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Full-Text Articles in Medicine and Health Sciences

The Association Between Cardiovascular Disease Risk And Fractures In Postmenopausal Women, Rafeka Hossain Jan 2024

The Association Between Cardiovascular Disease Risk And Fractures In Postmenopausal Women, Rafeka Hossain

All ETDs from UAB

Background: Fragility fractures pose a significant healthcare and economic burden in the United States. While age and bone mineral density (BMD) are the primary established risk factors for fragility fractures, the relationship between cardiovascular disease (CVD) and fractures remains underexplored. The primary objective of this analysis was to estimate the association of CVD risk with fractures in postmenopausal women. Methods: Utilizing 30 years of data from the WHI, Atherosclerotic Cardiovascular Disease (ASCVD) risk scores were computed using baseline age, race, systolic blood pressure, total cholesterol, high-density lipoprotein, diabetes, anti-hypertension medications, and smoking. Fracture outcomes encompassed any clinical fracture, major osteoporotic …


Associations Between Grit, Life Satisfaction, And Academic Outcomes In Elementary And Middle School Students, Charles Jaylon Williams Jan 2024

Associations Between Grit, Life Satisfaction, And Academic Outcomes In Elementary And Middle School Students, Charles Jaylon Williams

All ETDs from UAB

Grit is used to predict various positive benefits within students. Grit is trying to get back up to attempt another try at one’s goal after failure. Recently, grit has been seen as a potential candidate in improving the life satisfaction and academic performance of individuals. Grit is conceptualized as having two components, perseverance of effort and consistency of interest. Perseverance of effort is trying again until you finally accomplish your goal, while consistency of interest is a constant drive to complete one’s goals over a long-time span. This study measured the effects that grit has on elementary and middle school …


Investigating Hiv-1 Transmission To Human Cervix Using Reporter Virus Technologies, Dana Frances Indihar Jan 2024

Investigating Hiv-1 Transmission To Human Cervix Using Reporter Virus Technologies, Dana Frances Indihar

All ETDs from UAB

Around 39 million people globally are currently infected with Human immunodeficiency virus 1 (HIV-1), more than half of whom are women. HIV-1 is a retrovirus that infects and depletes an individual’s immune cells, culminating in the development of acquired immunodeficiency syndrome (AIDS) if not managed with anti-retroviral therapies (ART). Most women acquire HIV-1 through heterosexual intercourse. However, the early mechanisms and virologic determinants of HIV-1 transmission to women remain unclear. Herein, we demonstrate transmitted/founder (TF) HIV-1 representing two genetically and pathogenically distinct subtypes (A and D) in vivo have distinct replication phenotypes in an ex vivo cervical explant tissue (CET) …


Physical And Optical Properties Of Material Used For Injection Molding, Nadia Christine Farias Machado Jan 2024

Physical And Optical Properties Of Material Used For Injection Molding, Nadia Christine Farias Machado

All ETDs from UAB

Background: This project investigates the materials used in injection molding dental resin composites which involves injecting flowable composite into a clear mold. Understanding the physical and optical properties of both the resin composite and the clear mold material is crucial for successful clinical outcomes. For the clear mold material, its translucency, curing light transmission, and rigidity are vital factors. Correlations may be present between trans-lucency and curing light transmission. For the resin composite, comparing wear, hardness, translucency, radiopacity, shrinkage stress, flexural strength, and modulus will affect mate-rial performance. Finally, the depth of cure of the material will be dependent on …


Understanding Disparities In Hypertension Treatment Cascade And Validating Blood Pressure Measurement Among Persons Living With Or At Risk For Hiv, Jessica Blair Jan 2024

Understanding Disparities In Hypertension Treatment Cascade And Validating Blood Pressure Measurement Among Persons Living With Or At Risk For Hiv, Jessica Blair

All ETDs from UAB

In the United States, 44% of adult women >18 years have hypertension. Although non-Hispanic Black adults were more likely to be aware of and treated for hypertension compared to non-Hispanic White adults, Black individuals had the highest prevalence of uncontrolled hypertension. Persons living with HIV have a higher prevalence of hypertension, which is a major modifiable risk factor for cardiovascular disease. Similar to the geographic distribution of hypertension in the US, people living in the South have higher incidence of both hypertension and HIV diagnoses compared to other US regions. Furthermore, accurate diagnosis of hypertension and initiation of treatment is …


Novel Roles Of Rab35 In Development And Disease, Kelsey Ruth Clearman Jan 2024

Novel Roles Of Rab35 In Development And Disease, Kelsey Ruth Clearman

All ETDs from UAB

As the largest and most dynamic family of GTPases within the mammalian cell, Rabs play an essential role as molecular switches in regulating intracellular vesicular trafficking and serve as significant signaling transducers. Over the last few decades, Rabs have been identified to regulate endocytic, transcytosis, and exocytotic pathways, and mutations in Rabs, or alterations in downstream effectors lead to embryonic lethality and diseases such as cancer and ciliopathies. Ciliopathies are a class of pathologies that result from defects in structure or function of the primary cilia. Primary cilia, found on virtually all mammalian cells, is a microtubule-derived appendage that relies …


The Modification Of Single Domain Antibody Framework And Variable Regions To Impart Novel Pharmacodynamic And Pharmacokinetic Properties, Lucinda Ann Hall Jan 2024

The Modification Of Single Domain Antibody Framework And Variable Regions To Impart Novel Pharmacodynamic And Pharmacokinetic Properties, Lucinda Ann Hall

All ETDs from UAB

In recent years, nanobodies have become important theranostic molecules, and research has focused on improving their pharmacokinetics and binding for novel targets. Nanobodies are characterized by their high kidney uptake, leading to potentially unsafe exposure of the kidneys when delivering cytotoxic payloads. Researchers hypothesize that positively charged amino acids contribute to this kidney uptake. To address this, we assessed the impact of substituting lysine residues within the 2Rs15d HER2 nanobody scaffold to alanine on its in vivo pharmacokinetics using positron emission tomography (PET) imaging. We found that nanobodies bearing lysine-to-alanine substitutions maintained their affinity for HER2. Characterization of the K88A …


Trends In Reported Sexual Behaviors Among Alabama High School Students From 2011-2021, Sarah Franklin Jan 2024

Trends In Reported Sexual Behaviors Among Alabama High School Students From 2011-2021, Sarah Franklin

All ETDs from UAB

Background: Sexual health education is associated with better outcomes among adolescents proper use of contraception, STI prevention methods, and lower rates of teenage pregnancy and STIs. In Alabama, sexual health education is not mandated in public schools. It is unknown how the lack of mandated sexual education has impacted trends in the sexual health of Alabama high school students. Methods: Using 2011-2021 data from the Youth Risk Behavior Survey (YRBS), this study evaluated trends in sexual behaviors, including: 1) sexual history, 2) current sexual activity, 3) risky or protective sexual behaviors, and 4) history of HIV testing, over time among …


Interplay Of Antibody Responses To Closely Related Viruses And Autoimmunity, Chun-Yang Lin Jan 2024

Interplay Of Antibody Responses To Closely Related Viruses And Autoimmunity, Chun-Yang Lin

Theses and Dissertations (ETD)

Antibodies produced by B cells are crucial for eliminating infectious pathogens and preventing secondary infection. However, antibodies may also bind to self-antigens and contribute to autoimmune disease. While pathogen infections have been associated with development of autoimmune diseases, the precise contributions of viral infections to autoimmunity remain elusive. The presence of autoreactive antibodies is associated with an increased risk of developing autoimmune disease. Thus, analyzing the impact of viral infection and vaccination on the development of autoreactive antibodies will provide essential insight into mechanisms that contribute to autoimmune disease.


Examining How Non-Antifungal Medications Impact Host-Fungal Interactions, Parker Ryan Reitler Jan 2024

Examining How Non-Antifungal Medications Impact Host-Fungal Interactions, Parker Ryan Reitler

Theses and Dissertations (ETD)

Invasive fungal infections (IFIs) are estimated to kill 1.5 million people each year with mortality rates remaining high (around 30-70%), despite the availability of three major classes of antifungal drugs. Furthermore, millions more suffer debilitating infections of the mucosal membranes or destructive subcutaneous mycoses. One of the most common IFIs is invasive candidiasis, mostly commonly caused by Candida albicans infections, with mortality rates of approximately 30%. In addition, the population of susceptible individuals and the incidences of both mucosal and systemic mycoses continue to rise due to the widespread use of broad-spectrum antibacterial agents, cancer chemotherapies, and the immune suppressive …


Genotypes Of Snps Of Key Genes Regulate Susceptibility And Drug Sensitivity To Neovascular Amd, Jinglin Cui Jan 2024

Genotypes Of Snps Of Key Genes Regulate Susceptibility And Drug Sensitivity To Neovascular Amd, Jinglin Cui

Theses and Dissertations (ETD)

Age-related macular degeneration (AMD), particularly its neovascular form, stands as a leading cause of blindness globally, with its prevalence in our country on a steady rise. This underscores the critical impact of neovascular AMD (nAMD) management on patient quality of life and societal burden. Current optimal treatments hinge on anti-vascular endothelial growth factor (anti-VEGF) therapies, though their efficacy varies across different drugs and individuals, highlighting the importance of precise drug selection in clinical outcomes. Research suggests that factors such as baseline vision, age, disease duration, lesion size, central retina thickness, neovascularization type, and demographic differences influence nAMD prognosis. In addition, …


The Validity And Reliability Of Ultrasound As A Tool For Assessing Skeletal Muscle Characteristics In The Pediatric Population, Elizabeth Seewer Jan 2024

The Validity And Reliability Of Ultrasound As A Tool For Assessing Skeletal Muscle Characteristics In The Pediatric Population, Elizabeth Seewer

Theses and Dissertations (ETD)

Annually, around 5 million people in the U.S. are admitted to Intensive Care Units (ICU) due to critical conditions, with pediatric patients comprising 21% of these admissions. Approximately 40% of pediatric ICU (PICU) patients require mechanical ventilation and extended stays, and about 6% result in death. Survivors often face long-term disabilities, including loss of skeletal muscle mass (SMM), a risk factor for morbidity and mortality. Abdominal computed tomography (CT) scans, often performed during PICU admissions, can assess muscle mass but pose risks of increased cost and radiation exposure. While CT and Magnetic Resonance Imaging (MRI) are gold standards for muscle …


Molecular Determinants Of Trp Channel Gating, Briar J. Bell Jan 2024

Molecular Determinants Of Trp Channel Gating, Briar J. Bell

Theses and Dissertations (ETD)

Transient Receptor Potential (TRP) ion channels are a family of proteins that contribute to a myriad of physiological functions. They have been extensively studied since their discovery 35 years ago; however, there are still many questions regarding the mechanisms by which they function. This family of proteins is characterized by a generally shared structure: an intracellular N terminus featuring ankyrin repeats, six transmembrane helices including the pore domain, a re-entrant loop and TRP helix, and an intracellular C terminus with varying structure. Each of these regions has been implicated in the regular function of TRPs, while mutations that alter trafficking …


Anatomical And Physiological Characterization Of Striatal Activation Of The Cerebral Cortex, Yuhan Wang Jan 2024

Anatomical And Physiological Characterization Of Striatal Activation Of The Cerebral Cortex, Yuhan Wang

Theses and Dissertations (ETD)

Purpose. The striatum receives excitatory glutamatergic input from nearly all parts of the cerebral cortex, and its output is delivered by direct pathway medium spiny neurons (dMSNs) expressing D1 type dopamine (DA) receptors (D1Rs) and indirect pathway MSNs (iMSNs) expressing D2 DA receptors (D2Rs). Loss of DA results in the imbalance between the activities of dMSNs and iMSNs in Parkinson’s disease (PD), leading to ab-normal interactions between the cerebral cortex and striatum. Thus, understanding the inter-actions between the cortex and striatum is important. The monosynaptic corticostriatal cir-cuit has been extensively studied. In contrast, due to the poly-synaptic nature of the …


Biomechanical Outcomes Of Distinct Tka Surgical Alignments And Implant Designs, Alexis Kathleen Nelson-Tranum Jan 2024

Biomechanical Outcomes Of Distinct Tka Surgical Alignments And Implant Designs, Alexis Kathleen Nelson-Tranum

Theses and Dissertations (ETD)

Introduction. Total knee arthroplasty (TKA) has advanced over the past two decades from traditional post-operative neutral alignment methods with an overall goal of implant longevity to ones that are more personalized to better replicate individual native knee kinematics. Personalizing TKA knee kinematics to better replicate a patient’s native knee kinematics has evolved in response to a reported 20% dissatisfaction by patients with their TKA. These personalization advancements include innovations in surgical alignment techniques include the kinematic alignment (KA) and joint line obliquity (JLO) restoration, in contrast to the mechanical alignment (MA) technique that places everyone into the same mold. Additionally, …


The Impact Of Candida Albicans Glycogen On Fitness, Virulence And Host Response, Jian Miao Jan 2024

The Impact Of Candida Albicans Glycogen On Fitness, Virulence And Host Response, Jian Miao

Theses and Dissertations (ETD)

Candida albicans is an opportunistic human fungal pathogen that presents in healthy persons colonizing the oropharyngeal, esophageal, and gastrointestinal mucosa. This polymorphic fungal pathogen remains a leading cause of both invasive and superficial mycoses. C. albicans can cause oropharyngeal candidiasis (OPC) and disseminated candidiasis when normal host immunity is disturbed, while also causing vulvovaginal candidiasis (VVC) in healthy women. Adaptation to different host niches requires rapid and coordinated changes in Candida metabolism and physiology to cope with host immune surveillance and to counteract host-imposed constraints such as glucose limitation. Although largely unexplored in C. albicans, the glycogen metabolism pathway is …


Characterizing The Cellular Response To Astrovirus Infection In The Central Nervous System, Amy E. Davis Jan 2024

Characterizing The Cellular Response To Astrovirus Infection In The Central Nervous System, Amy E. Davis

Theses and Dissertations (ETD)

Central nervous system (CNS) diseases caused by infectious agents pose significant health challenges, often leading to severe neurological dysfunction with high morbidity and mortality rates. Astroviruses (AstVs), traditionally known for causing gastroenteritis, have recently been identified as neuroinvasive pathogens capable of inducing neurological diseases. This study explores the cellular and molecular mechanisms by which AstV, specifically non-classical VA1 and classical HAstV1 genotypes, induce CNS pathology in human neurons and astrocytes. Utilizing primary human neurons and astrocytes from various brain regions, this research investigates the cytotoxic effects, apoptotic pathways, and inflammatory responses triggered by these viruses. This study reveals that VA1 …


On Thymic Regulatory T-Cell Ontogeny, Menglin Jiang Jan 2024

On Thymic Regulatory T-Cell Ontogeny, Menglin Jiang

Theses and Dissertations (ETD)

Regulatory T (Treg) cells play a pivotal role in maintaining immune homeostasis and preventing autoimmunity. Like most T cells, Treg development occurs primarily in the thymus, where T-cell precursors undergo a series of developmental stages, including double-negative (DN), double-positive (DP), and single-positive (SP) stages, leading to the formation of distinct mature T cells. To ensure a diverse and self-tolerant T-cell repertoire capable of effectively responding to a wide range of pathogens while preventing autoimmunity, the differentiation process of thymocytes is closely supervised by sequential programs, including the rearrangement of T-cell receptor (TCR) gene segments, β-selection of cells expressing a functional …


Improving Health Outcomes In Children And Adolescents With Asthma, Elizabeth Kate Coffey Moore Jan 2024

Improving Health Outcomes In Children And Adolescents With Asthma, Elizabeth Kate Coffey Moore

Theses and Dissertations (ETD)

Asthma is among the most prevalent chronic illnesses found in the United States, affecting millions of people under the age of 18 each year. The disease burden for affected children, adolescents, their families, and the healthcare system is immense. Finding ways to mitigate its impact is critical to improving the lives of affected children, adolescents, and their families. The three chapters included in this dissertation aimed to document the asthma triggers that children and adolescents are exposed to and strategies for reducing them and to demonstrate using Imogene King’s conceptual framework to guide nursing practice to care for and nursing …


Pan-Cancer Genomic Characterization Of Human Papillomavirus Associated Tumors, Jeremiah Ray Holt Jan 2024

Pan-Cancer Genomic Characterization Of Human Papillomavirus Associated Tumors, Jeremiah Ray Holt

Theses and Dissertations (ETD)

Infection with high-risk human papillomavirus (HPV) accounts for nearly all cervical cancers (CESC), a subset of other anogenital squamous cancers, and increasing rates of head and neck squamous cell carcinomas (HNSC), with each cancer type having heterogenous outcomes due to a general lack of personalized care. Large scale genomic analyses have catalogued the somatic alterations occurring frequently among squamous tumor types including HNSC and CESC, but few studies have incorporated a thorough analysis of HPV genomics. High-risk HPVs are double-stranded DNA (dsDNA) viruses capable of integrating their genomes into host chromosomes, a phenomenon known to promote HPV-associated cancer formation. HPV …


Ftsk Regulates The Assembly Of The Division Machinery In The Ftsz-Less Chlamydia Trachomatis, Mckenna Katherine Harpring Jan 2024

Ftsk Regulates The Assembly Of The Division Machinery In The Ftsz-Less Chlamydia Trachomatis, Mckenna Katherine Harpring

Theses and Dissertations (ETD)

In evolving to obligate intracellular dependence, Chlamydia trachomatis serovar L2 (Ct), has eliminated several gene products essential for cell division in most other bacteria, including FtsZ, the central coordinator of divisome assembly. In the absence of FtsZ, we show that divisome assembly in Ct is initiated by FtsK, a chromosomal translocase. Chlamydial FtsK forms discrete foci at the septum and at the base of the progenitor mother cell, and our data indicate that FtsK foci at the base of the mother cell mark the location of nascent divisome complexes that form at the site where a daughter cell will emerge …


The Role Of Altered Cell-Cell Communication Between Glia And Neurons In Alzheimer’S Disease, Tabea Marga Soelter Jan 2024

The Role Of Altered Cell-Cell Communication Between Glia And Neurons In Alzheimer’S Disease, Tabea Marga Soelter

All ETDs from UAB

Alzheimer’s disease is the most prevalent neurodegenerative disease and is characterized by progressive memory loss and cognitive decline, affecting behavior, speech, and motor abilities. The neuropathology includes the formation of extracellular amyloid-β plaques and intracellular neurofibrillary tangles of phosphorylated tau. Additionally, neurons become functionally impaired before degenerating and dying. While neuronal loss is a disease hallmark, glia maintain neuronal health and homeostasis through cell-cell communication with neurons. Cellular crosstalk is mediated through the release of chemical intermediates (i.e., ligands), which are taken up by cell surface membrane receptors. Previous studies have shown dysregulation of global cell-cell communication patterns and communication …


Impact Of Traditional Education And Learner-Centered Education On Standardized Tests, Courtney Marie Winslow Jan 2024

Impact Of Traditional Education And Learner-Centered Education On Standardized Tests, Courtney Marie Winslow

Walden Dissertations and Doctoral Studies

There is a current shortage of approximately 45,000 nurses and nursing faculty to train student nurses, a number that is projected to grow. One proposed method to combat the shortage is to transition from traditional lecture-based classrooms to a learner-centered approach. Asking or requiring faculty to transition an entire nursing program from one teaching method to another without supporting data could be a waste of valuable time and resources. It could also prove detrimental to a program if students were unable to pass the NCLEX-RN exam, and a program was forced to close. The current study examined whether there was …


Senior Mental Health Clinicians’ Understanding Of Their Self-Efficacy While Providing Services At Community-Based Agencies, Rukiya Symister Jan 2024

Senior Mental Health Clinicians’ Understanding Of Their Self-Efficacy While Providing Services At Community-Based Agencies, Rukiya Symister

Walden Dissertations and Doctoral Studies

Many mental health clinicians strive to provide their clients with rehabilitative and psychotherapy services resulting in a client gaining stable income and housing. However, the role of a senior mental health clinician (SMHC) is not without its challenges of trying to balance their well-being while dealing with increased coworker turnover, demanding caseloads, and limited access to community resources to provide clients with getting their lives back on track, thereby impacting clinicians’ understanding of their self-efficacy. Much of the research on self-efficacy has focused on mental health clients, mental health graduate students, and mental health trainees, often leaving out the lived …


Missed Medical Appointments And The Effect On Patient Care For African Americans Living With Hiv In Alabama, Perpetua Nazon Jan 2024

Missed Medical Appointments And The Effect On Patient Care For African Americans Living With Hiv In Alabama, Perpetua Nazon

Walden Dissertations and Doctoral Studies

This quantitative correlational study examined the relationship between the independent variable of missed medical appointments and the dependent variables of race and gender for African American patients living with HIV/AIDS. Previous studies described the major issue that occurs with HIV patients is an increase of missed medical appointments, causing a panic for hospital administrators, who try to implement methods to reduce the rates of missed appointments. The study sample from the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) database covered a total population of 14,521 African American males and females living with HIV in Alabama. Pearson’s …


The Impact Of Human Attachment To A Pet Bird On Psychological Well-Being, Kathryn Marie Trautmann Jan 2024

The Impact Of Human Attachment To A Pet Bird On Psychological Well-Being, Kathryn Marie Trautmann

Walden Dissertations and Doctoral Studies

Few studies have addressed human attachment to a pet bird and psychological well-being, and the research that has been conducted is largely anecdotal and anthropomorphic perspectives on human relationships with birds. In this quantitative study, the relationships between humans and their birds were explored using Bowlby's attachment theory and Fredrickson and Losada's broaden and build theory. The study consisted of a randomized experiment, in which individuals were randomly assigned to either an attachment (n = 81) or detachment (n = 88) group. The security priming manipulation was used to prime the groups. The attachment group was asked to list things …


A Multidisciplinary Approach To Managing Financial Toxicity In Oncology Patients, Katelin Muse Jan 2024

A Multidisciplinary Approach To Managing Financial Toxicity In Oncology Patients, Katelin Muse

Walden Dissertations and Doctoral Studies

Patients with a cancer diagnosis are counseled at length about the standard of care treatment options, which may include surgery, radiation, anticancer medications, and chemo/immunotherapy through an informed consent process. Unfortunately, the potential economic burden and the accompanying psychological burden is seldom discussed up front. There is a significant need for routine screening and a multidisciplinary approach to the prevention of financial toxicity for the oncology patient. The purpose of this doctoral project was to lead an interprofessional team in the development of a clinical practice guideline for routine financial screening using the Comprehensive Score for Financial Toxicity (COST) tool …


Cbct Perceptions Of Radiology Leaders In The Midwest Dental Schools: A Qualitative Study, Tenzin Dadul Jan 2024

Cbct Perceptions Of Radiology Leaders In The Midwest Dental Schools: A Qualitative Study, Tenzin Dadul

Dissertations

Problem

The integration of Cone Beam Computed Tomography (CBCT) in dental education is hindered by a lack of formal training among radiology leaders, insufficient institutional support, and financial constraints. Despite the proven efficacy of CBCT in enhancing diagnostic accuracy and treatment planning, its adoption in pre-doctoral curricula remains limited. This gap in education poses significant challenges for dental graduates, who are increasingly expected to utilize advanced imaging technologies in clinical practice.

Purpose of Study

This qualitative study aimed to explore the perceptions of radiology leaders in Midwest dental schools regarding the integration of CBCT education into pre-doctoral curricula. The objectives …


Employees' Perception Of The Management Of The Covid-19 Crisis At Najran University, Saudi Arabia, Noora Nasser Alsuhaibani Jan 2024

Employees' Perception Of The Management Of The Covid-19 Crisis At Najran University, Saudi Arabia, Noora Nasser Alsuhaibani

Dissertations

Problem

During the COVID-19 crisis, particularly in the context of Saudi education, the ability to physically attend schools and colleges was greatly hindered due to the widespread transmission of the virus and the resulting obstacles. The issues necessitated the use of crisis management strategies. Some Saudi universities are capable of implementing an organized plan both before to and during crisis management, whereas others lack this competence. This is a substantial problem. Several universities in Saudi Arabia effectively managed the COVID-19 epidemic, whereas others did not. Furthermore, prior studies on crisis management indicate that administrators exhibit diverse responses. By participating in …


Initial Refugee Health Assessment Educational Session, Yolondra Cochnan Jan 2024

Initial Refugee Health Assessment Educational Session, Yolondra Cochnan

Doctor of Nursing Practice Projects

The initial refugee health assessment presents an excellent opportunity to identify communicable diseases in newly arriving refugees. As the number of refugee arrivals increases, so will the need for nurses who possess the skills necessary to conduct the initial refugee health assessment. Prior to the pandemic, the United States was facing a nursing shortage. The impact of the pandemic devastated the nursing community, leaving them exhausted and burnt out, which led many nurses to retire and leave the field of nursing (National Council of State Boards of Nursing [NCSBN], 2023). Skilled nurses are needed to prevent the spread of communicable …