Brian P. Scannell, MD

• The University of Georgia - B.S. with Honors in Biology
• The University of North Carolina School of Medicine - Doctorate of Medicine
  
• Atrium Health - Carolinas Medical Center - Orthopedic Research Fellowship
  
• Atrium Health - Carolinas Medical Center - Orthopedic Surgery, Internship/Residency
  
• Rady Children’s Hospital of San Diego - Pediatric Orthopaedic and Scoliosis Fellowship
  

Academic Positions

• Associate Professor of Orthopaedic Surgery, Atrium Health
• Program Director for Atrium Health - Carolinas Medical Center Orthopaedic Residency
• Adjunct Associate Professor, Wake Forest School of Medicine

• Named a 2023 Top Doctor by Charlotte Magazine
• 2022 North Carolina's Top Doctors, Charlotte Region, SouthPark Magazine

Atrium Health/Carolinas HealthCare System

• Charlotte Magazine: Named as a Charlotte Top Doctor in pediatric orthopedic surgery, 2016, 2017, 2018, 2019, and 2021 
• Elected to Alpha Omega Alpha Honor Medical Society from the University of North Carolina School of Medicine, as Medical Student Director nominated by medical students, 2017
• Levine Children’s Hospital Physician of the Quarter Award, First Quarter 2017
• Excellence in Simulation-Based Education Award by the Center for Faculty Excellence, February 18, 2015
• Faculty Teaching Award, 2014-2015

Rady Children's Hospital San Diego

• 2013 Lena Sefton Clark Fellowship Award – outstanding performance during fellowship as a clinician, teacher, and researcher

Atrium Health - Carolinas Medical Center (Residency)

• Selected for AOA Resident Leadership Conference, 2012.
• Best Clinical Research Paper for “Perfusion Assessment after Pediatric Supracondylar Humerus Fracture with Near Infrared Spectroscopy” at 2012 Atrium Health - Carolinas Medical Center Resident Research Day
• Resident Teaching Award, 2011-2012
• Best Basic Science Research Paper for “An update on Cell-Based Therapy for Rotator Cuff Tendon-Bone Healing in a Rat Model” at the 2008 Atrium Health - Carolinas Medical Center Resident Research Day
• Second place resident paper for “Biomechanical Comparison of Five Femoral Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction” at the 2008 NCOA Annual Meeting
• Second place resident paper for “Efficacy of Intraoperative Red Blood-Cell Salvage and Autotransfusion in the Treatment of Acetabular Fractures” at the 2007 NCOA Annual Meeting

University of North Carolina School of Medicine

• Christopher C. Fordham III Award, 2006
• Recognizes a graduating student for outstanding/creative leadership at the medical school
• Heusner Pupil Award, 2005-2006
• Eugene S. Mayer Community Service Honor Society, 2004
• Peer selected; honors third year medical students who demonstrate great capacity to grasp the principles of science, heal the sick, comfort the troubled, and be humble before God.

Grants/Funding:

• Trauma Survivors Network at Levine Children’s Hospital. Scannell B (Co-Principal Investigator), Bosse M, Brighton B, VanderHave K., Seymour, R., the Carolinas Trauma Network Research Center of Excellence. Baxter Foundation, Carolinas HealthCare Foundation. $90,000, 8/1/16-7/31/17.
• Low-fidelity Educational Models for Arthroscopic Knot Techniques. Hamid N, Bemenderfer T, Scannell B (Co-Principal Investigator). Winkler Orthopaedic Fellowship Fund. $8354, 8/1/16-1/31/18.
• Teaching Cortical Screw Insertion: Evaluation of a Torque-directed Training Protocol. Hsu J, Seymour R, Scannell B (Co-Principal Investigator). Winkler Orthopaedic Fellowship Fund. $5994, 8/1/16-1/31/17.
• Registry of Orthopaedic Trauma in Children (ROTC). VanderHave K, Scannell B (Co-Principal Investigator), Brighton B, Bosse M, Seymour R, METRC Colleagues at Johns Hopkins University, MacKenzie E, Castillo R, Carlini A. Orthopaedic Trauma Association Clinical Research Grant. $79,495, 1/1/15-12/31/15.
• Assessment of Peripheral Perfusion after Pediatric Supracondylar Humerus Fracture with Near Infrared Spectroscopy (NIRS). Scannell B (Principal Investigator), VanderHave K, Brighton B. The George W. and Ruth R. Baxter Foundation. $50,000, 7/2014-OPEN.
• The Perfused Pulseless Supracondylar Humerus Fracture: Long-term Evaluation of Postoperative Perfusion. Internal funding through Winkler Grant. $4800, 2011-2012.
• Assessment of Peripheral Perfusion after Pediatric Supracondylar Humerus Fracture with Near Infrared Spectroscopy (NIRS). Internal funding through Winkler Grant. $4800, 2011-2012.
• Augmentation of Tendon-Bone Healing with the Utilization of Cell-Based Tissue Engineering in a Rat Supraspinatus Model. Internal funding through Winkler Grant. $39,500, 2007-2008.
• Biomechanical Comparison of Five Femoral Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction. Internal funding through Winkler Grant. $5,000, 2006-2007.
• Biomechanical Comparison of Four Tibial Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction. Internal funding through Winkler Grant. $5,000, 2006-2007.

Publications:

1. Ode G, Loeffler B, Chadderdon RC, Haines N, Scannell B, Patt J, Gaston G. Wrist Arthroscopy: Can We Gain Proficiency Through Knee Arthroscopy Simulation? J Surg Educ. 2018 May 2;pii: S1931-7204(17)30342-2. [Epub ahead of print: doi:10.1016/j.jsurg.2018.04.009] PMID: 29730181
2. Jackson JB, Vincent S, Davies J, Phelps K, Cornett C, Grabowski G, Scannell B, Stotts A, Bice M. A Prospective multicenter evaluation of the value of the on-call orthopedic resident. J Grad Med Educ. 2018, 10(1):91-94. PMID 29467980.
3. Ruder JA, Brighton BK, Vanderhave KL, Turvey B, Hsu JR, Scannell BP. Effectiveness of a Low Fidelity Cast Removal Module in Orthopaedic Surgical Simulation. Journal of Surgical Education, 2018 Feb 23 [Epub ahead of print] PMID 29483034.
4. VanderHave KL, Perkins C, Scannell BP, Brighton BK. Orthopaedic Manifestations of Sickle Cell Disease. J Am Acad Orthop Surg. 2018, 26(3):94-101.
5. Ford SE, Scannell BP. Pediatric Flatfoot: Pearls and Pitfalls. Foot and Ankle Clinics. 2017 Sep; 22(3):643-656. [Epub ahead of print; doi: 10.1016/j.fcl.2017.04.008] PMID: 28779814
6. Ruder JA, Turvey B, Hsu JR, Scannell BP. Effectiveness of a Low Cost Drilling Module in Orthopaedic Surgical Simulation. Journal of Surgical Education. 2017 May-June;74(3);471-476. PMID 27839695
7. Scannell B, Yaszay B, Bartley C, Newton P, Mubarak S. Surgical Correction of Scoliosis in Patients with Duchenne Muscular Dystrophy: 30 Year Experience. J Ped Orthop. 2017;37(8):e464-4469. PMID 26756984
8. Bell P, Scannell B, Loeffler BJ, Brighton BK, Gaston RG, Casey V, Peters ME, Frick S, Cannada L, VanderHave KL. Adolescent Distal Humerus Fractures: ORIF versus CRPP. J Ped Orthop. 2017; 37(8):511-520. PMID 26683504
9. Ford SE, Patt JC, Scannell BP. A Comprehensive, High-Quality Orthopedic Intern Surgical Skills Program. J Surg Educ. 2016;73(4):553-558. PMID 27142722.
10. Perkins C, Scannell B, Brighton B, Seymour R, VanderHave K. Orthopaedic Firearm Injuries in Children and Adolescents: An Eight-Year Experience at a Major Urban Trauma Center. Injury. 2016;74(1):173-177. PMID 26365475
11. Scannell BP, Brighton BK, VanderHave KL. Neurological and Vascular Complications Associated with Surpacondylar Humeral Fractures in Children. JBJS Reviews. 2015;3(12):e2. [Epub ahead of print; <a href="]
12. Sun" class="redactor-autoparser-object">http://dx.doi.org/10.2106/JBJS... Y, Scannell BP, Honeycutt PR, Mauerhan DR, Norton HJ, Hanley EH. Cartilage Degeneration, Subchondral Mineral and Meniscal Mineral Densities in Hartley and Strain 13 Guinea Pigs. The Open Rheumatology Journal. 2015;9:65-70. PMID 26401159
13. Schmitz MR, Farnsworth CL, Doan JD, Glaser DA, Scannell BP, Edmunds EW. Biomechanical Testing of Unstable Slipped Capital Femoral Epiphysis Screw Fixation: Worth the Risk of a Second Screw? J Pediatr Ortho. 2015;35(5):496-500. PMID 25171682
14. Yaszay B, Scannell B, Bomar JD, Sponseller PD, Shah SA, Asghar J, Samdani AF, Bastrom TP, Newton PO, Harms Study Group. Although Inconvenient, Baclofen Pumps Do Not Complicate Scoliosis Surgery in Patients with Cerebral Palsy. Spine. 2015;40(8):E504-509. PMID 25868105.
15. Scannell B, Loeffler B, Hoenig M, Peindl R, D’Alessandro D, Connor P, Fleischli J. Biomechanical Comparison of Femoral Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction. Part I: Five Femoral Devices. Am J Orthop. 2015;44(1):32-36. PMID 25566554
16. Scannell B, Loeffler B, Hoenig M, Peindl R, D’Alessandro D, Connor P, Fleischli J. Biomechanical Comparison of Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction. Part II: Four Tibial Devices. Am J Orthop. 2015;44(2)82-85. PMID 25658077
17. Scannell B, Yaszay B. Scoliosis, Spinal Fusion, and Intrathecal Baclofen Pump Implantation. Phys Med Rehabil Clin N Am. 2015;26(10):79-88. PMID 25479781
18. VanderHave KL, Brighton B, Casey V, Montijo H, Scannell B. Applications of Musculoskeletal Ultrasonography in Pediatric Patients. J Am Acad Orthop Surg. 2014;22:691-698. PMID 25344594
19. Scannell BP, Jackson JB, Bray C, Roush TS, Brighton BK, Frick SL. The Perfused Pulseless Supracondylar Humerus Fracture: Intermediate-Term Follow-up of Vascular Status and Function. Journal of Bone and Joint Surgery Am. 2013;95(21):1913-1919. PMID 24196460
20. Loeffler B, Scannell B, Peindl R, Connor P, Davis D, Hoelscher G, Norton H, Hanley E, Gruber H. Cell-based tissue engineering augments tendon-to-bone healing in a rat supraspinatus model. Journal of Orthopaedic Research. 2013;31(3):407-412. PMID 23070709
21. Hicks-Little C, Peindl R, Hubbard T, Scannell B, Springer B, Fehring T, Cordova M. Lower Extremity Joint Kinematics during Stair Climbing in Knee Osteoarthritis. Med Sci Sports Exerc. 2010;Aug 2. PMID: 20689453
22. Gruber H, Deepe R, Hoelscher G, Ingram J, Norton H, Scannell B, Loeffler B, Zinchenko N, Hanley E, Tapp H. Human Adipose-derived Mesenchymal Stem Cells: Direction to a Phenotype Sharing Similarities with the Disc, Gene Expression Profiling, and Co-culture with Human Annulus Cells. Tissue Engineering: Part A. 2010;16(9):2843-2860. PMID: 20408770
23. Berkes M, Obremsky W, Scannell B, Ellington K, Hymes R, Bosse M, and the Southeast Fracture Consortium. Maintenance of Hardware After Early Postop Infection Following Fracture Internal Fixation. J Bone Joint Surg Am. 2010;92(4):823-828. PMID: 20360504
24. Scannell B, Waldrop N, Sasser H, Sing R, Bosse M. Skeletal Traction versus External fixation in the initial temporization of femoral shaft fractures in severely injured. Journal of Trauma. 2010;68(3):633-640. PMID 20220421
25. Scannell B, Loeffler B, Bosse M, Kellam J, Sims S, Norton H. Efficacy of Intraoperative Red Blood-Cell Salvage and Autotransfusion in the Treatment of Acetabular. J Orthop Trauma. 2009;23:340-345. PMID: 19390361

Podium Presentations:

• Scannell B. Trauma Survivors Network and Expansion to Pediatrics. Interurban Orthopaedic Society, Rochester, NY, October 5-8, 2017.
• Bemenderfer T, VanderHave K, Scannell B, Clark C, Paloski M, Casey V, Brighton B. Enhancing the Economy of Surgery through Standardized Surgical Preference Cards. North Carolina Orthopaedic Association, Williamsburg, VA, October 6-8, 2017. (NCOA Peds/Trauma Session Winner)
• Alamanda VK, Massengill DL, Rozario N, Moore CG, Scannell B, Brighton B, VanderHave KL. Blood Loss Trends and Financial Implications in Adolescent Idiopathic Scoliosis. North Carolina Orthopaedic Association, Williamsburg, VA, October 6-8, 2017.
• Buck JS, Wally M, Scannell B, Seymour R, Hsu J. Teaching Cortical Screw Insertion: Evaluation of a Simple, Affordable, Torque-Directed Training Protocol to Avoid Stripping. Limb Lengthening and Reconstruction Society Annual Meeting, Park City, UT, July 21-22 2017.
• Miranda B, Cornett CA, Davies J, Grabowski G, Jackson JB, Phelps K, Scannell B, Stotts A, Vincent SA. A Multicenter Prospective Evaluation of the Value of the On-Call Orthopaedic Resident. American Academy of Orthopaedic Surgeons, San Diego, CA, March 14-18, 2017.
• Wally M, Simril T, Leflore M, Scannell B, Hsu J, Seymour R. Narcotic Prescribing Following Orthopaedic Injury in the Pediatric Population. American Public Health Association Annual Meeting, Denver, CO, October 29-November 2, 2016.
• Scannell B. Advances in Surgical Simulation: Development of Our Program. Interurban Orthopaedic Society, Charlotte, NC, September 16, 2016.
• Simril T, Wally M, Leflore M, Seymour R, Scannell B, Hsu J and the PRIMUM Research Group. Narcotic Prescribing Following Orthopaedic Injury in the Pediatric Population. Limb Lengthening and Reconstruction Society, Charleston, SC, July 22-23, 2016.
• Scannell B, Brighton B, Vanderhave K, Frick S, Seymour R. Perfusion Assessment after Pediatric Supracondylar Humeral Fractures with Near Infrared Spectroscopy. Pediatric Orthopaedic Society of North America, Indianapolis, IN, April 27-May 1, 2016.
• Jackson JB, Vincent S, Davies J, Phelps K, Cornett C, Grabowski G, Scannell B, Stotts A, Bice M. A Prospective Multicenter Evaluation of the Value of the On-call Orthopaedic Resident. Mid-Atlantic Orthopaedic Association, Bonita Springs, FL, April 13-17, 2016.
• Scherl SA, Blasier RD, Scannell BP, Ho CA, Riccio AL, Hennrikus WL, Horn BD, Denning J, Eberson C, Epps HR, Herman MJ. Challenges in the Management of Fractures in Adolescents: A Case-Based Approach. Instructional Course Lecture, American Academy of Orthopaedic Surgeons, Orlando, FL, March 1-5, 2016.
• Pierre SN, Scannell BP, Brighton BK, VanderHave KL. Prevalence and Complications of Musculoskeletal Infections in Adolescents: A Result of Delay in Diagnosis? North Carolina Orthopaedic Association, Kiawah Island, SC, October 9-11, 2015.
• Roulette P, Gettys F, Scannell B, Frick S, Rozario N, VanderHave K, Brighton B. The Utility of Screening MRI for Pediatric Patients with Suspected Musculoskeletal Infection. North Carolina Orthopaedic Association, Kiawah Island, SC, October 9-11, 2015.
• Ode G, Loeffler BJ, Chadderdon RC, Haines NM, Scannell B, Patt JC, Gaston RG. Knee Arthroscopy Simulation Training: Does it Translate to Improved Proficiency in Wrist Arthroscopy? American Society for Surgery of the Hand, Seattle, WA, September 10-12, 2015.
• Perkins C, Seymour R, Brighton B, Scannell B, VanderHave K. Orthopaedic Firearm Injuries in Children and Adolescents: A Ten-Year Experience at a Major Urban Trauma Center. North Carolina Orthopaedic Association, Asheville, NC, October 31-November 2, 2014.
• Bray C, Scannell B, Bosse M, Clark D, Casey V, Wattenbarger M, Frick S. On-call Coverage for Pediatric Orthopaedic Emergencies: Description of An Effective Call System to Optimize Pediatric Patient Care. OrthoCarolina Oscar Miller Day, Charlotte, NC, October 16, 2009.
• Scannell B, Loeffler B, Bosse M, Kellam J, Sims S, Norton H. Efficacy of Intraoperative Red Blood-Cell Salvage and Autotransfusion in the Treatment of Acetabular Fractures. American Academy of Orthopaedic Surgery Annual Meeting, San Francisco, CA, March 5-9, 2008.
• Scannell B, Waldrop N, Sing R, Sasser H, Bosse M. Skeletal Traction versus External fixation in the initial temporization of femoral shaft fractures in severely injured. American Association for the Surgery of Trauma Annual Meeting, Maui, HI, September 24-27, 2008.
• Scannell B, Waldrop N, Sing R, Sasser H, Bosse M. The Role of the Traction Pin for Temporization of Femur Fractures in Severely Injured Patients. Orthopaedic Trauma Association Annual Meeting, Denver, CO, October 15-18, 2008.
• Loeffler B, Scannell B, Bosse M, Kellam J, Sims S, Sing R. Indications and Complications of Angiography and Embolization in the Management of High Energy Pelvic Ring Injuries. Orthopaedic Trauma Association Annual Meeting, Denver, CO, October 15-18, 2008.
• Obremsky W, Scannell B, Ellington K, Bosse M, and the Southeast Fracture Consortium. Maintenance of Hardware After Early Postop Infection Following Fracture Internal Fixation. Orthopaedic Trauma Association Annual Meeting, Denver, CO, October 15-18, 2008.
• Scannell B, Loeffler B, Bosse M, Kellam J, Sims S. Use of Cell Saver in Acetabular Fracture Surgery: Does Intraoperative Red Blood-Cell Salvage and Autotransfusion Reduce the Need for Blood Transfusion? International Society of Orthopaedic Surgery and Traumatology (SICOT) Annual Meeting, Hong Kong, China, August 24-28, 2008.
• Scannell B, Loeffler B, Bosse M, Kellam J, Sims S, Norton H. Efficacy of Intraoperative Red Blood-Cell Salvage and Autotransfusion in the Treatment of Acetabular Fractures. North Carolina Orthopaedic Association Annual Meeting, Myrtle Beach, SC, October 26-28, 2007.
• Pierre SN, Scannell BP, Brighton BK, VanderHave KL. Prevalence and Complications of Musculoskeletal Infections in Adolescents: A Result of Delay in Diagnosis? Pediatric Orthopaedic Society of North America, Atlanta, GA, April 27-May 2, 2015.
• Scannell B. Challenges in the Management of Fractures in Adolescents: A Case Based Approach. Instructional Course Lecture, American Academy of Orthopaedic Surgeons, Las Vegas, NV, March 24-28, 2015.
• Scannell B. Challenges in the Management of Fractures in Adolescents: A Case Based Approach. Instructional Course Lecture, American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, LA, March 11, 2014.
• Yaszay B, Scannell B, Bomar J, Sponseller P, Shah S, Asghar M, Samdani A, Bastrom T, Newton P, and the Harms Study Group. While Inconvenient, Baclofen Pumps Do Not Complicate Scoliosis Surgery in Cerebral Palsy Patients. American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, LA, March 11-15, 2014.
• Scannell B, Bartley C, Mubarak S, Newton P, Yaszay B. Evolution of the Surgical Correction of Scoliosis in Patients with Duchenne Muscular Dystrophy. American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, LA, March 11-15, 2014.
• Vanderhave KL, Bell P, Brighton B, Scannell B. Distal Humerus Fractures in Children and Adolescents. Pediatric Orthopaedic Society of North America, Hollywood, CA, April 30-May 3, 2014.
• Schmitz M, Scannell B, Doan J, Farnsworth C, Glaser D, Edmonds E. Biomechanical testing of unstable slipped capital femoral epiphysis screw fixation – should SCFE be reduced? Society of Military Orthopaedic Surgeons Annual Meeting, Vail, CO, December 9-13, 2013.
• Frick S, Scannell B, Bray C, Jackson B, Brighton B, Roush T. The Perfused Pulseless Supracondylar Humerus Fracture: Long-term Evaluation of Postoperative Perfusion. Pediatric Orthopaedic Society of North America, Denver, CO, May 16-19, 2012.
• Griffin S, Nelson K, Loeffler B, Scannell B, Bosse M, Kellam J, Sims S, Sing R, Wang E. Appropriateness of Angiography and Embolization in the Management of High Energy Pelvic Ring Injuries. Orthopaedic Trauma Assocation Annual Meeting, Minneapolis, MN, October 3-6, 2012.
• Scannell B, Waldrop N, Sing R, Sasser H, Bosse M. Temporization of femur fractures in severely injured patients: skeletal traction vs external fixation. American Academy of Orthopaedic Surgeons Annual Meeting, Las Vegas, NV, February 22-25, 2009.
• Bray C, Scannell B, Bosse M, Clark D, Casey V, Wattenbarger M, Frick S. On-call Coverage for Pediatric Orthopaedic Emergencies: Description of An Effective Call System to Optimize Pediatric Patient Care. Orthopaedic Trauma Association Annual Meeting, San Diego, CA, October 7-10, 2009.
• Scannell B, Hoenig M, Loeffler B, Brown S, D’Alessandro D, Connor P, Fleischli J, Peindl R. Biomechanical Comparison of Five Femoral Hamstring Tendon Fixation Devices for Anterior Cruciate Ligament Reconstruction. North Carolina Orthopaedic Association Annual Meeting, Asheville, NC, October 2-5, 2008.
• Loeffler B, Scannell B, Bosse M, Kellam J, Sims S, White J. Morbidity Associated with Pelvic Angiography and Embolization in the Management of High Energy Pelvic Ring Injuries. North Carolina Orthopaedic Association Annual Meeting, Asheville, NC, October 2-5, 2008.
• Scannell B, Waldrop N, Sing R, Sasser H, Bosse M. Skeletal Traction versus External fixation for the temporary stabilization of femoral shaft fractures in severely injured patients. North Carolina Orthopaedic Association Annual Meeting, Asheville, NC, October 2-5, 2008.

Book Chapters:

• Scannell B, Yaszay B. (Chapter 27) “Baclofen Pump: Preoperative, Intraoperative, and Postoperative Management.” In: Pediatric Neuromuscular Spine Deformity. Samdani AF, Newton PO, Sponseller PD, Shufflebarger HL, Betz RR. (eds.), New York:Thieme Publishing; 2017.
• Brighton B, Scannell BP. (Chapter 35) “Child Abuse.” In: Orthopaedic Knowledge Update: Pediatric 5. Martus JE (ed.), Rosemont, IL:American Academy of Orthopaedic Surgeons; 2016.
• Iobst C, Scannell BP. (Chapter 6) “Growth of the Muscuskeletal System.” In: Orthopaedic Knowledge Update: Pediatric 5. Martus JE (ed.), Rosemont, IL:American Academy of Orthopaedic Surgeons; 2016.
• Scannell B, Yaszay B. (Chapter 13) “Other Neuromuscular Diseases.” In: The Growing Spine: Management of Spinal Disorders in Young Children. 2^nd Edition. Alkbarnia B, Yazici M, Thompson GH. (eds.), New York, NY:Springer;2016:211-227.
• Scannell B, Chambers H. (Chapter 10) “Osteochondritis Dissecans in the Talus.” In: AAOS Monograph Series: Osteochondritis Dissecans. Carey JL, Schwartz AJ (eds.), Rosemont, IL:American Academy of Orthopaedic Surgeons;2015:77-85.
• Scannell B, Taft T, Bushnell B. (Chapter 55) “Acromioclavicular Joint Injections.” In: Miller’s Essential Orthopaedics. Philadelphia, PA:Elsevier; 2008.