Digital Commons Network^™

The Association Of Liver Fibrosis And Chronic Kidney Disease In Patients With Metabolic Associated Fatty Liver Disease: A Cross-Sectional Study, Rehab Badawi, Sara Essam Hasby, Walaa Elkhalawany, Waleed Elrefaey, Nahla Ahmed Khalf, Hanaa Ibrahim Okda

Saudi Medical Journal

Objectives: To examine the relation between liver fibrosis and chronic kidney disease (CKD) in metabolic-associated fatty liver disease (MAFLD) patients and its risk factors. Methods: The current study was carried out at Tanta University Hospital, Tanta, Egypt, from May 2021 to January 2023 and included 84 MAFLD patients with CKD and 80 MAFLD patients without CKD. All participants had been examined by abdominal ultrasonography and transient elastography with controlled attenuation parameter. Results: Chronic kidney disease patients exhibited a greater incidence of fibrosis compared to patients without CKD (75.6% vs. 24.4%). Logistic analysis demonstrated that the presence of multiple health conditions, …

Global Strategic Preparedness And Response Plan Launched By Who To Contain Mpox Outbreak

Saudi Medical Journal

No abstract provided.

Construction And Empirical Assessment Of An Employee Health Management Index System For Chinese Enterprises, Ming Dong

Dissertations and Theses Collection (Open Access)

Purpose: Employee health management is critical for enhancing corporate productivity, and scientific evaluation is core to effective health management practices. This study aims to construct an evaluation index system for assessing the employee health management effectiveness tailored to China’s national conditions (Hereinafter called “evaluation system”), and to empirically assess its differentiation, accuracy, and universality.

Methodology: (1) Grounded in literature and policy analysis, the study adopts the PDCA theory as a foundational framework and employs a modified Delphi method to finalize the evaluation system's structure. Indicator weights were determined using the Analytic Hierarchy Process, and a standard scale was created for …

Peritonsillar Abscess, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Viability Discrimination Of Bacterial Microbiomes In Home Kitchen Dish Sponges Using Propidium Monoazide Treatment, Christina K Carstens, Joelle K Salazar, Shreela Sharma, Wenyaw Chan, Charles Darkoh

Faculty, Staff and Student Publications

Dish sponges are known to support the proliferation of human bacterial pathogens, yet they are commonly used by consumers. Exposure to foodborne pathogens via sponge use may lead to illness, a serious concern among susceptible populations. The extent of exposure risks from sponge use has been limited by constraints associated with culture-independent or dependent methods for bacterial community characterization. Therefore, five used dish sponges were characterized to evaluate the presence of viable bacterial foodborne pathogens using the novel application of propidium monoazide (PMA) treatment and targeted 16S rRNA gene amplicon sequencing. Select pathogen viability was confirmed using targeted selective enrichment. …

Accuracy Of Nine-Item Patient Health Questionnaire Against Psychiatric Diagnosis For Depression Among People With Hiv, Marcela Yotebieng, Natalia Zotova, Charlotte Bernard, Suzanne Goodrich, Ajeh Rogers Awoh, Dana Watnick, Dominique Mahambu Nsonde, Elodie Flore Tchiengang Moungang, Moussa Seydi, Lukoye Atwoli

Internal Medicine, East Africa

Objective: The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH).

Design: Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d’Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days.

Results: Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d’Ivoire, …

The Accurate Conversion Of Biological Experiments From Cesium Irradiation To X-Ray Irradiation: The Significance, Problems, And The Future Of Experimental Radiation Research, Gretchen Carpenter

Dartmouth College Master’s Theses

Preclinical small animal irradiation studies, once conducted on Cesium irradiators, are increasingly being performed with X-ray-based irradiators. The transition stems from concerns regarding national security risks, making X-ray irradiators which are compact and easy to operate an enticing alternative. However, questions regarding the relative biological effectiveness between the two sources have revealed a lack of adequate dosimetric characterization of X-ray beams, standardized protocol for dose calibration, and thorough understanding of experimental biological parameters. A literature review conducted on orthovoltage irradiators has revealed that there are over 54 different types of beam structures used, a dramatic departure from the one uniform …

Mental Health And Quality Of Life Following Breast Cancer Diagnosis In Patients Seen At A Tertiary Care Hospital In Nairobi, Kenya: A Qualitative Study, Innocent Abayo, Noureen Karimi, Karishma Sharma, Isaiah Omedo, Sehrish Rupani, Mansoor Saleh

Haematology and Oncology, East Africa

Mental health challenges are common following cancer diagnosis, negatively impacting treatment and quality of life for breast cancer (BC) patients. This pilot study provides an understanding of the impacts of BC diagnosis and care experiences on the mental health of patients seen at the Aga Khan University Hospital in Nairobi, Kenya. We conducted 40 in-depth interviews, including 10 women with newly diagnosed BC, 10 women with metastatic BC, 10 family members and 10 healthcare professionals. Data were transcribed, translated into English as needed and coded using Dedoose software. Following BC diagnosis, it was reported that patients faced various physical, social, …

Transgender Women With Hiv Demonstrate Unique Non-Alcoholic Fatty Liver Disease Profiles, Jordan E Lake, Ana N Hyatt, Han Feng, Hongyu Miao, Anoma Somasunderam, Netanya S Utay, Kathleen E Corey

Faculty, Staff and Student Publications

Purpose: Non-alcoholic fatty liver disease (NAFLD) prevalence and severity may be higher in people with human immunodeficiency virus (HIV) than the general population, and vary with sex and age. We explored NAFLD characteristics by gender.

Methods: Adult transgender women (TW), cisgender women (CW), and cisgender men (CM) with HIV on antiretroviral therapy and without other known causes of liver disease underwent screening for NAFLD (2017-2020). Circulating factors associated with NAFLD were measured. Hepatic steatosis and fibrosis were assessed using transient elastography by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. Analysis of variance/Wilcoxon testing compared normally/non-normally distributed variables, …

Meta-Analysis Of Censored Adverse Events, Xinyue Qi, Shouhao Zhou, Christine B Peterson, Yucai Wang, Xinying Fang, Michael L Wang, Chan Shen

Faculty, Staff and Student Publications

Meta-analysis is a powerful tool for assessing drug safety by combining treatment-related toxicological findings across multiple studies, as clinical trials are typically underpowered for detecting adverse drug effects. However, incomplete reporting of adverse events (AEs) in published clinical studies is frequently encountered, especially if the observed number of AEs is below a pre-specified study-dependent threshold. Ignoring the censored AE information, often found in lower frequency, can significantly bias the estimated incidence rate of AEs. Despite its importance, this prevalent issue in meta-analysis has received little statistical or analytic attention in the literature. To address this challenge, we propose a Bayesian …

Characterization Of Stealth Liposome-Based Nanoparticles Encapsulating Acat1/Soat1 Inhibitor F26: Potential Therapeutics For Niemann-Pick Type C And Other Neurodegenerative Diseases., Junghoon Lee

Dartmouth College Ph.D Dissertations

Cholesterol dysregulation is implicated in neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD) and Niemann-Pick type C disease (NPCD). This study focused on evaluating the potent ACAT1 inhibitor, F26, as a therapeutic strategy for NPCD. F26 demonstrated superior ACAT1 inhibition and efficacy compared to the previously studied inhibitor, F12511, both in vitro and in vivo. Notably, F26 exhibited enhanced pharmacokinetic properties, including prolonged duration of action and better brain retention, making it a more promising candidate for treating neurodegenerative diseases.

F26 was encapsulated in a liposome-based nanoparticle system, DSPE-PEG2000 with phosphatidylcholine (PC), for enhancing its …

Psychological Distress Among Ethnically Diverse Participants From Eastern And Southern Africa, Kester Tindi, Allan Kalungi, Eugene Kinyanda, Bizu Gelaye, Alicia Martin, Ronald Galiwango, Wilber Ssembajjwe, Fred Kirumira, Adele Pretorius, Lukoye Atwoli

Internal Medicine, East Africa

Importance: Psychological distress is characterized by anxiety and depressive symptoms. Although prior research has investigated the occurrence and factors associated with psychological distress in low- and middle-income countries, including those in Africa, these studies’ findings are not very generalizable and have focused on different kinds of population groups.

Objective: To investigate the prevalence and characteristics (sociodemographic, psychosocial, and clinical) associated with psychological distress among African participants.

Design, setting and participants: This case-control study analyzed data of participants in the Neuropsychiatric Genetics in African Populations-Psychosis (NeuroGAP-Psychosis) study, which recruited from general outpatient clinics in Eastern (Uganda, Kenya, and Ethiopia) and Southern …

Blurring Boundaries: A Proposed Research Agenda For Ethical, Legal, Social, And Historical Studies At The Intersection Of Infectious And Genetic Disease, Seethal Jose, Juli Bollinger, Gail Geller, Jeremy Greene, Leslie Meltzer Henry, Brian Hutler, Eric Thomas Juengst, Jeffrey Kahn, Anna Mastroianni, Graham Mooney

Articles

Contemporary understanding of the mechanisms of disease increasingly points to examples of “genetic diseases” with an infectious component and of “infectious diseases” with a genetic component. Such blurred boundaries generate ethical, legal, and social issues and highlight historical contexts that must be examined when incorporating host genomic information into the prevention, outbreak control, and treatment of infectious diseases.

Reaction Toward Potential Resurgent Multiple Risks: Understanding Risk Information Seeking And Behavior In The Post-Pandemic Era, Shudan Huang

Theses and Dissertations

This study applies the Risk Information Seeking and Processing (RISP) model to understand how individuals seek and process information related to overlapping pandemics, including COVID-19, flu, monkeypox, and polio. These overlapping health crises have created a complex media environment, contributing to pandemic fatigue, information overload, and varied preventive behaviors. The research explores how pandemic fatigue influences informational behaviors—such as information seeking, processing, and avoidance—and how these behaviors, in turn, predict preventive behavioral intentions.

Using an online survey of 443 participants, structural equation modeling was employed to test the hypotheses. Results indicate that information insufficiency positively predicts both information seeking and …

Using Machine Learning And Deep Learning Algorithms To Improve Low Birthweight Prediction, Yang Ren

Theses and Dissertations

Low birthweight (LBW) is a major public health issue resulting in increased neonatal mortality and long-term health complications. Traditional LBW analysis methods, focusing on incidence rates and risk factors through statistical models, often struggle with complex unseen data, and thus, their effectiveness is limited in early prevention of LBW, requiring more advanced LBW prediction models. Therefore, this dissertation delves into this important research area by proposing and examining novel machine learning (ML) and deep learning (DL) algorithms, aiming to predict LBW more accurately during the early stage of pregnancy. This dissertation consists of three studies, strategically designed to build upon …

The Dengue Vaccine Initiative: A Bibliometric Analysis Of Research Publications, Festus Mulakoli, Abednego Ongeso, Horatius Musembi

School of Nursing & Midwifery, East Africa

Dengue fever has become a significant public health problem in tropical and subtropical regions and affects millions of people annually. Approximately 390 million people worldwide are estimated to be infected with dengue every year, of which 96 million develop dengue fever. Recently, there has been a noticeable increase in dengue cases, primarily in areas with tropical and subtropical climates. Vaccines have been developed to prevent or reduce the severity of the disease. This study reviews the number of publications on dengue vaccines and related topics worldwide. We aimed to evaluate the research output and create a narrative on global vaccine …

Impact Of Race And Ethnicity On Outcomes After Umbilical Cord Blood Transplantation, Karen Ballen, Tao Wang, Naya He, Jennifer M Knight, Sanghee Hong, Haydar Frangoul, Leo F Verdonck, Amir Steinberg, Miguel A Diaz, C Fred Lemaistre, Sherif M Badawy, Jeffrey J Pu, Hasan Hashem, Bipin Savani, Akshay Sharma, Hillard M Lazarus, Muhammad Bilal Abid, Jason Tay, Hemalatha G Rangarajan, Tamila Kindwall-Keller, Cesar O Freytes, Amer Beitinjaneh, Lena E Winestone, Usama Gergis, Nosha Farhadfar, Neel S Bhatt, Raquel M Schears, David Gómez-Almaguer, Mahmoud Aljurf, Vaibhav Agrawal, Yachiyo Kuwatsuka, Sachiko Seo, David I Marks, Leslie Lehmann, William A Wood, Shahrukh Hashmi, Wael Saber

Faculty, Staff and Student Publications

Background: Umbilical cord blood transplant (UCBT) improves access to transplant for patients lacking a fully matched donor. Previous Center for International Blood and Marrow Transplant Research (CIBMTR) showed that Black patients had a lower overall survival (OS) than White patients following single UCBT. The current study draws on a larger modern cohort and compares outcomes among White, Latinx, Black, and Asian patients.

Objective: To compare outcomes by social determinants of health.

Study design: We designed a retrospective study using CIBMTR data. US patients were between ages 1 and 80; 983 received single and 1529 double UCBT as reported to CIBMTR, …

Does Time To Initiation Of Adjuvant Radiotherapy Affect Reconstruction Outcomes After Endoscopic Resection Of Skull Base Malignancies?, Franco Rubino, Bledi Brahimaj, Ehab Y Hanna, Shirley Y Su, Jack Phan, David R Grosshans, Franco Demonte, Shaan M Raza

Faculty, Staff and Student Publications

No abstract provided.

Does Time To Initiation Of Adjuvant Radiotherapy Affect Reconstruction Outcomes After Endoscopic Resection Of Skull Base Malignancies?, Franco Rubino, Bledi Brahimaj, Ehab Y Hanna, Shirley Y Su, Jack Phan, David R Grosshans, Franco Demonte, Shaan M Raza

Faculty, Staff and Student Publications

Introduction and Objective It is unclear if the length of the time interval to initiation of adjuvant radiation therapy (RT) after endoscopic endonasal surgery affects reconstruction outcomes. In this study we present our experience with adjuvant RT after endoscopic endonasal procedures, to determine if the time to RT after surgery impacts post-RT reconstruction complication rates.

Methods A retrospective cohort study of 164 patients who underwent endoscopic endonasal surgery between 1998 and 2021 was conducted. Using Cox proportional hazard ratios (HRs), we evaluated several variables and the complications that occurred during the 1-year period after starting RT.

Results Seventy-eight (47.5%) and …

Tcellsi: A Novel Method For T Cell State Assessment And Its Applications In Immune Environment Prediction, Jing-Min Yang, Nan Zhang, Tao Luo, Mei Yang, Wen-Kang Shen, Zhen-Lin Tan, Yun Xia, Libin Zhang, Xiaobo Zhou, Qian Lei, An-Yuan Guo

Faculty, Staff and Student Publications

T cell is an indispensable component of the immune system and its multifaceted functions are shaped by the distinct T cell types and their various states. Although multiple computational models exist for predicting the abundance of diverse T cell types, tools for assessing their states to characterize their degree of resting, activation, and suppression are lacking. To address this gap, a robust and nuanced scoring tool called T cell state identifier (TCellSI) leveraging Mann-Whitney

Jasbo: Jaya Average Subtraction Based Optimization With Deep Learning Model For Multi-Classification Of Infectious Disease From Unstructured Data, Vian Sabeeh, Ahmed Bahaaulddin A. Alwahhab, Ali Abdulmunim Ibrahim Al-Kharaz

Baghdad Science Journal

Infectious diseases have become an unavoidable big trouble in today's environment with a similar symptomatology that makes difficult of early detection and clear separation of infection. Hence, it is required to generate a new technique that best utilizes the various symptomatologies present in the illnesses for its multi-classification. Medical documents are considered an essential source for modern, invented, and robust analysis methods for accurate infection diagnoses. Accordingly, enriching medical text processing is beneficial in health informatics. In this research, proposed Jaya Average Subtraction Based Optimization (JASBO), which is enabled by Deep Learning (DL) is used to classify infectious diseases into …

The Origins Of The Major Questions Doctrine, Rachel Rothschild

Articles

In a series of recent cases, the Supreme Court has invoked the newly named “major questions doctrine” to strike down agency regulations that protect public health and the environment. Several Justices have argued that while the name “major questions” may be new, these decisions are simply the latest iteration in a longstanding effort of the courts to curtail the explosive growth of the administrative state since 1970. The first paradigmatic example of this line of cases is the 1980 “Benzene” case, in which the Supreme Court set aside the Occupational Safety and Health Administration (OSHA)’s new workplace standards for the …

Systemic Inflammation And Neurocognitive Deficits In School-Age Children With Sickle Cell Disease., Elizabeth A. Gillooly

Theses and Dissertations

Sickle cell disease (SCD) causes inflammation that contributes to poor clinical outcomes, including cerebrovascular disease (CVD). CVD can take several forms in SCD, including neurocognitive deficits without visible cerebral infarction. The role of chronic inflammation in cognitive development in SCD has received little attention to-date. We aimed to study novel markers of systemic inflammation: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic inflammation index (SII) to describe developmental trends and relationships to cognitive outcomes in SCD at early elementary school-age. Sixty-one children with SCD and no history of stroke were identified who completed an early elementary school age cognitive …

Outcomes In Solid Organ Transplant Recipients Receiving Organs From A Donor With Fusarium Solani Species Complex Meningitis, Isabel S Griffin, Dallas J Smith, Pallavi Annambhotla, Jeremy A W Gold, Luis Ostrosky-Zeichner, Carol A Kauffman, Lalitha Gade, Anastasia Litvintseva, Daniel Zp Friedman, Angie G Nishio Lucar, Tarina C Parpia, Joshua Lieberman, Janet Bujan, Julie Corkrean, Mukul K Divatia, Kevin Grimes, Jiejian Lin, Constance Mobley, Mary R Schwartz, Bashar Hannawi, Anne Malilay, Anne O'Boye, Jeffrey Lysne, Mrinalini Venkata Subramani, Hayley Heckmann, Venice Servellita, Charles Chiu, Sridhar V Basavaraju

Faculty, Staff and Student Publications

Background: Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare-associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico.

Methods: After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case-mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next-generation sequencing (mNGS) and fungal-specific polymerase chain reaction and in plasma by mNGS.

Results: Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored …

Development Of An Engineered Extracellular Vesicles-Based Vaccine Platform For Combined Delivery Of Mrna And Protein To Induce Functional Immunity, Xin Luo, Kathleen M Mcandrews, Kent A Arian, Sami J Morse, Viktoria Boeker, Shreyasee V Kumbhar, Yingying Hu, Krishnan K Mahadevan, Kaira A Church, Sriram Chitta, Nicolas T Ryujin, Janine Hensel, Jianli Dai, Dara P Dowlatshahi, Hikaru Sugimoto, Michelle L Kirtley, Valerie S Lebleu, Shabnam Shalapour, Joe H Simmons, Raghu Kalluri

Faculty, Staff and Student Publications

mRNA incorporated in lipid nanoparticles (LNPs) became a new class of vaccine modality for induction of immunity against COVID-19 and ushered in a new era in vaccine development. Here, we report a novel, easy-to-execute, and cost effective engineered extracellular vesicles (EVs)-based combined mRNA and protein vaccine platform (EVX-M+P vaccine) and explore its utility in proof-of-concept immunity studies in the settings of cancer and infectious disease. As a first example, we engineered EVs, natural nanoparticle carriers shed by all cells, to contain ovalbumin mRNA and protein (EVOvaM+P vaccine) to serve as cancer vaccine against ovalbumin-expressing melanoma tumors. EVOvaM+P administration to mice …

Leptospirosis In The Platypus (Ornithorhynchus Anatinus) In Australia: Who Is Infecting Whom?, Richard J. Whittington, Thomas R. Grant, Jarrad Mckercher, Monica Suann, Keith Hart, Kathrine A. Handasyde, James Macgregor, Mark E. Westman, Joanne H. Connolly

Research outputs 2022 to 2026

The platypus (Ornithorhynchus anatinus) is an amphibious, egg-laying mammal of high conservation value that is found only in Australia. The zoonotic bacterium Leptospira interrogans serovar Hardjo was discovered in platypuses in prior studies, but little is known about its epidemiology. Samples in the Platypus Serum Bank were tested in 2023 and the results were combined with historical records. Antibodies against L. interrogans serovar Hardjo were found in 50% of 464 serum samples from 411 platypuses collected from 14 river basins in southeastern Australia between 1981 and 2012; prevalence remained high over three decades in the Shoalhaven River population. Seroprevalence increased …

Isolating Microbes From The Surface Of An Introductory Laboratory Halite Hand Sample, Kesley G. Banks, Michael A. Gibson, Matthew A. Pritchett

The Compass: Earth Science Journal of Sigma Gamma Epsilon

Introductory geology labs stress simple physical testing (luster, hardness, etc.) to identify common minerals, using mineral charts to eliminate minerals not exhibiting a particular property. Special properties (magnetism, specific gravity, taste, etc.) for specific minerals narrows mineral identity. Students often express safety concerns about licking minerals, especially when they realize others have previously licked the specimen. As an exercise in medical geology, we cultured microbes from a halite sample used for nearly 25 years and licked by numerous students over that time span (Sample 1), a commercially purchased unused and freshly exposed surface of halite licked by one person (Sample …

Vaccine Decision-Making Among Pregnant Women: A Protocol For A Cross-Sectional Mixed-Method Study In Brazil, Ghana, Kenya And Pakistan, Jessica Schue, Prachi Singh, Berhaun Fesshaye, Emily Miller, Shanelle Quinn, Ruth Karron, Renato Souza, Maria Laura Costa, Ferdinand Okwaro, Marleen Temmerman

Centre of Excellence in Women and Child Health

Maternal immunization is a critical strategy to prevent both maternal and infant morbidity and mortality from several infectious diseases. When the first COVID-19 vaccines became available during the pandemic, there was mixed messaging and confusion amongst the broader public and among those associated with health care systems about the recommendations for COVID-19 vaccinations in pregnancy in many countries. A multi-country, mixed-methods study is being undertaken to describe how vaccine decision-making occurs amongst pregnant and postpartum women, with a focus on COVID-19 vaccines. The study is being conducted in Brazil, Ghana, Kenya, and Pakistan. In each country, participants are being recruited …

Clinical Patterns Of Guillain-Barré Syndrome Associated With The Covid-19 Pandemic, Ali Al-Shakerji, Akram Al-Mahdawi, Safaa Al Shammary

Iraqi Postgraduate Medical Journal

Clinical Patterns of Guillain-Barré Syndrome Associated with the COVID-19 PandemicBackground: Guillain Barré Syndrome is an autoimmune disease, with progressive weakness and areflexia, it can be triggered due to antigenic mimicry, and the association of COVID-19 and GBS cases throughout the pandemic has been reported worldwide.Objective: to identify the clinical patterns of GBS associated with COVID-19 and its neurophysiological variants. Method: (51) patients were collected during 2021 who were admitted to Baghdad Medical City and Neuroscience Hospital, and diagnosed with GBS according to the Asbury criteria, all of them had serological or radiological evidence of current or recent COVID-19 infection, the …

The Anaerobic Rose Chamber (Arc): Novel Applications For Probing Clostridioides Difficile Dynamics, Tatiana Zvonareva

Chemistry & Biochemistry Theses & Dissertations

Clostridioides difficile infection (CDI) is an urgent public health threat with a high rate of recurrence and limited treatment options. Caused by the anaerobic intestinal pathogen C. difficile, this disease affects up to 500,000 Americans annually. Despite progress in our understanding of CDI pathophysiology, the lack of effective and accessible experimental platforms compatible with obligate anaerobe physiology hinders the advancement of treatment therapy. The application of in vivo models has been indispensable in understanding CDI pathophysiology, probing the complexity of the host response to the microbe, and establishing treatment protocols, and it continues to be essential in preclinical testing. …