Anatomy Commons^™

Cholesterol Crystal Embolization Induced Kidney Disease, Shohan Pervaze, Shreya Mohandas, Pushkas Gopalan, Stephen A. Morse, Siddhartha Bajracharya, Landon A. Krone, Farshid Yazdi

School of Medicine Faculty Publications

Cholesterol crystal embolization (CCE) results from the release of cholesterol crystals from ruptured atherosclerotic plaques into circulation, resulting in the occlusion of small arteries and arterioles in various organs. Ischemia triggers a systemic inflammatory response resulting in vascular obstruction and organ dysfunction. Kidneys are often involved because of the proximity to the aorta and CCE in the kidneys can result in acute, sub-acute, or chronic kidney disease. There are many known risk factors for renal involvement of CCE, including iatrogenic and spontaneous causes. The pathophysiology of CCE includes complex pathways that lead to acute and chronic effects that can have …

Unusual Wave Morphologies In Ulnar Neuropathy With Marinacci Anastomosis: A Case Report, Micaela Owens

Marshall Journal of Medicine

Marinacci anastomosis is a normal but rare anatomic variant of the median and ulnar nerves, consisting of an interconnection from the ulnar nerve to the median nerve within the proximal forearm. This is a case of Marinacci anastomosis occurring in the presence of both median and ulnar neuropathies, producing unusual waveform characteristics. Knowledge of normal anatomic variation can improve diagnostic accuracy in nerve conduction studies.

"Star Sign" Of Subarachnoid Hemorrhage, Shivani Ruf

Florida Journal of Emergency Medicine (FJEM)

A 60-year-old female who was brought to the emergency department after a syncopal episode. She was found to have a subarachnoid hemorrhage (SAH) from a ruptured anterior communicating artery aneurysm. Her CT showed the classic "star sign" of SAH.

Concurrent Presentation Of An Anomalous Right Coronary Artery And An Unusual Bovine Arch: Case Report, Vasiliki Tasouli-Drakou, Jasmine Dugal, Divuansh Sharma, Kachon Lei, Chowdhury Ahsan

Department of Internal Medicine Faculty Research

Anomalous coronary arteries from the opposite sinus of Valsalva are rare but can increase the risk for life-threatening complications. We present the case of a 59-year-old man who was found to have an anomalous right coronary artery and a rare bovine arch variant with a single common brachiocephalic trunk, along with severe proximal left anterior descending artery stenosis on left heart catheterization. The patient underwent a minimally invasive coronary artery bypass graft and unroofing of the anomalous coronary artery. To our knowledge, this is the first reported case of these concurrent anomalies in an individual without tetralogy of Fallot.

Vibration-Based Detection For The Monitoring Of Neonatal Bcpap Respiratory Support To Minimize Duration Of Disconnections, Kaitlyn G. Calabresi, Meera R. Bhat, Lavinia L. Kong, Eli J. Foster, Jonathan Wang, Sangeeta Koilada, Angela Mak, Aastha Kapadia, Niam Mohseni, W. Keith Leung, Suneetha Desiraju, Constanza Miranda

School of Medicine Faculty Publications

Bubble continuous positive airway pressure (bCPAP) is a minimally invasive respiratory support for neonates experiencing respiratory distress syndrome (RDS). It exerts continuous, oscillatory air pressure to encourage lung function and development. Neonates’ movement may cause disconnections at the nasal interface. These disconnections are characterized by the cessation of bubbling at the bCPAP respiratory circuit output and frequently go unnoticed until hypoxia develops. Common Neonatal Intensive Care Unit (NICU) bCPAP systems lack a built-in alarm or accessory device to monitor for disconnections. As a result, nursing personnel must exercise extreme caution utilizing current bCPAP procedure. If a neonate is disconnected, it …

Cilia In The Brain Display Region-Dependent Oscillations Of Length And Orientation, Roudabeh Vakil Monfared, Sherif Abdelkarim, Pieter Derdeyn, Kiki Chen, Hanting Wu, Kenneth Leong, Tiffany Chang, Justine Lee, Sara Versales, Surya M. Nauli, Kevin Beier, Pierre Baldi, Amal Alachkar

Pharmacy Faculty Articles and Research

In this study, we conducted high-throughput spatiotemporal analysis of primary cilia length and orientation across 22 mouse brain regions. We developed automated image analysis algorithms, which enabled us to examine over 10 million individual cilia, generating the largest spatiotemporal atlas of cilia. We found that cilia length and orientation display substantial variations across different brain regions and exhibit fluctuations over a 24-h period, with region-specific peaks during light-dark phases. Our analysis revealed unique orientation patterns of cilia, suggesting that cilia orientation within the brain is not random but follows specific patterns. Using BioCycle, we identified rhythmic fluctuations in cilia length …

Distinct Echinocandin Responses Of Candida Albicans And Candida Auris Cell Walls Revealed By Solid-State Nmr, Malitha C. Dickwella Widanage, Kalpana Singh, Jizhou Li, Jayasubba Reddy Yarava, Faith J. Scott, Yifan Xu, Neil A.R. Gow, Frederic Mentink-Vigier, Ping Wang, Frederic Lamoth, Tuo Wang

School of Graduate Studies Faculty Publications

Invasive candidiasis affects 1.6 million people annually, with high mortality among immunocompromised and hospitalized patients. Echinocandins are frontline antifungals, but rising resistance limits their efficacy. Here, we show that Candida albicans and multidrug-resistant Candida auris share a conserved cell wall architecture yet differ markedly in their adaptive responses to echinocandins. Solid-state NMR reveals that both species possess a rigid inner layer of tightly associated chitin microfibrils and β−1,3-glucans, supported by a flexible matrix of β−1,6-glucans and additional β−1,3-glucans. Outer mannan fibrils rely on α−1,2-linked sidechains to maintain contact with the inner wall. In both species, caspofungin rigidifies β−1,6-glucans and mannan …

The Articularis Genu As A Surrogate For Structural Determinants Of Peri-Articular Myopenia In Osteoarthritis, Davis Martin, José A.Cruz Ayala, Mary C. Gatterer, Tara Soria, Ryan Schroeder, Vinod Dasa, Luis Marrero

School of Medicine Faculty Publications

The functional limitations associated with the painful stiffness of knee osteoarthritis (kOA) can affect the muscles of the knee, such as the quadriceps femoris (QF) and articularis genu (AG). The vastus medialis oblique (VMO) of the QF complex is particularly sensitive to kOA. The AG, which can be sampled during total knee arthroplasty (TKA) for kOA, can provide information about the condition of the QF when affected by patient-reported disuse, helping to identify indicators of muscle weakness in the synovial fluid. This study compares the structural and gene expression changes between the VMO and the AG collected from patients with …

Mesenchymal Stem Cell-Derived Extracellular Vesicles: Seeking Into Cell-Free Therapies For Bone-Affected Lysosomal Storage Disorders, Andrés Felipe Leal, Harry Pachajoa, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Lysosomal storage disorders (LSDs) constitute a group of monogenic systemic diseases resulting from deficiencies in specific lysosomal enzymes that cause the intralysosomal accumulation of non- or partially degraded substrates, leading to lysosomal dysfunction. In some cases of LSDs, the bone is more severely affected, thus producing skeletal manifestations in patients. Current therapies, such as enzyme replacement therapy (ERT) and gene therapy (GT), show limited efficacy in correcting skeletal abnormalities. Increasing evidence suggests that microenvironmental disturbances also contribute significantly to disease pathogenesis. Therefore, therapeutic strategies targeting lysosomal dysfunction and microenvironmental dysregulation are needed. Mesenchymal stem-cell-derived extracellular vesicles (MSC-EVs) are emerging as …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Advances In Mechanical Circulatory Support (Mcs): Literature Review, Jasmine K. Dugal, Arpinder S. Malhi, Yuvraj Singh, Rooz Razmi, Joshua Vance, Divyansh Sharma

Department of Internal Medicine Faculty Research

Heart failure is a heterogeneous disorder that can lead to cardiogenic shock. Mechanical circulatory support (MCS) devices can replace the cardiac function in an attempt to bridge patients to transplant or they can serve as destination therapy to improve overall patient functionality and in turn quality of life. Currently utilized MCS devices include devices such as Left Ventricular Assist Devices (LVADs), Biventricular Assist Devices (BiVADs), Impella, Total Artificial Hearts (TAHs), and extracorporeal membrane oxygenation (ECMO). This literature review examines a range of studies, case reports, and meta-analyses to present current approaches to mechanical circulatory support (MCS), along with the challenges …

Psoriasis Genomics: A Review, Magna Hutasuhut, Windy Keumala Budianti, Wresti Indriatmi, Mirawati Setyorini

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Psoriasis is a dermatological condition influenced by genetic and epigenetic factors, environmental triggers, as well as immune responses. Genomics refers to the study of individual genes (genomes) and their interactions with environmental influences. In the context of psoriasis genomics, the interplay between genetic predisposition and environmental factors contributes to the manifestation and variations of the disease. With advancements in molecular genotyping technology and genome-wide association studies (GWASs), researchers have identified 50 genetic markers linked to psoriasis.

Discussion: Several genetic loci associated with psoriasis have been identified, including PSORS 1-15. The genetics of psoriasis is also linked to its onset, …

Factors Associated With The Severity Of Erythema Nodosum Leprosum Reactions, Ita Anggraini, Prima Kartika Esti, Eka Komarasari

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Leprosy is a chronic infection caused by Mycobacterium leprae. Leprosy reactions, including erythema nodosum leprosum (ENL), are induced by immune responses. ENL can cause neurological damage and deformities that result in disabilities. This study aimed to identify factors associated with the severity of ENL to help control the leprosy reactions.

Methods: This was an analytical study on 148 patients with ENL reactions, who were divided into two groups based on the severity of their reactions. A retrospective cross–sectional study was conducted in the medical record unit of Sitanala Hospital, Tangerang, Banten, Indonesia, from May 2022 to …

Effectiveness Of 5% Channa Striata Extract Gel In Wound Healing: A Double-Blind Randomized Controlled Trial, Yulia Farida Yahya, Yuli Kurniawati, Erial Bahar, Theresia Lumban Toruan, Soenarto Kartowigno, Muhammad Izazi Hari Purwoko, Tiar Marina Octyvani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Snakehead fish (Channa striata, CS) has traditionally been used in Indonesia as a nutrient to promote wound healing. It contains protein highly similar to human protein, which may be involved in wound healing via biological pathways. We aim to determine the effectiveness of the topical 5% CS extract gel in promoting wound healing.

Methods: A double-blind, placebo-controlled randomized clinical trial was conducted from June to August 2022 at the Department of Dermatology, Venereology, and Aesthetics of Dr. Mohammad Hoesin Hospital. We allocated 32 post-skin surgery participants with grade I acute superficial wounds on the face, neck, …

Topical Application Of Exosomes In A Patient With Acne Conglobata: A Case Report, Theressia Handayani, Stefani Luziani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Acne conglobata (AC) is a rare and severe acne characterized by interconnected nodules, cysts, and abscesses. Mesenchymal stem cell-derived exosomes (MSC-exosomes) have immunosuppressive properties that alleviate inflammation and immunological reactions. We present a case of AC in a patient who received topical administration of exosomes.

Case Illustration: A 20-year-old male was diagnosed with AC, presenting as inflammatory papules and cysts covered with yellowish crusts that had been present for five months. Exosomes (ASCE+®, Seoul, South Korea) were topically administered at a dose of 5 mL, applied evenly to the face. The patient underwent three treatment sessions, with a …

Herpes Zoster Reactivation Following Covid-19 Mrna Vaccination In An Elderly Patient: A Case Report, Ratu Siti Khadijah Sarah, Yari Castiliani Hapsari, Shannaz Nadia Yusharyahya, Eliza Miranda, Sarah Qanita Edwar

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Latent varicella-zoster virus (VZV) in nerve ganglia may reactivate into herpes zoster infection. The coronavirus disease (COVID-19) vaccine is suspected of triggering VZV reactivation, although the exact cause is unclear. This case report aims to raise awareness of the potential complications induced by the COVID-19 mRNA vaccine, particularly in elderly patients.

Case Illustration: A 62-year-old woman complained of itchy and painful unilateral dermatomal herpetiform blisters six days after mRNA COVID-19 vaccination. The vesicle first appeared on the left breast, spreading to the back. The patient has a history of hypertension. After the administration of 800 mg of acyclovir five …

Serial Excision Of A Nevus Sebaceous Of Jadassohn On The Scalp, Belladikna Brillianty Sugiatno, Arif Widiatmoko, Adinda Amalia Dani, Diah Prabawati Retnani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Nevus sebaceous of Jadassohn (NSJ) is a non-hereditary hamartoma of the skin’s adnexal structures. The incidence of NSJ in newborns is estimated at 0.1-0.3% with no gender or ethnic propensity. Surgical excision is a common treatment for NSJ, although there is no definite consensus on the timing or recommendations for the removal. This article aims to present the advantages of serial excision therapy in a case of NSJ.

Case Illustration: A 14-year-old male presented with a complaint of a bump on the scalp since birth, which had progressively enlarged during puberty. Dermatological examination revealed a well-demarcated, yellow-orange …

Validity And Reliability Of The Indonesian Version Of Nordic Occupational Skin Questionnaire 2002 (Nosq-2002), Listya Paramita, Fajar Waskito, Dikky Prawiratama, Niken Indrastuti, Tuntas Rayinda, Sri Awalia Febriana

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Epidemiological data on occupational hand eczema in Indonesia is still limited, partly because there are no valid and reliable instruments in the Indonesian language as a means of survey. This study aims to translate the Nordic Occupational Skin Questionnaire 2002 (NOSQ-2002) into the Indonesian language and assess the validity and reliability of the Indonesian NOSQ-2002 as an instrument for epidemiological surveys and screening of occupational hand eczema.

Methods: The original English version of NOSQ-2002 was translated into the Indonesian language following the standard procedure of translation. The Indonesian NOSQ-2002 version, which had been collectively approved, was subsequently completed by …

Comparing Sodium Fusidate And Petrolatum For Electrosurgery-Related Wound Healing: A Double-Blind Randomized Controlled Trial, Firman Parrol, Larisa Paramitha Wibawa, Irma Bernadette Simbolon Sitohang, Siti Rizny Fitriana Saldi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Electrosurgery is a common surgical technique used to treat skin tumors. This procedure produces necrotic skin, which might impair the wound healing process, prompting physicians to prescribe topical antibiotics to prevent infection. This study aims to analyze the efficacy of sodium fusidate ointment compared to petrolatum for wound healing after electrosurgery.

Methods: We conducted a double-blind, randomized, controlled study with a within-person design. The inclusion criteria were adult subjects with seborrheic keratosis or acrochordon with a size of 4 mm to 10 mm on the face and neck, with a minimum of 2 lesions. Electrodessication was performed on the …

Skin Rejuvenation With Microbotox: A Review, Ifen Ayu Malinda, Nelva Karmila Jusuf

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Skin aging is characterized by a gradual loss of tissue and organ function. Skin aging can be classified into two types: intrinsic aging, associated with the aging process itself, and extrinsic aging, which is linked to external factors. Microbotox—an intradermal injection of diluted botulinum toxin—has emerged as a promising technique for rejuvenation by improving skin texture, pore size, and sebum control. This review aims to provide a comprehensive overview of the microbotox technique in the context of skin aging, emphasizing its mechanisms, indications, and clinical outcomes.

Discussion: In Asia, intradermal injection of botulinum toxin or microbotox has been widely …

Partial Least Squares Multimodal Analysis Of Brain Network Correlates Of Language Deficits In Aphasia, Sigfus Kristinsson, Dirk B. Den Ouden, Chris Rorden, Roger Newman-Norlund, Lisa Johnson, Janina Wilmskoetter, Ezequiel Gleichgerrcht, Argye E. Hillis, Gregory Hickok, Julius Fridriksson, Leonardo Bonilha

Communication Sciences and Disorders Faculty Articles and Research

Lesion-symptom mapping techniques are essential to determine brain regions critical for language functions. However, high collinearity in neuroimaging and behavioural data remains a challenge for distinguishing neural substrates supporting multiple language domains (shared variance) and those subserving specific language functions (unique variance). Here, we employed a novel approach to multimodal lesion-symptom mapping using multivariate partial least squares regression to delineate the latent structure of lesion-behavioural mapping in aphasia and decompose the shared and unique neural determinants of language impairments. A total of 86 participants with chronic (>12-month post-stroke) aphasia after left hemisphere strokes were examined. Language impairment was assessed …

Early Recurrent Midgut Volvulus Post Ladd's Procedure In A Newborn: A Case Report, Nicole Clarke, Joanna Sajdlowska, John Paul Bustamante, Nishith Bhattacharyya

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Ladd's procedure is the standard surgical intervention for intestinal malrotation. Although generally curative, rare cases of early postoperative complications, including adhesions or recurrent volvulus, can necessitate reoperation. We present the case of a full-term newborn girl who underwent emergent Ladd's procedure on Day 3 of life for malrotation with volvulus. She was discharged on postoperative Day 17 but returned the following day with recurrent bilious emesis. Imaging suggested partial obstruction. Exploratory laparotomy revealed recurrent volvulus with two twists at the duodenojejunal junction, which was successfully reduced. The patient recovered well and was discharged on postoperative Day 8. This case underscores …

The "Dual-Port" Approach To The Posterior Incisura: A Quantitative Cadaver Study Of A Combined Endoscopic Paramedian Supracerebellar Infratentorial And Occipital Interhemispheric Transtentorial Approach, Wesley Shoap, Ezequiel Goldschmidt, Roberto Rodriguez Rubio

School of Medicine Faculty Publications

BACKGROUND: The posterior incisura is a deep and surgically challenging area with complex neurovasculature. Endoscopic paramedian supracerebellar infratentorial approaches (EPSCITAs) have improved access and visualization of this region. However, endoscope and instrument conflict within this deep and narrow corridor remains a key limitation. This study evaluates the feasibility of a combined EPSCITA and endoscopic occipital interhemispheric transtentorial approach (EOIHTTA) with the aim of improving surgical freedom and visualization in this region. METHODS: Five embalmed and latex-injected cadaveric donors were dissected bilaterally (10 sides total). Measurements were taken at the EPSCITA port and then were repeated after addition of the EOIHTTA …

Molecular Mechanisms Of L-Type Calcium Channel Dysregulation In Heart Failure, Arbab Khalid, Abu-Bakr Ahmed, Randeep Gill, Taha Shaikh, Joshua Khorsandi, Ali Kia

Department of Internal Medicine Faculty Research

The L-type calcium channels (LTCCs) function as the main entry points that convert myocyte membrane depolarization into calcium transients, which drive every heartbeat. There is increasing evidence to show that maladaptive remodeling of these channels is the cause of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Recent experimental, translational, and clinical studies have improved our understanding of the roles LTCC expression, micro-domain trafficking, and post-translational control have in disrupting excitation–contraction coupling, provoking arrhythmias, and shaping phenotype specific hemodynamic compromise. We performed a systematic search of the PubMed and Google Scholar databases (2015–2025, …

The Evolvement Of The 100 Most Cited Articles In Spine Surgery In The Last Decade Compared To All-Time, Mark Miller, Matthew Meade, Ruchir Nanavati, William T Diciurcio, Maneesha Palakurthi, Adam Kohring, Justin Le, Christopher Giuditta, Christopher Kepler, Barrett Woods

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Decision-making in spine surgery is continuously shaped by advancements in the field through evidence-based medicine. This is demonstrated through the evolution of the quality and impact of scientific research within the field of spine surgery. To date, there is limited literature investigating interval changes in methodological rigor of scientific investigation within the field of spine surgery.

METHODS: The top 100 cited articles were recorded for manuscripts from January 1, 2013, to December 31, 2023, and the top 100 most cited manuscripts of all time for spine surgery, via the Scopus abstract and citation database. Data collected included year of …

Gust, Stroll, Veil, Jungeun Park

Masters Theses

I witness the unsettling and chaotic moments of everyday life:

blood clots in fried eggs, a dead rat on my porch, mites crawling on our skin . . .

These quiet tragedies exist with almost brutal indifference!

We eat, digest, excrete. We menstruate. We parasitize. We coexist.

I seek the intersection of repulsion and wonder in my daily experience and body sensations, visualizing unseen stimuli. I employ veil as a strategy. It conceals yet reveals. Sometimes, it acts as a transparent layer, sharpening what lies beneath. Other times, it blurs colors and forms, rendering them ambiguous. Veil transforms, entices, and …

Field Journal: The Excluded Middle, Carrie E. Kouts

Masters Theses

What does it look like to engage with organisms and landscapes at the periphery of anthropocentric value structures? How does one break the internalized myth that the “built” environment is excluded from the natural world? When does a hyper-mobile and hyper-commodified society confront the exponential crisis of animal death? Within this series of journal entries, field notes, collection observations, weird prose, and sensory musings, one will find questions on the nature of being human and the complex narratives of care we encounter in a world shared with more-than-humans. Each handwritten vignette and photograph from daily life weaves a non-linear and …

Benchmarking Machine Learning Models In Lesion-Symptom Mapping For Predicting Language Outcomes In Stroke Survivors, Deepa Tilwani, Christian O'Reilly, Nicholas Riccardi, Valerie L. Shalin, Dirk B. Den Ouden, Julius Fridriksson, Svetlana V. Shinkareva, Amit P. Sheth, Rutvik H. Desai

Communication Sciences and Disorders Faculty Articles and Research

Several decades of research have investigated the neural connections between stroke-induced brain damage and language difficulties. Typically, lesion-symptom mapping (LSM) studies that address this connection have relied on mass univariate statistics, which do not account for multidimensional relationships between variables. Machine learning (ML) techniques, which can capture these intricate connections, offer a promising complement to LSM methods. To test this promise, we benchmarked ML models on structural and functional MRI to predict aphasia severity (N = 238) and naming impairment (N = 191) for a cohort of chronic-stage stroke survivors. We used nested cross-validation to examine performance along …

The Role Of G6pd Variants And 3d Genomic Structure In The Development Of Pulmonary Hypertension, Christina M. Signoretti Ph.D.

NYMC Student Theses and Dissertations

Pulmonary hypertension is an under-recognized global health epidemic which is estimated to affect 1% of the population. It is associated with sustained mean pulmonary artery pressure greater than 20 mmHg, pulmonary artery remodeling, smooth muscle and endothelial cell proliferation and subsequent increased right ventricle hypertrophy due to increased afterload. Glucose-6-phosphate dehydrogenase (G6PD) is one of the key enzymes in the pentose phosphate pathway and has been previously linked to the development of pulmonary hypertension. G6PD deficiency is the most common human enzymopathy which affects approximately 400 million people worldwide and is a result of agricultural and epidemiological evolution in different …

Are Cycles Of Neural Activity The Algorithm Of The Brain?, Edwin Omondi Onyango

Computer Science Senior Theses

We propose that precisely timed neural activity cycles can serve as structural primitives for memory and computation in a system that exhibits associative learning like the brain. Inspired by biologically grounded mechanisms such as calcium-dependent plasticity, spike-timing-dependent learning, and phase-sensitive excitability, we construct a spiking neural network model in which repeated temporal coincidences drive the formation of self-sustaining activity loops. These cycles, once formed, persist as dynamic memory traces: not stored as static weights, but as reverberating patterns that replay in time when these loops are restarted. We show that noise alone fails to induce stable structure, but even sparse, …