Effect of Jianpi Shengxue Tablet on Iron Metabolism and Nutritional Status in Patients with Renal Anemia:A Prospective,Randomized,Open,Parallel Controlled and Multicenter Clinical Study

Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.

Exploring the Impact of Alcohol Consumption and Smoking on Primary Open Angle Glaucoma: A Mendelian Randomization Study

Objective: Utilizing Mendelian Randomization, this study employs Single Nucleotide Polymorphisms (SNPs) as instrumental variables to explore the causal relationships between bibulosity, smoking, and Primary Open Angle Glaucoma (POAG). Methods: GWAS data for bibulosity, smoking, and POAG were obtained from the Social Science Genetic Association Consortium website and the IEU OpenGWAS Project website, respectively. Using a P-value threshold of −8, a linkage disequilibrium coefficient (r2) of 0.001, and a linkage disequilibrium region width of 10,000 kb, the data were aggregated, resulting in 6 SNPs for bibulosity and 253 SNPs for smoking. Three regression models, MR-Egger, Weighted Median Estimator (WME), and Random-Effects Inverse-Variance Weighted (IVW) were applied to analyze the causal impact of bibulosity and smoking on POAG. Results: The GWAS data for alcohol consumption and smoking were derived from European populations, while the GWAS data for Primary Open-Angle Glaucoma (POAG) were sourced from East Asian populations, with no gender restrictions. Analysis using three different regression models revealed that neither excessive alcohol consumption nor smoking significantly increased the risk of developing POAG. Specifically, the odds ratios with 95% confidence intervals for the alcohol consumption group were 0.854 (0.597 - 1.221) in MR-Egger regression, 0.922 (0.691 - 1.231) in WME regression, and 0.944 (0.711 - 1.252) in IVW regression. For the smoking group, the odds ratios were 1.146 (0.546 - 2.406) in MR-Egger regression, 0.850 (0.653 - 1.111) in WME regression, and 0.939 (0.780 - 1.131) in IVW regression. Given the significant heterogeneity in the SNPs associated with smoking, the focus was primarily on the results from the IVW regression model. Conclusion: Alcohol consumption and smoking are not significant risk factors for the development of POAG.

Effect of Mouth Opening Training Stick Combined with Oral Massage on Mouth Opening Difficulty in Head and Neck Cancer Patients after Treatment

Objective: To study the application effect of mouth-opening training sticks combined with oral massage on patients with mouth-opening difficulty after treatment for head and neck cancer. Methods: Using convenient sampling, 60 patients with mouth-opening difficulty after treatment for head and neck cancer admitted to the Oncology Department from February 2022 to October 2023 were selected for a 2-week exercise and nursing program. The patients were divided into a control group (February 1, 2022 to November 30, 2022) and an observation group (December 1, 2022 to October 31, 2023), with 30 patients in each group. The control group underwent routine mouth-opening functional exercises combined with cork for oral support training, while the observation group underwent routine mouth-opening functional exercises combined with oral massage and mouth-opening training sticks for oral support training. The mouth-opening degree, mouth-opening difficulty level, comfort level, compliance, and quality of life were observed in both groups. Results: Before the intervention, there were no statistically significant differences in mouth-opening degree and mouth-opening difficulty level between the two groups (P > 0.05). After the intervention, the mouth-opening degree, mouth-opening difficulty level, oral comfort level, compliance, and QLICP-HN scores in the observation group were all better than those in the control group, with statistically significant differences (P < 0.05). Conclusion: The combination of mouth-opening training sticks and oral massage with mouth-opening functional exercises can effectively improve the degree of mouth-opening difficulty, enhance oral comfort, increase compliance with mouth-opening exercises, and improve quality of life.

Can propensity score matching replace randomized controlled trials?

Randomized controlled trials(RCTs)have long been recognized as the gold standard for establishing causal relationships in clinical research.Despite that,various limitations of RCTs prevent its widespread implementation,ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria,amongst others.However,with the introduction of propensity score matching(PSM)as a retrospective statistical tool,new frontiers in establishing causation in clinical research were opened up.PSM predicts treatment effects using observational data from existing sources such as registries or electronic health records,to create a matched sample of participants who received or did not receive the intervention based on their propensity scores,which takes into account characteristics such as age,gender and comorbidities.Given its retrospective nature and its use of observational data from existing sources,PSM circumvents the aforementioned ethical issues faced by RCTs.Majority of RCTs exclude elderly,pregnant women and young children;thus,evidence of therapy efficacy is rarely proven by robust clinical research for this population.On the other hand,by matching study patient characteristics to that of the population of interest,including the elderly,pregnant women and young children,PSM allows for generalization of results to the wider population and hence greatly increases the external validity.Instead of replacing RCTs with PSM,the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each other.For example,in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial,the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization protocol.Therefore,PSM was incorporated in its analysis to create samples from the treatment and control arms that were matched in terms of these baseline characteristics,thus providing a fairer comparison for the impact of mannitol.This literature review reports the applications,advantages,and considerations of using PSM with RCTs,illustrating its utility in refining randomization,improving external validity,and accounting for non-compliance to protocol.Future research should consider integrating the use of PSM in RCTs to better generalize outcomes to target populations for clinical practice and thereby benefit a wider range of patients,while maintaining the robustness of randomization offered by RCTs.

FURTHER OPENING- UP IS KEY FOR CHINA’S HIGH-QUALITY DEVELOPMENT

The Central Economic Work Conference was held in Beijing from December 11 to 12.The conference discussed the plans,prospects and challenges for China’s economy heading into 2024,as well as evaluating the events of this year.It goes without saying that 2023 has been a challenging year for countries around the world as the global context has been unsatisfactory.Various geopolitical tensions have created a rise in uncertainties which have led to reduced growth worldwide and sent many economies into stagnation.In light of the critical factors affecting the stability of the global economy,China’s primary economic goal corresponds with the promotion and sustaining of free trade.

Characteristics and demographic factors of traditional Chinese medicine constitution types among elderly individuals in China:A national multistage cluster random study Author links open overlay panel

Objective To reveal the distribution characteristics and demographic factors of traditional Chinese medicine(TCM)constitution among elderly individuals in China.Methods Elderly individuals from seven regions in China were selected as samples in this study using a multistage cluster random sampling method.The basic information questionnaire and Constitution in Chinese Medicine Questionnaire(Elderly Edition)were used.Descriptive statistical analysis,chi-squared tests,and binary logistic regression analysis were used.Results The single balanced constitution(BC)accounted for 23.9%.The results of the major TCM constitution types showed that BC(43.2%)accounted for the largest proportion and unbalanced constitutions ranged from 0.9%to 15.7%.East China region(odds ratio[OR]=2.097;95%confidence interval[CI],1.912 to 2.301),married status(OR=1.341;95%CI,1.235 to 1.457),and managers(OR=1.254;95%CI,1.044 to 1.505)were significantly associated with BC.Age>70 years was associated with qi-deficiency constitution and blood stasis constitution(BSC).Female sex was significantly associated with yang-deficiency constitution(OR=1.646;95%CI,1.52 to 1.782).Southwest region was significantly associated with phlegm-dampness constitution(OR=1.809;95%CI,1.569 to 2.086).North China region was significantly associated with inherited special constitution(OR=2.521;95%CI,1.569 to 4.05).South China region(OR=2.741;95%CI,1.997 to 1.3.763),Central China region(OR=8.889;95%CI,6.676 to 11.835),senior middle school education(OR=2.442;95%CI,1.932 to 3.088),and managers(OR=1.804;95%CI,1.21 to 2.69)were significantly associated with BSC.Conclusions This study defined the distribution characteristics and demographic factors of TCM constitution in the elderly population.Adjusting and improving unbalanced constitutions,which are correlated with diseases,can help promote healthy aging through the scientific management of these demographic factors.

National Image Construction from the Perspective of Multimodal Metaphor-A Case Study of the Opening Ceremony of the Beijing Winter Olympics

The national image is a comprehensive concept with a distinct political feature,including the international image presented to the outside world,and also encompassing the national identity of the people.With the development of globalization,international cultural communication has become a crucial part of shaping the national image,and the opening ceremony of the Beijing Winter Olympics has become an important opportunity for China to showcase its national image to the world in the post-pandemic era.Based on Forceville’s multimodal metaphor theory,this paper examines the metaphorical phenomena contained in the performance and their functions,effects,and purposes in the construction of the national image.It is found that there are many scenes,images,and narratives in the opening ceremony,including war metaphor,competition metaphor,personification metaphor,and other conceptual metaphors.The focus of this paper is on multimodal metaphor in a broad sense,mainly encompassing auditory and visual modes.Through the use of these multimodal metaphors,the opening ceremony of the Winter Olympics builds an image of a vibrant,peace-loving,and responsible country,which not only demonstrates China’s cultural self-confidence,but also expresses the Chinese people’s beautiful vision for the early reunification of the motherland.

A High-Randomness and High-Stability Electronic Quantum Random Number Generator without Post Processing

Random numbers are one of the key foundations of cryptography.This work implements a discrete quantum random number generator(QRNG)based on the tunneling effect of electrons in an avalanche photo diode.Without any post-processing and conditioning,this QRNG can output raw sequences at a rate of 100 Mbps.Remarkably,the statistical min-entropy of the 8,000,000 bits sequence reaches 0.9944 bits/bit,and the min-entropy validated by NIST SP 800-90B reaches 0.9872 bits/bit.This metric is currently the highest value we have investigated for QRNG raw sequences.Moreover,this QRNG can continuously and stably output raw sequences with high randomness over extended periods.The system produced a continuous output of 1,174 Gbits raw sequence for a duration of 11,744 s,with every 8 Mbits forming a unit to obtain a statistical min-entropy distribution with an average value of 0.9892 bits/bit.The statistical min-entropy of all data(1,174 Gbits)achieves the value of0.9951 bits/bit.This QRNG can produce high-quality raw sequences with good randomness and stability.It has the potential to meet the high demand in cryptography for random numbers with high quality.

基于CAPE-OPEN标准的简捷炼油过程建模及常减压蒸馏流程在线模拟

简捷炼油过程模型广泛应用于运行监测、在线计算、实时优化等领域,但大多数模型只是将输入、输出变量进行关联,无法计算出各组分流量组成,难以集成在模拟软件中进行全流程模拟。本研究简化了炼油分离过程,开发了基于CAPE-OPEN标准的简捷炼油塔模型。首先,将炼油过程简化为连续的分离单元,根据实际产品数据校正模型参数,实现某一实际工况流程模拟;其次,将模型参数与实际工况操作变量数据相结合,采用径向基函数插值确定操作变量对模型参数的影响关系,实现多种工况流程模拟;最后,通过常减压蒸馏工业装置实例的3种工况进行验证。结果表明:各工况模拟结果与Aspen计算结果相比,初馏塔塔顶油馏出温度点偏差大多在2%以内,常减压蒸馏塔各侧线油的馏出温度点平均偏差在3%以内;与实际结果相比,平均误差都在5%以内,符合工程允许误差范围要求。所建模型的计算速度快,各塔均在0.2 s左右完成计算,适用于在线生产、调度等。

我国高质量教育资源供给机制创新与路径研究——来自美国“#GoOpen”计划的启示

数字化是当下教育改革的重点,也是未来教育发展的趋势。无论是作为“十四五”规划中的战略举措,还是党的二十大中提出的必然要求,构建数字化教育资源为主体的高质量教育资源体系在当下具有必要性与迫切性。美国#GoOpen计划自实施以来,在教育资源数字化、个性化、均等化三个方面均取得了一定成果。通过对该计划官方文件与政策进行解读,对其内涵与特点进行分析,我国在进行高质量教育资源建设及其供给路径探究过程中应当重视统筹规划,循序渐进,同时完善多重考核与评估机制,结合社会多方力量,保证每个学习者的享有权利,最终走向教育公平,共同发展。

MdDGK3-like as a negative regulator participates in ALA-induced PP2AC to promote stomatal opening in apple leaves

5-Aminolevulinic acid(ALA)can inhibit abscisic acid(ABA)-induced stomatal closure.However,the molecular mechanism is unclear.In this study,we found that ALA upregulated the MdPP2AC expression and PP2A activity in the apple(Malus domestica Borkh.cv.‘Fuji’)leaves.With the promoter of MdPP2AC as bait,a diacylglycerol kinase MdDGK3-like was selected by the Yeast One Hybrid(Y1H)from the cDNA library of the epidermis of apple leaves treated by exogenous ALA.Additional to binding the promoter of MdPP2AC,MdDGK3-like was found to inhibit the transcription activity of MdPP2AC promoter,while ALA significantly eliminated the role of MdDGK3-like.In tobacco leaves,MdDGK3-like was localized in the nucleus of stomatal guard cells.Therefore,MdDGK3-like might act as a transcription factor negatively regulating MdPP2AC expression and causing stomatal closure.To further identify MdDGK3-like functions,several transiently transgenic apple leaves(including overexpression and interference)were established.The results revealed that overexpression of MdDGK3-like promoted stomatal closure by increasing Ca^(2+)and H_(2)O_(2)and decreasing flavonol levels in the guard cells.Conversely,MdDGK3-like(i)led the stomatal opening with lower levels of Ca^(2+)and H_(2)O_(2)but higher flavonols.Based on these,we proposed a new hypothesis that ALA up-regulated MdPP2AC expression via negatively regulating the expression of MdDGK3-like to up-regulate PP2A expression and the enzyme activity,which improved the stomatal aperture.Since it was the first time that MdDGK3-like was showed to act as a transcription factor,the proposed model provided a new insight onto the mechanisms of ALA-induced stomatal opening.

CsIPT1b and CsUGT85A2 delay female corolla opening in cucumber by regulating the content of cytokinins

Corolla opening is essential for the propagation of unisexual flowering plants,meanwhile commodity fruits with opening corolla have higher commodity value in cucumber fresh food market.Until now,there is little research on the mechanism of corolla opening in cucumber.In a previous paper,we identified a unique cucumber(Cucumis sativus)line(‘6457’)that possesses super ovaries and shows delayed corolla opening when nutrient supplies are abundant.We also previously showed that the expression of CsIPT1b(isopentenyl transferase)and CsUGT85A2(cytokinin glycosyltransferase)is correlated with the delayed opening of the female corolla.Here,we investigated the mechanism of delayed female corolla opening in cucumber by conducting transgenic experiments,hormone assays,and yeast one-hybrid assays.CsIPT1b and CsUGT85A2 positively and negatively regulated delayed female corolla opening,respectively.In CsIPT1b-overexpressing plants and CsUGT85A2 knockout plants,the content of the trans-zeatin riboside,trans-zeatin,and N6-isopentenyladenosine was increased.Overall,our findings indicate that CsIPT1b and CsUGT85A2 were important regulators of the timing of female corolla opening.These genes could thus be targets to cucumber molecular breeding of fruit with flowers remaining on the tip.

First-line atezolizumab monotherapy versus single-agent chemotherapy in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen(IPSOS):a phase 3,global,multicentre,open-label,randomised controlled study

Background:Despite immunotherapy advancements for patients with advanced or metastatic non-small-cell lung cancer(NSCLC),pivotal first-line trials were limited to patients with an Eastern Cooperative Oncology Group performance status(ECOG PS)0-1 and a median age of 65 years or younger.We aimed to compare the efficacy and safety of first-line atezolizumab monotherapy with single-agent chemotherapy in patients ineligible for platinum-based chemotherapy.Methods:This trial was a phase 3,open-label,randomised controlled study conducted at 91 sites in 23 countries across Asia,Europe,North America,and South America.Eligible patients had stage IIIB or IV NSCLC in whom platinum-doublet chemotherapy was deemed unsuitable by the investigator due to an ECOG PS 2 or 3,or alternatively,being 70 years or older with an ECOG PS 0-1 with substantial comorbidities or contraindications for platinum-doublet chemotherapy.Patients were randomised 2:1 by permuted-block randomisation(block size of six)to receive 1200 mg of atezolizumab given intravenously every 3 weeks or single-agent chemotherapy(vinorelbine[oral or intravenous]or gemcitabine[intravenous];dosing per local label)at 3-weekly or 4-weekly cycles.The primary endpoint was overall survival assessed in the intention-to-treat population.Safety analyses were conducted in the safety-evaluable population,which included all randomised patients who received any amount of atezolizumab or chemotherapy.This trial is registered with ClinicalTrials.gov,NCT03191786.

Has China-ASEAN Trade opening increased China’ s carbon emissions?

This study uses carbon emission data at the provincial level in China between 1998-2018 and the proportion of the total import and export trade between provinces and the Association of Southeast Asian Nations(ASEAN)in GDP to measure the level of China-ASEAN trade openness.It examines the impact of China ASEAN trade openness on carbon emissions and its transmission mechanism,and selects the RMB/USD exchange rate as an instrumental variable to address the endogeneity of China-ASEAN trade openness variables.The impact of China-ASEAN trade openness on China’s environment is estimated within a two-stage least squares framework.The results show that trade openness between China and ASEAN positively impacts China’s environment and can facilitate carbon emission reduction.The scale,structural,and technology effects brought by China-ASEAN trade liberalization jointly promote China’s carbon dioxide emission reduction.An inverted“U”relationship is found between economic growth and environmental quality in China,and some provinces and municipalities have now crossed the inflection point of the curve,in which carbon emi ssions decrease with an increase in per capita wealth.

基于YOLO-OpenMax的水声通信信号开集识别方法

水声通信信号调制方式随着技术进步从典型的传统调制方式发展为水声通信机厂商私有开发的新型调制方式,这使得现有的水声通信信号闭集调制识别技术实用性受到制约,但现阶段鲜有研究基于深度学习的水声通信信号调制方式的开集识别方法。针对此现状,提出一种基于YOLO图像检测识别网络和OpenMax模型的开集识别方法。利用YOLOv5网络的输出特点,将传统OpenMax模型的处理方法进行改进,提出一种两步测试方法,实现了在多径信道下的水声通信信号的开集识别。仿真实验表明:在归一化系数为0.5,信噪比等于10 dB条件下的归一化开集识别准确率达到90%以上,实测数据同样验证了本文方法的有效性。

Theoretical and experimental study of a bi-stable piezoelectric energy harvester under hybrid galloping and band-limited random excitations

In the practical environment,it is very common for the simultaneous occurrence of base excitation and crosswind.Scavenging the combined energy of vibration and wind with a single energy harvesting structure is fascinating.For this purpose,the effects of the wind speed and random excitation level are investigated with the stochastic averaging method(SAM)based on the energy envelope.The results of the analytical prediction are verified with the Monte-Carlo method(MCM).The numerical simulation shows that the introduction of wind can reduce the critical excitation level for triggering an inter-well jump and make a bi-stable energy harvester(BEH)realize the performance enhancement for a weak base excitation.However,as the strength of the wind increases to a particular level,the influence of the random base excitation on the dynamic responses is weakened,and the system exhibits a periodic galloping response.A comparison between a BEH and a linear energy harvester(LEH)indicates that the BEH demonstrates inferior performance for high-speed wind.Relevant experiments are conducted to investigate the validity of the theoretical prediction and numerical simulation.The experimental findings also show that strong random excitation is favorable for the BEH in the range of low wind speeds.However,as the speed of the incoming wind is up to a particular level,the disadvantage of the BEH becomes clear and evident.

Effect of fence opening configurations on dune development

Fences have been widely used in coastal protection engineering for their low cost,simple deployment,and easy integration with ecosystems.The effects of fence porosity and height on dune development have been investigated while not much attention has been paid to the effects of fence opening configurations,such as opening size and geometry,and porosity distributions.In this study,we deployed eight fences with same height and similar porosity,but different opening configurations on a sandy beach in Pingtan,Fujian Province.Results indicate that there is a similar two-dune-one-trough pattern for all fences at the beginning of dune development,and opening size,orientation,and geometry,and porosity distribution control the leeward dune peak locations.Fences with small openings and non-uniform porosity have high trapping efficiency,and upper denser porosity may be the optimal design as these fences have the highest trapping efficiency and capacity.The conclusions from this study can provide guidance on practical fence design.

Postdoctoral Openings in Wenzhou University(China)for Chemistry,Chemical Engineering and Materials Science

About us:The Clige of Cemistry and Materials Engineering(CME)in Wenzhou University(Zhejing Province,China)is looking for postdoctoral candidates(up to 25) specialized in Chemistry Chemical Engineering and Materials Secence. The college has is Chemistry program ranking ESI Top 6‰ worldwide.

Effect of weak randomness flaws on security evaluation of practical quantum key distribution with distinguishable decoy states

Quantum key distribution provides an unconditional secure key sharing method in theory,but the imperfect factors of practical devices will bring security vulnerabilities.In this paper,we characterize the imperfections of the sender and analyze the possible attack strategies of Eve.Firstly,we present a quantized model for distinguishability of decoy states caused by intensity modulation.Besides,considering that Eve may control the preparation of states through hidden variables,we evaluate the security of preparation in practical quantum key distribution(QKD)scheme based on the weak-randomness model.Finally,we analyze the influence of the distinguishability of decoy state to secure key rate,for Eve may conduct the beam splitting attack and control the channel attenuation of different parts.Through the simulation,it can be seen that the secure key rate is sensitive to the distinguishability of decoy state and weak randomness,especially when Eve can control the channel attenuation.

Immune cell signatures and causal association with irritable bowel syndrome:A mendelian randomization study

BACKGROUND The mucosal barrier's immune-brain interactions,pivotal for neural development and function,are increasingly recognized for their potential causal and therapeutic relevance to irritable bowel syndrome(IBS).Prior studies linking immune inflammation with IBS have been inconsistent.To further elucidate this relationship,we conducted a Mendelian randomization(MR)analysis of 731 immune cell markers to dissect the influence of various immune phenotypes on IBS.Our goal was to deepen our understanding of the disrupted brain-gut axis in IBS and to identify novel therapeutic targets.AIM To leverage publicly available data to perform MR analysis on 731 immune cell markers and explore their impact on IBS.We aimed to uncover immunophenotypic associations with IBS that could inform future drug development and therapeutic strategies.METHODS We performed a comprehensive two-sample MR analysis to evaluate the causal relationship between immune cell markers and IBS.By utilizing genetic data from public databases,we examined the causal associations between 731 immune cell markers,encompassing median fluorescence intensity,relative cell abundance,absolute cell count,and morphological parameters,with IBS susceptibility.Sensitivity analyses were conducted to validate our findings and address potential heterogeneity and pleiotropy.RESULTS Bidirectional false discovery rate correction indicated no significant influence of IBS on immunophenotypes.However,our analysis revealed a causal impact of IBS on 30 out of 731 immune phenotypes(P<0.05).Nine immune phenotypes demonstrated a protective effect against IBS[inverse variance weighting(IVW)<0.05,odd ratio(OR)<1],while 21 others were associated with an increased risk of IBS onset(IVW≥0.05,OR≥1).CONCLUSION Our findings underscore a substantial genetic correlation between immune cell phenotypes and IBS,providing valuable insights into the pathophysiology of the condition.These results pave the way for the development of more precise biomarkers and targeted therapies for IBS.Furthermore,this research enriches our comprehension of immune cell roles in IBS pathogenesis,offering a foundation for more effective,personalized treatment approaches.These advancements hold promise for improving IBS patient quality of life and reducing the disease burden on individuals and their families.