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In this paper, we study a backward stochastic differential equation driven by a Lévy process with two right continuous and left limited reflecting barriers. We show the existence and uniqueness of solution by means of the penalization method when the coefficient is stochastic Lipschitzian. As an application, we give a fair price for the American game option. [ABSTRACT FROM AUTHOR]

Wheat is the major cereal crops in Pakistan and inoculation of beneficial microbes plays a major role in crop growth enhancement. This study was conducted to evaluate bacteria with potential to contribute to enhanced plant nutrient uptake and wheat growth. A total of 10 bacterial strains, isolated from the wheat crop, were characterised. The results showed that selected isolates were able to produce Indole-3-acetic acid (IAA) and biofilm, fix atmospheric nitrogen and solubilise inorganic phosphate. However, NIA-2 and NIA-5 were the most efficient among the isolated bacteria in regard to N2-fixation, biofilm production, P-solubilisation (57.32 and 45.38 %) and IAA production (4.28 and 3.49 mg L-1). A pot study was conducted on wheat crop to investigate the effect of NIA-2 and NIA-5 isolates with full NP fertilisers (120 kg N ha-1 in the form of urea, 90 kg P2O5 ha-1 in the form of DAP) and at half rates of NP fertilizers (60 kg N ha-1 in the form of urea, 45 kg P2O5 ha-1 in the form of DAP). The highest plant height (34.49 cm) and root length (10.38 cm) were observed in half NP fertiliser application inoculated with NIA-5 inoculated treatments. Similarly, the highest plant dry biomass (1.270 g plant-1) was recorded in half fertiliser application inoculated with NIA-5. All bacterial inoculated treatments showed the existence of microbes in the soil after 45 days of sowing. Nevertheless, the highest bacterial population was recorded in half NP fertiliser with NIA-05 (5.560 log CFU g-1 soil). Significantly highest plant nitrogen (1.344 %), phosphorus (0.697 %) and potassium uptake (0.310 %) were observed in half NP fertiliser with NIA-05. Overall, the half rate of the NP fertiliser inoculated with bacterial isolate NIA-5 improved nutrient uptake and growth of the wheat crop. Thus, this study suggests that these bacterial isolates might be used as an inoculum for enhancing plant growth by supplying plant nutrient and phytohormones. [ABSTRACT FROM AUTHOR]

Hypothesis: Pyrene derivatives are effective motifs when designing graphene-philic surfactants, enabling the use of hydrophobic graphene-based nanomaterials in waterborne formulations. Hence, novel pyrene end-functionalized polymeric stabilizers show promise for stabilizing aqueous graphene nanomaterial dispersions, and offer benefits over traditional small molecule surfactants., Experiments: Pyrene end-functionalized poly(methacrylic acid) (Py-PMAA n , where n = 68 to 128) was synthesized by reversible addition-fragmentation chain-transfer (RAFT) polymerization of MAA using a pyrene-containing RAFT chain-transfer agent. These polymers were evaluated as aqueous graphene nanoplatelet (GNP) stabilizers. Subsequently, polymer-stabilized GNPs were formulated into film-forming polymer latex dispersions and the properties of the resulting GNP-containing films measured., Findings: Py-PMAA n homopolymers with well-defined molecular weights were prepared via RAFT solution polymerization. They served as efficient stabilizers for aqueous GNP dispersions and performed better than a traditional small molecule surfactant and non-functionalized PMAA, especially at higher pH and with higher molecular weight polymers. The use of Py-PMAA n allowed GNPs to be readily formulated into waterborne latex coatings. When compared to controls, the resulting films were significantly reinforced due to the improved homogeneity of dried nanocomposite films and chain entanglement between the polymer matrix and stabilizers. Thus, the ability to readily incorporate GNPs into aqueous formulations and enhance GNP/polymer matrix interfaces was demonstrated for these novel amphiphilic stabilizers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Heart transplantation is a vital procedure for patients with end-stage heart failure, but it faces significant challenges, including graft dysfunction, rejection, and cardiac allograft vasculopathy (CAV), which can compromise long-term graft success. Research suggests that statin therapy may offer significant benefits to heart transplant recipients, such as improved long-term survival and reduced rates of graft rejection and mortality. The aim of this review is to thoroughly examine the recent literature on this topic since 2005. Early use of high-dose statins appears to be particularly effective in preventing vasculopathy and improving outcomes, although a titrated approach may help to reduce side effects. High-dose statins may provide superior cardiovascular benefits, including lower rates of CVD, slower progression of CVD and improved long-term graft survival. Despite potential concerns about adverse effects, evidence suggests that high-intensity statins improve cholesterol levels without increasing serious adverse events after transplantation. The goal of statin therapy in heart transplant recipients is to balance the well-established benefits seen in the general population with the specific needs of this group, with the ultimate goal of improving both longevity and quality of life., (© 2024 Wiley Periodicals LLC.)

Background: Complications related to diabetic foot ulcers (DFU) due to diabetes are increasing. One of the factors influencing the management and treatment of complications related to DFU is the vitamin D serum levels of patients. Therefore, we sought to comprehensively review meta-analyses from randomized controlled trials and observational studies examining the link between serum vitamin D levels and DFU outcomes in diabetic patients., Methods: We searched PubMed, Scopus, and ISI Web of Science until September 2024 and extracted the required data from related articles according to Inclusion criteria. The certainty of the evidence and the quality of conduct of the published meta-analyses were rated using the ASMTAR 2 tools, respectively., Result: A total of 8 meta-analyses studies that met inclusion criteria were included. Based on the obtained results, it has been noted that individuals with DFU exhibit serum vitamin D levels significantly lower, ranging from -7.14 (5.44, 8.83) to -0.93 (95% CI: 0.17, 1.68) ng/ml, compared to those with diabetes but without DFU. Furthermore, individuals exhibiting severe vitamin D deficiency are found to be at least 1.82 times more susceptible to developing DFU. Conversely, administering varying doses of vitamin D supplementation has been shown to positively affect the size and number of ulcers in DFU patients., Conclusion: This study suggests a potential link between lower levels of vitamin D in the blood and the risk of DFU, hinting at the benefits of vitamin D supplementation in improving outcomes associated with DFU. However, caution is warranted due to the potential bias present in the included studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Zhang, Jamali, Guimarães, Radkhah, Jamilian and Wang.)

This systematic review and meta-analysis of randomized controlled trials (RCTs) sought to evaluate the effects of Nigella sativa (N. sativa) consumption on glycemic index in adults. A systematic literature search up to December 2023 was completed in PubMed, Scopus, and Web of Science, to identify eligible RCTs. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as weighted mean differences with a 95 % confidence interval. Finally, a total of 30 studies were found to be eligible for this meta-analysis. The pooled results using random effects model indicated that N. sativa supplementation significantly reduced FBS (SMD: -1.71; 95 % CI: -2.11, -1.31, p <0.001; I 2 = 92.7 %, p-heterogeneity <0.001) and HA1c levels (SMD: -2.16; 95 % CI: -3.04, -1.29, p <0.001; I 2 = 95.7 %, p-heterogeneity <0.001) but not effect on insulin (SMD = 0.48; 95 % CI: -0.53, 1.48, P = 0.353; I 2 = 96.1 %, p-heterogeneity <0.001), and HOMA-IR (SMD: -0.56; 95 % CI: -1.47, 0.35, p=0.229; I 2 = 95.0 %, p-heterogeneity <0.001).Overall, the evidence supports the consumption of N. sativa to reduce FBS and HA1c levels. Additional research, featuring extended durations and robust study designs, is necessary to determine the ideal dosage and duration of N. sativa supplementation for achieving a positive impact on glycemic markers., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations., Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations., Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate., Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Key Clinical Message: Accurately identifying the ruptured aneurysm in patients with subarachnoid hemorrhage and multiple aneurysms is critical to prevent rebleeding and optimize outcomes. Vessel wall MRI with contrast can aid in pinpointing the culprit aneurysm, informing a tailored surgical or endovascular management strategy for these complex cases. In patients with subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms, MRI with contrast and DSA are crucial for identifying the ruptured aneurysm, guiding a shift from endovascular to microsurgical clipping. Successful single-session treatment and absence of postsurgical deficits highlight the effectiveness of a multidisciplinary approach. Further research on optimal strategies is needed., Abstract: Multiple intracranial aneurysms make up approximately 20% of cases of aneurysmal SAH. In patients with aneurysmal SAH and multiple intracranial aneurysms, definite treatment of the ruptured aneurysm causing SAH is of the highest priority. However, identifying the bleeding source can be challenging, and it may not be recognizable by the hemorrhage pattern. Misdiagnosis and mistreatment of a ruptured aneurysm in a patient with multiple aneurysms can lead to bleeding recurrence and an undesirable outcome. We report a 65-year-old woman who presented with severe sudden onset headache. Neuroimaging studies revealed diffuse SAH and concurrent PICA and ACom aneurysm with triplicate A2. However, the ruptured aneurysm responsible for the patient's symptoms was not obvious based on routine neuroimaging studies. Magnetic resonance imaging with contrast was performed, revealing circumferential enhancement of the PICA aneurysm. In this report, we demonstrate the real-world effect of vessel wall MRI with contrast on decision-making regarding identifying the ruptured aneurysm and surgical planning in cases of multiple aneurysms. Furthermore, we show that MRI and aneurysm wall enhancement could be a promising option in detecting ruptured aneurysms in cases of multiple aneurysms., Competing Interests: The author(s) do NOT have any potential conflicts of interest for this manuscript., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

From sequences of speech sounds 1,2 or letters 3 , humans can extract rich and nuanced meaning through language. This capacity is essential for human communication. Yet, despite a growing understanding of the brain areas that support linguistic and semantic processing 4-12 , the derivation of linguistic meaning in neural tissue at the cellular level and over the timescale of action potentials remains largely unknown. Here we recorded from single cells in the left language-dominant prefrontal cortex as participants listened to semantically diverse sentences and naturalistic stories. By tracking their activities during natural speech processing, we discover a fine-scale cortical representation of semantic information by individual neurons. These neurons responded selectively to specific word meanings and reliably distinguished words from nonwords. Moreover, rather than responding to the words as fixed memory representations, their activities were highly dynamic, reflecting the words' meanings based on their specific sentence contexts and independent of their phonetic form. Collectively, we show how these cell ensembles accurately predicted the broad semantic categories of the words as they were heard in real time during speech and how they tracked the sentences in which they appeared. We also show how they encoded the hierarchical structure of these meaning representations and how these representations mapped onto the cell population. Together, these findings reveal a finely detailed cortical organization of semantic representations at the neuron scale in humans and begin to illuminate the cellular-level processing of meaning during language comprehension., (© 2024. The Author(s).)

Objectives: This study compared the effects of glazing versus polishing on mechanical, optical, and surface properties of zirconia ceramics with different translucencies., Materials and Methods: In this in vitro study, 120 bar-shaped specimens (25 × 4 × 1.2 mm) were fabricated from three different types of zirconia with different translucencies (n = 40, DD Bio ZW, ZX2, and Cube X2). After sintering, each zirconia group was randomly divided into five subgroups of control (glazing), glazing + bur abrasion, glazing + bur abrasion + polishing with EVE Diacera® kit, glazing + bur abrasion + reglazing, and glazing + bur abrasion + polishing with EVE Diacera® kit + reglazing. The specimens underwent surface roughness, hardness, flexural strength, and translucency tests, as well as X-ray diffraction (XRD) and scanning electron microscopy (SEM) for assessment of surface topography. Data were analyzed by one-way analysis of variance, Tukey test, and Pearson test (α = .05)., Results: Flexural strength, surface hardness, and translucency were significantly correlated with zirconia type. ZW zirconia had significantly higher flexural strength and surface hardness and significantly lower translucency than Cube X2 and ZX2 (p < .001). Surface roughness had no significant correlation with zirconia type (p = .274). Polishing created the smoothest, and bur abrasion created the roughest surface (p < .001). Flexural strength and hardness in most experimental groups were significantly lower than in the control group (p < .001). Translucency was not significantly different in bur abrasion and polishing groups, compared with the control group; however, reglazing significantly increased the translucency (p < .001). SEM micrographs confirmed the surface roughness results. XRD showed monoclinic phase only in reglazed groups., Conclusion: Of different surface treatments, polishing improved the surface properties and caused the smallest change in mechanical properties of zirconia with different translucencies., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Fetal movement monitoring is one of the strategies used to assess the fetus's health. Until now, most studies focused on the decreased fetal movement and neonatal outcome, although this systematic review and meta-analysis is designed to assess the association between increased fetal movements (IFM) with perinatal outcomes., Method: The electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched for studies investigating the perinatal outcome of women with increased fetal movements from inception to July 2023. Following that, a random-effect meta-analysis model was used to obtain the combined diagnostic and predictive parameters including perinatal mortality (still birth and early neonatal mortality), operative delivery, Apgar score, neonatal resuscitation at birth and NICU Admission., Results: After the initial screening, seven studies examining the association between increased third trimester fetal movement and various perinatal outcomes were included. Meta-analysis revealed a significant reduction in the risk of cesarean delivery among patients with IFM compared to controls, suggesting a potential protective effect during childbirth. However, no statistically significant difference was observed in birth weight, small or large for gestational age births, neonatal intensive care unit admission, maternal age, umbilical cord around the neck, gestational diabetes mellitus, and hypertension, indicating that IFM may not be a major predictor of adverse perinatal outcomes or maternal conditions. Notably, IFM was significantly associated with a higher likelihood of labor induction., Conclusion: The findings suggest that IFM may have a protective effect against cesarean delivery. Additionally, IFM does not appear to be significantly associated with maternal age, umbilical cord around the neck, gestational diabetes mellitus and hypertension. However, the observed significant association with labor induction warrants further investigation., (© 2024. The Author(s).)

Background: Ophthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes., Methods: All the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant., Results: Among 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores., Conclusion: OAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment., (© 2024. The Author(s).)

Pancreatic ductal adenocarcinoma (PDAC) is poised to become the second leading cause of cancer-related death by 2030, necessitating innovative therapeutic strategies. Genetic and epigenetic alterations, including those involving the COMPASS-like complex genes, have emerged as critical drivers of PDAC progression. This review explores the genetic and epigenetic landscape of PDAC, focusing on the role of the COMPASS-like complex in regulating chromatin accessibility and gene expression. Specifically, we delve into the functions of key components such as KDM6A , KMT2D , KMT2C , KMT2A , and KMT2B , highlighting their significance as potential therapeutic targets. Furthermore, we discuss the implications of these findings for developing novel treatment modalities for PDAC.

Purpose: In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL., Methods: Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi., Results: More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi., Conclusion: There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers.

Objective: This study aimed to examine the association between cervical length and the risk of adverse outcomes in placenta previa pregnancies. In addition, the diagnostic accuracy of cervical length in predicting emergency cesarean delivery due to hemorrhage was evaluated., Data Sources: PubMed, Web of Science, and Embase were systematically searched up to January 21, 2023., Study Eligibility Criteria: Observational studies investigating the relationship between cervical length and maternal adverse outcomes in patients with placenta previa were considered eligible. The primary outcome was the diagnostic accuracy of cervical length measured at 28 to 34 weeks of gestation for the prediction of emergency cesarean delivery due to hemorrhage. The secondary outcomes were the probability of antenatal bleeding, preterm birth (both iatrogenic and spontaneous), and postpartum hemorrhage >2000 mL. Insufficient data were available on the transfusion procedure in cases where the cervical length was <30 mm., Methods: For prognostic analysis, the random-effects model was used to pool the odds ratios and the corresponding 95% confidence intervals. For the diagnostic part, we used a summary receiver-operating characteristic curve, pooled sensitivities and specificities, area under the curve, and summary likelihood ratios., Results: A total of 13 studies presenting data on 1462 pregnancies with placenta previa were included. Cervical length ≤30 mm at 28 to 34 weeks of gestation had a sensitivity of 61% (95% confidence interval, 43-77), specificity of 83% (95% confidence interval, 76-88), and area under the curve of 0.83 (95% confidence interval, 0.80-0.86) for the prediction of emergency cesarean delivery. Furthermore, cervical length ≤30 mm was associated with antenatal bleeding (odds ratio, 3.62; 95% confidence interval, 2.09-6.26; P<.001; I 2 =54.8%), preterm birth (odds ratio, 8.46; 95% confidence interval, 3.05-23.44; P<.001; I 2 =83.6%), and postpartum hemorrhage (odds ratio, 6.89; 95% confidence interval, 4.51-10.53; P<.001; I 2 =0.00%)., Conclusion: Short cervical length (≤30 mm) measured at 28 to 34 weeks of gestation can assist in predicting the risk of emergency cesarean delivery due to hemorrhage in pregnancies with placenta previa. Furthermore, short cervical length is significantly associated with the risk of antenatal bleeding, preterm birth, and postpartum hemorrhage in pregnancies with placenta previa., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Migrants and refugees are at a disadvantage in accessing basic necessities. The objective of this study is to assess the inequity in access, needs and determinants of COVID-19 vaccination among refugees and migrant populations in Pakistan., Design: We conducted a mixed-method study comprising a cross-sectional survey and a qualitative study. In this paper, we will only report the findings from the cross-sectional survey., Setting: This survey was conducted in different cities of Pakistan including Quetta, Karachi and Hyderabad., Participants: A total of 570 participants were surveyed including refugees and migrants, both in regular and irregular situations., Primary and Secondary Outcome Measures: The primary outcome of the study was to estimate the proportion of refugees and migrants, both in regular and irregular situations vaccinated against COVID-19 and assess the inequity. The χ 2 test and Fisher's exact test were used to determine the significant differences in proportions between refugees and migrants and between regions., Results: The survey showed that only 26.9% of the refugee and migrant population were tested for COVID-19, 4.56% contracted coronavirus, and 3.85% were hospitalised due to COVID-19. About 66% of the refugees and migrants were fully vaccinated including those who received the single-dose vaccine or received all two doses, and 17.6% were partially vaccinated. Despite vaccination campaigns by the government, 14.4% of the refugee and migrant population remained unvaccinated mostly because of vaccines not being offered, distant vaccination sites, limited access, unavailability of COVID-19 vaccine or due to a difficult registration process. Vaccination rates varied across provinces, genders and migrant populations due to misconceptions, and several social, cultural and geographical barriers., Conclusion: This study highlights the COVID-19 vaccine coverage, access and inequity faced by refugees and migrants during the pandemic. It suggests early prioritisation of policies inclusive of all refugees and migrants and the provision of identification documents to ease access to basic necessities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA., Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process., Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit., Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

The use of conventional chemotherapy in conjunction with targeted and immunotherapy drugs has emerged as an option to limit the severity of side effects in patients diagnosed with head and neck cancer (HNC), particularly oropharyngeal cancer (OPC). OPC prevalence has increased exponentially in the past 30 years due to the prevalence of human papillomavirus (HPV) infection. This study reports a comprehensive review of clinical trials registered in public databases and reported in the literature (PubMed/Medline, Scopus, and ISI web of science databases). Of the 55 clinical trials identified, the majority (83.3%) were conducted after 2015, of which 77.7% were performed in the United States alone. Eight drugs have been approved by the FDA for HNC, including both generic and commercial forms: bleomycin sulfate, cetuximab (Erbitux), docetaxel (Taxotere), hydroxyurea (Hydrea), pembrolizumab (Keytruda), loqtorzi (Toripalimab-tpzi), methotrexate sodium (Trexall), and nivolumab (Opdivo). The most common drugs to treat HPV-associated OPC under these clinical trials and implemented as well for HPV-negative HNC include cisplatin, nivolumab, cetuximab, paclitaxel, pembrolizumab, 5-fluorouracil, and docetaxel. Few studies have highlighted the necessity for new drugs specifically tailored to patients with HPV-associated OPC, where molecular mechanisms and clinical prognosis are distinct from HPV-negative tumors. In this context, we identified most mutated genes found in HPV-associated OPC that can represent potential targets for drug development. These include TP53 , PIK3CA , PTEN , NOTCH1 , RB1 , FAT1 , FBXW7 , HRAS , KRAS, and CDKN2A .

Head and neck cancer (HNC) is the 6th most common cancer across the world, with a particular increase in HNC associated with human papilloma virus (HPV) among younger populations. Historically, the standard treatment for this disease consisted of combined surgery and radiotherapy or curative platinum-based concurrent chemoradiotherapy, with associated long term and late toxicities. However, HPV-positive HNC is recognized as a unique cancer subtype, typically with improved clinical outcomes. As such, treatment de-escalation strategies have been widely researched to mitigate the adverse effects associated with the current standard of care without compromising efficacy. These strategies include treatment de-escalation, such as novel surgical techniques, alternative radiation technologies, radiation dose and volume reduction, as well as neoadjuvant chemotherapies, immunotherapies, and combined therapies. Although these therapies show great promise, many of them are still under investigation due to hesitation surrounding their widespread implementation. The objective of this review is to summarize the most recent progress in de-escalation strategies and neoadjuvant therapies designed for HPV-positive HNC. While specific treatments may require additional research before being widely adopted, encouraging results from recent studies have highlighted the advantages of neoadjuvant chemotherapy and immunotherapy, as well as radiation and surgical de-escalation approaches in managing HPV-positive HNC., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background:  Intracranial aneurysms are more commonly associated with inflammation as a cause of their development, progression, and rupture. Macrophages and other cells can express the CD68 antigen. The aim of this study was to assess the CD68 antigen levels in cerebral aneurysm (CA) patients compared to a control group at a referral center in Iran., Methods:  A case-control investigation was undertaken on 88 individuals (44 of whom were cases and 44 were controls). Individuals with CA as the case group consisted of 28 ruptured and 16 unruptured subgroups. Clinical, radiographic, and CD68 levels were evaluated and registered., Results:  The average age of the participants was 49 years. Males comprised 43.2% of the patients, while 56.8% were females ( p  = 0.002). There was a statistically significant difference in the CD68 levels between the two groups. There was no significant difference ( p  = 0.42) between the ruptured and unruptured subgroups (23.66 and 20.47, respectively) in this comparison. No significant correlation was seen between the patients' CD68 and Glasgow Coma Scale (GCS) levels and their aneurysm diameter ( p  = 0.74 and 0.45, respectively). A link between CD68 levels and age was found, but it was not statistically significant ( r  = 0.44 and p  = 0.002)., Conclusions:  A possible involvement of CD68 as an inflammatory agent in the development of CAs but not in aneurysm rupture has been suggested. Inflammation and CD68 were positively associated with age. The CD68 antigen should be studied further in population-based cohort studies., Competing Interests: None declared., (Thieme. All rights reserved.)

Reversible addition-fragmentation chain transfer (RAFT) aqueous emulsion polymerization is used to prepare well-defined ABCB tetrablock copolymer nanoparticles via sequential monomer addition at 30 °C. The A block comprises water-soluble poly(2-( N -acryloyloxy)ethyl pyrrolidone) (PNAEP), while the B and C blocks comprise poly( t -butyl acrylate) (PtBA) and poly( n -butyl acrylate) (PnBA), respectively. High conversions are achieved at each stage, and the final sterically stabilized spherical nanoparticles can be obtained at 20% w/w solids at pH 3 and at up to 40% w/w solids at pH 7. A relatively long PnBA block is targeted to ensure that the final tetrablock copolymer nanoparticles form highly transparent films on drying such aqueous dispersions at ambient temperature. The kinetics of polymerization and particle growth are studied using 1 H nuclear magnetic resonance spectroscopy, dynamic light scattering, and transmission electron microscopy, while gel permeation chromatography analysis confirmed a high blocking efficiency for each stage of the polymerization. Differential scanning calorimetry and small-angle X-ray scattering studies confirm microphase separation between the hard PtBA and soft PnBA blocks, and preliminary mechanical property measurements indicate that such tetrablock copolymer films exhibit promising thermoplastic elastomeric behavior. Finally, it is emphasized that targeting an overall degree of polymerization of more than 1000 for such tetrablock copolymers mitigates the cost, color, and malodor conferred by the RAFT agent., Competing Interests: The authors declare the following competing financial interest(s): The industrial sponsor of this study has filed a US patent application to protect the associated IP., (© 2024 The Authors. Published by American Chemical Society.)

Humans are capable of generating extraordinarily diverse articulatory movement combinations to produce meaningful speech. This ability to orchestrate specific phonetic sequences, and their syllabification and inflection over subsecond timescales allows us to produce thousands of word sounds and is a core component of language 1,2 . The fundamental cellular units and constructs by which we plan and produce words during speech, however, remain largely unknown. Here, using acute ultrahigh-density Neuropixels recordings capable of sampling across the cortical column in humans, we discover neurons in the language-dominant prefrontal cortex that encoded detailed information about the phonetic arrangement and composition of planned words during the production of natural speech. These neurons represented the specific order and structure of articulatory events before utterance and reflected the segmentation of phonetic sequences into distinct syllables. They also accurately predicted the phonetic, syllabic and morphological components of upcoming words and showed a temporally ordered dynamic. Collectively, we show how these mixtures of cells are broadly organized along the cortical column and how their activity patterns transition from articulation planning to production. We also demonstrate how these cells reliably track the detailed composition of consonant and vowel sounds during perception and how they distinguish processes specifically related to speaking from those related to listening. Together, these findings reveal a remarkably structured organization and encoding cascade of phonetic representations by prefrontal neurons in humans and demonstrate a cellular process that can support the production of speech., (© 2024. The Author(s).)

Background  Plastic surgery has developed to benefit in a variety of challenging areas formerly handled by other disciplines. Medical students do not have a clear picture of plastic surgery as a career due to lacking scope, clinical practice, and understanding of plastic surgery as a clinical area of expertise, including general practitioners, nursing staff, medical trainees, and the general public, and misconceptions about the extent of reconstructive and plastic surgery. Methods  A cross-sectional observational study was conducted on Kuwait University Medical students (2nd-7th Years) over a period of 1 month. A questionnaire and a consent form were provided to eligible students. The inclusion criteria were Kuwait University Medical students from 2nd to 7th Years with signed consent form. The response was collected via email sent in coordination with the Vice Dean of Student Affairs in the Faculty of Medicine. Using statistical package for the social sciences, responses were statistically analyzed. Pearson's chi-square test was used to calculate p -values, where p  < 0.05 was considered statistically significant. Results  A total of 244 eligible medical students, 121 males and 123 females, were included in the study, with a mean age of 21 (±2) years. Similarly, 126 (51.6%) were preclinical students (2nd-4th-year students), while 118 (48.4%) were clinical students (5th-7th-year students). About 79.8% of medical students believed that plastic surgery plays an essential role in trauma management, whereas 9.2% did not consider plastic surgery significant for trauma management. This study found that only 15.5% of medical students were interested in enrolling in plastic surgery residency after graduation, while 47.1% of students did not consider plastic surgery residency after graduation. However, 37.4% were uncertain. The two most driving factors in deciding on plastic surgery residency were expected income (61.8%) and lifestyle (14.3%). Conclusion  Improving medical students' education quality can enhance their perception and awareness of plastic surgery. Students should be taught the broader scope of plastic surgery. The inclusion of formal training during undergraduation is the essence of time and should be added to or improved during plastic surgery rotations with more emphasis on reconstructive and hand/peripheral nerve surgery. Student-led interest groups can be a useful tool for educating students about their specialty., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

The green synthesis method which is aligned with the sustainable development goals (SDGs) theory, is proposed to synthesize ZnO nanoparticles using ginger extract to treat the acidic wastewater and acidic factory effluent as a current challenge and the effects of the concentration of extracts on the synthesized ZnO nanostructures are investigated. The results declare that the single-phase hexagonal ZnO is formed using ginger extract concentration of less than 25 mL and the crystallite size of green synthesized ZnO NPs increased with increasing the concentration of ginger extract. Also, the significant effects of ginger extract concentration on the morphology of nanoparticles (nanocone, nanoflakes, and flower-like) and the particle size are demonstrated. The low concentration of ginger extract leads to the formation of the ZnO nanoflakes, while the flower-like structure is gradually completed by increasing the concentration of the ginger extract. Furthermore, significant changes in the specific surface area (SSA) of the samples are observed (in the range of 6.1-27.7 m 2 /g) by the variation of ginger extract concentration and the best SSA is related to using 10 mL ginger extract. Also, the strong effect of using ginger extract on the reflectance spectra of the green synthesized ZnO NPs, especially in the UV region is proved. The indirect (direct) band gap energies of the ZnO samples are obtained in the range of 3.09-3.20 eV (3.32-3.38 eV). Furthermore, the photocatalytic activities of the samples for the degradation of methylene blue indicate the impressive effect of ginger extract concentration on the degradation efficiency of ZnO nanoparticles and it reaches up to 44% and 83% for ZnO NPs prepared using 5 mL ginger extract in a pH of 4.3 and 5.6, respectively. This study provided new insights into the fabrication and practical application of high-performance ZnO photocatalysts synthesized using ginger extract in degrading organic pollutants in an acidic solution., (© 2024. The Author(s).)

Background: Effective skin rejuvenation treatments with RF technologies exist, with potential for personalized combination therapies based on individual factors. We compared microneedling and fractional RF laser effectiveness in rejuvenation, pore healing, and skin lightening., Method: The research was a non-randomized clinical trial study conducted in 2021 at Ilam Skin Clinic, Ilam, western Iran on people applying for rejuvenation, skin lightening and improvement of open pores. People were voluntarily divided into two groups based on personal preferences (group A: microneedling, 25 people, group B: fractional RF, 25 people). After data collection, SPSS22 software was used for data analysis., Results: The study revealed significant differences in the rates of low, moderate, and severe pain between the microneedling and fractional groups (10 vs. 16, 14 vs. 4, 1 vs. 5, respectively). Erythema showed no significant difference, with low, moderate, and severe cases reported in both groups. Swelling was lower in the microneedling group, but the difference was not significant. Bruising was similar in both groups, and staining was minimal. No herpes or infections were reported. The microneedling group showed better improvement in skin pores and skin lightening compared to the fractional group, with outcomes rated as good and excellent., Conclusion: Microneedling surpassed the fractional group in skin rejuvenation, lightening, and improved pores. Considering RF lasers are approximately three times more expensive than microneedling, the research indicates that choosing microneedling is not only more cost-effective but also a superior rejuvenation technique., Competing Interests: There are no conflicts of interest in terms of the present manuscript.

Purpose: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles., Materials and Methods: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies)., Results: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864., Conclusions: The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Purpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice., Materials and Methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured., Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%)., Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Objective: This study aimed to estimate the perinatal mortality associated with prenatally diagnosed vasa previa and to determine what proportion of those perinatal deaths are directly attributable to vasa previa., Data Sources: The following databases have been searched from January 1, 1987, to January 1, 2023: PubMed, Scopus, Web of Science, and Embase., Study Eligibility Criteria: Our study included all studies (cohort studies and case series or reports) that had patients in which a prenatal diagnosis of vasa previa was made. Case series or reports were excluded from the meta-analysis. All cases in which prenatal diagnosis was not made were excluded from the study., Methods: The programming language software R (version 4.2.2) was used to conduct the meta-analysis. The data were logit transformed and pooled using the fixed effects model. The between-study heterogeneity was reported by I 2 . The publication bias was evaluated using a funnel plot and the Peters regression test. The Newcastle-Ottawa scale was used to assess the risk of bias., Results: Overall, 113 studies with a cumulative sample size of 1297 pregnant individuals were included. This study included 25 cohort studies with 1167 pregnancies and 88 case series or reports with 130 pregnancies. Moreover, 13 perinatal deaths occurred among these pregnancies, consisting of 2 stillbirths and 11 neonatal deaths. Among the cohort studies, the overall perinatal mortality was 0.94% (95% confidence interval, 0.52-1.70; I 2 =0.0%). The pooled perinatal mortality attributed to vasa previa was 0.51% (95% confidence interval, 0.23-1.14; I 2 =0.0%). Stillbirth and neonatal death were reported in 0.20% (95% confidence interval, 0.05-0.80; I 2 =0.0%) and 0.77% (95% confidence interval, 0.40-1.48; I 2 =0.0%) of pregnancies, respectively., Conclusion: Perinatal death is uncommon after a prenatal diagnosis of vasa previa. Approximately half of the cases of perinatal mortality are not directly attributable to vasa previa. This information will help in guiding physicians in counseling and will provide reassurance to pregnant individuals with a prenatal diagnosis of vasa previa., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Educational posters play a crucial role in education, information dissemination, and awareness. Their visual appeal efficiently communicates condensed yet vital information on significant topics, making them valuable for teaching sequential concepts. We aimed to assess the effectiveness of educational posters in the oral and maxillofacial surgery department for student education., Methods: The study was carried out during the fall semester of 2022 at Mashhad Dental School, Mashhad, Iran utilizing a questionnaire-based approach. The questionnaire gathered demographic information and assessed students' perspectives on educational posters. Statistical analysis was performed using SPSS version 23 with a significance level set at 0.05., Results: This study was conducted on 70 students (35 females and 35 males). Gender-based analysis demonstrated significant differences in beauty, adaptability, and learning, with male students scoring lower than females ( P values = 0.036 and 0.031, respectively). Further analysis by academic year unveiled higher beauty and adaptability scores among third-year students compared to second-year students, showing statistical significance ( P value = 0.035). A two-by-two comparison highlighted that the average beauty score of third and fifth-year students surpassed that of second-year students ( P values = 0.041 and 0.038, respectively). In summary, higher academic years correlated with superior performance, emphasizing the potential impact of educational posters on academic outcomes., Conclusion: Posters in the oral and maxillofacial surgery department received commendable ratings in various areas, positively impacting the teaching and learning process., Competing Interests: None.

Background: The COVID-19 pandemic, which had recorded 769 million cases and resulted in 6.95 million deaths by August 2023, has put pressure on healthcare systems. Frontline medical professionals face stress, potentially leading to health challenges. This research aimed to examine the mental health of staff during the COVID-19 pandemic., Methods: This cross-sectional descriptive-analytical study was conducted in several hospitals in Tehran, Kerman, and Golpayegan between 2021 and 2022. The study encompassed a population of 1,231 nurses and physicians. Data collection was done using the General Health Questionnaire-28 (GHQ-28). We applied the K-means clustering algorithm to unveil hidden patterns within the data and extract valuable insights from participants' responses to the GHQ-28. This method was chosen because our dataset lacked explicit labels, making grouping individuals with similar characteristics necessary. The primary aim was to delineate how the COVID-19 pandemic affected the mental health of hospital staff and identify which factors played a more significant role in this process., Results: We have observed that Cluster two exhibits the highest scores in response to the GHQ-28 questions, indicating a more significant degree of mental distress. Within this cluster, 83.0% of individuals identify as female, 71.0% hold bachelor's degrees and 42.8% are nurses who have experienced the most substantial impact. Among these individuals, 90.4% did not have a history of smoking. Additionally, 59.7% are married, suggesting that these mental health issues may also affect their families., Conclusion: Given that the most critical subscale is related to anxiety/insomnia within the second cluster, it is necessary to implement management plans aimed at appropriately redistributing night shifts to improve employee health., (© 2023. The Author(s).)

Introduction: Dromedary camels robustly withstand dehydration, and the rough desert environment but the adaptation mechanisms are not well understood. One of these mechanisms is that the dromedary camel increases its body temperature to reduce the process of evaporative cooling during the hot weather. Stress in general, has deleterious effects in the body. In this study, we sought to determine the effects of dehydration and rehydration on stress parameters in the dromedary camels and how it pacifies these effects., Methods: Nineteen male camels were randomly divided into control, dehydrated and rehydrated groups, and fed alfalfa hay ad-libitum . The dehydrated and rehydrated groups were water-restricted for 20 days after which the rehydrated camels were provided with water for 72 h. The control and dehydrated camels were slaughtered at day 20 from the start of experiment whereas the rehydrated group was killed 72 h later. Many biochemical, hematological histopathological parameters and gene analysis were performed in relevant tissues collected including blood, plasma, and tissues., Results and Discussion: It was observed that severely dehydrated camels lost body weight, passed very hard feces, few drops of concentrated urine, and were slightly stressed as reflected behaviorally by loss of appetite. Physiologically, the stress of dehydration elicited modulation of plasma stress hormones for water preservation and energy supply. Our results showed significant increase in cortisol, norepinephrine and dopamine, and significant decrease in epinephrine and serotonin. The significant increase in malondialdehyde was accompanied with significant increase in antioxidants (glutathione, retinol, thiamin, tocopherol) to provide tissue protection from oxidative stress. The physiological blood changes observed during dehydration serve different purposes and were quickly restored to normality by rehydration. The dehydrated/rehydrated camels showed reduced hump size and serous atrophy of perirenal and epicardial fat. The latter changes were accompanied by significantly increased expression of genes encoding proteins for energy production (ANGPTL4, ACSBG1) from fat and significantly decreased expression of genes (THRSP; FADS 1&2) encoding proteins enhancing energy expenditure. This process is vital for camel survival in the desert. Dehydration induced no major effects in the vital organs. Only minor degenerative changes were observed in hepatic and renal cells, physiological cardiomyocyte hypertrophy in heart and follicular hyperplasia in splenic but lipidosis was not depicted in liver hepatocytes. Ketone bodies were not smelled in urine, sweat and breathing of dehydrated animals supporting the previous finding that the ß hydroxybutyrate dehydrogenase, a key enzyme in ketone body formation, is low in the camel liver and rumen. Rehydration restored most of blood and tissues to normal or near normal. In conclusion, camels are adapted to combat dehydration stress and anorexia by increasing anti-stressors and modulating genes involved in fat metabolism., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer PB declared a past co-authorship with the author(s) MAl and DM to the handling editor., (Copyright © 2023 Ali, Abu Damir, Adem, Ali, Amir, Shah, Al Muhairi, Al Abdouli, Khawaja, Fagieri, Adam, Elkhouly, Al Marri, Jamali, Murphy and Adem.)