Digital Commons Network^™

Reactions To The Mpox Vaccine Regarding Absences And Disruption Of Daily Activities In The United States, Robert Rossi

Walden Dissertations and Doctoral Studies

Since its global outbreak in 2022, the monkeypox (Mpox) virus has infected over 32,000 individuals in the United States, resulting in approximately 58 deaths. Although the JYNNEOS vaccine is effective at disease prevention, it has also been found to cause side effects, such as a disruption in daily activities and/or attendance at work or school. This quantitative, cross-sectional study was conducted to investigate whether differences existed in reactions to the Mpox vaccine, using secondary data from the Centers for Disease Control and Prevention’s V-safe Mpox survey. The two dependent variables were work/school absenteeism and disruption of daily activities, and the …

Inconsistent Implementation And Continuous Improvement Of Elementary School-Based Multi-Tiered System Of Supports, Cheryl Holbrook Barnett

Walden Dissertations and Doctoral Studies

In a rural Georgia school district, the multi-tiered system of supports (MTSS) framework has been formally implemented and facilitated by system-level coordinators for a 4-year period. As the 2021–2022 school year started, the district began the process of transitioning the leadership of the MTSS process to individual school-level teams and administrators. The problem that was addressed through this study is the inconsistent implementation and continuous improvement of the MTSS framework along with the supports that are needed as the transition is made from system facilitation to school-based teams. The purpose of this qualitative study was to explore teacher and administrator …

The 21st Century Coach: A Diversity, Equity, And Inclusion Resource For Youth Lacrosse Coaches, Maria D'Ugo, Jillian Lowey, Sean Mapoles, Brian Gearity

Graduate School of Professional Psychology: Faculty Scholarship

This document provides educational information, resources, and support to coaches and administrators with the goal of empowering and encouraging diversity, equity, and inclusion in daily sporting practices. This document may aid in efforts to increase inclusion and participation in youth sport, specifically lacrosse. Furthermore, it may help to increase coaches’ and administrators’ cultural awareness and competencies.

Integrating Multiple Biodiversity Metrics To Assess Diatom Diversity And Diatom/Macrophyte Host Specificity In Four Florida Benchmark Lakes, Alana Jade Bronk

USF Tampa Graduate Theses and Dissertations

Biodiversity is declining across all natural environments, however, freshwater systems are thought to be among the most threatened. Quantifying and understanding trends in freshwater biodiversity has become more urgent as rapid biodiversity loss continues. To provide a robust ecological assessment, more than one bioindicator should be used, along with multiple biodiversity metrics. Macrophytes and diatoms are important components of aquatic systems, especially in shallow lakes. The relationship between macrophytes and epiphytic diatoms, though, is not clearly understood, and has not been well-studied, particularly in Florida, which has the largest abundance of natural freshwater lakes in the southeastern U.S This study …

The George-Anne Inkwell Edition, Georgia Southern University

The Inkwell

No abstract provided.

Biologic And Clinical Analysis Of Childhood Gamma Delta T-All Identifies Lmo2/Stag2 Rearrangements As Extremely High Risk, Shunsuke Kimura, Chun Shik Park, Lindsey E Montefiori, Ilaria Iacobucci, Petri Pölönen, Qingsong Gao, Elizabeth D Arnold, Andishe Attarbaschi, Anthony Brown, Barbara Buldini, Kenneth J Caldwell, Yunchao Chang, Chelsey Chen, Cheng Cheng, Zhongshan Cheng, John Choi, Valentino Conter, Kristine R Crews, Hester A De Groot-Kruseman, Takao Deguchi, Mariko Eguchi, Hannah E Muhle, Sarah Elitzur, Gabriele Escherich, Burgess B Freeman, Zhaohui Gu, Katie Han, Keizo Horibe, Toshihiko Imamura, Sima Jeha, Motohiro Kato, Kean H Chiew, Tanya Khan, Michal Kicinski, Stefan Köhrer, Steven M Kornblau, Rishi S Kotecha, Chi-Kong Li, Yen-Chun Liu, Franco Locatelli, Selina M Luger, Elisabeth M Paietta, Atsushi Manabe, Hanne V Marquart, Riccardo Masetti, Mellissa Maybury, Pauline Mazilier, Jules P P Meijerink, Sharnise Mitchell, Takako Miyamura, Andrew S Moore, Koichi Oshima, Katarzyna Pawinska-Wasikowska, Rob Pieters, Mollie S Prater, Shondra M Pruett-Miller, Ching-Hon Pui, Chunxu Qu, Michaela Reiterova, Noemi Reyes, Kathryn G Roberts, Jacob M Rowe, Atsushi Sato, Kjeld Schmiegelow, Martin Schrappe, Shuhong Shen, Szymon Skoczeń, Orietta Spinelli, Jan Stary, Michael Svaton, Masatoshi Takagi, Junko Takita, Yanjing Tang, David T Teachey, Paul G Thomas, Daisuke Tomizawa, Jan Trka, Elena Varotto, Tiffaney L Vincent, Jun J Yang, Allen E J Yeoh, Yinmei Zhou, Martin Zimmermann, Hiroto Inaba, Charles G Mullighan

Faculty, Staff and Student Publications

Acute lymphoblastic leukemia expressing the gamma delta T-cell receptor (γδ T-ALL) is a poorly understood disease. We studied 200 children with γδ T-ALL from 13 clinical study groups to understand the clinical and genetic features of this disease. We found age and genetic drivers were significantly associated with outcome. γδ T-ALL diagnosed in children under 3 years of age was extremely high-risk and enriched for genetic alterations that result in both LMO2 activation and STAG2 inactivation. Mechanistically, using patient samples and isogenic cell lines, we show that inactivation of STAG2 profoundly perturbs chromatin organization by altering enhancer-promoter looping, resulting in …

The Role Of Ontologies And Knowledge In Explainable Ai, Roberto Confalonieri, Oliver Kutz, Diego Calvanese, Jose Maria Alonso-Moral, Shang-Ming Zhou

School of Nursing and Midwifery

No abstract provided.

Tissue-Agnostic Targeting Of Neurotrophic Tyrosine Receptor Kinase Fusions: Current Approvals And Future Directions, Mohamed A Gouda, Kyaw Z Thein, David S Hong

Faculty, Staff and Student Publications

NTRK fusions are oncogenic drivers for multiple tumor types. Therefore, the development of selective tropomyosin receptor kinase (TRK) inhibitors, including larotrectinib and entrectinib, has been transformative in the context of clinical management, given the high rates of responses to these drugs, including intracranial responses in patients with brain metastases. Given their promising activity in pan-cancer cohorts, larotrectinib and entrectinib received U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) approval for tissue-agnostic indications in patients with advanced solid tumors harboring NTRK fusions. The safety profiles for both drugs are quite manageable, although neurotoxicity driven by the on-target inhibition …

Hossain V. Cherry

All Decisions

In this post-eviction proceeding, the court granted the tenant's motion to vacate a default judgment of possession due to improper service. The landlord's process server served papers to a 13-year-old, which was deemed inadequate under CPLR 308, as proper service requires delivery to a person of suitable age and discretion, defined as at least 16 years old. The court found the service was rushed and did not meet the statutory requirements, thus restoring the tenant to possession.

Jpmorgan Chase Bank, National Association V. Carrasquillo

All Decisions

In this post-foreclosure holdover proceeding, the court found the predicate notice defective due to the petitioner's failure to comply with the required 90-day notice under the Protection Tenants at Foreclosure Act (PTFA). The petitioner issued a conflicting notice that created ambiguity by presenting two timelines and then filed for eviction within two weeks, violating the notice's provisions. As a result, the court dismissed the case without prejudice, emphasizing that a defective notice cannot be amended.

Quantifying The Impact Of Rain-On-Snow Induced Flooding In The Western United States, Brennan Lynn Bean, Emma Watts

Mathematics and Statistics Faculty Publications

The potentially destructive flooding resulting from rain-on-snow (ROS) events motivates efforts to better incorporate these events and their residual effects into flood-related infrastructure design. This paper examines relationships between measured streamflow surges at streamgages across the Western United States and the meteorological conditions preceding them at SNOTEL stations within the same water catchment. Relevant stream surges are identified using a peak detection algorithm via time series analysis, which are then labeled ROS- or non-ROS-induced based on the preceding meteorological conditions. Both empirical and model-derived differences between ROS- and non-ROS-induced stream surges are then explored, which suggest that ROS-induced stream surges …

Cd28 Costimulation Augments Car Signaling In Nk Cells Via The Lck/Cd3Ζ/Zap70 Signaling Axis, Sunil Acharya, Rafet Basar, May Daher, Hind Rafei, Ping Li, Nadima Uprety, Emily Ensley, Mayra Shanley, Bijender Kumar, Pinaki P Banerjee, Luciana Melo Garcia, Paul Lin, Vakul Mohanty, Kun H Kim, Xianli Jiang, Yuchen Pan, Ye Li, Bin Liu, Ana K Nunez Cortes, Chenyu Zhang, Mohsen Fathi, Ali Rezvan, Melisa J Montalvo, Sophia L Cha, Francia Reyes-Silva, Rejeena Shrestha, Xingliang Guo, Kiran Kundu, Alexander Biederstädt, Luis Muniz-Feliciano, Gary M Deyter, Mecit Kaplan, Xin R Jiang, Enli Liu, Antrix Jain, Janos Roszik, Natalie W Fowlkes, Luisa M Solis Soto, Maria G Raso, Joseph D Khoury, Pei Lin, Francisco Vega, Navin Varadarajan, Ken Chen, David Marin, Elizabeth J Shpall, Katayoun Rezvani

Faculty, Staff and Student Publications

Multiple factors in the design of a chimeric antigen receptor (CAR) influence CAR T-cell activity, with costimulatory signals being a key component. Yet, the impact of costimulatory domains on the downstream signaling and subsequent functionality of CAR-engineered natural killer (NK) cells remains largely unexplored. Here, we evaluated the impact of various costimulatory domains on CAR-NK cell activity, using a CD70-targeting CAR. We found that CD28, a costimulatory molecule not inherently present in mature NK cells, significantly enhanced the antitumor efficacy and long-term cytotoxicity of CAR-NK cells both in vitro and in multiple xenograft models of hematologic and solid tumors. Mechanistically, …

The Lipid Profile Parameter In Chronic Obstructive Pulmonary Disease Patients And Correlation With Severity Of Disease, Hajir Ibraheem Makhlif Al-Taee, Mohammed Waheeb Salman Al-Obaidi

Muthanna Medical Journal

COPD, a chronic respiratory illness with high mortality and morbidity worldwide, may be exacerbated by dyslipidemia. The aim of study is to assess prevalence of dyslipidemia in COPD patients and to evaluate its correlation with COPD severity. Between 2023 and 2024, Baghdad teaching hospital respiratory diseases outpatient clinic recruited 70 COPD patients for cross-sectional research. Anyone over 40 with COPD was sampled. Patients' lung function and lipid levels were documented. The study of 70 COPD patients found significant differences in demographics and clinical metrics across three severity groups (A, B, E). Key findings include higher mean age and lower mean …

Impact Of Obesity On Spirometric Parameters In Asthmatic, Hawraa Fadhil Abdulameer, Oday Taher Mohammed

Muthanna Medical Journal

Obesity is a public health issue and a risk factor and disease modifier for juvenile and adult asthma. Due to the high prevalence of obesity and asthma, this connection may worsen asthma burden in individuals and populations. The extent to which obesity impressing lung function still vague. This research focus on impact of obesity on asthmatic spirometric parameters. Aim of the study: To determine the effect of obesity on spirometry parameters in asthmatic patients. 93 asthmatic patients are enrolled in this cross-sectional study. The diagnosis of asthma was made clinically and by PFT. The study done in Baghdad teaching hospital …

Academic Policies Committee Minutes Of The Academic Senate 2024-10-04, University Of Dayton. Academic Senate. Academic Policies Committee

All Committee Minutes

Approved minutes of a meeting of the Academic Policies Committee of the Academic Senate of the University of Dayton.

Faculty Advisory Committee Minutes Of The Academic Senate 2024-10-04, University Of Dayton. Faculty Affairs Committee

All Committee Minutes

Approved minutes of a meeting of the Faculty Affairs Committee of the Academic Senate of the University of Dayton.

The Employment Situation Of Veterans: September 2024, Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

In September 2024, U.S. employment rose by 254,000, with the unemployment rate holding steady at 4.1%. Veterans experienced notable improvements, with overall unemployment dropping to 2.7% from 3.5% in August, and specific age and demographic groups seeing varying trends—such as a decrease in unemployment for younger veterans and a significant drop for female veterans. While some subgroups, like Hispanic veterans, had higher unemployment rates than their nonveteran peers, Black veterans saw lower unemployment than their counterparts.

2024 Clinical Practice Guideline Update By The Infectious Diseases Society Of America On Complicated Intra-Abdominal Infections: Risk Assessment, Diagnostic Imaging, And Microbiological Evaluation In Adults, Children, And Pregnant People, Robert A Bonomo, Anthony W Chow, Morven S Edwards, Romney Humphries, Pranita D Tamma, Fredrick M Abrahamian, Mary Bessesen, E Patchen Dellinger, Ellie Goldstein, Mary K Hayden, Keith S Kaye, Brian A Potoski, Jesús Rodríguez-Baño, Robert Sawyer, Marion Skalweit, David R Snydman, Sarah Pahlke, Katelyn Donnelly, Jennifer Loveless

Faculty, Staff and Students Publications

As the first part of an update to the clinical practice guideline on the diagnosis and management of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America, the panel presents 21 updated recommendations. These recommendations span risk assessment, diagnostic imaging, and microbiological evaluation. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Education And Tolerance Of Homosexuality In Diverse Islamic Contexts, Camila Swift

Dissertations and Theses

This study examines the relationship between educational attainment and moral tolerance of homosexuality among Muslims in Algeria, Malaysia, Pakistan, and Turkey. Utilizing human development theory to understand how educational attainment affects social values, the analysis draws on data from over 5,000 respondents from the Pew Research Center's "World's Muslims" dataset, which includes responses from a nationally representative sample of Muslims in these four countries. Logistic regression models and predicted probabilities are used to explore how educational attainment relates to moral tolerance of homosexuality, adjusting estimates for various alternate explanations through the use of control variables. The findings reveal that the …

Terminal Differentiation Precedes Functional Circuit Integration In The Peduncle Neurons In Regenerating Hydra Vulgaris, Alondra Escobar, Soonyoung Kim, Abby S Primack, Guillaume Duret, Celina E Juliano, Jacob T Robinson

Faculty, Staff and Students Publications

Understanding how neural circuits are regenerated following injury is a fundamental question in neuroscience. Hydra is a powerful model for studying this process because it has a simple neural circuit structure, significant and reproducible regenerative abilities, and established methods for creating transgenics with cell-type-specific expression. While Hydra is a long-standing model for regeneration and development, little is known about how neural activity and behavior is restored following significant injury. In this study, we ask if regenerating neurons terminally differentiate prior to reforming functional neural circuits, or if neural circuits regenerate first and then guide the constituent naive cells toward their …

Multi-Ancestry Gwas Meta-Analyses Of Lung Cancer Reveal Susceptibility Loci And Elucidate Smoking-Independent Genetic Risk, Bryan R Gorman, Sun-Gou Ji, Michael Francis, Anoop K Sendamarai, Yunling Shi, Poornima Devineni, Uma Saxena, Elizabeth Partan, Andrea K Devito, Jinyoung Byun, Younghun Han, Xiangjun Xiao, Don D Sin, Wim Timens, Jennifer Moser, Sumitra Muralidhar, Rachel Ramoni, Rayjean J Hung, James D Mckay, Yohan Bossé, Ryan Sun, Christopher I Amos, Va Million Veteran Program, Saiju Pyarajan

Faculty, Staff and Student Publications

Lung cancer remains the leading cause of cancer mortality, despite declining smoking rates. Previous lung cancer GWAS have identified numerous loci, but separating the genetic risks of lung cancer and smoking behavioral susceptibility remains challenging. Here, we perform multi-ancestry GWAS meta-analyses of lung cancer using the Million Veteran Program cohort (approximately 95% male cases) and a previous study of European-ancestry individuals, jointly comprising 42,102 cases and 181,270 controls, followed by replication in an independent cohort of 19,404 cases and 17,378 controls. We then carry out conditional meta-analyses on cigarettes per day and identify two novel, replicated loci, including the 19p13.11 …

Identification Of An Ionic Mechanism For Erα-Mediated Rapid Excitation In Neurons, Meng Yu, Na Yin, Bing Feng, Peiyu Gao, Kaifan Yu, Hesong Liu, Hailan Liu, Yongxiang Li, Olivia Z Ginnard, Kristine M Conde, Mengjie Wang, Xing Fang, Longlong Tu, Jonathan C Bean, Qingzhuo Liu, Yue Deng, Yuxue Yang, Junying Han, Sanika V Jossy, Megan L Burt, Huey Zhong Wong, Yongjie Yang, Benjamin R Arenkiel, Yang He, Shaodong Guo, Pierre Gourdy, Jean-Francois Arnal, Francoise Lenfant, Zhao Wang, Chunmei Wang, Yanlin He, Yong Xu

Faculty, Staff and Students Publications

The major female ovarian hormone, 17β-estradiol (E2), can alter neuronal excitability within milliseconds to regulate a variety of physiological processes. Estrogen receptor-α (ERα), classically known as a nuclear receptor, exists as a membrane-bound receptor to mediate this rapid action of E2, but the ionic mechanisms remain unclear. Here, we show that a membrane channel protein, chloride intracellular channel protein-1 (Clic1), can physically interact with ERα with a preference to the membrane-bound ERα. Clic1-mediated currents can be enhanced by E2 and reduced by its depletion. In addition, Clic1 currents are required to mediate the E2-induced rapid excitations in multiple brain ERα …

2024 Clinical Practice Guideline Update By The Infectious Diseases Society Of America On Complicated Intra-Abdominal Infections: Utility Of Blood Cultures In Adults, Children, And Pregnant People, Robert A Bonomo, Romney Humphries, Fredrick M Abrahamian, Mary Bessesen, Anthony W Chow, E Patchen Dellinger, Morven S Edwards, Ellie Goldstein, Mary K Hayden, Keith S Kaye, Brian A Potoski, Jesús Rodríguez-Baño, Robert Sawyer, Marion Skalweit, David R Snydman, Pranita D Tamma, Sarah Pahlke, Katelyn Donnelly, Jennifer Loveless

Faculty, Staff and Students Publications

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this guideline, the panel provides recommendations for obtaining blood cultures in patients with known or suspected intra-abdominal infection. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Magic For The Blind: Are Auditory Tricks Impossible?, Gustav Kuhn, Cyril Thomas, Tyler Gibgot, Vebjorn Ekroll

School of Psychology

Many magic tricks rely solely on vision, but there are few, if any, that rely on auditory perception alone. Here, we question why this is so and argue that research focusing on this issue could provide deeper theoretical insights into the similarities and differences between our senses.

A Multivariate Approach To Assessing Landscape Structure Effects On Wildlife Crossing Structure Use, Thomas J. Yamashita, Humberto L. Perotto-Baldivieso, David B. Wester, Kevin W. Ryer, Richard J. Kline, Michael E. Tewes, John H. Young Jr., Jason V. Lombardi

School of Earth, Environmental, & Marine Sciences Faculty Publications

Background

Complexity in landscape structure is often assessed using individual metrics related to ecological processes. However, this rarely incorporates important relationships among metrics and may miss landscape structure effects. Multivariate statistics provide techniques for assessing overall landscape structure effects. We assessed how multivariate statistics could be used to connect landscape structure with an ecological process [bobcat (Lynx rufus) wildlife crossing structure (WCS) use]. We tested how landscape structure at WCS sites compared to the surrounding landscape and how structure affected detections at WCS sites. Our study was conducted in Cameron County, Texas, USA where WCSs are in various …

Final 2024 Residential Metals Abatement Program (Rmap) Walkerville Park (Alley Of North Main And Alley Of West Daly) Soil Remedial Action Work Plan (Rawp), Pioneer Technical Services, Inc.

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

Butte Priority Soils Operable Unit (Bpsou) Revised Draft Final Insufficiently Reclaimed Sites Field Sampling Plan (Fsp) Bres No. 181 – Mountain Con-3 Dump And Responses To Agency Comments, Mike Mcanulty

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

2024 Clinical Practice Guideline Update By The Infectious Diseases Society Of America On Complicated Intraabdominal Infections: Diagnostic Imaging Of Suspected Acute Cholecystitis And Acute Cholangitis In Adults, Children, And Pregnant People, Robert A Bonomo, Morven S Edwards, Fredrick M Abrahamian, Mary Bessesen, Anthony W Chow, E Patchen Dellinger, Ellie Goldstein, Mary K Hayden, Romney Humphries, Kaye, Brian A Potoski, Rodríguez-Baño, Robert Sawyer, Marion Skalweit, David R Snydman, Pranita D Tamma, Katelyn Donnelly, Jennifer Loveless

Faculty, Staff and Students Publications

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intraabdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this article, the panel provides recommendations for diagnostic imaging of suspected acute cholecystitis and acute cholangitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

2024 Clinical Practice Guideline Update By The Infectious Diseases Society Of America On Complicated Intra-Abdominal Infections: Diagnostic Imaging Of Suspected Acute Intra-Abdominal Abscess In Adults, Children, And Pregnant People, Robert A Bonomo, Pranita D Tamma, Fredrick M Abrahamian, Mary Bessesen, Anthony W Chow, E Patchen Dellinger, Morven S Edwards, Ellie Goldstein, Mary K Hayden, Romney Humphries, Keith S Kaye, Brian A Potoski, Jesús Rodríguez-Baño, Robert Sawyer, Marion Skalweit, David R Snydman, Katelyn Donnelly, Jennifer Loveless

Faculty, Staff and Students Publications

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this article, the panel provides recommendations for diagnostic imaging of suspected acute intra-abdominal abscess. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update By The Infectious Diseases Society Of America On Complicated Intra-Abdominal Infections: Diagnostic Imaging Of Suspected Acute Appendicitis In Adults, Children, And Pregnant People, Robert A Bonomo, Pranita D Tamma, Fredrick M Abrahamian, Mary Bessesen, Anthony W Chow, E Patchen Dellinger, Morven S Edwards, Ellie Goldstein, Mary K Hayden, Romney Humphries, Keith S Kaye, Brian A Potoski, Jesús Rodríguez-Baño, Robert Sawyer, Marion Skalweit, David R Snydman, Katelyn Donnelly, Jennifer Loveless

Faculty, Staff and Students Publications

This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America (IDSA). In this paper, the panel provides recommendations for diagnostic imaging of suspected acute appendicitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.