Digital Commons Network^™

Beyond Hemostasis: A Narrative Review On The Multifaceted Therapeutic Potential Of Ankaferd Blood Stopper, Salima E. Tibi, Muhammad Hashir Nazir, Saleha Nazir, Bhumi Daishik Patel, Gayatri Misra, Tirath Patel, Fatima Nasir, Muhammad Farhan, Nana Sardarova, Nikhilesh Anand

School of Medicine Publications

Background: Effective hemorrhage control is essential in managing trauma and surgical patients, with uncontrolled bleeding being a leading cause of mortality. Ankaferd Blood Stopper (ABS), a hemostatic agent historically used in Anatolia, has gained recognition for its ability to modulate red blood cell-fibrinogen interactions to form a stable protein network for rapid bleeding cessation.

Objective: This review explores the multifaceted applications of ABS, evaluating its efficacy, safety, and potential therapeutic roles across various medical fields, including hemostasis, wound healing, antimicrobial activity, and antineoplastic effects.

Methods: A comprehensive synthesis of clinical trials, case reports, and experimental studies was conducted to assess …

Breaking The Resistance: A Narrative Review Of The Evolution From Traditional Drugs To Precision Therapies In Epilepsy, Tirath Patel, Fathimathul Henna, Ashfaq Ahmed, Ayesha Ahmad, Noor Ul Huda, Syed Aaraiz Ul Hassan, Aiman Muhammad, Amna Javed, Maryem Filal, Nikhilesh Anand

School of Medicine Publications

Background: Epilepsy is a chronic neurological disorder characterized by recurrent seizures, affecting approximately 50 million individuals globally. While conventional antiseizure medications (ASMs) control seizures in 70-80% of patients, about 30% experience drug resistance or intolerable side effects, necessitating alternative approaches.

Objective: To critically compare the efficacy, safety, and accessibility of conventional and emerging therapies for epilepsy, particularly in the context of treatment-resistant cases and global disparities in care.

Methods: This narrative review synthesized evidence from 120 peer-reviewed articles published between 2015 and 2025. Literature was retrieved from PubMed, Embase, Cochrane Library, and Scopus using predefined search terms related to epilepsy …

Early Detection In Oral Cancer: Are We Prepared For Artificial Intelligence-Driven Precision Medicine?, Nikil Kumar, Sinnha Kumari, Sadia Sultana, Muhammad Saad Khan, Tirath Patel, Nikhilesh Anand

School of Medicine Publications

Oral cancer, particularly oral squamous cell carcinoma, remains a serious health concern, with a poor prognosis and a late diagnosis. Leukoplakia, erythroplakia, lichen planus, and submucous fibrosis are examples of oral potentially malignant disorders that must be detected early but are not always so by traditional, laborious, and subjective diagnostic techniques. In oral cancer, artificial intelligence (AI) and precision medicine are becoming game-changing technologies that enhance individualized care, treatment planning, and diagnostic precision. Complex imaging and histopathology data may be analyzed using machine learning and deep learning algorithms, particularly convolutional neural networks, which can identify patterns that are invisible to …

Una Nueva Herramienta Para Estimar El Volumen Muscular Independientemente De La Edad, El Sexo Y El Nivel De Actividad Física, José J. Rivera-Sánchez, Laura P. Burgos-Morelos, Daniel Castillo-Castillo, Gerardo Méndez-Suárez, Juan C. Lopez-Alvarenga, Damián Carrillo-Ruíz

School of Medicine Publications

Antecedentes: Actualmente, la evaluación del volumen muscular requiere técnicas invasivas o de imagen, lo que aumenta los costos y retrasa la evaluación, y las mediciones antropométricas con frecuencia son inexactas.

Objetivo: Desarrollar una fórmula matemática para estimar el volumen del cuádriceps.

Material y métodos: Se evaluaron 127 sujetos: 40 adultos sedentarios de 20 a 35 años, 47 atletas adultos de 20 a 45 años y 40 adultos sedentarios de 70 a 94 años. Se dividieron en grupos de desarrollo y de validación. Se realizaron mediciones de variables antropométricas y fuerza de agarre, y se desarrolló la fórmula de predicción del …

A Position Statement On Endovascular Models And Effectiveness Metrics For Mechanical Thrombectomy Navigation, On Behalf Of The Stakeholder Taskforce For Artificial Intelligence-Assisted Robotic Thrombectomy (Start), Harry Robertshaw, Anna Barnes, Phil Blakelock, Raphael Blanc, Robert Crossley, Rebecca Fahrig, Ameer E. Hassan, Benjamin Jackson, Lennart Karstensen

School of Medicine Publications

Although we are making progress in overcoming infectious diseases and cancer, one of the major medical challenges of the mid-21st century will be the increasing prevalence of stroke. Occlusions in large vessels are especially debilitating, yet effective treatment—needed within hours to achieve best outcomes—remains limited because of geographic accessibility. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the widespread deployment of robotic surgical systems. Artificial intelligence assistance may enable the safe and effective upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating artificial …

Training Tomorrow’S Hand Surgeons: Clinical, Leadership, And Structural Trends In Fellowship Education, Ogonna N. Nnamani Silva, Aaron I. Dadzie, Chinenye Ogbonnah, Lydia A. Helliwell, Abhiram R. Bhashyam, Catherine M. Curtin, Tamara D. Rozental, Krystle R. Tuaño

School of Medicine Publications

Purpose: Hand surgery fellowships include trainees from orthopedic, plastic, and general surgery. These pathways present an opportunity to examine variations in graduate medical education structures, such as program size, sponsoring department, and leadership composition. Limited research exists on the characteristics of these programs. The purpose of this study is to assess the structural and leadership characteristics of the Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States. We hypothesized that characteristics (ie, faculty-to-fellow ratios and case volume) vary by specialty sponsorship. Leadership, although shaped by merit-based criteria, faces challenges in achieving broader demographic diversity.

Methods: A …

Tuberculosis Presenting As Multiple Pulmonary Nodules Mimicking Malignancy, Abdel Martinez Borrego, Fatimah Bello, Brandon Cantazaro, Luisa Montoya, Frank Mediola

School of Medicine Publications

Multiple pulmonary nodules often raise concern for metastatic malignancy; however, the differential diagnosis is broad and includes infectious, inflammatory, granulomatous, vascular, and benign etiologies. Tuberculosis (TB), although uncommon, can present with multiple nodules that closely mimic metastatic disease on advanced imaging, requiring careful clinicoradiologic and microbiologic correlation. We describe a woman in her 50s who presented with dyspnea and new-onset heart failure, in whom imaging revealed mediastinal lymphadenopathy and bilateral pulmonary nodules concerning for malignancy. Evaluation was limited by concurrent COVID-19 infection, and CT-guided biopsy demonstrated necrotizing granulomas without evidence of malignancy or infection. She later re-presented with fever and …

Pediatric Both Bone Fracture Leading To Median Nerve Entrapment: A Case Report, Joshua Lyndon Dale, Frank Gerold

School of Medicine Publications

Introduction: Both-bone forearm fractures are common in pediatric patients and most often result from a fall onto an outstretched hand. Although rare, nerve entrapments, particularly of the median nerve, can occur, especially following closed reduction.

Case report: We present the case of a 13-year-old male who sustained a both-bone forearm fracture while on vacation in Mexico. The injury was managed with closed reduction and casting. Despite appropriate treatment, the patient developed progressive numbness, tingling, and thenar atrophy in the median nerve distribution. Electromyography and nerve conduction studies confirmed significant median nerve dysfunction. Surgical exploration revealed the median nerve entrapped in …

Experimental Investigation Into The Effects Of Air Staging On Fouling In A Fixed-Bed Biomass Combustor, Akram Elsebaie

Theses: Doctorates and Masters

Biomass offers significant potential as a sustainable and renewable substitute for fossil fuels in energy generation, playing a critical role in the reduction of global warming. However, despite its environmental benefits, biomass combustion faces persistent operational challenges, particularly fouling, which reduces efficiency and increases maintenance costs. Although fouling mechanisms have been studied in various combustion systems, there is limited research which addresses its formation and behaviour in fixed-bed biomass combustors under different air staging conditions. This research investigates fouling behaviour in a counter-current combustor, focusing on the influence of design (secondary air location), operational (air staging flowrates between the primary …

Tools Used To Measure Fear Avoidance Behaviour In The Management Of Mild Traumatic Brain Injury (Concussion), Liam Sherwood

Theses: Doctorates and Masters

Concussion can present challenges with respect to diagnosis and management. Fear avoidance behaviour and beliefs may be perpetuating factors in the clinical course of concussion. Understanding which patients may adopt such behaviours and beliefs can offer important information to allow tailoring of clinical management and implementing strategies to minimise the risk of progression to persisting post-concussion symptoms.

In this thesis, I:

-       systematically reviewed the current measurement tools used to assess fear avoidance behaviours and beliefs associated with concussion;

-       explored the experience of clinicians, researchers and people with lived experience of concussion in relation to fear avoidance behaviours;

- …

Synergistic Removal Of Microplastic Fibres: Integrating Chitosan Coagulation In Hybrid Water Pre-Treatment Systems, Jayasuriya Arachchilage Nimesha Thathsarani

Theses: Doctorates and Masters

Microplastic fibres (MPFs) are the most prevalent form of microplastics detected in the influents of water and wastewater treatment plants. Owing to their elongated shape and low density, MPFs frequently evade removal even during tertiary processes such as membrane filtration. Enhancing pretreatment, particularly through cost-effective coagulation-flocculation can reduce the treatment burden on downstream systems. However, conventional inorganic coagulants often necessitate high dosages and can leave residual ions, posing environmental concerns.

As a sustainable alternative, the use of environmentally friendly coagulants such as Chitosan has gained attention for MPF removal. While Chitosan exhibits favourable qualities, its practical application is hindered by …

Detecting Habitat Use Of Three Endemic Freshwater Fish Of Far Southwestern Australia, Paige Rhiannon Wilson

Theses: Doctorates and Masters

The wetland ecosystems of far southwestern Australia face multiple threats including land clearing, historical cattle grazing, changed hydrology, extensive groundwater extraction, and changed fire regimes. Each is exacerbated by a drying climate, and together they provide a significant challenge to the on-going survival of the freshwater fish in this region particularly fish that are endemic, range restricted, and therefore, more likely to be more vulnerable. This study focuses on three such species: Galaxiella munda, Galaxiella nigrostriata and Lepidogalaxias salamandroides, the latter two of which are known to aestivate.

In order to make conservation decisions regarding management of wetlands for …

An Investigation Into The Mechanisms, Barriers, Degree And Sphere Of Risk Influence In Corporate Security, Nicola Lockhart

Theses: Doctorates and Masters

This study investigates the sphere of corporate security risk influence within organisations, addressing the conceptual and practical ambiguity surrounding the activity’s capacity to shape organisational decisions, behaviours, and risk priorities. While corporate security’s protective role is widely recognised, its broader organisational risk influence remains under-theorised. The study defines the sphere of risk influence as the range of organisational stakeholders and environments with which the corporate security activity interacts, and within which it may engage, persuade, and mobilise action. This sphere is analytically constituted through the intersection of three dimensions: the mechanisms through which influence is attempted, the barriers that constrain …

The Development Of A Midwifery Specific Tool To Identify The Barriers And Enablers To Change Within The Midwifery Setting, Sara Davis

Theses: Doctorates and Masters

Despite being well-positioned to identify service gaps and propose improvements, many midwives lack the knowledge, skills, confidence, or tools to effect practice change. Implementation science (IS) offers a structured approach to moving evidence-based innovations into practice; however, existing IS theories, models, and frameworks do not reflect the unique context of midwifery practice. The first step in the intentional implementation of an evidence-based practice innovation is to conduct a context assessment to identify factors that may facilitate or impede its uptake. There are numerous evidence-based checklists for this, but none capture all the influences on midwifery practice environments.

In this study, …

The Experience Of Homelessness Among Older Adults In Bhutan - A Narrative Inquiry Study, Phuntsho Om

Theses: Doctorates and Masters

A shift in the demographics of homelessness started to occur in the 1900s, with a significant increase in the number of middle-aged or elderly men and women being recognised as a part of the homeless population. The rising urgent global concern of homelessness of older adults necessitates a deeper understanding of the lived experience and holistic well-being of these marginalised adults. This thesis aimed to explore the phenomenon of homelessness of older adults in Bhutan, which is an often neglected topic in both national and international gerontological research.

Employing narrative inquiry within the constructivist approach as articulated by Pino Gravidia …

Understanding Climate Change And Wellbeing Through Bhutan's Pursuit Of Gross National Happiness, Tashi Dorji

Theses: Doctorates and Masters

Climate change has evolved into one of the biggest global challenges of the twenty first century reshaping ecological systems and social conditions with wide-ranging implications for human wellbeing. Bhutan offers a distinct context to explore interactions between climate change and wellbeing as it remains guided by its wellbeing-centred development philosophy of Gross National Happiness (GNH). At the same time, it remains highly vulnerable to climate change despite being the only carbon negative country in the world. Nonetheless, the intersections between climate change and GNH have not been systematically explored.

This research aims to explore the relationship between climate change and …

Patient Experiences Of Receiving Home-Based Immunotherapy Infusions - A Constructivist Grounded Theory Study, Patricia Ann Cook

Theses: Doctorates and Masters

Context: The treatment of cancer and chronic health conditions has been greatly revolutionised via intravenous immunotherapy infusions. Demand, both globally and in Australia, is increasing due to several factors including aging and increased populations, subsequent increases of cancer cases, new immunotherapy indications and increased survival rates.

In Perth, Western Australia, a private service provider commenced delivering a home based immunotherapy infusions model of care as a hospital substitution service provider in 2013 and the service has now been extended across Australia. The safety and efficacy of home-based infusions have been well documented in research, and an increasing number of patients …

Advancing Treatment Of Pleural Infection, Estee Pui Mun Lau

Theses: Doctorates and Masters

Introduction: Pleural infection remains a major clinical concern, with an increasing incidence worldwide. The use of intrapleural tissue plasminogen activator (tPA) with deoxyribonuclease (DNase) therapy represents a major breakthrough as it offers an effective alternative to surgery for patients who fail conventional treatment. However, the optimal dosage of tPA is yet to be established. Indwelling pleural catheter (IPC)-related infections, especially IPC-related pleural infections are a significant concern and a barrier to the uptake of IPC. The development of a long-term preventative strategy is imperative to promote uptake and improve the quality of life of patients, particularly in those who have …

Next-Generation Virtual Environment Training For Cybersecurity In The Maritime Logistics Industry: A Position Paper, Tyler Cheng, Rory Hopcraft, Kimberly Tam, Ji-Jian Chin

School of Engineering, Computing and Mathematics

The maritime logistics industry is the most dependent on it in the modern world, yet it is not well protected against cyber risks. Recently, the maritime industry has been transitioning into industry-specific tech, and threats of cyberattacks are increasing as the adoption of technology and automation continues. One of the most effective methods to protect industries and ships from such security incidents, is to train seafarers to mitigate and handle such incidents. However, to the best of our knowledge, we did not find anything that addresses this gap. This article will present the idea and benefits of using virtual environments …

Rapid Electrochemical Biosensor With Enhanced Accuracy And Repeatability Using Pyrene Nhs Ester Modified 3d Graphene Electrodes, S. Nazir, D. Jenkins, G. Pan

School of Engineering, Computing and Mathematics

A consistent and reproducible chemical modification of the transducer interface is essential to ensure effectiveimmobilization of bioreceptors, thereby improving the sensitivity and reproducibility of biosensors. Althoughnotable progress has been made in fabricating graphene-based biosensors, the effects of surface biofunctionalization on sensing performance remain not fully understood. This study shows that combining threedimensional (3D) graphene foam electrodes with a straightforward, single-step surface biofunctionalizationmethod is key to enhancing the performance of graphene-based biosensors. Specifically, it presents a single-stepapproach to functionalize the 3D graphene foam (Gii-Sens) with 1-pyrenebutyric acid N-hydroxysuccinimideester (Pyrene-NHS ester). Electrochemical techniques, including cyclic voltammetry (CV) and differential pulsevoltammetry (DPV), confirmed …

Biocompatibility Of Silver And Hydroxyapatite Antimicrobial Nanocoatings On Titanium Alloy Dental Implants With Human Gingival Fibroblasts, S Morgan, R D Handy, V M Salih, R N Salaie, C J Tredwin, A Besinis

School of Engineering, Computing and Mathematics

OBJECTIVES: Peri-implantitis compromises soft and hard tissues around dental implants, often leading to implant failure. Antibacterial nanocoatings offer a promising infection control strategy, but maintaining biocompatibility is essential. This study investigated, through a range of assays and analytical techniques, the biocompatibility of antimicrobial silver and hydroxyapatite (HA) nanocoatings applied to titanium implants with human gingival fibroblasts (HGFs).

METHODS: Silver and hydroxyapatite nanocoatings were applied to the surface of titanium alloy specimens using electroplating, deposition and sintering techniques. The biocompatibility of the nanocoatings with HGFs was assessed by measuring cell metabolic activity (alamarBlue), lactate dehydrogenase (LDH) release, collagen production (Sircol assay), …

Understanding The Support And Information Needs Of Family Members After Acquired Brain Injury: A Systematic Review, Craig Andrews, Alyson Norman, Sue Jackson, Mark Holloway

School of Psychology

The aim of this systematic review was to (a) identify the specific information and support needs of family members caring for ABI survivors and (b) assess the effectiveness of current support systems and resources available. A comprehensive search of the literature was carried out, focusing on studies that were published between the years 2000 and 2025. Seventeen studies met the inclusion criteria. The review employed a narrative synthesis approach to collate findings across papers. The analysis identified five key themes: ABI Knowledge, The Strain of Unsupported Transitions, Emotional and Financial Cost, ABI Support Groups, and Supporting Social Connectedness. The findings …

Dampened Social Motivation In Dysphoria: The Role Of Negative Social Expectancies And Internal Causal Attribution Style, Julie L Ji, Nilly Mor, Colin Macleod

School of Psychology

Dysphoria is associated with dampening of social interaction intention, but the cognitive mechanisms that underpin this relationship are under-investigated. This study tested the hypothesis that heightened negative social expectancies mediate the association between dysphoria and dampened social motivation. Additionally, it tested the hypothesis that the association between dysphoria and negative social expectancies is mediated by an attribution style bias that attributes negative, but not positive, outcomes to internal causes. University students (N = 271) with varied levels of dysphoria read vignettes describing hypothetical situations where they initiate a social interaction that results in positive or negative outcomes. Participants rated their …

Optimization Of A Group-Based Intervention For People Living With Severe Obesity (Progroup): Understanding Fidelity To Delivery And The Patient Experience, Lily Hawkins, Mark Tarrant, Shokraneh Moghadam, Dawn Swancutt, Rod Sheaff, Laura Hollands, Jonathan Pinkney, Jenny Lloyd

School of Psychology

Objectives: Understanding the fidelity of delivery of complex health behaviour interventions is crucial in determining their effectiveness and identifying aspects needing refinement. PROGROUP is a group-based intervention for people with severe obesity. It aims to promote a shared social identity to support behaviour change. Data from a feasibility randomized controlled trial (fRCT) were used to assess fidelity of intervention delivery and the impact on patient experiences, to optimize the intervention for a main trial. Methods: Data from 18 patient and five facilitator interviews, audio and video data of group sessions, two fidelity checklists, support calls and a group processes questionnaire …

Training Healthcare Professionals To Deliver A Group-Based Intervention For People Living With Severe Obesity: Lessons From The Progroup Feasibility Trial, Shokraneh Moghadam, Mark Tarrant, Lily Hawkins, Dawn Swancutt, Rod Sheaff, Laura Hollands, Raff Calitri, Jonathan Pinkney, Jenny Lloyd

School of Psychology

Introduction: Group-based programmes are increasingly adopted to support people living with obesity, as they have the potential to reduce staff time and costs and enhance motivation and capability for behaviour change. Group-based programmes could also provide members with opportunities to form meaningful social connections. As such, training should equip healthcare professionals to deliver group interventions successfully and be accessible and feasible for them to complete. This study presents how mixed-methods process evaluation data from the feasibility randomised controlled trial of PROGROUP (a group-based weight management intervention for people living with severe obesity) informed optimisation of the PROGROUP training programme. Methods: …

Children And Adults Across 15 Countries Believe In Human Uniqueness Of Mind: A Cross-Cultural Investigation Of Cross-Species Mind Perception, Karri Neldner, Luke Maurits, Magie Junker, Lara Abbas, Nayrouz Abbas, Arianna Abis, Federica Amici, Bernardo Arroyo-Garcia, Negar Asghari, Giovanna Barragán Pardo, Zhen Zhang, Junior Peña Chumacero, Ardain Dzabatou, Dustin Eirdosh, Susan Hanisch, Tom Herrnsdorf, Tom Hovehne, Alicia Junker, Patricia Kanngiesser, Felipe Villa Larens, Safaa Mahmoud, Sandra Masaquiza, Iino Masato, Risma Illa Maulany, Tongtong Meng, Kardelen Mutlu, Putu Oka Ngakan, Ebru Peközer, Ljubica Petrović, Mirella Christy Rehatalanit

School of Psychology

The way humans relate to other animals is fundamentally shaped by whether we perceive ourselves as unique, with feelings and thoughts not shared by other animals. How beliefs about animals’ ability to feel and think develop across cultures remains largely unexplored. We asked children and adolescents (4–17 years, N = 1025) and adults (N = 190) from 33 urban and rural communities across 15 countries whether animals have thoughts or feelings (judgments of presence), and whether those thoughts or feelings are human-like (judgments of similarity). Bayesian analyses revealed that participants generally ascribed non-human animals the ability for thoughts and feelings. …

“The True Me”: Unravelling The Dual Narrative Of Borderline Personality Disorder And Autistic Spectrum Disorder, Robin Iliffe-Lewis, Alison Bacon

School of Psychology

Objectives: There is growing recognition that some individuals who receive a diagnosis of Borderline Personality Disorder (BPD) are later diagnosed with autism. However, existing literature on this topic remains limited. This study aimed to explore the experiences of individuals diagnosed with BPD prior to autism, how they made sense of these diagnoses, navigated clinical systems, and learnt to manage the complex challenges associated with this diagnostic sequence.Methods: Thirteen (6 male, 6 female, 1 non-binary) adult participants took part in semi-structured interviews exploring their diagnostic journeys. Reflexive thematic analysis was used to develop a nuanced understanding of their experiences.Results: Three themes …

Integrating Neuroscience And Social Psychology In Researching Interprofessional Education: The Inspire Framework, Kimberley Schenke, Pamela Rae, Jaysan Charlesford, Phil Gee

School of Psychology

There is an increasing focus on the importance of interprofessional education as an integral part of health and social care training. However, the fundamental psychological processes underlying successful interprofessional education are not well understood. Here we propose a single framework, Integrating Neuroscience and Social Psychology In Researching Interprofessional Education (INSPIRE), grounded in evidence from social psychology and neuroscience that could be used to generate testable hypotheses to inform the design, development and evaluation of interprofessional education. The application of this framework offers a novel, scientifically grounded approach to improving the learning outcomes of interprofessional education and provides a foundation for …

Picturing The Past: The Role Of Photo Cue Visual Perspective On Positive Autobiographical Memory Recall In Dysphoria, Sarah Snow, Zachary Adolph Niese, Julie L Ji

School of Psychology

Positive autobiographical memory plays a key role in emotional well-being and is distorted by cognitive processing biases in dysphoria. This experiment investigated how the visual perspectives (first-person vs. third-person) of personal photographs influence recall of positive memories depending on dysphoria. Eighty-five participants (42 low dysphoria, 43 high dysphoria) submitted photos of positive events from both perspectives. Later, participants recalled these events while viewing either a first- or third-person photo before rating and describing their memory. While first-person photos promoted more recall from an own-eyes vantage point regardless of dysphoria level, dysphoria was still associated with greater observer-like recall, reduced mental …

Video Interaction Guidance With Adults With Intellectual Disabilities And Their Support Workers: A Service Evaluation, Áine Maguire, Vicky Anagnostopoulou, Joe Levi-French, Deanna J. Gallichan

School of Psychology

Background: This service evaluation focused on support workers' perceptions of Video Interaction Guidance (VIG) offered by an NHS Community Learning Disabilities Team. Methods: A mixed-methods design was employed. Support workers developed goals and rated their progress before and after VIG sessions. Thematic analysis was used to analyse qualitative data on the nature of the goals developed, and the strengths and working points identified. The differences between progress ratings before and after VIG were analysed using the Wilcoxon signed-rank test. Retrospective interviews helped to further understand support workers' experiences of VIG. Findings: Support workers identified goals, strengths and working points that …