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Structural Dynamics And Encapsulation Properties Of Polyelectrolyte Complex Micelles, Sachit Shah

Electronic Theses and Dissertations, 2020-2023

Charged therapeutics such as nucleic acids and proteins can treat a vast range of human diseases that are traditionally undruggable. Their broadness in treating disease is due to their ability to influence cellular function. However, their high charge density and physiological barriers such as enzymatic degradation, hinder the deliverability of these molecules to the sites of disease. Polyelectrolyte complex (PEC) micelles are core-corona nanostructures that can encapsulate charged molecules and offer a platform for delivery. PECs form the core, when two oppositely charged polyelectrolytes are mixed in an aqueous solution, and the micelle corona is a neutral hydrophilic polymer that …

Clinical Follow-Up Practices After Cervical Cancer Screening By Co-Testing: A Population-Based Study Of Adherence To U.S. Guideline Recommendations, Rebecca B. Perkins, Rachael Adcock, Vicki Benard, Jack Cuzick, Alan Waxman, Jean Howe, Stephanie Melkonian, Janis Gonzales, Charles Wiggins, Cosette M. Wheeler

Pathology Research and Scholarship

Failure to follow-up women after abnormal cervical screening could lead to cervical cancers, yet little is known about adherence to recommended follow-up after abnormal co-testing [cytology and high-risk human papillomavirus (hrHPV) testing]. We documented clinical management following cervical screening by co-testing in a diverse population-based setting. A statewide surveillance program for cervical screening, diagnosis, and treatment was used to investigate all cytology, hrHPV and biopsy reports in the state of New Mexico from January 2015 through August 2019. Guideline-adherent follow-up after co-testing required 1) biopsy within 6 months for low-grade cytology if positive for hrHPV, for high-grade cytology irrespective of …

The Aged Care Crisis In Australia’S Covid-19 Success Story: A Commentary, Cymbeline Buhler, Nidhi Wali, Charles Ball, Supriya Gurung, Spyros Schismenos

Humboldt Journal of Social Relations

The world took a beating from COVID-19, with no nation spared. Australia’s response to the pandemic has been recognized as particularly successful, with the comparatively small total of COVID-19 related fatalities. However, these achievements in controlling the virus and keeping the economy buoyant are contrasted by significant failures, particularly the Federal and state governments’ inability to contain the outbreak within the aged care sector. This commentary forms an understanding of the COVID-19 outbreak in Australia’s aged care sector, drawing from articles published in the ‘The Australian’ newspaper. We focus on priorities, responses and management at different levels, observing subsequent impacts, …

Metabolic Syndrome And Acute Respiratory Distress Syndrome In Hospitalized Patients With Covid-19, Joshua L Denson, Aaron S Gillet, Yuanhao Zu, Margo Brown, Thaidan Pham, Yilin Yoshida, Franck Mauvais-Jarvis, Ivor S Douglas, Mathew Moore, Kevin Tea, Andrew Wetherbie, Rachael Stevens, John Lefante, Jeffrey G Shaffer, Donna Lee Armaignac, Katherine Belden, Margit Kaufman, Smith F Heavner, Valerie C Danesh, Sreekanth R Cheruku, Catherine A St Hill, Karen Boman, Neha Deo, Vikas Bansal, Vishakha K Kumar, Allan J Walkey, Rahul Kashyap, Society Of Critical Care Medicine Discovery Viral Infection And Respiratory Illness Universal Study (Virus): Covid-19 Registry Investigator Group

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Importance: Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome.

Objective: To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19.

Design, setting, and participants: This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined …

Bssm: Bayesian Inference Of Non-Linear And Non-Gaussian State Space Models In R, Jouni Helske, Matti Vihola

The R Journal

We present an R package bssm for Bayesian non-linear/non-Gaussian state space modeling. Unlike the existing packages, bssm allows for easy-to-use approximate inference based on Gaussian approximations such as the Laplace approximation and the extended Kalman filter. The package also accommodates discretely observed latent diffusion processes. The inference is based on fully automatic, adaptive Markov chain Monte Carlo (MCMC) on the hyperparameters, with optional importance sampling post-correction to eliminate any approximation bias. The package also implements a direct pseudo-marginal MCMC and a delayed acceptance pseudo-marginal MCMC using intermediate approximations. The package offers an easy-to-use interface to define models with linear-Gaussian state …

Diproperm: An R Package For The Diproperm Test, Andrew G. Allmon, J.S. Marron, Michael G. Hudgens

The R Journal

High-dimensional low sample size (HDLSS) data sets frequently emerge in many biomedical applications. The direction-projection-permutation (DiProPerm) test is a two-sample hypothesis test for comparing two high-dimensional distributions. The DiProPerm test is exact, i.e., the type I error is guaranteed to be controlled at the nominal level for any sample size, and thus is applicable in the HDLSS setting. This paper discusses the key components of the DiProPerm test, introduces the diproperm R package, and demonstrates the package on a real-world data set

(R)-2,5-Dimethoxy-4-Iodoamphetamine [(R)-Doi] Influences Coping Strategies To An Escapable Social Stress, Kevin Thomas Krupp

Dissertations and Theses

Depressive mood disorders are a leading cause of disability worldwide and pharmacological treatments for these disorders are inadequate, requiring new compounds with greater efficacy be investigated. The etiology of depression is heterogeneous; however, it is well established that stress exposure, and the proinflammatory effects of stress have a major role. Psychedelic compounds have rapid and long-lasting anxiolytic and antidepressive effects in humans and animal models of stress induced affective behavior. However, it is not completely understood how these compounds produce such rapid effects. We investigated whether the psychedelic compound (R)-2,5-dimethoxy-4-iodoamphetamine [(R)-DOI], a selective 5-HT2A partial agonist with potent anti-inflammatory properties, …

Predicting Death From Covid-19 Using Pre-Existing Conditions: Implications For Vaccination Triage, Shujie Xiao, Neha Sahasrabudhe, Samantha Hochstadt, Whitney Cabral, Samantha Simons, Mao Yang, David E. Lanfear, Keoki L. Williams

Center for Individualized and Genomic Medicine Research Articles

INTRODUCTION: Global shortages in the supply of SARS-CoV-2 vaccines have resulted in campaigns to first inoculate individuals at highest risk for death from COVID-19. Here, we develop a predictive model of COVID-19-related death using longitudinal clinical data from patients in metropolitan Detroit.

METHODS: All individuals included in the analysis had a laboratory-confirmed SARS-CoV-2 infection. Thirty-six pre-existing conditions with a false discovery rate p<0.05 were combined with other demographic variables to develop a parsimonious prediction model using least absolute shrinkage and selection operator regression. The model was then prospectively validated in a separate set of individuals with confirmed COVID-19.

RESULTS: The study population consisted of 15 502 individuals with laboratory-confirmed SARS-CoV-2. The main prediction model was developed using data from 11 635 individuals with 709 reported deaths (case fatality ratio 6.1%). The final prediction model consisted …

Brothers - In - Arms: Visual Commonalities Between The Us And Is Recruitment Strategies, Maha Ghalwash, Lawrie Phillips

Political Science

This article claims that the visual image contributes to, reflects and supports the dominant discourse of two powerful armed groups that have operated in Iraq and Syria: the US military and the Islamic State (IS). This research uses multimodal discourse analysis to explore two crucial insights into the ideological power of the visual image: the power of the image as spectatorship or spectacle and the sublime or transcendental nature of the visual image. The authors conclude that US and IS recruitment and propaganda videos share these two crucial ideological elements: pride in the spectacle of their military power, discipline and …

Burden Of Mycoplasma Genitalium And Bacterial Coinfections In A Population-Based Sample In New Mexico, Anne Hammer, Patti E. Gravitt, Rachael Adcock, Nicole Patterson, Jack Cuzick, Cosette M. Wheeler

Pathology Research and Scholarship

In this population-based US study, the overall prevalence of Mycoplasma genitalium was 1.95% (95% confidence interval [CI], 1.62%-2.34%), declining from 6.12% (95% CI, 4.72%-7.92%) in women aged 21 to 24 years to 0.48% (95% CI, 0.25%-0.94%) in women aged 40 to 64 years. The prevalence of coinfections with Chlamydia trachomatis and Trichomonas vaginalis was low.

Institute Of Public Health Newsletter- Volume2, Issue4, Institute Of Public Health (Iph)

Institute of Public Health Newsletter (IPHNL) and Other Publications

No abstract provided.

Adverse Effect Of Nitroxynil And Albendazole On Rabbits, Eman Elalfy, Azza Hassan, Magdy Amer

Mansoura Veterinary Medical Journal

Objective:The present study aims to investigate the possible adverse effects of the subcutaneous injection of nitroxynil and oral administration of albendazole in rabbits. Design:Randomized controlled experimental study. Animals: 18 New Zealand rabbits of 1.50 ± 0.5 kg body weight, were allocated randomly into three groups (n=6). Procedures: Group A served as control, the group B was treated with albendazole (20 mg /kg B. wt.) orally and the group C was treated with nitroxynil (10mg /kg B. wt.) subcutaneously. Blood samples were collected at 1st, 7th and 14th days post drugs administration for hematological and biochemical determination. In addition, histopathological examination …

Reproductive Success Of Captive-Reared Allegheny Woodrats (Neotoma Magister) Released Into Genetically Depauperate Populations, Miracle M. Davis, Timothy J. Smyser, Scott A. Johnson, Joseph Duchamp, Jeffery L. Larkin, Robert K. Swihart, Jacqueline M. Doyle

United States Department of Agriculture Wildlife Services: Staff Publications

Habitat fragmentation and degradation have led to a proliferation of small and isolated populations that are vulnerable to genetic erosion. Reduction in habitat and concomitant declines in population connectivity can expediate the collapse of species that exist as natural metapopulations. In recent years, Allegheny woodrats (Neotoma magister) have experienced local extirpations and declines in genetic diversity across their range due to disease-related mortality, reduced food availability, and disruption of connectivity among subpopulations. In response, we developed a captive-breeding program to facilitate genetic management of isolated woodrat populations in Indiana. Between 2010 and 2012, 27 captive-reared individuals were released to four …

Charting A New Frontier Integrating Mathematical Modeling In Complex Biological Systems From Molecules To Ecosystems, Katharine A. White, Kira D. Mcentire, Nicole R. Buan, Lecia Robinson, Elisar Barbar

Department of Biochemistry: Faculty Publications

Advances in quantitative biology data collection and analysis across scales (molecular, cellular, organismal, and ecological) have transformed how we understand, categorize, and predict complex biological systems. This surge of quantitative data creates an opportunity to apply, develop, and evaluate mathematical models of biological systems and explore novel methods of analysis. Simultaneously, thanks to increased computational power, mathematicians, engineers, and physical scientists have developed sophisticated models of biological systems at different scales. Novel modeling schemes can offer deeper understanding of principles in biology, but there is still a disconnect between modeling and experimental biology that limits our ability to fully realize …

Integrating Multiple Survey Techniques To Document A Shifting Bat Community In The Wake Of White-Nose Syndrome, D. Scott Reynolds, Kevin Shoemaker, Susi Von Oettingen, Stephen Najjar, Jacques P. Veilleux, Paul R. Moosman Jr

KIP Articles

The long-term study of bat communities often depends on a diverse set of sampling methodologies that are chosen based on the species or habitat management priorities of the research project. Integrating the data from a diverse set of methodologies (such as acoustic monitoring and mist net sampling) would improve our ability to characterize changes in community structure or composition over time, such as one would expect following an emergent infectious disease such as white-nose syndrome. We developed a Bayesian state-space model to integrate these disparate data into a common currency (relative abundance). We collected both acoustic monitoring and mist net …

The Potential Of Location Data For Contact Tracing And Understanding Individual Mobility During The Covid-19 Pandemic, Marcus Figaro

Electronic Theses and Dissertations, 2020-2023

In this study, we first review contact tracing methods used during the COVID-19 pandemic and provide an analysis of the benefits and drawbacks of different data collection and privacy protection methods. Our findings provide the benefits and drawbacks of using GPS versus Bluetooth for contact tracing, as well as the different data collection and storage methods and their effectiveness in protecting user privacy. We then analyze Twitter data to understand individual mobility behavior and sentiment by using a Natural Language Processing tool on text content of user tweets and Tweet coordinate data. Social media's ability to provide data on location …

Uab Receives Funding To Support Early-Career Investigators Impacted By Covid-19 Pandemic, Staff

Browse All News

No abstract provided.

Siderophore-Mediated Zinc Acquisition Enhances Enterobacterial Colonization Of The Inflamed Gut, Judith Behnsen, Hui Zhi, Allegra T. Aron, Venkateswaran Subramanian, William Santus, Michael H. Lee, Romana R. Gerner, Daniel Petras, Janet Z. Liu, Keith D. Green, Sarah L. Price, Jose Camacho, Hannah Hillman, Joshua Tjokrosurjo, Nicola P. Montaldo, Evelyn M. Hoover, Sean Treacy-Abarca, Benjamin A. Gilston, Eric P. Skaar, Walter J. Chazin, Sylvie Garneau-Tsodikova, Matthew B Lawrenz, Robert D Perry, Sean-Paul Nuccio, Pieter C. Dorrestein, Manuela Raffatellu

Pharmacy Nuclear Magnetic Resonance Center Faculty Publications

Zinc is an essential cofactor for bacterial metabolism, and many Enterobacteriaceae express the zinc transporters ZnuABC and ZupT to acquire this metal in the host. However, the probiotic bacterium Escherichia coli Nissle 1917 (or “Nissle”) exhibits appreciable growth in zinc-limited media even when these transporters are deleted. Here, we show that Nissle utilizes the siderophore yersiniabactin as a zincophore, enabling Nissle to grow in zinc-limited media, to tolerate calprotectin-mediated zinc sequestration, and to thrive in the inflamed gut. We also show that yersiniabactin’s affinity for iron or zinc changes in a pH-dependent manner, with increased relative zinc binding as the …

Trump, Bolsonaro, And The Framing Of The Covid-19 Crisis: How Political Institutions Shaped Presidential Strategies, Daniel Beland, Philip Rocco, Catarina Ianni Segatto, Alex Waddan

Political Science Faculty Research and Publications

Background and Purpose:

Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.

Methods:

Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance. Individuals with stroke walked on a split-belt treadmill. Measures of symmetry (%Propulsion_walk, %Work_ped) and interlimb phase coordination index (PCI_walk, PCI_ped) were …

Structured To Fail: Lessons From The Trump Administration’S Faulty Pandemic Planning And Response, Alejandro E. Camacho, Robert L. Glicksman

Michigan Journal of Environmental & Administrative Law

The Trump Administration’s response to the COVID-19 pandemic is a stark reminder that poorly designed government can be a matter of life and death. This article explains how the Administration’s careless and delayed response to the crisis was made immeasurably worse by its confused and confusing reallocation of authority to perform or supervise tasks essential to reducing the virus’s ravages.

After exploring the rationale for and impact of prior federal reorganizations responding to public health crises, the article shows how a combination of unnecessary and unhelpful overlapping authority and a thoughtless mix of centralized and decentralized authority contributed to the …

Association Of Body Composition With Odds Of Breast Cancer By Molecular Subtype: Analysis Of The Mechanisms For Established And Novel Risk Factors For Breast Cancer In Nigerian Women (Mend) Study, Tomi Akinyemiju, Kelley Jones, Anjali Gupta, Taofik Oyekunle, Veeral Saraiya, April Deveaux, Omolola Salako, Allison Hall, Olusegun Alatise, Gabriel Ogun, Adewale Adeniyi, Omobolaji Ayandipo, Thomas Olajide, Olalekan Olasehinde, Olukayode Arowolo, Adewale Adisa, Oludolapo Afuwape, Aralola Olusanya, Aderemi Adegoke, Trygve O. Tollefsbol, Donna Arnett, Samuel Ajayi, Yemi Raji, Timothy Olanrewaju, Charlotte Osafo, Ifeoma Ulasi, Adanze Asinobi, Cheryl A. Winkler, David Burke, Fatiu Arogundade, Ivy Ekem, Jacob Plange-Rhule, Manmak Mamven

Faculty Publications

Background: The association between obesity and breast cancer (BC) has been extensively studied among US, European and Asian study populations, with often conflicting evidence. However, despite the increasing prevalence of obesity and associated conditions in Africa, the continent with the highest age-standardized BC mortality rate globally, few studies have evaluated this association, and none has examined in relation to molecular subtypes among African women. The current analysis examines the association between body composition, defined by body mass index (BMI), height, and weight, and BC by molecular subtype among African women. Methods: We estimated odds ratios (ORs) and 95% confidence intervals …

A Landscape Planning Agenda For Global Health Security: Learning From The History Of Hiv/Aids And Pandemic Influenza, James Nguyen H. Spencer

Faculty Publications

This paper considers the role of landscape planning and design in the context of a growing need for research and policy recommendations associated with Emerging Infectious Diseases (EIDs), of which COVID-19 is the most recent. Beginning with a definition of EIDs and their origins within the context of landscape planning, the paper then argues that planning and design scholars and practitioners should begin by seeing the importance of a “global urban ecosystem” (GUE) comprised of rapidly transforming metropolitan and regional “patches” connected through “corridors” of relatively unregulated global transportation and mobility networks. It then revisits the history of the two …

Ale Beer Containing Free And Immobilized Lactobacillus Brevis, A Potential Delivery System For Probiotics, Kriza Faye Calumba, Vondel Reyes, Franklin Bonilla, Elio Villasmil, Subramaniam Sathivel

Faculty Publications

Abstract: Probiotics in ale beer may be attractive to health-conscious consumers. However, beer conditions may decrease probiotic viability. Powder produced from durian (Durio zibethinus) rind, a by-product that is currently unutilized, can be used for the immobilization of probiotics. MRS medium was incubated with Lactobacillus brevis and periodically sampled to obtain the growth curve. Ale beer with free L. brevis and cells immobilized in durian rind powder was produced and separately assessed during storage at 21 °C for 24 days. The physico-chemical parameters of both beers did not differ significantly. Durian rind powder conferred protection up to 12 days of …

Access To And Safety Of Covid-19 Convalescent Plasma In The United States Expanded Access Program: A National Registry Study, Jonathon W. Senefeld, Brenda J. Grossman, Et Al

Open Access Publications

BACKGROUND: The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma.

METHODS AND FINDINGS: Mayo Clinic served as the central …

The Genome Of The Stable Fly, Stomoxys Calcitrans, Reveals Potential Mechanisms Underlying Reproduction, Host Interactions, And Novel Targets For Pest Control, Pia U. Olafson, Serap Aksoy, Geoffrey M. Attardo, Greta Buckmeier, Xiaoting Chen, Craig J. Coates, Megan Davis, Justin Dykema, Scott J. Emrich, Markus Friedrich, Christopher J. Holmes, Panagiotis Ioannidis, Evan N. Jansen, Emily C. Jennings, Daniel Lawson, Ellen O. Martinson, Gareth L. Maslen, Richard P. Meisel, Terence D. Murphy, Dana Nayduch, David R. Nelson, Kennan J. Oyen, Tyler J. Raszick, José M.C. Ribeiro, Hugh M. Robertson, Andrew J. Rosendale, Timothy B. Sackton, Perot Saelao, Sonja L. Swiger, Sing Hoi Sze, Aaron M. Tarone, David B. Taylor, Wesley C. Warren, Robert M. Waterhouse, Matthew T. Weirauch, John H. Werren, Richard K. Wilson, Evgeny M. Zdobnov, Joshua B. Benoit

United States Department of Agriculture-Agricultural Research Service / University of Nebraska-Lincoln: Faculty Publications

Background: The stable fly, Stomoxys calcitrans, is a major blood-feeding pest of livestock that has near worldwide distribution, causing an annual cost of over $2 billion for control and product loss in the USA alone. Control of these flies has been limited to increased sanitary management practices and insecticide application for suppressing larval stages. Few genetic and molecular resources are available to help in developing novel methods for controlling stable flies. Results: This study examines stable fly biology by utilizing a combination of high-quality genome sequencing and RNA-Seq analyses targeting multiple developmental stages and tissues. In conjunction, 1600 genes were …

Agent Based Modeling Of The Spread Of Social Unrest Based On Infectious Disease Spread Model, Anup Adhikari

School of Computing: Dissertations, Theses, and Student Research

Social unrest activities are the tools for people to show dissatisfaction, and often people are motivated by similar unrest activities in another region. This causes a spread of unrest activities across space and time. In this thesis, we model the spread of social unrest across time and space. The underlying novel methodology is to model the regions as agents that transition from one state to another based on changes in their environment. The methodology involves (1) creating a region vector for each agent based on socio-demographic, cultural, economic, infrastructural, geographic, and environmental (SCEIGE) factors, (2) formulating neighborhood distance function to …

Comparative Analysis Of Kmer Counting And Estimation Tools, Ankitha Vejandla

School of Computing: Dissertations, Theses, and Student Research

The rapid development of next-generation sequencing (NGS) technologies for determining the sequence of DNA has revolutionized genome research in recent years. De novo assemblers are the most commonly used tools to perform genome assembly. Most of the assemblers use de Bruijn graphs that break the sequenced reads into smaller sequences (sub-strings), called kmers, where k denotes the length of the sub-strings. The kmer counting and analysis of kmer frequency distribution are important in genome assembly. The main goal of this research is to provide a detailed analysis of the performance of different kmer counting and estimation tools that are currently …

Central Line Associated Bloodstream Infection Caused By Kodamaea Ohmeri In A Young Child, Amier Haidar, Farhana Khaja, Brian Simms, Amr Issam Elgehiny, Tracy Omoegbele, Nikita Khetan

Faculty, Staff and Student Publications

INTRODUCTION:

CASE REPORT: The patient is a 5-year-old male with a history of short gut syndrome, and total parenteral nutrition (TPN) dependence who presented to the emergency room with a two-day history of productive-cough, rhinorrhea, and fever. Antibiotic therapy was initiated with cefepime and vancomycin for suspected CLABSI. However, within the first twenty-four hours of his admission, his initial blood culture from his central venous catheter became positive for yeast so fluconazole was added due to suspicion of candidemia. During his admission, his initial central line and peripheral blood culture were later speciated as

CONCLUSIONS: This case report further acknowledges …

Mental Health And Adolescents: The Impact Of Social Isolation In Adolescents During The Covid-19 Pandemic, Gabriella Aguinaldo

Nursing | Senior Theses

In early 2020, the coronavirus pandemic, first detected in late 2019, afflicted the world. The disease associated with the virus became known as COVID-19. COVID-19 was recognized as a highly contagious and deadly disease. In California, United States, COVID-19 was detected in February and the first shelter-in-place orders were ordered by the counties and state, which forced children and adults to stay at home and attend school and work virtually. Shelter-in-place orders were quickly implemented around the world.

As the world began this sudden switch in lifestyle, many were concerned for the mental health and safety of themselves and their …

The Physiological Benefits Of A Plant-Based Diet On Cardiovascular Health, Jenevieve Petray

Nursing | Senior Theses

Cardiovascular disease (CVD) is increasingly more prevalent in today’s society and is attributed to an alarming percentage of American hospitalizations and deaths. Americans are unhealthier than ever before, and the main contributor is the Western diet. Diet is a double-edged sword that can offer benefits or detriments to one’s health. CVD encompasses numerous diagnoses originating from various underlying physiological alterations. These alterations are downstream effects of increased body weight and BMI, increased cholesterol levels, decreased insulin sensitivity and increased arterial plaque buildup. Research shows that a plant-based diet has the potential to manage and reverse all fundamental physiological alterations that …