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Assessing The Correlation Between The Socioeconomic Level And Cognitive Function Among Older Adults In Egypt, Macy Abougabal Jun 2023

Assessing The Correlation Between The Socioeconomic Level And Cognitive Function Among Older Adults In Egypt, Macy Abougabal

Theses and Dissertations

The number of older adults is increasing worldwide at an unprecedented rate. Some countries began to understand the challenges of aging, while others are still at the stage of comprehending the true dimensions of the situation. There is a global focus on aging research to appropriately mitigate the negative impact of aging and cognitive decline. Not only that dementia add economic pressure on governments, it also increase the psychological and physical burden of the caregivers. Scholars have previously studied socioeconomic level in three variables, namely work, education, and income, and their relationship with cognitive function. It was concluded that the …


Association Of Health Literacy With Demographic Features, Health-Related Behaviors, And Health Risk Indicators Among Egyptian Adults: Online Cross-Sectional Study, Rana Gamal Hassan Jun 2023

Association Of Health Literacy With Demographic Features, Health-Related Behaviors, And Health Risk Indicators Among Egyptian Adults: Online Cross-Sectional Study, Rana Gamal Hassan

Theses and Dissertations

Health literacy is recognized as a significant determinant of health. Limited health literacy is a growing issue worldwide. It has a significant role facing the rising trends of non-communicable diseases (NCDs) through improving its modifiable risk factors. Therefore, studying the association between health literacy and different health-related behaviors is very important to guide both healthcare professionals and policy makers to set up the proper interventions. Our study aims to a) examine the health literacy levels among Egyptian adults, b) investigate the association of health literacy relative to socio-demographic features, health related behaviors, and self-reported health status. This is a cross-sectional …


Chemical And Polymer Characterization Of The Potential Modes Of Degradation Of An Injectable Nucleus Pulposus Replacement Device, Antonio G. Abbondandolo Jun 2023

Chemical And Polymer Characterization Of The Potential Modes Of Degradation Of An Injectable Nucleus Pulposus Replacement Device, Antonio G. Abbondandolo

Theses and Dissertations

HYDRAFIL™ is a poly(vinyl alcohol)/poly(ethylene glycol)-based hydrogel nucleus pulposus replacement device that is injected in situ and has demonstrated efficacy in lowering the prevalence and pain associated with back. In this work, we developed a method to analyze HYDRAFIL™ polymer composition using (TGA) and characterized intermolecular bonding interactions within the hydrogel through (FTIR). To function as a permanent implant for nucleus pulposus replacement, HYDRAFIL™ must be stable when exposed to a multitude of degradation pathways, namely, thermal, chemical, and mechanical. We subjected HYDRAFIL™ to accelerated thermal and chemical degradation pathways and described compositional, physical and chemical property changes using a …


Examining The Determinants Of Timeliness In Crises Policy Responses: The Case Of Covid-19 In Egypt, Abdelhalim Abdalla Jun 2023

Examining The Determinants Of Timeliness In Crises Policy Responses: The Case Of Covid-19 In Egypt, Abdelhalim Abdalla

Theses and Dissertations

Timely responses to crises and pandemics play a significant role in navigating and minimizing the adverse impacts of such critical periods on the public and governments worldwide. COVID-19 could show and prove how a single virus originating in a single country can rapidly spread throughout the world, transforming an epidemic in China into a global pandemic. The virus caused more than 6.5 million deaths and around 660 million confirmed cases worldwide, according to the WHO, and sparked the worst economic catastrophe globally in more than a century, as estimated by the World Bank. Evidence suggests that the extent of the …


Catecholamine System Function Of The Medial Prefrontal Cortex Following Repetitive Mild Traumatic Brain Injury And The Use Of Benzoyl Chloride To Quantify And Identify Neurotransmitters, Leah Horvat May 2023

Catecholamine System Function Of The Medial Prefrontal Cortex Following Repetitive Mild Traumatic Brain Injury And The Use Of Benzoyl Chloride To Quantify And Identify Neurotransmitters, Leah Horvat

Theses and Dissertations

Traumatic brain injury (TBI) is a serious global health burden that causes a wide range of neurocognitive symptoms. These cognitive processes are regulated by catecholamine signaling within the prefrontal cortex (PFC) region of the brain. To quantify functional deficits in catecholamine signaling after TBI, norepinephrine (NE) and dopamine (DA) levels within the PFC were quantified from microdialysate samples using high-performance liquid chromatography coupled with electrochemical detection. A method for benzoyl chloride derivatization of neurotransmitters and analysis with liquid chromatography and tandem mass spectrometry instrumentation was also developed to detect and analyze these neurotransmitters. Overall, it was found that catecholamine signaling …


Contingency Management For Opioid Use Disorder: Early Treatment Adherence And Mood, Shelby Renee Goodwin May 2023

Contingency Management For Opioid Use Disorder: Early Treatment Adherence And Mood, Shelby Renee Goodwin

Theses and Dissertations

Opioid use results in potentially devastating consequences, but medications for opioid use disorder, such as buprenorphine, serve as effective ways to curb cravings and withdrawal, helping an individual reduce their use. Unfortunately, around half of patients discontinue buprenorphine treatment within 30 days and co-occurring conditions such as mood symptoms may serve as additional barriers and decrease engagement. This study sought to examine contingency management (CM; incentives for meeting behavioral goals) as a potential intervention to increase early treatment engagement, as well as the role of total depression, anxiety, and stress (mood) severity in the efficacy of contingency management. New patients …


Artemisinin And Its Derivatives Reactions: Characterization Of The Reaction Products Using Lc/Tof Ms, Kogila Vijayan May 2023

Artemisinin And Its Derivatives Reactions: Characterization Of The Reaction Products Using Lc/Tof Ms, Kogila Vijayan

Theses and Dissertations

Artemisinin (ART) is a sesquiterpene lactone and a popular malaria drug with potential anticancer properties. In this work, LC/TOF MS was used to investigate the reaction of ART with DNA bases and estradiol. ART-deoxyadenosine and ART-deoxycytidine interactions were studied in the presence of Fe (II) ions. ART-deoxyadenosine and ART-deoxycytidine reaction mixtures gave chromatographic signatures that remained unchanged at room temperature but grew after incubation at 37°C. The change in temperature from room temperature to 37°C was the main driver of adduct formation in these reactions. ART was found to react with Fe (II) ions as observed from several new chromatographic …


Computational Study Of Foldamer-Based Water Channels, Shadi Houshyar Azar May 2023

Computational Study Of Foldamer-Based Water Channels, Shadi Houshyar Azar

Theses and Dissertations

One of the most serious global challenges of this century is water scarcity, stemming primarily from the growing demand for freshwater and the depletion of freshwater resources. Water desalination has the potential to address this problem, but current technologies are expensive and inadequate. Here, we present novel, computationally designed channels with high water permeability and selectivity against ions, inspired by natural water channels, aquaporins. Aquaporin's unique property of transporting water while rejecting protons and other ions has led to numerous studies on incorporating such channels into different membranes for water purification applications. However, use of an aquaporin-incorporated membrane is limited …


The Impact Of The Tobacco-Free Policy On The Auc New Cairo Campus, Fatimah Badawy May 2023

The Impact Of The Tobacco-Free Policy On The Auc New Cairo Campus, Fatimah Badawy

Theses and Dissertations

In 2019, the American University in Cairo (AUC) conducted a research study on campus attitudes towards tobacco use and smoking behaviors within their community, in light of the then newly enforced tobacco-free policy. They found most campus members in support of the policy, with higher rates of disapproval from the smoking community. In 2021, this research aimed to follow-up on changes in attitudes towards the policy as well was smoking behaviors. It hypothesized that over time, levels of support to the policy would increase, smoking habits would be positively impacted and that positive health behaviors would correlate with policy support. …


Importance Of Prioritization Of Health Care Data Quality In Managed Care Leadership, Grace V. Crossette-Thambiah May 2023

Importance Of Prioritization Of Health Care Data Quality In Managed Care Leadership, Grace V. Crossette-Thambiah

Theses and Dissertations

As we progress towards the fourth industrial revolution, where emerging technologies such as artificial intelligence, machine learning, and the Internet of Things (IoT) are becoming more dominant, the quality of data becomes even more crucial. These technologies rely immensely on data to generate insights and make accurate predictions. Poor quality data can lead to incorrect or incomplete insights, resulting in erroneous decision-making that can have significant consequences. It is essential that data quality is addressed early in the development of these technologies to ensure that they operate successfully and provide accurate insights that can lead to positive outcomes. As such, …


The Neuroprotective Role Of Vitamin D In Humans With A Traumatic Brain Injury: A Systematic Review, Hailey Jarr May 2023

The Neuroprotective Role Of Vitamin D In Humans With A Traumatic Brain Injury: A Systematic Review, Hailey Jarr

Theses and Dissertations

Traumatic brain injuries (TBI) are a leading cause of death worldwide. Previous research supports a relationship between vitamin D and TBI outcomes; however, they rely on animal studies. This review aimed to examine the neuroprotective role of vitamin D in humans with TBIs. A search was completed (PubMed and Scopus) following PRISMA guidelines to review publications investigating the relationship between vitamin D deficiency (VDD) and TBI or the effect of vitamin D supplementation on TBI outcomes; 8 studies were identified. Patients had the
/="/">following ranges: 26-88% deficiency and 62-88% insufficiency compared to 24% and 49% of the general population. …


Identifying Limitations In Using Diagnostic Testing For Absorption Of Passive Maternal Immunity In Neonatal Beef Calves To Predict Pre-Weaning Disease, Alexis Charlotte Thompson May 2023

Identifying Limitations In Using Diagnostic Testing For Absorption Of Passive Maternal Immunity In Neonatal Beef Calves To Predict Pre-Weaning Disease, Alexis Charlotte Thompson

Theses and Dissertations

Calves are born agammaglobulinemic and rely on colostrum consumption for the transfer of maternal passive immunity. Calves that fail to absorb adequate amounts of maternal antibodies from colostrum are commonly referred to as having failed transfer of passive immunity (FTPI). The overall aim of this dissertation was to explore the usefulness of FTPI testing in neonatal beef calves to predict their risk for subsequent illness or death. The objectives were to evaluate the impact of FTPI on pre-weaning disease in beef and dairy calves, quantify and compare the variance in IgG concentrations measured by radial immunodiffusion and serum total protein …


Identifying Barriers To Data Use On U.S. Beef Cow-Calf Operations And Developing Solutions To Improve Cow-Calf Record-Keeping, William Isaac Jumper May 2023

Identifying Barriers To Data Use On U.S. Beef Cow-Calf Operations And Developing Solutions To Improve Cow-Calf Record-Keeping, William Isaac Jumper

Theses and Dissertations

Cattle health and production records (CHPR) are data collected by cattle producers and veterinarians in the form of measurements, observations, counts of events over time, and physiologic attributes that describe individual and group-level health and production. These data are useful to both veterinarians and cattle producers for making evidence-based decisions on cow-calf operations. Currently, there are no uniform, industry-wide methods of capturing and recording CHPR in the U.S. cow-calf industry. Although many cow-calf producers in the U.S. are thought to collect some form of CHPR, it is believed that relatively few are doing so in an electronic manner that facilitates …


Evolution And Epidemiology Of Channel Catfish Virus (Ccv), Arun Venugopalan May 2023

Evolution And Epidemiology Of Channel Catfish Virus (Ccv), Arun Venugopalan

Theses and Dissertations

Channel catfish virus disease (CCVD) is the principal viral disease in the United States catfish industry. The CCVD is caused by channel catfish virus (CCV), with mortality reaching up to 100% in fingerlings. CCV is assigned taxonomically to the family Alloherpesviridae, genus Ictalurivirus, species Ictalurid herpesvirus 1 (IcHV-1). To date, virulence, immunogenicity, and genome plasticity of the CCV field isolates have not been investigated. Three genotypes of CCV (IcHV-1A, IcHV-1B, and BCAHV) were identified using restriction fragment length polymorphism (RFLP) analysis. Virulence assessment of three representative isolates of RFLP groups suggests that IcHV-1B (pooled survival [mean ± SE]: 58.3% ± …


Development Of Live Attenuated A. Hydrophila Vaccines And Understanding Of Macrophage-Aeromonas Hydrophila Interactions, Eda Ozdemir May 2023

Development Of Live Attenuated A. Hydrophila Vaccines And Understanding Of Macrophage-Aeromonas Hydrophila Interactions, Eda Ozdemir

Theses and Dissertations

Channel catfish farming is the largest aquaculture industry in the U.S., and virulent Aeromonas hydrophila is an important re-emerging bacterial pathogen of farmed catfish. A. hydrophila is ubiquitous in the aquatic environment and causes motile Aeromonas septicemia (MAS) in farmed catfish. A. hydrophila infection is challenging to treat due to rapidly progressive mass mortalities. Although florfenicol has been used in managing outbreaks, acute onset of anorexia, drug cost, and emergence of antimicrobial-resistant strains are significant concerns. Prevention of MAS by vaccination could be a promising approach, but a commercial vaccine is not available. Thus, it is critical to develop effective …


Quality Of Life Among Caregivers Of Individuals With 22q11.2 Deletion Syndrome And Intellectual Disability, Sandra Garza Ochoa May 2023

Quality Of Life Among Caregivers Of Individuals With 22q11.2 Deletion Syndrome And Intellectual Disability, Sandra Garza Ochoa

Theses and Dissertations

Caregiving for a person with 22q11.2 chromosome deletion syndrome (22q) often entails dealing with medically life-threatening complications and is significantly compounded when the care recipient has comorbid 22q and intellectual disability (ID). The purpose of this study was to examine the effect of support, spirituality, and resiliency on the quality of life (QOL) of caregivers of individuals with comorbid 22q/ID to ascertain if these protective factors would reduce their caregiving burden. Study participants consisted of 469 caregivers of persons with 22q/ID who were recruited through 22q social advocacy groups. Correlational analyses, analyses of variance, and multiple regression analysis were used …


Attitudes And Compassion Of Student Counselors-In-Training Toward Individuals Who Are Homeless, Kristine R. Gonzalez May 2023

Attitudes And Compassion Of Student Counselors-In-Training Toward Individuals Who Are Homeless, Kristine R. Gonzalez

Theses and Dissertations

With the increased numbers of homeless individuals over the past several years, it is important to consider factors that contribute to chronic homelessness, including barriers to service delivery that impede one’s ability to exit homelessness. The purpose of this quantitative study was to examine the attitudes and compassion among student counselors-in-training (SCITs) toward individuals experiencing homelessness as these students represent future mental health providers who will be serving the homeless, a highly marginalized population. A total of 162 graduate students from two southwestern Hispanic-serving institutions were recruited for the study. A correlational analysis, independent t-tests, and one-way ANOVAs were conducted …


Data Science For Hospital Antibiotic Stewardship, Saikou Jawla May 2023

Data Science For Hospital Antibiotic Stewardship, Saikou Jawla

Theses and Dissertations

Antibiotics are widely used to treat bacterial infections, but their misuse leads to antibiotic resistance. Antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality. Antimicrobial stewardship is an approach to measure and improve the appropriate use of antibiotics in healthcare settings. Data science has the potential to support these programs by providing insights into antibiotic prescribing patterns, identifying areas for improvement, and predicting patient outcomes. We explored the role of data science in hospital antibiotic stewardship programs, including statistical methods …


From “Cowardice” To “Shellshock”: The Definition And Treatment Of Mental Health In The United States Marine Corps During The Age Of The Great War, Itzel Marquez May 2023

From “Cowardice” To “Shellshock”: The Definition And Treatment Of Mental Health In The United States Marine Corps During The Age Of The Great War, Itzel Marquez

Theses and Dissertations

The aim of my master’s thesis is to study how the United States’ Marine Corps recognized, defined, and treated mental health issues during the Great War and how this translated into the treatment of Marines by their peers and commanding officers. Similar to other countries that fought in the Great War, also referred to as World War I, the United States witnessed intense discussions about the psychological effects of war. The question of whether and how modern warfare affected troops’ mental health was addressed by all branches of the United States’ military. Yet, the issue of mental health in the …


Mapping Psychological Safety In The Nursing Classroom: A Situational Analysis, Lori Beth Beard Apr 2023

Mapping Psychological Safety In The Nursing Classroom: A Situational Analysis, Lori Beth Beard

Theses and Dissertations

The purpose of the qualitative situational analysis was to explore the interconnectedness of human and non-human elements that shape psychological safety in the associate degree nursing classroom learning environment. Using grounded theory methods together with situational analysis, specifically situational mapping, a theory of psychological safety in the nursing classroom emerged from the data. The data highlighted several theoretical categories that capture how faculty use various elements to construct psychological safety in the classroom. From the data emerged the theory that nurse faculty connect their nurse identities to the elements when building psychological safety into the classroom learning environment. Implications for …


Non-Fatal Strangulation During Sexual Assault: A Retrospective Review, Brooke E. Stacey Apr 2023

Non-Fatal Strangulation During Sexual Assault: A Retrospective Review, Brooke E. Stacey

Theses and Dissertations

Background: Non-fatal strangulation (NFS) is a life-threatening event in cases of sexual assault. The incidence of NFS during sexual assault is increasing on a global scale. NFS is a gendered crime as most victims are women and most assailants are men and is more common in intimate partner violence. Strangulation victims only have visible neck injuries around 50% of the time, but visible injuries are not a reliable indicator of the severity of the assault. NFS can cause neurological damage from lack of blood flow to the brain and result in physical and psychological trauma. NFS indicates a high degree …


The Impact Of Data Quality On Adverse Event Detection Methodologies In Medical Claims Data, Mary Aruna Jyothi Gadde Apr 2023

The Impact Of Data Quality On Adverse Event Detection Methodologies In Medical Claims Data, Mary Aruna Jyothi Gadde

Theses and Dissertations

A 2016 survey conducted by the Office of the National Coordinator for Health Information Technology (ONC) found that 96 percent of United States hospitals currently utilize certified Electronic Health Record (EHR) technology and meet meaningful use requirements promoted by the Centers for Medicare and Medicaid Services. With the increasing use of EHR, early studies on data quality within electronic health records revealed a long list of concerns within EHR workflows. The work in this dissertation applied Rule-based data quality assessment to Adverse Events (AEs) within the All Payers Claim Database (APCD). An adverse event is any patient harm resulting from …


Aortopathies: Mechanism Of Pathogenesis And Therapy, Mengistu G. Gebere Apr 2023

Aortopathies: Mechanism Of Pathogenesis And Therapy, Mengistu G. Gebere

Theses and Dissertations

The aorta is the largest artery in the body which is directly connected to the left ventricle of the heart and functions as an elastic conduit that transports the ejected blood from the left ventricle to peripheral vessels. There are three layers to the aortic wall, tunica intima, tunica media, and tunica adventitia. The tunica media, the thickest middle layer, is composed of vascular smooth muscle cells (SMC) and the extracellular matrix (ECM) as its essential components. SMCs are circumferentially arranged and embedded in elastic lamellae. They are responsible for producing and maintaining/remodeling the extracellular matrix of the aortic media. …


A Cross-Sectional Analysis Of Infectious Causes Of Congenital Morbidity And Mortality In Central America: Torch, El Salvador, Mary Katherine Lynn Apr 2023

A Cross-Sectional Analysis Of Infectious Causes Of Congenital Morbidity And Mortality In Central America: Torch, El Salvador, Mary Katherine Lynn

Theses and Dissertations

The primary goal of this dissertation was to understand the prevalence of the most regionally salient TORCH pathogens among a group of perinatal women from a highly vulnerable region of El Salvador at the time of parturition. TORCH pathogens, that cause TORCH congenital syndromes, are classically defined as Toxoplasma gondii, other infectious causes of concern (Zika virus, malaria, human immunodeficiency virus, etc), Rubella virus, Cytomegalovirus(CMV), and Herpes Simplex Viruses. These infections can be passed from mother to fetus through the placenta or other perinatal routes and cause severe maternal and neonatal morbidity and mortality. This dissertation sought to understand perinatal …


Exploration Into The Relationship Between Colitis And Depression: A Potential Role For The Aryl Hydrocarbon Receptor, Kasie Lynn Roark Apr 2023

Exploration Into The Relationship Between Colitis And Depression: A Potential Role For The Aryl Hydrocarbon Receptor, Kasie Lynn Roark

Theses and Dissertations

Inflammatory Bowel Disease (IBD) is a group of chronic gastrointestinal disorders with unclear etiology comprised of two defined disorders – Crohn’s Disease (CD) and Ulcerative Colitis (UC). IBD leads to chronic pain, socially isolating symptoms, and an overall reduction in patient quality of life. There is currently no cure for IBD. Due to decreased mucous production and weakening of the colonic epithelial lining, gut-microbiota and their metabolites can invade the intestinal lamina propria and circulate systemically, a term known as “leaky gut”. Recent studies show a relationship exists between peripheral inflammation, such as IBD, and depression. The gut-brain axis (GBA) …


Food Insecurity In Youth And Young Adults With Diabetes: Prevalence And Association With Health Behaviors, Lauren Helene Martini Apr 2023

Food Insecurity In Youth And Young Adults With Diabetes: Prevalence And Association With Health Behaviors, Lauren Helene Martini

Theses and Dissertations

Given the life-long impact of diabetes(1-5), it is important to engage in behaviors that promote health and wellness to delay or prevent negative health outcomes(3, 6-10). Despite this, youth and young adults with diabetes generally do not adhere to nutritional(11-17) or physical activity(18, 19) recommendations. In households experiencing financial difficulties, especially those who are having difficulty providing sufficient food to all of its members, adhering to recommendations may be even more difficult.

The purpose of this dissertation is to better understand and contextualize food insecurity among youth and young adults (YYA) with youth-onset T1DM and T2DM. The first aim addresses …


Examining Associations Between Social Needs And Mental Health Among Youth And Young Adults With Diabetes, Andrea Danielle Brown Apr 2023

Examining Associations Between Social Needs And Mental Health Among Youth And Young Adults With Diabetes, Andrea Danielle Brown

Theses and Dissertations

Household food insecurity (HFI) disproportionally affects people with diabetes living in the United States and is more likely to occur in households with children and in minority race/ethnicity households. Food insecure people with youth-onset diabetes likely have increased risk for poor mental health due to dealing with stress and cost related to diabetes management, especially if facing additional health-related social needs that intersect with HFI. If left untreated, poor mental health among youth and young adults (YYA) with diabetes can lead to diabetes-related complications, increased health care costs, and mortality. Yet few studies have examined associations between HFI and mental …


Is There A Relationship Between Direct Patient Care Registered Nurses Emotional Intelligence And Patient Satisfaction?, James J. Leach Apr 2023

Is There A Relationship Between Direct Patient Care Registered Nurses Emotional Intelligence And Patient Satisfaction?, James J. Leach

Theses and Dissertations

Many studies have examined Emotional Intelligence (EI) ’s role in various groups of people. However, to date, there have not been any studies examining the role of EI in direct patient care given by ICU nurses and the relationship between the nurses’ EI and patient satisfaction. With the importance of patient satisfaction tied to hospital reimbursement and the many approaches that have been made to improve patient satisfaction, studying the people (nurses) who spend the most time with the patient seems right. The data used for this study was obtained from an EI inventory for the nurses and an ICU-specific …


Leptin, Serotonin, And The Control Of Food Intake, Nicholas David Maxwell Apr 2023

Leptin, Serotonin, And The Control Of Food Intake, Nicholas David Maxwell

Theses and Dissertations

Obesity has created a devastating public health crisis that severely affects both quality of life and exacerbates serious health conditions such as heart disease and diabetes. For this reason, better treatments are critical, yet there are very few. The systems that regulate our metabolism and food consumption are intricate, complex, and still poorly understood, as the brain integrates peripheral signals with central neural networks to control our energy balance. One of these peripheral signals, leptin, holds great promise as a way to treat obesity but has been ineffective in patients with obesity. Therefore, our goal is to better understand the …


Targeting Of Mediator Kinases For Cancer Therapy And Resistance Prevention, Zachary Thomas Mack Apr 2023

Targeting Of Mediator Kinases For Cancer Therapy And Resistance Prevention, Zachary Thomas Mack

Theses and Dissertations

Estrogen receptor (ER)-positive breast cancers make up 70% of all breast cancer incidences in the US. Cell cycle progression of ER-positive breast cancer is highly dependent on cyclin-dependent kinases (CDK) 4 and 6, the G1/S checkpoint kinases. Inhibitors of CDK4/6 have become a major addition to the clinical arsenal against ER-positive breast cancers. CDK4/6 inhibitor palbociclib (IBRANCETM) has been approved for the treatment of ER-positive breast cancers. However, palbociclib treatment eventually fails due to the development of resistance. Laboratory studies revealed several diverse mechanisms of palbociclib resistance, making universal re-sensitization difficult to achieve. However, prevention of the adaptive process that …