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Epidemiology Commons™

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2020

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Articles 361 - 390 of 592

Full-Text Articles in Epidemiology

Investigating Attitudes And Beliefs Of University Students Aged 18 To 24 Years That Influence Their Decision To Take Pre-Exposure Prophylaxis Medication, Philip Danquah May 2020

Investigating Attitudes And Beliefs Of University Students Aged 18 To 24 Years That Influence Their Decision To Take Pre-Exposure Prophylaxis Medication, Philip Danquah

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Contemporary research findings affirm that young adults aged 18 to 24 years have high prevalence of new HIV infections. Pre-Exposure Prophylaxis (PrEP) medication is the latest strategy in HIV prevention. Rates of PrEP uptake or use have been negligible among university students aged 18 to 24 years, especially among racial and ethnic minority students.

Objective: The objective of this study is to investigate the attitudes and beliefs that influence the uptake of PrEP medications and the HIV risk behaviors associated with the willingness to take PrEP medications among university students aged 18 to 24 years attending the University of …


Associations Of Sickness Absence For Pain In The Low Back, Neck And Shoulders With Wider Propensity To Pain, David Coggon, Georgia Ntani, Karen Walker-Bone, Vanda E. Felli, Raul Harari, Lope H. Barrero, Sarah A. Felknor, Marianela Rojas, Anna Cattrell, Muhammad Masood Kadir May 2020

Associations Of Sickness Absence For Pain In The Low Back, Neck And Shoulders With Wider Propensity To Pain, David Coggon, Georgia Ntani, Karen Walker-Bone, Vanda E. Felli, Raul Harari, Lope H. Barrero, Sarah A. Felknor, Marianela Rojas, Anna Cattrell, Muhammad Masood Kadir

Community Health Sciences

Objectives: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain.
Methods: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised …


Ubiquitination Of The Dna-Damage Checkpoint Kinase Chk1 By Traf4 Is Required For Chk1 Activation, Xinfang Yu, Wei Li, Haidan Liu, Qipan Deng, Xu Wang, Hui Hu, Zijun Y Xu-Monette, Wei Xiong, Zhongxin Lu, Ken H Young, Wei Wang, Yong Li May 2020

Ubiquitination Of The Dna-Damage Checkpoint Kinase Chk1 By Traf4 Is Required For Chk1 Activation, Xinfang Yu, Wei Li, Haidan Liu, Qipan Deng, Xu Wang, Hui Hu, Zijun Y Xu-Monette, Wei Xiong, Zhongxin Lu, Ken H Young, Wei Wang, Yong Li

Faculty, Staff and Students Publications

BACKGROUND: Aberrant activation of DNA damage response (DDR) is a major cause of chemoresistance in colorectal cancer (CRC). CHK1 is upregulated in CRC and contributes to therapeutic resistance. We investigated the upstream signaling pathways governing CHK1 activation in CRC.

METHODS: We identified CHK1-binding proteins by mass spectrometry analysis. We analyzed the biologic consequences of knockout or overexpression of TRAF4 using immunoblotting, immunoprecipitation, and immunofluorescence. CHK1 and TRAF4 ubiquitination was studied in vitro and in vivo. We tested the functions of TRAF4 in CHK1 phosphorylation and CRC chemoresistance by measuring cell viability and proliferation, anchorage-dependent and -independent cell growth, and mouse …


A Model For The Spread Of Infectious Diseases In A Region, Elizabeth Hunter, Brian Mac Namee, John D. Kelleher Apr 2020

A Model For The Spread Of Infectious Diseases In A Region, Elizabeth Hunter, Brian Mac Namee, John D. Kelleher

Articles

In understanding the dynamics of the spread of an infectious disease, it is important to understand how a town’s place in a network of towns within a region will impact how the disease spreads to that town and from that town. In this article, we take a model for the spread of an infectious disease in a single town and scale it up to simulate a region containing multiple towns. The model is validated by looking at how adding additional towns and commuters influences the outbreak in a single town. We then look at how the centrality of a town …


Nicaragua's Response To Covid-19 – Authors' Reply, Mateo Jarquin, Andrea M. Prado, Benjamin Gallo Marin Apr 2020

Nicaragua's Response To Covid-19 – Authors' Reply, Mateo Jarquin, Andrea M. Prado, Benjamin Gallo Marin

History Faculty Articles and Research

An author's to John Perry's commentary ("Nicaragua's Response to COVID-19"), which was itself written in response to Mather, Gallo Marin, Medina Perez, et al.'s "Love in the Time of COVID-19: Negligence in the Nicaraguan Response".

Original article: Salazar Mather TP, Gallo Marin B, Medina Perez G, et al. Love in the time of COVID-19: negligence in the Nicaraguan response. The Lancet Global Health. 2020;8(6):e773. doi:10.1016/S2214-109X(20)30131-5 Perry's commentary: Perry J. Nicaragua’s response to COVID-19. The Lancet Global Health. Published online April 2020. doi:10.1016/S2214-109X(20)30218-7


Ua94/6/1 My Story: Track & Field's Dedrick Troxell, Dedrick Troxell Apr 2020

Ua94/6/1 My Story: Track & Field's Dedrick Troxell, Dedrick Troxell

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by cross county sophomore Dedrick Troxell, who had just wrapped up a great indoor season and was primed for a dominant outdoor campaign.


¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla Apr 2020

¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.

Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.

Methods: Participants were recruited at public …


Ua3/10/2 Cares Act For Students, Wku President's Office - Caboni Apr 2020

Ua3/10/2 Cares Act For Students, Wku President's Office - Caboni

WKU Administration Documents

Email from WKU president Timothy Caboni to faculty & staff regarding the Coronavirus Aid Relief & Economic Security Act for students.


Epidemiologic Survey Of Legionella Urine Antigen Testing Within A Large Wisconsin-Based Health Care System, Caroline P. Toberna, Hannah M. William, Jessica J. F. Kram, Kayla Heslin, Dennis J. Baumgardner Apr 2020

Epidemiologic Survey Of Legionella Urine Antigen Testing Within A Large Wisconsin-Based Health Care System, Caroline P. Toberna, Hannah M. William, Jessica J. F. Kram, Kayla Heslin, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose: Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County.

Methods: A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons …


Exploratory Analysis Of The Relationship Between Tnf-Α And Sbp In The Baseline Cohort Of The Dietary Approaches To Stop Hypertension (Dash)-Sodium Trial, Khalid Farhan Apr 2020

Exploratory Analysis Of The Relationship Between Tnf-Α And Sbp In The Baseline Cohort Of The Dietary Approaches To Stop Hypertension (Dash)-Sodium Trial, Khalid Farhan

Annual SHSP Student Research and Scholarship Day

No abstract provided.


Global Injury Morbidity And Mortality From 1990 To 2017: Results From The Global Burden Of Disease Study 2017, Spencer L. James, Veincent Christian F. Pepito, Global Burden Of Disease Collaborators, 595 Co-Authors Apr 2020

Global Injury Morbidity And Mortality From 1990 To 2017: Results From The Global Burden Of Disease Study 2017, Spencer L. James, Veincent Christian F. Pepito, Global Burden Of Disease Collaborators, 595 Co-Authors

Ateneo School of Medicine and Public Health Publications

Background
Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods
We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate …


Doubling Time Of The Covid-19 Epidemic By Province, China, Kamalich Muniz-Rodriguez, Gerardo Chowell, Chi-Hin Cheung, Dongyu Jia, Po-Ying Lai, Yiseul Lee, Manyun Liu, Sylvia Ofori, Kimberlyn M. Roosa, Lone Simonsen, Cecile Viboud, Isaac Fung Apr 2020

Doubling Time Of The Covid-19 Epidemic By Province, China, Kamalich Muniz-Rodriguez, Gerardo Chowell, Chi-Hin Cheung, Dongyu Jia, Po-Ying Lai, Yiseul Lee, Manyun Liu, Sylvia Ofori, Kimberlyn M. Roosa, Lone Simonsen, Cecile Viboud, Isaac Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

In China, the doubling time of the coronavirus disease epidemic by province increased during January 20–February 9, 2020. Doubling time estimates ranged from 1.4 (95% CI 1.2–2.0) days for Hunan Province to 3.1 (95% CI 2.1–4.8) days for Xinjiang Province. The estimate for Hubei Province was 2.5 (95% CI 2.4–2.6) days.


How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp Apr 2020

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Ua3/10/2 Covid-19 Update, Wku President's Office - Caboni Apr 2020

Ua3/10/2 Covid-19 Update, Wku President's Office - Caboni

WKU Administration Documents

Email from WKU president Timothy Caboni to faculty & staff regarding Covid-19 pandemic.


Ua94/6/1 My Story: Wku Softball's Morgan Mcelroy, Morgan Mcelroy Apr 2020

Ua94/6/1 My Story: Wku Softball's Morgan Mcelroy, Morgan Mcelroy

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by softball senior Morgan McElroy, whose career came to a sudden end last month between the team’s midweek game and weekend series in Texas.


483— Effectiveness Of Mmr Vaccination In Orthodox Jewish Neighborhoods, Meenu Mundackal Apr 2020

483— Effectiveness Of Mmr Vaccination In Orthodox Jewish Neighborhoods, Meenu Mundackal

GREAT Day Posters

Measles is a highly contagious disease, where large outbreaks arise by direct contact between susceptible (unvaccinated) and infectious individuals. Many Orthodox Jewish neighborhoods were affected by measles from 2018-2019. To quantify the vaccination effort on this susceptible population, a retrospective analysis was used to study the NYC and Rockland County populations using a differential equations model. A subsequent model, known as a realistically-structured network model, studied only the NYC population, in relation to typical household size. Vaccination strategies were applied to three cohorts: unvaccinated family members, members with 1 prior MMR dose, and members with 2 prior MMR doses. The …


484— Modeling Social Distancing Methods And Their Effectiveness In Combating The Spread Of Ebola, Rachel Fair Apr 2020

484— Modeling Social Distancing Methods And Their Effectiveness In Combating The Spread Of Ebola, Rachel Fair

GREAT Day Posters

Ebola Virus Disease (EVD) is a rare but severe disease that is transmitted among humans through direct-contact with, and close proximity to, infected bodily fluids. From 2014-16, West Africa experienced the largest Ebola outbreak ever recorded, infecting over 28,000 people, and killing over 11,000. Although the symptoms of EVD are treatable, the disease can be extremely deadly, with an average of 50% EVD cases resulting in fatality. In areas where healthcare is scarce and vaccinations are not readily available, the practices of social distancing and self-quarantining have been shown to be highly effective in combating the spread of EVD. To …


Coronavirus Closes In On Rohingya Refugees In Bangladesh’S Cramped, Unprepared Camps, Saleh Ahmed Apr 2020

Coronavirus Closes In On Rohingya Refugees In Bangladesh’S Cramped, Unprepared Camps, Saleh Ahmed

University Author Recognition Bibliography: 2020

Coronavirus is spreading quickly in densely populated Bangladesh, despite a nationwide shutdown put in place a month ago.

This preventive measure has proven challenging to implement due to lack of awareness of the coronavirus and the absence of a social safety net. Extreme poverty also forces many Bangladeshis to keep working and looking for food despite the risks. Bangladesh had 2,948 confirmed COVID-19 cases as of April 20.

The disease has not yet spread into the refugee camps that house the Rohingya Muslims who fled ethnic violence in Myanmar in 2017, according to a recent update from the humanitarian organizations …


Nepal's Response To Contain Covid-19 Infection, Rano Mal Piryani, Suneel Piryani, Jay Narayan Shah Apr 2020

Nepal's Response To Contain Covid-19 Infection, Rano Mal Piryani, Suneel Piryani, Jay Narayan Shah

Community Health Sciences

Nepal is a landlocked country bordering two most populous countries, India and China. Nepal shares open border with India from three sides, east, south and west. And, in north with China, where the novel coronavirus infection (CVOVID-19) began in late December 2019. The first confirmed imported case in Nepal was reported in 2nd week of January 2020. The initial response of Nepal to COVID-19 were comparably slow but country geared efforts after it was declared a 'global pandemic' by WHO on 11 March, 2020. Government of Nepal's steps from 18 March, 2020 led to partial lock down and countrywide lockdown …


Canine Cognitive Dysfunction (Ccd), Alzheimer’S Disease (Ad), And Β-Amyloid Accumulation: Using Ccd As A Reference For The Development Of Ad Treatments And Therapies, Isabel Gibbs Apr 2020

Canine Cognitive Dysfunction (Ccd), Alzheimer’S Disease (Ad), And Β-Amyloid Accumulation: Using Ccd As A Reference For The Development Of Ad Treatments And Therapies, Isabel Gibbs

Virginias Collegiate Honors Council Conference

I researched the similarities and differences between Canine Cognitive Dysfunction (CCD)—a disease with symptoms and progression pattern that parallels Alzheimer’s Disease (AD)—and AD. I studied how β-amyloid accumulates in various brain regions—such as the prefrontal, occipital, entorhinal and parietal cortices—in canines to determine how β-amyloid accumulation is associated with the development of behaviors signifying cognitive decline observed in CCD and AD—such as changes in the sleep-wake cycle, social interaction, housetraining, and general orientation—in order to understand how neuroscientists may be able to derive new understandings from a canine model with CCD, and apply them to humans with AD to develop …


Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool Apr 2020

Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool

Journal of Appalachian Health

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.

Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.

Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted …


Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton Apr 2020

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Journal of Appalachian Health

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …


Ua94/6/1 My Story: Wku Golf's Mary Joiner, Mary Joiner Apr 2020

Ua94/6/1 My Story: Wku Golf's Mary Joiner, Mary Joiner

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by golf senior Mary Joiner, whose season came to a sudden end as the team was between events on their spring break trip in Florida.


Auspicious Symbols Of Rank And Status, Byron Breedlove, Isaac Fung Apr 2020

Auspicious Symbols Of Rank And Status, Byron Breedlove, Isaac Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Work published in Emerging Infectious Diseases.


Detecting Anaemia At High Altitude, Kaylee Sarna, Cynthia M. Beall Apr 2020

Detecting Anaemia At High Altitude, Kaylee Sarna, Cynthia M. Beall

Faculty Scholarship

No abstract provided.


Copd Exacerbation Caused By Sars-Cov-2: A Case Report From The Louisville Covid-19 Surveillance Program, Forest W. Arnold, Kamran Mahmood, Angeline Prabhu, Darmaan Aden, Anupama Raghuram, Mark Burns, Leslie A. Beavin, Donghoon Chung, Kenneth E. Palmer, Julio A. Ramirez Apr 2020

Copd Exacerbation Caused By Sars-Cov-2: A Case Report From The Louisville Covid-19 Surveillance Program, Forest W. Arnold, Kamran Mahmood, Angeline Prabhu, Darmaan Aden, Anupama Raghuram, Mark Burns, Leslie A. Beavin, Donghoon Chung, Kenneth E. Palmer, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

A 53-year-old male with a history of chronic obstructive pulmonary disease (COPD) on home oxygen presented to the hospital with worsening shortness of breath plus cough. He was admitted to the intensive care unit for COPD exacerbation and respiratory failure. A routine evaluation was performed, including a nasopharyngeal swab for a respiratory viral panel, which was negative. His symptoms improved over 48 hours, after which time a surveillance test for SARS-CoV-2 returned as positive. After clinical improvement, he was discharged to home isolation.


How To Prevent Covid-19 In Nurses And Physicians In The Hospital Setting: Universal Test-And-Isolate For All Patients Admitted To Hospitals, Julio A. Ramirez, Ruth Carrico, Forest W. Arnold, Paul Schulz Apr 2020

How To Prevent Covid-19 In Nurses And Physicians In The Hospital Setting: Universal Test-And-Isolate For All Patients Admitted To Hospitals, Julio A. Ramirez, Ruth Carrico, Forest W. Arnold, Paul Schulz

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Ua94/6/1 My Story: Wku Baseball's Ray Zuberer Iii, Ray Zuberer Iii Apr 2020

Ua94/6/1 My Story: Wku Baseball's Ray Zuberer Iii, Ray Zuberer Iii

Student/Alumni Personal Papers

My Story is a series of first-person feature articles written by WKU student-athletes. The student-athletes will be telling their own stories in their own words. This article written by baseball senior outfielder Ray Zuberer III, whose season came to a sudden end as the team was heading to Birmingham, Alabama for its first conference series of the year.


Comorbidity Factors Influence Covid-19 Mortality Much More Than Age, Steven Gjerstad, Andrea Molle Apr 2020

Comorbidity Factors Influence Covid-19 Mortality Much More Than Age, Steven Gjerstad, Andrea Molle

ESI Working Papers

This paper demonstrates that once we control for comorbidity factors, age has a minor effect on COVID-19 mortality. This has implications for the treatment of current and recovered COVID-19 patients, including health screenings of recovered COVID-19 patients, triage decisions for patients in critical care, and prioritization of vaccinations when one is developed. The coronavirus epidemic in Italy has strained hospital resources, including ICU beds and ventilators for those experiencing acute respiratory failure. Studies of COVID-19 in China [1], Italy [2], and the United States [3] show that fatality rates increase rapidly with age, especially beyond age 60. The same studies …


Love In The Time Of Covid-19: Negligence In The Nicaraguan Response, Thais P. Salazer Mather, Benjamin Gallo Marin, Giancarlo Medina Perez, Briana Christophers, Marcelo L. Paiva, Rocío Oliva, Baraa A. Hijaz, Andrea M. Prado, Mateo C. Jarquín, Katelyn Moretti, Catalina González Marqués, Alejandro Murillo, Elizabeth Tobin-Tyler Apr 2020

Love In The Time Of Covid-19: Negligence In The Nicaraguan Response, Thais P. Salazer Mather, Benjamin Gallo Marin, Giancarlo Medina Perez, Briana Christophers, Marcelo L. Paiva, Rocío Oliva, Baraa A. Hijaz, Andrea M. Prado, Mateo C. Jarquín, Katelyn Moretti, Catalina González Marqués, Alejandro Murillo, Elizabeth Tobin-Tyler

History Faculty Articles and Research

"The response of the Nicaraguan government to the coronavirus disease 2019 (COVID-19) pandemic has been perhaps the most erratic of any country in the world to date. Directly contradicting mitigation strategies recommended by WHO, President Daniel Ortega has refused to encourage any physical distancing measures. Vice President Rosario Murillo (Daniel Ortega's wife) instead called on thousands of sympathisers to congregate in street marches under the slogan 'love in the time of COVID-19'. By downplaying the danger of the pandemic and increasing the risk of community transmission in the second-poorest country in the western hemisphere, the Nicaraguan government is violating the …