Digital Commons Network^™

Staphylococcus Aureus Bacteremia In Pediatric Patients: Uncovering A Rural Health Challenge, Kyle J Whittington, Sara M Malone, Patrick G Hogan, Faria Ahmed, Jessieann Flowers, Grace Milburn, John J Morelli, Jason G Newland, Stephanie A Fritz

2020-Current year OA Pubs

BACKGROUND:

METHODS: To investigate factors influencing

RESULTS: Of 251 patients, 69 (27%) were from rural areas; 28 (11%) were initially admitted to an OSH. Treatment failure occurred in 39 (16%) patients. Patients from rural areas were more likely to be infected with methicillin-resistant

CONCLUSIONS: Children from rural areas face barriers to specialized health care. These challenges may contribute to severe illness and worse outcomes among children with

Autologous Humanized Pdx Modeling For Immuno-Oncology Recapitulates Features Of The Human Tumor Microenvironment, Michael Chiorazzi, Bradley Krasnick, Keenan J Robbins, Zachary Skidmore, Jacqueline Mudd, Ye Bi, S Peter Goedegebuure, Malachi Griffith, Obi Griffith, Abimbola Oyedeji, Ryan C Fields, Et Al.

2020-Current year OA Pubs

BACKGROUND: Interactions between immune and tumor cells are critical to determining cancer progression and response. In addition, preclinical prediction of immune-related drug efficacy is limited by interspecies differences between human and mouse, as well as inter-person germline and somatic variation. To address these gaps, we developed an autologous system that models the tumor microenvironment (TME) from individual patients with solid tumors.

METHOD: With patient-derived bone marrow hematopoietic stem and progenitor cells (HSPCs), we engrafted a patient's hematopoietic system in MISTRG6 mice, followed by transfer of patient-derived xenograft (PDX) tissue, providing a fully genetically matched model to recapitulate the individual's TME. …

Enhanced 3d Visualization Of Human Fallopian Tube Morphology Using A Miniature Optical Coherence Tomography Catheter, Hongbo Luo, Shuying Li, Sitai Kou, Yixiao Lin, Ian S Hagemann, Quing Zhu

2020-Current year OA Pubs

We demonstrate the use of our miniature optical coherence tomography catheter to acquire three-dimensional human fallopian tube images. Images of the fallopian tube's tissue morphology, vasculature, and tissue heterogeneity distribution are enhanced by adaptive thresholding, masking, and intensity inverting, making it easier to differentiate malignant tissue from normal tissue. The results show that normal fallopian tubes tend to have rich vasculature accompanied by a patterned tissue scattering background, features that do not appear in malignant cases. This finding suggests that miniature OCT catheters may have great potential for fast optical biopsy of the fallopian tube.

Dietary Patterns Are Not Associated With Disease Activity Among Patients With Inflammatory Conditions Of The Pouch In A Prospective Cohort, Edward L Barnes, Poonam Beniwal-Patel, Parakkal Deepak, Laura Raffals, Maia Kayal, Marla Dubinsky, Shannon Chang, Peter D R Higgins, Jennifer I Barr, Chelsea Anderson, Raymond K Cross, Millie D Long, Hans H Herfarth

2020-Current year OA Pubs

BACKGROUND: Evidence-based recommendations regarding the influence of diet on inflammatory conditions of the pouch after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) are limited.

METHODS: We analyzed dietary patterns at enrollment in a prospective registry of patients with 1 of 4 inflammatory conditions of the pouch (acute pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic refractory pouchitis, and Crohn's disease of the pouch). We analyzed dietary intake by disease activity at enrollment and then compared dietary patterns among patients who remained in remission throughout the 12-month follow-up to those patients who experienced a disease relapse. We also compared dietary patterns among patients …

Healthcare Costs Of Clostridioides Difficile Infection In Commercially Insured Younger Adults, John M Sahrmann, Margaret A Olsen, Matthew R Keller, Holly Yu, Erik R Dubberke

2020-Current year OA Pubs

In a US adult population aged <65 years, attributable costs due to

Ethanolaminephosphate Cytidylyltransferase Is Essential For Survival, Lipid Homeostasis And Stress Tolerance In Leishmania Major, Somrita Basu, Mattie C. Pawlowic, Fong-Fu Hsu, Geoff Thomas, Kai Zhang

2020-Current year OA Pubs

Glycerophospholipids including phosphatidylethanolamine (PE) and phosphatidylcholine (PC) are vital components of biological membranes. Trypanosomatid parasites of the genus Leishmania can acquire PE and PC via de novo synthesis and the uptake/remodeling of host lipids. In this study, we investigated the ethanolaminephosphate cytidylyltransferase (EPCT) in Leishmania major, which is the causative agent for cutaneous leishmaniasis. EPCT is a key enzyme in the ethanolamine branch of the Kennedy pathway which is responsible for the de novo synthesis of PE. Our results demonstrate that L. major EPCT is a cytosolic protein capable of catalyzing the formation of CDP-ethanolamine from ethanolamine-phosphate and cytidine triphosphate. …

Real-World Outcomes Associated With Poly(Adp-Ribose) Polymerase Inhibitor Monotherapy Maintenance In Patients With Primary Advanced Ovarian Cancer, John K Chan, Jinan Liu, Jinlin Song, Cheryl Xiang, Eric Wu, Linda Kalilani, Jean A. Hurteau, Premal H. Thaker

2020-Current year OA Pubs

OBJECTIVE: This study used real-world population data to assess the trends of first-line (1L) poly(ADP-ribose) polymerase inhibitor (PARPi) maintenance treatment uptake and outcomes in patients with primary advanced ovarian cancer (AOC).

METHODS: Patients diagnosed with AOC between January 1, 2017, and June 30, 2021, who completed 1L chemotherapy were selected from a real-world database. Descriptive analyses were performed to evaluate patient demographics, clinicopathological characteristics, and 1L treatment patterns. Time to next treatment or death was used as a proxy for real-world progression-free survival (rwPFS). Kaplan-Meier methods and Cox models were used for statistical analyses.

RESULTS: Of 705 patients who completed …

Safety And Efficacy Of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem From A Phase 2, Randomized Clinical Trial In Pediatric Participants With Complicated Intra-Abdominal Infection, Carl-Christian A. Jackson, Jason Newland, Nataliia Dementieva, Julia Lonchar, Feng-Hsiu Su, Jennifer A. Huntington, Mekki Bensaci, Myra W. Popejoy, Matthew G. Johnson, Carisa De Anda, Elizabeth G. Rhee, Christopher J. Bruno

2020-Current year OA Pubs

BACKGROUND: Ceftolozane/tazobactam, a cephalosporin-β-lactamase inhibitor combination, is approved for the treatment of complicated urinary tract infections and complicated intra-abdominal infections (cIAI). The safety and efficacy of ceftolozane/tazobactam in pediatric participants with cIAI were assessed.

METHODS: This phase 2 study (NCT03217136) randomized participants to either ceftolozane/tazobactam+metronidazole or meropenem for treatment of cIAI in pediatric participants (<18 years). The primary objective was to assess the safety and tolerability of intravenous ceftolozane/tazobactam+metronidazole. Clinical cure at end of treatment (EOT) and test of cure (TOC) visits were secondary end points.

RESULTS: The modified intent-to-treat (MITT) population included 91 participants (ceftolozane/tazobactam+metronidazole, n = 70; meropenem, n = 21). Complicated appendicitis was the most common diagnosis (93.4%); Escherichia coli was the most common pathogen (65.9%). Adverse events (AEs) occurred in 80.0% and 61.9% of participants receiving ceftolozane/tazobactam+metronidazole …

Domain Restriction Zones: An Evolution Of The Military Exclusion Zone, Cole M. Mooty, Robert A. Bettinger, Mark G. Reith

Faculty Publications

Since the early part of the twenty-first century, US adversaries have expanded their military capabilities within and their access to new warfighting domains. When faced with the growth of adversaries’ asymmetric capabilities, the means, tactics, and strategies previously used by the US military lose their proportional effectiveness. To avoid such degradation of capability, the operational concept of the military exclusion zone (MEZ) should be revised to suit the modern battlespace while also addressing the shifts in national policy that encourage diplomacy over military force. The concept and development of domain restriction zones (DRZs) increase the relevancy of traditional MEZs in …

Sherrilyn Denise Clayton

African American Funeral Programs

Sherrilyn_Denise_Clayton.pdf - Funeral program for Sherrilyn Denise Clayton

Free Ferrous Ions Sustain Activity Of Mammalian Stearoyl-Coa Desaturase-1, Jiemin Shen, Gang Wu, Brad S Pierce, Ah-Lim Tsai, Ming Zhou

Faculty, Staff and Student Publications

Mammalian stearoyl-CoA desaturase-1 (SCD1) introduces a double-bond to a saturated long-chain fatty acid in a reaction catalyzed by a diiron center. The diiron center is well-coordinated by conserved histidine residues and is thought to remain with the enzyme. However, we find here that SCD1 progressively loses its activity during catalysis and becomes fully inactive after about nine turnovers. Further studies show that the inactivation of SCD1 is due to the loss of an iron (Fe) ion in the diiron center and that the addition of free ferrous ions (Fe

Apolipoprotein E O-Glycosylation Is Associated With Amyloid Plaques And Apoe Genotype, Paige E Lawler, James G Bollinger, Suzanne E Schindler, Cynthia R Hodge, Nicolas J Iglesias, Vishal Krishnan, John B Coulton, Yan Li, David M Holtzman, Randall J Bateman

2020-Current year OA Pubs

Although the APOE ε4 allele is the strongest genetic risk factor for sporadic Alzheimer's disease (AD), the relationship between apolipoprotein (apoE) and AD pathophysiology is not yet fully understood. Relatively little is known about the apoE protein species, including post-translational modifications, that exist in the human periphery and CNS. To better understand these apoE species, we developed a LC-MS/MS assay that simultaneously quantifies both unmodified and O-glycosylated apoE peptides. The study cohort included 47 older individuals (age 75.6 ± 5.7 years [mean ± standard deviation]), including 23 individuals (49%) with cognitive impairment. Paired plasma and cerebrospinal fluid samples underwent analysis. …

Complete Hydatidiform Mole With A Coexisting Viable Male Fetus Detected By Cell-Free Dna, Mackenzie Lemieux, Lauren Kus, Kali Stewart, Mai He, Jackson Rowe, Matthew Brady, Katherine Bligard, Megan Lawlor, Jeannie Kelly

2020-Current year OA Pubs

Complete hydatidiform mole with coexisting fetus (CHMCF) is rare, and diagnosis is challenging due to limited data. Here, we present the case of a patient with noninvasive prenatal test (NIPT) resulting in "likely molar pregnancy" in the second trimester. Subsequent ultrasound confirmed a cystic appearing portion of the placenta. At 22 weeks, the patient delivered a demised fetus and two placentas. Pathology was consistent with CHMCF. This case is the first to show primary detection of a CHMCF with single-nucleotide polymorphism (SNP)-based NIPT prior to ultrasound identification. Our case suggests the use of SNP-based NIPT as an alternative noninvasive method …

Aga Clinical Practice Update On Interventional Eus For Vascular Investigation And Therapy: Commentary, Marvin Ryou, John M Dewitt, Koushik K Das, Vanessa M Shami

2020-Current year OA Pubs

DESCRIPTION: The purpose of this AGA Institute Clinical Practice Update is to review the available evidence supporting and examine opportunities for future research in endoscopic ultrasound-guided vascular investigation and therapies.

METHODS: This Clinical Practice Update was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important as well as recently published …

Blood Neurofilament Light Levels Predict Non-Relapsing Progression Following Anti-Cd20 Therapy In Relapsing And Primary Progressive Multiple Sclerosis: Findings From The Ocrelizumab Randomised, Double-Blind Phase 3 Clinical Trials, Amit Bar-Or, Anne H Cross, Et Al.

2020-Current year OA Pubs

BACKGROUND: Neurofilament light chain (NfL), a neuronal cytoskeletal protein that is released upon neuroaxonal injury, is associated with multiple sclerosis (MS) relapsing activity and has demonstrated some prognostic ability for future relapse-related disease progression, yet its value in assessing non-relapsing disease progression remains unclear.

METHODS: We examined baseline and longitudinal blood NfL levels in 1421 persons with relapsing MS (RMS) and 596 persons with primary progressive MS (PPMS) from the pivotal ocrelizumab MS trials. NfL treatment-response and risk for disease worsening (including disability progression into the open-label extension period and slowly expanding lesions [SELs] on brain MRI) at baseline and …

Neuroinflammation And White Matter Alterations In Occupational Manganese Exposure Assessed By Diffusion Basis Spectrum Imaging, Susan R Criswell, Susan Searles Nielsen, Irene M Faust, Joshua S Shimony, Robert L White 3rd, Jason Lenox-Krug, Brad A Racette

2020-Current year OA Pubs

OBJECTIVE: To evaluate in-vivo neuroinflammation and white matter (WM) microstructural integrity in occupational manganese (Mn) exposure.

METHODS: We assessed brain inflammation using Diffusion Basis Spectrum Imaging (DBSI) in 26 Mn-exposed welders, 17 Mn-exposed workers, and 26 non-exposed participants. Cumulative Mn exposure was estimated from work histories and the Unified Parkinson's Disease Rating Scale motor subsection 3 (UPDRS3) scores were completed by a movement specialist. Tract-based Spatial Statistics allowed for whole-brain voxel-wise WM analyses to compare WM DBSI-derived measures between the Mn-exposed and non-exposed groups. Exploratory grey matter region of interest (ROI) analyses examined the presence of similar alterations in the …

Associated Radiation Exposure From Medical Imaging And Excess Lifetime Risk Of Developing Cancer In Pediatric Patients With Pulmonary Hypertension, Malini Mahendra, Philip Chu, Elena K Amin, Hythem Nawaytou, James R Duncan, Jeffrey R Fineman, Rebecca Smith-Bindman

2020-Current year OA Pubs

Pediatric patients with pulmonary hypertension (PH) receive imaging studies that use ionizing radiation (radiation) such as computed tomography (CT) and cardiac catheterization to guide clinical care. Radiation exposure is associated with increased cancer risk. It is unknown how much radiation pediatric PH patients receive. The objective of this study is to quantify radiation received from imaging and compute associated lifetime cancer risks for pediatric patients with PH. Electronic health records between 2012 and 2022 were reviewed and radiation dose data were extracted. Organ doses were estimated using Monte Carlo modeling. Cancer risks for each patient were calculated from accumulated exposures …

Postmortem Diagnosis Of Very Long Chain Acyl-Coa Dehydrogenase (Vlcad) Deficiency In A Neonate With Sudden Cardiac Death, Prapti Singh, Deirdre Amaro, Olugbemisola Obi, Fnu Kiran, Erin Hediger, Tomi L Toler, Patricia I Dickson, Dorothy K Grange

2020-Current year OA Pubs

Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is an autosomal recessive long chain fatty acid β-oxidation disorder with a variable clinical spectrum, ranging from an acute neonatal presentation with cardiac and hepatic failure to childhood or adult onset of symptoms with hepatomegaly or rhabdomyolysis provoked by illness or exertion. Neonatal cardiac arrest or sudden unexpected death can be the presenting phenotype in some patients, emphasizing the importance of early clinical suspicion and intervention. We report a patient who had a cardiac arrest and died at one day of age. Following her death, the newborn screen reported biochemical evidence of VLCAD …

Characteristics Of Patients With Pulmonary Arterial Hypertension From An Innovative, Comprehensive Real-World Patient Data Repository, Harrison W Farber, Murali M Chakinala, Michelle Cho, Robert P Frantz, Andrew Frick, Lisa Lancaster, Scott Milligan, Ronald Oudiz, Sumeet Panjabi, Yuen Tsang, Steven D Nathan

2020-Current year OA Pubs

Pulmonary arterial hypertension (PAH) is a rare, life-limiting disease. PAH registries provide real-world data that complement clinical trial data and inform treatment decisions. The TRIO comprehensive, integrated patient data repository (TRIO CIPDR), is an innovative US repository capturing data on contemporary patients diagnosed with pulmonary hypertension and receiving US Food and Drug Administration-approved PAH therapies. This repository uniquely combines clinical data from electronic medical records with the ability to track drug-prescription and drug-dispensing characteristics, and includes 946 adult patients with PAH (data collected January 2019 to December 2020) enrolled from nine representative US specialist tertiary care centers. Potentially eligible patients …

A Word From The Writing Team (July 2023), Pam Walter, Mfa, Liz Declan, Ma, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• Academic Commons Launches New Website
• Publication Spotlight
• Reminders
• First Friday Writing Retreat Hiatus
• Scott Renovations and You
• MS4 Residency Personal Statement Workshops

Biological Flora Of Coastal Freshwater And Brackish Marshes: Cladium Jamaicense Crantz, Richard Stalter, Robert I. Lonard

School of Integrative Biological & Chemical Sciences (Formerly Dept. of Biology)

Cladium jamaicense Crantz, also known as sawgrass, has a broad distributional range from the Atlantic coast of Virginia to Florida, to southern Texas, the Caribbean, and along the Atlantic coast of Mexico to Central America, and to Brazil. Cladium jamaicense typically occurs in oligotrophic sloughs and fresh and brackish marshes where optimal salinity values range from 0 to 3.5 ppt. This species is a long-lived perennial with a highly developed rhizome system with rhizomes up to 20 cm long and 2.5 to 10 mm in diameter. Asexual reproduction is common. Its fibrous root system comprises short dauciform roots characterized by …

Covering By Planks And Avoiding Zeros Of Polynomials, Alexey Glazyrin, Roman Karasev, Alexandr Polyanskii

School of Mathematical & Statistical Sciences Faculty Publications

We note that the recent polynomial proofs of the spherical and complex plank covering problems by Zhao and Ortega-Moreno give some general information on zeros of real and complex polynomials restricted to the unit sphere. As a corollary of these results, we establish several generalizations of the celebrated Bang plank covering theorem. We prove a tight polynomial analog of the Bang theorem for the Euclidean ball and an even stronger polynomial version for the complex projective space. Specifically, for the ball, we show that for every real nonzero d-variate polynomial P of degree n⁠, there exists a point in the …

Integrable Discretizations For A Generalized Sine-Gordon Equation And The Reductions To The Sine-Gordon Equation And The Short Pulse Equation, Han-Han Sheng, Bao-Feng Feng, Guo-Fu Yu

School of Mathematical & Statistical Sciences Faculty Publications

In this paper, we propose fully discrete analogues of a generalized sine-Gordon (gsG) equation utx=(1+ν∂2x)sinu. The bilinear equations of the discrete KP hierarchy and the proper definition of discrete hodograph transformations are the keys to the construction. Then we derive semi-discrete analogues of the gsG equation from the fully discrete gsG equation by taking the temporal parameter b→0. Especially, one full-discrete gsG equation is reduced to a semi-discrete gsG equation in the case of ν=−1 (Feng {\it et al. Numer. Algorithms} 2023). Furthermore, N-soliton solutions to the semi- and fully discrete analogues of the gsG equation in the determinant form …

Contractive Symmetric Matrix Completion Problems Related To Graphs, Sangmin Chun, In Hyoun Kim, Jaewoong Kim, Jasang Yoon

School of Mathematical & Statistical Sciences Faculty Publications

In this paper, we consider the contractive real symmetric matrix completion problems motivated in part by studies on sparse (or dense) matrices for weighted sparse recovery problems and rating matrices with rating density in recommender systems. We completely characterize symmetric patterns P with the property (C) that every partially contractive real symmetric matrix with pattern P has a contractive real symmetric completion using graphs.

Er Translocon Inhibitor Ipomoeassin F Inhibits Triple-Negative Breast Cancer Growth Via Blocking Er Molecular Chaperones, Shishi Tao, Eun Ju Yang, Guanghui Zong, Pui Kei Mou, Guowen Ren, Liang Chen, Ho Jeong Kwon, Jianhong Zhou, Zhijian Hu, Arman Khosravi, Qingyang Zhang, Yuchun Du, Wei Q. Shi, Joong Sup Shim

Biological Sciences Faculty Publications and Presentations

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer where no effective therapy has been developed. Here, we report that the natural product ER translocon inhibitor ipomoeassin F is a selective inhibitor of TNBC cell growth. A proteomic analysis of TNBC cells revealed that ipomoeassin F significantly reduced the levels of ER molecular chaperones, including PDIA6 and PDIA4, and induced ER stress, unfolded protein response (UPR) and autophagy in TNBC cells. Mechanistically, ipomoeassin F, as an inhibitor of Sec61α-containing ER translocon, blocks ER translocation of PDIA6, inducing its proteasomal degradation. Silencing of PDIA6 or PDIA4 by RNA interferences …

A Dynamical Systems Approach To Characterizing Brain–Body Interactions During Movement: Challenges, Interpretations, And Recommendations, Derek C. Monroe, Nathaniel T. Berry, Peter C. Fino, Christopher K. Rhea

Rehabilitation Sciences Faculty Publications

Brain–body interactions (BBIs) have been the focus of intense scrutiny since the inception of the scientific method, playing a foundational role in the earliest debates over the philosophy of science. Contemporary investigations of BBIs to elucidate the neural principles of motor control have benefited from advances in neuroimaging, device engineering, and signal processing. However, these studies generally suffer from two major limitations. First, they rely on interpretations of ‘brain’ activity that are behavioral in nature, rather than neuroanatomical or biophysical. Second, they employ methodological approaches that are inconsistent with a dynamical systems approach to neuromotor control. These limitations represent a …

Impacts Of Land Use On Stormwater Runoff In The Lower Rio Grande Valley And Improving Long Term Municipal Stormwater Management Systems, Maria Vanessa Pruneda

Theses and Dissertations

Exponentially noticeable growth in population and land development in the Lower Rio Grande Valley has directly influenced growth in urbanization. Urbanization is the leading cause for lower pervious cover, and the increase in storm water runoff. The increase of storm water runoff leads to excess flooding areas and higher peak flows. The overflow flows freely and is exposed to contaminants, affecting the consumption and use factors. The changes of land use have a direct relationship with impervious cover limitations and individual site retentions. This study will assess the relationship between stormwater quantity and land use in the Lower Rio Grande …

Utrgv Edinburg Campus Two-Dimensional Flood Modeling For Development Of Flood Inundation Map, Roxana Tello

Theses and Dissertations

Severe flooding is a natural hazard worldwide, potentially subjecting people to life threatening situations and leaving infrastructure vulnerable to structural damage or complete destruction. The common threat of flooding poses constant challenges for state and local agencies in identifying flood risks and proposing the necessary mitigation improvements. Developing hydraulic models to predict the hydrological interactions and identify areas at risk is a beneficial tool for urban planning. The Lower Rio Grande Valley (LRGV) is a rapid growing region in South Texas along the border of Mexico and west of the Gulf of Mexico. The LRGV has historically suffered through various …

Measuring Social Vulnerability And Exposure To Potential Risks Induced By Spaceport Operations In South Texas: An Empirical Study Utilizing Gis Methods And Social Vulnerability Indicators, Evan D. Garcia

Theses and Dissertations

The commercialization of space has increased spaceport development and activity across the United States. The magnitude of growth can be witnessed through the spaceport expansion and spacecraft testing at the SpaceX “Starbase” Launch Facility, located along the Texas-Mexico border. Matching the pace of SpaceX’s growth while evaluating levels of risk, the Federal Aviation Administration (FAA) diligently conducted a comprehensive Programmatic Environmental Assessment (PEA). While this assessment provides significant environmental impact data and risk analysis, much is left to understand regarding hazards and risk exposure to local communities. More specifically, research is needed to understand hazards associated with operational- and anomaly- …

Spatiotemporal Modulated Non-Hermitian Structures And Their Application In Photonic Devices, Amir Targholizadeh

Theses and Dissertations

Periodically refractive index modulation has been known as a novel method to introduce non-reciprocity in optical lattices inspiring many works to propose on-chip optical components such as optical insulators and amplifiers. This type of modulation by coupling two waveguide propagating modes, let them exchange a population called photonic intraband transition. This modulation type also can be applied to the imaginary part of the refractive index, which perturbs the absorption in the waveguide. Non-hermitian physics is a promising field that studies physical effects in such systems without energy conservation. These systems have degeneracy points called Exceptional points in which two or …