Veterans and Agent Orange

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Author :
Publisher : National Academies Press
ISBN 13 : 0309477166
Total Pages : 739 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Veterans and Agent Orange by : National Academies of Sciences, Engineering, and Medicine

Download or read book Veterans and Agent Orange written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-20 with total page 739 pages. Available in PDF, EPUB and Kindle. Book excerpt: From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academies of Sciences, Engineering, and Medicine was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 11 (2018) examines peer-reviewed scientific reports concerning associations between various health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published between September 30, 2014, and December 31, 2017, and integrates this information with the previously established evidence database.

Veterans and Agent Orange

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Author :
Publisher : National Academies Press
ISBN 13 : 9780309075299
Total Pages : 791 pages
Book Rating : 4.0/5 (752 download)

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Book Synopsis Veterans and Agent Orange by : Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides

Download or read book Veterans and Agent Orange written by Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides and published by National Academies Press. This book was released on 1994-01-15 with total page 791 pages. Available in PDF, EPUB and Kindle. Book excerpt: Have U.S. military personnel experienced health problems from being exposed to Agent Orange, its dioxin contaminants, and other herbicides used in Vietnam? This definitive volume summarizes the strength of the evidence associating exposure during Vietnam service with cancer and other health effects and presents conclusions from an expert panel. Veterans and Agent Orange provides a historical review of the issue, examines studies of populations, in addition to Vietnam veterans, environmentally and occupationally exposed to herbicides and dioxin, and discusses problems in study methodology. The core of the book presents What is known about the toxicology of the herbicides used in greatest quantities in Vietnam. What is known about assessing exposure to herbicides and dioxin. What can be determined from the wide range of epidemiological studies conducted by different authorities. What is known about the relationship between exposure to herbicides and dioxin, and cancer, reproductive effects, neurobehavioral disorders, and other health effects. The book describes research areas of continuing concern and offers recommendations for further research on the health effects of Agent Orange exposure among Vietnam veterans. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals.

Veterans and Agent Orange

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Publisher : National Academies Press
ISBN 13 : 0309147921
Total Pages : 707 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Veterans and Agent Orange by : Institute of Medicine

Download or read book Veterans and Agent Orange written by Institute of Medicine and published by National Academies Press. This book was released on 2009-11-20 with total page 707 pages. Available in PDF, EPUB and Kindle. Book excerpt: From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of U.S. base camps and outlying fire-support bases. In response to concerns and continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Veterans and Agent Orange provides a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam. The 2008 report is the eighth volume in this series of biennial updates. It will be of interest to policy makers and physicians in the federal government, veterans and their families, veterans' organizations, researchers, and health professionals.

Veterans and Agent Orange

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Publisher : National Academies Press
ISBN 13 : 0309083389
Total Pages : 42 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Veterans and Agent Orange by : Institute of Medicine

Download or read book Veterans and Agent Orange written by Institute of Medicine and published by National Academies Press. This book was released on 2002-04-25 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2001, in response to a request by the U.S. Department of Veterans Affairs (DVA), the Institute of Medicine (IOM) called together a committee to conduct a review of the scientific evidence regarding the association between exposure to dioxin and other chemical compounds in herbicides used in Vietnam and acute myelogenous leukemia in the offspring of Vietnam veterans. Based on the scientific evidence reviewed in this report, the committee finds there is inadequate or insufficient evidence to determine if an association exists between exposure to the herbicides used in Vietnam or their contaminants and acute myelogenous leukemia (AML) in the children of Vietnam veterans. This is a change in classification from the recent Veterans and Agent Orange: Update 2000 report, which found limited/suggestive evidence for such an association.

Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft

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Publisher : National Academies Press
ISBN 13 : 0309308933
Total Pages : 110 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft by : Institute of Medicine

Download or read book Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft written by Institute of Medicine and published by National Academies Press. This book was released on 2015-05-20 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt: From 1972 to 1982, approximately 1,500-2,100 US Air Force Reserve personnel trained and worked on C-123 aircraft that had formerly been used to spray herbicides in Vietnam as part of Operation Ranch Hand. After becoming aware that some of the aircraft on which they had worked had previously served this purpose, some of these AF Reservists applied to the US Department of Veterans Affairs (VA) for compensatory coverage under the Agent Orange Act of 1991. The Act provides health care and disability coverage for health conditions that have been deemed presumptively service-related for herbicide exposure during the Vietnam War. The VA denied the applications on the basis that these veterans were ineligible because as non-Vietnam-era veterans or as Vietnam-era veterans without "boots on the ground" service in Vietnam, they were not covered. However, with the knowledge that some air and wipe samples taken between 1979 and 2009 from some of the C-123s used in Operation Ranch Hand showed the presence of agent orange residues, representatives of the C-123 Veterans Association began a concerted effort to reverse VA's position and obtain coverage. At the request of the VA, Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft evaluates whether or not service in these C-123s could have plausibly resulted in exposures detrimental to the health of these Air Force Reservists. The Institute of Medicine assembled an expert committee to address this question qualitatively, but in a scientific and evidence-based fashion. This report evaluates the reliability of the available information for establishing exposure and addresses and places in context whether any documented residues represent potentially harmful exposure by characterizing the amounts available and the degree to which absorption might be expected. Post-Vietnam Dioxin Exposure rejects the idea that the dioxin residues detected on interior surfaces of the C-123s were immobile and effectively inaccessible to the Reservists as a source of exposure. Accordingly, this report states with confidence that the Air Force Reservists were exposed when working in the Operation Ranch Hand C-123s and so experienced some increase in their risk of a variety of adverse responses.

Veterans and Agent Orange

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Publisher : National Academies Press
ISBN 13 : 0309380669
Total Pages : 1115 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Veterans and Agent Orange by : National Academies of Sciences, Engineering, and Medicine

Download or read book Veterans and Agent Orange written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2016-04-29 with total page 1115 pages. Available in PDF, EPUB and Kindle. Book excerpt: From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far.

Possible Health Effects of Exposure to Residential Electric and Magnetic Fields

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Publisher : National Academies Press
ISBN 13 : 0309054478
Total Pages : 379 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Possible Health Effects of Exposure to Residential Electric and Magnetic Fields by : National Research Council

Download or read book Possible Health Effects of Exposure to Residential Electric and Magnetic Fields written by National Research Council and published by National Academies Press. This book was released on 1997-03-18 with total page 379 pages. Available in PDF, EPUB and Kindle. Book excerpt: Can the electric and magnetic fields (EMF) to which people are routinely exposed cause health effects? This volume assesses the data and draws conclusions about the consequences of human exposure to EMF. The committee examines what is known about three kinds of health effects associated with EMF: cancer, primarily childhood leukemia; reproduction and development; and neurobiological effects. This book provides a detailed discussion of hazard identification, dose-response assessment, exposure assessment, and risk characterization for each. Possible Health Effects of Exposure to Residential Electric and Magnetic Fields also discusses the tools available to measure exposure, common types of exposures, and what is known about the effects of exposure. The committee looks at correlations between EMF exposure and carcinogenesis, mutagenesis, neurobehavioral effects, reproductive and developmental effects, effects on melatonin and other neurochemicals, and effects on bone healing and stimulated cell growth.

Agent Orange Review

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Publisher :
ISBN 13 :
Total Pages : 8 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Agent Orange Review by :

Download or read book Agent Orange Review written by and published by . This book was released on 1997 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Blue Water Navy Vietnam Veterans and Agent Orange Exposure

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Author :
Publisher : National Academies Press
ISBN 13 : 0309162475
Total Pages : 158 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Blue Water Navy Vietnam Veterans and Agent Orange Exposure by : Institute of Medicine

Download or read book Blue Water Navy Vietnam Veterans and Agent Orange Exposure written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-01 with total page 158 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over 3 million U.S. military personnel were sent to Southeast Asia to fight in the Vietnam War. Since the end of the Vietnam War, veterans have reported numerous health effects. Herbicides used in Vietnam, in particular Agent Orange have been associated with a variety of cancers and other long term health problems from Parkinson's disease and type 2 diabetes to heart disease. Prior to 1997 laws safeguarded all service men and women deployed to Vietnam including members of the Blue Navy. Since then, the Department of Veteran Affairs (VA) has established that Vietnam veterans are automatically eligible for disability benefits should they develop any disease associated with Agent Orange exposure, however, veterans who served on deep sea vessels in Vietnam are not included. These "Blue Water Navy" veterans must prove they were exposed to Agent Orange before they can claim benefits. At the request of the VA, the Institute of Medicine (IOM) examined whether Blue Water Navy veterans had similar exposures to Agent Orange as other Vietnam veterans. Blue Water Navy Vietnam Veterans and Agent Orange Exposure comprehensively examines whether Vietnam veterans in the Blue Water Navy experienced exposures to herbicides and their contaminants by reviewing historical reports, relevant legislation, key personnel insights, and chemical analysis to resolve current debate on this issue.

Veterans and Agent Orange

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Publisher : National Academies Press
ISBN 13 : 0309091888
Total Pages : 74 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Veterans and Agent Orange by : Institute of Medicine

Download or read book Veterans and Agent Orange written by Institute of Medicine and published by National Academies Press. This book was released on 2004-05-02 with total page 74 pages. Available in PDF, EPUB and Kindle. Book excerpt: From 1962 to 1971, US military forces sprayed herbicides over Vietnam to strip the thick jungle canopy that helped conceal opposition forces, to destroy crops that enemy forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the majority of the herbicides sprayed. Agent Orange was a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD, one form of dioxin) was an unintended contaminant from the production of 2,4,5-T and was present in Agent Orange and some other formulations sprayed in Vietnam. In 1991, because of continuing uncertainty about the long-term health effects on Vietnam veterans of the herbicides sprayed, Congress passed Public Law 102-4, the Agent Orange Act of 1991. In response to the request from the VA, IOM extended the service of the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides that was responsible for Update 2002 to address the question of presumptive period and respiratory cancer. The charge to the committee was to undertake a review and evaluation of the evidence regarding the period between cessation of exposure to herbicides used in Vietnam and their contaminants (2,4-D, 2,4,5-T and its contaminant TCDD, cacodylic acid, and picloram) and the occurrence of respiratory cancer.

Veterans and Agent Orange

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Publisher : National Academies Press
ISBN 13 : 0309075521
Total Pages : 623 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Veterans and Agent Orange by : Institute of Medicine

Download or read book Veterans and Agent Orange written by Institute of Medicine and published by National Academies Press. This book was released on 2001-12-13 with total page 623 pages. Available in PDF, EPUB and Kindle. Book excerpt: Veterans and Agent Orange: Update 2000 examines the state of the scientific evidence regarding associations between diseases and exposure to dioxin and other chemical compounds in herbicides used in Vietnam. It is the fourth in a series of comprehensive reviews of epidemiologic and toxicologic studies of the agents used as defoliants during the Vietnam War. Over forty health outcomes in veterans and their children are addressed. Among the report's conclusions is that there is sufficient evidence of a link between exposure and the development of soft-tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne in veterans. Additionally, it found that scientific studies offer "limited or suggestive" evidence of an association with other diseases in veteransâ€"including Type 2 diabetes, respiratory cancers, prostate cancer, multiple myeloma and some forms of transient peripheral neuropathyâ€"as well as the congenital birth defect spina bifida in veterans' children.

Veterans and Agent Orange

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Author :
Publisher : National Academies Press
ISBN 13 : 0309214475
Total Pages : 836 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Veterans and Agent Orange by : Institute of Medicine

Download or read book Veterans and Agent Orange written by Institute of Medicine and published by National Academies Press. This book was released on 2012-02-12 with total page 836 pages. Available in PDF, EPUB and Kindle. Book excerpt: Because of continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Congress passed the Agent Orange Act of 1991. The legislation directed the Secretary of Veterans Affairs (VA) to request the Institite of Medicine to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam to be followed by biennial updates. The 2010 update recommends further research of links between Vietnam service and specific health outcomes, most importantly COPD, tonsil cancer, melanoma, brain cancer, Alzheimer's disease, and paternally transmitted effects to offspring.

The Financial Crisis Inquiry Report

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Publisher : Cosimo, Inc.
ISBN 13 : 1616405414
Total Pages : 692 pages
Book Rating : 4.6/5 (164 download)

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Book Synopsis The Financial Crisis Inquiry Report by : Financial Crisis Inquiry Commission

Download or read book The Financial Crisis Inquiry Report written by Financial Crisis Inquiry Commission and published by Cosimo, Inc.. This book was released on 2011-05-01 with total page 692 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Financial Crisis Inquiry Report, published by the U.S. Government and the Financial Crisis Inquiry Commission in early 2011, is the official government report on the United States financial collapse and the review of major financial institutions that bankrupted and failed, or would have without help from the government. The commission and the report were implemented after Congress passed an act in 2009 to review and prevent fraudulent activity. The report details, among other things, the periods before, during, and after the crisis, what led up to it, and analyses of subprime mortgage lending, credit expansion and banking policies, the collapse of companies like Fannie Mae and Freddie Mac, and the federal bailouts of Lehman and AIG. It also discusses the aftermath of the fallout and our current state. This report should be of interest to anyone concerned about the financial situation in the U.S. and around the world.THE FINANCIAL CRISIS INQUIRY COMMISSION is an independent, bi-partisan, government-appointed panel of 10 people that was created to "examine the causes, domestic and global, of the current financial and economic crisis in the United States." It was established as part of the Fraud Enforcement and Recovery Act of 2009. The commission consisted of private citizens with expertise in economics and finance, banking, housing, market regulation, and consumer protection. They examined and reported on "the collapse of major financial institutions that failed or would have failed if not for exceptional assistance from the government."News Dissector DANNY SCHECHTER is a journalist, blogger and filmmaker. He has been reporting on economic crises since the 1980's when he was with ABC News. His film In Debt We Trust warned of the economic meltdown in 2006. He has since written three books on the subject including Plunder: Investigating Our Economic Calamity (Cosimo Books, 2008), and The Crime Of Our Time: Why Wall Street Is Not Too Big to Jail (Disinfo Books, 2011), a companion to his latest film Plunder The Crime Of Our Time. He can be reached online at www.newsdissector.com.

Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan

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Publisher : National Academies Press
ISBN 13 : 030921758X
Total Pages : 192 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan by : Institute of Medicine

Download or read book Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan written by Institute of Medicine and published by National Academies Press. This book was released on 2011-10-31 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many veterans returning from the conflicts in Iraq and Afghanistan have health problems they believe are related to their exposure to the smoke from the burning of waste in open-air "burn pits" on military bases. Particular controversy surrounds the burn pit used to dispose of solid waste at Joint Base Balad in Iraq, which burned up to 200 tons of waste per day in 2007. The Department of Veterans Affairs asked the IOM to form a committee to determine the long-term health effects from exposure to these burn pits. Insufficient evidence prevented the IOM committee from developing firm conclusions. This report, therefore, recommends that, along with more efficient data-gathering methods, a study be conducted that would evaluate the health status of service members from their time of deployment over many years to determine their incidence of chronic diseases.

NAS Committee Report on Agent Orange

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Publisher :
ISBN 13 :
Total Pages : 232 pages
Book Rating : 4.:/5 (327 download)

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Book Synopsis NAS Committee Report on Agent Orange by : United States. Congress. Senate. Committee on Veterans' Affairs

Download or read book NAS Committee Report on Agent Orange written by United States. Congress. Senate. Committee on Veterans' Affairs and published by . This book was released on 1993 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry

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Publisher : National Academies Press
ISBN 13 : 0309451175
Total Pages : 253 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry by : National Academies of Sciences, Engineering, and Medicine

Download or read book Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-28 with total page 253 pages. Available in PDF, EPUB and Kindle. Book excerpt: Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990â€"1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA's information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA's Airborne Hazards and Open Burn Pit Registry.

Alternatives for the Demilitarization of Conventional Munitions

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Publisher : National Academies Press
ISBN 13 : 0309477352
Total Pages : 133 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Alternatives for the Demilitarization of Conventional Munitions by : National Academies of Sciences, Engineering, and Medicine

Download or read book Alternatives for the Demilitarization of Conventional Munitions written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-11 with total page 133 pages. Available in PDF, EPUB and Kindle. Book excerpt: The U.S. military has a stockpile of approximately 400,000 tons of excess, obsolete, or unserviceable munitions. About 60,000 tons are added to the stockpile each year. Munitions include projectiles, bombs, rockets, landmines, and missiles. Open burning/open detonation (OB/OD) of these munitions has been a common disposal practice for decades, although it has decreased significantly since 2011. OB/OD is relatively quick, procedurally straightforward, and inexpensive. However, the downside of OB and OD is that they release contaminants from the operation directly into the environment. Over time, a number of technology alternatives to OB/OD have become available and more are in research and development. Alternative technologies generally involve some type of contained destruction of the energetic materials, including contained burning or contained detonation as well as contained methods that forego combustion or detonation. Alternatives for the Demilitarization of Conventional Munitions reviews the current conventional munitions demilitarization stockpile and analyzes existing and emerging disposal, treatment, and reuse technologies. This report identifies and evaluates any barriers to full-scale deployment of alternatives to OB/OD or non-closed loop incineration/combustion, and provides recommendations to overcome such barriers.