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TB Notes 2, 2003


Karen Allen has joined DTBE and FSB/Field Operations Section II as the new Program Operations Assistant for FOS II. Karen began her federal government career with the Department of Defense at the Naval Research Laboratory in Washington, DC, as an Employee Development Assistant from 1987 to1999. She moved to Atlanta in 1999 and worked in private industry before rejoining the federal government. She joined CDC in July 2001 and worked with the National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Maternal and Infant Health Branch in administrative support.

McKenzie Andre, MD, Epidemic Intelligence Service Officer in DTBE’s Surveillance and Epidemiology Branch, has been accepted into CDC’s Preventive Medicine Residency (PMR) Program. Mac will begin his new assignment (away from CDC headquarters as required by the program) in July.

Lori Armstrong, PhD, joined the Surveillance Section of the Surveillance and Epidemiology Branch as a Senior Epidemiologist on March 10. Prior to joining DTBE, Lori had worked in the Cancer Surveillance Branch, Division of Cancer Prevention and Control, CDC, since 1999. Her duties there included serving as a project officer for several state cancer registries, lead for an analysis to compare mortality rates of colorectal cancer in Appalachia and elsewhere in the United States, and principal investigator in a large study of eight state-wide central cancer registries to study patterns of care in breast, colorectal, and prostate cancer in the United States and a study looking at the end-of-life care for men with prostate cancer in two large managed care organizations. Lori also supervised an EIS officer in analyzing cervical cancer incidence in Hispanic women in the United States and socioeconomic factors for women with cervical cancer in California. Lori received her PhD in Epidemiologic Science from Rackham School of Graduate Studies, University of Michigan, in 1990. Her other educational achievements include an MS degree in toxicology, also from the University of Michigan (1985), a BS degree in biology from Eastern Michigan University (1981), and an RN degree (1976). Following her postdoctoral research fellowship in the Department of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Lori joined the Epidemic Intelligence Service (Class of 1993), Special Pathogens Branch, Division of Viral and Rickettsial Diseases, CDC, and then worked in Viral Exanthems and Herpesvirus Branch through mid-1999. Lori has been a first author or co-author on more than 20 scientific articles published in peer-reviewed journals and the MMWR on topics including hantavirus, juvenile respiratory papillomatosis, and ebola viral hemorraghic fever. In DTBE, Lori will be developing several analytic projects using the national surveillance database to help disseminate information on high-priority topics, and contributing to the development of sureillance-related applied research and evaluation projects. We are pleased that the addition of a senior epidemiologist will help the Surveillance Section expand its analytic, research /evaluation, and technical assistance capacity.

Subroto Banerji, MPH, was selected for a program consultant position with DTBE Field Services Branch (FSB). He began this assignment on May 5, 2003. In this new role, Subroto will be representing FSB on several projects. These include collaborating with CDC Division of Global Migration and Quarantine to continue progress on the Electronic Disease Notification project for Class Bs; partnering with staff from DTBE’s CSB and SEB to coordinate the groundwork for the development of a TB information system that will support core patient management and mandated surveillance activities; and participating on the DTBE TB Program Evaluation work group. Subroto joined CDC in June 2000 as a Public Health Advisor assigned to the California Department of Health Services (CDHS), TB Control Branch (TBCB), Surveillance and Epidemiology Section (SES). In this assignment, Subroto directed the TBCB’s Class B Surveillance Project, supported California’s statewide TB information systems development initiative, and assisted in the development of a strategic plan that identified interventions to prevent and control TB among Mexican-born persons in California. Additionally, Subroto provided programmatic and technical assistance to the TBCB and SES chiefs. Prior to joining CDC, Subroto spent 3 years with the Alameda County TB Control Program, located in Oakland, CA. Subroto served as the Assistant Director and Epidemiologist for the TB Program. In this capacity, he was responsible for all program operations, management, and epidemiologic analysis. From January 1996 to April 1997, Subroto worked as a Public Health Epidemiologist with the San Bernardino County Public Health Department, in the TB and STD/HIV control programs. His responsibilities included surveillance, reporting, and investigative activities as well as database development and data management. Between August 1993 and December 1995, Subroto completed graduate work towards an MPH in epidemiology at the San Diego State University School of Public Health and also worked with the San Diego County TB Control Program on various epidemiologic and programmatic projects. His masters thesis describing the epidemiology of TB in San Diego County and its impact on a border community was published in Public Health Reports.

Lorna Bozeman, MS, was promoted in April 2003 to the position of Lead Epidemiologist of the Data Management Team for the Research and Evaluation Branch (REB), DTBE. Lorna has been with the division since April 1996, when she came to REB to work as an epidemiologist on Study 22 of the TB Trials Consortium. Before joining REB, Lorna worked for 6 years in the Agency for Toxic Substances and Disease Registry (ATSDR) in the Federal Facilities Branch, conducting health assessments at military installations. From 1984 to 1990, she was on the staff of the Clinical Immunology Branch of the National Center for Infectious Diseases (NCID), where she worked as a microbiologist on AIDS-related projects; before that, she worked briefly as a chemist in the Division of Bacterial Diseases of NCID. Lorna’s expertise and skills as a laboratorian and an epidemiologist have made her an invaluable member of the branch, and her easy-going and friendly nature allows effective collaboration with disparate groups and organizations.

Dave Crowder, MPH, has been selected for the Field Services Branch, Field Operations Section 1 chief. Dave started his career with CDC in 1988 as a Public Health Associate in the Florida Sexually Transmitted Disease Program. He was promoted to front-line supervisor in 1990 working in the Orlando, Florida, area. After gaining expertise in programmatic issues, Dave left the STD Program and transferred to TB in 1991. He was assigned to the New Orleans, Louisiana, area managing the city’s TB program. After 2 years, Dave was transferred to the Tennessee TB Program, where he was the state TB program manager. In 1997, he transferred to the headquarters position of program consultant where he become the main link to his program areas and headquarter. In 2001, Dave was promoted to team leader and program consultant for the southeastern region of the United States. Dave has a masters degree in public health from Emory University, Atlanta, Georgia.

Derrick Felix joined the Field Services Branch as a Public Health Advisor assigned to the Chicago, Illinois, TB Program on April 7, 2003. Derrick brings his recent experience gained while working in the TB program of Palm Beach County Department of Health in Florida. In his work as a health services representative, he was assigned TB case work involving completion of therapy. Before joining the Florida Department of Health, Derrick worked as a health fitness specialist for Johnson and Johnson Health Care in Juno Beach, Florida. Derrick is a graduate of the University of Florida and has a BS degree in health science education.

Gloria Gambale of DTBE’s Computer and Statistics Branch received a promotion in November 2002. In her new position Gloria is helping to improve the branch’s information technology (IT) business processes. She triages and assigns all requests for assistance received in the DTBE LAN Support Help Desk, develops and analyzes databases to evaluate Help Desk performance, and reports the findings to the Branch Chief, CSB, DTBE. In addition, she has become the technical monitor for the DTBE microcomputer support services contract, assists in the IT procurement process, and monitors the management of computer property in DTBE.

Regina Gore was selected for the position of Frankfort, Kentucky, special projects coordinator for the TB Control Program. Regina began her new assignment in late January 2003. Regina started her CDC career in 1989 as a public health associate assigned to the Fulton County Sexually Transmitted Disease (STD) control program in Atlanta, Georgia. She also held STD positions in Tampa, Florida, from June 1990 until January 1992 when she was promoted to a first-line supervisor position in Kansas City, Missouri. After resigning from CDC in the summer of 1994, she moved to Miami, Florida, where she became the program coordinator for a mobile HIV testing team until September 1998. In 1998, she relocated to Atlanta, Georgia, and became a research interviewer for Emory University, providing STD services for clients enrolled in a program called Project Prevent, which provided assistance for expectant mothers who had substance abuse problems. She was rehired by CDC in the DTBE program in January 2000 and has been on assignment in Palm Beach County, Delray Beach Health Department, TB Program since that time. Her duties in Delray Beach have included providing DOT and DOPT therapy, presenting cases in chart review with the regional consultant, and conducting contact investigations and case management.

Sherry Hussain has been selected as a Training Specialist in the Communications and Education Branch. Sherry first came to DTBE in 1981 in the Research and Evaluation Branch under Dr. Dixie Snider. Since 1998, she has served as Program Specialist in the Communications and Education Branch. In Sherry’s new position, she will serve as a lead point of contact in the development and implementation of training, education, and communication materials; CEB workshops and education/training courses; and other training- and education-related activities for the division. Sherry started in her new position on March 23.

Amera Khan, MPH, has joined the Communications and Education Branch as a Health Education Specialist. Amera, who is originally from Illinois, has an undergraduate degree from the University of Illinois at Urbana-Champaign and a masters degree in public health from the University of North Carolina at Chapel Hill. Amera has extensive experience as a Health Educator at CDC. She has worked for the National Center for Infectious Disease (NCID) in the Division of Parasitic Diseases, as well as in the Special Pathogens Branch. She has a wide range of experience in the development of educational materials for health care professionals as well as for the general public on issues related to viral and hemorrhagic fervers. In addition, Amera has designed, maintained, and evaluated Web sites and various databases.

Venkatarama (Ram) Rao Koppaka, MD, PhD, recently transferred to DTBE headquarters after a 4 1/2 year assignment in Richmond, Virginia. Ram will be the liaison between the field medical staff and headquarters in Atlanta. Ram will also have responsibility for policy development. He will first address the issue of maintaining medical expertise for oversight of TB care and treatment. Ram graduated from the University of Florida in 1986 with a BS degree in microbiology. He earned his MD degree and a PhD degree in microbiology from the same institution in 1992. He completed an internship and residency in internal medicine at Barnes Hospital at Washington University in St. Louis, Missouri, followed by a fellowship in pulmonary and critical care medicine, also at Washington University. Ram joined FSB/DTBE in July 1998 and was assigned as Medical Director for the TB control program in Virginia. In 2000, he became Director of the Division of TB Control and TB Control Officer for the Commonwealth of Virginia, a position he held until January 21, 2003. The accomplishments of the Division under Ram’s leadership included enactment of the Virginia TB Control Act of 2001, which expanded reporting requirements and strengthened the health department’s ability to mandate complete treatment of all patients with TB disease. In addition, the Division led a successful effort to establish risk-based targeted tuberculin testing as the official TB screening policy for all state agencies throughout Virginia. A major reorganization, carried out between 2000 and 2002, expanded the Division staff to include full-time education, refugee health, and surveillance and epidemiology coordinators. Most recently, legislation that will expand the authority of public health nurses to use their discretion in administration of the tuberculin skin test and ordering collection and submission of specimens for AFB smear and culture was introduced in the Virginia General Assembly and is under consideration. As FSB Field Medical Officer, he has been involved in a number of special assignments for the Division of Quarantine, including the screening of Kosovar refugees at Ft. Dix, New Jersey, in 1999, the evaluation of immigrant screening in India in 2000, and the evaluation of asylees from Burma on Guam in 2001. Dr. Koppaka was the Chest Physician for the City of Richmond Department of Public Health from 1998 to 2003 and holds an appointment as Clinical Assistant Professor of Pulmonary Medicine Medical College of Virginia, where he plans to continue to serve as attending pulmonary consultant a few weeks each year. He is an officer in the US Public Health Service and holds the rank of Commander.

Lauren Lambert, Program Analyst in the Outbreak Investigations Section of the Surveillance and Epidemiology Branch, was selected for an assignment with the “Stop Transmission of Polio” (STOP) program to Ethiopia from February 2 through April 26, 2003. Lauren conducted surveillance for acute flaccid paralysis (AFP, “not to be confused with AFB,” Lauren reminds us) and helped to arrange National Immunization Days in Ethiopia.

Diane Lowry, MPH, MSW joined the Prevention Effectiveness (PE) Team, Research and Evaluation Branch, DTBE, on March 10, 2003, to complete her second 6-month headquarters assignment with CDC’s Public Health Prevention Service (PHPS) Program. She is working with PE Team members on the health care workers adherence study and an evaluation of targeted testing and treatment of LTBI programs. Diane obtained her graduate degrees from the University of Washington and, before joining the PHPS Program last fall, worked for 3 years with immigrant and refugee communities in Seattle. Her first CDC headquarters assignment was with the Division of International Health, EPO, where she developed an evaluation plan for outbreak investigations conducted by Field Epidemiology Training Program participants.

Kelly Martin, Program Specialist in the Surveillance and Epidemiology Branch, accepted a promotion to the position of Management and Program Analyst in the Division of HIV/AIDS Prevention - Surveillance and Epidemiology after having been on a temporary assignment in this position. Kelly provided many years of outstanding service and dedication to the branch and the division. She played an important part in maintaining continuity and “institutional memory” as SEB experienced significant turnover about 3 years ago. We will miss Kelly’s professional attitude, team spirit, and friendly personality, but we are proud that she has been able to achieve this goal in her career with CDC.

David Montanez, MPA, MA, was selected for the public health advisor (PHA) Texas border position with the Texas TB Program. He started the job on February 9, 2003. David comes from the National Center for Chronic Disease Prevention and Health Promotion, where he served as a program consultant in the REACH 2010 Program. He provided guidance and technical assistance to community-based coalitions in developing, implementing, and evaluating community action plans that address health disparities in communities of color. From 1993 to 1999, David served as a PHA in the National Center for Environmental Health’s (NCEH) Birth Defects and Genetic Diseases Branch before it became part of the new Center. There, he advanced to the position of principal management official for the proposed Division. During his stay at NCEH, he oversaw a Texas-Mexico Border cooperative agreement with the Texas Department of Health, which promoted the prevention of neural tube defects (e.g., spina bifida) through the consumption of folic acid. From the beginning of his CDC career in 1988 to 1993, David held field assignments with the STD Program in Los Angeles and with the National Immunization Program (NIP) in Florida and Texas. He holds a bachelors degree in business administration, a masters degree in public administration, and a master of arts degree in urban and regional affairs from the University of Texas.

John Oeltmann, MPH, PhD, will join the Outbreak Investigation Section, Surveillance and Epidemiology Branch (SEB), as its new EIS officer. He will start in August and be with DTBE for 2 years. John received both his PhD in epidemiology and his masters degree in public health in health promotion, education, and behavior from the University of South Carolina in Columbia, SC. He has had a wide range of experience in directing or participating in public health projects involving diabetes control, alcoholism, cancer prevention, and health services for American Indians, and from 1997 to 1998 he was an ASPH Fellow with the Division of Adolescent and School Health at CDC. His goal is to make a contribution “in a position where I can blend my interests in public health promotion / education and epidemiologic research, specifically surveillance.”

David Patlan joined the Field Services Branch as a Public Health Advisor assigned to the Miami, Florida, TB Program on April 22, 2003. David brings 9 years of experience in public health from his work in the Dallas, Texas, HIV/STD program. David, who is fluent in Spanish, earned a BA degree from the University of Texas at Austin.

Margaret Patterson joined the Field Services Branch as a Public Health Advisor assigned to the West Palm Beach, Florida, TB Program on April 22, 2003. Margaret has over 15 years of public health experience, working mostly in the South Carolina STD Program. In 2001 Margaret was hired by CDC and continued her work in STD, when she was assigned to the Washington, DC, STD Program. Margaret has a BS in biology from the College of Charleston, SC.

Vivian Siler has accepted a Management and Program Analyst position with FSB. Vivian will be responsible for analyzing and establishing management systems related to personnel, support needs, meetings, and guideline development. Vivian started her career with CDC in 1993 employed by the Viral & Rickettsial Disease Branch as a Call Management Operator. From 1995 to 1999, she worked with the National Prevention Information Network (NPIN) as a Senior Information Specialist within the NCHSTP Office of Communications providing support to the Information/Dissemination Section. In 1999, Vivian joined the Division of TB Elimination, Communications and Education Branch, as a Program Operations Assistant.

Elizabeth Talbot, MD, will be leaving DTBE and CDC to pursue a new opportunity in New Hampshire. She has accepted a new position as the New Hampshire Deputy State Epidemiologist with a joint appointment in the Infectious Disease (ID) Section of Dartmouth-Hitchcock Medical Center and Dartmouth Medical School. For the State, she will be responsible for infectious disease outbreak investigations and for disease prevention and control activities, and will serve as liaison between State agencies and Dartmouth-Hitchcock Medical Center on bioterrorism activities. In addition to teaching and clinical consulting for Dartmouth, she'll be able to keep her hand in international TB research, since the ID section has an established TB research field site in Tanzania, under the direction of Fordham Von Reyn. She’ll be leaving DTBE on June 15 and will be starting her new position around July 1. Elizabeth began her career at CDC in July 1998 as an Epidemic Intelligence Service (EIS) officer, at which time she was assigned to the International Activity unit of DTBE. During her time as an EIS officer she made very significant contributions to DTBE research and TB program support efforts in Botswana at BOTUSA, as well as to other important projects in DTBE. Among her many activities during that period, she lead efforts to conduct the second national anti-TB drug resistance survey of Botswana as part of the WHO/IUATLD global project, and she conducted a very important case-control study looking at risk-factors for HIV among TB patients (60% of TB patients in Botswana are HIV-positive). Additionally, she evaluated the evolving epidemiology of TB among foreign-born persons in the U.S., among other domestic-oriented projects. Subsequent to EIS, she remained on staff with DTBE, accepting a position as the Associate Director for TB Research at BOTUSA. She and her family then moved to Gaborone, Botswana, in September 2000. While serving as the Associate Director at BOTUSA, Elizabeth made tremendous contributions to the rapidly evolving field of TB/HIV. Among her many contributions was validation of the use of rapid HIV testing (Oraquick®) directly on sputum of TB patients as a means of performing HIV surveillance; evaluating risk factors for TB patient treatment interruption; determining knowledge, attitudes, and beliefs regarding antiretroviral therapy for HIV among TB patients; supporting the Botswana national isoniazid preventive therapy pilot project focused on preventing TB among HIV-positive persons; and determining that nonresponse to antibiotics predicts TB in AFB smear-negative patients. Also in that role, she managed a staff of nearly 20 persons involved in the BOTUSA TB/HIV project work, and she supervised a number of medical students on rotations at BOTUSA as well as EIS officers. Additionally, Elizabeth contributed a great deal to the anthrax investigation in 2001 involving the U.S. Embassy in Gaborone. She moved on February 14 from her role as Associate Director of TB Research at the BOTUSA Project to a 3-month assignment with WHO in Geneva, where she assisted in finalizing and consolidating the draft operational guidelines on TB, HIV, Malaria, and Gonococcal resistance monitoring into a technical document. We will miss Elizabeth very much and wish her and her family all the best with this new opportunity.

Peg Tipple, MD, transferred to Richmond, Virginia, in January 2003 to serve as Director of the Virginia TB Control Program. Peg earned her medical degree at the State University of New York (SUNY) - Downstate Medical Center in Brooklyn, New York. She trained as a pediatrician and as a fellow in infectious diseases at the Medical College of Virginia. She received additional training in pediatric infectious diseases at the University of Chicago. She was an EIS Officer in the Hospital Infections Program, and continued her work at CDC in the NCID Division of Viral and Rickettsial Diseases, followed by assignments to the Division of Quarantine and the Office of Health and Safety. She joined the Field Services Branch in July 1999 and was assigned to the District of Columbia Department of Health, serving as chief of the DC TB Control Program.

Vic Tomlinson was recently selected for a program consultant position with Field Services Branch (FSB) effective May 4, 2003. He started his public health career as a TB investigator with the Virginia Department of Health in the eastern part of Virginia in 1970-1971. Vic began his career with CDC as a public health advisor in the Sexually Transmitted Disease (STD) program in 1972 in Washington, DC, and also worked in the STD program in Baltimore (1974-75). His next two federal assignments were with DTBE in Norristown, PA (1975-77) and Boston, MA (1977). In the latter assignment, Vic was assigned to the City of Boston and also served as a liaison to the state TB program. Vic accepted a position as a project officer with the Bureau of Community Health Services in the Regional Office in Philadelphia (1977-81). This position involved working with communities to establish federally funded primary health care centers in medically underserved areas of Pennsylvania and to place health professionals in these communities through the National Health Service Corp program. Vic left federal service in 1981 and returned to the State of Virginia where he worked in the state’s certificate of need program and then as a budget analyst in local government before he returned to CDC/DTBE, in January 1990. From 1990 to 1992, he served as the program manager for a statewide tuberculosis control program while assigned to Missouri’s state health department. From 1992 to 1994, Vic was assigned to the Texas Department of Health’s TB control program. In his role as a Public Health Advisor, Vic supervised a few program staff directly and also worked with the division director to establish a coalition to address TB issues. For the period 1994-1996, Vic was assigned to the Louisiana Department of Health in New Orleans and served in the role of program manager. In 1996, he accepted a transfer back to Missouri and again served in the role of the program manager for TB control for most of his tenure there (1996-2003). In addition to his work with TB control, Vic was also asked to accept the dual role of managing the Immunization program in Missouri from 1998 to 2003. In terms of his TB responsibilities, Vic initiated the first TB collaborative case conferences, which are videoconferenced every 4 or 5 months across the state. Vic initiated a screening project in local jails that included implementing a signs and symptoms checklist for TB. Vic also played an active role in Missouri’s TB Awareness Fortnight/World TB Day activities each year by planning and participating in TB seminars around the state and conducting interviews with the media to draw attention to TB. Other activities included working with the department’s bioterrorism unit to coordinate smallpox vaccinations for the Division of Environmental Health and Communicable Disease Prevention and establishing an advisory committee for communicable diseases, which holds its first meeting on May 13, 2003.

Maureen Wilce, MS, has transferred within DTBE, accepting a health scientist position with the Field Services Branch (FSB). Maureen will be responsible for program evaluation activities. She will provide technical assistance and assist in the development of policy and procedures on how to implement and evaluate TB elimination programs. Maureen brings to the position 14 years of experience in evaluation and health and human services research. She is a skilled evaluator with experience in survey instrument design, data collection and analysis, site visiting, and database manipulation. For the last 4 years Maureen has worked in the Research and Evaluation Branch at DTBE leading/coleading projects evaluating case management practices in TB control programs, developing self-evaluation tools designed to improve their contact investigation processes, assessing policies related to contact investigations, assessing health care worker adherence to TB screening recommendations, and examining the contributions of social science to TB control. In addition, she has worked to develop two training courses, based on the 6 Steps in the Framework for Program Evaluation to help prepare TB program staff to conduct evaluations. Most recently, she is coleading a major effort to help expand evaluation capacity for TB program staff - a role that will expand in her new position. Prior to joining DTBE, Maureen worked as an evaluator for a private consulting firm and for the Office of the Inspector General, HHS. She is active in the Atlanta-area Evaluation Association and the American Evaluation Association.

Cheryl Williams, MPH, joined the DTBE Field Services Branch (FSB) as a Public Health Advisor assigned to the New York City TB program on April 7, 2003. Cheryl will be working out of the Brooklyn office with network managers implementing latent TB infection (LTBI) activities. Her duties will consist of collaborating with community leaders, area service providers, and other key persons to provide education, outreach, treatment, follow-up, and referrals of persons needing services offered by the program. Cheryl holds a bachelor of arts degree in biology from the University of Virginia, and an MPH degree in epidemiology and international health from the Rollins School of Public Health at Emory University. With CDC since 1997, Cheryl has worked as an epidemiologist with the National Center for Infectious Diseases, Division of Viral Hepatitis (DVH), Epidemiology Branch. While at DVH, Cheryl conducted studies of the sexual transmission of hepatitis C virus and the role of foodborne transmission of hepatitis A virus, supported a variety of epidemiologic investigations and studies of viral hepatitis, and managed the national Viral Hepatitis Surveillance Project. Since 1999, she has served as project manager for the Sentinel Counties Acute Viral Hepatitis Surveillance Study, which is conducted in six county health departments across the United States and provides data used to estimate national incidence of acute viral hepatitis, to monitor trends in incidence and risk factors, and to form recommendations for prevention and control of viral hepatitis. Cheryl has provided oversight and technical assistance to the counties and coordinated study activities, including case and contact investigation, data collection and management, epidemiologic analysis, and development of survey instruments and annual data summary reports. Cheryl is a founding member of Forging New Tomorrows, an international health and environmental nongovernmental organization (NGO) with health, training, and development projects in several African countries. Prior to earning her MPH degree, Cheryl worked for 10 years as an environmental health scientist and consultant in the private sector, where she investigated Superfund and RCRA hazardous waste sites, conducted baseline public health risk assessments for waste sites, prepared toxicological profiles of hazardous chemicals, conducted lead and asbestos contamination assessments and abatement oversight, and developed guidelines and remediation plans for toxic substances in environmental media.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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