Digital Commons Network^™

The Female Athlete Triad At Pace, Maile Makaafi

Honors College Theses

No abstract provided.

"I Should Have Known". The Perceptual Barriers Faced By Mental Health Practitioners In Recognizing And Responding To Their Own Burnout Symptoms, Marieke Ledingham, P Standen, Chris Skinner, Robbie Busch

Sciences Papers and Journal Articles

Studies have shown burnout to be a significant problem in the mental health field, causing workers serious health problems and reducing quality of care provided to clients. Yet despite mental health practitioners’ training in supporting others’ emotional health, they may be reluctant to seek help for burnout symptoms. This paper addresses this paradox by showing how human cognitive processes could act as powerful blocks to the recognition of and response to burnout. Fifty-five mental health practitioners’ beliefs and perceptions about burnout were examined using qualitative interview and survey data interpreted through a phenomenological perspective on attribution theory. The study identified …

A Descriptive Study Of The Experiences Of Obese Pregnant Women, Mary Beth Mccloud

MUSC Theses and Dissertations

Research has highlighted the growing prevalence of obesity across the age spectrum, including childbearing women. There have been numerous studies on maternal and fetal complications i n mothers who are obese and pregnant; however, little is known about the experiences and feelings of the women who are pregnant and obese. This dissertation is a compendium of three manuscripts. The first manuscript is an integrative review that examines motivators and barriers in health behavior intervention studies in pregnant women who are obese, using the transtheoretical model stages of change. The second and third manuscripts are the result of a qualitative descriptiv …

Invented Purposes And Blue Sky Predictions: Why The Trump Administration Cannot Win The Medicaid Work Experiment Cases, Sara Rosenbaum

Health Matrix: The Journal of Law-Medicine

No abstract provided.

High Times Ahead: Products Liability In Medical Marijuana, Steven B. Perlmutter

Health Matrix: The Journal of Law-Medicine

No abstract provided.

Incorporating Collateral Consequences Into Criminal Procedure, Paul T. Crane

Law Faculty Publications

A curious relationship currently exists between collateral consequences and criminal procedures. It is now widely accepted that collateral consequences are an integral component of the American criminal justice system. Such consequences shape the contours of many criminal cases, influencing what charges are brought by the government, the content of plea negotiations, the sentences imposed by trial judges, and the impact of criminal convictions on defendants. Yet, when it comes to the allocation of criminal procedures, collateral consequences continue to be treated as if they are external to the criminal justice process. Specifically, a conviction’s collateral consequences, no matter how severe, …

Maternal Restricted- And Over-Feeding During Gestation Result In Distinct Lipid And Amino Acid Metabolite Profiles In The Longissimus Muscle Of The Offspring, Dominique E. Martin, Amanda K. Jones, Sambhu M. Pillai, Maria L. Hoffman, Katelyn K. Mcfadden, Steven A. Zinn, Kristen E. Govoni, Sarah A. Reed

Fisheries, Animal and Veterinary Sciences Faculty Publications

Maternal over- and restricted-feeding during gestation have similar negative consequences for the offspring, including decreased muscularity, increased adiposity, and altered metabolism. Our objective was to determine the effects of poor maternal nutrition during gestation (over- and restricted-feeding) on the offspring muscle metabolite profile. Pregnant ewes (n = 47) were fed 60% (RES), 100% (CON), or 140% (OVER) of NRC requirements starting at day 30.2 ± 0.2 of gestation. Offspring sample collection occurred at days 90 and 135 of gestation, and within 24 h of birth. C2C12 myoblasts were cultured in serum collected from offspring at birth (n = …

Dental Dimensions In Non-Syndromic Patients With Unilateral Cleft Palate, Blake Boleware

All ETDs from UAB

Objective: The main objective of this study is to determine if any difference in tooth size exists between the maxillary quadrants in non-syndromic patients with unilateral cleft palate using cone beam computed tomography. By understanding the effects of cleft palate on tooth morphology, the multidisciplinary team of specialists involved with the care and treatment of a patient with cleft lip/palate can better understand the intricacies of necessary therapy. This understanding can, in turn, be used for proper planning of desired treatments which can increase the chance of successful achievement of desired outcomes. Materials and Methods: CBCT volumes for 18 patients …

Assessing Diabetes Risk Among Hispanic Populations: Development And Validation Of A Risk Score Using Readily Available Information, Lucia Juarez

All ETDs from UAB

Background: Diabetes prevalence is increasing worldwide affecting vulnerable popula-tions, in particular Hispanics living in the United States (U.S.). The burden of diabetes and its complications can be reduced by identifying those at high risk and routing them to treatment and intensive behavioral interventions. Aim: The aim of this study is to develop and validate a simple score to identify undiag-nosed diabetes among Hispanics living in the U.S. Methods: A representative sample of Hispanics living in the U.S. was used to develop and validate the score. Logistic regression was used to identify significant risk factors and model coefficients were used to …

Relationship Between Physical Activity, Screen Time, And Sleep Quantity And Quality In Us Adolescents Aged 16–19, Furong Xu, Sue K. Adams, Steven A. Cohen, Jacob E. Earp, Mary L. Greaney

Kinesiology Faculty Publications

Despite the health benefits associated with physical activity (PA), screen time reduction, and sleep quantity and quality, the relationships between PA, screen time, and sleep quantity and quality remain unclear in adolescents. The present study is a cross-sectional analysis of data from adolescents aged 16–19 years who participated in the 2005–2006 National Health and Nutrition Examination Survey (n = 542). Multivariable logistic regression models, adjusted for confounders, examined the relationship between objectively measured PA, self-reported screen time, and sleep quantity and quality. Respondents who met the current PA recommendation had 50% lower odds of having sufficient sleep (≥8 h) …

Effectiveness Of Surf Therapy For Children With Disabilities, Emily D. Clapham, Linda S. Lamont, Minsuk K. Shim, Shabnam Lateef, Courtney N. Armitano

Kinesiology Faculty Publications

Background: Few researchers have examined the effects of surf programs on children with disabilities. Due to previous research findings, surfing is being used, as the focus of physical activity intervention due to its numerous health and therapeutic benefits.

Objective/Hypothesis: The purpose of this study was to explore the effects of an eight-week surfing intervention on various physical fitness measures in 71 children with disabilities such as autism spectrum disorder, down syndrome, global developmental delays, and cerebral palsy. The study also sought to compare the differences in overall fitness levels between the surf therapy group and an unstructured pool playgroup. Researchers …

Racial/Ethnic Disparities In Us Adolescents’ Dietary Quality And Its Modification By Weight-Related Factors And Physical Activity, Furong Xu, Steven A. Cohen, Mary L. Greaney, Disa L. Hatfield, Geoffrey W. Greene

Kinesiology Faculty Publications

There are well-known disparities in the prevalence of obesity across racial-ethnic groups, although the behavioral and psychological factors driving these disparities are less well understood. Therefore, the objectives of this study were: (1) to examine differences in dietary quality by race/ethnicity and weight-related variables [body mass index (BMI), weight loss attempt, and weight dissatisfaction] and physical activity (PA) using the Health Eating Index-2015 (HEI-2015); and (2) to investigate the interactions and independent associations of race/ethnicity, weight-related variables and PA on dietary quality. Data for adolescents aged 12–19 years (n = 3373) were abstracted from the 2007–2014 National Health and Nutrition …

“If You Let Them, They Will Be On It 24 Hours A Day”: Qualitative Study Conducted In The United States Exploring Brazilian Immigrant Mothers’ Beliefs, Attitudes, And Practices Related To Screen Time Behaviors Of Their Preschool-Age Children, Ana Cristina Lindsay, Carlos André Moura Arruda, Márcia M. T. Machado, Mary L. Greaney

Kinesiology Faculty Publications

Background: The increasing prevalence of excessive screen time (ST) among children is a growing public health concern, with evidence linking it to an increased risk of overweight and obesity among children.

Objective: This study aimed to explore the beliefs, attitudes, and practices of Brazilian immigrant mothers living in the United States related to their preschool-age children’s ST behaviors.

Methods: A qualitative study comprising 7 focus group discussions (FGDs) was conducted with Brazilian immigrant mothers living in the United States. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analyzed using thematic analysis.

Results: In total, 37 women …

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

Expanding Services To Detect, Manage, And Prevent Pre-Eclampsia And Eclampsia In Tando Allahyar District Of Sindh Province, Pakistan, Ali M. Mir, Irfan Masood, Mumraiz Khan, Sharif M.I. Hossain, Tracy Mcclair, Pooja Sripad, Charlotte E. Warren

Reproductive Health

This endline report documents a USAID-supported implementation research project carried out by the Population Council in one district in Sindh province, as part of the global—Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan—Ending Eclampsia initiative. This project assessed community midwives’ (CMWs) abilities to screen and detect pre-eclampsia/severe pre-eclampsia/eclampsia (PE/SPE/E) in pregnant and postnatal women and provide a loading dose of magnesium sulfate (MgSO4) to clients suffering from SPE/E and referrals to facilities for further management. This study also explored opportunities to enhance collaboration between CMWs and lady health workers (LHWs), encouraging LHWs to refer pregnant women for group antenatal care (ANC) and postnatal …

Hypertensive Disorders In Pregnancy: Assessing Postnatal Quality Of Care And Outcomes For Women And Their Infants In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Salma Rouf, Rabeya Akter, Shongkour Roy, Sumaiya Anwar, Karen Kirk, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages …

Situation Analysis Of Reproductive Health Of Adolescents And Youth In Pakistan, Iram Kamran, Rehan M. Niazi, Kiren Khan, Faisal Abbas

Reproductive Health

This report presents a situation analysis of the reproductive health of adolescents and youth in Pakistan. It is intended to contribute to evidence-based policies and programs for realizing reproductive rights and choices for young people through health information and services, education programs, and strategic partnerships. The study included a literature review, secondary analysis of data from the Pakistan Demographic Health Surveys and Multiple Indicator Cluster Surveys, and a qualitative study of perspectives of unmarried adolescent boys and girls (aged 15–19), including both school-going and out-of-school individuals, as well as boys and girls with disabilities, in peri-urban areas of Islamabad, Lahore, …

Assessment Of In-Service Training And Continuing Education (Ist/Ce) For Frontline Health Workers In Bauchi And Cross River States, Nigeria, Ekechi Okereke, Iliyasu Zubairu, Udoh Nsekpong, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

Training contributes tremendously to the development and sustenance of health workers’ competencies for quality healthcare services. Although Nigeria has a higher stock of human resources for health compared to other African countries, the World Health Organization argues that its distribution is highly skewed toward urban areas. Building and maintaining staff capacities requires continuing professional development through in-service training (IST) and continuing education (CE). This study assesses current IST and CE for health workers in Bauchi and Cross River states to provide evidence to inform policy and planning and improve implementation of capacity-building for health workers in Nigeria.

Reference Guide For Data Collection: Qualitative Social Network Interviews, Bettina Shell-Duncan, Amadou Moreau, Sarah Smith, Holly B. Shakya

Reproductive Health

The purpose of this document is to guide researchers who plan to use qualitative social network methods drawing on our experiences implementing a qualitative study entitled, “The End of Female Genital Mutilation/Cutting in Senegal: Tracing Social Networks, Investigating the Role of Gender and Intergenerational Influence.” Qualitative fieldwork was carried out in two contrasting settings in Senegal: 1) a region with a low prevalence of female genital mutilation/cutting (FGM/C) characterized by ethnic heterogeneity, and 2) a region with a high prevalence of FGM/C characterized by relative ethnic homogeneity. The goal of this research was to investigate the ways in which social …

Effectiveness Of An Early Mobility Protocol For Stroke Patients In Intensive Care Unit, Majed S. Alamri, Intsar S. Waked, Fatma M. Amin, Khalid W. Al-Quliti, Mohammad D. Manzar

Neurosciences

Objectives: To evaluate the effectiveness of an early mobility protocol for stroke patients in the intensive care unit. Methods: Participants were patients with first or recurrent stroke (n=60, age=49.02±6.36 years, body mass index=32.95±5.67 kg/m 2 ) admitted to the intensive care stroke unit in general hospitals, Riyadh during October and December 2016. Single group pretest-posttest design involving an early mobility protocol was started within first 24 hours admission. Pre and post measurements of muscle strength, pulmonary function and quality of life were carried out. Results: There were significant improvements in muscle strength of upper and lower extremities´ muscles after treatment …

Tennessee Ag Insider, A Guide The The State's Farms, Food, And Forestry, 2019 Edition, Tennessee. Department Of Agriculture.

Tennessee Ag Insider

No abstract provided.

Cancer In Tennessee 2015-2019, Tennessee. Department Of Health.

Cancer in Tennessee

No abstract provided.

Fatigue Identification And Management In Flight Training: An Investigation Of Collegiate Aviation Pilots, Flavio A. Coimbra Mendonca Mr, Julius Keller, Chientsung Lu

International Journal of Aviation, Aeronautics, and Aerospace

Objective: The purpose of this study was to evaluate collegiate aviation students’ self-awareness of their fatigue issues; to investigate possible causes of fatigue afflicting collegiate aviation students; and to investigate the collegiate aviation students’ lifestyle and perceptions of personal solutions to fatigue.

Background: Pilot fatigue is a significant safety hazard in aviation operations. Several factors can contribute to fatigue, including inadequate sleep, long work hours, and inadequate nutritional habits. Some factors, such as social and academic activities, could be unique for Title 14 Code of Federal Regulations (CFR) Part 141 collegiate aviation pilots. Previous studies have addressed fatigue in …

Evaluation Of An Algal Biomass As An Ingredient In Cattle Feed, Mitchell M. Norman, Zachary E. Carlson, F. Henry Hilscher Hilscher, Andrea K. Watson, Galen E. Erickson, Bruce W. Brodersen, J. Dustin Loy, Jonathan W. Wilson

Nebraska Beef Cattle Reports

A study was conducted evaluating the effects of feeding condensed algal residue solubles (CARS; available in 2019 in Blair, NE area) to finishing cattle for 100 days. Four levels of CARS were evaluated with 5 steers and 5 heifers individually fed per level of inclusion. The diets consisted of 70% dry rolled corn with CARS displacing corn at 0, 2.5, 5, and 7.5% of dry matter. Increasing CARS inclusion resulted in a linear decrease in intake, a quadratic increase in daily gain, and a linear decrease in feed:gain. Calculations showed a linear increase in dietary net energy as …

Beyond Bird Feed: Proso Millet For Human Health And Environment, Saurav Das, Rituraj Khound, Meenakshi Santra, Dipak K. Santra

Department of Agronomy and Horticulture: Faculty Publications

Domesticated in 8000–10,000 BP in northern China, proso millet (Panicum miliaceum L.) is the best adaptive rotational crop for semiarid central High Plains of the USA, where average annual precipitation is 356–407 mm. Proso millet has multiple benefits when consumed as human food. Proso millet is rich in minerals, dietary fiber, polyphenols, vitamins and proteins. It is gluten-free and therefore, ideal for the gluten intolerant people. Proso millet contains high lecithin which supports the neural health system. It is rich in vitamins (niacin, B-complex vitamins, folic acid), minerals (P, Ca, Zn, Fe) and essential amino acids (methionine and cysteine). …

A Spatial Framework For Ex-Ante Impact Assessment Of Agricultural Technologies, José F. Andrade, Juan I. Rattalino Edreira, Andrew Farrow, Marloes P. Van Loon, Peter Q. Craufurd, Jairos Rurinda, Shamie Zingore, Jordan Chamberlin, Lieven Claessens, Julius Adewopo, Martin K. Van Ittersum, Kenneth G. Cassman, Patricio Grassini

Department of Agronomy and Horticulture: Faculty Publications

Traditional agricultural research and extension relies on replicated field experiments, on-farm trials, and demonstration plots to evaluate and adapt agronomic technologies that aim to increase productivity, reduce risk, and protect the environment for a given biophysical and socio-economic context. To date, these efforts lack a generic and robust spatial framework for ex-ante assessment that: (i) provides strategic insight to guide decisions about the number and location of testing sites, (ii) define the target domain for scaling-out a given technology or technology package, and (iii) estimate potential impact from widespread adoption of the technology(ies) being evaluated. In this study, we developed …

Ultrastructural Studies Of Acrosomal Formation In The Testis Of Male Greater Cane Rat (Thryonomys Swinderianus), A. O. Adebayo, A. K. Akinloye, Amadi O. Ihunwo, V. O. Taiwo, B. O. Oke

Brain and Mind Institute

Purpose:

In furthering the understanding of the process of spermatogenesis in the greater cane rat, this study describes the ultrastructural spermiogenic transformation and acrosomal formation in the testes of this hystricomorphic rodent that is currently undergoing domestication in parts of West Africa.

Materials and Methods:

Testicular samples were obtained from ten sexually mature cane rats that were perfused-fixed using Karnovsky's fixative (phosphate buffered 2% paraformaldehyde – 2.5% glutaraldehyde fixative at pH 7.4). The samples were processed for ultrastructural analysis and examined under the transmission electron microscope.

Results:

The testes of the cane rat showed uniqueness in its cellular associations and …

การสื่อสารยุคดิจิทัลกับพฤติกรรมการดูแลสุขภาพของพนักงานการท่าเรือแห่งประเทศไทย เขตคลองเตย จังหวัดกรุงเทพมหานคร, วริษฐา จีนโต

Chulalongkorn University Theses and Dissertations (Chula ETD)

การวิจัยเรื่อง “การสื่อสารยุคดิจิทัลกับพฤติกรรมการดูแลสุขภาพของพนักงานการท่าเรือแห่ง ประเทศไทย เขตคลองเตย จังหวัดกรุงเทพมหานคร” มีวัตถุประสงค์เพื่อศึกษาพฤติกรรมการดูแลสุขภาพกับการใช้สื่อสังคมออนไลน์ด้านสุขภาพของพนักงานการท่าเรือแห่งประเทศไทย และศึกษาปัจจัยการใช้สื่อสังคมด้านสุขภาพที่มีความสัมพันธ์กับพฤติกรรมการดูแลสุขภาพของพนักงานการท่าเรือแห่งประเทศไทย เขตคลองเตย จังหวัดกรุงเทพมหานคร ที่ใช้การวิจัยแบบผสมผสาน(Mixed Method) คือ วิจัยเชิงปริมาณและวิจัยเชิงคุณภาพ โดยการสำรวจด้วยแบบสอบถามออนไลน์ จำนวน 100 ชุด สถิติที่ใช้ประกอบด้วยสถิติเชิงบรรยาย (Descriptive statistics) ได้แก่ สถิติค่าความถี่(Frequency) ค่าร้อยละ(Percent) ค่าเฉลี่ย(Mean) และค่าเบี่ยงเบนมาตรฐาน(Standard deviation) สถิติเชิงอนุมาน (Inferential statistics) ได้แก่ การทดสอบค่าเฉลี่ยของกลุ่มตัวอย่างสองกลุ่มที่มีความเป็นอิสระต่อกัน(Independent Sample T-test) การวิเคราะห์ความแปรปรวนทางเดียว(One way ANOVA) การวิเคราะห์ค่าสัมประสิทธิ์สหสัมพันธ์แบบเพียรสัน(Pearson’s Correlation) และการวิเคราะห์ค่าสัมประสิทธิ์สหสัมพันธ์แบบสเปียแมน(Spearman’s Correlation) ผลการเก็บข้อมูลจากการสำรวจจากกลุ่มตัวอย่าง จำนวน 100 คน พบว่า พนักงานการท่าเรือแห่ง ประเทศไทยส่วนใหญ่เป็นเพศหญิง ช่วงอายุ 30-39 ปี มีการศึกษาในระดับปริญญาตรี ส่วนใหญ่มีรายได้ต่อเดือนตั้งแต่ 20,001-30,000 บาท และผู้ตอบแบบสอบถามส่วนใหญ่ไม่มีโรคประจำตัว คิดเป็นร้อยละ 78 ผู้ตอบแบบสอบถามส่วนใหญ่ใช้สื่อสังคมออนไลน์เพื่อรับข้อมูลข่าวสารด้านสุขภาพผ่านสื่อเฟซบุ๊ก(Facebook) คิดเป็นร้อยละ 86 ส่วนการรับข้อมูลด้านสุขภาพผ่านสื่อออนไลน์ของหน่วยงานการท่าเรือฯ ส่วนใหญ่รับสื่อผ่านช่องทางไลน์(Line) จากหน่วยงานสำนักแพทย์และอนามัยการท่าเรือแห่งประเทศไทย ได้รับประโยชน์ด้านความรู้เบื้องต้นในการดูแลสุขภาพและสังเกตความผิดปกติของตนเอง ผู้ตอบแบบสอบถามส่วนใหญ่มีระดับพฤติกรรมการดูแลสุขภาพด้านการป้องกันโรคอยู่ในระดับสูง ผลการวิจัยพบว่า ปัจจัยส่วนบุคคลด้านเพศ อายุและรายได้มีความสัมพันธ์ทางบวกกับพฤติกรรมการดูแลสุขภาพด้านการป้องกันโรคอย่างมีนัยสำคัญทางสถิติที่ระดับ .05 ทัศนคติการรับข่าวสารด้านสุขภาพผ่านสื่อออนไลน์มีความสัมพันธ์ทางบวกกับพฤติกรรมการดูแลสุขภาพด้าน การจัดการความเครียดอย่างมีนัยสำคัญทางสถิติที่ระดับ .05 และความถี่ของสื่อสุขภาพออนไลน์ของหน่วยงาน การท่าเรือฯที่กระตุ้นให้มีการดูแลสุขภาพมากขึ้นมีความสัมพันธ์ทางบวกกับพฤติกรรมการดูแลสุขภาพด้านการจัดการความเครียดและการป้องกันโรคอย่างมีนัยสำคัญทางสถิติที่ระดับ .05

Training As An Intervention To Decrease Medical Record Abstraction Errors Multicenter Studies., Meredith Nahm Zozus, Leslie W. Young, Alan E. Simon, Maryam Garza, Lora Lawrence, Songthip T. Ounpraseuth, Megan Bledsoe, Sarah Newman-Norlund, J Dean Jarvis, Mary Mcnally, Kimberly R. Harris, Russell Mcculloh, Rachel Aikman, Sara Cox, Lacy Malloch, Anita Walden, Jessica Snowden, Irene Mangan Chedjieu, Chester A. Wicker, Lauren Atkins, Lori A. Devlin

Manuscripts, Articles, Book Chapters and Other Papers

Studies often rely on medical record abstraction as a major source of data. However, data quality from medical record abstraction has long been questioned. Electronic Health Records (EHRs) potentially add variability to the abstraction process due to the complexity of navigating and locating study data within these systems. We report training for and initial quality assessment of medical record abstraction for a clinical study conducted by the IDeA States Pediatric Clinical Trials Network (ISPCTN) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) using medical record abstraction as the primary data …

Determinants Of Life Expectancy In The Central African Republic, Taylor Rizzo

Empirical Economic Bulletin, An Undergraduate Journal

This paper investigates the determinants of life expectancy in the Central African Republic. The study uses economic, social, and environmental factors to estimate a health production function. The study aims to offer suggestions on ways to target life expectancy as a method for increasing economic growth. The results show that the best way to increase longevity in the CAR and solve the mortality crisis are to increase sanitation facilities and regulation, solve the hunger/malnutrition problem, and to reduce the deadly spread of HIV. Aid was determined to be significant in improving the well-being of citizens in the CAR.