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Mary Hayden

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Christiana Amalba

University of Cape Coast

David Van Sickle

University of Wisconsin-Madison

CIRAD

Hélène BROUTIN

Centre National de la Recherche Scientifique / French National Centre for Scientific Research

University of Amsterdam

Julia Leimkugel

Jeanpierre Dangy

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Papers by Mary Hayden

The Economic Burden of Meningitis to Households in Kassena-Nankana District of Northern Ghana

by Mary Hayden and Gertrude N Nyaaba

Objective: To estimate the direct and indirect costs of meningitis to households in the Kassena-N... more Objective: To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana. Methods: A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident. Results: The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest. Conclusion: Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

Using Weather Forecasts to Help Manage Meningitis

by Thomas Hopson, Mary Hayden, and Gertrude N Nyaaba

Integrating research, operations, and community engagement, a multinational and multidisciplinary... more

Urban Sustainability and Resilience: From Theory to Practice

by Paty Romero Lankao, Olga Wilhelmi, Mary Hayden, and Daniel Gnatz

Urbanization and urban areas are profoundly altering the relationship between society and the env... more Urbanization and urban areas are profoundly altering the relationship between society and the environment, and affecting cities' sustainability and resilience in complex ways at alarming rates. Over the last decades, sustainability and resilience have become key concepts aimed at understanding existing urban dynamics and responding to the challenges of creating livable urban futures. Sustainability and resilience have also moved and are now core analytic and normative concepts for many scholars, transnational networks and urban communities of practice. Yet, even with this elevated scholarly attention, strategies for bridging between research and practice remain elusive, and efforts to understand and affect change towards more sustainable and resilient urban centers have often fallen short. This paper seeks to synthesize, from this issue's papers and other strands of literature, the knowledge, theory and practice of urban sustainability and resilience. Specifically, we focus on what capacities urban actors draw on to create sustainability and resilience and how different definitions of these concepts intersect, complement, or contradict each other. We then examine the implications of those intersections and differences in the efforts by urban actors to enhance the capacity to change unsustainable trajectories and transform themselves, their communities, and their cities toward sustainable and resilient relationships with the environment.

Using Weather Forecasts to Help Manage Meningitis in the West African Sahel

by Fredrick Semazzi, Thomas Hopson, and Mary Hayden

Bulletin of the American Meteorological Society, 2014

Microclimate and Human Factors in the Divergent Ecology of Aedes aegypti along the Arizona, U.S./Sonora, MX Border

by Mary Hayden and Cecilia Rosales

EcoHealth, 2010

This study examined the association of human and environmental factors with the presence of Aedes... more This study examined the association of human and environmental factors with the presence of Aedes aegypti, the vector for dengue fever and yellow fever viruses, in a desert region in the southwest United States and northwest Mexico. Sixty-eight sites were longitudinally surveyed along the United States-Mexico border in Tucson, AZ, Nogales, AZ, and Nogales, Sonora during a 3-year period. Aedes aegypti presence or absence at each site was measured three times per year using standard oviposition traps. Maximum and minimum temperature and relative humidity were measured hourly at each site. Field inventories were conducted to measure human housing factors potentially affecting mosquito presence, such as the use of air-conditioning and evaporative coolers, outdoor vegetation cover, and access to piped water. The results showed that Ae. aegypti presence was highly variable across space and time. Aedes aegypti presence was positively associated with highly vegetated areas. Other significant variables included microclimatic differences and access to piped water. This study demonstrates the importance of microclimate and human factors in predicting Ae. aegypti distribution in an arid environment.

CORRIGENDUM: False Alarm Rate or False Alarm Ratio?

Weather and Forecasting, 2009

... Lindsey R. Barnes enXco, Denver, Colorado. David M. Schultz ... The first paper that used the... more

Epidemic Dengue and Dengue Hemorrhagic Fever at the Texas-Mexico Border: Results of a Household-based Seroepidemiologic Survey, December 2005

A dengue-2 epidemic causing dengue hemorrhagic fever (DHF) occurred in the contiguous border citi... more A dengue-2 epidemic causing dengue hemorrhagic fever (DHF) occurred in the contiguous border cities of Matamoros, Tamaulipas (Mexico), and Brownsville, TX, in 2005. In December, we conducted a household-based epidemiologic survey to determine the incidence and seroprevalence of dengue infection among Matamoros and Brownsville residents and to identify risk factors associated with infection. Antibodies to dengue were measured in 273 individuals. The estimated incidence of recent dengue infection was 32% and 4% among Matamoros and Brownsville participants, respectively. The estimated prevalence of past dengue infection was 77% and 39% among Matamoros and Brownsville participants, respectively. The Breteau index was 28 in Matamoros and 16 in Brownsville, reflecting an abundant winter population of Aedes mosquitoes. Discarded waste tires and buckets were the two largest categories of infested containers found in both cities. Our results underscore the risk for epidemic dengue and DHF in the Texas-Mexico border region.

False Alarms and Close Calls: A Conceptual Model of Warning Accuracy

Weather and Forecasting, 2007

The false alarm rate (FAR) measures the fraction of forecasted events that did not occur, and it ... more The false alarm rate (FAR) measures the fraction of forecasted events that did not occur, and it remains one of the key metrics for verifying National Weather Service (NWS) weather warnings. The national FAR for tornado warnings in 2003 was 0.76, indicating that only one in four tornado warnings was verified. The NWS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;s goal for 2010 is to reduce this

Barriers and Bridges to Prevention and Control of Dengue: The Need for a Social–Ecological Approach

Ecohealth, 2005

This article critically examines how programs for the prevention and control of dengue fever have... more This article critically examines how programs for the prevention and control of dengue fever have been conducted in the absence of an integrated approach, and considers the social and ecological factors influencing their effectiveness. Despite recognition of dengue fever as the most important arboviral disease affecting humans, and in spite of a greater emphasis on community-based control approaches, the burden placed on the communities, countries, and regions affected by this disease continues to rise. In considering historical experience in the Americas and the Asia-Pacific region, as well as the global forces that are exerting new pressures, the important elements of successful control programs are identified as community ownership, partnership with government, leadership, scalability, and control of immature mosquitoes. The key barriers to the exchange of knowledge and the transdisciplinary cooperation necessary for sustainable dengue control are rooted in differences in values among policy-makers, citizens, and scientists and are repeatedly expressed in technical, economic, cultural, geographic, and political dimensions. Through consideration of case studies in Cuba, Guatemala, Singapore, Thailand, Indonesia, and Vietnam, the limitations of control approaches that fail to take into account the complexities of ecological and social systems are presented. Bridges to effective control are identified as the basis for adaptability, both of control programs to the mosquito vector’s changing behavior and of education programs to public, regional and local particularities, as well as transdisciplinarity, community empowerment, the ability to scale local experiences up to the macro-level, and the capacity to learn from experience to achieve sustainability.

Storm Surge and “Certain Death”: Interviews with Texas Coastal Residents following Hurricane Ike

Weather, Climate, and Society, 2010

Hurricane Ike made landfall near Galveston, Texas, on 13 September 2008 as a large category 2 sto... more Hurricane Ike made landfall near Galveston, Texas, on 13 September 2008 as a large category 2 storm that generated significant storm surge and flooding. This article presents findings from an empirical case study of Texas coastal residents' perceptions of hurricane risk, protective decision making, and opinions of hurricane forecasts related to Hurricane Ike. The results are based on data from interviews with 49 residents affected by Hurricane Ike, conducted approximately five weeks after landfall. While most interviewees were aware that Ike was potentially dangerous, many were surprised by how much coastal flooding the hurricane caused and the resulting damage. For many-even long-time residents-Ike was a learning experience. As the hurricane approached, interviewees and their households made complex, evolving preparation and evacuation decisions. Although evacuation orders were an important consideration for some interviewees, many obtained information about Ike frequently from multiple sources to evaluate their own risk and make protective decisions. Given the storm surge and damage Ike caused, a number of interviewees believed that Ike's classification on the Saffir-Simpson scale did not adequately communicate the risk Ike posed. The ''certain death'' statement issued by the National Weather Service helped convince several interviewees to evacuate. However, others had strong negative opinions of the statement that may negatively influence their interpretation of and response to future warnings. As these findings indicate, empirical studies of how intended audiences obtain, interpret, and use hurricane forecasts and warnings provide valuable knowledge that can help design more effective ways to convey hurricane risk.

Differential Adaptive Capacity to Extreme Heat: A Phoenix, Arizona, Case Study

Weather, Climate, and Society, 2011

Climate change is projected to increase the number of days producing excessive heat across the so... more Climate change is projected to increase the number of days producing excessive heat across the southwestern United States, increasing population exposure to extreme heat events. Extreme heat is currently the main cause of weather-related mortality in the United States, where the negative health effects of extreme heat are disproportionately distributed among geographic regions and demographic groups. To more effectively identify vulnerability to extreme heat, complementary local-level studies of adaptive capacity within a population are needed to augment census-based demographic data and downscaled weather and climate models. This pilot study, conducted in August 2009 in Phoenix, Arizona, reports responses from 359 households in three U.S. Census block groups identified as heat-vulnerable based on heat distress calls, decedent records, and demographic characteristics. This study sought to understand social vulnerability to extreme heat at the local level as a complex phenomenon with explicit characterization of coping and adaptive capacity among urban residents.

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach

Journal of Agricultural, Biological, and Environmental Statistics, 2012

Climate Services to Improve Public Health

International Journal of Environmental Research and Public Health, 2014

A high level expert panel discussed how climate and health services could best collaborate to imp... more A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4-6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate-sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers.

Connecting people and place: a new framework for reducing urban vulnerability to extreme heat

Environmental Research Letters, 2010

Climate change is predicted to increase the intensity and negative impacts of urban heat events, ... more Climate change is predicted to increase the intensity and negative impacts of urban heat events, prompting the need to develop preparedness and adaptation strategies that reduce societal vulnerability to extreme heat. Analysis of societal vulnerability to extreme heat events requires an interdisciplinary approach that includes information about weather and climate, the natural and built environment, social processes and characteristics, interactions with stakeholders, and an assessment of community vulnerability at a local level. In this letter, we explore the relationships between people and places, in the context of urban heat stress, and present a new research framework for a multi-faceted, top-down and bottom-up analysis of local-level vulnerability to extreme heat. This framework aims to better represent societal vulnerability through the integration of quantitative and qualitative data that go beyond aggregate demographic information. We discuss how different elements of the framework help to focus attention and resources on more targeted health interventions, heat hazard mitigation and climate adaptation strategies.

The Economic Burden of Meningitis to Households in Kassena-Nankana District of Northern Ghana

by Mary Hayden and Gertrude N Nyaaba

Objective: To estimate the direct and indirect costs of meningitis to households in the Kassena-N... more Objective: To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana. Methods: A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident. Results: The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest. Conclusion: Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

Using Weather Forecasts to Help Manage Meningitis

by Thomas Hopson, Mary Hayden, and Gertrude N Nyaaba

Integrating research, operations, and community engagement, a multinational and multidisciplinary... more

Urban Sustainability and Resilience: From Theory to Practice

by Paty Romero Lankao, Olga Wilhelmi, Mary Hayden, and Daniel Gnatz

Urbanization and urban areas are profoundly altering the relationship between society and the env... more Urbanization and urban areas are profoundly altering the relationship between society and the environment, and affecting cities' sustainability and resilience in complex ways at alarming rates. Over the last decades, sustainability and resilience have become key concepts aimed at understanding existing urban dynamics and responding to the challenges of creating livable urban futures. Sustainability and resilience have also moved and are now core analytic and normative concepts for many scholars, transnational networks and urban communities of practice. Yet, even with this elevated scholarly attention, strategies for bridging between research and practice remain elusive, and efforts to understand and affect change towards more sustainable and resilient urban centers have often fallen short. This paper seeks to synthesize, from this issue's papers and other strands of literature, the knowledge, theory and practice of urban sustainability and resilience. Specifically, we focus on what capacities urban actors draw on to create sustainability and resilience and how different definitions of these concepts intersect, complement, or contradict each other. We then examine the implications of those intersections and differences in the efforts by urban actors to enhance the capacity to change unsustainable trajectories and transform themselves, their communities, and their cities toward sustainable and resilient relationships with the environment.

Using Weather Forecasts to Help Manage Meningitis in the West African Sahel

by Fredrick Semazzi, Thomas Hopson, and Mary Hayden

Bulletin of the American Meteorological Society, 2014

Microclimate and Human Factors in the Divergent Ecology of Aedes aegypti along the Arizona, U.S./Sonora, MX Border

by Mary Hayden and Cecilia Rosales

EcoHealth, 2010

This study examined the association of human and environmental factors with the presence of Aedes... more This study examined the association of human and environmental factors with the presence of Aedes aegypti, the vector for dengue fever and yellow fever viruses, in a desert region in the southwest United States and northwest Mexico. Sixty-eight sites were longitudinally surveyed along the United States-Mexico border in Tucson, AZ, Nogales, AZ, and Nogales, Sonora during a 3-year period. Aedes aegypti presence or absence at each site was measured three times per year using standard oviposition traps. Maximum and minimum temperature and relative humidity were measured hourly at each site. Field inventories were conducted to measure human housing factors potentially affecting mosquito presence, such as the use of air-conditioning and evaporative coolers, outdoor vegetation cover, and access to piped water. The results showed that Ae. aegypti presence was highly variable across space and time. Aedes aegypti presence was positively associated with highly vegetated areas. Other significant variables included microclimatic differences and access to piped water. This study demonstrates the importance of microclimate and human factors in predicting Ae. aegypti distribution in an arid environment.

CORRIGENDUM: False Alarm Rate or False Alarm Ratio?

Weather and Forecasting, 2009

... Lindsey R. Barnes enXco, Denver, Colorado. David M. Schultz ... The first paper that used the... more

Epidemic Dengue and Dengue Hemorrhagic Fever at the Texas-Mexico Border: Results of a Household-based Seroepidemiologic Survey, December 2005

A dengue-2 epidemic causing dengue hemorrhagic fever (DHF) occurred in the contiguous border citi... more A dengue-2 epidemic causing dengue hemorrhagic fever (DHF) occurred in the contiguous border cities of Matamoros, Tamaulipas (Mexico), and Brownsville, TX, in 2005. In December, we conducted a household-based epidemiologic survey to determine the incidence and seroprevalence of dengue infection among Matamoros and Brownsville residents and to identify risk factors associated with infection. Antibodies to dengue were measured in 273 individuals. The estimated incidence of recent dengue infection was 32% and 4% among Matamoros and Brownsville participants, respectively. The estimated prevalence of past dengue infection was 77% and 39% among Matamoros and Brownsville participants, respectively. The Breteau index was 28 in Matamoros and 16 in Brownsville, reflecting an abundant winter population of Aedes mosquitoes. Discarded waste tires and buckets were the two largest categories of infested containers found in both cities. Our results underscore the risk for epidemic dengue and DHF in the Texas-Mexico border region.

False Alarms and Close Calls: A Conceptual Model of Warning Accuracy

Weather and Forecasting, 2007

The false alarm rate (FAR) measures the fraction of forecasted events that did not occur, and it ... more The false alarm rate (FAR) measures the fraction of forecasted events that did not occur, and it remains one of the key metrics for verifying National Weather Service (NWS) weather warnings. The national FAR for tornado warnings in 2003 was 0.76, indicating that only one in four tornado warnings was verified. The NWS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;s goal for 2010 is to reduce this

Barriers and Bridges to Prevention and Control of Dengue: The Need for a Social–Ecological Approach

Ecohealth, 2005

This article critically examines how programs for the prevention and control of dengue fever have... more This article critically examines how programs for the prevention and control of dengue fever have been conducted in the absence of an integrated approach, and considers the social and ecological factors influencing their effectiveness. Despite recognition of dengue fever as the most important arboviral disease affecting humans, and in spite of a greater emphasis on community-based control approaches, the burden placed on the communities, countries, and regions affected by this disease continues to rise. In considering historical experience in the Americas and the Asia-Pacific region, as well as the global forces that are exerting new pressures, the important elements of successful control programs are identified as community ownership, partnership with government, leadership, scalability, and control of immature mosquitoes. The key barriers to the exchange of knowledge and the transdisciplinary cooperation necessary for sustainable dengue control are rooted in differences in values among policy-makers, citizens, and scientists and are repeatedly expressed in technical, economic, cultural, geographic, and political dimensions. Through consideration of case studies in Cuba, Guatemala, Singapore, Thailand, Indonesia, and Vietnam, the limitations of control approaches that fail to take into account the complexities of ecological and social systems are presented. Bridges to effective control are identified as the basis for adaptability, both of control programs to the mosquito vector’s changing behavior and of education programs to public, regional and local particularities, as well as transdisciplinarity, community empowerment, the ability to scale local experiences up to the macro-level, and the capacity to learn from experience to achieve sustainability.

Storm Surge and “Certain Death”: Interviews with Texas Coastal Residents following Hurricane Ike

Weather, Climate, and Society, 2010

Hurricane Ike made landfall near Galveston, Texas, on 13 September 2008 as a large category 2 sto... more Hurricane Ike made landfall near Galveston, Texas, on 13 September 2008 as a large category 2 storm that generated significant storm surge and flooding. This article presents findings from an empirical case study of Texas coastal residents' perceptions of hurricane risk, protective decision making, and opinions of hurricane forecasts related to Hurricane Ike. The results are based on data from interviews with 49 residents affected by Hurricane Ike, conducted approximately five weeks after landfall. While most interviewees were aware that Ike was potentially dangerous, many were surprised by how much coastal flooding the hurricane caused and the resulting damage. For many-even long-time residents-Ike was a learning experience. As the hurricane approached, interviewees and their households made complex, evolving preparation and evacuation decisions. Although evacuation orders were an important consideration for some interviewees, many obtained information about Ike frequently from multiple sources to evaluate their own risk and make protective decisions. Given the storm surge and damage Ike caused, a number of interviewees believed that Ike's classification on the Saffir-Simpson scale did not adequately communicate the risk Ike posed. The ''certain death'' statement issued by the National Weather Service helped convince several interviewees to evacuate. However, others had strong negative opinions of the statement that may negatively influence their interpretation of and response to future warnings. As these findings indicate, empirical studies of how intended audiences obtain, interpret, and use hurricane forecasts and warnings provide valuable knowledge that can help design more effective ways to convey hurricane risk.

Differential Adaptive Capacity to Extreme Heat: A Phoenix, Arizona, Case Study

Weather, Climate, and Society, 2011

Climate change is projected to increase the number of days producing excessive heat across the so... more Climate change is projected to increase the number of days producing excessive heat across the southwestern United States, increasing population exposure to extreme heat events. Extreme heat is currently the main cause of weather-related mortality in the United States, where the negative health effects of extreme heat are disproportionately distributed among geographic regions and demographic groups. To more effectively identify vulnerability to extreme heat, complementary local-level studies of adaptive capacity within a population are needed to augment census-based demographic data and downscaled weather and climate models. This pilot study, conducted in August 2009 in Phoenix, Arizona, reports responses from 359 households in three U.S. Census block groups identified as heat-vulnerable based on heat distress calls, decedent records, and demographic characteristics. This study sought to understand social vulnerability to extreme heat at the local level as a complex phenomenon with explicit characterization of coping and adaptive capacity among urban residents.

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach

Journal of Agricultural, Biological, and Environmental Statistics, 2012

Climate Services to Improve Public Health

International Journal of Environmental Research and Public Health, 2014

A high level expert panel discussed how climate and health services could best collaborate to imp... more A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4-6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate-sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers.

Connecting people and place: a new framework for reducing urban vulnerability to extreme heat

Environmental Research Letters, 2010

Climate change is predicted to increase the intensity and negative impacts of urban heat events, ... more Climate change is predicted to increase the intensity and negative impacts of urban heat events, prompting the need to develop preparedness and adaptation strategies that reduce societal vulnerability to extreme heat. Analysis of societal vulnerability to extreme heat events requires an interdisciplinary approach that includes information about weather and climate, the natural and built environment, social processes and characteristics, interactions with stakeholders, and an assessment of community vulnerability at a local level. In this letter, we explore the relationships between people and places, in the context of urban heat stress, and present a new research framework for a multi-faceted, top-down and bottom-up analysis of local-level vulnerability to extreme heat. This framework aims to better represent societal vulnerability through the integration of quantitative and qualitative data that go beyond aggregate demographic information. We discuss how different elements of the framework help to focus attention and resources on more targeted health interventions, heat hazard mitigation and climate adaptation strategies.