Role Of Inheritance Research Articles

Random regression animal models for genetic evaluation of test-day milk yield and milking duration in Saudi dairy goats

Random regression animal model was applied for analyzing the relationships between daily milk yield (MK) and milking duration (DR) in dairy goats comparing with reviewed estimates in dairy cows. The current analyzed data involved 17345 sample test-day records from multiparous Saudi dairy goats. A cubic random regression was applied for representing additive genetic variances in all studied traits across all different days in milk (12 groups). Based on multi-lactation random regression data-set analysis, the role of inheritance was greatest during the later stages of lactation. Heritability estimates of daily milk yield (h2MK) ranged from 0.15 to 0.54. While estimates of heritability for milking duration (h2DR) were very low during the first 60 days of lactation, being not more than 0.04. During the 2nd half of lactation the estimates of h2DR ranged from 0.35 to 0.39. Results of genetic variations for lactation records during early production life showed that highest milk harvest with intermediate milking rate could be achieved. Estimates of expected breeding values for milk yield and milking duration increased in different rates with progressing days in milk groups. These results indicated that individual selection results would be favorably achieved during the late part of lactation. Additive genetic correlations between measures of all traits at different lactation months continuously decreased as the interval between test days increased. Additive genetic correlations between milking duration and milk yield were positive and considerably high. Correlations between expected breeding values of both traits ranged from 0.41 to 0.83 (mean = 0.69) across different lactation months. More details on estimates of breeding values, estimates of permanent environmental and additive genetic correlations for all traits were tabulated.

The role of inheritance in the development of adolescent varicoceles.

BackgroundThe prevalence of varicoceles is estimated to be 15% in the general population but is nearly 35% among men with primary infertility and increases by 10% with each decade of life. Studies among adults infer a higher rate of varicoceles among first-degree relatives of patients with varicoceles. However, these studies do not consider the presence of varicoceles, or other venous abnormalities, at the time of desired paternity in first-degree relatives of adolescent patients. Our aim was to document the prevalence of varicoceles and varicose veins among first-degree relatives of pediatric patients diagnosed with varicoceles.MethodsA series of 884 patients between the ages of 17 and 22 diagnosed with a varicocele were contacted and of the responders, permission was asked to discuss family history. Each patient underwent a telephone survey regarding the presence of a varicocele in the father prior to achieving paternity, the presence of a varicocele in brothers in childhood, or varicose veins in the father and mother prior to achieving pregnancy. If a varicocele or varicose vein was present, a history of intervention was surveyed. Descriptive statistics were performed to assess overall prevalence of varicocele and varicose veins in first-degree relatives. Chi-squared and logistic regression analyses were performed.ResultsIn total, 152 patients (17.2%) responded and 139 (91.4%) consented to the telephone survey (mean age 19.5±1.84 years old). Overall, 12.9% of fathers had varicoceles and 8.6% of fathers underwent surgical intervention. Among siblings, 18 individuals had a varicocele and 5.6% of siblings with varicocele required intervention. Varicose veins were diagnosed in 7.9% of fathers and 25.2% of mothers; 8.6% of mothers underwent intervention. Surveillance was employed in 76.3% of patients, and surgery undertaken 21.6%. Patients with grade 2 or 3 varicoceles were more likely to have a father with a varicocele than those with grade 1 varicocele (P=0.037). Patients with grade 2 varicocele were more likely to have a father who required varicocele surgery than grade 1 (P=0.019). There was no statistical association of adolescent varicocele and varicose veins in first degree relatives (P=0.306).ConclusionsThis series shows that while a father’s prevalence is similar to that of the general population, higher grade varicoceles were associated with a higher prevalence of varicoceles and surgical ligation. This suggests the existence of a hereditary predisposition to high grade varicoceles. Furthermore, varicocele is not associated with varicose veins in first degree relatives.

What Genetics Tells us about Cardiovascular Disease in Diabetic Patients?

Long-term diabetes causes other disease development such as cardiovascular diseases (CVD). Genetics can help us to predict cardiovascular diseases in diabetic patients. We searched PubMed and Google scholar for the terms: Cardiovascular disease, Diabetes, Polymorphism, Genetics from 2000 to 2017, and then included the relevant studies in our study. Essential role of inheritance in multifactorial disease is obviously clear, however, varies by disease and by other factors such as age of disease onset and subtype of disease. CVD is a multifactorial disease which can develop in diabetes patients as a result of increase in oxidative stress. It may also increase expression of pro-inflammatory factors and induce apoptosis in cardiomyocytes. Predictive polymorphisms are risk estimators for CVD incidence in diabetes patients. SNPs such as 894G>T in NOS3 gene, V16 in MnSOD gene, Rs3918188 in NOS3 gene and Rs11614913 in MiR-196a2 increase the risk of CVD in diabetic patients are precious polymorphisms for CVD prediction in diabetic population. CDKN2B, MTHFR and ACE genes have polymorphisms which increase the risk of diabetes and other polymorphisms on these genes increase the risk of CVD, we suggest these genes are valuable to study and find out if there are any polymorphisms that predict CVD susceptibility in diabetic patients.

On the Accumulation of Wealth: The Role of Inheritances

Inheritances reduce relative measures of wealth inequality according to recent evidence from several countries. Using a theoretical model and Swedish administrative data, we first show that this counter-intuitive finding can be explained by high intergenerational wealth mobility and low inheritance inequality relative to wealth inequality. We then exploit two quasi-experiments: randomness in the timing of death and an inheritance tax repeal. We find that the equalizing effect of inheritances is short-lasting and reverted within a decade since less wealthy heirs deplete their inherited wealth rapidly in contrast to more affluent heirs. This depletion represents a constant reduction in annual savings equivalent in size to 10% of the average inheritances amount. 70% of this additional annual non-labor income are allocated to consumption (half of it is car purchases) in the first years, compared to 90% in later years. The remaining 30% (or 10%) reflect a considerable albeit declining labor supply elasticity with respect to inheritances. Taken together, our findings suggest that inheritance taxation can reduce long-run wealth inequality solely through the taxation of very large inheritances.

Intergenerational Wealth Mobility and the Role of Inheritance: Evidence from Multiple Generations

This study estimates intergenerational correlations in mid-life wealth across three generations, and a young fourth generation, and examines how much of the parent-child association that can be explained by inheritances. Using a Swedish data set we find parent-child rank correlations of 0.3–0.4 and grandparents-grandchild rank correlations of 0.1–0.2. Conditional on parents’ wealth, grandparents’ wealth is weakly positively associated with grandchild’s wealth and the parent-child correlation is basically unchanged if we control for grandparents’ wealth. Bequests and gifts strikingly account for at least 50 per cent of the parent-child wealth correlation while earnings and education are only able to explain 25 per cent.

Genetic Analysis of Some Agronomic Traits in Two Bread Wheat Crosses under Heat Stress Conditions.

The present study was carried out at Shandaweel Agric., Res., Station, ARC, Egypt, in 2014/2015, 2015/2016 and 2016/2017 seasons. The present investigation aimed to determine genetic parameters and type of gene action controlling some agronomic traits of the two bread wheat crosses, Shandawel 1× Gemmeiza 11 and Misr 1× Giza 168 under normal 20th Nov. and heat stress 20th Dec. conditions, using six populations model (P1, P2, F1, F2, BC1 and BC2). Scaling test indicated the presence of non-allelic interactions for all studied traits except number of spikes/plant in cross 2 under normal conditions, number of grains/spike in cross1 under favorable conditions and in cross 2 under heat stress and grain yield/plant in cross 1 under normal conditions. The relative importance of additive and dominance effects varied for traits and crosses under normal and heat stress conditions. Dominance effects were generally greater than additive, except for days to heading in cross 2 under heat stress, plant height under normal conditions in cross 2 and biological yield in cross 1 under heat stress and in cross 2 under normal conditions, indicating that dominant genes playing major role in inheritance of these beside the additive one. Dominance × dominance gene interaction was higher in magnitude than additive × additive and additive × dominance in most traits, indicating that these traits greatly affected by dominance and non-allelic interactions. Therefore, it is advisable to delay selection to later generations with increased homozygosity. Positive highly significant heterosis over better parent values were observed for all studied traits, except for plant height in cross 2 under both sowing dates, number of grains/spike in cross 1 under heat stress and in cross 2 under both environments. Broad sense and narrow sense heritability and genetic advance ranged from moderate to high in most cases. Based on these results, these two crosses could be selected to produce high yielding lines under heat stress conditions.

Waardenburg Syndrome Expression and Penetrance

Through a combination of in silico research and reviews of previous work, mechanisms by which nonsense-mediated mRNA decay (NMD) affects the inheritance and expressivity of Waardenburg syndrome is realized. While expressivity and inheritance both relate to biochemical processes underlying a gene's function, this research explores how alternative splicing and premature termination codons (PTC's) within mRNAs mutated in the disease are either translated into deleterious proteins or decayed to minimize expression of altered proteins. Elucidation of splice variants coupled with NMD perpetuating the various symptoms and inheritance patterns of this disease represent novel findings. By investigating nonsense mutations that lie within and outside the NMD boundary of these transcripts we can evaluate the effects of protein truncation versus minimized protein expression on the variable expressivity found between Type I and Type III Waardenburg syndrome, PAX3, while comparatively evaluating EDN3 and SOX10's role in inheritance of Type IV subtypes of the disease. This review will demonstrate how alternative splicing perpetuates or limits NMD activity by way of PTC positioning, thereby affecting the presentation of Waardenburg syndrome.

The extension of biology through culture

Biology is the study of life. How our understanding of the nature and evolution of living systems is being enriched and extended through new discoveries about social learning and culture in human and nonhuman animals is the subject of the collection of articles we introduce here. Recent decades have revealed that social learning and the transmission of cultural traditions are much more widespread in the animal kingdom than earlier suspected, affecting numerous forms of functional behavior and creating a secondary form of evolution, built onto the better-known primary, genetically based form. New scientific approaches to the study of human cultural evolution have also emerged and become productive. However, these developments in the study of cultural phenomena in both human and nonhuman animals have yet to be seriously integrated into mainstream evolutionary biology. Here we offer an introductory overview of the background and scope of a collection of articles that report recent progress in these fields, and outline their proposed significance for biology at large. The theoretical backbone of the life sciences, its central organizing principle, is of course evolution, by now rich in both theory and empirical support (1⇓–3). The great synthesis of Darwin’s and Wallace’s evolutionary insights and early 20th century understanding of genetics that became known as the “Modern Synthesis” was achieved by a brilliant set of biologists mainly in the period 1938–1946 (4), and its principles have provided the core of evolutionary theory since that time (5). Thus, contemporary texts on “evolution” focus on such topics as mutation, genetically based inheritance, population genetics, genomics, and the natural and sexual selection pressures that shape gene frequencies, genotypes, and phenotypes (1, 2, 6, 7). Genes and their role in inheritance have come to be celebrated as the pivotal elements in evolution (8). … [↵][1]1To whom correspondence should be addressed. Email: a.whiten{at}st-andrews.ac.uk. [1]: #xref-corresp-1-1

How to prevent SCD in the young?

Sudden cardiac death in the young (SCDY) is always a devastating event. The death is sudden and unexpected and often in a person who was thought to be healthy. In recent years our understanding of these tragic events have drastically improved; 10–20years ago we did not know how often SCD occurred in the young, and we had sparse knowledge on the role of inheritance. We have found that SCD corresponds to 7% of all deaths with an overall (highest possible) incidence rate of 2.8 per 100,000 person-years (autopsy rate of sudden death cases of 75%). This incidence rate is higher than in the Veneto region (1.0), in the Netherlands (1.6), and in the UK (1.8), but can be explained by differences in definition and methodological factors. Cause of death in SCDY also differs to some extent between countries. Recent data suggest that there are identifiable risk factors for SCDY such as symptoms, comorbidities and polypharmacy. SCDY is to some extent preventable and this can be achieved through several initiatives: 1. better OCHA treatment including readily available AEDs, 2. family screening on the families left behind, and 3. better diagnostics and treatment for patients at risk for SCDY.

Evaluation of reciprocal cross populations for spike-related traits in early consecutive generations of bread wheat (Triticum aestivum L.)

Breeding effort on increasing grain yield of wheat will incessantly continue because it is indispensable product. Obtaining the genetic information such as genotypic variation, heritability, genetic advance is the fundamental components of these studies. It is important that the maternal effects are put forward throughout successive generations because of genotypic and/or environmental effects as far as variation. This research was conducted to investigate changes of reciprocal crosses throughout successive generations and determine selection criteria for high yield in early generations. For this purpose, the populations were analyzed with regard to genotypic and phenotypic variation coefficient, heritability, genetic advance and Unweighted Pair Group Method (UPGMA) cluster analysis for real crosses, reciprocals and all genotypes separately. According to the results, heritability and genetic advance values of traits investigated were highly varied throughout successive generations among real crosses, reciprocals and all genotypes. This finding indicated that non-additive gen effects or epitasis played a role in inheritance of all traits. Dissimilarity of crosses than their reciprocals indicated variation of successive generation. Dissimilarity value of each parent differed as generation progresses according to combination created. This condition suggested that there were maternal effects in this population throughout successive generations. Grain weight per spike, spike harvest index and spike density had high direct and indirect effects on the grain yield at all of three generations, it proved that these traits can be a selection criterion for early generations. Sana was the best parent and ?Bezostaja x Krasunia? and ?Krasunia x Pehlivan? were best performance in most of traits at all generations.

Reduced small world brain connectivity in probands with a family history of epilepsy.

The role of inheritance in ascertaining susceptibility to epilepsy is well established, although the pathogenetic mechanisms are still not very clear. Interviewing for a positive family history is a popular epidemiological tool in the understanding of this susceptibility. Our aim was to visualize and localize network abnormalities that could be associated with a positive family history in a group of patients with hot water epilepsy (HWE) using resting-state functional magnetic resonance imaging (rsfMRI). Graph theory analysis of rsfMRI (clustering coefficient γ; path length λ; small worldness σ) in probands with a positive family history of epilepsy (FHE+, 25) were compared with probands without FHE (FHE-, 33). Whether a closer biological relationship was associated with a higher likelihood of network abnormalities was also ascertained. A positive family history of epilepsy had decreased γ, increased λ and decreased σ in bilateral temporofrontal regions compared to FHE- (false discovery rate corrected P ≤ 0.0062). These changes were more pronounced in probands having first degree relatives and siblings with epilepsy. Probands with multiple types of epilepsy in the family showed decreased σ in comparison to only HWE in the family. Graph theory analysis of the rsfMRI can be used to understand the neurobiology of diseases like genetic susceptibility in HWE. Reduced small worldness, proportional to the degree of relationship, is consistent with the current understanding that disease severity is higher in closer biological relations.

Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association.

Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn's disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as "the explosive mixture" at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.

Intergenerational Wealth Mobility and the Role of Inheritance: Evidence from Multiple Generations

This study estimates intergenerational correlations in mid-life wealth across three generations, and a young fourth generation, and examines how much of the parent-child association that can be explained by inheritances. Using a Swedish data set we find parent-child rank correlations of 0.3–0.4 and grandparents-grandchild rank correlations of 0.1–0.2. Conditional on parents' wealth, grandparents' wealth is weakly positively associated with grandchild's wealth and the parent-child correlation is basically unchanged if we control for grandparents' wealth. Bequests and gifts strikingly account for at least 50 per cent of the parent-child wealth correlation while earnings and education are only able to explain 25 per cent.

The role of inheritance in forming and deforming hyper-extended rift systems and creating collisional orogens

The role of inheritance in forming and deforming hyper-extended rift systems and creating collisional orogens

Studies on age at first semen freezing and age at first semen use of Sahiwal bulls

The objective of this study was to investigate the studies on the reproduction traits i.e. Age at first semen freezing and Age at first semen use in Sahiwal bulls. Informations on Sahiwal bulls during last 27 years (1987-2013) were collected from reproductive records, bull AI register maintained at different sections of institute viz. record room of DCB Division, Cattle Yard, Artificial Breeding Research Centre (ABRC), National Dairy Research Institute (NDRI), Karnal. The present study revealed that the average Age at first freezing and Age at first use in Sahiwal breeding bulls were estimated as (3.17 ± 0.01) years and (5.35 ± 0.01) years, respectively and the coefficient of variation were 18.93% and 20%, respectively. It was found that highest rank was in Set VIII th and lowest rank was in Set IV th for early Age at first semen freezing of Sahiwal bull. For early Age at first semen use of bull, highest rank was in Set IX th and lowest rank was in Set III th . Since, temporary environmental factors are major role in inheritance of traits so better breeding management should be implemented. Multi-trait evaluation with reproductive traits may be carried out for simultaneous improvement of reproductive performances of Sahiwal bulls in the herd.

Le rôle de l’héritage et du revenu du travail dans les choix matrimoniaux

Cet article etudie l’importance du patrimoine herite dans les choix matrimoniaux en France. A partir des enquetes Actifs financiers et Patrimoine, nous utilisons l’information disponible sur le patrimoine parental afin d’estimer le patrimoine herite espere des individus tout au long de leur vie, ce qui permet d’etudier le patrimoine herite total. Nous montrons qu’il existe une similarite des conjoints du point de vue du patrimoine herite. De plus, il est tres improbable pour une personne n’ayant pas recu d’heritage d’epouser un riche heritier (ou une riche heritiere). Alors que l’education explique la majeure partie de l’homogamie en termes de revenu permanent, elle explique seulement 20 % de la correlation du patrimoine herite. Enfin, nous mettons en evidence une faible substituabilite entre heritage et revenus du travail. Ces derniers ne compensent que partiellement un manque de richesse parentale. Nos estimations font etat d’un degre d’homogamie relativement stable entre 1992 et 2010. Le degre de substituabilite augmente quant a lui legerement a la fin de la periode d’etude. Deux mecanismes peuvent expliquer ces resultats : le processus de socialisation et l’effet des preferences. Ces nouveaux resultats sont determinants pour comprendre la dynamique des inegalites et plus particulierement les consequences de l’evolution a long terme de l’heritage dans les pays riches.

Milly Bloom as Blind Spot in Ulysses

What little criticism exists on the function of Milly Bloom in Ulysses discusses her in the narrow roles of a younger version of Molly and/or as the object of Bloom’s incestuous desire. While the Telemachean plot does lend Oedipal interpretation to Ulysses , it is by focusing more narrowly on Milly’s ubiquitous presence and displacement in Bloom’s moments of inheritance anxiety that her significance becomes apparent. Using a psychoanalytic approach that privileges the role of displacement over Freudian kinship dynamics, we can see that Bloom’s nostalgia for the past is always accompanied by some documentation of a displacement of Milly that is never quite registered. These crucial moments, or blind spots, point to Milly’s role in inheritance that is almost always avowed but never fully recognized; they cue the reader to imagine a reproductive futurity for Bloom outside the son-as-heir model of inheritance—the possibility of daughter-as-heir or non-sex-bound succession.

Potence Ratio and Path Analysis for Yield and Quality Traits in Single Crosses of Maize ( Zea mays L. ) Produced in Syria

The present study was carried out at the Maize Researches Department in General Commission for Science agriculture Research (G-C-S-A-R) Damascus, Syria. This study aimed at estimating the potence ratio and phenotypic correlations and path analysis coefficient analysis for protein, oil, and starch content in grain, grain yield per plant and 100-kernel weight. Twenty eight single cross hybrids were produced using a half diallel cross in 2008 cropping season and consequently evaluated during 2009 cropping season. Potence ratio results indicated that partial and over-dominance gene effects played a major role in inheritance of protein, oil, and starch content in grain while, over-dominance gene effects were the most dominant in the inheritance grain yield per plant and 100-kernel weight. Positive and high significantly correlations were observed between protein and oil content in grain (0.366) and between grain yield and100-kernel weight (0.386). Potence ratio estimates indicating partial and over-dominance towards the higher starch, oil, protein, for 100 grain yield per plant over-dominance gene effects played a major role in inheritance of this trait. Path analysis results showed the contribution of oil content in grain, 100-kernel weight and grain yield per plant for protein content in grain variation account 15.55%, and the relative important of oil content in grain reach to 13.40%. So, it can be considered as selection criteria which may lead to improve protein content in maize grain.

Incidence, clinical features and possible etiology of early onset (≤40 years) colorectal neoplasms

The aim of the study was to investigate the clinical features, including survival, of patients with colorectal malignancies developed at a very early age (≤40 years), together with possible factors involved in the pathogenesis of these rare neoplasms. The study took advantage of the existence of a specialized colorectal cancer Registry active from 1984. 57 patients met the criteria of early onset cancer; main epidemiological data, morphology, stage, familial aggregation, possible role of inheritance and survival were analyzed. Despite the relevant increase over time of all registered patients, joiningpoint analysis of crude incidence rate of early onset colorectal neoplasms revealed a certain stability of these tumors (EAPC: 2.4, CI 14-22) with a constant prevalence of the male sex. Stage at diagnosis did not show significant variations between early onset and maturity onset colorectal neoplasms. Hereditary as well as familial cases were significantly (P < 0.005 and 0.03) more frequent among patients with early onset tumors, although in the majority of them no specific etiological factor could be identified. Survival was more favorable in patients with early onset tumors, though this had to be attributed to the higher presence of some histological types in early onset cases. Survival was significantly more favorable for patients of all ages registered in the last decade. Incidence of early onset colorectal cancer was relatively stable between 1984 and 2008. A male preponderance was evident through the registration period. Hereditary and familial cases were significantly more frequent among early onset case. A well defined etiology could be observed in 16% of the cases (versus 2-3% in older individuals). Five-year survival showed a significant improvement over time.

Exploring risk, prevention and educational approaches for the non‐diabetic offspring of patients with type 2 diabetes – a qualitative study

To understand the knowledge and perceptions of type 2 diabetes and to explore preferable educational strategies in the non-diabetic offspring of patients with the disease. Type 2 diabetes is an increasingly prevalent disease with significant long-term consequences. Offspring of patients with type 2 diabetes have an increased risk of developing the disease compared with the general population. Previous studies have shown that offspring have a poor perception of their own risk. A qualitative study was carried out using semi-structured one-to-one interviews. Analysis was completed using a structured framework approach. Research was carried out during January-March 2011 in the north east of UK. Six offspring of patients diagnosed with the disease were interviewed. Participants balanced positive and negative aspects of their lifestyle behaviours to estimate their own risk. They had adequate knowledge of healthy lifestyle behaviours, but were uncertain about the long-term effects and seriousness of the disease and the role of inheritance. Behavioural changes at an individual level would only be motivated by an event, which would impact on their own health. Participants believed that 'fear'-based strategies to health promotion would be most effective to encourage behaviour change. Knowledge of individual risk and why diabetes was serious was limited and variable. The health behaviours of this at-risk group were complex. Nurses engaged in the care of at-risk individuals must take this complexity into account when developing and implementing multi-faceted strategies to improve awareness.