Effectiveness Of Different Approaches Research Articles

The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education

ObjectiveTo compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support (DSME/S). MethodsWe randomized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education. The primary outcome was change in HbA1C over 6 months. ResultsAt 6 months, HbA1C improved within the plate method [−0.83% (−1.29, −0.33), P<0.001] and carbohydrate counting [−0.63% (−1.03, −0.18), P=0.04] groups but not the control group [P=0.34]. Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months (carbohydrate counting, P=0.36; modified plate method, P=0.08). In a pre-specified subgroup analysis of patients with a baseline HbA1C 7–10%, change in HbA1C from baseline improved in the carbohydrate counting [−0.86% (−1.47, −0.26), P=0.006] and plate method groups [−0.76% (−1.33, −0.19), P=0.01] compared to controls. ConclusionCDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10%. Practice implicationsBoth carbohydrate counting and the modified plate method improve glycemic control as part of DSME/S.

The effect of data structure and model choices on MFA results: A comparison of phosphorus balances for Denmark and Austria

Material Flow Analysis (MFA) studies for a particular substance often exist for several different countries or regions, but share a similar goal and scope. In direct comparisons of such regional resource budgets, the importance of the choices made in establishing an MFA system tends to be disregarded.We identify and quantify the effects of choices made in system layout, data material and uncertainty assessment on the outcome of regional MFAs using two recent country-scale MFAs (of Denmark and Austria) of phosphorus as a case study.We highlight the differences in system boundaries and definition of flows and processes. We quantify types and choice of data sources; analyse the consistency of the data used by looking at the extent of data reconciliation, as a measure of model quality; quantify the effect of different approaches to uncertainty assessment; and show the influence of aggregating/disaggregating flows.We show that differences in system layout are mostly attributable to varying goals and scope definitions. Direct comparison of uncertainties across studies is problematic: both studies draw on similar types of data sources, yet they show very different uncertainty assessments; the uncertainty assessment in MFA is always subjective to a certain extent. We demonstrate that reconciliation of conflicting data provides a useful measure to assess data consistency and model quality: data are more consistent (5% average change in reconciled data) in the Austrian than in the Danish (9%) case. We suggest an iterative approach to uncertainty assessment. Likewise, we demonstrate the effect of the aggregation of flows on model uncertainty.These findings quantify and emphasise the importance of examining MFA studies’ metadata and suggest an approach to be followed when drawing on such studies as a source of information.

“I see a drawing. I think it is. . .” Investigating visual ‘literacy’ among adult learners in KwaZulu-Natal

This article reports on a research project in KwaZulu-Natal which investigated how Zuluspeaking adults who attended literacy classes interpreted illustrations from health education materials. Individual interviews were conducted in rural and urban areas, where participants responded to a range of pictures in order to assess the effectiveness of different approaches to communication. The research intended to discover whether dated guidelines on illustrating for readers with limited education are still useful, and to offer insights to guide the future practice of illustrators in similar contexts. Patterns of interpretation were observed which suggested different levels of interpretation of the illustrations, revealing ways in which participants made and expressed meaning from what they saw. These levels correspond with semiotic theories of visual communication. Semiotic approaches to visual analysis provide tools with which to explore the construction of meaning. In this way the article theorises visual interpretation in the context of health education materials designed for audiences with limited education

Evaluation of crack width in RC ties through a numerical “range” model

Crack phenomenon in reinforced concrete (RC) ties is studied herein by means of a numerical “range model”, based on bond between steel and concrete. Since a unique definition of the crack pattern evolution is not possible for these elements, through the definition of this “range”, defined by the curves of maximum and minimum crack spacing (and consequently width), all the possible crack patterns of the considered tension member are so included. Comparisons with significant experimental results available in the technical literature prove that the proposed approach can be successfully adopted also for design purposes, since it provides a correct estimate of maximum crack width. The obtained results are compared with Codes provisions (ACI and Model Code 2010) and the effectiveness of different approaches for predicting crack width is analyzed and discussed.

Promotion of literacy and numeracy in pyramid classrooms in Germany

Students’ school success in literacy and numeracy is often hampered by limited prerequisites in these domains, yet the effectiveness of different approaches to support students is unclear. Using professional training programmes for kindergarten teachers, we tested the effects of three kindergarten approaches in a quasi-experimental pre- and post-test-control-group design: (1) the ‘Pyramid Approach’, (2) a domain-specific training programme focusing on literacy and numeracy and (3) a domain-specific Developmentally Appropriate Approach focusing on literacy and numeracy. A control group without any professional training for teachers and therefore without explicit domain-specific support for the children was also tested. Twenty-five kindergartens in Germany with 397 children between 5 and 6 years of age participated. The three intervention groups performed significantly better in terms of achievement in literacy and numeracy than the control group did, but there were no significant effects between the three intervention groups.

Quicker response results in better SpO2 control - a comparison of 3 FiO2-titration strategies in ventilated preterm infants.

The impact of SpO2 target ranges (TR) has been carefully studied; however, reports suggest a wide variation among infants and centres in maintaining the intended range. Little is known about the effectiveness of different approaches to manual control. Auto-SpO2 controllers are now available which show promise. The aim was to compare two different protocol-driven manual strategies with different response requirements to each other, and a faster automated system (AveaCLiO2, Yorba Linda, CA, USA). In a crossover design, each of the three FiO2/SpO2 approaches was implemented in three randomly assigned consecutive 2.5-hour runs. The two manual strategies (Attentive and Observational) were implemented by a trained operator. The primary endpoints were time in 1) SpO2 TR, 2) < 80% SpO2 and 3) >98% SpO2. Fifteen studies were completed. All three approaches resulted in good control, with time in the target range >60%. CLiO2 use reflected reduced exposure at the two SpO2 extremes. Post hoc analysis determined that the differences were more marked in the infants with more frequent desaturations. Likewise, in this group, the Attentive strategy performed better than the Observative. All three approaches provided excellent control of SpO2 in infants with infrequent desaturations, significantly better than typical routine care. In hard to manage infants with frequent desaturations, faster response appeared to result in better control. The potential of automating the tedious error prone FiO2 adjustment offers significant promise. If manual titration of FiO2 is to remain the usual method of care, additional studies are needed to identify optimal approaches.

Sexual Partnership Patterns Among South African Adolescent Girls Enrolled in HPTN [corrected] 068: Measurement Challenges and Implications for HIV/STI Transmission.

Estimates of sexual partnership durations, gaps between partnerships, and overlaps across partnerships are important for understanding sexual partnership patterns and developing interventions to prevent transmission of HIV/sexually transmitted infections (STIs). However, a validated, optimal approach for estimating these parameters, particularly when partnerships are ongoing, has not been established. We assessed 4 approaches for estimating partnership parameters using cross-sectional reports on dates of first and most recent sex and partnership status (ongoing or not) from 654 adolescent girls in rural South Africa. The first, commonly used, approach assumes all partnerships have ended, resulting in underestimated durations for ongoing partnerships. The second approach treats reportedly ongoing partnerships as right-censored, resulting in bias if partnership status is reported with error. We propose 2 "hybrid" approaches, which assign partnership status to reportedly ongoing partnerships based on how recently girls last had sex with their partner. We estimate partnership duration, gap length, and overlap length under each approach using Kaplan-Meier methods with a robust variance estimator. Median partnership duration and overlap length varied considerably across approaches (from 368 to 1024 days and 168 to 409 days, respectively), but gap length was stable. Lifetime prevalence of concurrency ranged from 28% to 33%, and at least half of gap lengths were shorter than 6 months, suggesting considerable potential for HIV/STI transmission. Estimates of partnership duration and overlap lengths are highly dependent on measurement approach. Understanding the effect of different approaches on estimates is critical for interpreting partnership data and using estimates to predict HIV/STI transmission rates.

Evaluating alternatives for decommissioning California's offshore oil and gas platforms.

This paper introduces a series of 6 additional papers in this issue that describe an in-depth analysis of options for decommissioning oil and gas platforms offshore southern California. Although current leases require lessees in both state and federal waters to completely remove all production facilities and restore the seafloor to its pre-platform condition, other options have emerged since these leases were signed. Laws and regulations in other jurisdictions (particularly in federal waters) have evolved to allow a number of other uses such as aquaculture, alternative energy production, and artificial reefing. In response, the California Natural Resources Agency initiated an effort to investigate the issues associated with these and other decommissioning alternatives. The papers in this series are the result of the second phase in this process, a broad investigation of the engineering, economic, and environmental costs and benefits of the most feasible and likely options. In addition to the project's final report, the authors produced an interactive mathematical decision model, PLATFORM, that enables users to explore the implications of different decommissioning projects and options, as well as the effects of different approaches to valuing the associated costs and benefits.

The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation

BackgroundThis study was set in 39 neighbourhoods involved in a government-funded regeneration programme called New Deal for Communities (NDC) that began in 1998. We tested whether or not different approaches to engage residents in decision-making in these areas had different social and health impacts.MethodsFirst, NDC approaches to community engagement (CE) were grouped into four types. We then assessed the impact of these types and whether or not their cost-effectiveness could be calculated. We used existing data from surveys and from NHS and government sources. New data were collected from interviews with residents of NDC areas and former staff. We have also made these data publicly available so that other researchers can assess impacts over a longer time period.ResultsThe four CE types included an empowering resident-led approach (type A), in which residents had a lot of control over decisions, and an instrumental professional-led approach (type D), in which CE was more often used to promote the priorities of public sector organisations. Type B was initially empowering but over time became instrumental and type C balanced empowerment and instrumental approaches from the beginning. There were few statistically significant differences in health and social impacts by CE type. However, when there were statistically significant differences, the results suggest that type A, and to a lesser extent, types B and C approaches may have had better outcomes than the type D approach in relation to levels of participation and trust between residents, control or influence over decisions, social cohesion and mental health. NDC areas with a type D approach were the only ones where residents’ ‘sense of control’ deteriorated over time. Residents of these areas were less likely to feel that the NDC had improved their area and to experience improvements in mental health. However, some aspects of cohesion and trust improved in type D areas. The findings of our economic analyses are mixed. It was difficult to cost engagement activities, measures of effectiveness were not robust and relating costs that could be calculated to specific measures of effectiveness was difficult. There were almost as many negative as positive scores, making the calculation of cost-effectiveness an arbitrary exercise.ConclusionsOur results are consistent with a theory that the greater the levels of control that residents have over decisions affecting their lives the more likely there are to be positive impacts. It is plausible that an empowerment approach to CE would help build trust and community cohesion, and that having a greater influence over NDC decisions could lead to more people feeling that the NDC initiative had improved an area. Conversely, our results are also consistent with a theoretical position which suggests that instrumental approaches, which try to engage residents in agendas that are not theirs, will have relatively little positive impact and that community cohesion and well-being may be undermined. The study has not produced firm evidence on the effectiveness of different approaches to CE. However, the findings do suggest that programmes involving CE will be more likely to have positive impacts if the approaches to CE are experienced as more empowering and less instrumental (i.e. less focused on the agendas of external agencies). Future methodological research is needed to develop better measures of empowerment at the collective level and more robust approaches to empowerment on health and well-being at the population level.FundingThe National Institute for Health Research Public Health Research programme.

Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation.

Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.

Examining mixing methods in an evaluation of a smoking cessation program

Three different methods were used in an evaluation of a smoking cessation study: surveys, focus groups, and phenomenological interviews. The results of each method were analyzed separately and then combined using both a pragmatic and dialectic stance to examine the effects of different approaches to mixing methods. Results show that the further apart the methods are philosophically, the more diverse the findings. Comparisons of decision maker opinions and costs of the different methods are provided along with recommendations for evaluators’ uses of different methods.

Improving partial mutual information-based input variable selection by consideration of boundary issues associated with bandwidth estimation

Input variable selection (IVS) is vital in the development of data-driven models. Among different IVS methods, partial mutual information (PMI) has shown significant promise, although its performance has been found to deteriorate for non-Gaussian and non-linear data. In this paper, the effectiveness of different approaches to improving PMI performance is investigated, focussing on boundary issues associated with bandwidth estimation. Boundary issues, associated with kernel-based density and residual computations within PMI, arise from the extension of symmetrical kernels beyond the feasible bounds of potential inputs, and result in an underestimation of kernel-based marginal and joint probability distribution functions in the PMI. In total, the effectiveness of 16 different approaches is tested on synthetically generated data and the results are used to develop preliminary guidelines for PMI IVS. By using the proposed guidelines, the correct inputs can be identified in 100% of trials, even if the data are highly non-linear or non-Gaussian.

Effect of Low-Energy Diets Differing in Fiber, Red Meat, and Coffee Intake on Cardiac Autonomic Function in Obese Individuals With Type 2 Diabetes.

The autonomic nervous system (ANS) regulates both the cardiovascular system and energy balance and is disturbed in diabetes and obesity. The effect of different approaches of caloric restriction on ANS function has not been assessed in individuals with diabetes. Thus, we sought to determine whether low-energy diets differing in fiber, red meat, and coffee intake exert differential effects on cardiac autonomic function. In this randomized parallel-group pilot trial, obese patients with type 2 diabetes were randomly allocated to consume either a diet high in cereal fiber, free of red meat, and high in coffee (n = 13) or a diet low in fiber, high in red meat, and coffee free (n = 15) over 8 weeks. Eight measures of heart rate variability (HRV) indicating vagal and/or sympathetic modulation over 3 h and inflammatory markers were determined during a hyperinsulinemic-euglycemic clamp. After 8 weeks, both dietary interventions resulted in a mean weight loss of 5-6 kg, a mean decline in heart rate of 4-6 bpm, and improvement in vagally mediated HRV. However, the changes in HRV parameters from baseline to 8 weeks did not differ between the groups. In the entire study cohort, incremental HRV from baseline to 8 weeks was associated with enhanced oxidative glucose utilization (P < 0.05), but not with insulin sensitivity and inflammatory markers. In obese patients with type 2 diabetes, energy restriction per se over 8 weeks contributed to improved cardiac vagal function in relation to improved oxidative glucose utilization. This preliminary finding should be verified in a confirmatory trial.

Meiofaunal community analysis by high-throughput sequencing: Comparison of extraction, quality filtering, and clustering methods

Using molecular tools to examine community composition of meiofauna, animals 45μm to 1mm in size living between sediment grains in aquatic environments, is relatively new in comparison to bacterial and archaeal microbial studies. Although high-throughput molecular approaches are starting to be applied to these ccommunities, effectiveness of different approaches for nucleic acid extraction from meiofauna is poorly known and bioinformatic pipelines vary between studies. Given this situation, there is a need for protocols to be developed that promote consistency in sample collection and processing, sequence quality filtering, and Operational Taxonomic Unit (OTU) clustering methods. Herein, we assess different approaches used for DNA extraction (DNA extracted directly from sediment versus elutriated material retained on a 45μm sieve) as well as how different quality filtering methods of sequences and OTU clustering algorithms impact genetic assessment of meiofauna community composition. DNA extracted directly from sediment resulted in higher presence of non-metazoan eukaryotic taxa; in contrast, an elutriation (resuspension with decanting) approach increased meiofauna abundance and enriched metazoan OTUs. In regards to bioinformatics analyses, the number of overall OTUs varied by clustering algorithm, primarily due to the applied method of sequence quality filtering. However, alpha and beta diversity analyses showed similar trends regardless of bioinformatics pipeline utilized. Based on our results, we recommend studies of meiofauna communities first elutriate samples prior to DNA extraction and include multiple biological replicates to account for variation in community-level composition. The quality filtering method should be carefully considered as this step accounted for large discrepancy in the number of OTUs inferred.

Yes, but does it produce better doctors?

Yes, but does it produce better doctors?

Improvement in the long-term stability of parameters of encapsulated magnetic field sensors based on La[sbnd]Sr[sbnd]Mn[sbnd]O thin films

The effectiveness of different approaches used for improvement of stability of colossal magnetoresistance-B-scalar magnetic field sensors made from polycrystalline manganite La0.83Sr0.17MnO3 thin films were considered. We show that the ageing process of sensors can be accelerated by annealing the films in Ar atmosphere at 75–125°C and covering them by hot melt adhesive (polyethylene). Ageing kinetics of electrical resistance and magnetoresistance (MR) were investigated as well as the influence of hot melt adhesive. Despite of increased resistance only small changes of the MR and the temperature coefficient of resistance were observed. The obtained results are explained by the oxygen release, displacement or redistribution which takes place most probably in grain boundaries of polycrystalline manganites. Based on the obtained results optimal conditions for the stabilization of encapsulated sensors parameters were found resulting in the resistance drift less than 1.5% per year.

Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period.

To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation. Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management. The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients. A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes.

Increased frequency of dietitian visits is associated with improved body mass index outcomes in obese youth participating in a comprehensive pediatric weight management program.

Comprehensive weight management (CWM) interventions are most effective for obese youth when they include multiple components, such as nutrition, physical activity, and behavioral strategies. However, effectiveness of different approaches to delivering the nutrition component is unknown. Our aim was to evaluate two dietary approaches and extent of registered dietitian (RD) involvement on outcomes of obese youth participating in a CWM program. A retrospective review of CWM patients was conducted before and after redesign of the nutrition component. The earlier clinical model (CM1) introduced a portion-controlled diet at an RD visit after the initial medical visit, whereas the later clinical model (CM2) introduced a reduced glycemic load diet at the initial medical visit. CWM patients were included if they had at least one RD visit and an initial and 3- to 6-month medical follow-up visit during CM1 or CM2. Differences between CM1 and CM2 groups regarding changes in BMI and programmatic success (BMI change ≤0) were evaluated. Median BMI change during follow-up did not differ between CM1 (n=41) and CM2 (n=51) groups (p=0.41). In a multiple logistic regression model combining study groups, each additional RD visit was associated with a 28% increased odds of success (odds ratio [95% confidence interval]: 1.28 [1.00, 1.64]; p=0.05). The probability of success exceeded 78% with ≥1 RD visit/month versus 43% with minimal RD exposure. Increased frequency of RD visits is associated with improved BMI outcomes in obese youth participating in a CWM program regardless of dietary intervention implemented.

The effects of partitioning on phylogenetic inference.

Partitioning is a commonly used method in phylogenetics that aims to accommodate variation in substitution patterns among sites. Despite its popularity, there have been few systematic studies of its effects on phylogenetic inference, and there have been no studies that compare the effects of different approaches to partitioning across many empirical data sets. In this study, we applied four commonly used approaches to partitioning to each of 34 empirical data sets, and then compared the resulting tree topologies, branch-lengths, and bootstrap support estimated using each approach. We find that the choice of partitioning scheme often affects tree topology, particularly when partitioning is omitted. Most notably, we find occasional instances where the use of a suboptimal partitioning scheme produces highly supported but incorrect nodes in the tree. Branch-lengths and bootstrap support are also affected by the choice of partitioning scheme, sometimes dramatically so. We discuss the reasons for these effects and make some suggestions for best practice.

Engineering Gesture-Based Authentication Systems

Gestures are a topic of increasing interest in authentication, but successfully implementing them as a security layer requires reliable gesture recognition. So far, much work focuses on new ways to recognize gestures, leaving discussion on the viability of recognition in an authentication scheme to the background. It's as yet unclear how gesture recognition should be deployed for practical and robust real-world authentication. In this article, the authors analyze the effectiveness of different approaches to recognizing gestures and the potential for use in secure gesture-based authentication systems. This article is part of a special issue on privacy and security.