(Archived document, may contain errors)
322 January 13, 1983 THE STOCKHOLM TALKS m OPPORTUNITIES FOR
-THE WEST INTRODUCTION When the Conference on Disarmament and
Security-Building Measures (referred to as CDE) convenes on January
17 in Stockholm, it will receive a high level of public attention.
F or one thing it will permit the first meeting between U.S.
Secretary of State George Shultz and Soviet Foreign Minister Andrei
Gromyko since the two had a tense encounter in Madrid in September
1983 after the Soviet downing of Korean Airlines Flight 0
07. For another, it will be the only current forum at which East
and West discuss arms control, since the Soviets have refused to
continue three separate arms negotiations-the talks on strategic
and interme diate-range nuclear systems and those .on convention al
reductions.
With this new--and unexpected--importance, the CDE has become a
high priority for U.S. policymakers a Promoted mainly by some
Western European nations to demonstrate to their citizens that they
are serious .about arms issues, and by the Sovi et Union as an
opportunity to achieve some of its European security goals, the CDE
was endorsed somewhat reluctantly by the U.S. government. Now
forced to make the best of the situation Washington should work to
ensure that Western positions at the CDE re flect the overall
European security balance-a NATO force somewhat inferior
conventionally to the Warsaw Pact, dependent upon U.S. resupply,
and particularly vulnerable to a surprise attack.
The U.S. must counsel the Western nations to pursue limited Such
c onfidence and security-building measures (CSBMs). Some of these
may improve marginally the security of the West in Europe measures
include pre-notification of troop movements above certain levels
and unimpeded observation of .military maneuvers. The U.S. s hould
insist upon adequate verification wherever required and seek to
make any agreements binding under international law. At 2 the same
time, the U.S beyond limited CSBMs or interests should work against
proposals that go that would impair important secu rity If
Washington conducts skillful diplomacy, it could emerge from CDE
having demonstrated correctly that it is the Soviet Union that
remains intransigent at the bargaining table and is the major
obstacle to equitable arms limitations.
BACKGROUND There i s no generally accepted definition of a
confidence and security-building measure At a minimum it is any
action or measure that provides useful information about the
military inten- tions, actions, or activities of a nation or a
group of nations. The polit i cal purpose of CSBMs is to provide a
barometer of peaceful intentions between nations and to reduce the
possibility of unintended conflict; the security purpose is to
provide signals of unusual military activity and, in particular, to
reduce the possibili ty of a successful surprise attack. CSBMs
either can be used as an adjunct to an arms control agreement or
can stand alone.
The main components of CSBMs are 1) notification measures that
require governments to publicize in advance their plans for
specified military activity and 2) inspection measures that call
for non-national observers to be present at specified military
activities at agreed times or on request by the foreign nati0ns.l
Measures that today might be termed CSBMs have been agreed to in
the p a st, but the development of a conceptual framework for CSBMs
did not begin until the late 1960s itself in a variety of
international forums, including the Final Act agreed to by the
Conference on Security and Cooperation in Europe (usually called
the Helsi n ki Accord proposals made at the Mutual Reduction of
Force and Armaments and Associated Measures in Central Europe
conference (referred to in the West as the Mutual Balanced Force
Reduction [MBFR] talks) in Vienna; the CDE conference under review
here; and various others It now manifests The Helsinki process
mainly focused on human rights issues and the de facto ratification
of post-World War I1 European borders, but also included
non-legally binding2 CSBMs. These were 1) notification to be given
at least 2 1 days in advance of military maneuvers including over
25,000 troops 2) voluntary For background on CSBMs, see Jonathan
Alford, "The Future of Arms Control Part I11 Confidence-Building
Measures," Adelphi Paper No. 149 Interna tional Institute for
Strategic Studies, London, 1979; and Johan Jorgen Holst and Karen
Alette Melander European Security and Confidence-Building
Measures," Survival, July-August 1977, pp. 146-154.
Also known as "politically binding I 3 notification of maneuvers
and military movements i nvolving under 25,000 troops; and (3)
Helsinki signatory nations voluntarily to invite each other to send
observers to military maneuver At the Vienna talks to reduce arms
levels in Europe, which began in 1973, Western proposals at first
focused almost ex c lu- sively on methods of counting current
military force levels and specific force reduction proposals. But
in 1979, the West tabled a group of "associated measures. These
contained elements that could "build confidence,Il although they
were designed prim a rily to ensure verification of any force
reductions (if and when such reductions were im~lemented The Vienna
talks' CSBMs were 1) pre-notificati~n~ of out-of-garrison activity
2) exchange of observers at out-of- garrison activities 3)
pre-notification of m ajor movements by ground forces of direct
MBFR participants 4) right of inspec- tions up to 18 times per year
5) permanent entry and exit points to observe force movements 6)
exchange of information on relative forces 7) non-interference with
Ibational te c hnical means i.e non on-site) of verification. While
some of these proposals were intended to cover specific areas where
force reductions had taken place, the principles involved were
clearly applicable to CSBMs. At the MBFR talks, CSBMs are an
integral p art of actual force reduction issues. real progress on
these issues, there has therefore been no signi- ficant movement on
the CSBM question.
The CDE talks now will provide another forum for discussion of
CSBMs. Meeting in Stockholm are 35 nations, includi ng all the NATO
states, the Soviet bloc plus eleven of Europe's neutral and smaller
nations. They are convening as the result of a number of factors 1)
the longstanding Soviet drive for a European security conference
which led to active support for CDE be g inning in 1979 2) the
Soviet interest in diverting attention from the Helsinki process,
which has emphasized human rights issues 3) the French proposal of
1978, made under pressure from French leftists, for France to
participate in some kind of arms contr o l forum 4) a feeling by
Western European governments that another arms control parley would
allay some of the popular fears concerning deployment of the
Pershing I1 and cruise missiles; and (5) a genuine feeling in the
West and perhaps by the Soviets that some specific CSBM measure
might not be harmful to, and possibly beneficial to, their security
interests Since there has been no At the Belgrade follow-up to
Helsinki, some limited CSBMs were tabled but nothing was agreed
to.
For further discussion, see Lothar Rudel MBFR: Lessons and
Problems,"
Adelphi Paper No. 176, International Institute for Strategic
Studies London 1982 That is, notice prior to the initiation of the
military activities 4 The Western nations in December 1980, after
extensive consul tat ion, presented a proposal for a CDE conference
at the Madrid review conference follow-up of the Helsinki process.
Last Sep tember, this proposal was accepted,6 after the U.S.
yielded somewhat on the earlier effort to tightly link improvement
in the Soviet human rights performance to a CDE meeting.
DIFFERENCES BETWEEN MBFR AND CDE The prime differences between
the Mutual and Balanced Force Reduction talks in Vienna and the CDE
discussion (which is part of the Helsinki process) include subject
matter, geography, and legality. The MBFR talks cover reduction in
conventional forces while the CDE, at least in its first phase, is
supposed to focus on non-force reduction, confidence-building
measures. Geographical ly, the PBFR covers mainly Central Europe,
not including Hungary while CDE covers Europe from the Western
coastline to the Ural Mountains (ten times farther than the
Helsinki coverage) and adjacent sea and air. The French are in CDE
but not in MBFR.
With respect to legality, MBFR would resu lt in a legally
binding treaty, whereas CDE is a part of the non-binding Helsinki
process. 7 SOVIET INTERESTS AND CDE MOSCOW~S interest in CDE
reflects the Soviets' general inter est in European security, the
Soviet record with respect to the MBFR and Ifa s sociated
measures,Il and the Soviet record on Helsinki's confidence-building
measures.8 Soviet general. European security goals include 1)
maintenance of the European military balance in favor of the
Soviets 2) maintenance and strengthening of Soviet cont r ol of
Eastern Europe 3) Soviet political dominance in Western Europe 4)
recognition of (l 2) and (3) by the West 5) lowering of Western
military efforts 6) diminishing or 'breaking U.S.-Western European
ties; and (7) making Soviet-style lIdetentell irreve rsible.
At the MBFR talks, the Soviet response to Western "associated
measurell initiatives has been tepid. While the Soviets have agreed
that "associated measurest1 are a subject for discussion For the
text, see "The Madrid CSCE Review Meeting Washington, D.C
Commission on Security and Cooperation, 1983), pp. 74-75.
The interntional legal dimensir..ts of the Helsinki Final Act
are discussed in Oscar Schachter The Twilight Existence of
Non-binding International Agreements American Journal of
International Law, April 1977, pp 296-304.
The Eastern European nations are, of course, a part of the CDE
process but while they may occasionally offer a variation on Soviet
proposals they are not independent actors.
For further discussion of Soviet goals in Europe, s ee John
Erickson European Security Winter 1976, pp. 37-43 Soviet
Preferences and Priorities," Strategic Review 5 there is little
evidence of serious Soviet interest in useful associated measures
The Soviets at times also have argued that Itassociated meas urest1
are merely a pretext for the West to obtain military data.
Soviet record on compliance nonetheless indicates the Soviet ap
proach toward CSBM. While generally following the letter of the
agreements MOSCOW'S observance of the spirit has been question
able. For example, the Soviets have hampered Western observers in
various ways, such as giving them defective binoculars. West ern
observers have been carefully restricted, made to stay in prepared
stands, and permitted to watch set piece maneuvers only.
Most important, some of the Soviet large-scale maneuvers during
the Polish crisis of 1980-1981 were made without the proper
notification as required by the Helsinki CSBMs including those most
analogous to CSBMs Although the Helsinki CSBMs are not legally
binding, the WESTERN INTERESTS AND CDE Western interests must first
be viewed within the context of current security factors in
Europe.ll Most relevant are 1) the conventional military balance
tilts in favor of the Warsaw Pact over NATO 2) the Soviet bloc
fighting doctrine, training, and force capabilities are oriented
toward offensive rather than defensive posture 3) for primarily
political reasons, NATO doctrine spreads out forces along the West
German border with the East, thus making the West particula rly
vulnerable to a surprise attack 4) a successful Western defense
absolutely requires a rapid deployment of U.S. forces to
Europe.
Western nations have observed the spirit as well as the letter
of the Helsinki CSBMs. Further, Western CSBM proposals at the MBFR
talks have not been accepted by the East.
CDE AGENDA The CDE will involve all of the states that are part
of the Helsinki process and will occur in two stages. In the first
stage, beginning on January 17, the main focus is to be on limited
CSBMs. H owever, there is nothing to prevent other issues related
to arms control from being raised. The CDE mandate specifies that
any CSBM measures must be tlpoliticallyll binding, militarily lo In
its June 1983 MBFR proposals, the Soviet Union did appear to sli
ghtly modify its rigid opposition to all on-site inspection, but
its position was that any particular inspection could be rejected,
thus negating the purpose of inspections.
For a general review of U.S.'policy and CSBMs, see: U.S.
Department of State Secur ity and Arms Control Washington, D.C
Office, 1983 pp. 4350 l1 Government Printing 6 significant,
Itprovided with adequate forms of verification which corresponds to
their content I' and applicable throughout Europe to the Urals.
The results of the first stage of CDE are to be evaluated at the
Helsinki follow-up meeting scheduled for Vienna on November 4,
19
86. If all parties. agree,;a second stage of the CDE will begin,
which will have an official mandate to deal directly with arms
control issues. The U.S has not committed itself to a second
stage.
The specific issues to be raised at CDE concern 1 trans parency"
measures, such as the pre-notification of exercises, exchange of
military data, improved communications, and inspec-
tion/observation 2) restrictive measures, or limitations, such as
limits o n aspects of military maneuvers and'nuclear free zones;
and 3) declaratory measures, a favorite of the Soviets such as
pledges of nonaggression and of no first-use of nuclear weapons.
Western proposals.wil1 focus on information, notifica- tion,
verificati o n and.communication CSBMs.12 CDE: PROBLEMS AND
POLICIES Participation in CDE raises some problems for the West,
the U.S. in particular. These should be taken into consideration as
the U.S. reviews CDE usefulness. These problems are o The CDE will
draw att e ntion away from one of the most vulnerable Soviet
points-human rights issues. Soviets consistently have sought to
weaken the human rights dimension of the Helsinki process. of the
CDE, segregated from human rights issues, which are supposed to be
an integ r al part of the Helsinki process, will divert public
attention from a major Soviet vulnerability--its extensive human
rights violations The The convening o The CDE may serve as a
propaganda forum for Soviet propo- sals intended primarily to
persuade the We s tern European public that Moscow has peaceful
intentions.13 Certain to l2 On January 11, 1984, the NATO members
stated that the Western proposals at CDE will include and exercises
2) regular exchanges of military information 3) rights of
observation of mi l itary activities; and 4) improved
communications on military matters On January 10, 1984, the Soviets
proposed a ban on chemical weapons in Europe, but did not include
any verification measures be the opening round of the Soviet CDE
propaganda effort. On chemical weapons, see Manfred Hamm Deterring
Chemical War The Reagan Formula,"
Heritage Backgrounder No. 272; and Hamm, "Chemical Weapons and
Europe forthcoming from the Institute for European Defense and
Strategic Studies London 1) obligatory advance noti ce of troop
movements l3 This could well 7 have a superficial appeal are such
proposals as 'Ino first use of nuclear weapons and nuclear free
zones.I' Careful and detailed analysis demonstrates the negative
impact of many of.these proposals on Western sec u rity, but this
is a laborious and repetitive process while the Soviets have only
to offer the ideas in order to create a positive image with some
sectors of European opinion. Western governments are vulnerable to
public opinion while the Soviets are not. o The CDE could
exacerbate tensions between the Western zones, and by repeated
condemnation of the continuing allies-a prime Soviet goal--by
offering superficially appealing Ildeclaratory measures, such as
nuclear free Intermediate-Range Nuclear Force (INF ) deployment.
Pres sure could increase for a full European return to a 1970s type
detente with the Soviets and some governments could fall even
further behind in meeting the NATO commitment of 3 percent real
defense budget growth per year.' Not only could t here be
differences between the U.S. and its NATO allies, there could well
emerge tensions among the Europeans themselves over such issues as
nuclear free zones 14 0 The Soviets may seek to utilize the CDE as
a forum for unrelated issues such as the INF o r even the Strategic
Arms Reduction (START) issues. Because of the great number of
nations attending, this could add an unnecessary layer of
complexity to the already muddled arms control situation. Further
it could at least implicitly involve the European s directly in
START talk issues, which are relevant principally to U.S. security
o CDE could remove whatever modest pressure currently exists on the
Soviets in the now-suspended Vienna MBFR talks for actual
conventional force reductions in Europe.
Improved warning time is use'ful (although it can be ignored),
but actual force reductions could be more significant o Locating
the conference in Stockholm means that the Swedish government of
Olof Palme, known for his strong criticism of U.S. policies, may
tilt m atters slightly against the U.S. and Western interests,
although perhaps the recent Swedish experience with intruding
Soviet sub marines has been a chastening cannot determine the
outcome, it often plays the role of a conciliator, as Spain did
with the Ma d rid follow-up to the Helsinki accord While the host
government l4 This process already may have started announced that
it would seek a Balkans nuclear-free zone despite U.S and NATO
opposition On January 10, 1984, Greece 8 o As with all Helsinki Act
confe r ences, any CSBMs must be unanimously agreed to by all 35
participating states, which often means that the least
objectionable, least meaningful measures will be accepted, rather
than those that could be truly effective CSBMs As the U.S. pursues
its intere s ts at CDE, Washington should consider the following
policy guidelines o ItTransparencyif measures consistent with U. S
security interests include 1) lowering of the threshold number for
notification of maneuvers from 25,000 to a substan- tially lower
numb e r 10,000-15,000) troops;15 (2) requir- ing notification of
maneuvers earlier than the 21-day notice called for in the current
Helsinki CSBMs 3 exchanges of information, which should be
verifiable, on. military force structures and budgets 4) improved
com- munications; and 5) real verification measures, such as
on-site inspections (ground and aerial) and'a right to unscheduled
inspections o The most serious Western vulnerability is a surprise
attack on Western Europe.l6 Any CSBMs that provide more warning t i
me without.damaging Western security should be fully pursued.
Notification and information measures of the general type described
earlier, combined with ef fective intelligence capabilities, could
provide some additional indications of attack preparation,
especially since the area covered includes the Soviet Union to the
Urals. Such indications include dispersal of aircraft, removal of
materials from storage, movement of forces of out-of-garrison
areas, and interference with CSBM observers. No amount of in
formation, however, can substitute for informed evaluation and
judgment, but this can be enhanced by good information. the West
must review its intelligence evaluation procedures to assure that
Soviet actions are correctly interpreted.
Should such measures be adopted o CDE should establish
limitations on the ability of the Soviets to intimidate neighbors
with military buildups and troop movements during periods of
tension primarily by means of early pre-notification of maneuvers
l5 l6 Since the Warsaw Pact tabled a similar proposal in Vienna in
1979 agreement on this measure at CDE is likely.
Since the Soviets have in the past rejected the idea that the
West is vulnerable to a surprise attack. the likelihood of
effective CSBMs to deal with this problem is n ot great.' See
Jeffrey Record, Force Reductions in Europe: Strategy Over
(Cambridge: Institute for Foreign Policy Analysis 19801 p 76. For a
discussion of problems related to surprise attack see Richard K.
Belts, "Surprise Attack Washington D.C Brookings Institution 1982
Lessons for Defense Planning 9 Exchanges of information should be
pursued. Assuming they are accurate (and some verifications
measures should be devised), such information should benefit the
open West more than the secretive East.
The West should avoid any Ilrestrictive measurestt or other
force capability limitations on the carrying out of maneu vers at
this time; given the current military balance in Europe, this could
have a negative impact on Western security interests. At some point
i n the future, however some such measures might be appropriate,
but only with very stringent verification measures.17 At present,
NATO security requires realistic training involving very large
numbers of troops; practice is essential to be ready for the pos
sible transporting of thousands of U.S. troops on very short notice
and the deployment of forces in a for ward defense position. Any
weakening of U.S. reinforce ment capability would also inevitably
lower the nuclear threshold.
The West should not agree to include air and naval maneu vers at
this time; such activities, alone, simply are.no threat to the
security of the Warsaw Pact. The U.S in particular as an
essentially maritime power, cannot allow any measures that, even
implicitly, would impinge on free dom of the seas, or its ability
to operate in the Mediterranean or other waters close to
Europe.
The West should oppose any Soviet efforts to extend the range of
coverage for CSBMs into the Atlantic or the Mediterranean or to
include the U.S. East Coast. S uch areas are clearly away from
direct relevance to European security and would in fact include
U.S. military activi ties totally unrelated to European
security.
The U.S. should oppose measures that would require reporting or
observing forces merely in transit between two non-European
points.
Soviet efforts to turn CDE into a forum for lldeclaratoryll
measures should be resisted. Such measures traditionally raised.by
the Soviets include the non-first use of nuclear weapons,
non-aggression pacts, and the e stablishment of nuclear and
chemical weapon free zones in various parts of Europe. The former
would deprive the West of its most significant deterrent and
potential response to a Soviet attack on Europe and would
psychologically undermine U.S allies while the Soviets would not
believe it anyway.
The latter would serve no useful purpose and, most impor tant,
almost by definition cannot be verified. Alterna tively,
imaginative counterdeclaratory proposes that l7 Such limitations
could be on the size, area of manuever, or duration. 10 place the
Soviets on the defensive could be offered by the U.S.--such as
nonintervention by the Soviets in Poland o As with any agreements
negotiated with the Soviets, the terms should be absolutely clear
and not subject to dif f ering interpretations, and any terms
subject to dispute should be carefully defined within the text of
the agree ment It is essential that the Russian translation be
carefully scrutinized for deliberate loopholes. Transla tions must
not be viewed as a mer e formality.
Adequate verification must be a top priority for Western
negotiators; the Soviets are vulnerable on their consistent refusal
to consider meaningful verification measures especially on-site
inspection. At a minimum, observers should have consid erable
freedom of movement, be adequate ly supplied, and free from
harassment. Soviet willingness to 'agree to adequate CSBM
inspection would be a first step to such agreement on arms
reduction negotiations.
Refusal would indicate a lack of seriousness in arms talks as
well. Verification is essential to assure observance of CSBMs and
to assure that the principal Western interest in them-adequate
warning time-is achieved. At the same time, any "intrusive"
inspection measures, in the unlikely event that the Soviets were
agreeable to negotiating them, should be carefully weighed for
their impact upon Western security. Non-intrusive verfication is
not sufficient because 1) it cannot detect all that needs to be
detected 2) to do so could reveal U.S. intelligenc e capabilities;
and (3) on-site inspection would be a significant signal of
political intentions o r o An agreement should provide a mechanism
for definitively determining that violations have occurred. In
devising such a mechanism, the experience of the U .S.-Soviet
Standing Consultative Commission of SALT should be re viewed; it
has not always been a satisfactory forum for clearly determining
whether violations have occurred.
At a minimum, the forum should. be public o Penalties for
non-compliance with a CSBM should be pro posed unannounced on-site
inspections be allowed for any viola tion, or to require
cancellation by the violating party of an equivalent already
announced fu t ure activity. Of course, for a serious violation or
systematic non-compli ance, the reaction should be severe, such as
withdrawal from the agreement, military countermeasures, or other
appropriate response One possibility would be to require that
addition al o In the evaluation of all suggested CSBMs, full
considera tion should be given as to how they would work in a time
of great tension, and what the impact would be on Western 11
security were they to be suddenly ignored at such a time.
Further, considera tion should be given to .other CSBMs which
would be triggered at the time of a crisis, although these should
be approached with some skepticism as the measures would also
likely be non-binding, and a nation that has violated binding
treaties would not lik ely observe such measures in times of
crisis. Actions for consideration as subjects of crisis CSBMs
include calling up of reserves, placing units on alert, and
marshalling of supplies.
The West should use the CDE as an educational forum for European
public s, including the smaller and neutral na- tions that will be
involved in an arms control forum for the first time, to point out
that Soviet conventional capabilities have increased substantially
beyond those needed for self-defense, and that their planning and
exercises are based on an offensive strategy including integrated
use of chemical weapons As with any treaty negotiation, the U.S.
should not enter into preemptive concessions; that is to say, the
U.S should know what it can and cannot accept and shou ld not go
beyond that for any reason, be that to keep the Soviets at the
table, to placate sectors of public opinion, or merely to reach an
agreement for the sake of reaching an agreement.
The Western position at CDE should be coordinated with ongoing
MBFR interests (assuming the Soviets return to Vienna longer be
available as a bargaining chip for actual force reductions,
although the likelihood of the Soviets agreeing to such reductions
with adequate verification is minimal. Alternatively, the substance
o f Western MBFR positions could eventually be transferred to
Stockholm since there is considerable overlap A concession or
compromise made at CDE will no The West should propose that any
CSBMs agreed to be separated out and put into the form of a treaty,
b i nding under international law. Of course, this does not assure
Soviet compliance, as existing covenants have been violated, but it
nonetheless removes the argument that the agreements do not require
obligatory observance. Labeling an agreement negotiated within the
Helsinki context as "mandatory" does not make the agreement binding
under international law. It is perhaps bett..x than nothing but
falls far short of the best result.
The West should not allow the CDE and Soviet public relations
exercises in ar ms control to divert attention from the Soviet
huinan rights record. also point out that it would be more
confident about the Soviets were they to allow for human rights and
political freedoms The West should 12 CONCLUSION A well-thought out
and executed U .S. policy at CDE could achieve the following 1)
agreement to a small number of CSBMs that could marginally enhance
Western security 2) the preserva- tion of alliance unity on
security issues 3) the maintenance of continued pressure on the
Soviets on the h uman rights issue 4 the encouragement of even
modest political independence by the East Europeans; and 5) the
blunting of Soviet propaganda initia- tives and efforts at
declaratory CSBMs with clear presentations of the Soviet military
buildup and its impa ct upon the East-West balance along with the
offering of imaginative counter-propaganda where appropriate.
The West, of course, should be realistic about the likelihood of
Soviet compliance with any measures agreed to in view of MOSCOW'S
record on such mat ters. This Soviet record also makes verification
measures even more important as part of an overall package. Cer-
tainly, if the Soviets will not agree to the minimal on-site
requirements of CSBMs, there is little hope that they will accept
them for more s ignificant negotiations on nuclear and conventional
force reductions A realism should inform expectations about the
CDE. present circumstances, only two things could significantly
improve the West's security positions: first, genuine, balanced and
truly v e rifiable arms reductions, or, second, a strengthening of
'Western military capabilities to assure deterrence or the ability
to counter the Soviets militarily if necessary. with respect to
CSBMs, the most important actions that would create confidence woul
d be for the Soviet Union to renounce expansionism, end its quest
for overwhelming military predominance in Europe and to respect
human rights. Without such measures, the West must remain viligant
regardless of whatever CSBMs may be adopted at the CDE Unde r W.
Bruce Weinrod Director of Foreign Policy and Defense Studies The
author wishes to acknowledge the assistance of James Hackett in the
preparation of this study.