Digital Commons Network^™

An Exploratory Investigation Of The Impact Of Psychological Intimate Partner Violence On College Women: A Qualitative Study, Dana Juel Conzemius-Schindler

Theses and Dissertations

Researchers have found psychological intimate partner violence (P-IPV; defined as emotional and verbal abuse utilized to degrade, demean, create fear, control, or isolate; Tolman, 1989; Sullivan et al., 2012) is detrimental to mental health functioning, including increased sexual risk behaviors, depressive and anxious symptomology, and relationship dissatisfaction (Hellemans et al., 2015; Overstreet et al., 2015). Despite this, little is known regarding the academic and psychological lived experiences of survivors of P-IPV. Therefore, the current study sought to qualitatively explore the lived experiences of female-identified students exposed to psychological intimate partner violence while in college. Through a Consensual Qualitative Research (CQR; …

Congolese Refugee Narratives Of Belonging, Grief, And Cultural Continuity In Appalachia, Kayla Davis

Theses and Dissertations

This research examines the communicative challenges that Congolese refugees face after resettlement, particularly as they strive to reconstruct a sense of belonging in the United States that reflects their experiences in either their home country or secondary countries where they endured protracted displacement in refugee camps. Narrative qualitative research methods were used to conduct interviews with five Congolese refugees in Appalachia. Through qualitative thematic and lexical analysis derived from the interviews, the study reveals patterns of linguistic isolation, community continuity, and emotional displacement. A key finding is that participants often conceptualize community not as a geographic entity, but as an …

Exploring Refugee Students’ Experiences In Midwest Higher Education Environments: Culturally Responsive Practices For Educators, Rohana De Silva

Theses and Dissertations

This qualitative study examined the teaching and learning strategies used by highereducation faculty to support refugee students at a Midwestern university. Recognizing that refugee students bring diverse cultural, linguistic, and experiential backgrounds to academic environments, this research examined how instructional practices can either promote or hinder their educational success. Traditional teaching methods often fall short in addressing the complex needs of this student population. Using Yosso’s Community Cultural Wealth Framework, Bourdieu’s Theory of Cultural Capital, and Resilience Theory, this study analyzed the narratives of refugee students to uncover how their lived experiences influenced their educational journeys. Findings revealed that refugee …

Religion-Justified Childhood Maltreatment, Maladjustment, And Child Abuse Potential, Hannah Doctor

Theses and Dissertations

Childhood abuse is a widely studied construct that has been shown to be related to higher levels of maladjustment and physical discipline and abuse perpetration in adulthood. Religion has been studied in relation to traumatic experiences and shown to be a factor that may help mitigate subsequent maladjustment. The idea religion may have been used to justify abusive acts has not been as widely studied but may complicate the picture of religion being a protective or resiliency factor. The present study sought to explore the relationships between religion, childhood abuse, maladjustment, and parenting behaviors. It was hypothesized that religion being …

The Effects Of Chronic Sleep Deprivation On Visuomotor Performance Using Electroencephalographic Measurement, Jaxon Duane Erie

Theses and Dissertations

The present study investigated the impact of acute and chronic sleep deprivation on visuomotor performance using both electroencephalographic (EEG) and behavioral measures (Senaptec Sensory Station) in a sample of 43 college students aged 18 to 27. Participants were assigned to low or high sleep conditions based on Chronic Sleep Reduction Questionnaire (CSRQ) scores, while acute sleep deprivation was assessed via the Karolinska Sleepiness Scale (KSS). Heart rate variability (HRV) was recorded to support condition placement, but comparisons revealed no significant differences between groups. No significant differences were found in visuomotor control or eye-quickness assessments. However, visual clarity was significantly better …

Laboratory Application Of An Aircraft Particle Imaging Probe To Characterize Levitated Ice Crystals And Their Aerodynamic Drag, Cheyenne Phoenix Harrison

Theses and Dissertations

Ice crystals in the upper atmosphere range in size from a few nanometers to a few millimeters, creating potential damage to vehicles traveling at hypersonic speeds; this problem has not yet been investigated with controlled laboratory techniques. This thesis investigates ice crystal impacts on high-speed flight vehicles and their aerodynamics by exploring a new method to combine ice crystal and shock wave experimental apparatuses to achieve experiments of observing ice crystals and shock waves interacting. The objectives of this research are: (1) to consistently produce levitated ice crystals in a setup that can feasibly release the ice crystals into a …

Measuring The Clinical Effectiveness Of Telenutrition Medical Nutrition Therapy Among American Indian And Alaska Native Adults Newly Diagnosed With Type 2 Diabetes, Charisse Lindsey Holiday

Theses and Dissertations

The COVID-19 global pandemic was the impetus of the transition from in-person medical nutrition therapy (MNT) visits to telephone MNT. This occurred without evaluation of its clinical effectiveness, especially for American Indians and Alaska Natives (AI/AN). It is known that in-person MNT is clinically effective at lowering hemoglobin A1c (A1c) and that people with diabetes who experience food insecurity have poorer health. However, research characterizing food insecurity among AI/ANs is limited. This retrospective observational analytical study was conducted at the Phoenix Indian Medical Center (PIMC) in Phoenix, Arizona to assess the clinical effectiveness of telephone delivered MNT services by a …

Visible, Invisible: (Levantine) Arab American Men On Mental Health, Nesreen Jaber

Theses and Dissertations

To address the dearth in psychological research and practice in regards to Arab American men, this study examined the lived experiences of seven Levantine (Belad Al Sham) Arab American men with origins in Palestine, Lebanon, and Iraq. Semi-structured interviews, Interpretive Phenomenological Analysis (IPA), and a Liberation Psychology framework were utilized to explore their definitions of mental health, their experiences of stigma, their experiences with mental health therapy, and their attitudes towards psychology and therapy. A total of seven superordinate themes emerged that highlighted the roles of gendered stigma, cultural incongruence in therapeutic praxis, Eurocentric norms in psychology, and conceptualizations of …

Energy Systems Optimization Techniques In The Oil And Gas Industry With Special Attention On Oil Field Reciprocating Compressors, Sean Jainarine

Theses and Dissertations

The oil and natural gas exploration and production industry is undergoing rapid growth, resulting in an increased number of operational wells and heightened potential for air emissions from oil and natural gas sources. Within production sites, compressors play a pivotal role and are often regarded as the "heart of a manufacturing plant" in the oil and gas sector. These crucial devices are designed to compress air or other gases to pressures higher than atmospheric pressure. Gas compression is typically achieved using devices with rotating blades or cylinders featuring reciprocating compressors while are essential for operations demanding high-pressures in small packages. …

The Ability Of The Millon Pre-Adolescent Clinical Inventory (M-Paci) To Distinguish Between Adhd And Non-Adhd Clinical Groups, Michael Jowkar

Theses and Dissertations

The M-PACI is a personality scale based on Millon’s biosocial personality theory designed to measure emerging personality patterns in pre-adolescents (9-12 years old). There is minimal published research on this inventory, particularly in clinical contexts. For this study, we used a data set collected at a Midwestern private practice clinic where children are assessed for ADHD and learning disabilities. This study looks at how those diagnosed with ADHD differ in emerging personality patterns and current clinical signs scales compared to those in a clinical sample who have not been diagnosed with ADHD. Some studies have shown differences between children diagnosed …

Perceptions Of Emotional Abuse As A Partial Function Of The Abuser-Victim Gender Dyad, Kaitlyn Kidder

Theses and Dissertations

Emotional abuse affects approximately half of people in an intimate relationship, yet it is often not considered intimate partner violence (IPV) on its own (Dokkedahl et al., 2022; Leemis et al., 2022). Despite the prevalence, there is a lack of consistency on the definition of emotional abuse and IPV as well as a lack of clarity of what acts qualify for these terms. Past research has largely focused on IPV, specifically physical or sexual abuse, in heterosexual relationships with a male perpetrator and female victim. Few studies have explored the interactions of the gender of the victim and perpetrator in …

An Intersectional Exploration And Analogue Investigation Of Transgender And Gender Diverse Bi+ Women’S Preferences For Sexual Violence Vulnerability Reduction Interventions, Sara K. Kuhn

Theses and Dissertations

Transgender and gender diverse (TGD) bisexual+ (bi+, e.g., pansexual, polysexual) women disproportionately experience sexual violence victimization and their acceptability of applicable interventions is under-researched. Online self-report data was collected from 240 ethnoracially diverse bi+ adult American women, who identified as TGD (n = 69) or cisgender (cis; n = 171), and who read standardized descriptions of interventions. TGD bi+ women found intervention descriptions inclusive of their sexual and gender identities—and those including in-person active resistance strategy instruction (bystander/self-defense)—more acceptable. Intervention descriptions with alcohol use and/or sexual activity reduction components were largely found to be less acceptable. Intervention elements of importance …

Doctoral Student Mentoring: A Quantitative Analysis Of Faculty And Student Perceptions And Expectations, Laura Margaret Look

Theses and Dissertations

Doctoral student success is heavily influenced by the quality of mentoring and advising relationships with graduate faculty, yet doctoral student completion rates remain at a low rate of around 50%. The purpose of this quantitative study was to examine the mentoring relationships of doctoral students by surveying doctoral students and graduate faculty who mentor graduate students to identify their expectations for the mentor and mentee in the mentoring relationship. Data were collected from 155 students and 68 faculty in the spring 2024 semester at the University of North Dakota, a Midwest R2 institution. Nonparametric statistical analysis revealed several misalignments between …

Impact Of Resin Grinding On Per- And Polyfluoroalkyl Substance Adsorption In Rapid Small-Scale Column Tests, Tihitna Gezahegn Mulugeta

Theses and Dissertations

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants with significant health risks. Among the different technologies for PFAS removal, adsorption is preferable due to low-cost, operational simplicity, and use of regenerable adsorbents. While pilot-scale fixed-bed columns are ideal for evaluating adsorption media, they are time- and resource-intensive. Rapid Small-Scale Column Tests (RSSCTs) offer a practical alternative, yet most studies have focused on granular activated carbon, with limited insight into ion exchange (IX) resins. Due to limited literature on the effect resin preparation on the performance of RSSCTs and their prediction accuracies are unexplored. This study investigates the effect of …

Barriers And Facilitators To Implementing A Task-Sharing Mental Health Intervention For Sickle Cell Disease Populations In Low- And Middle-Income Countries: A Qualitative Analysis Using The Consolidated Framework For Implementation Research (Cfir), John Patena, Leah Elster, Tania Hameed, Sumedha Kulkarni, Alden Yuanhong Lai, Annika C Sweetland, Joyce Gyamfi, Temitope Ojo, Angela Odoms-Young, Charmaine Royal, Emmanuel Peprah

2020-Current year OA Pubs

BACKGROUND: People living with Sickle Cell Disease (SCD) experience higher rates of common mental disorders (CMD). There is an alarming treatment gap in the provision of adequate mental health services for CMDs in low- and middle-income countries (LMIC). One solution is the implementation of task-sharing interventions such as the Friendship Bench which utilizes concepts of problem-solving therapy (PST). This investigation uses a qualitative study design to evaluate the acceptability and feasibility of implementing a PST-based task-sharing mental health intervention for SCD populations in LMICs using the Consolidated Framework for Implementation Research (CFIR).

METHODS: Purposive, convenience, and snowball sampling strategies were …

Evaluating And Supporting Leadership, Management, And Mentoring: A Framework For Catalyzing Responsible Research And Healthy Research Environments, Tristan Mcintosh, Alison L Antes

2020-Current year OA Pubs

Those who lead research teams have myriad roles and responsibilities that are pivotal to both producing rigorous and responsible scientific work and creating a supportive research environment that cultivates this work. We begin by presenting a leadership, management, and mentoring (LMM) framework focused on three critical roles researchers must play that have direct impact on the scientific work, the work environment, and research team dynamics: the role of research leader, research manager, and research mentor. Research leadership involves fostering a healthy research culture by building relationships where team members feel respected and supported. Research management involves providing oversight and direction …

The Gut Microbiome And Gastrointestinal Cancers: Mechanisms, Biomarkers And Therapeutic Opportunities, Sarbjeet Kaur Makkar, Kumar S Bishnupuri

2020-Current year OA Pubs

Gastrointestinal (GI) cancers remain a leading global cause of cancer-related mortality, significantly impacting public health and healthcare systems worldwide. Emerging evidence underscores the critical role of gut microbiome dysbiosis-characterized by disrupted microbial diversity and function-in GI carcinogenesis. Utilizing recent advancements in multi-omics technologies and sophisticated computational biology, researchers have elucidated distinct microbial signatures associated with colorectal, gastric, hepatobiliary, pancreatic, and esophageal cancers. This review comprehensively analyzes the primary mechanisms through which gut microbes contribute to cancer development and progression, encompassing genotoxicity, chronic inflammation, metabolic dysregulation, epigenetic modifications, and immunomodulation. Moreover, we explore innovative microbiome-derived biomarkers for potential clinical applications, including …

Barriers And Facilitators Of Integrating Cervical Cancer Screening Into Routine Hiv Care And Acceptability Of Self-Sampling For Hpv Dna Testing Among People With Hiv: An Exploratory Study In Southern Ghana, Evelyn Yayra Bonney, Emmanuel Frimpong Gyekye, Jonathan Klutse, Dzidzor Aku Attoh, Yeena Abla Tay, Nicholas Ekow Thomford, Mary Amoakoh-Coleman, Kwadwo Ansah Koram, George Boateng Kyei, Collins Stephen Ahorlu

2020-Current year OA Pubs

BACKGROUND: Cervical cancer poses a substantial global health challenge, disproportionately affecting low- and middle-income nations. Women living with HIV are disproportionately affected compared to the general population. Our study explored the acceptance and preferences of participants regarding cervical cancer screening procedures during their HIV clinic visits.

METHODS: Using the Consolidated Framework for Implementation Research (CFIR) to inform questions, we conducted semi-structured in-depth qualitative interviews with 85 people with HIV (PWH), across six southern Ghana sites, to identify factors that could promote or impede the integration of cervical cancer screening into HIV care in Ghana. We also explored the acceptability of …

Dermatology Scheduling Triage Of Transplant Patients And Transplant Candidates To Improve Early Diagnosis And Prevention Of Skin Cancer: International Immunosuppression And Transplant Skin Cancer Collaborative Cxpert Consensus Recommendations, Kelsey E Hirotsu, Basia Michalski-Mcneely, Et Al.

2020-Current year OA Pubs

Solid organ transplant recipients (SOTRs) have a high risk of developing aggressive skin cancers. However, there are no standardized triage guidelines to assist dermatology clinics with scheduling new patients pre- or post-transplant. Dermatologic care of SOTRs requires multidisciplinary coordination, extensive assessment, tailored counseling, and longitudinal care. Specialized high-risk transplant clinics are designed to address this clinical need but are a limited resource. This triage algorithm aims to provide a practical framework for tertiary care centers or community practice clinics receiving pre- or post-transplant referrals for active concerning growths or routine skin cancer screening exams. In summary, our expert panel recommends …

Advancing Public Health Leadership Through Culturally Centered And Responsive Research Mentorship Training In Nigeria, Rifkatu Reng, Manmak Mamven, Fatima Kyari, Elizabeth N Christian, Anthony Orji, Roseline Abah, Nanna Ripiye, Gregory Erhabor, Mark D Huffman, Dike Ojji, Leah C Neubauer, Lisa R Hirschorn

2020-Current year OA Pubs

Effective leadership in research and public health is critical to strengthen evidence generation and translation into policy and practice. Mentorship in research and public health is critical to develop leaders, but mentorship training is often

Adapting A Sexual And Reproductive Health Program For Latina Teens And Their Female Caregivers: A Qualitative Study, Katherine G Merrill, Ana A Baumann, Et Al.

2020-Current year OA Pubs

BACKGROUND: Adaptation is widely recognized as important when interventions are to be delivered in new settings or with new populations. However, there are gaps in the literature on how adaptations are carried out and documented. IMARA is a 12-h evidence-based sexual health intervention for Black teens and their mothers, designed for delivery over two days. We present our systematic process of adapting IMARA for Latinas to produce the

METHODS: Using a community-based participatory research (CBPR) approach, we carried out a qualitative study that included 7 focus groups: 4 with staff from community partner organizations (

RESULTS: Informed by the data, …

Problem-Solving Training To Improve Caregiver Burden And Depressive Symptoms Among Dementia Caregivers: Personal And Clinical Factors Of Responders Vs. Non-Responders, Shannon B Juengst, Matthew Lee Smith, Kristin Wilmoth, Brittany Wright, Gang Han, Charlene Supnet, Gladys Maestre

2020-Current year OA Pubs

INTRODUCTION: Metacognitive strategy training interventions, like Problem-Solving Training/Descubriendo Soluciones Juntos (PST/DSJ), have efficacy for improving caregiver burden and depressive symptoms. We previously demonstrated that PST/DSJ improved caregiver burden and depressive symptoms among caregivers of adults with Alzheimer's Disease and related dementias (ADRD), regardless of the number of sessions or boosters received. However, these results did not examine factors characterizing those who responded (improvement in caregiver burden or depressive symptoms) or did not respond to the intervention.

OBJECTIVE: To identify key personal and clinical factors associated with response to PST/DSJ. Personal factors included age, gender, race, Hispanic ethnicity, education, and employment …

Overcoming Recruitment Barriers Through Meaningful Community Engagement: Lessons Learned From A Maternal-Child Food Insecurity Assessment In Underserved Communities, Gabriela Buccini, Cristina Hernandez, Kristen N Herlosky, Shannon Rabb, Lizette Guillen, Dodds Simangan, Jyoti Desai, Alison Brown, Juanita Chinn, Timothy Grigsby, Jason Flatt, Ana A Baumann

2020-Current year OA Pubs

BACKGROUND: Recruiting participants from underserved communities for research can be challenging due to multilevel barriers. We conducted a maternal-child food insecurity needs assessment within underserved communities in urban Las Vegas, Nevada, and numerous barriers were faced to recruiting participants. This study aimed to examine barriers to participant recruitment, identify practical strategies for engaging participants, and analyze these strategies guided by the Meaningful Community Engagement Framework.

METHODS: This case study used an ethnography approach to analyze data collection barriers and community engagement strategies employed from March 2022 to February 2023 during a maternal-child food insecurity needs assessment. Inductive and deductive qualitative …

Tourette Syndrome Research Highlights From 2024 [Version 3; Peer Review: 2 Approved, 1 Approved With Reservations], Andreas Hartmann, Per Andrén, Cyril Atkinson-Clement, Virginie Czernecki, Cécile Delorme, Simon Morand-Beaulieu, Nanette Mol Debes, Kirsten Müller-Vahl, Peristera Paschou, Natalia Szejko, Apostolia Topaloudi, Kevin J Black

2020-Current year OA Pubs

We summarize research reports from 2024 relevant to Tourette syndrome, which the authors consider the most important or interesting. This working draft aims to submit this content for publication around the beginning of 2025 in the yearly Tourette Syndrome Research Highlights series on F1000Research. The authors welcome article suggestions and thoughtful feedback from readers, who can add a comment by clicking on the rectangular comment box icon to the left of the LOG IN link at the top of this page. For private comments, you can reach us by email ( [email protected] or [email protected]).

Pediatric Cervical Spine Clearance: A 10-Year Evaluation Of X-Ray In Evaluable Patients At A Level 1 Pediatric Trauma Center, William Starr, Stephanie Iantorno, Jing Wang, Richard Eldredge, Rajiv Iyer, Karch Smith, Natalya Mcnamara, Kezlyn Larsen, Stephen Fenton, Robert Swendiman, Katie Russell

2020-Current year OA Pubs

OBJECTIVES: Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.

METHODS: A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.

RESULTS: There were 2,081 negative …

Validating A Novel Measure For Assessing Patient Openness And Concerns About Using Artificial Intelligence In Healthcare, Bryan A Sisk, Alison L Antes, Sunny C Lin, Paige Nong, James M Dubois

2020-Current year OA Pubs

OBJECTIVES: Patient engagement is critical for the effective development and use of artificial intelligence (AI)-enabled tools in learning health systems (LHSs). We adapted a previously validated measure from pediatrics to assess adults' openness and concerns about the use of AI in their healthcare.

STUDY DESIGN: Cross-sectional survey.

METHODS: We adapted the 33-item "Attitudes toward Artificial Intelligence in Healthcare for Parents" measure for administration to adults in the general US population (AAIH-A), recruiting participants through Amazon's Mechanical Turk (MTurk) crowdsourcing platform. AAIH-A assesses openness to AI-driven technologies and includes 7 subscales assessing participants' openness and concerns about these technologies. The openness …

Plasma Nfl And Cognitive Functioning In Older Adults: The Moderating Role Of Hdl Cholesterol, Ramkrishna K Singh, Semere Bekena, Yiqi Zhu, Carlos Cruchaga, Steven E Arnold, Beau M Ances, Ganesh M Babulal

2020-Current year OA Pubs

BACKGROUND AND OBJECTIVES: Plasma neurofilament light chain (NfL) is a marker of neuroaxonal injury associated with cognitive decline. High-density lipoprotein (HDL) cholesterol has neuroprotective properties, but its interaction with neurodegeneration remains unclear. This study examined whether HDL moderates the association between NfL and cognitive performance.

METHODS: Baseline data from 417 participants in the Aging Adult Brain Connectome study were analyzed. Plasma NfL and HDL were measured via Simoa and enzymatic assays; cognition was assessed using Montreal Cognitive Assessment (MoCA) and Preclinical Alzheimer Cognitive Composite (PACC). Generalized linear models were used to evaluate NfL and HDL interactions, adjusting for demographics. Sensitivity …

Enhancing Safety: Multi-Institutional Fmea And Fta On 177 Lu-Based Radio-Pharmaceutical Therapy, Siju C George, Santiago Aguirre, Nichole M Maughan, Ranjini Tolakanahalli, E James Jebaseelan Samuel, Sven L Gallo, Jacqueline E Zoberi, Yongsook C Lee

2020-Current year OA Pubs

PURPOSE: This study investigates potential failure modes and conducts failure mode and effects analysis (FMEA) and fault tree analysis (FTA) on the administration of

METHODS: We reviewed the literature to investigate the administration of Pluvicto and Lutathera, focusing on prospective procedural failures and potential failure modes (PFMs) and their outcomes. We distributed an FMEA survey to multiple experienced centers in

RESULTS: The findings from the literature review and survey responses on the prospective study have identified several critical areas at risk of failure. These areas include non-optimized treatment delivery, inadequate patient monitoring, and lack of safety training, leading to radiation …

Wireless Modular Implantable Neural Device With One-Touch Magnetic Assembly For Versatile Neuromodulation, Inho Kang, John Bilbily, Choong Yeon Kim, Chuanqian Shi, Manish K Madasu, Eun Young Jeong, Kyle E Parker, Do A Kwon, Bum-Joon Jung, Jae-Soon Yang, Juhyun Lee, Noah D L Kabbaj, Wonhee Lee, Jun-Bo Yoon, Ream Al-Hasani, Jianliang Xiao, Jordan G Mccall, Jae-Woong Jeong

2020-Current year OA Pubs

Multimodal neural interfaces open new opportunities in brain research by enabling more sophisticated and systematic neural circuit dissection. Integrating complementary features across distinct functional domains, these multifunctional neural probes have greatly advanced the interrogation of complex neural circuitry. However, introducing multiple functionalities into a compact form factor for freely behaving animals presents substantial design hurdles that complicate the device or require more than one device. Moreover, fixed functionality poses challenges in meeting the dynamic needs of chronic neuroscience inquiry, such as replacing consumable parts like batteries or drugs. To address these limitations, the modular implantable neural device (MIND) is introduced …

Early Alzheimer's Disease Patient Care Pathway And Health System Readiness: A Framework For Integrated Care, Ilya M Nasrallah, Erik S Musiek, Et Al.

2020-Current year OA Pubs

UNLABELLED: Alzheimer's disease (AD) is often underdiagnosed, especially at early stages when symptoms are mild, and patients may benefit from new and recently approved anti-amyloid therapies. An updated patient care pathway may facilitate timely diagnosis and intervention. We conducted a scan of published information and convened an expert panel of health care professionals to gain insights on early AD care pathways. We developed an Early AD Patient Care Pathway as an implementation guide that includes new diagnostic and treatment modalities and addresses needs and opportunities. The Early AD Patient Care Pathway focuses on patient identification, assessment, diagnosis, treatment, and management …