GPS Locator Devices for People With Dementia

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GPS Locator Devices for Along with Dementia
Leigh-Ann Topfer.
Published online: August 31, 2016.
Summary
* Wanderinga is really a common behaviour in people with dementia, but cognitive impairment can cause them to become disoriented and lost.
* Locatorb devices that use GPS (global positioning system) are assistive technologies that can help to promote safe walking by alerting caregivers when a person with dementia wanders outside of a designated area, and providing the geographic coordinates of will not so they could be found more instantly.
* Because locator devices are submit form of surveillance, utilizing them raises ethical and legal issues regarding privacy and autonomy, but people with dementia and their caregivers believe possibilities benefits outweigh potential harms.
* Locator devices may reduce the time required to find missing individuals with dementia and similar problems related to associated with search and rescue function.
* Locator devices may increase the independence, autonomy, and freedom of some people with early- to moderate-stage dementia, and reduce caregiver anxiety and stress.
* Evidence towards the cost-effectiveness of locator devices is still needed.
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Background
Dementia is a fast term for various disorders that affect cognitive functions, including reasoning, speech, the ability to process information, and memory.2,3
A common behavioural characteristic of dementia is wandering.3 Sufficient include pacing, lapping (repetitive walking around large areas), random walking with no clear route or with repetition, direct travel from one location to another, or elopement.1,7 Wandering can occur inside day or night for various reasons; for example, as a response to confinement, pain, hunger, or thirst, or from boredom.810
Mobility and the liberty to walk outdoors are important for maintaining quality of life.11,12 Wandering provide beneficial physical exercise, a sense of personal autonomy, and social contact.4,10,11,1315 The involvement of people with dementia in activities outside of the home can also relieve some of the stress of their health care providers.11 But, as their disease progresses and memory becomes impaired, along with dementia may become lost, even in familiar places.16
As a result, individuals with dementia can go missing or experience critical incidents when they leave home alone and are unable to find their long ago.8,15,17 People with dementia may also become lost while driving or taking public transit where a much larger territory may need to be covered in a search to find men and women.8,17
Individuals with dementia who wander tend to be at increased risk of injury or death from traffic accidents, hypothermia, dehydration, falls, fractures, and drowning.6,7,1416,18,19 They're also more quite likely going to be sedated, physically restrained, malnourished or losing weight, and just to be admitted to institutional care homes.5,6,13,19
Dementia also imposes a burden on family caregivers and incurs substantial fitness problem and societal costs.20 This includes costs for police and emergency response services assist you search for missing people.21 In Toronto, for example, emergency services responded a good estimated 1,200 calls (five to seven calls per day) in 2013 from caregivers of together with dementia who went missing.22 The Grande Prairie Royal Canadian Mounted Police (RCMP), as part with the Alberta Locator Device Project, estimated that seven to 15 of their 257 missing persons incidents in 2014 involved people with dementia.23
Locator devices may:
* help caregivers and emergency responders quickly locate and make sure the safety individuals who who wander24
* get people to with dementia feel more reliable and allow them to be a little more independent24
* provide reassurance as well as reducing caregiver trepidation.13
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The Technology
There are two main types of locating device technologies:
* GPS Identifies a person's location employing a transmitter that sends a symptom to a network of telecommunications satellites, which then relay the signal through mobile phone networks together with a caregiver's computer or mobile device, in order to a call centre. Merely use satellites, GPS devices can find a person across large areas, theoretically anywhere on earth that a satellite signal can achieve. Some systems incorporate additional technologies (such as assisted GPS [A-GPS] or Bluetooth) increase locating serious amounts of location accuracy in locations where satellite signals may be impeded; for example, by high-rise set ups. GPS devices can also be would build virtual boundaries or geofences, which trigger a notification if for example the user goes outside a designated safe area.13,25 Associated with GPS locator devices found in Canada are shown in Table 1 particular.
* Radiofrequency (RF) Identifies a person's location a new transmitter that emits radio waves, that is definitely picked up by an antenna. The nature of radio waves limits their use to relatively small geographic areas.26
Many different GPS locator devices are commercially available, but only a few of the product have been assessed your past published studies summarized in this particular bulletin. The 2006 Ontario Locating Technology Project identified 26 locating technologies or services.28 Many of the devices lengthier exist or have been superseded: as with most communications technologies, this is often a rapidly changing area.
All GPS locator technologies rely on someone typically a caregiver, but sometimes a call centre being offered to monitor and be affected by alerts, monitor the individual, and bring them home.4
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Regulatory Status
In Canada, GPS locator devices are not considered medical devices underneath the Food and Drugs Behave. As such, they are not regulated by Health Canada but as consumer products the actual Canada Consumer Product Safety Act(Medical Devices Bureau, Health Canada, Ottawa, ON: personal communication, 2016 May 18). Canadian certification and licensing requirements for communication technologies may apply at GPS locator devices. Absolutely no their regulatory classification, locator devices are assistive technologies that help individuals to complete the risks associated with independent full time living.30
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People Who May Benefit
Alzheimer disease is the most prevalent type of dementia, affecting about 63% of along with progressive dementia.31Other types include vascular dementia (caused by reduced blood flow to the brain), Parkinson dementia, and Lewy body dementia.31
The Alzheimer Society of Canada estimates that longer than 564,000 Canadians have dementia.32 This number is for you to more than double your next three decades as individuals ages.21,31,32 A 2008 forecast estimated presently there will be approximately 103,700 new cases of dementia in Canada each year, increasing to 257,800 new cases annually by the majority 2038.31 Issue number of people with dementia also means a corresponding increase in the number of caregivers who'll be needed.33
Estimates for the prevalence of wandering in people with dementia range widely possibly because of differing definitions of wandering and as early as the stages of dementia in the research change from study to check.24Published estimates are that 12% to 60% of individuals with dementia will wander and become lost several point, resulting in 5% of these people will repeatedly wander and become lost.6,13,18,21,3436 However, a recent systematic review noted individuals reliable information on the nature and prevalence of critical incident strolling.14
Alberta Health Services estimates that 60% of people with dementia inevitable the community may surf.37 But, in the recent Alberta Locator Device Project, only around 11% to 13% of the participants experienced wandering or incidents of going missing.30
Not everyone with dementia wanders or might witness GPS locator devices. While the devices always be useful to be able to in if you let stages of dementia and in addition to their caregivers for the people with advanced disease, unsupervised walking is not safe.13 A UK survey of 99 caregivers found out that only about 7% of individuals with dementia in their care might have benefited locator device at period of the survey, while another 11% could have benefited earlier in the course of their .6 Although this bulletin focuses on the use of GPS locator devices by individuals with dementia, the extender may even be useful our kids have to and adults with autism and other cognitive troubles.27
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Current Practice
Identifying and addressing no matter if for wandering is recommended as credit card interest rate step in care planning.10 Barriers and restraints (physical or drug) have been used avoid wandering, separate can cause adverse effects, including pressure ulcers, sedation, falls, and increased anxiety symptoms.24
Current clinical practice aims to recognize and increase autonomy of individuals with dementia while ensuring their basic.13,19 Music, walking, or other exercise programs; access to safe outdoor spaces; and dementia-friendly design changes to make institutional environments more and also pleasant may also reduce strolling.1,10,19,36
In Canada, programs that work with law enforcement, social services, any other agencies to determine missing persons with dementia and other cognitive disorders include MedicAlert Safely Home (Canada),38 Ontario's Finding Your way program,35 and Project Lifesaver.39
MedicAlert Safely Home is really a partnership program between the Alzheimer Society of Canada and the MedicAlert Foundation Canada. For an annual fee of $60, the person with dementia receives a MedicAlert ID bracelet engraved with MedicAlert's emergency hotline number. If they is found or goes missing, emergency responders may call the hotline to find emergency and medical information (alzheimer.ca/en/Living-with-dementia/Day-to-day-living/Safety/Safely-Home).
GPS Device that Tracks Dementia Patients a Huge Success and charitable agencies in Canada participate in Project Life saver. This US-based agency works in collaboration with police and emergency responders motors atlanta missing anyone. Its program is intended for any individuals who might wander (including along with autism, Alzheimer disease, or other cognitive disorders). Users wear a wrist or ankle bracelet that emits an RF signal. York Regional Police has used the RF locator technology of Project Lifesaver since 2005. The technology still relies on caregivers to alert police earn money is suffered to loss of. Most Project Lifesaver participants are within 30 minutes of the 911 call by making use of the tracking equipment (Chris Plante, York Regional Police, Aurora, Ontario: personal communication, 2016 May 24). Only the locator devices purchased through Project Lifesaver are supported. The cost of the radio transmitter device in Project Lifesaver is C$300 and battery replacement is $10 per month (in some jurisdictions, charitable agencies or subsidies may cover or partially cover the costs).3941 Project Lifesaver recently added a GPS watch to the service alternate options.42
A 2013 review of non-GPS locator programs the particular US, with regard to MedicAlert and Project Lifesaver, concluded that further research on great and bad such programs is needed.14
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The Evidence
The seven most recent surveys (from 2011 to present) of locator devices if you have dementia are described which follows. Evidence from an earlier (2006) Ontario study is discussed in the Implementation section on page 10.
Alberta Locator Device Project
The Alberta Locator Device Project (2015) is the most recent Canadian study on the use of these resources.23,30 The project followed 45 dyads (individuals with dementia and their caregivers) in rural (Grande Prairie, n = 14) and urban (Calgary, n = 31) Alberta Health Services home care companies. The participants with dementia had most of age of 76 years and were at moderate risk for wandering (measured making use of the Revised Algase Wandering Scale [Community Version]).23 All participants were receiving home care; most (70%) lived using spouse some other family caregiver, and 22% lived entirely.23
Three types of locator devices were moved to the study (ST200 Prime, SmartSole, and TRiLOC). Participants used their GPS devices for around 5.8 june thru september.23 About half of the participants used their GPS devices onrr a daily basis mainly for walking or during other activities outside want to find out. In addition to the weekly caregiver log reports from the experiences, focus groups with caregivers and stakeholders (such as the Alzheimer Society of Alberta and Northwest Territories, and police services) were held at the end of the thrust outward.
The usability of the locator devices was rated as high by the dyads. Most (89%) said they would eventually be willing to be charged a GPS device; however, 75% felt that government funding in order to be provided.23 Although most caregivers did not mention concerns using the devices, some noted issues with charging (or forgetting to charge) the device, having the care-recipient wear the device, false alarms with geofences, and discomfort while wearing one for the devices.23
The Alberta Locator Device Project concludes that:
* Locator devices end up being a standard option for home care and supportive living services, and must be provided with an earlier stage of dementia so people with dementia can participate in decisions regarding their use.
* Costs of locator devices and telecommunications charges should be looked at for public funding or subsidy, depending on the ability of users to fund.
* Caregivers should result in monitoring, however responders along with stakeholders could facilitate accessibility GPS devices for people that may need them.
* People with other cognitive conditions (such as autism) could also benefit via the devices.
Two additional recommendations were that:
* Those involved should collaborate with police services to collect data in the number of missing persons with dementia.
* GPS Fleet Tracking Reviews -term study should be undertaken of the cost-effectiveness of using locator devices, including the impact of television . on use and price health care and first responder assistance.23,30
In the Alberta Locator Device Project, false alarms with the geofences were common and indoor location readings are not as accurate as outdoor readings, however the addition of Bluetooth technology may lessen number of false alarms and improve finding indoor locations.30
Before the Alberta Locator Device Project began, several participants regularly needed police help getting their comparable with dementia. During GPS for the Elderly - Why It's a Good Idea , whilst the GPS devices were in use, police services were not used in.30
Other Studies
Other recent surveys of GPS locator machines are summarized by three main outcomes, as follows:
Time motors atlanta missing person
A 2016 simulation study, funded from the US Department of Veterans Affairs, assessed the time to locate missing persons (role-played by researchers) under various outdoor scenarios using three commercially available RF locator devices and four GPS devices.26 Each device was tested thrice in both three scenarios (open, wooded, and urban). Two device tests (one with RF and one with GPS) failed find the missing person within 25 minutes, but overall, the GPS devices were almost twice as time-effective in finding the wanderer and performed better over larger kilometers. The RF devices were limited by their range; however, the study did not test the devices indoors, where RF devices probably have performed enhanced.26
A 2014 UK study looked at the feasibility of conducting a randomized controlled trial of GPS locating devices for people with dementia.13 The pilot study used various GPS services but found the main differences were format and battery everyday life.13 Although the study was small (12 participants as well as their caregivers) and relied on caregiver estimates, it found the utilization of GPS technology reduced period spent searching for missing sufferers.13
A 2012 pilot project launched the particular Halifax Regional Police, called Project SOFT (Satellite Option Finding Technology), tested GPS devices in 10 along with dementia over a one-year period.43 A report on the study just isn't published, however the principal investigator for the project noted a lowering in time and staff utilized with searching for missing along with dementia.23
Independence, autonomy, and freedom
Caregivers globe Alberta Locator Device Project reported that their family member with dementia was given more freedom as consequence of using machine.30
A 2015 Norwegian study assessed the usage of various commercial GPS devices by 208 individuals with dementia and their caregivers.3 Almost half of the participants in this particular study used their GPS locator for approximately one a year, 23% used the device for considerably two years, and 12% used unit fitted for far more two years. Caregivers considered the main benefit of the GPS devices to work as increased safety and freedom it specified. Reports by participants with mild dementia showed they valued the liberty to have the ability to continue their outdoor activities, and viewed GPS devices as less intrusive than physical or chemical vices. The researchers concluded that the devices allowed individuals with dementia to carry on to take part in outdoor activities and maintain their autonomy.3
Similarly, a 2015 Swedish report of three case studies found that the utilization of GPS locating devices increased the independent outdoor activities of a pair of the three participants with dementia.44 Perhaps the locator reduced the caregivers' anxiety wasn't clear.44 A beginning Swedish study, by equivalent investigators, examined the experiences of five couples (individuals with early- to moderate-stage dementia as well spouses) when using a GPS locator.45 All participants felt the GPS device improved their safety outdoors, and the aspect to become monitored has not been a challenge.45
In a UK study published in 2014, 10 caregivers of folks with dementia prioritized the raised safety of your other half with dementia when using GPS devices over concerns about their privacy.25 Moreover, they viewed independence and freedom as a crucial part of their care-recipient's quality of life.25
A 2012 pilot study the Netherlands assessed the acceptability and benefits relying on GPS locating technology in 33 care-recipients with early-stage dementia who lived at home with their caregivers (mainly spouses).46 Twenty-eight dyads completed the three-month learn about.46 Approximately 25% of the participants reported they were outside save more, and 45% indicated they had more independence from their caregivers along with the GPS system.46About 60% of the caregivers reported they allowed more freedom on their care-recipient, and 30% felt they themselves had more time for extremely own activities utilizing the GPS device.46 About 50% of the care-recipients reported feeling less anxious about being outside alone buying a locator device.46
Reducing caregiver anxiety and stress
Although caregivers in the Alberta Locator Device Project reported how the GPS devices gave them peace of mind knowing they could locate family members member that they wandered away the study did not find a great reduction in caregiver debt load.30 The Dutch study also found good things about the associated with GPS locator devices but no significant impact on caregiver burden.46 However, the Norwegian study found that caregiver anxiety was reduced with the use of GPS technology,3 and caregivers in one UK study also reported that utilisation of the GPS devices reduced their anxiety and allowed them a break from constant caregiving.25
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Adverse Effects
While GPS technology reduces searching time for lost wanderers, this increases overall safety was not demonstrated.4,13 For example, GPS devices cannot alert users to dangers such as traffic, or ensure persons are wearing appropriate clothing for temperature if they wander away from.3,13
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Administration and value
Users of GPS locator devices need training and continuing technical enable.3,23,30,33,45 Battery life is an important aspect with fractional treatments. The client or caregiver must remember to charge system daily.4 Calories from fat frequently the missing person's location is transmitted, tougher quickly battery will be drained.4
The Alberta Locator Device Project noted that costs for three GPS devices ranged from $225 to $400, with monthly monitoring fees of $35 to $40.30 Current device fees are slightly higher, as shown in Table 1. Instead to purchasing device, the TRiLOC GPS is also available for a monthly lease fee of $69.95 (Vince Morelli, SafeTracks GPS Canada, Red Deer, Alberta: personal communication, 2016 Jul 4).
No studies of the cost-effectiveness of locator devices for people with dementia were identified for this bulletin probably an earlier (2006) UK review.36 An additional evidence could assess, for example, your house devices can prevent or delay admittance to residential care, or lessen costs of emergency services for search and try. If funding is available, the Alberta Locator Device Project research group plans to attempt such a report.23,30
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Concurrent Developments
Devices that offer navigational assistance are in development. Automobiles help those with mild cognitive disorders discover their way using GPS devices coupled with visual, audio, or sensory directional sticks.33 Researchers are also investigating whether GPS technology can help the driving ability of using mild dementia,47 or help to assess their driving effectiveness.48
Researchers at CanAssist, in the University of Victoria in British Columbia, have designed a Wandering Redirect System to deter nighttime wandering in individuals with dementia. This displays messages from caregivers on a tablet-sized screen placed within door. Each and every sensor activates the device, the messages remind man or woman that is actually also nighttime and not just time to look outside.49
Although not designed for those who have dementia, many smartphones offer GPS location apps, with regard to example Find My friends (iPhone) and iWander (iPhone and Android phones).1,5,50
Assistive therapy dogs will also being trained to help individuals with dementia.51,52 The dogs respond on command to lead the person with dementia home. For that programs, the dogs come with GPS collars that encourage the caregiver find the dog and its owner and activate a transmission that prompts the dog to bring them your home. The dog is also qualified to bark to attract attention if something is wrong and to their owner if they wander out of the house alone.51
The Canadian Dementia Priority Setting Partnership, in collaboration with the James Lind Alliance as well as the Alzheimer Society of Canada, is currently identifying the priorities of with dementia and their caregivers for dementia preparation.53
Aging Gracefully across Environments using Technology to Support Wellness, Engagement and Durability (AGE-WELL) Networks of Centres of Excellence and the Alzheimer Society of Ontario are investigating the role of GPS technologies in supporting people with dementia along with caregivers. Dr. Lili Liu, at the University of Alberta, is leading the AGE-WELL Consumer Guideline for Locator Technologies project (May 2016 to April 2017).54,55 This kind of include identification of the technologies available and the type of information offered by vendors to customers. The reason for the project is to increase standards as well as a online resource that collects the information consumers need on GPS-based products (Alex Mihailidis, AGE-WELL Network of Centres of Excellence, Toronto, Ontario: personal communication: 2 May 2016).
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Rate of Technology Diffusion
The 2006 Ontario Locating Technology Project identified 26 locating technologies or services.28 Many of the devices much exist or have been superseded by newer technologies as with most communications technologies, this can be a rapidly changing area.
We found no information about how widely GPS devices are usually adopted by people with dementia and caregivers across Canada. Marketing to consumers and the pervasiveness of technological developments with cellphones and GPS capabilities may affect the diffusion individuals devices.4,13
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Implementation Issues
Ethical and Legal Considerations
To date, discussions of ethical issues regarding locator technologies also been driven more by professional opinion when compared with people with dementia plus their caregivers.25 A key concern is balancing the rights of your mate with dementia, including their right to privacy, when using the potential primary advantages of the technology in reducing their chance of harm and it could enhancing their personal liberty.25 A 2009 report from the Nuffield Council on Bioethics recommends that GPS any other assistive devices for people with dementia in order to be assessed on the subject of risk-benefit instead of merely risk assessment for example, ought to and perils of independent walking versus people being limited.56
Advanced directives are in order to ensure that individuals with dementia take part decisions located on the use of locator technologies while capable to make informed decisions.3,14,24,25,27,34,57
There is often a potential stigma with the utilization of locator devices (i.e., marking the user as disabled, and possibly leading to social isolation or exclusion). There additionally be the negative connotation of the technology when associated with tagging or tracking technologies used in law administration.4 However, UK caregivers did not associate the use of GPS locator devices with stigma rather, they went to the theater as a system for enabling independence.25
The needs of and possible benefits to both the care-recipients and also the caregivers also need to be considered recognizing caregivers as individuals too, beyond their caregiving contracts.4,25
The main intent of people who used GPS locator devices was to enhance the safety of the one that might take off.24 This took precedence over the individual's right to privacy had been seen as already curtailed by constant caregiver surveillance. GPS technology was also created to enhance the freedom of the user with dementia, enabling these types of leave home independently.25 Locator devices were considered staying less restrictive than practices aimed at reducing wandering, such as psychotropic drug therapies and locked doorways.24
Another dilemma is whether using these devices will lead to decreased personal contact with caregivers or greater social isolation.24 Could also be viewed as one way to cost-savings through reducing staffing levels (particularly in for-profit care facilities).9,10,57 The regarding locator technology may also detract because of the need for funding for adequate home care support for together with dementia and their caregivers.57
Other Issues to Consider
The Alzheimer Society of Canada has produced a checklist of features to help consumers compare different locator detectors.58 This information will be updated by the AGE-WELL Consumer Guideline for Locator Technologies project that is now underway and in order to be the actual in December 2016.54,55
Valuing whomever and providing person-centred care is key, and consists of obtaining input from using dementia and the caregivers on the design and use of the extender.14,34,59 Locator systems must be easy to use, with minimal use of log-in passwords and generated for use by older professionals. The instruction manual should be as simple as possible, with a much larger type font and clear diagrams.33,45 It should also be simple to charge the battery and to clean the strategy.27
Whether gadget is supposed to have been worn or carried or can be secured (such as a lockable watch strap) are also factors to consider.24 Some of the participants in the Alberta Locator Device Project had tried consumer GPS products before entering the study, but found them too complicated for use by together with dementia, since they wasn't wearable or lockable, these folks were too easily lost.30
The worth of devices that allow two-way communication was also noted.45 Obvious a preferred feature for participants in both the Ontario and the Alberta locator studies.23,27,30
At period of the Ontario locator study, a lot of the devices were only in the prototype stage of development, but no devices assessed met all the needs of the participants.24 However, GPS locator technology is beginning to change rapidly as new features are . Early studies cite user feedback that these devices should be lightweight, small, and comfortable and use improvements that are incorporated into current creations.24,34
GPS locator devices should be seen for addition to, rather than as new ones for, other sorts of care enhance the safety of which dementia. Simple identification bracelets or clothing tags are also important because those with dementia may not be able to communicate their name and address to emergency colleagues.17
In 2007, the Mental Welfare Commission for Scotland published help with using technologies for using dementia who may take off.10 The guidance notes that location technologies may rise above the crowd as a questionnaire of restraint; however, While use of technology plays a part in maintaining independence, or enabling continuity of care, we think it is highly recommended.10 The Scottish guidance consists of a checklist of issues to consider when implementing locator technologies.10
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Final Remarks
Locator technologies are a type of assistive device for people with dementia and funding ought to be to support the use because of devices by those vulnerable to benefit.23,24,30,33 It was actually a recommendation of each Ontario as well as the Alberta locator projects.23,24,30
Although more evidence is needed, appealing of the Alberta Device Locator Project indicates that GPS devices may reduce the involvement of police services in search and rescue for missing individuals with dementia.30
There is greater awareness that better types of dementia care are needed. Examples of innovative care models are the Netherlands' Hogewey (dementia village) and Green Care farms.21,60,61 These programs provide safe environments for walking, exercise, and task for people with dementia.
Most people, including people dementia, in order to stay regarding own places of residence.4,20,59 Coordinated home care services and the actual usage of of appropriate technologies works to make this possible.20,44 Rather than preventing wandering, attention buy a focusing on ensuring safe walking if you are with dementia.15,36 Locator devices can add up to this by some people who dementia to participate in activities outside of their home while reducing the associated hazards.