About

ASTHO Board of Directors

Officers

John WiesmanPresident
John M. Wiesman, DrPH, MPH
Secretary of Health, Washington State Department of Health

John Wiesman was appointed secretary of health for the Washington State Department of Health in April 2013.

He has worked in four local public health departments in Washington and Connecticut. He started his public health career in Connecticut in 1986 and was in its first group trained to provide HIV counseling and testing.

During his career, Wiesman has transformed health departments from providing individual clinical services to implementing policies, systems and environmental changes that make healthy choices easier and less expensive. He also partnered with a community clinic to provide integrated primary care and behavioral health. Wiesman also worked at the University of Washington, School of Public Health as a project director on a back pain outcome assessment team grant.

A native of Wisconsin, Wiesman earned his Doctorate of Public Health in public health executive leadership from the University of North Carolina-Chapel Hill in 2012. He received a Master of Public Health in chronic disease epidemiology from Yale University in 1987 and his Bachelor of Arts degree in biology from Lawrence University in Wisconsin in 1983.

 

Nicole Alexander-ScottPresident-Elect
Nicole Alexander-Scott, MD, MPH
Director, Rhode Island Department of Health

Nicole Alexander-Scott has been the director of the Rhode Island Department of Health since May 2015. She brings to this position tremendous experience from her work as a specialist in infectious diseases for children and adults at hospitals in Rhode Island affiliated with Brown University and at the Rhode Island Department of Health. Her clinical and academic responsibilities were balanced with serving as a consultant medical director for the Office of HIV/AIDS, Viral Hepatitis, STDs, and TB in the Division of Infectious Diseases and Epidemiology at the Rhode Island Department of Health. Alexander-Scott is board certified in pediatrics, internal medicine, pediatric infectious diseases, and adult infectious diseases. She obtained a Master of Public Health degree from Brown University in 2011. She is also an assistant professor of pediatrics and medicine at the Warren Alpert Medical School of Brown University.

Originally from Brooklyn, New York, Alexander-Scott attended Cornell University, majoring in human development and family studies, and subsequently graduated from medical school in 2001 from SUNY Upstate Medical University at Syracuse. After completing a combined internal medicine-pediatrics residency at SUNY Stony Brook University Hospital in 2005, Alexander-Scott finished a four-year combined fellowship in adult and pediatric infectious diseases at Brown in 2009.

 

Jay ButlerImmediate Past President
Jay Butler, MD
Director of Public Health, Alaska Department of Health and Social Services

Jay Butler was appointed chief medical officer for the Alaska Department of Health and Social Services and director of the Division of Public Health by Governor Bill Walker in December 2014. From 2010 to 2014, Butler served as senior director for community health services at the Alaska Native Tribal Health Consortium in Anchorage, where he was also a clinical infectious diseases consultant and medical director for infection control and employee health. His earlier work includes serving as chief medical officer of the Alaska Department of Health Social Services from 2007 to 2009, Alaska state epidemiologist, 2005-07, director of CDC's Arctic Investigations Program, 1998-2005, and medical epidemiologist in CDC’s National Center for Infectious Diseases in Atlanta, 1991-98.

He is a graduate of the University of North Carolina Medical School, has completed clinical training at Vanderbilt and Emory universities, and maintains clinical board certifications in infectious diseases, internal medical, and pediatrics. He has authored or co-authored over 100 scientific papers and medical textbook chapters on infectious diseases and emergency preparedness, and he is an affiliate professor of medicine at the University of Alaska Anchorage. In 2010, he received ASTHO’s National Excellence in Public Health Award.

 

Karen McKeownPast President
Karen McKeown, MSN, RN
Administrator and State Health Official, Wisconsin Department of Health

Karen McKeown is the state health officer and has served as administrator of the division of public health in the Wisconsin Department of Health Services since January 2012. In this role, she leads the division and works with many partners to realize the vision of Everyone Living Better, Longer.

As an oncology staff nurse and leader for 11 years, McKeown previously oversaw the clinical operations of inpatient and outpatient oncology departments. McKeown’s health policy experience includes a student fellowship with the U.S. Senate finance committee and a graduate fellowship with the Heritage Foundation. McKeown holds a bachelor’s degree from the University of Texas in Tyler, and a master’s degree in nursing management, policy and leadership from Yale University.

 

Gerd W. Clabaugh Secretary-Treasurer
Gerd W. Clabaugh, MPA
Assistant Secretary for Public Health, Iowa Department of Health

Gerd Clabaugh was appointed by Governor Branstad in May 2014 as the Director of the Iowa Department of Public Health (IDPH). Clabaugh has served in many capacities within IDPH, including Deputy Director, Director of Health Promotion and Chronic Disease Prevention, Director of Acute Disease Epidemiology and Emergency Response. During the early 1990s, he was appointed Director of the Center for Health Policy.

Clabaugh has experience in both state government operations and nonprofit organizations. He is the former director of operations at the Iowa Healthcare Collaborative (IHC) where he worked with Iowa hospitals in promoting infection reduction strategies. As a private consultant, he supported public health agencies in assessing community health needs, program development, planning for public health improvement, and grant writing.

He is past-president and past-legislative chair of the Iowa Public Health Association, and has served as an adjunct faculty member at the University of Iowa, Montana State University-Billings, Des Moines University, and Iowa State University. He has authored or contributed to academic publications in the journals Value in Health, American Journal of Medical Quality, and Vaccine.

Clabaugh has pursued doctoral studies at the University of Iowa, holds a Master's degree in Public Administration from Iowa State University and a Bachelor’s degree from Drake University. He is married with four children.

 

Regional Representatives

Nicole Alexander-ScottRepresentative, Region I [Map]
Nicole Alexander-Scott, MD, MPH
Director, Rhode Island Department of Health

Nicole Alexander-Scott has been the director of the Rhode Island Department of Health since May 2015. She brings to this position tremendous experience from her work as a specialist in infectious diseases for children and adults at hospitals in Rhode Island affiliated with Brown University and at the Rhode Island Department of Health. Her clinical and academic responsibilities were balanced with serving as a consultant medical director for the Office of HIV/AIDS, Viral Hepatitis, STDs, and TB in the Division of Infectious Diseases and Epidemiology at the Rhode Island Department of Health. Alexander-Scott is board certified in pediatrics, internal medicine, pediatric infectious diseases, and adult infectious diseases. She obtained a Master of Public Health degree from Brown University in 2011. She is also an assistant professor of pediatrics and medicine at the Warren Alpert Medical School of Brown University.

Originally from Brooklyn, New York, Alexander-Scott attended Cornell University, majoring in human development and family studies, and subsequently graduated from medical school in 2001 from SUNY Upstate Medical University at Syracuse. After completing a combined internal medicine-pediatrics residency at SUNY Stony Brook University Hospital in 2005, Alexander-Scott finished a four-year combined fellowship in adult and pediatric infectious diseases at Brown in 2009.

 

Representative, Region II [Map]
Japhet C. Rivera
Puerto Rico Department of Health

Mr. Rivera's bio will be available soon.

 

Rahul GuptaRepresentative, Region III [Map]
Rahul Gupta, MD, MPH
Commissioner and State Health Officer, West Virginia Bureau for Public Health

Rahul Gupta serves as the West Virginia state health officer and commissioner for the West Virginia Department of Health and Human Resources, Bureau for Public Health. Gupta is a practicing internist who also serves as adjunct professor in the department of health policy, management, and Leadership at the West Virginia University School of Public Health and adjunct associate professor at the University of Charleston's School of Pharmacy.

Gupta earned a Doctorate of Medicine and subspecialty training in pulmonary medicine from the University of Delhi and completed his internship and residency training at St. Joseph Hospital/Northwestern University in Chicago, Illinois. Additionally, he earned a Master of Public Health degree in healthcare organization and policy from the University of Alabama-Birmingham.

 

Mary Currier Representative, Region IV [Map]
Mary Currier, MD, MPH
State Health Officer, Mississippi State Department of Public Health

Mary Currier became Mississippi's state health officer in 2010 after serving as state epidemiologist from 1993 to 2003, and again from 2007 to 2009.

Currier has 30 years of state service experience and 25 years serving in public health. Prior to serving as state epidemiologist, Currier was a medical consultant with the Mississippi State Department of Health, where she began her career as a staff physician for the prenatal care, family planning, STD, and pediatrics programs.

Currier is a member of the American Medical Association, the Mississippi Central Medical Society, the American Public Health Association, and is board certified in general preventive medicine and public health. She received her Doctor of Medicine degree from the University of Mississippi School of Medicine in 1983 and her Master of Public Health degree from the Johns Hopkins School of Hygiene and Public Health in 1987.

 

Karen McKeownRepresentative, Region V [Map]
Karen McKeown, MSN, RN
Administrator and State Health Official, Wisconsin Department of Health

Karen McKeown is the state health officer and has served as administrator of the division of public health in the Wisconsin Department of Health Services since January 2012. In this role, she leads the division and works with many partners to realize the vision of Everyone Living Better, Longer.

As an oncology staff nurse and leader for 11 years, McKeown previously oversaw the clinical operations of inpatient and outpatient oncology departments. McKeown’s health policy experience includes a student fellowship with the U.S. Senate finance committee and a graduate fellowship with the Heritage Foundation. McKeown holds a bachelor’s degree from the University of Texas in Tyler, and a master’s degree in nursing management, policy and leadership from Yale University.

 

Nate SmithRepresentative, Region VI [Map]
Nathaniel Smith, MD, MPH
 
Director and State Health Officer, Arkansas Department of Health

As a member of Governor Asa Hutchinson’s cabinet, Dr. Nate Smith serves as Director and State Health Officer for the Arkansas Department of Health (ADH). In this position, he provides senior scientific and executive leadership for the agency. The ADH has over 2000 personnel and a budget of over 250 million dollars and delivers services throughout the state in over 94 different locations. Smith was appointed Director in 2013 by Governor Mike Beebe and then reappointed by Governor Hutchinson in 2015.

Smith has a strong commitment to the mission of ADH, “To protect and improve the health and well-being of all Arkansans.” In his role as Director he strives to help colleagues achieve their full potential using public health best practices supported by science-based decisions.

Smith has previously served the ADH as Branch Chief for Infectious Diseases, State Epidemiologist, and Deputy Director for Public Health Programs. He is board-certified in Internal Medicine and Infectious Diseases and holds voluntary faculty positions in the Division of Infectious Diseases at the UAMS College of Medicine and in the Epidemiology Department at the College of Public Health. His clinical interests include HIV, tropical medicine, and emerging infectious diseases.

 

Randall W. Williams, MD, FACOG Representative, Region VII [Map]
Randall W. Williams, MD, FACOG

Director, Missouri Department of Health & Senior Services

Randall W. Williams, MD, FACOG, is an obstetrician and gynecologist who graduated from the University of North Carolina with Honors in History and Zoology and received his medical training at the University of North Carolina where he was a Holderness Fellow.

Williams was appointed by Governor Eric Greitens to serve in his Cabinet as Director of Health and Senior Services (DHSS) and was subsequently unanimously confirmed by the Missouri Senate on March 9, 2017. He believes a fundamental tenet of effective leadership is to be readily available and accessible and he has visited all of Missouri’s 115 counties to listen and learn from all of Missouri’s citizens.

DHSS accomplishments to date with Williams include passage of Missouri’s Good Samaritan Law and Universal Narcan Availability Law; working with Governor Grietens on the Executive Order establishing a statewide PDMP; holding opioid summits throughout the state; and bringing together and meeting with all 115 local health departments for the first time in more than a decade. The department is also working to increase the number of providers in rural and underserved areas; improve behavioral health services for veterans and their families; promote physical fitness and community engagement through the My Missouri Steps Up initiative; enhance interagency coordination and collaboration with the state Departments of Social Services and Mental Health; and improve all aspects of women’s health, especially to reduce infant and maternal mortality.

Williams previously served as both the Deputy Secretary for Health and State Health Director in the Department of Health and Human Services in North Carolina. His responsibilities there included developing, integrating and communicating state health policy and helping lead a 17,000 member agency with a 20 billion dollar budget that combined Medicaid, social services, public health and mental health services.

To help patients and families affected by the opioid crisis, Williams led efforts in North Carolina that resulted in the legislature voting unanimously to implement a statewide standing order to treat narcotic overdoses by making naloxone available to everyone in North Carolina under his authority. He also visited stakeholders and citizens in all 100 counties in the state during his time with the department.

Williams has also previously served on local and state boards of health, in addition to delivering 2000 babies as a practicing obstetrician. He also helped serve the medical needs of people in overseas conflict zones. His ongoing work has taken him to Iraq 12 times, and he has also worked in Afghanistan, Libya and Haiti. Recognition of these efforts was reflected in his selection as Triangle Red Cross Humanitarian of the Year and the Raleigh News & Observer’s Tar Heel of the Week.

He is also an avid runner. Williams believes physical exercise contributes greatly to a sense of wellness and led a campaign to encourage families to run 5Ks for charity. He enjoys training for and running marathons and has run marathons in Boston, New York, Paris, Athens, Florence and Jerusalem.

 

Mylynn TufteRepresentative, Region VIII [Map]
Mylynn Tufte
State Health Officer North Dakota Department of Health

State Health Officer Mylynn Tufte’s previous experiences as a health management executive and former critical care nurse bring an extensive background to the top leadership role in the North Dakota Department of Health. Tufte brings more than 20 years of experience in the health industry, serving in a strategic and health advisory role to some of the largest payers and providers in the country. Her diverse experience includes working with state governments, national and regional health plans, integrated delivery networks, academic and community medical centers, physician groups, and accountable care organizations.

As a progressive leader with extensive experience in strategy, operations, and health information technology, she has helped organizations develop and implement innovative solutions that improve healthcare for broad populations. Her experience in population health management has helped organizations improve quality and access to care, decrease the total cost of care, and improve the overall experience for consumers.

Tufte earned a bachelor’s degree in nursing from Case Western Reserve University in Cleveland, Ohio, followed by a Master of Business Administration degree and a master’s degree in information management degree from Arizona State University.

 

Karen Smith, MD, MPH Representative, Region IX [Map]
Karen Smith, MD, MPH 
Director and State Public Health Officer, California Department of Public Health

On March 23, 2015, Karen Smith was sworn in as director of the California Department of Public Health and state public health officer. Smith is a physician specializing in infectious disease and public health. Prior to her appointment, she served as public health officer and deputy director at the Napa County Health and Human Services Agency beginning in 2004. She was also on medical staff for infectious disease at Queen of the Valley Medical Center in Napa from 2012 to 2014.

Smith served as clinical faculty at the Santa Clara County Valley Medical Center Division of Infectious Diseases from 1997 to 2004. She served as assistant section chief at the California Department of Health Services Tuberculosis Control Branch from 2000 to 2001 and was a faculty consultant for the Francis J. Curry International Tuberculosis Center at the University of California, San Francisco from 1997. Smith held several positions at the Stanford University School of Medicine from 1992 to 2004, including resident, fellow, and international health course director. Smith also served as TB Controller and Deputy Health Officer for Santa Clara County from 1997 to 2004.

Smith completed her medical training and infectious diseases fellowship at Stanford University after having obtained a Master of Public Health degree at Johns Hopkins School of Hygiene and Public health. Prior to her medical training, Smith served in the Peace Corp as Public Health Laboratory Director for the Marrakesh Province in Morocco and at the Wichienburi Regional Hospital in Thailand.

 

Elke Shaw-Tulloch Representative, Region X [Map]
Elke Shaw-Tulloch, MHS
Public Health Administrator, Idaho Department of Health and Welfare

Elke Shaw-Tulloch began her current position as administrator of the Idaho Department of Health and Welfare on Sept. 2, 2012. The division of health provides services ranging from immunizations, testing for communicable diseases, regulating food safety, certifying emergency medical personnel, vital record administration, and compilation of health statistics to bioterrorism preparedness. The division’s programs and services actively promote healthy lifestyles and prevention activities, while monitoring and intervening in disease transmission and health risks as a safeguard for Idaho citizens.

Shaw-Tulloch began working for the division of health as a health education specialist in 1996. She was promoted to manager of the Radiation Health Effects Program (1998) and then became manager of the Environmental Health Education and Assessment Program (1998-2001). In 2001, Shaw-Tulloch was hired as bureau chief for environmental health and safety, which evolved under her leadership to become the Bureau of Community and Environmental Health in 2003.

Shaw-Tulloch has an undergraduate degree in environmental health with a biology minor and a Master of Health Science degree with an environmental health emphasis from Boise State University.

 

Esther L. Muña, MHA, CPC, CEOUSAPI Director
Esther L. Muña, MHA, CPC, CEO
Chief Executive Officer and Financial Services Administrator, Commonwealth Healthcare Corporation

Esther Muña was appointed chief executive officer for the Commonwealth Healthcare Corporation (CHCC), the health agency for the Commonwealth of the Northern Mariana Islands in April 2014. As CEO, Muña oversees strategic direction and all operations of the Commonwealth Health Center Hospital, Rota Health Center, Tinian Health Center, Public Health Services, and Behavioral Health Services and provides leadership and direction of Kagman Community Health Center.

Past experiences include: 

  • April 2013-April 2014: interim CEO for CHCC
  • October 2012-April 2013: chief operations officer for CHCC; instrumental in the abatement of immediate jeopardies issued in September 2012 CMS survey
  • January 2012-September 2012: Medicaid advisor and Medicaid HIT coordinator under the governor’s office; instrumental in the amendment of the Medicaid State Plan to change the payment methodology for the only hospital in the CNMI (CHC)

Muña also worked for the Commonwealth Health Center Hospital under the Department of Public Health for several years. She was a hospital administrator for one and a half years and hospital CFO for four years. She held other healthcare management positions including business office manager, privacy officer, and medical records manager.

She received a Master of Health Administration degree from Saint Joseph’s College of Maine and is an alumna of Indiana University, Bloomington, Indiana (social and behavioral science major) and Northern Marianas College (accounting major).

She is active in several membership organizations, including the Pacific Island Health Officers Association – Board of Directors secretary, 2013 to current, the American Public Health Association, the American College of Healthcare Executives, the Healthcare Financial Management Association, the American Hospital Association, and the American Association of Professional Coders – president (Guam-CNMI Chapter), 2010.

Other recognitions of note include being featured in the February 2010 issue of AAPC Coding Edge Magazine: “Minute with a Member”, the winner of CDC Sustainable Management Project and presented winning project in CDC Sustainable Management Conference in Cape Town, South Africa (2006): “Improving Revenue Collections with Total Quality Management”. She is also a certified professional coder since 2004 and AHIMA-Approved ICD-10 coding instructor since 2012.

 

Michelle S. Davis, PhDAtlantic Director
Michelle S. Davis, PhD
Health Commissioner and Chief Health Officer, Virgin Islands Department of Health

Michelle Davis currently holds the position of regional health administrator (RHA) with the U.S. Department of Health and Human Services (HHS) New York Regional office. The RHA serves as the principal federal public health authority for the secretary of HHS and the assistant secretary for health. The RHA also assures collaborative promotion of the Surgeon General's initiatives.

Prior to her current position, she served as the deputy RHA for the Mid-Atlantic region (DC, DE, MD, PA, VA, WV) as the health liaison between DHHS and state/local agencies, coordinated regional/national programs, recommended policies and served on the federal emergency preparedness, response and recovery team.

Davis has worked as a public health professional in a variety of positions at the federal, state, and municipal levels. This included the deputy secretary for the Pennsylvania Department of Health. She was responsible for oversight of over 600 staff and a budget of $250 million.

Before working with the Commonwealth of Pennsylvania she held positions as deputy health commissioner for policy and planning with the city of Philadelphia and senior epidemiologist with CDC. She has also held positions with the states of South Carolina, Indiana, and New York and at the local level with the city of Detroit and with the District of Columbia as a CDC federal assignee.

Davis has held several elected positions within professional organizations including: president and chair of the board of the Pennsylvania Public Health Association (PPHA), president and vice-president of the Black Caucus of Health Workers of the American Public Health Association (APHA) and governing councilor for the epidemiology section of APHA.

Davis matriculated at the University of Michigan majoring in biology and psychology at the undergraduate level. She continued her education at the University of South Carolina, Johns Hopkins, and the University of North Carolina where she majored in epidemiology for her graduate degrees.

 

Ex Officio Members

Michael Fraser Michael Fraser, PhD, CAE, FCPP
Chief Executive Officer, ASTHO

Michael Fraser has served as ASTHO's executive director since August 2016. Most recently, he served as the executive vice president and CEO of the Pennsylvania Medical Society in Harrisburg, Pa. During his tenure there, he worked with physician leaders to transform the organization into a dynamic, relevant, and effective membership organization representing all of the state’s physicians, and tackling critical issues such as the opioid misuse and drug abuse crisis.

Fraser served as CEO of the Association of Maternal and Child Health Programs (AMCHP) from 2007 to 2013, where his leadership was recognized nationally by the Maternal and Child Health Bureau’s Director’s Award in 2014. In addition, the American Public Health Association’s MCH Section awarded AMCHP the Outstanding Leadership and Advocacy Award. Prior to joining AMCHP, Fraser was the deputy executive director of the National Association of County and City Health Officials (NACCHO) from 2002 to 2007, and served in several capacities at the U.S. Department of Health and Human Services, including positions at the Health Resources and Services Administration and CDC.

Fraser received his doctorate and masters degrees in sociology from the University of Massachusetts at Amherst and a masters of science in management with a concentration on management, strategy and leadership from the Eli Broad School of Management at Michigan State University. He received a B.A. in sociology from Oberlin College in 1991. Fraser is an Adjunct Faculty in the Department of Global and Community Health at the George Mason University College of Health and Human Services and a Professional Lecturer in Health Policy & Management at the Milken Institute School of Public Health at George Washington University.

 

Traci Berreth, MD, MPH Traci Berreth, MD, MPH
Chair, Senior Deputies Committee

Chief of Business Operations, Division of Public Health
Idaho Department of Health and Welfare

Traci Berreth has a Ph.D. in Organizational Leadership and a Master’s Degree in Public Health. She serves as the Chief of Business Operations for the Division of Public Health where she leads the Division’s public health accreditation efforts, strategic planning, workforce development, and policy development. Traci’s bureau supports the entire division and includes the Institutional Review Board, performance management and quality improvement, health data analytics and research, federal compliance, communication, and general business operations, including budget oversight.

Prior to becoming bureau chief in 2012, Traci served in various positions including launching the first Immunization Reminder Information System, managing the Idaho Immunization Program, managing, and coordinating special projects for the Maternal and Child Health block grant, and coordinating special projects for Public Health Administration. Traci has been with the Idaho Department of Health and Welfare-Division of Public Health since 2000.

 

Claire Hannan, MPH
Chair, Affiliate Council

Executive Director, Association of Immunization Managers

Ms. Hannan's bio will be available soon.

 

Terry L. Dwelle, MD, MPHTM, FAAP, CPH Terry L. Dwelle, MD, MPHTM, FAAP, CPH
Alumni Society Representative

Terry Dwelle graduated with an MD degree from St Louis University in 1975. He completed a Pediatric Residency at Cardinal Glennon Hospital for Children in St. Louis in 1978 and a Pediatric Infectious Disease Fellowship at St. Louis University in 1983. He also completed a Master’s of Public Health and Tropical Medicine in 1987 at Tulane University, a Preventive Medicine Residency specializing in International Health and Tropical Medicine at Tulane University in 1990, and a Community Engagement Fellowship in East Africa in 1994. Dwelle is board certified in pediatrics, 1981-present, certified in public health, 2008-present, and tropical and travel medicine, 1997-present. He is also a licensed minister with the Assemblies of God 1988-present.

Dwelle was clinical director for the Indian Health Service clinic at Fort Totten from 1978-80, assistant professor of pediatrics for the University of North Dakota School of Medicine from 1980-1991, a pediatric infectious disease consultant, Bismarck ND from 1980-1991, a pediatric consultant for the Indian Health Service at Spirit Lake, Turtle Mountain, and Standing Rock, 1980-1991, a medical missionary to Central and East Africa 1991-2001, State Health Officer for the North Dakota Department of Health 2001-2016, an adjunct professor of public health at the University of Minnesota School of Public health, 2008-present, a clinical assistant professor of family medicine 2001-present, University of North Dakota School of Medicine and Health Sciences, a private public health consultant 2017-present, and founder and director of the North Dakota Public Health Training Network, 2017-present.

Dwelle has been the recipient of the St. Louis University Benjamin H. Cohen resident’s award (1978), Tulane University School of Public Health Dean’s Scholarship award (1987), University of North Dakota School of Medicine Family Practice Excellence in teaching award (1989), the Information Technology Council of North Dakota Outstanding Achievement in Digital Government award (2006), and the ASHTO Arthur T. McCormack award (2008).

Dwelle has written and co-authored several articles and four books including an Introduction to Public Health with Drs. Ray and Karen Goldsteen and three E-texts: Extreme Leadership; Engagement vs Coercion; and Faith Based Engagement.