mixed genetic C57/129J PANDER knockout (PANKO) mouse. However, PANDER's overall role in glycemic regulation and glucose homeostasis has yet to be studied in a purebred C57BL/6J PANDER knockout model. Here we present the first phenotypic characterization of our global PANDER knockout mouse on a C57BL/6J background (PANKO-C57) where …


Assessing Appropriate Technology Handwashing Stations In Mali, West Africa, Colleen Claire Naughton Jan 2013

Assessing Appropriate Technology Handwashing Stations In Mali, West Africa, Colleen Claire Naughton

USF Tampa Graduate Theses and Dissertations

Proper hand hygiene is the most effective and efficient method to prevent over 1.3 million deaths annually from diarrheal disease and Acute Respiratory Infections (ARIs). Hand hygiene is also indispensable in achieving the fourth Millennium Development Goal (MDG) to reduce the childhood mortality rate by 2/3rds between 1990 and 2015. Handwashing has been found in a systematic review of studies to reduce diarrhea by 47%#37; and is, thus, capable of preventing a million deaths (Curtis et. al., 2003). Despite this evidence, hand washing rates remain seriously low in the developing world (Scott et al., 2008).

This study developed and implemented …


Weather Patterns Associated With Green Turtle Hypothermic Stunning Events In St. Joseph Bay And Mosquito Lagoon, Florida, Kelsey Roberts Jan 2013

Weather Patterns Associated With Green Turtle Hypothermic Stunning Events In St. Joseph Bay And Mosquito Lagoon, Florida, Kelsey Roberts

USF Tampa Graduate Theses and Dissertations

January of 2010 brought record-breaking cold temperatures to Florida. Such freeze events can upset vulnerable populations of marine life and other species that rely on stable water temperatures. Sea turtles are one group of species that are particularly susceptible to abrupt drops in water temperature. When water temperatures drop below 10°C, a mass hypothermic stunning, or cold-stunning, event for sea turtles can be expected, with many debilitated turtles washing onshore with a very limited time window to be rehabilitated (Foley et al. 2007). The species of sea turtle that appears to cold-stun with the most frequency is the green turtle, …


Treatment Maintenance Of Cognitive-Behavioral Therapy For Anxiety In Youth With Autism Spectrum Disorders, Robert Rein Selles Jan 2013

Treatment Maintenance Of Cognitive-Behavioral Therapy For Anxiety In Youth With Autism Spectrum Disorders, Robert Rein Selles

USF Tampa Graduate Theses and Dissertations

Anxiety disorders commonly co-occur in children and adolescents with an autism spectrum disorder (ASD). Recently, treatment of anxiety using cognitive behavioral therapy (CBT) has been modified and studied in youth with ASD, with results consistently demonstrating positive treatment outcomes. In typically developing populations, CBT gains are well maintained as long as 14-years post-treatment; however, maintenance of CBT has not yet been studied in anxious youth with ASD. Using a sample of 32 youth who previously completed one of three CBT for anxiety in ASD treatment studies, the present study re-assessed parent report of anxiety symptoms in youth, 12-26 months (M …


Factors Related To The Professional Management Of Early Breastfeeding Problems: Perspectives Of Lactation Consultants, Erica Hesch Anstey Jan 2013

Factors Related To The Professional Management Of Early Breastfeeding Problems: Perspectives Of Lactation Consultants, Erica Hesch Anstey

USF Tampa Graduate Theses and Dissertations

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, …


Diet-Induced Ketosis And Calorie Restriction In Mouse Models Of Alzheimer's Pathology, Milene Lara Brownlow Jan 2013

Diet-Induced Ketosis And Calorie Restriction In Mouse Models Of Alzheimer's Pathology, Milene Lara Brownlow

USF Tampa Graduate Theses and Dissertations

Dietary manipulations and their pharmacological outcomes have been increasingly studied in neurodegenerative diseases. However, a systematic comparison among different methods in validated animal models of Alzheimer's disease is made necessary due to several different approaches applied in recent studies. Moreover, despite the large body of evidence on the effects of calorie restriction (CR) and ketogenic diets (KDs) on amyloid pathology, no consistent data is available on the effects of calorie restriction, ketogenic diet or ketone supplements on tau pathology in transgenic models of AD. Moreover, the ketogenic diet used in our studies was custom made with low carbohydrate content and …


A Descriptive Study Of Four Principals' Experiences In Leading, Lewis Curtwright Jan 2013

A Descriptive Study Of Four Principals' Experiences In Leading, Lewis Curtwright

USF Tampa Graduate Theses and Dissertations

ABSTRACT

The purpose of this portraiture study is to describe four African-American principals'

experiences, in the context of their principal's role, with the interventions they championed in

meeting the needs of their struggling students. This research attempts to answer questions

concerning: What role did the four principals play in the targeted school reform? What

interventions did each principal introduce and what evidence of effects do they identify for each

one? How did each principal's values and beliefs affect what they chose to do? Framed within

Social Justice Theory (SJT), the study provides insight into how these respondents increased

student achievement …


The Political Economy Of Maternal Health In A Medically Pluralistic Environment: A Case Study In The Callejón De Huaylas, Isabella Chan Jan 2013

The Political Economy Of Maternal Health In A Medically Pluralistic Environment: A Case Study In The Callejón De Huaylas, Isabella Chan

USF Tampa Graduate Theses and Dissertations

This thesis examines maternal decision-making regarding prenatal care and childbirth in the rural, north-central Andes in the province of Carhuaz. Semi-structured interviews (n=30) and participatory action research workshops (n=7) were conducted with local women to elucidate how they conceptualize, experience, and negotiate the shifting landscape of prenatal care and childbirth practices and providers. Semi-structured interviews with obstetricians, midwives, and social workers (n=9) were also conducted to compare perspectives and identify disconnects in knowledge and practices existing between these two groups in order to facilitate an open conversation on how to jointly improve the maternal experience and reduce maternal mortality and …


Metabolism In Corals From Antarctica, The Deep-Sea, And The Shallow Subtropics: Contrasts In Temperature, Depth, And Light, Lara Henry Jan 2013

Metabolism In Corals From Antarctica, The Deep-Sea, And The Shallow Subtropics: Contrasts In Temperature, Depth, And Light, Lara Henry

USF Tampa Graduate Theses and Dissertations

Coral habitats span the range from tropical to polar, extremely shallow to thousands of meters deep. The differences in light and temperature experienced in these varied habitats likely affect the metabolic rates of the corals residing there. The metabolism of three coral species from different habitats have been examined to elucidate the effects of these environmental parameters on metabolism, an under-studied aspect of coral biology. For all three species, measurements of oxygen uptake, ammonium excretion, and activity of the enzymes lactate dehydrogenase (LDH), malate dehydrogenase (MDH), and citrate synthase (CS) were used to characterize their metabolism. Off Florida's Gulf coast, …


Variations Of Ghrelin, Growth Hormone, And Insulin-Like Growth Factor I In The West Indian Manatee (Trichechus Manatus), Rachel Lynn Cimino Jan 2013

Variations Of Ghrelin, Growth Hormone, And Insulin-Like Growth Factor I In The West Indian Manatee (Trichechus Manatus), Rachel Lynn Cimino

UNF Graduate Theses and Dissertations

The metabolic hormones ghrelin, growth hormone, and insulin-like growth factor I are influenced by developmental age, sex, and nutritional status in domestic and free-ranging species. However the role these hormones play has not previously been explored in sub-tropical/ tropical mammals. Furthermore, the seasonality of species with less dynamic environmental cues, such as the West Indian manatee, have not been studied. The West Indian manatee is and endangered species distributed in the southeastern United States and throughout the Caribbean basin, and its nutritional physiology is influenced by environmental factors. Understanding the hormone response to nutritional status in this species and its …


Practitioners' Use Of Clinical Practice Guidelines: An Evidence-Based Approach, Sondra Michelle Phipps Santana Jan 2013

Practitioners' Use Of Clinical Practice Guidelines: An Evidence-Based Approach, Sondra Michelle Phipps Santana

UNF Graduate Theses and Dissertations

Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria.

There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. …


Gvsu Undergraduate And Graduate Catalog, 2013-2014, Grand Valley State University Jan 2013

Gvsu Undergraduate And Graduate Catalog, 2013-2014, Grand Valley State University

Course Catalogs, 1963 - Current

Grand Valley State University 2013-2014 undergraduate and/or graduate course catalog published annually to provide students with information and guidance for enrollment.


Osmb Ais Funds Final Report: Task 1 Boat Ramp Monitoring For New Zealand Mud Snails, Valance Brenneis, Samuel Cimino, Angela L. Strecker Jan 2013

Osmb Ais Funds Final Report: Task 1 Boat Ramp Monitoring For New Zealand Mud Snails, Valance Brenneis, Samuel Cimino, Angela L. Strecker

Center for Lakes and Reservoirs Publications and Presentations

The New Zealand mud snail (Potamopyrgus antipodarum; NZMS) is an invasive species found in a variety of ecosystems in Oregon, including brackish estuaries, heavily used recreational rivers, and highly trafficked coastal freshwater lakes. NZMS are an invasive species of concern because once established, they may out-compete native invertebrate grazers, such as native insect larvae that provide important food resources for fish, and NZMS themselves provide little nutritional value. Monitoring for the presence and population density of NZMS was performed at boat ramps located along several water bodies in 2006 – 2007. These water bodies were then re-sampled during the summer …


Climate Change And Ragweed Allergy Risk Assessment: A Study Of The Grand Forks Metropolitan Statistical Area, Shumila Rani Ahmad Jan 2013

Climate Change And Ragweed Allergy Risk Assessment: A Study Of The Grand Forks Metropolitan Statistical Area, Shumila Rani Ahmad

Theses and Dissertations

Nowadays the association between anthropogenic climate change and public health is in the early stages of universal recognition. Yet one fundamental aspect that remains largely unappreciated is the impact of climate change on ragweed (Ambrosia species) biology and the ensuing pathophysiology of human systems. Ragweed pollen is one of the primary causes of seasonal pollen allergy in the world. Allergic reactions to ragweed pollen can range from mild hay fever to life-threatening asthma attacks. The aim of this thesis was to conduct a ragweed allergy risk assessment for the Grand Forks ND-MN Metropolitan Statistical Area (MSA).

The study area is …