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Articles 8671 - 8700 of 73703
Full-Text Articles in Entire DC Network
Understanding Patient-Reported Outcome Measures Used In Adult Survivors Experiencing Long-Term Effects After Covid-19 Infection: A Rapid Review, Egle Barilaite, Harry Watson, Mevhibe B. Hocaoglu
Understanding Patient-Reported Outcome Measures Used In Adult Survivors Experiencing Long-Term Effects After Covid-19 Infection: A Rapid Review, Egle Barilaite, Harry Watson, Mevhibe B. Hocaoglu
Journal of Patient-Centered Research and Reviews
Purpose
Patient-reported outcome measures (PROMs) are used in individuals experiencing long-term effects from COVID-19 infection, or Long COVID, to evaluate the quality of life and functional status of these individuals. However, little is known about which PROMs are being utilised and the psychometric properties of these PROMs. Our purpose was thus to explore which PROMs are used in Long COVID patients and to discuss the psychometric properties of the PROMs.
Methods
For this rapid review, a systematic literature search was performed in the PubMed, Embase, and CINAHL databases. The found studies were screened using the PRISMA flowchart. We then performed …
Broken Promises: Prolonged Diminished Quality-Of-Life Among Liberian Ebola Survivors Half A Decade After The 2014-16 West African Outbreak, Jessi Hanson-Defusco, Decontee Davis, Meghana Bommareddy, Zainab Olaniyan
Broken Promises: Prolonged Diminished Quality-Of-Life Among Liberian Ebola Survivors Half A Decade After The 2014-16 West African Outbreak, Jessi Hanson-Defusco, Decontee Davis, Meghana Bommareddy, Zainab Olaniyan
Journal of Social, Behavioral, and Health Sciences
The 2014–2016 Ebola outbreak left thousands of Liberian survivors with severely diminished quality of life. Applying a social determinants framework, this mixed method study investigates to what extent Ebola virus disease (EVD) survivors suffer long-haul psychosocial stress, diminished quality-of-life factors, and the impact of EVD-related service provisions on their ongoing healing. We present the results of a quantitative analysis survey of data collected from 19 Liberian EVD survivors in 2022 using snowball sampling. Additionally, a qualitative analysis of survivor statements helps triangulate key statistical findings and inform causal mechanisms. Survivors report experiencing 5.25 of a total of 7 ongoing stressors …
Antibiotic Treatment For Well-Appearing Infants Born At ≥35 Weeks’ Gestation To Mothers With Chorioamnionitis Before And After Implementation Of Neonatal Early-Onset Sepsis Calculator, Surichhya Bajracharya, Preetha Prazad, Catherine Bennett, Nahren Asado
Antibiotic Treatment For Well-Appearing Infants Born At ≥35 Weeks’ Gestation To Mothers With Chorioamnionitis Before And After Implementation Of Neonatal Early-Onset Sepsis Calculator, Surichhya Bajracharya, Preetha Prazad, Catherine Bennett, Nahren Asado
Journal of Patient-Centered Research and Reviews
Purpose
Our quality improvement study aimed to determine whether application of a neonatal early-onset sepsis calculator (NSC) among well-appearing infants born at ≥ 35 weeks’ gestation to mothers with chorioamnionitis decreases the number of lab evaluations (LEs) and antibiotic treatments (Abxs) without missing early-onset sepsis.
Methods
We compared 2 years (January 1, 2019–January 3, 2021) of data from a historical-control group before implementation of the NSC to 1 year (January 4, 2021–December 31, 2021) of data from a calculator group after implementation of the NSC to evaluate whether LE and Abx decreased following implementation of the NSC on January 4, …
Antigen-Clustered Nanovaccine Achieves Long-Term Tumor Remission By Promoting B/Cd 4 T Cell Crosstalk, Chengyi Li, Ryan Clauson, Luke F Bugada, Fang Ke, Bing He, Zhixin Yu, Hongwei Chen, Binyamin Jacobovitz, Hongxiang Hu, Polina Chuikov, Brett Dallas Hill, Syed M Rizvi, Yudong Song, Kai Sun, Pasieka Axenov, Daniel Huynh, Xinyi Wang, Lana Garmire, Yu Leo Lei, Irina Grigorova, Fei Wen, Marilia Cascalho, Wei Gao, Duxin Sun
Antigen-Clustered Nanovaccine Achieves Long-Term Tumor Remission By Promoting B/Cd 4 T Cell Crosstalk, Chengyi Li, Ryan Clauson, Luke F Bugada, Fang Ke, Bing He, Zhixin Yu, Hongwei Chen, Binyamin Jacobovitz, Hongxiang Hu, Polina Chuikov, Brett Dallas Hill, Syed M Rizvi, Yudong Song, Kai Sun, Pasieka Axenov, Daniel Huynh, Xinyi Wang, Lana Garmire, Yu Leo Lei, Irina Grigorova, Fei Wen, Marilia Cascalho, Wei Gao, Duxin Sun
Faculty, Staff and Student Publications
Current cancer vaccines using T cell epitopes activate antitumor T cell immunity through dendritic cell/macrophage-mediated antigen presentation, but they lack the ability to promote B/CD4 T cell crosstalk, limiting their anticancer efficacy. We developed antigen-clustered nanovaccine (ACNVax) to achieve long-term tumor remission by promoting B/CD4 T cell crosstalk. The topographic features of ACNVax were achieved using an iron nanoparticle core attached with an optimal number of gold nanoparticles, where the clusters of HER2 B/CD4 T cell epitopes were conjugated on the gold surface with an optimal intercluster distance of 5-10 nm. ACNVax effectively trafficked to lymph nodes and cross-linked with …
Ai Is A Viable Alternative To High Throughput Screening: A 318-Target Study, The Atomwise Aims Program
Ai Is A Viable Alternative To High Throughput Screening: A 318-Target Study, The Atomwise Aims Program
Faculty, Staff and Student Publications
High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, …
A Compendium Of Multi-Omics Data Illuminating Host Responses To Lethal Human Virus Infections, Amie J Eisfeld, Larissa B Thackray, Qing Tan, Michael S Diamond, Et Al.
A Compendium Of Multi-Omics Data Illuminating Host Responses To Lethal Human Virus Infections, Amie J Eisfeld, Larissa B Thackray, Qing Tan, Michael S Diamond, Et Al.
2020-Current year OA Pubs
Human infections caused by viral pathogens trigger a complex gamut of host responses that limit disease, resolve infection, generate immunity, and contribute to severe disease or death. Here, we present experimental methods and multi-omics data capture approaches representing the global host response to infection generated from 45 individual experiments involving human viruses from the Orthomyxoviridae, Filoviridae, Flaviviridae, and Coronaviridae families. Analogous experimental designs were implemented across human or mouse host model systems, longitudinal samples were collected over defined time courses, and global multi-omics data (transcriptomics, proteomics, metabolomics, and lipidomics) were acquired by microarray, RNA sequencing, or mass spectrometry analyses. For …
Benefits Of The Use Of Probiotics In Preventing Secondary Infections, Sarah Cutcher
Benefits Of The Use Of Probiotics In Preventing Secondary Infections, Sarah Cutcher
Scholars Week
Through evidence based research, the use of supplemental probiotics has been shown to have a positive effect in preventing secondary infections in hospital patients. Although there are other techniques that have decreased the incidence of infections, such as reducing invasive procedures and aseptic techniques, these are external procedures designed to prevent infection. Probiotics are an effective method of internally preventing infection. By studying certain infections and the effect that probiotics have on their prevention, researchers can safely conclude which bacteria strain could help to prevent each infection. Some different types of issues that will be looked at are healthcare acquired …
A Communication-Efficient Federated Learning Framework For Sustainable Development Using Lemurs Optimizer, Mohammed Azmi Al-Betar, Ammar Kamal Abasi, Zaid Abdi Alkareem Alyasseri, Salam Fraihat, Raghad Falih Mohammed
A Communication-Efficient Federated Learning Framework For Sustainable Development Using Lemurs Optimizer, Mohammed Azmi Al-Betar, Ammar Kamal Abasi, Zaid Abdi Alkareem Alyasseri, Salam Fraihat, Raghad Falih Mohammed
Machine Learning Faculty Publications
The pressing need for sustainable development solutions necessitates innovative data-driven tools. Machine learning (ML) offers significant potential, but faces challenges in centralized approaches, particularly concerning data privacy and resource constraints in geographically dispersed settings. Federated learning (FL) emerges as a transformative paradigm for sustainable development by decentralizing ML training to edge devices. However, communication bottlenecks hinder its scalability and sustainability. This paper introduces an innovative FL framework that enhances communication efficiency. The proposed framework addresses the communication bottleneck by harnessing the power of the Lemurs optimizer (LO), a nature-inspired metaheuristic algorithm. Inspired by the cooperative foraging behavior of lemurs, the …
Predictive Policing, Emily Musgrove
Predictive Policing, Emily Musgrove
Richard T. Schellhase Essay Prize in Ethics
Currently, machine learning and artificial intelligence are still somewhat new to the world of law enforcement, however, they appear to be rapidly gaining traction for their usefulness in a variety of manners. In this paper, I will examine how technically useful machine learning-based predictive policing is, the ethical conundrums that come with its practical uses, and how to mitigate the risks of its use.
Monarch Science Observer, Volume 18, College Of Sciences, Old Dominion University
Monarch Science Observer, Volume 18, College Of Sciences, Old Dominion University
College of Sciences Newsletter
Spring 2024, issue of Monarch Science Observer, ODU Colleges of Sciences Newsletter.
The Utah Statesman, April 1, 2024, Utah State University
The Utah Statesman, April 1, 2024, Utah State University
The Utah Statesman
Weekly student newspaper of Utah State University in Logan.
The Impact Of Neurological Diseases In Kisumu, Kenya: Case Studies At Jootrh And Kcrh, Jack F. Dunham
The Impact Of Neurological Diseases In Kisumu, Kenya: Case Studies At Jootrh And Kcrh, Jack F. Dunham
Independent Study Project (ISP) Collection
Introduction: The burden that neurological diseases put on health systems is high, and growing across the globe, especially in Low- and Middle-Income Countries (LMICs) like Kenya. For this reason, our study sought out to study the burden and impact of neurological diseases at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCRH), which are in Western Kenya.
Methods: Utilizing data from handwritten patient records spanning 23 months, our study collected said data and analyzed the prevalence, incidence, distribution, and outcomes of different neurological diseases as they impact the Kisumu community.
Results/Discussion: Comparing …
White-Fronted Capuchins (Cebus Albifrons Aequatorialis) In La Hesperia Cloud Forest Reserve: A Study Of Aggressive Behaviors In Response To Human Presence, Marin Lynch
Independent Study Project (ISP) Collection
The Ecuadorian white-fronted capuchin, Cebus albifrons aequatorialis, is a critically endangered primate species native to Ecuador and northern Peru. Their population consists of only a handful of surviving troops spread out across this region. One surviving population exists in La Hesperia Cloud Forest Reserve in Ecuador. This reserve serves as an education and volunteer site for dozens of international travelers every year. I studied the effect of the presence of humans and the lodging they have constructed. Specifically, I investigated the effect on behavior of the proximity of the troops alpha male to manmade structures in the reserve. I …
Analyzing Deaths From Extreme Weather Events And Their Relevance To The Life Insurance Industry, Erika Roof
Analyzing Deaths From Extreme Weather Events And Their Relevance To The Life Insurance Industry, Erika Roof
Honors Projects in Biological and Biomedical Sciences
This study aims to discover the effect of extreme weather events on the life insurance industry. As climate change progresses and global temperatures increase, extreme weather events, which are separated into drought, freeze, severe storms, tropical cyclones, wildfires, and winter storms are expected to occur more often. Extreme weather events not only impact the local economies but increase local death rates as well. Using data from the National Oceanic and Atmospheric Administration’s National Centers for Environmental Information (NOAA NCEI), this study uses regression analysis to examine the correlation between extreme weather and mortality data. Time series regression analysis suggests that …
Lobbying Impact: Assessing The Effects Of Lobbying On Healthcare Access For Minority Communities, Aastha Soni
Lobbying Impact: Assessing The Effects Of Lobbying On Healthcare Access For Minority Communities, Aastha Soni
Honors Projects in Politics, Law, and Society
The United States healthcare system suffers from significant flaws stemming from the absence of universal healthcare and entrenched systemic racism, resulting in a predominantly market-driven approach to healthcare provision. Unfortunately, this has created barriers that disproportionately limit access to healthcare for minority communities. The unequal healthcare landscape reflects the culmination of disparate health policies and social determinants of health. Moreover, the influence of large corporations and Washington's K Street on the legislation through lobbying further exacerbates these systemic disparities. This paper aims to explore the impact of lobbying on healthcare access for minority communities by analyzing two bills. By identifying …
An Analysis Of The Feasibility Of An Overdose Prevention Center In The City Of Worcester, Adam Cohen, Pieter Vanderbrug, Gus Hoy, Blake Leasure
An Analysis Of The Feasibility Of An Overdose Prevention Center In The City Of Worcester, Adam Cohen, Pieter Vanderbrug, Gus Hoy, Blake Leasure
School of Professional Studies
The opioid epidemic raging across the United States is causing overdose deaths to skyrocket, prompting policy-makers across all levels of government to embrace non-traditional and sometimes controversial means of combating the worsening crisis. Overdose prevention centers (OPCs) represent one such method rapidly gaining prominence. Only emerging in North America relatively recently, these centers offer clients a supervised environment where they can use pre-obtained drugs, spaces designed to mitigate the risk of fatal overdose and increase access to other health services. This study investigates both the capacity of OPCs to reduce opioid-related overdose deaths and their derivative impacts as well as …
Malaria, A Burden For Sub-Saharan Africa, Alpha Mamadou Hady Barry
Malaria, A Burden For Sub-Saharan Africa, Alpha Mamadou Hady Barry
Health and Kinesiology Theses
Malaria has been a worldwide health problem for centuries causing between 1.5 to 2.7 million deaths annually, and mostly affecting children aged 5 and under and pregnant women in Sub-Saharan Africa (SSA) (Phillips, 2001). The discovery of malaria parasites by Laveran in 1880 as well as the finding of mosquitoes as vectors for avian malaria by Ross in 1897, made scientific studies about malaria possible. Between 1898 and 1900, the Italian scientists Grassi, Bignami, Bastianelli, Celli, Golgi and Marchiafava discovered human malaria (Cox, 2010). Malaria has been eradicated from developed countries such as the United Staes and most European countries …
A Summary Of Two Decades Of Qtl And Candidate Genes That Control Seed Tocopherol Contents In Maize (Zea Mays L.), My Abdelmajid Kassem, Dounya Knizia, Khalid Meksem
A Summary Of Two Decades Of Qtl And Candidate Genes That Control Seed Tocopherol Contents In Maize (Zea Mays L.), My Abdelmajid Kassem, Dounya Knizia, Khalid Meksem
College of Health, Science, and Technology
Tocopherols are secondary metabolites synthesized through the shikimate biosynthetic pathway in the plastids of most plants. It is well known that ?–Tocopherol (vitamin E) has many health benefits for humans and animals; therefore, it is highly used in human and animal diets. Tocopherols vary considerably in most crop (and plant) species and within cultivars of the same species depending on environmental and growth conditions; tocopherol content is a polygenic, complex traits, and its inheritance is poorly understood. The objective of this review paper was to summarize all identified quantitative trait loci (QTL) that control seed tocopherols and related contents identified …
Malaria Parasite, Host, And Drug Dynamics In The Context Of Artemether-Lumefantrine Treatment And Hiv-Infection, Justin Goodwin
Malaria Parasite, Host, And Drug Dynamics In The Context Of Artemether-Lumefantrine Treatment And Hiv-Infection, Justin Goodwin
Yale Graduate School of Arts and Sciences Dissertations
Malaria is a leading cause of global morbidity and mortality with an estimated 249 million cases and 608,000 deaths in 2022, overwhelmingly in sub-Saharan Africa (SSA). Artemisinin-based combination therapies (ACTs) are the primary treatment for malaria and combine a potent short-acting artemisinin with a longer-acting partner drug. ACTs rapidly reduce the initial parasite burden, eliminate residual parasites, and provide post-treatment prophylaxis against new infections. Artemether-lumefantrine (AL) is the most widely prescribed ACT globally and in SSA. Unfortunately, ACT efficacy is threatened by widespread resistance in Southeast Asia, and by the emergence of partial artemisinin resistance in SSA. SSA also bears …
Ensuring K-12 School Safety During A Respiratory Viral Pandemic, Dan Li
Ensuring K-12 School Safety During A Respiratory Viral Pandemic, Dan Li
Yale Graduate School of Arts and Sciences Dissertations
In recent times, the world has witnessed an unprecedented global crisis with the outbreak of COVID-19. This pandemic has not only brought about a paradigm shift in our daily lives but has also significantly impacted various sectors of society, including the education system. K-12 schools are a major concern for viral transmission due to the close social interactions between children, crowded institutional environments, and suboptimal vaccine coverage. Children have close interactions with their household members, who are active in all sectors of society. The K-12 educational landscape has faced an array of challenges in the face of managing the COVID-19 …
Identifying The Multilevel Factors Influencing Provider Recommendations For Adolescent Vaccines, Mallory Kathryn Ellingson
Identifying The Multilevel Factors Influencing Provider Recommendations For Adolescent Vaccines, Mallory Kathryn Ellingson
Yale Graduate School of Arts and Sciences Dissertations
Health care provider (HCP) recommendations are a key predictor of vaccineacceptance among parents of adolescents. However, HCP recommendations for adolescent vaccines are not universal. In order to address disparities in HCP recommendations, we must first understand why recommendations vary. The factors that influence a HCP recommendation are multilevel. At the individual level, a HCP’s own knowledge, attitudes and beliefs about a vaccine can influence how or if they recommend the vaccine to a patient. At the interpersonal level, the characteristics of the patient can impact how a HCP perceives disease risk or need for a vaccine in their patient. At …
Utilizing Meta-Analytical And Causal Inference Methods To Evaluate The Impacts Of Environmental Risk Factors On Non-Hodgkin Lymphoma, Xiaoting Shi
Yale Graduate School of Arts and Sciences Dissertations
Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies in the world. Despite substantial efforts to identify causes and risk factors for NHL over the past few decades, the etiology of NHL is largely unclear. The overarching goal of this three-part dissertation is to use different meta-analytical and causal inference methods to identify and evaluate potential environmental risk factors for NHL. For the first project of this dissertation, we conducted an umbrella review to summarize the range, strength, and consistency of all associations between environmental risk factors and NHL reported in published meta-analyses. We identified 85 meta-analyses of …
An Introduction To The Yanomami Humanitarian Crisis And An Interview With Carlos Messiass On Contemporary Brazilian Indigenous Issues, Ethan Mccullough
An Introduction To The Yanomami Humanitarian Crisis And An Interview With Carlos Messiass On Contemporary Brazilian Indigenous Issues, Ethan Mccullough
Four Valleys Archive Scholarship
The following document covers how the rise of Jair Bolsonaro, based around a coalition of expansionist cattle ranchers and extractive industry representatives, has led to the massive explosion of illegal gold mining within the Yanomami in the Amazon. This increase in mining has led to a rapid increase of malnutrition, malaria, and mercury poisoning within the Yanomami population, as well as a significant rise in violence and human rights abuses. Other topics covered include, the previous increase of illegal mining on Yanomami land in the 1980s, Bolsonaro's anti-Indigenous rhetoric while campaigning for presidency, the role of the U.S. in Operation …
2024 University Research Symposium Program Book, The Graduate School
2024 University Research Symposium Program Book, The Graduate School
University Research Symposium Programs
Program book for the 2024 University Research Symposium.
Crisis Support Through Policies For Medical Professionals In 2020 And 2021 During The Covid-19 Pandemic, Malik James Fonville-Simmons
Crisis Support Through Policies For Medical Professionals In 2020 And 2021 During The Covid-19 Pandemic, Malik James Fonville-Simmons
Walden Dissertations and Doctoral Studies
No abstract provided.
Gibbon Surgical Review, Volume 7, Issue 1, 2024
Gibbon Surgical Review, Volume 7, Issue 1, 2024
Gibbon Surgical Review
Table of Contents
6 - Socially Responsible Surgery: Better Practices for Better Outcomes
8 - Interview with Dr. Talar Tatarian - Assistant Professor
10 - Global Surgery : Current State and Involvement as a Trainee
12 - Interview with Dr. Ibnouf Sulieman - Transplant Surgery Fellow
14 - Resident Spotlight - Dr. Sam Nasser - PGY3
16 - A Review of the FIRST and SECOND Trials
18 - Residency Signaling in General Surgery
20 - Navigating Competency: Entrustable Professional Activities (EPAs)
22 - The Effect of Language Barriers on Surgical Outcomes
24 - Research Spotlight: The First Complete Human Eye …
Minding The Gap: An Introduction To Empirical Critical Race Scholarship And Complexity Science (With Resources On Agent-Based Modeling), Kevin P. Lee
North Carolina Civil Rights Law Review
No abstract provided.
The Ghanaian War Against Malaria: A Geospatial Approach To Malaria And Healthcare Access In Ghana, Emmanuel Aklie
The Ghanaian War Against Malaria: A Geospatial Approach To Malaria And Healthcare Access In Ghana, Emmanuel Aklie
Theses
This geospatial research project aims to analyze the complex factors influencing malaria incidence in Ghana, including healthcare access, cultural beliefs, and preventive measures. Using GIS mapping and spatial analysis, the study examines malaria distribution and healthcare facility locations to identify hotspots and access inequalities. Combining quantitative data from sources like Demographic and Health Surveys with qualitative methods like surveys and interviews, the project analyzes the relationship between malaria prevalence and vaccination rates, bed net usage, and cultural views on treatment. By taking a comprehensive approach focused on evidence-based insights, the research seeks to inform targeted interventions by the Ghanaian government …
Avian Diversity And Abundance Among Agricultural Land, Forested Land, And Their Ecotone In Guadalupe, Cerro Punta, Chiriquí Province, Republic Of Panamá., Stella Rae Kinard
Avian Diversity And Abundance Among Agricultural Land, Forested Land, And Their Ecotone In Guadalupe, Cerro Punta, Chiriquí Province, Republic Of Panamá., Stella Rae Kinard
Independent Study Project (ISP) Collection
As the human population increases, finding the balance between modifying land use for resources and protecting areas to preserve species that are threatened by anthropogenic disturbance is an ever growing problem. Guadalupe is a town in the Western Highlands of Panamá that struggles in this balance as its primary income source is agriculture, but it is located on the border of two protected areas, Parque Nacional La Amistad and Parque Nacional Volcán Barú. By understanding the unique ways in which avifauna utilize distinct vegetative landscapes, recommendations can be made for management styles of farms in Guadalupe to implement practices that …
A Physiological Approach To Renal Clearance: From Premature Neonates To Adults, Nick Holford, Conor J. O'Hanlon, Karel Allegaert, Brian Anderson, Amilcar Falcão, Nicolas Simon, Yoke Lin Lo, Alison H. Thomson, Catherine M.T. Sherwin, Evelyne Jacqz-Aigrain, Carolina Llanos-Paez, Stefanie Hennig, Linas Mockus, Carl Kirkpatrick
A Physiological Approach To Renal Clearance: From Premature Neonates To Adults, Nick Holford, Conor J. O'Hanlon, Karel Allegaert, Brian Anderson, Amilcar Falcão, Nicolas Simon, Yoke Lin Lo, Alison H. Thomson, Catherine M.T. Sherwin, Evelyne Jacqz-Aigrain, Carolina Llanos-Paez, Stefanie Hennig, Linas Mockus, Carl Kirkpatrick
Pediatrics Faculty Publications
Aims: We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance. Methods: Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed-effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight, age and serum creatinine. A dataset created from 18 sources resulted in 27,338 drug concentrations from 9,901 patients. Body size and composition, maturation and renal function were used to describe differences in drug clearance and volume of distribution. Results: This study demonstrates that GFR is a predictor of two distinct …