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Articles 721 - 750 of 1100
Full-Text Articles in Public Health
Acute Impact Of Moderate-Intensity And Vigorous-Intensity Exercise Bouts On Daily Physical Activity Energy Expenditure In Postmenopausal Women, Xuewen Wang, Barbara J. Nicklas
Acute Impact Of Moderate-Intensity And Vigorous-Intensity Exercise Bouts On Daily Physical Activity Energy Expenditure In Postmenopausal Women, Xuewen Wang, Barbara J. Nicklas
Faculty Publications
This study determined whether performing a single moderate- or vigorous-intensity exercise bout impacts daily physical activity energy expenditure (PAEE, by accelerometer). Overweight/obese postmenopausal women underwent a 5-month caloric restriction and moderate- (n = 18) or vigorous-intensity (n = 18) center-based aerobic exercise intervention. During the last month of intervention, in women performing moderate-intensity exercise, PAEE on days with exercise (577.7 ± 219.7 kcal·d−1) was higher (P = .011) than on days without exercise (450.7 ± 140.5 kcal·d−1); however, the difference (127.0 ± 188.1 kcal·d−1) was much lower than the energy expended …
Proposition 26: The Cost To All Women, Emma S. Ketteringham, Allison Korn, Lynn M. Paltrow
Proposition 26: The Cost To All Women, Emma S. Ketteringham, Allison Korn, Lynn M. Paltrow
Faculty Scholarship
No abstract provided.
Workplace Explosions: A Comparison Of The Mine Safety And Health Administration And The Occupational Safety And Health Administration, Jessica Dawn Burba
Workplace Explosions: A Comparison Of The Mine Safety And Health Administration And The Occupational Safety And Health Administration, Jessica Dawn Burba
Online Theses and Dissertations
This research compares how the Mine Safety and Health Administration (MSHA) and the Occupational Safety and Health Administration (OSHA) prevent the occurrence of and respond to incidents of workplace explosions in their industries. This was a qualitative study that utilized interpretivism as the theoretical framework. The study sought to answer four research questions. (1) What are the explosive hazards present in the coal mining and sugar refining environments? (2) What explosion prevention methodologies are available? (3) What MSHA regulations apply to coal mine explosions and what OSHA regulations apply to refinery explosions? (4) Are there differences in the way that …
Modeling And Surveillance Of Pandemic Influenza Outbreaks, Diana Prieto
Modeling And Surveillance Of Pandemic Influenza Outbreaks, Diana Prieto
USF Tampa Graduate Theses and Dissertations
Pandemic outbreaks are unpredictable as to their virus strain, transmissibility, and impact on our quality of life. Hence, the decision support models for mitigation of pandemic outbreaks must be user-friendly and operational, and also incorporate valid estimates of disease transmissibility and severity. This dissertation research is aimed at 1) reviewing the existing pandemic simulation models to identify their implementation gaps with regard to usability and operability, and suggesting research remedies, 2) increasing operability of simulation models by calibrating them via an epidemiological model that estimates infection probabilities using viral shedding profiles of concurrent pandemic and seasonal influenza, and 3) developing …
Social Mobilization Strategy, Family Advancement For Life And Health (Falah)
Social Mobilization Strategy, Family Advancement For Life And Health (Falah)
Reproductive Health
This document outlines social mobilization strategies at the national and community levels of the Family Advancement for Life and Health (FALAH) project in Pakistan. The project aims to improve the health and well-being of women, men, and their children through tackling the major obstacles in adoption of birth spacing to improve maternal and child health outcomes and family well-being, by increasing knowledge of the benefits of birth spacing as well as knowledge, increased demand for, and effective use of contraceptive methods. The strategy aims to achieve a significant increase in couples’ knowledge and understanding of the need for and benefits …
Tanning Predicts Bone Mass But Not Structure In Adolescent Females Living In Hawaii, Daniel L. Osborne, Connie M. Weaver, Linda D. Mccabe, George P. Mccabe, Rachel Novotny, Carol Boushey, Dennis A. Savaiano
Tanning Predicts Bone Mass But Not Structure In Adolescent Females Living In Hawaii, Daniel L. Osborne, Connie M. Weaver, Linda D. Mccabe, George P. Mccabe, Rachel Novotny, Carol Boushey, Dennis A. Savaiano
Department of Anthropology: Faculty Publications
Objectives: To evaluate the relationship between facultative skin pigmentation, which predicts circulating levels of plasma 25-hydroxymitamin D, and several measures of bone mass and structure in a cross sectional sample of adolescent females living in Hawaii.
Methods: Our sample was composed of adolescent females (n = 94) living in Hawaii where seasonal sun exposure is minimal, and who self-identified as either white (n = 16) or Asian (n = 78). Bone mineral content (BMC) of the total body, the lumbar spine and the hip, and cross sectional area (CSA) and section modulus (Z) at the …
Social Meaning Of Alcohol-Related Flushing Among University Students In China, Ian M. Newman, Izumi Jinnai, Jie Zhao, Zhaoqing Huang, Jia Pu, Ling Qian
Social Meaning Of Alcohol-Related Flushing Among University Students In China, Ian M. Newman, Izumi Jinnai, Jie Zhao, Zhaoqing Huang, Jia Pu, Ling Qian
Department of Educational Psychology: Faculty Publications
This study explored drinking patterns, alcohol-related flushing, and ways students themselves and other people respond to flushing in drinking situations. Of 1080 Chinese undergraduate university students given the survey questionnaire, 725 (67.1%) returned the completed surveys. Eighty percent of the students were drinkers (93% of males and 69% of females); 68% of the drinkers were flushers. Most of the students (59.3%) said flushing had no special meaning, that is, would ignore flushing; 54% of the flushers said they could keep drinking “but less” when they flush; 27% of the students said that a flushing person should stop drinking; however, if …
Considering The Perspective Of Emergency Management Professionals Regarding Radiological Response And School Resiliency, Ronald G. Edmond
Considering The Perspective Of Emergency Management Professionals Regarding Radiological Response And School Resiliency, Ronald G. Edmond
Ed.D. Dissertations
The purpose of the study is to consider the perspective of emergency management professionals regarding need for a radiological response plan and its implications to school resiliency. This study utilizes a three-round, Modified Delphi Method to provide structure for the group process, elicit experts’ opinions, and build consensus regarding radiological response and school resiliency. The experts’ opinions are analyzed at the conclusion of each round and synthesized to create considerations for school systems for a school-system-based radiological-specific response plan. The recommendations align existing school system’s capabilities, roles and responsibilities with required emergency response actions necessary to protect the health and …
Leadership Traits, Tools, And Practices: Decision Making In A Crisis, Linda M. Murawski
Leadership Traits, Tools, And Practices: Decision Making In A Crisis, Linda M. Murawski
Ed.D. Dissertations
Crises often present complex, uncertain, and unstable situations where routine decision making is not enough. Crises are typically unpredictable yet leaders must prepare to make decisions using a variety of traits, tools and practices. While all leadership is dependent on many factors and subject to many variables, in a crisis, those variables are magnified. Effective decision making during a crisis is a key trait of crisis leaders and is developed over time and with practice.
Using the classic Delphi Technique, the researcher obtained qualitative data from experts in crisis management concerning (a) the difference between non-crisis and crisis decision making, …
Scaling Up The Integration Of Tuberculosis Screening Into Reproductive Health Services, Aphia Ii Or Project In Kenya
Scaling Up The Integration Of Tuberculosis Screening Into Reproductive Health Services, Aphia Ii Or Project In Kenya
Reproductive Health
The Population Council’s APHIA II Operations Research and Kenya’s Ministry of Health implemented a pilot project in five facilities across Nairobi Province in 2010 with the aim of improving access to care and treatment for tuberculosis (TB) for women during postnatal care (PNC) services. As tuberculosis persists in Kenya, integration of screening and referrals within postnatal care services will increase case detection and treatment for those infected. Integration of TB screening is likely to be scaled up throughout PNC and maternal and child health services in Kenya. Strong linkages between health services, training, and supervision, and simple provider tools will …
Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council
Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council
Reproductive Health
The Population Council APHIA II Operations Research Project collaborated with the Ministry of Public Health and Sanitation to improve the quality of services offered by community-based midwives in two districts in Western Kenya, to prepare them to offer more comprehensive maternal services through antenatal, obstetric, postpartum, and newborn care. The study found that community midwives can tremendously increase clients’ access to essential maternal health services and other reproductive health services. Therefore Ministry of Health and its partners should scale up community midwives’ activities to enable more women access these services. Furthermore, information campaigns are needed to promote the range of …
Provider-Related Barriers To Accessing Emergency Contraception In Developing Countries: A Literature Review, Katherine Williams
Provider-Related Barriers To Accessing Emergency Contraception In Developing Countries: A Literature Review, Katherine Williams
Reproductive Health
This systematic literature review aims to identify and describe existing provider-related barriers to accessing emergency contraception (EC) in developing countries, as well as the prevalence of these barriers and documented research programs to address them. Findings from this review will contribute to specific recommendations on provider attitudes and behaviors related to emergency contraception and inform the development of a global advocacy strategy to increase access to the method.
Using Positive Deviance For Determining Successful Weight- Control Practices, Heather L. Stuckey, Jarol Boan, Jennifer L. Kraschnewski, Michelle Miller-Day, Erik B. Lehman, Christopher N. Sciamanna
Using Positive Deviance For Determining Successful Weight- Control Practices, Heather L. Stuckey, Jarol Boan, Jennifer L. Kraschnewski, Michelle Miller-Day, Erik B. Lehman, Christopher N. Sciamanna
Communication Faculty Articles and Research
Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3×/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and …
Situation Analysis Of Disability Resources And Needs Of Shantytowns Near Lima, Peru, Jessica Hunt
Situation Analysis Of Disability Resources And Needs Of Shantytowns Near Lima, Peru, Jessica Hunt
Master of Public Health Program Student Publications
Individuals in shantytowns of Lima, Peru experience unique challenges due to socioeconomic status and perceived inabilities. A situation analysis using qualitative ethnographic interviews of key participants (n=15) and one focus group (n=7) was conducted to explore life with disability in a shantytown of Lima, Peru. Findings showed that individuals with disability face physical and attitudinal barriers that limit social inclusion through the avenues of rehabilitation, education, and employment. The familial complex is expected to provide care for the individual with disability. The adult family member often chooses between providing income for the household and providing care and safety for their …
The Effect Of Prenatal Care And Other Factors On Preterm Births In Montgomery County 2007-2009, Leslie A. Schmieder
The Effect Of Prenatal Care And Other Factors On Preterm Births In Montgomery County 2007-2009, Leslie A. Schmieder
Master of Public Health Program Student Publications
Introduction Preterm birth is defined as a baby who is born before 37 weeks of pregnancy. Problems with preterm birth include an increased risk for health complications throughout life as well as having significantly more medical expenses compared to a full term infant. Prenatal care has shown to decrease the risk for preterm birth nationally. The objective of this project was to analyze prenatal care and other risk and demographic factors to determine their association with preterm birth in Montgomery County.
Method Data used included the 2007-2009 Montgomery County Birth Certificate Data for mothers who had singleton births. The Kessner …
Medical Encounter Characteristics Of Hiv Seroconverters In The Us Army And Air Force, 2000–2004, Shilpa Hakre, David Brett-Major, Darrell E. Singer, Robert J. O'Connell, Warren B. Sateren, Jose L. Sanchez, Brian K. Agan, Nelson L. Michael, Paul T. Scott
Medical Encounter Characteristics Of Hiv Seroconverters In The Us Army And Air Force, 2000–2004, Shilpa Hakre, David Brett-Major, Darrell E. Singer, Robert J. O'Connell, Warren B. Sateren, Jose L. Sanchez, Brian K. Agan, Nelson L. Michael, Paul T. Scott
Journal Articles: Epidemiology
BACKGROUND AND METHODS: Active duty US Army and Air Force military personnel undergo mandatory biennial HIV antibody screening. We compared pre- and post-HIV seroconversion health status by conducting a case-control study, which evaluated all medical encounters and sociodemographic factors among incident HIV seroconverters and HIV-negative controls from June 2000 through February 2004.
RESULTS: A total of 274 HIV seroconverters and 6205 HIV-negative personnel were included. In multivariate analysis restricted to male personnel (cases = 261, controls = 5801), single marital status (adjusted odds ratio [AOR] = 14.37), clinical indicators or symptoms within four years of HIV diagnosis (AOR = 6.22), …
Quality Of Life Perceptions Of Caregivers Of Individuals With Intellectual Disabilities In The United States And The Czech Republic, Milan Valenta, Jan Michalík, Sharon Raver-Lampman, Anne Michalek
Quality Of Life Perceptions Of Caregivers Of Individuals With Intellectual Disabilities In The United States And The Czech Republic, Milan Valenta, Jan Michalík, Sharon Raver-Lampman, Anne Michalek
Human Movement Studies & Special Education Faculty Publications
Caregivers of individuals with disabilities in the United States have been reported to experience additional hardships than families with typical children as they attempt to balance family and work (Parish, Rose, Grinstein-Weiss, Richman, & Andrews, 2008). In this study, 31 caregivers of individuals with intellectual disabilities from the United States and 225 from the Czech Republic completed a qualitative quality of life survey. Similarities in the two groups were found in reported gains and losses from caregiving responsibilities. Differences in perceived spirituality, personal sense of peace and serenity, life optimism, ability to rejoice in life, personal life perspective, health, financial …
"Knowing Myself First": Feasibility Of Self-Testing Among Health Workers In Kenya, Sam Kalibala, Waimar Tun, William Muraah, Peter Cherutich, Erick Oweya, Patricia Oluoch
"Knowing Myself First": Feasibility Of Self-Testing Among Health Workers In Kenya, Sam Kalibala, Waimar Tun, William Muraah, Peter Cherutich, Erick Oweya, Patricia Oluoch
HIV and AIDS
Report of a study exploring the feasibility and acceptability of free HIV home self-testing among health workers in Kenya, within the range of other HIV testing options available.
Prevalence Of Sexually Transmitted Infections Among Men Who Have Sex With Men And Injecting Drug Users And Validation Of Audio Computer-Assisted Self Interview (Acasi) Technique In Abuja, Lagos, And Ibadan, Nigeria: Report Fact Sheet, Enhancing Nigeria's Hiv/Aids Response (Enr) Programme
Prevalence Of Sexually Transmitted Infections Among Men Who Have Sex With Men And Injecting Drug Users And Validation Of Audio Computer-Assisted Self Interview (Acasi) Technique In Abuja, Lagos, And Ibadan, Nigeria: Report Fact Sheet, Enhancing Nigeria's Hiv/Aids Response (Enr) Programme
HIV and AIDS
Most-at-risk populations (MARPS), including men who have sex with men (MSM) and injecting drug users (IDUs), represent only 1 percent of Nigeria’s population yet account for 38 percent of new HIV infections. Despite their elevated risk, MSM and IDUs are less likely than the general population to access HIV prevention and sexual health services because of stigmatization. There is a dearth of data on prevalence of HIV and sexually transmitted infections (STIs) among MSM and IDUs because their behaviors make them difficult to be reached programmatically and engaged in research. While the need for HIV and STI prevalence data is …
Review Of The Multi-Level Factors Contributing To Fruit And Vegetable Consumption In The U.S., Qi Zhang, Liuliu Fu
Review Of The Multi-Level Factors Contributing To Fruit And Vegetable Consumption In The U.S., Qi Zhang, Liuliu Fu
Community & Environmental Health Faculty Publications
The consumption of fruits and vegetables (F&V) has a significant protective effect in reducing various cardiometabolic diseases. In recent years, the U.S. government has made a lot of effort to promote F&V consumption through different projects and programs, including the MyPyramid food guidance system supported by the USDA’s Center for Nutrition Policy and Promotion, and the Fruits & Veggies More Matters program (previously called the 5-A-Day for Better Health program), supported by the Centers for Disease Control and Prevention (CDC) and other public and private agencies. However, modest success has been achieved in promoting healthy diets among the American public. …
Setting Research Priorities To Reduce Almost One Million Deaths From Birth Asphyxia By 2015, Joy E. Lawn, Rajiv Bahl, Staffan Bergstrom, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Matthew Ellis, Mike English, Jennifer J. Kurinczuk, Anne C. C. Lee, Mario Merialdi, Mohamed Mohamed, David Osrin, Robert Pattinson, Vinod Paul, Siddarth Ramji, Ola D. Saugstad, Lyn Sibley, Nalini Singhal, Steven N. Wall, Dave Woods, John Wyatt, Kit Yee Chan, Igor Rudan
Setting Research Priorities To Reduce Almost One Million Deaths From Birth Asphyxia By 2015, Joy E. Lawn, Rajiv Bahl, Staffan Bergstrom, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Matthew Ellis, Mike English, Jennifer J. Kurinczuk, Anne C. C. Lee, Mario Merialdi, Mohamed Mohamed, David Osrin, Robert Pattinson, Vinod Paul, Siddarth Ramji, Ola D. Saugstad, Lyn Sibley, Nalini Singhal, Steven N. Wall, Dave Woods, John Wyatt, Kit Yee Chan, Igor Rudan
Woman and Child Health
No abstract provided.
Indian Health Service Strategic Plan 2006-2011, Indian Health Service
Indian Health Service Strategic Plan 2006-2011, Indian Health Service
Native Health Database Full Text
The main health challenges currently faced by American Indian and Alaska Native people are the increasing health conditions and chronic diseases that are related to lifestyles issues such as obesity, physical inactivity, poor diet, substance abuse, and injuries. To help meet these challenges, the Indian Health Service (IHS) has launched a Health Promotion and Disease Prevention (HPj DP) Initiative to develop a coordinated and systematic approach to enhance preventive health approaches at the local, regional, and national levels. This Initiative is aligned with the President's HealthierUS, HHS Steps to a HealthierUS, and Healthy People 2010.
Naming Global Health, David Brett-Major
Naming Global Health, David Brett-Major
Journal Articles: Epidemiology
No abstract provided.
Santé Et Sécurité Des Étudiants Qui Occupent Un Emploi Durant L'Année Scolaire : Les Effets Du Cumul D'Activités Et De Contraintes De Travail, Luc Laberge, Élise Ledoux, Chloé Thuilier, Michaël Gaudreault, Jeanne-Sophie Martin, Esther Cloutier, Julie Auclair, Lise Lachance, Suzanne Veillette, Claude Rozon, Marco Gaudreault, Nadine Arbour, Sandra Bescou, Thomas Agenais, Laurence Hostiou
Santé Et Sécurité Des Étudiants Qui Occupent Un Emploi Durant L'Année Scolaire : Les Effets Du Cumul D'Activités Et De Contraintes De Travail, Luc Laberge, Élise Ledoux, Chloé Thuilier, Michaël Gaudreault, Jeanne-Sophie Martin, Esther Cloutier, Julie Auclair, Lise Lachance, Suzanne Veillette, Claude Rozon, Marco Gaudreault, Nadine Arbour, Sandra Bescou, Thomas Agenais, Laurence Hostiou
Rapports de recherche scientifique
Click here for the English version of this report
Cette recherche s'inscrit dans la foulée des travaux publiés au Québec depuis les années 1990 qui ont contribué à l'émergence d'un nouveau champ de recherche sur le travail rémunéré chez les étudiants. Ces travaux s'intéressent plus particulièrement à l'incidence du travail rémunéré sur les études. Cependant, rares sont ceux qui ont directement abordé les atteintes potentielles à la santé en lien avec le travail rémunéré des étudiants, notamment les accidents de travail, les troubles musculo-squelettiques (TMS), la détresse psychologique et la fatigue.
Bien que les étudiants travailleurs soient moins à risque …
Enquête Québécoise Sur Des Conditions De Travail, D'Emploi Et De Santé Et De Sécurité Du Travail (Eqcotesst), Michel Vézina, Esther Cloutier, Susan Stock, Katherine Lippel, Éric Fortin, Alain Delisle, Marie St-Vincent, Amélie Funes, Patrice Duguay, Samuel Vézina, Pascale Prud'homme
Enquête Québécoise Sur Des Conditions De Travail, D'Emploi Et De Santé Et De Sécurité Du Travail (Eqcotesst), Michel Vézina, Esther Cloutier, Susan Stock, Katherine Lippel, Éric Fortin, Alain Delisle, Marie St-Vincent, Amélie Funes, Patrice Duguay, Samuel Vézina, Pascale Prud'homme
Rapports de recherche scientifique
Le ministère du Travail doit réaliser tous les cinq ans une étude sur l'évolution des conditions de travail au Québec. À cette fin, il a mandaté, en 2007, l’Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), l’Institut national de santé publique du Québec (INSPQ), l’Institut de la statistique du Québec (ISQ), le ministère du Travail, le ministère de la Santé et des Services sociaux et la Commission des normes du travail (CNT) d’effectuer l’Enquête québécoise sur des conditions de travail, d’emploi, et de santé et de sécurité du travail (EQCOTESST). Le rapport brosse un portrait des …
Self-Reported Poor Oral Hygiene Among In-School Adolescents In Zambia, Seter Siziya, Adamson S. Muula, Emmanuel Rudatsikira
Self-Reported Poor Oral Hygiene Among In-School Adolescents In Zambia, Seter Siziya, Adamson S. Muula, Emmanuel Rudatsikira
Community & Environmental Health Faculty Publications
Background
Dental health is a neglected aspect of adolescent health globally but more so in low-income countries. Secondary analysis using the 2004 Zambia Global School-Based Health Survey (GSHS) was conducted in which we estimated frequencies of relevant socio-demographic variables and explored associations between selected explanatory variables and self-reported poor oral hygiene (not cleaning or brushing teeth) within the last 30 days of the completion of questionnaire.
Findings
Most of the 2257 respondents were males (53.9%) and went hungry (82.5%). More than 4 in 10 respondents drank alcohol (42.2%) while 37.2% smoked cannabis. Overall 10.0% of the respondents reported to have …
Evaluation Of The Sageplus Steps Program To Promote Physical Activity And Decrease Cardiovascular Risk In Low-Income Women, Callie Anne Avis
Evaluation Of The Sageplus Steps Program To Promote Physical Activity And Decrease Cardiovascular Risk In Low-Income Women, Callie Anne Avis
All Graduate Theses, Dissertations, and Other Capstone Projects
There is little known about the effectiveness of the Steps Program specifically used in the SagePlus program in Minnesota to promote physical activity and reduce cardiovascular risk. The purpose of this study was to evaluate the effectiveness of the SagePlus Steps Program for low-income middle-aged women ages 40 to 64 to meet a daily physical activity goal of 10,000 steps and reduce their cardiovascular disease risk, measured by their Framingham Risk Score. A nonexperimental, descriptive correlational design was used to guide data collection for this study. Demographic data, step counts after weeks 1, 4, 12, and 24, activity level at …
Ethical Issues In Global Health Education, David Barnard, T. Thuy Bui, Jack Chase, Evaleen Jones, Scott Loeliger, Anvar Velji, Mary T. White
Ethical Issues In Global Health Education, David Barnard, T. Thuy Bui, Jack Chase, Evaleen Jones, Scott Loeliger, Anvar Velji, Mary T. White
Population and Public Health Sciences Faculty Publications
No abstract provided.
Evaluation Of The Informed Consent Process For Male Circumcision Scale-Up In Zambia, Barbara Friedland, Louis Apicella, Katie D. Schenk, Meredith Sheehy, Paul C. Hewett
Evaluation Of The Informed Consent Process For Male Circumcision Scale-Up In Zambia, Barbara Friedland, Louis Apicella, Katie D. Schenk, Meredith Sheehy, Paul C. Hewett
HIV and AIDS
This report evaluates the informed consent process for male circumcision conducted through the Male Circumcision Partnership for Zambia, led by Population Services International (Society for Family Health, Zambia), in partnership with Jhpiego, Marie Stopes International, and the Population Council. The objectives of the study were to assess male circumcision clients' comprehension of the informed consent process, examine social norms and practices regarding informed consent for adolescents, compare clients' expectations and experiences, and make additional recommendations for improving the informed consent process.