Retooling for an Aging America

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Publisher : National Academies Press
ISBN 13 : 0309131952
Total Pages : 316 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Retooling for an Aging America by : Institute of Medicine

Download or read book Retooling for an Aging America written by Institute of Medicine and published by National Academies Press. This book was released on 2008-08-27 with total page 316 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.

Providing Healthy and Safe Foods As We Age

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Publisher : National Academies Press
ISBN 13 : 0309158834
Total Pages : 192 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Providing Healthy and Safe Foods As We Age by : Institute of Medicine

Download or read book Providing Healthy and Safe Foods As We Age written by Institute of Medicine and published by National Academies Press. This book was released on 2010-11-29 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: Does a longer life mean a healthier life? The number of adults over 65 in the United States is growing, but many may not be aware that they are at greater risk from foodborne diseases and their nutritional needs change as they age. The IOM's Food Forum held a workshop October 29-30, 2009, to discuss food safety and nutrition concerns for older adults.

Families Caring for an Aging America

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Author :
Publisher : National Academies Press
ISBN 13 : 0309448093
Total Pages : 367 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Families Caring for an Aging America by : National Academies of Sciences, Engineering, and Medicine

Download or read book Families Caring for an Aging America written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2016-11-08 with total page 367 pages. Available in PDF, EPUB and Kindle. Book excerpt: Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.

Handbook of Rural Aging

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Author :
Publisher : Routledge
ISBN 13 : 1000334368
Total Pages : 511 pages
Book Rating : 4.0/5 (3 download)

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Book Synopsis Handbook of Rural Aging by : Lenard W. Kaye

Download or read book Handbook of Rural Aging written by Lenard W. Kaye and published by Routledge. This book was released on 2021-03-24 with total page 511 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Handbook of Rural Aging goes beyond the perspective of a narrow range of health professions, disciplines, and community services that serve older adults in rural America to encompass the full range of perspectives and issues impacting the communities in which rural older adults live. Touching on such topics as work and voluntarism, technology, transportation, housing, the environment, social participation, and the delivery of health and community services, this reference work addresses the full breadth and scope of factors impacting the lives of rural elders with contributions from recognized scholars, administrators, and researchers. This Handbook buttresses a widespread movement to garner more attention for rural America in policy matters and decisions, while also elevating awareness of the critical circumstances facing rural elders and those who serve them. Merging demographic, economic, social, cultural, health, environmental, and political perspectives, it will be an essential reference source for library professionals, researchers, educators, students, program and community administrators, and practitioners with a combined interest in rural issues and aging.

Rural Poverty in the United States

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Publisher : Columbia University Press
ISBN 13 : 0231544715
Total Pages : 456 pages
Book Rating : 4.2/5 (315 download)

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Book Synopsis Rural Poverty in the United States by : Ann R. Tickamyer

Download or read book Rural Poverty in the United States written by Ann R. Tickamyer and published by Columbia University Press. This book was released on 2017-08-22 with total page 456 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's rural areas have always held a disproportionate share of the nation's poorest populations. Rural Poverty in the United States examines why. What is it about the geography, demography, and history of rural communities that keeps them poor? In a comprehensive analysis that extends from the Civil War to the present, Rural Poverty in the United States looks at access to human and social capital; food security; healthcare and the environment; homelessness; gender roles and relations; racial inequalities; and immigration trends to isolate the underlying causes of persistent rural poverty. Contributors to this volume incorporate approaches from multiple disciplines, including sociology, economics, demography, race and gender studies, public health, education, criminal justice, social welfare, and other social science fields. They take a hard look at current and past programs to alleviate rural poverty and use their failures to suggest alternatives that could improve the well-being of rural Americans for years to come. These essays work hard to define rural poverty's specific metrics and markers, a critical step for building better policy and practice. Considering gender, race, and immigration, the book appreciates the overlooked structural and institutional dimensions of ongoing rural poverty and its larger social consequences.

Quality Through Collaboration

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Publisher : National Academies Press
ISBN 13 : 0309094399
Total Pages : 289 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Quality Through Collaboration by : Institute of Medicine

Download or read book Quality Through Collaboration written by Institute of Medicine and published by National Academies Press. This book was released on 2005-04-24 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.

Elderhood

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Publisher : Bloomsbury Publishing USA
ISBN 13 : 1620405482
Total Pages : 467 pages
Book Rating : 4.6/5 (24 download)

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Book Synopsis Elderhood by : Louise Aronson

Download or read book Elderhood written by Louise Aronson and published by Bloomsbury Publishing USA. This book was released on 2019-06-11 with total page 467 pages. Available in PDF, EPUB and Kindle. Book excerpt: Finalist for the Pulitzer Prize in General Nonfiction A New York Times Bestseller Longlisted for the Andrew Carnegie Medal for Excellence in Nonfiction Winner of the WSU AOS Bonner Book Award Winner of the 2022 At Home With Growing Older Impact Award As revelatory as Atul Gawande's Being Mortal, physician and award-winning author Louise Aronson's Elderhood is an essential, empathetic look at a vital but often disparaged stage of life. For more than 5,000 years, "old" has been defined as beginning between the ages of 60 and 70. That means most people alive today will spend more years in elderhood than in childhood, and many will be elders for 40 years or more. Yet at the very moment that humans are living longer than ever before, we've made old age into a disease, a condition to be dreaded, denigrated, neglected, and denied. Reminiscent of Oliver Sacks, noted Harvard-trained geriatrician Louise Aronson uses stories from her quarter century of caring for patients, and draws from history, science, literature, popular culture, and her own life to weave a vision of old age that's neither nightmare nor utopian fantasy--a vision full of joy, wonder, frustration, outrage, and hope about aging, medicine, and humanity itself. Elderhood is for anyone who is, in the author's own words, "an aging, i.e., still-breathing human being."

Aging in Rural Places

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Publisher : Springer Publishing Company
ISBN 13 : 0826198112
Total Pages : 336 pages
Book Rating : 4.8/5 (261 download)

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Book Synopsis Aging in Rural Places by : Elaine T. Jurkowski, MSW, PhD

Download or read book Aging in Rural Places written by Elaine T. Jurkowski, MSW, PhD and published by Springer Publishing Company. This book was released on 2014-09-08 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: Research documents that rural elders are poorer, live in less adequate housing, and have far fewer health and service options available to them than their urban counterparts, yet there is a critical lack of current and detailed information on the problems facing rural elders and on the professional practices that serve this population. This text fills this gap by introducing readers to rural areas and their residents and discussing the issues, programs, and policies designed to meet their needs. Through a multidisciplinary lens, it examines and defines specific competencies required for successful work with older adults and their families in these communities. The text presents a research-driven, competency-based approach for the health and human service professionals who work with older rural residents. It discusses both the problems facing older adults and their families and evidence-based solutions regarding policy and best practices. Key issues examined include health and wellness, transportation, housing, long-term care, income, employment, and retirement, along with the needs of special populations (ethnic minorities, immigrants, and the LGBT population). Case examples reinforce an interdisciplinary model that addresses practice with rural elders that encompasses professional competencies, values and ethics, and the roles of a spectrum of health and human service professionals. The text also examines current policies affecting health and social services to rural elders and recommendations for policy change to build an effective health and human service workforce in rural communities. Links to Podcast interviews with scholars and respected professionals working in the field and "Spotlight" excerpts from the text reinforce information. In addition, the text provides discussion questions, PowerPoint slides, a test question bank, and suggested activities and exercises. Key Features: Fills a vacuum regarding information on health and social services for rural elders Provides current and comprehensive knowledge about issues besetting this population and programs and policies designed to meet their needs Examines and defines specific competencies required for effective health and social services Based on a research-driven, competency-based, interdisciplinary approach to policy and best practice Includes links to Podcast interviews with scholars and respected professionals in the field

Aging in Asia

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Author :
Publisher : National Academies Press
ISBN 13 : 0309254094
Total Pages : 486 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Aging in Asia by : National Research Council

Download or read book Aging in Asia written by National Research Council and published by National Academies Press. This book was released on 2012-07-31 with total page 486 pages. Available in PDF, EPUB and Kindle. Book excerpt: The population of Asia is growing both larger and older. Demographically the most important continent on the world, Asia's population, currently estimated to be 4.2 billion, is expected to increase to about 5.9 billion by 2050. Rapid declines in fertility, together with rising life expectancy, are altering the age structure of the population so that in 2050, for the first time in history, there will be roughly as many people in Asia over the age of 65 as under the age of 15. It is against this backdrop that the Division of Behavioral and Social Research at the U.S. National Institute on Aging (NIA) asked the National Research Council (NRC), through the Committee on Population, to undertake a project on advancing behavioral and social research on aging in Asia. Aging in Asia: Findings from New and Emerging Data Initiatives is a peer-reviewed collection of papers from China, India, Indonesia, Japan, and Thailand that were presented at two conferences organized in conjunction with the Chinese Academy of Sciences, Indian National Science Academy, Indonesian Academy of Sciences, and Science Council of Japan; the first conference was hosted by the Chinese Academy of Social Sciences in Beijing, and the second conference was hosted by the Indian National Science Academy in New Delhi. The papers in the volume highlight the contributions from new and emerging data initiatives in the region and cover subject areas such as economic growth, labor markets, and consumption; family roles and responsibilities; and labor markets and consumption.

Preparing for an Aging World

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Publisher : National Academies Press
ISBN 13 : 0309170877
Total Pages : 326 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Preparing for an Aging World by : National Research Council

Download or read book Preparing for an Aging World written by National Research Council and published by National Academies Press. This book was released on 2001-06-26 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: Aging is a process that encompasses virtually all aspects of life. Because the speed of population aging is accelerating, and because the data needed to study the aging process are complex and expensive to obtain, it is imperative that countries coordinate their research efforts to reap the most benefits from this important information. Preparing for an Aging World looks at the behavioral and socioeconomic aspects of aging, and focuses on work, retirement, and pensions; wealth and savings behavior; health and disability; intergenerational transfers; and concepts of well-being. It makes recommendations for a collection of new, cross-national data on aging populationsâ€"data that will allow nations to develop policies and programs for addressing the major shifts in population age structure now occurring. These efforts, if made internationally, would advance our understanding of the aging process around the world.

Rebuilding the Unity of Health and the Environment in Rural America

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Author :
Publisher : National Academies Press
ISBN 13 : 0309180570
Total Pages : 116 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Rebuilding the Unity of Health and the Environment in Rural America by : Institute of Medicine

Download or read book Rebuilding the Unity of Health and the Environment in Rural America written by Institute of Medicine and published by National Academies Press. This book was released on 2006-02-28 with total page 116 pages. Available in PDF, EPUB and Kindle. Book excerpt: Throughout much of its history, the United States was predominantly a rural society. The need to provide sustenance resulted in many people settling in areas where food could be raised for their families. Over the past century, however, a quiet shift from a rural to an urban society occurred, such that by 1920, for the first time, more members of our society lived in urban regions than in rural ones. This was made possible by changing agricultural practices. No longer must individuals raise their own food, and the number of person-hours and acreage required to produce food has steadily been decreasing because of technological advances, according to Roundtable member James Merchant of the University of Iowa. The Institute of Medicine's Roundtable on Environmental Health Science, Research, and Medicine held a regional workshop at the University of Iowa on November 29 and 30, 2004, to look at rural environmental health issues. Iowa, with its expanse of rural land area, growing agribusiness, aging population, and increasing immigrant population, provided an opportunity to explore environmental health in a region of the country that is not as densely populated. As many workshop participants agreed, the shifting agricultural practices as the country progresses from family operations to large-scale corporate farms will have impacts on environmental health. This report describes and summarizes the participants' presentations to the Roundtable members and the discussions that the members had with the presenters and participants at the workshop.

Nutrition and Healthy Aging in the Community

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Author :
Publisher : National Academies Press
ISBN 13 : 0309253101
Total Pages : 152 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Nutrition and Healthy Aging in the Community by : Institute of Medicine

Download or read book Nutrition and Healthy Aging in the Community written by Institute of Medicine and published by National Academies Press. This book was released on 2012-06-15 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt: The U.S. population of older adults is predicted to grow rapidly as "baby boomers" (those born between 1946 and 1964) begin to reach 65 years of age. Simultaneously, advancements in medical care and improved awareness of healthy lifestyles have led to longer life expectancies. The Census Bureau projects that the population of Americans 65 years of age and older will rise from approximately 40 million in 2010 to 55 million in 2020, a 36 percent increase. Furthermore, older adults are choosing to live independently in the community setting rather than residing in an institutional environment. Furthermore, the types of services needed by this population are shifting due to changes in their health issues. Older adults have historically been viewed as underweight and frail; however, over the past decade there has been an increase in the number of obese older persons. Obesity in older adults is not only associated with medical comorbidities such as diabetes; it is also a major risk factor for functional decline and homebound status. The baby boomers have a greater prevalence of obesity than any of their historic counterparts, and projections forecast an aging population with even greater chronic disease burden and disability. In light of the increasing numbers of older adults choosing to live independently rather than in nursing homes, and the important role nutrition can play in healthy aging, the Institute of Medicine (IOM) convened a public workshop to illuminate issues related to community-based delivery of nutrition services for older adults and to identify nutrition interventions and model programs. Nutrition and Healthy Aging in the Community summarizes the presentations and discussions prepared from the workshop transcript and slides. This report examines nutrition-related issues of concern experienced by older adults in the community including nutrition screening, food insecurity, sarcopenic obesity, dietary patterns for older adults, and economic issues. This report explores transitional care as individuals move from acute, subacute, or chronic care settings to the community, and provides models of transitional care in the community. This report also provides examples of successful intervention models in the community setting, and covers the discussion of research gaps in knowledge about nutrition interventions and services for older adults in the community.

World Report on Ageing and Health

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Author :
Publisher : World Health Organization
ISBN 13 : 9241565047
Total Pages : 260 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis World Report on Ageing and Health by : World Health Organization

Download or read book World Report on Ageing and Health written by World Health Organization and published by World Health Organization. This book was released on 2015-10-22 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt: The WHO World report on ageing and health is not for the book shelf it is a living breathing testament to all older people who have fought for their voice to be heard at all levels of government across disciplines and sectors. - Mr Bjarne Hastrup President International Federation on Ageing and CEO DaneAge This report outlines a framework for action to foster Healthy Ageing built around the new concept of functional ability. This will require a transformation of health systems away from disease based curative models and towards the provision of older-person-centred and integrated care. It will require the development sometimes from nothing of comprehensive systems of long term care. It will require a coordinated response from many other sectors and multiple levels of government. And it will need to draw on better ways of measuring and monitoring the health and functioning of older populations. These actions are likely to be a sound investment in society's future. A future that gives older people the freedom to live lives that previous generations might never have imagined. The World report on ageing and health responds to these challenges by recommending equally profound changes in the way health policies for ageing populations are formulated and services are provided. As the foundation for its recommendations the report looks at what the latest evidence has to say about the ageing process noting that many common perceptions and assumptions about older people are based on outdated stereotypes. The report's recommendations are anchored in the evidence comprehensive and forward-looking yet eminently practical. Throughout examples of experiences from different countries are used to illustrate how specific problems can be addressed through innovation solutions. Topics explored range from strategies to deliver comprehensive and person-centred services to older populations to policies that enable older people to live in comfort and safety to ways to correct the problems and injustices inherent in current systems for long-term care.

Social Isolation and Loneliness in Older Adults

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Author :
Publisher : National Academies Press
ISBN 13 : 0309671035
Total Pages : 317 pages
Book Rating : 4.3/5 (96 download)

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Book Synopsis Social Isolation and Loneliness in Older Adults by : National Academies of Sciences, Engineering, and Medicine

Download or read book Social Isolation and Loneliness in Older Adults written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-05-14 with total page 317 pages. Available in PDF, EPUB and Kindle. Book excerpt: Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Improving Data on America's Aging Population

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Author :
Publisher : National Academies Press
ISBN 13 : 0309056330
Total Pages : 64 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Improving Data on America's Aging Population by : National Research Council

Download or read book Improving Data on America's Aging Population written by National Research Council and published by National Academies Press. This book was released on 1996-12-20 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Committee on National Statistics and the Committee on Population, at the request of the NIA, convened a workshop in March 1996 to discuss data on the aging population that address the emerging and important social, economic, and health conditions of the older population. The purposes of the workshop were to identify how the population at older ages in the next few decades will differ from the older population today, to understand the underlying causes of those changes, to anticipate future problems and policy issues, and to suggest future needs for data for research in these areas. The scope of the workshop was broader than that of the 1988 CNSTAT report, including not only data on health and long-term care, but also actuarial, economic, demographic, housing, and epidemiological data needs for informing public policy.

Rural Public Health

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Author :
Publisher : Springer Publishing Company
ISBN 13 : 0826108954
Total Pages : 294 pages
Book Rating : 4.8/5 (261 download)

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Book Synopsis Rural Public Health by : K. Bryant Smalley, PhD, PsyD

Download or read book Rural Public Health written by K. Bryant Smalley, PhD, PsyD and published by Springer Publishing Company. This book was released on 2014-01-14 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: "[A] welcome addition to the rural health care practitioner's tool kit. It will energize those interested in vulnerable rural residents and their unique characteristics through a public health perspective... Highly recommended."--CHOICE: Current Reviews for Academic Libraries "This call to action for healthcare providers is a comprehensive review of issues in rural healthcare, including both obstacles and ways to begin to overcome them. It is easy to read... This enjoyable book encourages healthcare providers working or considering working in rural healthcare with clear direction."--Doody's Medical Reviews "The Warren & Smalley book is an excellent look at the challenges while also presenting solutions and hope. It recognizes the medical challenges that are present and the cost of bring medical care to these communities... There is so much in this book that will be refreshing and encouraging. The book needs to be read. It is also a book that needs to be placed in the hands of the movers and shakers, as well other interested parties who are in a position to 'make this happen.'" -- Illness, Crisis & Loss Rural residents face distinct health challenges due to economic conditions, cultural/behavioral factors, and health provider shortages that combine to impose striking disparities in health outcomes among rural populations. This comprehensive text about the issues of rural public health is the only book to focus on rural health from the perspectives of public health and prevention. It covers specific diseases and disorders faced by rural populations, service delivery challenges, practitioner shortfalls in rural areas, and promising community health approaches and preventive measures. The text also addresses rural health care ethics and international perspectives. Nearly all chapters offer best practice recommendations and evidence-based prevention programs. This book is a cohesive, centralized resource for researchers, public health practitioners, health organizations, and graduate education programs that focus on the public health of rural populations. Key Features: Comprises the only text to address rural health from the perspectives of public health and prevention Includes best practice recommendations and evidence-based prevention programs in each chapter Presents a cohesive, expansive synthesis of current research and practice Addresses specific diseases and disorders of rural populations, service delivery problems, and practitioner shortfalls in rural areas Discusses promising community health approaches and preventative measures

Ageing in India

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Author :
Publisher : Academic Foundation
ISBN 13 : 9788171885350
Total Pages : 298 pages
Book Rating : 4.8/5 (853 download)

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Book Synopsis Ageing in India by : Moneer Alam

Download or read book Ageing in India written by Moneer Alam and published by Academic Foundation. This book was released on 2006 with total page 298 pages. Available in PDF, EPUB and Kindle. Book excerpt: The socioeconomic, health, and public-policy aspects of aging in India are presented in this study that draws on empirical research to assess the country’s preparedness. This analysis argues that many of the fundamental issues that need to be addressed by a country with a large aging population are not fully understood by public agencies. A number of policy options for the welfare of the growing number of elderly, particularly women, are proposed.