Quality Of Practice Research Articles

Free open source communities sustainability: Does it make a difference in software quality?

ContextFree and Open Source Software (FOSS) communities’ ability to stay viable and productive over time is pivotal for society as they maintain the building blocks that digital infrastructure, products, and services depend on. Sustainability may, however, be characterized from multiple aspects, and less is known how these aspects interplay and impact community outputs, and software quality specifically.ObjectiveThis study, therefore, aims to empirically explore how the different aspects of FOSS sustainability impact software quality.Method16 sustainability metrics across four categories were sampled and applied to a set of 217 OSS projects sourced from the Apache Software Foundation Incubator program. The impact of a decline in the sustainability metrics was analyzed against eight software quality metrics using Bayesian data analysis, which incorporates probability distributions to represent the regression coefficients and intercepts.ResultsFindings suggest that selected sustainability metrics do not significantly affect defect density or code coverage. However, a positive impact of community age was observed on specific code quality metrics, such as risk complexity, number of very large files, and code duplication percentage. Interestingly, findings show that even when communities are experiencing sustainability, certain code quality metrics are negatively impacted.ConclusionFindings imply that code quality practices are not consistently linked to sustainability, and defect management and prevention may be prioritized over the former. Results suggest that growth, resulting in a more complex and large codebase, combined with a probable lack of understanding of code quality standards, may explain the degradation in certain aspects of code quality.

Parameterization of Physiologically Based Biopharmaceutics Models: Workshop Summary Report.

This Article shares the proceedings from the August 29th, 2023 (day 1) workshop "Physiologically Based Biopharmaceutics Modeling (PBBM) Best Practices for Drug Product Quality: Regulatory and Industry Perspectives". The focus of the day was on model parametrization; regulatory authorities from Canada, the USA, Sweden, Belgium, and Norway presented their views on PBBM case studies submitted by industry members of the IQ consortium. The presentations shared key questions raised by regulators during the mock exercise, regarding the PBBM input parameters and their justification. These presentations also shed light on the regulatory assessment processes, content, and format requirements for future PBBM regulatory submissions. In addition, the day 1 breakout presentations and discussions gave the opportunity to share best practices around key questions faced by scientists when parametrizing PBBMs. Key questions included measurement and integration of drug substance solubility for crystalline vs amorphous drugs; impact of excipients on apparent drug solubility/supersaturation; modeling of acid-base reactions at the surface of the dissolving drug; choice of dissolution methods according to the formulation and drug properties with a view to predict the in vivo performance; mechanistic modeling of in vitro product dissolution data to predict in vivo dissolution for various patient populations/species; best practices for characterization of drug precipitation from simple or complex formulations and integration of the data in PBBM; incorporation of drug permeability into PBBM for various routes of uptake and prediction of permeability along the GI tract.

EVALUATING AUTOMOTIVE SPICE® AS PROCESS REQUIREMENTS

AbstractSoftware and Systems engineering projects in the Automotive industry are often mandated to develop according to the Automotive SPICE® standard. Despite a highly qualified workforce, many projects or organizations fail to implement compliant processes. This paper reinterprets the Automotive SPICE® standard, viewing its base practices as process requirements. Using a set of quality criteria for requirements, the subsequent evaluation of base practices for quality results in an aggregate and individual analysis of the ASPICE base practices. The analyses reveal, amongst others, deficiencies in the aspects of singularity, unambiguity, and reasoning structure. The paper proposes a public, collaborative effort to enrich the requirements with purpose, detail, and structure.

Ethnomathematics-based Fraction Number E-modules for Prospective Elementary School Teachers

Fractions are one of the materials that could be clearer to understand for students and prospective MI teacher students. Problems in understanding fractions often arise due to the need for more connection with everyday life. This research aims to develop ethnomathematics-based fractional number e-modules. This research type uses the ADDIE model, which is limited to the development stage. The subjects involved in this study were experts consisting of material experts and media experts, as well as twelve students in second-semester class A as small group test subjects. Data collection in the study was carried out through observation, interviews, and questionnaires with research instruments in the form of module validation sheets, response questionnaires, and test questions. The data obtained were then analyzed using qualitative descriptive and quantitative descriptive analysis. The results obtained from this development research are as follows: (1) the validity of the ethnomathematics-based fractional number e-module was declared valid with the results of the material expert review of 97.93% and the results of the media expert review of 96.66%, (2) the practicality of ethnomathematics-based fractional number e-module based on student responses is declared practical, namely with test results of 90.21% Based on these results, it can be concluded that the ethnomathematics-based fraction number e-module teaching materials developed are valid and practical qualifications.

Practical quality improvement changes for a low-resourced pediatric unit.

This work describes a sustainable and replicable initiative to optimize multi-disciplinary care and uptake of clinical best practices for patients in a pediatric intensive care unit in Low/Middle Income Countries and to understand the various factors that may play a role in the reduction in child mortality seen after implementation of the Quality Improvement Initiative. This was a longitudinal assessment of a quality improvement program with the primary outcome of intubated pediatric patient mortality. The program was assessed 36 months following implementation of the quality improvement intervention using a t-test with linear regression to control for co-variates. An Impact Pathway model was developed to describe potential pathways for improvement, and context was added with an exploratory analysis of adoption of the intervention and locally initiated interventions. 147 patients were included in the sustainability cohort. Comparing the initial post-implementation cohort to the sustainability cohort, the overall PICU unexpected extubations per 100 days mechanical ventilation decreased significantly from baseline (6.98) to the first year post intervention (3.52; p < 0.008) but plateaued without further significant decrease in the final cohort (3.0; p = 0.73), whereas the mortality decreased from 22.4 (std 0.42) to 9.5% (std 0.29): p value: 0.002 (confidence intervals: 0.05;0.21). The regression model that examined age, sex, diagnosis and severity of illness (via aggregate Pediatric Risk of Mortality (PRISM) scores between epochs) yielded an adjusted R-squared (adjusting for the number of predictors) value of 0.046, indicating that approximately 4.6% of the variance in mortality was explained by the predictors included in the model. The overall significance of the regression model was supported by an F-statistic of 3.198 (p = 0.00828). age, weight, diagnosis, and severity of illness. 15 new and locally driven quality practices were observed in the PICU compared to the initial post-implementation time period. The Impact Pathway model suggested multiple unique potential pathways connecting the improved patient outcomes with the intervention components. Sustained improvements were seen in the care of intubated pediatric patients. While some of this improvement may be attributable to the intervention, it appears likely that the change is multifactorial, as evidenced by a significant number of new quality improvement projects initiated by the local clinical team. Although currently limited by available data, the use of Driver Diagram and Impact Pathway models demonstrates several proposed causal pathways and holds potential for further elucidating the complex dynamics underlying such improvements.

Do food quality, service quality, and hygiene practices in street food affect satisfaction and behavioral intentions? The role of emotion: in Istanbul and Bangkok

ABSTRACT This study has three main purposes. First, the impact of perceived hygiene practices, food and service quality in street food consumption on satisfaction was examined. Second, the role of positive emotions in these relationships was examined. Finally, the impact of satisfaction from street food experiences on revisit and recommendation intention was studied. The sample for Study 1 was 344 local tourists who experienced street food in Istanbul between July–August 2020. And the sample for Study 2 was 325 local tourists who experienced street food in Bangkok between January-February 2020. To test the research model, a two-study approach was used. For both samples, hygiene practices and service quality in street food were found to positively and significantly affect satisfaction. On the other hand, the impact of food quality was observed in Study 1. In both studies (Studies 1 and 2), no moderator role of emotion was observed in the impact of hygiene practices, food and service quality perceptions on satisfaction. Plus, satisfaction with street food directly affects revisit and recommendation intentions. As consumers’ attitudes and behaviors toward street food consumption were examined in two different research sites and the street foods were significantly different in both regions, the similarities and differences in the findings are valuable. Furthermore, the role of positive emotions on the perceptions that affect satisfaction with street food consumption in two research sites was examined for the first time.

The Effect of Service Quality and Sustainability Practices on Brand Equity: The Case of Korean Air Passengers

The Effect of Service Quality and Sustainability Practices on Brand Equity: The Case of Korean Air Passengers

A critical review of the reporting of reflexive thematic analysis in Health Promotion International.

Using the concept of methodological congruence-where the different elements of a study 'fit' together-we explore both problematic and good practice in (reflexive) thematic analysis (TA) as reported in Health Promotion International (HPI). Aligning with the importance we place on 'owning your perspectives' we situate this exploration in relation to our understanding of the variation in approaches to TA and qualitative research more broadly. This contextualization is necessary for highlighting why we judge practices to be in/congruent, and to facilitate more knowing congruence in future research. We critically reviewed a 'sample' of 31 papers published in HPI between 2010 and 2023 citing Braun and Clarke as reference for TA. We overview a range of problematic and good features of the use of TA in HPI, before focusing on two domains that seemed to present key challenges: theory and themes. Methodological incongruence can occur when postpositivist values and practices unwittingly creep into ostensibly non-positivist TA; we encourage thoughtfully and what we term 'knowing' consideration of theory, and quality practices and criteria. Methodological incongruence can also occur through mismatched conceptualizations of themes-notably, the use of 'topic summaries' as themes for reflexive TA (and fragmented thematic structures with 'thin' themes). We provide examples from the reviewed papers to demonstrate good practice in researcher reflexivity, articulation of theoretical and methodological frameworks and congruent themes. However, mindful of power dynamics, we only discuss problematic practice in general terms, to protect author anonymity. To facilitate thoughtful, quality TA-of all kinds-we provide eight pointers for researchers (and reviewers) to guide quality practice, and facilitate the use of concepts, procedures and criteria that promote knowing methodological congruence.

Developing a model for measuring performance of universities in fragile countries and its application in Somali universities

PurposeThe study addresses the critical need for a performance measurement model tailored to universities in fragile countries. It aims to identify and prioritise criteria and sub-criteria within the model, specifically designed to accommodate the unique challenges faced by the higher education institutions in fragile nations.Design/methodology/approachThe study employs the analytic hierarchy process (AHP) methodology, combining responses from respondents in four fragile countries: Somalia, Afghanistan, Sudan and Chad. The absolute measurement approach of AHP was employed for the final ranking of 15 Somali universities.FindingsThe study unveils a comprehensive performance measurement model customised for fragile countries. It identifies the necessary criteria and sub-criteria to assess university performance in such challenging contexts. The findings also reveal the significant performance disparities among 15 Somali universities, shedding light on areas for improvement.Research limitations/implicationsThis study’s small sample of countries and response bias are its limitations. The study is limited to fragile countries and may not fully depict the complexity of issues experienced by all types of universities.Practical implicationsThis research provides a practical guide for universities in fragile countries to enhance their performance in the face of unique challenges. The model offers a framework for fostering quality practices, improving education quality and enhancing overall performance. Decision-makers and educators can leverage this model to drive changes within their institutions.Originality/valueThis research pioneers a performance-measuring model for fragile countries, filling a long-standing gap in the literature. It provides novel insights into the challenges of judging university performance in demanding contexts and is useful for academics, policymakers and top management of institutions.

A Human Saliva Quality and Holistic Practices A Review on the Effects of Meditation, Dance and Exercise

This review article provides an overview of the effects of meditation, dance, and exercise on human saliva quality. Physical and mental fitness is essential for overall well-being, and engaging in these activities has been shown to promote physical and mental health. However, with the decline in physical activity due to technological advancements, stress has become a prevalent issue in modern society. Meditation, dance, and exercise have emerged as effective strategies for stress management. Stress levels can be measured through biomarkers, including those found in blood and saliva. Saliva may serve as a potential indicator of stress levels. Saliva contains various components that can serve as biomarkers for detecting systemic diseases and assessing overall health. Exploring the changes in saliva composition and understanding the physiological significance in response to meditation, dance, and exercise can provide valuable insights into the mechanisms underlying their positive effects on health. Saliva biomarkers have been associated with stress, inflammation, immune function, and even neurodegenerative disorders. Therefore, investigating the impact of these practices on saliva quality can uncover novel connections between mind-body interventions and overall well-being. This review highlights the importance of considering saliva as a valuable biofluid and encourages further research on salivary biomarkers in the context of meditation, dance, and exercise to expand our understanding of their therapeutic potential and optimise health outcomes.

Continuous quality evaluation of the Asanté rapid test for recent infection for robust kit lot quality verification.

The Sedia Biosciences Asanté rapid test for recent infection (RTRI) can identify HIV infections and characterize HIV-1 as recent or long-term infection via the positive verification (V) line and long-term line (LT) line, respectively. Tracking with Recency Assays to Control the Epidemic (TRACE) program uses RTRI assays. Successful implementation of TRACE requires high-quality test performance. The goal of this study is to evaluate the additional quality practices established for new kit lots prior to field use. Asanté lot quality control data from the manufacturer is reviewed by the Centers for Disease Control and Prevention International Laboratory Branch (CDC-ILB) in the Division of Global HIV and TB using. If a lot passes manufacturer quality control and CDC-ILB review, test kits are sent to CDC-ILB for further evaluation. Evaluation by CDC includes inter-rater reliability and linear regressions comparing the V and LT lines against reference data as well as V and LT line data between testers. A Bland-Altman analysis was conducted to assess bias and systematic error. Overall, CDC-ILB passed 29 (91%) out of 32 Sedia Biosciences Asanté kit lots that initially passed manufacturing quality control from July 2017 to May 2020. Regression analyses demonstrate that test kits are performing as expected with consistent R2≥0.92 for both V and LT lines. On average, inter-rater reliability kappa was 0.9, indicating a strong level of agreement. Bland-Altman analyses demonstrate high agreement with little to no systematic error and bias. Ongoing evaluation of new RTRI kit lots is important to ensure high quality test performance. Rejecting 9% of kit lots highlight the importance of continuing to work with manufacturers to ensure consistent kit production and quality assurance (QA) activities. Investing in effective QA measures, conducting both pre- and post-market performance data reviews, could help improve RTRI accuracy and outcomes in similar testing programs.

Considerations of quality: examining theoretical perspectives informing infant and toddler pedagogy in Aotearoa/New Zealand

ABSTRACT With the growing participation of infants and toddlers in group care settings ongoing examination and research into what constitutes quality education and care for this age group is paramount. Theories and approaches espoused in Aotearoa/New Zealand’s mandated early childhood curriculum Te Whāriki: He whāriki mātauranga mo ngā mokopuna o Aotearoa. Early childhood curriculum (Ministry of Education, 2017) were examined to ascertain how they could inform quality pedagogy and practice with infants and toddlers. The research used an integrative literature review methodology to investigate the theoretical underpinnings of this curriculum and how these aligned to quality pedagogy for infants and toddlers. Evidence emerging from the research found many similarities between the pedagogical practices related to each theory and alignment with quality experiences for infants and toddlers. Moving forward it is suggested that an increased depth of knowledge of theories and their relationship to pedagogy for infants and toddlers would enhance teaching practice. The review also recommends that further research should be undertaken into how kaiako conceptualise and enact educational theory in infant and toddler ECEC settings.

THE EXTENT OF THE IMPACT OF TOTAL QUALITY MANAGEMENT ON ACHIEVING THE COMPETITIVE ADVANTAGE OF INFANT MILK COMPANIES IN BAGHDAD/DIYALA PROVINCE

Companies in the infant formula industry are currently facing multiple challenges and difficulties due to advancing technological trends, increased global competition, and changing consumer behaviors. However, these companies can achieve excellence and maximize their profits by adopting new methods and mechanisms, establishing internal rules within the company, and applying them professionally and distinctly. Among these crucial methods is the adoption of Total Quality Management (TQM) to achieve a competitive advantage for infant formula companies in local and global markets Total Quality Management is a fundamental element for improving a company's competitiveness and ensuring its continuity and success. TQM effectively contributes to enhancing organizational performance and achieving operational and production objectives by focusing on employee efficiency and achieving organizational unity in performance. The implementation of Total Quality Management requires companies to adhere to recognized quality standards and practices, continuously improve processes, and work towards achieving customer satisfaction. Total Quality Management is an ongoing process and not time-bound; it does not end when a company meets a quality standard. Therefore, quality management is built on performing tasks correctly from the beginning to prevent the repetition of mistakes. It serves as a proactive and strategic approach that replaces the need for rework. Achieving a competitive advantage in infant formula companies heavily depends on Total Quality Management to obtain superior and excellent outputs for competitive markets. These companies are interrelated and depend on each other, so linking quality management to achieving outstanding performance can build numerous sustainable competitive advantages for companies

Key performance indicators to inform evaluation of wound care programmes for people with complex wounds: a protocol for systematic review.

The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken. Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer. Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search. This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

A Qualitative Study on Quality Practices in Hospitals During the COVID-19 Pandemic

A Qualitative Study on Quality Practices in Hospitals During the COVID-19 Pandemic

Geospatial Insights into Greece’s Desertification Vulnerability: A Composite Indicator Approach

The Environmentally Sensitive Areas Index (ESAI) is a comprehensive tool for assessing the susceptibility of areas to desertification. This index analyzes various parameters that are vital for environmental health. Through this index, factors such as human activities, geology, soil quality, vegetation and climate patterns are scrutinized. The analysis assigns weights to each participating factor. Thus, the index is derived from the aggregation of four categories (vegetation, climate, soil quality and management practices), and each of them is independently assessed to understand ecological health. In this way, the level of vulnerability to desertification is effectively measured. The application of the index in Greece (for a period of 20 years, 1984–2004) showed signs of environmental degradation and identified many areas with a high risk of desertification. Notably, there was a substantial increase in cultivated land within rural areas, contributing to shifts in the environmental landscape. Furthermore, this period is distinguished as the driest in the last century, with a peak between 1988 and 1993. The consequential rise in irrigation demand, driven by the simultaneous growth of crops and the intensification of agricultural practices, underscores the intricate interplay between human activities and environmental vulnerability.

The quality landscape of economics: The top five and beyond

Abstract Whereas a growing number of studies evidence that research quality notions and evaluative practices are field- and context-specific, many focus on single evaluative practices or moments. This paper introduces the concept of quality landscape to capture dynamics of interrelated quality notions, evaluative moments and practices in a research field. This concept shifts focus to (1) the field-specific universe of practices, devices and notions of research quality; (2) ways that interrelated valuations provide structure and boundeness to a landscape; (3) ways that perspectives on a shared landscape may change with position within the landscape; and (4) ways in which a quality landscape is intertwined with the field’s socio-epistemic conditions. With extensive interview data from top ranked departments in three Scandinavian countries, we use economics as a case for exploring the value of a quality landscape lens. We find that the field’s journal hierarchy and its ‘Top 5’ journals dominate the landscape, while other important evaluative practices beyond the top five are interlinked with the journal hierarchy. However, quantitative evaluative metrics common in other fields are virtually absent. We further find that national and local policy reinforce the journal hierarchy emphasis, and that career stages affect quality perspectives. We argue that the quality landscape is structured as a quality hierarchy with a focus on the core ‘general interest’, and suggest the notion of ordinalization (the process of rank ordering) as an organizing principle linking the quality landscape to the field’s socio-epistemic conditions. Finally, we offer suggestions for further research.

Lean Construction: A Sustainability Operation for Government Projects

The current state budget allocated for Indonesian government projects has exceeded 10% for infrastructure development. This large budget indicates a need for the construction industry to implement more professional management practices for better cost, time, quality, safety, and environmental impact. Lean construction is used to increase productivity and reduce waste in a project. Therefore, this study aimed to extend lean construction principles to the planning and execution phases of DB projects, where these two entities are integrated into the main contractor. Quantitative and qualitative study methods were used to analyze secondary data from six DB project sites and conduct focus group discussions (FGDs) with expert panels using the Delphi method for consensus. The results showed the factors and variables that influence the implementation of lean construction in government projects in Indonesia.

Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

Investigation of Biogenic Amine Levels and Microbiological Activity as Quality Markers in Some Dairy and Fish Products in Food Markets in the Kingdom of Saudi Arabia.

This study aimed to verify the presence of biogenic amines (BAs) and evaluate the microbiological activity of some food samples collected from retail stores in the Kingdom of Saudi Arabia. A total of thirty-five dairy and fish products were collected and analyzed for BAs, including putrescine (PUT), cadaverine (CAD), spermidine (SPE), histamine (HIS), spermine (SPR), and tyramine (TYR), as well as for total colony count (TCC), lactic acid bacteria (LAB), Enterobacteriaceae, yeast and mold (Y and M), coliforms, and aerobic sporulation count (ASF). The thin layer chromatography (TLC) method was used in the analytical methodology to identify the BAs. The results showed the presence of BAs in all dairy products, but their concentration did not exceed the maximum permissible limit, which in contrast was established by the Food and Drug Administration (FDA) at 10 mg/100 g. The amounts of BAs in fish products varied significantly. All fish product samples contained levels of BAs below the permissible limit. Results of an independent study also indicated potential toxicity at levels of BAs (>10 mg/100 g) in Egyptian herring. Enterobacteriaceae and the coli group were present in higher concentrations in the Egyptian herring samples, whereas other samples (particularly frozen shrimp) showed increased TCC levels with a higher concentration of histamine-producing bacteria. From a consumer safety perspective, this study also indicated that food samples generally contained acceptable levels of BAs. In conclusion, there is a need to improve and standardize food quality and hygiene practices during production and storage to ensure human safety and prevent HIS formation.