2010 Master of Public Health Graduates

Capstone Abstracts & Presentations

2010 graduates

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  R. Lee Barnes, MD, MPH | Identifying Obstructive Sleep Apnea in the Commercial Truck Driver: Literature Review with Proposed Revisions to the Department of Transportation Medical Examination Form

MPH Graduate, R. Lee Barnes Ronald.Barnes@adm.com
Advisor: Michael Farrell, MD, Assistant Professor, Department of Medicine - General Internal Medicine


The goal of this paper is to examine the current literature regarding obstructive sleep apnea and its implications for identification of the commercial motor vehicle operator with sleep apnea. Obstructive sleep apnea is a common condition with significant impact upon the health of the commercial driver as well as public safety. This paper will examine the current recommendations for screening the commercial driver for obstructive sleep apnea as well as make suggestions for modification of the current Department of Transportation Commercial Driver Examination Form. The intent of these suggested modifications are to aid the commercial driver examiner in the identification of those drivers that may have obstructive sleep apnea with the goal of improved driver health and public safety.

PowerPoint Presentation (PDF)

  Steven Bratman, MD, MPH | The Current Status of Observational Studies as Scientific Evidence: A Critical Appraisal

MPH Graduate, Steven Bratman stevenbratman@googlemail.com
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


Purely observational studies have long been considered problematic as a source of cause/effect conclusions and, for this reason, have been placed below experimental studies in the hierarchy of evidence. However, in many important areas of medicine and public health, experimental studies (specifically randomized controlled trials) are impractical to perform. In consequence, observational studies are often the primary source of public health recommendations. This practice has recently been called into question by the results of several large randomized controlled trials, which not only failed to confirm predictions based on observational studies but in some cases inverted them, transforming expectation of benefit into a discovery of harm. In this article, we interrogate the use of epidemiologic evidence as a source of “evidence-based” public health advice.

Full Text of Paper (PDF)

  Casey J. Brown, MPH | The Homeless Population: A Literature Review of Health Care Access with a Case-study of Autumn West and the Homeless Outreach Nursing Center Programs in Milwaukee, WI

MPH Graduate, Casey J. Brown caseyjobrown@yahoo.com
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


Introduction: Over 3 million individuals in the United States experience homelessness on any given night, yet the homeless population has long been neglected by policy makers and society overall, especially within the realm of health care.

Methods: A literature search of homelessness and health was conducted to determine the cause and effect of limited health care access to homeless persons as well as to seek potential recommendations to alleviate this public health issue. A field study conducted in Milwaukee, WI, qualitatively examines the homeless condition and programs working to alleviate lacking access in Milwaukee.

Scope & Characteristics of Homelessness: It is believed that the rise in homelessness over the past two decades is largely due to a shortage of affordable housing and simultaneous increase in poverty. The homeless population demonstrates numerous health disparities, suffering in greater proportions than the general population in terms of acute health problems, communicable disease, HIV/AIDS, and mental illness.

Lack of Access: This literature review cites numerous studies to determine the health concerns of the homeless population, the access issues the homeless face when seeking healthcare, nursing outreach and integration efforts, and the need for advocacy by healthcare workers to improve the homeless condition.

Field Study in Milwaukee, Wisconsin: This field study provides an example of a successful nursing outreach model embraced by the Homeless Outreach Nursing Center and Autumn West programs. Background information about the programs and their processes is included as well as de-identified composites of homeless persons that demonstrate stages of progress through the programs.

Conclusion: There needs to be an increase in the number of studies conducted concerning homelessness and healthcare access. These studies must be conducted throughout the nation in many diverse communities. Funding and efforts should focus on nursing outreach, as it appears to be the most viable option to alleviate lacking access given the current economic and political climate of the United States.

PowerPoint Presentation (PDF)

  Erwin Cabacungan, MD, MPH | Racial and Ethnic Disparities in Maternal Morbidities and Preexisting Medical Conditions during Labor and Delivery Hospitalizations in Wisconsin

MPH Graduate, Erwin Cabacungan ecabacun@mcw.edu
Advisor: Emmanuel Ngui, DrPH, MSc, Assistant Professor, Department of Pediatrics


Background: Maternal morbidities (MM) and preexisting medical conditions (PMC) during pregnancy are important measures of maternal health. Although mostly preventable, these conditions are increasing and often lead to adverse perinatal outcomes and increased healthcare costs.

Objective: To compare MM and PMC during labor and delivery among racial/ethnic groups in Wisconsin.

Methods: Retrospective analysis of 206,428 pregnant women aged 13-53 years included in the 2005-2007 Wisconsin Healthcare Cost and Utilization Project State Inpatient Dataset. Logistic regression models were estimated for MM and PMC. Covariates included race/ethnicity, maternal age, socioeconomic factors, and comorbidities.

Results: About 29% of labor and delivery hospitalizations had ≥1 MM and 8% had ≥1 PMC. For MM, adjusted results showed that black women had significantly higher likelihood of infections, preterm labor, antepartum hemorrhage, and hypertension complicating pregnancy compared to white women. Hispanics, Asian/Pacific Islanders and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders. For the MM, cesarean section, Blacks, Hispanics and Asian/Pacific Islanders had significantly lower likelihood of primary and repeat cesarean sections than Whites. For PMC, Blacks had significantly higher likelihood of asthma, diabetes mellitus, chronic hypertension, and obesity than Whites. Diabetes was significantly higher for Hispanics and Native Americans. The likelihood of ≥1 MM was significantly higher for Blacks (OR = 1.27; 1.23 - 1.32), Hispanics (OR = 1.05; 1.01 - 1.09), Asian/Pacific Islanders (OR = 1.07; 1.01 - 1.13) and Native Americans (OR = 1.32; 1.20 - 1.44). Blacks were more likely to have ≥1 PMC (OR = 2.10; 1.99 - 2.21).

Conclusions/Implications: Findings suggest significant racial/ethnic disparities in MM and PMC. Better screening, management and timely referral of these conditions, particularly among racial/ethnic women, should be implemented.


Cabacungan, ET., Ngui EM, McGinley EL. Racial/Ethnic Disparities in Maternal Morbidities: A Statewide Study of Labor and Delivery Hospitalizations in Wisconsin. Maternal and Child Health Journal, 2011 Nov 22. [Epub ahead of print] PMID: 2215738.

  Thomas Frye, DDS, MPH | Access to Dental Care for Rural and Underserved Areas: Applying Evidence to the Practice Setting

MPH Graduate, Thomas Fryetfrye@mhtc.net
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


Background: A lack of access to dental health care for rural and underserved populations throughout the country and State of Wisconsin is a critical health care problem. Studies at the state and national levels have failed to reach a consensus on solutions to this problem, and many states are falling below the goals of Healthy People 2010 to ensure adequate access to dental care.

Methods: A literature review of both population and dental provider demographics evaluated the extent of the unmet dental needs. The Surgeon General’s 2000 Report - Oral Health in America, the American Dental Association 2005 – Report on Current and Projected Dental Workforce, and the Wisconsin Dental Association/Delta Dental Report 2010 – Supply and Demand for Dental Services Wisconsin provide the basis for this study.

Results: Data indicate there is no shortage of dental providers nationwide or statewide in Wisconsin, but the problem is one of distribution. Contributing to the lack of access in the rural areas is the Federal Medicaid (MA) program that provides low re-imbursement rates resulting in low provider participation and utilization of services. The establishment of Federally Qualified Health Centers (FQHCs), expanding auxiliary dental provider positions, and the development of market based partnerships have been proposed to eliminate the disparity of dental care delivery.

Conclusions: Efforts in states to increase the reimbursement rates paid to dental providers have been shown to increase utilization. Initiatives to target rural pre-dental students for admission to dental schools and admission of in-state students will increase the retention of dental graduates in the state in all practice locations. The introduction of innovative dental personnel, such as the dental therapist and community dental health coordinator, may also increase access and utilization of services. The development of market-based initiatives that partner dentists and auxiliaries with local state and national programs has been shown to significantly improve the access to dental services for the underserved populations and may provide the solution to the disparity of care existing on the state levels.

PowerPoint Presentation (PDF)

  Jessica Gathirimu, MPH | A Mother's Perspective: An Analysis of Fetal Infant Mortality Review (FIMR) Maternal Interviews

MPH Graduate, Jessica Gathirimujessicagathirimu@yahoo.com
Advisor: Emmanuel Ngui, DrPH, MSc, Assistant Professor, Department of Pediatrics


Objective: To use data collected though Fetal and Infant Mortality Review (FIMR) maternal interviews to enhance our understanding of infant and fetal deaths.

Methods: As part of the City of Milwaukee FIMR program, maternal interviews were conducted during the years 2005-2007. We analyzed selected questions from these interviews for this study. Frequencies were calculated on demographics and questions that were dichotomous or multiple choice in response. A qualitative analysis was conducted for open-ended questions to identify important themes.

Results: We identified the following five major themes: 1) unintended pregnancy and inconsistent or lack of birth control use, 2) poor or limited quality of care from prenatal care providers and while at the delivery hospital, 3) communication problems between the patient and medical care providers, 4) increased stress, and 5) unsafe infant sleep practices.

Conclusion. These themes indicate that there is an ongoing need for women to be well informed and involved in their reproductive health decision making, before, during and after pregnancy. It is also clear that stress is still a significant factor in the lives of women and ultimately birth outcomes. Furthermore, programming efforts need to be continued in the area of safe sleep for infants. These results can be used to shape programs and policies in the area of improving birth outcomes.


Jessica presented her Capstone Project as a poster at the 2010 Wisconsin Public Health Association annual conference.

Visit our Facebook page to view photos.

PowerPoint Presentation (PDF)

  John Hall, MD, MPH | Hepatitis B Prevention Awareness in San Francisco Dental Offices


MPH Graduate, John Hall jlanehall@me.com
Advisor: Robert Goldberg, MD, Assistant Clinical Professor, Department of Population Health & Health Sciences Clinical Professor, Division of Occupational and Environmental Medicine, School of Medicine, University of California-San Francisco


Hepatitis B remains a significant public health problem. Although the hepatitis B vaccine has greatly reduced the risk of occupational exposures for dental workers, many remain unnecessarily at risk for this disease. A survey of dentists’ offices in San Francisco was performed to assess existing awareness of measures available to prevent hepatitis B in this population. Outcome was hampered by low response rates to the survey. Most offices responding are aware of the vaccination status of patient care employees but not necessarily their hepatitis B immune status. All offices attempt to provide periodic employee education but acknowledge existing barriers. Some offices seem unsure of current CDC recommendations concerning preventive measures. Potential solutions to improving education and immunity include incentives from the offices’ workers’ compensation carriers, streamlined recommendations from the California Dental Association, and strengthened periodic educational requirements from the state dental board.

PowerPoint Presentation (PDF)

  Elizabeth Kailath, MD, MPH | Emerging Infectious Diseases with an Emphasis on the Novel H1N1 Influenza Strain and its Impact on Public Health

MPH Graduate, Elizabeth Kailath sierraid@comcast.net
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


Background: In the spring of 2009, Mexico City announced that 2500 cases of an influenza-like illness had been identified, of which 150 (6%) resulted in death. It was weeks before this illness was identified as a new H1N1 Influenza A virus. The purpose of this paper is to determine the impact of this disease on the public health’s from a national and international perspective.

Methods: Using Medline, PubMed, Cochrane data base and other search engines, I have collected data on this infectious agent to report international and national trends in incidence and case fatality. Qualitatively, I have drawn upon my clinical setting, where I practice as a physician, to report from an individual community clinician perspective.

Results: The disease was most severe and mortality rates were the highest during the first six months after it emerged. The death rates, however, declined as time went on. The patient population afflicted most seriously with H1N1 Influenza consisted of young children, pregnant women and immune compromised, which is in stark contrast to the seasonal influenza, which typically affects the elderly. Initially, many health professionals feared this Influenza would deplete our medical resources; however, the impact on our medical resources was less than originally feared. To date, the disease has been reported in 207 countries. In the United States alone, there have been approximately 13,000 deaths attributed to this disease.

Conclusion: Pandemics of influenza have been reported around the world for centuries, leaving hundreds of thousands dead in their wake. With advances in overall supportive medical care and effective antiviral therapy, combined with expeditious vaccine development, the needs of vulnerable populations were generally well met during this pandemic, and thus the mortality rate was less than in pandemics years ago. Lastly, it is fortuitous that the elderly were relatively spared in this epidemic since historically they have suffered the greatest mortality risk from respiratory viral infections.

PowerPoint Presentation (PDF)

  James Laurino, MD, MPH | The Bioterrorism Research Handbook for Category A Biological Agents: Natural History of Disease, Pre-Research Testing, Post Exposure Testing, and Disease Treatments

MPH Graduate, James Laurino james_laurino@yahoo.com
Advisor: Robert Goldberg, MD, Assistant Clinical Professor, Department of Population Health & Health Sciences Clinical Professor, Division of Occupational and Environmental Medicine, School of Medicine, University of California-San Francisco


This handbook is designed to give the people doing research on bioterrorist agents a quick reference to the properties of the agent, what to do before handling, and what to do after they think they are ill from the agent.

The information is organized into the following sections:

  1. Description of the agent
  2. Pathophysiology or summary of how it infects
  3. Symptoms and signs in the infected organ systems, or how it looks
  4. Pre-experiment baseline tests recommended of the researcher
  5. Post exposure tests to determine if an infective exposure has resulted
  6. Treatments to give after contracting the disease

The handbook covers the following CDC Category A or B Biological Agents:

  • Anthrax
  • Bird Flu
  • Botulism
  • Brucellosis
  • Ebola Virus
  • Lassa Fever
  • Marburg Virus
  • Melioidosis
  • Plague
  • Small Pox
  • Tularemia

The cost of testing is variable, so the handbook gives a ballpark estimate of costs to allow for budgeting when a study is in proposal stages. The individual pages for biological agents will state which tests are recommended to be done on staff, prior to beginning experiments, and also what test to do when an exposed staff member becomes ill.

PowerPoint Presentation (PDF)

  Amir Nicknam, MD, MPH | Strategies and Intervention Methodologies to Achieve the Elimination of Childhood Lead Poisoning Disparities in Southern Nevada

MPH Graduate, Amir Nicknam anicknam1@yahoo.com
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


Objective: This study was conducted in an effort to identify and assess the effectiveness of lead poisoning prevention activities/interventions currently used in Southern Nevada, and to determine which barriers to the provision of these activities/interventions as part of the Southern Nevada Healthy Homes program currently exist.

1) Literature reviews of four separate studies, which report blood level outcomes. Review of these studies were used to determine the efficacy and viability of various intervention strategies for the Southern Nevada Childhood Lead Poisoning Prevention Program and the Southern Nevada Healthy Homes program to employ toward their goals of eliminating childhood lead poisoning in Southern Nevada, and to best advise these programs of preferred methods.
2) Retrospective study of 18 individual cases of children under 72 months of age who were reported as having a blood lead level equal to or greater than 10µg/dL. Interventions used by the Southern Nevada Childhood Lead Poisoning Prevention program were reviewed to determine their overall effect and viability as well as to identify and provide solutions to overcome barriers to the provision of these interventions.

Results: The methods employed in this study found that when implemented alone, educational interventions were not effective in reducing blood lead levels among the target population. Studies researching soil abatement (removal and replacement) were not able to be meta-analyzed due to substantial differences between studies, so no determination was made.

Culturally-sensitive, cost-effective universal screening was recommended for communities with inadequate data on blood lead level prevalence. Comprehensive case management services were also shown to be effective in reducing the blood lead level of a child. In fact, out of the 12 cases which received at least one case management visit and then received follow-up testing, 9 showed a reduction in blood lead level after the primary visit.

Conclusions: Outlined interventions and strategies that can be used in Healthy Homes program goals to eliminate childhood lead poisoning and reduce health disparities in Southern Nevada.

PowerPoint Presentation (PDF)

  Amanda Ruth Phillips-Savoy, MD, MPH | How to Select a Mass Notification System: A 12-Step Program

MPH Graduate, Amanda Phillips-Savoydramanda2001@yahoo.com
Advisor: Kenneth Yen, MD, Associate Professor, Department of Pediatrics - Emergency Medicine


This article was written to develop a logical, systematic process to select a mass notification system for a public health organization. Based on experience and internet research, a 12-step program was developed for use by public health officials. Topics and steps include selection committee considerations, request for proposals, narrowing the field to a final mass notification system, and finally negotiation of a contract. This process is outlined to help public health officials and organizations choose a mass notification system.

PowerPoint Presentation (PDF)

  Michael Rosenberg, MD, MPH | HIV/AIDS Issues Facing America: Understanding the Current Demographic Trends of the Epidemic and Addressing the Public Health Needs of High-Risk African American Women

Advisor: Robert Dedmon, MD, MPH, Volunteer Clinical Professor, Department of Population Health


Background: Current statistics reveal that HIV/AIDS remains a major public health problem in America. As the AIDS epidemic in America has matured, there has been a growing public misconception that the issue is under control. Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and they represent the majority of new AIDS cases and people living with HIV/AIDS. Today, women represent a larger share of new HIV infections compared to earlier in the epidemic, and African American women are particularly affected. Many socioeconomic and behavioral factors have been implicated as contributing to the spread of the disease among this demographic.

Objectives: To create recommendations for public health policies and interventions that can be used as guidelines for reducing the number of new HIV/AIDS infections among African American women and to provide better health services for those who are currently infected.

Methods: Comprehensive literature review, which presents the evolution of the HIV/AIDS epidemic in the African American population and establishes the social, behavioral, cultural, and political factors that have contributed to the current prevalence of the disease. Presentation of the epidemiologic findings of HIV/AIDS studies conducted within United States’ populations, and review of interventions that target African American women and their theoretical basis. This information was examined for the health status of minority demographics and possible determinants of illness among African American women.

Results: Significant findings were used to help identify what public health strategies might be most useful in targeting African American women and in what ways current public health policy fails to address their needs. Using this information, public health intervention recommendations were drafted in order to accomplish the stated objectives.

Conclusions: Strategy should focus on prevention. Recommendations for public health include reducing stigma associated with HIV/AIDS, increasing surveillance of the disease in the black population, increasing knowledge among African American females of their HIV status, increasing access to healthcare and reducing barriers to care, and facilitating behavior change among African American women to reduce risk behaviors. These recommendations would be best accomplished through culturally competent community-level and group-level interventions.

PowerPoint Presentation (PDF)

  Michael Schmalz, MPH | Analysis of Novel H1N1 Pandemic Plan for Wauwatosa’s Health Department: Communication and Mass Clinic Implementation

MPH Graduate, Michael Schmalzmichaeljschmalz@gmail.com
Advisor: Nancy Kreuser, PhD, RN, Assistant Adjunct Professor, Department of Population Health


In April of 2009, the United States diagnosed its first case of novel H1N1 or “swine flu”. On June 11th, the World Health Organization (WHO) declared H1N1 as a pandemic, their first pandemic in over forty years. Since its discovery, federal, state and local health departments (LHDs) have worked tirelessly to inform the public and protect them from infection. Pandemic flu plans exist and constantly evolve to meet the challenges particular to each new strain; however, these plans are formally updated more frequently on the federal and state levels than they are on the local level. Through literature review, data gathered from quality improvement meetings and a review of LHD H1N1 After Action Reports, this paper evaluates the pandemic preparedness planning of the Wauwatosa Health Department (WHD) for the novel H1N1 influenza virus, primarily looking at their mass clinic operations and the efficiency of their communication between the state, community partners and the Wauwatosa community at large. While federal public health agencies develop guidelines and approve vaccines for mass prophylaxis and state health departments coordinate the distribution of those vaccines to LHDs, it is at the local level that the public seeks receives vaccination services. Insufficient vaccine production at the beginning of the nationwide vaccination campaign coupled with unclear communication channels between various health agencies created challenges for the WHD communicating with the public, vaccinating the public and coordinating vaccination efforts with other LHDs. While the complications with vaccine supply were unavoidable, streamlining and practicing communication during mass vaccination campaigns could improve public health service in the future. This evaluation and any recommendations will be used by the WHD for their annual Preparedness Planning grant.

PowerPoint Presentation (PDF)

  Graciela Villadoniga, MD, MPH | Applying the Chronic Care Model to Diabetes Mellitus: Does its application improve Diabetes Mellitus outcome? A literature review.

MPH Graduate, Graciela Villadonigagracielavs@hotmail.com
Advisor: Srividya Kidambi, MD, Assistant Professor, Department of Medicine, Division of Endocrinology, Metabolism, and Clinical Nutrition


The objective of the present paper was to review the literature on the Chronic Care Model (CCM) and how its adoption in primary care clinics affects patients’ outcomes. Specifically we were interested in the adoption of the CCM in clinics that participated in Graduate Medical Education (or resident training clinics) and how the CCM affected patients’ outcomes and allowed teaching of core competencies (as dictated by Accreditation Council for Graduate Medical Education (ACGME)) in this setting. Articles included in this review were identified by searching through the United States National Library of Medicine database (Medline=PubMED database) in the English language. The following Medical Subject Headings (MeSH) and key phrases were used: “Chronic Care Model”, “chronic care”, “patient outcomes”, treatment outcome (MeSH), Diabetes Mellitus (MeSH), Internship and Residency (MeSH), [education, medical, graduate] (MeSH). Only articles in the English language were reviewed. All literature published before January 15, 2010, that was considered relevant was included.

Multiple studies describe the adoption of one or two elements of the CCM, but few describe the implementation of at least four of its six basic elements. Only five studies were found through our search that addressed the CCM in the type of setting we were interested in. From this review, we can conclude that evidence shows clinic processes are improved with the implementation of the CCM. In many studies and reviews, patient outcomes are also improved, nevertheless, this finding is not unanimous. In the very few studies considering patients’ overall quality of life, no significant change was noted with this intervention. In regards to the adoption of the CCM in resident training clinics, the CCM has been used as a tool for teaching core ACGME competencies and the barriers to this implementation are well described.

PowerPoint Presentation (PDF)

  Ghousia Wajida, MD, MPH | Salt and High Blood Pressure: A Community Experience

MPH Graduate, Ghousia Wajidagwajida@yahoo.com
Advisor: Alan Wells, PhD, Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine


We conducted a community based education module consisting of a 20-minute power point presentation regarding salt intake and blood pressure at local community centers in Cleveland, Ohio. Our aims were #1. To raise public awareness about the effects of dietary sodium on blood pressure, heart attack, stroke or kidney disease. #2. To develop an easily accessible curriculum for community members that discusses sodium content, concomitant lifestyle changes and nutritional strategies to reduce stroke risk factors. The power point and poster identifying sodium content in some ready-to-eat food choices, including snack foods and popular restaurants, were made by online searches of fast food restaurants and other websites. We also evaluated clinical studies for the relationship between dietary salt and high blood pressure and the cardiovascular risk reduction on a 2000 mg sodium diet. The participants submitted both pre- and post-talk questionnaires, which took 5-10 minutes to complete. The survey was anonymous and confidential. Results of the questionnaire were analyzed to determine the effect of the educational activity on community members’ understanding of dietary salt and the risks of high blood pressure.

The prevalence of high blood pressure in our study was 33.33%. Our educational activity resulted in statistically significant improvement in participants’ understanding of sodium content in a teaspoon. The pre- and post-educational activity correct responses for this question were n=8 (24.4%) and n=18 (52.94%), respectively, 95% CI = 0.064 - 0.5 and P= 0.016. A majority (73.53%) reported reading food labels compared with 26.47% who do not. A large proportion (81.8%) of participants with high blood pressure wanted to cut back on salt intake compared with 50% in the normal blood pressure group (P= 0.08). Even though this proportion was numerically much higher, it was not statistically significant, possibly due to small sample size. Between both groups, 63.3% wanted to cut back on salt intake. Our study demonstrates that community based educational activities highlighting clinical trials that emphasize healthy diet and lifestyle choices make significant improvement in community members’ understanding with a strong potential to promote healthy behavior and reduce long-term risk of cardiovascular events with substantial cost savings.

PowerPoint Presentation (PDF)

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