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2019

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Assessing Potential Impacts Of Climate Change On American Lobsters (Homarus Americanus) With Novel Tools And Techniques, Benjamin C. Gutzler Jan 2019

Assessing Potential Impacts Of Climate Change On American Lobsters (Homarus Americanus) With Novel Tools And Techniques, Benjamin C. Gutzler

Doctoral Dissertations

The Gulf of Maine is currently experiencing rapid environmental changes, in the form of warming temperatures, increasing acidity, and a benthic ecosystem that is dominated by the American lobster (Homarus americanus) as the sole major predator and most significant fishery. The overall goal of my dissertation research was to investigate how the increased stress from warmer, more acidic, waters might impact individual lobsters, and thus lobster populations. To address this overall objective it was necessary to develop novel methods for investigating lobster behavior and reproduction, a theme that will run throughout this dissertation. In Chapter Two, I developed a new …


Plain Meaning, Extrinsic Evidence, And Ambiguity: Myth And Reality In Insurance Policy Interpretation, Kenneth S. Abraham Jan 2019

Plain Meaning, Extrinsic Evidence, And Ambiguity: Myth And Reality In Insurance Policy Interpretation, Kenneth S. Abraham

Connecticut Insurance Law Journal

No abstract provided.


Falls In Individuals With Stroke During Inpatient Rehabilitation At A Tertiary Care Hospital In Saudi Arabia, Sami Ullah, Mohammed K. Al-Atwi, Ahmad Z. Qureshi, Sherif S. Tantawy, Amara Ilyas, Colleen A. Wunderlich Jan 2019

Falls In Individuals With Stroke During Inpatient Rehabilitation At A Tertiary Care Hospital In Saudi Arabia, Sami Ullah, Mohammed K. Al-Atwi, Ahmad Z. Qureshi, Sherif S. Tantawy, Amara Ilyas, Colleen A. Wunderlich

Neurosciences

Objectives: To determine the incidence and risk factors of falls in individuals with stroke undergoing inpatient rehabilitation. Methods: Retrospective analysis of all patients with stroke admitted to from January 2011 to June 2013 was carried out in Inpatient rehabilitation Unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Data collected included demographic variables, types of stroke, comorbidities, characteristics of falls, factors affecting falls and length of hospital stay. Data was descriptively analyzed. The Pearson Chi-square test was used to determine any significant relationship between the categorical variables. Binary logistic regression was used to evaluate predictors of falls during …


The Association Between Anxiety And Depression With 25(Oh)D And Thyroid Stimulating Hormone Levels, Habib Erensoy Jan 2019

The Association Between Anxiety And Depression With 25(Oh)D And Thyroid Stimulating Hormone Levels, Habib Erensoy

Neurosciences

Objectives: To evaluate the relationships between the serum levels of these parameters and mood disorders, including depression and anxiety. Methods: One hundred and fifty patients (77 with anxiety and 73 with depression), aged 18 to 79 years old, who were referred to the Neuro Psychiatry Clinic of Uskudar University in Istanbul, Turkey were included in this study from June 2018 to December 2018. According to the Beck Anxiety Inventory and Beck Depression Inventory II results, the anxiety patients met the mild and moderate anxiety criteria and the depression patients met the moderate and severe depression criteria, respectively. Venous blood samples …


A Guiding Hand Or A Slap On The Wrist: Can Drug Courts Be The Solution To Maternal Opioid Use?, Cara O'Connor Jan 2019

A Guiding Hand Or A Slap On The Wrist: Can Drug Courts Be The Solution To Maternal Opioid Use?, Cara O'Connor

Journal of Criminal Law and Criminology

As the opioid epidemic has expanded its reach, the number of pregnant women addicted to opioids has increased exponentially in recent years. The increase in the number of opioid-addicted pregnant women has resulted in a drastic expansion in the number of newborns who experience Neonatal Abstinence Syndrome (NAS). Newborns affected with NAS experience painful withdrawal and cost more to care for due to their increased health needs. In an effort to address the growing number of pregnant women using opioids and babies born with NAS, some states have turned to the criminal justice system. Three states–Tennessee, South Carolina, and Alabama–have …


Death With Dignity For The Seemingly Undignified: Denial Of Aid In Dying In Prison, Kathleen Messinger Jan 2019

Death With Dignity For The Seemingly Undignified: Denial Of Aid In Dying In Prison, Kathleen Messinger

Journal of Criminal Law and Criminology

The medical community has fundamentally changed how we think about life and death. Humans in privileged parts of the world are living longer and have access to life-saving treatment. The focus on quantity of life then has shifted to emphasizing quality of life and questioning whether longevity should at the expense of comfort or satisfaction. The conversation surrounding quality of life, and by extension end-of-life care, has included whether a competent adult has a right, or should have a right to end their own life on their own terms. The history of aid in dying is wrought with political ideology, …


Exposure To 1,4-Dioxane Dysregulates Stool Metabolomic Network, Yensheng Wang Jan 2019

Exposure To 1,4-Dioxane Dysregulates Stool Metabolomic Network, Yensheng Wang

Public Health Theses

1,4-dioxane is an environmental toxin found in drinking water that is highly associated with liver cancer. The interactions between environmental toxins and the human body can result in the development of tumorigenesis, it can also result in changes to metabolism and thus metabolites that circulate within the body. Some of these metabolites can be procarcinogenic, or can reflect changes to host processes that control metabolism. Stool contains copious information on metabolism that can provide an overview of the well-being of our body, and metabolites in the stool can provide information regarding the pathogenesis of disease and the toxicokinetics of toxicants. …


Differential Effects Of Medicaid Expansion On Racial/Ethnic Disparities In Primary Care Access, Janet Yim Jan 2019

Differential Effects Of Medicaid Expansion On Racial/Ethnic Disparities In Primary Care Access, Janet Yim

Public Health Theses

By providing health insurance to low-income and disabled children and adults, the United States’ Medicaid program increases health care access and utilization by those with limited access to affordable private insurance. To increase coverage, the Affordable Care Act (ACA) helped fund state expansions of Medicaid’s eligibility criteria to include low-income adults with incomes up to 138% of the Federal Poverty level. This paper examines the differential effects of Medicaid expansion on racial/ethnic disparities in primary care access using a quasi-experimental differences-in-differences design. Regression analyses consider low income adults (defined as below 138% FPL) ages 19-64. When analyzing both short term …


Scaling Up Group Prenatal Care: Analysis Of The Current Situation And Recommendations For Future Research And Policy Actions, Allissa Anne Desloge Jan 2019

Scaling Up Group Prenatal Care: Analysis Of The Current Situation And Recommendations For Future Research And Policy Actions, Allissa Anne Desloge

Public Health Theses

The United States consistently spends more on healthcare than other developed nations, but continues to suffer from inferior outcomes in maternal and infant morbidity and mortality. Innovation is needed within maternal and child healthcare to address these adverse outcomes. One identified innovative approach to tackle these issues is group prenatal care (GPNC). Women who participate in GPNC experience individual clinical care checks to monitor weight, blood pressure, and gestational age in addition to interactive learning and community-building activities and discussions. When compared to those who receive individual prenatal care, GPNC recipients have lower rates of preterm birth, fewer small for …


Temporal Trends In The Grip Strength Of Children And Adolescents, Faith Lavoy Dooley Jan 2019

Temporal Trends In The Grip Strength Of Children And Adolescents, Faith Lavoy Dooley

Theses and Dissertations

Objective: To estimate national and international temporal trends in the handgrip strength of children and adolescents, and to examine relationships between trends in handgrip strength and trends in health-related and sociodemographic indicators.

Methods: Data were obtained in two ways: (a) through a systematic electronic database search for studies reporting on temporal trends in the handgrip strength of apparently healthy 9–17-year-olds, (b) pearling reference lists, topical systematic reviews and personal libraries, and (c) by examining large national fitness datasets suitable to temporal trends analysis. Sample-weighted temporal trends were estimated using best-fitting regression models relating the year of testing to mean handgrip …


2019 Faculty Summer Seminar - Ethics & Our Disciplines, Center For Catholic Studies, Seton Hall University Jan 2019

2019 Faculty Summer Seminar - Ethics & Our Disciplines, Center For Catholic Studies, Seton Hall University

Center for Catholic Studies Faculty Seminars and Core Curriculum Seminars

Beth Bloom - The Ethics of Teaching Ethics to Undergraduates: A Librarian Perspective p.7

Maureen Byrnes - A Consideration of Ethics in Nursing Education and Healthcare p.10

Josephine DeVito - The Code of Ethics in the Nursing Profession p.13

Robert Faraci - Lonergan’s Saving Grace p.17

Anthony L. Haynor - The Ethics of Discernment, The Scale of Values and the Human Sciences p.21

Kathleen Nagel - Applying the Ethics of Discernment to Clinical Education p.24

Anthony Nicotera - Byrne’s Ethics of Discernment and Nicotera’s Circle of Insight: Inviting Personal and Institutional Movement toward More Ethical Decision-making p.27

Melinda D. Papaccio …


Pilot Gwas Of Caries In African-Americans Shows Genetic Heterogeneity, E. Orlova, J. C. Carlson, M. K. Lee, E. Feingold, D. W. Mcneil, R. J. Crout, R. J. Weyant, M. L. Marazita, J. R. Shaffer Jan 2019

Pilot Gwas Of Caries In African-Americans Shows Genetic Heterogeneity, E. Orlova, J. C. Carlson, M. K. Lee, E. Feingold, D. W. Mcneil, R. J. Crout, R. J. Weyant, M. L. Marazita, J. R. Shaffer

Faculty & Staff Scholarship

Background

Dental caries is the most common chronic disease in the US and disproportionately affects racial/ethnic minorities. Caries is heritable, and though genetic heterogeneity exists between ancestries for a substantial portion of loci associated with complex disease, a genome-wide association study (GWAS) of caries specifically in African Americans has not been performed previously.

Methods

We performed exploratory GWAS of dental caries in 109 African American adults (age > 18) and 96 children (age 3–12) from the Center for Oral Health Research in Appalachia (COHRA1 cohort). Caries phenotypes (DMFS, DMFT, dft, and dfs indices) assessed by dental exams were tested for association …


Hsl 4775 : Human Services Programs And Resource Management, Human Services Jan 2019

Hsl 4775 : Human Services Programs And Resource Management, Human Services

Approved Course Proposals

No abstract provided.


Colostrum Immunoglobulins And Oxidative Capacity May Be Affected By Infant Sex And Maternal Age And Parity, Davut Si̇nan Kaplan, Cahi̇t Bağci, Mustafa Örkmez, Özge Kömürcü Karuserci̇, Seyhun Sucu, Haki̇m Çeli̇k, Seyi̇than Taysi Jan 2019

Colostrum Immunoglobulins And Oxidative Capacity May Be Affected By Infant Sex And Maternal Age And Parity, Davut Si̇nan Kaplan, Cahi̇t Bağci, Mustafa Örkmez, Özge Kömürcü Karuserci̇, Seyhun Sucu, Haki̇m Çeli̇k, Seyi̇than Taysi

Turkish Journal of Medical Sciences

The aims of this study were to determine the levels of the total antioxidant status (TAS), the total oxidant status (TOS), the oxidative stress index (OSI), and the concentration of immunoglobulin A (IgA) and M (IgM) in colostrum, and evaluate relationships between these parameters and maternal age, maternal parity, and infant sex. Materials and methods: The analysis was performed in serum samples of colostrum which were collected from 90 mothers on the first day of lactation between 10:00 and 12:00 AM.Results: The measurements established that no significant association existed between the TAS level of colostrum and parity, maternal age, or …


Serum Adropin Levels In Psoriasis Vulgaris And Its Relation With Metabolic Parameters, Selma Korkmaz, Gülben Sayilan Özgün Jan 2019

Serum Adropin Levels In Psoriasis Vulgaris And Its Relation With Metabolic Parameters, Selma Korkmaz, Gülben Sayilan Özgün

Turkish Journal of Medical Sciences

Adropin is a peptide-structure hormone that plays a role in preventing the development of insulin resistance, which has been linked to obesity and metabolic regulation. The purpose of this study is to assess serum adropin levels and their relationship with metabolic parameters in psoriasis vulgaris patients both with and without metabolic syndrome (MetS).Materials and methods: Fifty-three patients and 26 healthy controls were included in this study. Serum adropin levels, fasting blood glucose, fasting serum insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, and triglyceride levels of all participants were analyzed. Enzyme-linked immunosorbent assay was used to measure serum adropin …


Branch Retinal Vein Occlusion Associated With Platelet Activation, Emrullah Beyazyildiz, Mehmet Çitirik, Mert Şi̇mşek, Özlem Beyazyildiz, İbrahi̇m Celaletti̇n Haznedaroğlu Jan 2019

Branch Retinal Vein Occlusion Associated With Platelet Activation, Emrullah Beyazyildiz, Mehmet Çitirik, Mert Şi̇mşek, Özlem Beyazyildiz, İbrahi̇m Celaletti̇n Haznedaroğlu

Turkish Journal of Medical Sciences

Background/aim: The aim of this study is to study subclinical platelet activation by detecting three important platelet activation parameters of mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with branch retinal vein occlusion (BRVO) in comparison to those in healthy control subjects.Materials and methods: This prospective study included 43 patients with BRVO (Group 1)and 40 control subjects (Group 2). The levels of MPV, PDW, and PCT were measured in both of the studied groups.Results: The mean serum level of MPV value was 7.64 ± 0.64 in Group 1 and 7.39 ± 0.42 in Group 2. …


Alterations In Serum Levels Of Copper, Zinc, And Selenium Among Children With Sickle Cell Anemia, Rana Hasanato Jan 2019

Alterations In Serum Levels Of Copper, Zinc, And Selenium Among Children With Sickle Cell Anemia, Rana Hasanato

Turkish Journal of Medical Sciences

Background/aim: Oxidative stress contributes to pathophysiological dysfunction in sickle cell anemia (SCA). Copper (Cu) is a prooxidant, whereas zinc (Zn) and selenium (Se) are antioxidant trace elements. This study investigates the serum levels of Cu, Zn, and Se among children with SCA.Materials and methods: This cross-sectional study was performed at King Khalid University Hospital, Riyadh. Thirty-three children with SCA in steady state and 33 age- and sex-matched normal healthy children were included in the study. Cu, Zn, and Se levels were measured by inductively coupled plasma-mass spectrometry (ICP-MS) instrument.Results: The median serum Cu levels among SCA patients (1.3 -g/mL) were …


Serum Prolidase Level In Patients With Brucellosis And Its Possible Relationship With Pathogenesis Of The Disease: A Prospective Observational Study, Oğuzhan Sitki Di̇zdar, Ayşe Turunç Özdemi̇r, Osman Başpinar, Derya Koçer, Yavuz Katircilar, İlhami̇ Çeli̇k Jan 2019

Serum Prolidase Level In Patients With Brucellosis And Its Possible Relationship With Pathogenesis Of The Disease: A Prospective Observational Study, Oğuzhan Sitki Di̇zdar, Ayşe Turunç Özdemi̇r, Osman Başpinar, Derya Koçer, Yavuz Katircilar, İlhami̇ Çeli̇k

Turkish Journal of Medical Sciences

Background/aim: Changes in collagen metabolism and fibroblastic activity may play a role in the pathogenesis of brucellosis. The prolidase enzyme plays an important role in collagen synthesis. We aimed to investigate the association of prolidase levels with brucellosis.Materials and methods: Serum prolidase levels in 20 patients newly diagnosed with brucellosis were compared with levels in 30 healthy control subjects. Patients with brucellosis were reassessed 3 months later for prolidase, other laboratory measurements, and response to treatment. Results: The levels of serum prolidase were significantly higher in brucellosis patients compared with those of healthy controls. Prolidase, sedimentation, and C-reactive protein levels …


Ntr 3500 : Professional Focus On Nutrition & Dietetics, Nutrition & Dietetics Jan 2019

Ntr 3500 : Professional Focus On Nutrition & Dietetics, Nutrition & Dietetics

Approved Course Proposals

No abstract provided.


A Survey Of Providers And Patients Assessing The Need For And Use Of Prevention Practitioners To Combat Obesity In The Primary Care Setting, Amanda R. Lyons Jan 2019

A Survey Of Providers And Patients Assessing The Need For And Use Of Prevention Practitioners To Combat Obesity In The Primary Care Setting, Amanda R. Lyons

DNP Projects

Purpose: The overall aim of this project was to gather information from two groups of stakeholders, providers and patients, on the feasibility of implementing prevention practitioners in the primary care system to address overweight and obesity.

Methods: This study utilized a quantitative descriptive design through the use of electronic surveys. Provider surveys were explained and presented during a monthly provider meeting. Patient flyers were posted in exam rooms and surveys were accessible through a provided link and QR code.

Results: Providers (N=10) agreed that they saw a need for the use of a prevention practitioner (Mean=4.44, SD=.88) as well as …


Amino Acids Profiling For The Diagnosis Of Metabolic Disorders, Yana Sandlers Jan 2019

Amino Acids Profiling For The Diagnosis Of Metabolic Disorders, Yana Sandlers

Chemistry Faculty Publications

Inborn errors of metabolism (IEM) represent a group of inherited diseases in which genetic defect leads to the block on a metabolic pathway, resulting in a single enzyme dysfunction. As a downstream consequence of the residual or full loss of the enzymatic activity, there is an accumulation of toxic metabolites in the proximity of the metabolic block and/or a deficiency of an essential metabolic product which leads to the clinical presentation of the disease. While individually IEMs are rare, a collectively estimated incidence of metabolic inherited disorders is 1:800. The genetic basis of IEMs can involve abnormalities such as point …


Inquiries Of Entomophagy: Developing And Determining The Efficacy Of Youth-Based Curriculum, Dakota Vaccaro, Kaitlyn Anderson, Lauren Clark, Ellie Gluhosky, Sarah Lutch, Spencer Lachman Jan 2019

Inquiries Of Entomophagy: Developing And Determining The Efficacy Of Youth-Based Curriculum, Dakota Vaccaro, Kaitlyn Anderson, Lauren Clark, Ellie Gluhosky, Sarah Lutch, Spencer Lachman

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Entomophagy is the human use of insects as food. This practice is exhibited around the world by a variety of cultures with densities highest in the continents of Africa, Australia, and South America. However, entomophagy is not commonly practiced in the United States and as a result many Americans lack the knowledge necessary for understanding, appreciating, and using this practice. As the value of finite natural resources and impacts of food production are recognized by Americans, entomophagy has become a more socially-viable alternative food source because its environmental benefits allow consumers to justify their interest and adoption of the practice. …


The Implied Promise Of A Guaranteed Education In The United States And How The Failure To Deliver It Equitably Perpetuates Generational Poverty, Anjaleck Flowers Jan 2019

The Implied Promise Of A Guaranteed Education In The United States And How The Failure To Deliver It Equitably Perpetuates Generational Poverty, Anjaleck Flowers

Mitchell Hamline Law Review

No abstract provided.


A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook Jan 2019

A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …


Foodini Marketing Plan, Dave Sherman, Rita Snodgrass, Bharat Verma, Michael Oluwole, Oneshin Aiken Jan 2019

Foodini Marketing Plan, Dave Sherman, Rita Snodgrass, Bharat Verma, Michael Oluwole, Oneshin Aiken

Engineering and Technology Management Student Projects

This plan provides the strategic direction for the rollout and marketing of the Foodini 2.0, the newest product from the Foodini division of Natural Machines. The Foodini 2.0 is the second 3D Food Printer produced by Natural Machines. The Foodini 1.0 was marketed exclusively to high end restaurants, with a small number released. The Foodini 2.0 builds on the Foodini 1.0 platform by adding an integrated oven and IoT functionality. With the Foodini 2.0, we will introduce subscription access to the new Foodini Design Library, as well as an option for customers to purchase individual designs. The Foodini 2.0 is …


Utilizing Telecommunication To Provide Patient Centered Care For Adults Newly Diagnosed With Gi Cancer: A Quality Improvement Project, Laurie Miller Jan 2019

Utilizing Telecommunication To Provide Patient Centered Care For Adults Newly Diagnosed With Gi Cancer: A Quality Improvement Project, Laurie Miller

DNP Scholarly Projects

INTRODUCTION: A confirmed diagnosis of GI Cancer causes anxiety and stress as patients become overwhelmed with questions, worries and fears. At diagnosis, patients are not yet formally connected to the support services available to those actively receiving chemotherapy, creating a “gap period”. To help reduce anxiety, as well as, foster therapeutic relationships and improve overall patient experiences, a structured telephone communication by the gastrointestinal cancer oncology nurse practitioner (GI NP) was proposed.

AVAILABLE KNOWLEDGE: Reduction of anxiety has been shown to enhance the quality of life, increase compliance with a prescribed treatment plan and foster the ability to sign informed …


The Power And Potential Of An Aging Nebraska, Julie L. Masters, Christopher M. Kelly Jan 2019

The Power And Potential Of An Aging Nebraska, Julie L. Masters, Christopher M. Kelly

Presentations

No abstract provided.


Exploring Secondary Science Teachers' Use Of Classroom Physical Activity, Shane Warehime, Kailey Snyder, Connie L. Schaffer, Matthew Bice, Megan Adkins-Bollwit, Danae Dinkel Jan 2019

Exploring Secondary Science Teachers' Use Of Classroom Physical Activity, Shane Warehime, Kailey Snyder, Connie L. Schaffer, Matthew Bice, Megan Adkins-Bollwit, Danae Dinkel

Teacher Education Faculty Publications

This study explored the use of classroom physical activity (PA) in secondary science rooms. To accomplish this, semistructured interviews were conducted with secondary science teachers (n = 11). Interviews were based on the constructs of the social-ecological model. Most teachers reported using classroom PA in some form—in-class breaks, outdoor activities, and curriculum support. Teachers used classroom PA to improve academic and behavioral outcomes of students. They had varied perceptions regarding collegial support of classroom PA, but mostly felt supported by administrators. Teachers reported being unaware of their district’s and the state department of education’s beliefs about classroom PA. Overall, factors …


Improvement Of Lipids And Reduction Of Oxidative Stress With Octacosanol After Taekwondo Training, Sang-Ho Lee, Steven D. Scott, Elizabeth J. Pekas, Jeong-Gi Lee, Song-Young Park Jan 2019

Improvement Of Lipids And Reduction Of Oxidative Stress With Octacosanol After Taekwondo Training, Sang-Ho Lee, Steven D. Scott, Elizabeth J. Pekas, Jeong-Gi Lee, Song-Young Park

Health and Kinesiology Faculty Publications

Athletes in combat sports undergo rapid changes in body weight prior to competition in order to gain a size advantage over their opponent. However, these large weight changes with concomitant high-intensity exercise training create poor lipid profiles and high levels of oxidative stress, which can be detrimental to health and sport performance. Therefore, the purpose of this study was to investigate the ability of the nutritional supplement octacosanol to combat the physiological detriments that occur in taekwondo players during rapid weight loss with high-intensity exercise training. Methods: A total of 26 male taekwondo players were randomly divided into 2 groups: …


Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel Jan 2019

Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel

Walden Dissertations and Doctoral Studies

Diabetes self-management education (DSME) is a key resource in the battle against diabetes and its secondary effects. This quality improvement project was conducted to address the decreased attendance rates of DSME classes in a community health center in the southern United States. The practice question for this project explored process-related strategies to increase patient attendance in DSME classes. Based on review of patient reports of reasons for nonattendance and an evaluation of peer reviewed literature on improving attendance in DSME, the following strategies were implemented: (a) alternative solutions such as providing patients with the dates for a year of initial …