Radiology Commons^™

A Hidden Source Of Ostomy Bleeding: Meckel Diverticulum, Shiva Morisetty, Ezekiel Kapusiak, Kumar Shah

East Florida Division GME Research Day 2025

Adult Meckel diverticulum can present atypically compared to classic childhood Meckel diverticulum. Given the increased likelihood of concurrent medical conditions in adults, it is often overlooked in the differential for lower gastrointestinal bleeding. We report a 61-year-old male with rectal adenocarcinoma status post low anterior resection and diverting loop ileostomy who presented repeatedly with hematochezia via the ostomy. Prior episodes were managed conservatively. During the index admission, esophagogastroduodenoscopy and ileoscopy did not identify a bleeding source; a clip was placed near the suspected site. Interventional radiology was consulted for mesenteric angiography. Superior mesenteric angiography demonstrated a tortuous aberrant ileal branch …

Volvulus Of A Wandering Spleen: A Case Report, Curtis Bethel, Allison Thompson

South Atlantic Division GME Research Day 2025

No abstract provided.

Fatal Overlapping Cns Infections: Radiologic Correlates Of Ventriculitis, Encephalitis, And Meningitis​, Jesse F. Simon, Sara Darwish, Stephanie Nagy, Richard Shalmiyev, David Kosoy, Bryan Rubio, Gustavo Pantol, Mauricio Danckers

East Florida Division GME Research Day 2025

Introduction: This case study explores an uncommon triad of encephalitis, ventriculitis, and meningitis complicated by ischemic strokes and seizures in a COVID-19-positive patient. Prior studies suggest that bacterial meningitis and encephalitis can lead to cerebral infarctions due to inflammation and vascular injury.1,2,5 Ventriculitis, in particular, is rarely observed and typically is seen as a severe complication of meningitis, and can be managed with neurosurgical interventions such as CSF shunt placement, ventricular drains, or other intracranial devices.3,4 The simultaneous presentation of all three conditions in a single patient is rare and poses significant challenges from a diagnostic and management standpoint.

Case …

Tryptophan Kynurenine Pathway-Based Imaging Agents For Brain Disorders And Oncology-From Bench To Bedside, Erik Stauff, Wenqi Xu, Heidi H. Kecskemethy, Sigrid A. Langhans, Vinay V. R. Kandula, Lauren W. Averill, Xuyi Yue

Jefferson Hospital Staff Papers and Presentations

Tryptophan (Trp)-based radiotracers have excellent potential for imaging many different types of brain pathology because of their involvement with both the serotonergic and kynurenine (KYN) pathways. However, radiotracers specific to the kynurenine metabolism pathway are limited. In addition, historically Trp-based radiopharmaceuticals were synthesized with the short-lived isotope carbon-11. A newer generation of Trp-based imaging agents using the longer half-lived and commercially available isotopes, such as fluorine-18 and iodine-124, are being developed. The newly developed amino acid-based tracers have been demonstrated to have favorable radiochemical and imaging characteristics in pre-clinical studies. However, many barriers still exist in the clinical translation of …

Comparing The Patient Shielding Practices For Healthcare Facilities In Southeast Georgia, Genesis Horton

Honors College Theses

Since the discovery of X-rays in 1895, research has consistently been conducted on their capabilities and limitations in healthcare. One primary focus of interest is patient shielding, especially regarding radiation protection and patient safety. Introduced in the mid-1900s, patient shielding has been practiced to protect the gonads, the thyroid, and other radiosensitive body parts. This research project investigated common shielding protocols implemented in healthcare facilities, specifically within Southeast Georgia. This study utilized anonymized in-person interviews with local imaging departments regarding their procedures and protocols for patient shielding. Results from these interviews have been analyzed and compared to shielding best practices …

Hospital Vs Clinic Setting, Hailey Gaines

A with Honors Projects

Being a radiologic technology student means not only showing up to class but also going to clinicals. Clinicals provide hands-on learning with the imaging equipment along with learning anatomy and positioning techniques. Clinicals can help students learn like Asure quotes, “Through clinical practice, students translate theory into real-life experiences thereby allowing them to develop professional clinical attributes, such as professional identity, interpersonal skills, expertise in patient care, practice competence and confidence,” (Asare, 2017) in clinicals, students use the information they learned in class and apply it to either clinic or hospital settings. Hospitals are more faced-paced and see lots of …

Magnetization Transfer Ratio In The Typically Developing Pediatric Spinal Cord: Normative Data And Age Correlation, Sara Naghizadeh Kashani, Iswarya Vel, Zahra Sadeghi Adl, Shiva Shahrampour, Devon Middleton, Mahdi Alizadeh, Laura Krisa, Scott Faro, Slimane Tounekti, Julien Cohen-Adad, Feroze Mohamed

Department of Radiology Faculty Papers

BACKGROUND AND PURPOSE: This study presents automated atlas-based magnetization transfer (MT) measurements of the typically developing pediatric cervical spinal cord (SC). We report normative MT ratio (MTR) values from the whole cervical cord white matter (WM) and WM tracts, examining variations with age, sex, height, and weight.

METHODS: MT scans of 33 healthy females (mean age = 12.8) and 22 males (mean age = 13.09) were acquired from the cervical SC (C2-C7) using a 3.0 T MRI. Data were processed using the SC Toolbox, segmented, and registered to the PAM50 template. Affine and non-rigid transformations co-registered the PAM50 WM atlas …

Risk Analysis Of Radiosurgery For Vestibular Schwannoma: Systematic Review And Comparative Study Of 10-Year Outcomes, Kevin M. Guy, April A. Pace, Derek S. Tsang, Peter G. Volsky

Department of Otolaryngology (ENT) Faculty Publications

Background: Determine the benefit of stereotactic radiosurgery (SRS) compared to no treatment for sporadic vestibular schwannoma (VS) by calculating epidemiologic risk using 10-year data; apply the analysis to VS that have demonstrated linear growth.

Methods: PubMed, Google Scholar, Web of Science, and Cochrane Library are systematically reviewed for VS tumor control 10 years after SRS and compared to an historical cohort of untreated VS (primary risk analysis). Subgroups of VS limited by size and observed growth are compared to the untreated cohort (secondary analysis).

Results: Twenty-four studies of 4,079 SRS-treated VS exhibited tumor control in 90.93% (87.0%-100%; SD 4.1%), while …

Size Of Pediatric Tracheostomy Tube And Predictors Of Postoperative Complications, Soukaina Eljamri, Jordyn Lucas, Amber Shaffer, Basil Hashimi, Marina Rushchak, Reema Padia

Department of Otolaryngology (ENT) Faculty Publications

Objective

(1) To investigate weight as an alternative guide for trach tube choice. (2) Evaluate complications 3-month posttracheostomy and associations with patient and trach tube factors.

Study design

Retrospective cohort study.

Setting

Single academic medical center.

Methods

Patients < 2 years old who underwent tracheostomy placement from 2017 to 2022 were identified. Associations between trach characteristics, trach size/length, chest x-ray (CXR) and intraoperative endoscopy measurements, and complications within 3 months posttracheostomy placement were evaluated.

Results

In total, 68 patients were included in the study, with a median age of 4 months (range: 1 day to 1.74 years) and weight of 4.1 kg (range: 1.8-11.6 kg) at the time of the procedure. The length of the trachea measured on CXR was more closely associated with weight (ρ = 0.403, P = .0007) than with age (ρ = …

Feasibility And Impact Of Knowledge-Based Automated Radiotherapy Treatment Planning In Low- And Middle-Income Countries, Awusi Kavuma, Solomon Kibudde, Yao Hao, Baozhou Sun

Faculty, Staff and Students Publications

Background and purpose: A high-quality treatment planning process is crucial in advanced radiotherapy techniques to ensure adequate dose to the target volume (TV) and sparing of organs at risk (OARs). This process often requires intensive labor, creating barriers for deployment in low- and middle-income countries (LMICs). We aimed to establish the feasibility of implementing knowledge-based auto-planning to facilitate clinical efficiency and increase patient throughput in an LMIC.

Materials and methods: We evaluated 60 randomly selected VMAT manual plans (VMPs), including 10 for each of the following sites: head and neck, oesophagus, breast, prostate, cervical, and rectal cancers. Using the same …

Percutaneous Stenting As Treatment For Chylothorax From Superior Vena Cava Syndrome: A Case Report, Arta Kasaeian, Taylor Hoffman, Mohammad Ghasemi Rad, David Wynne, David Léon

Faculty, Staff and Students Publications

Superior vena cava syndrome is a condition that results from obstruction of the superior vena cava, the etiology of which can be benign or malignant. The impaired venous return can cause facial and upper extremity swelling, dyspnea, and neurologic symptoms. Chylothorax is a rare complication of superior vena cava syndrome. We report a case of a 69-year-old male with end-stage renal disease, who developed both a chylothorax and a contralateral simple pleural effusion secondary to superior vena cava syndrome. He was successfully treated with percutaneous endovascular stenting.

Balancing Regeneration And Resistance: Targeting Dclk1 To Mitigate Gastrointestinal Radiation Injury And Oncogenesis, Landon L. Moore, Jerry Jaboin, Milton L. Brown, Courtney W. Houchen

Department of Medicine Faculty Publications

Ionizing radiation (IR) poses a dual challenge in medicine; while essential for cancer therapy, it inflicts collateral damage to normal tissues, particularly the gastrointestinal (GI) tract. High-dose IR triggers acute radiation syndrome (ARS), characterized by crypt stem cell depletion, mucosal barrier disruption, inflammation, and potential progression to fibrosis and secondary malignancy. Emerging evidence identifies the epithelial kinase doublecortin-like kinase 1 (DCLK1)—highly expressed in GI tuft cells and cancer stem-like cells—as a master regulator of post-IR responses. DCLK1 integrates DNA repair (via p53/ATM), and survival signaling (via NF-κB, TGF-β, and MAPK) to promote epithelial regeneration, yet these same mechanisms contribute to …

Sarcoidosis With Isolated Osseous Manifestations Mimicking Metastatic Malignancy, Ahmed Ismail, Ahmed Saleh, Yanis Boumber

Department of Medicine Faculty Publications

Sarcoidosis is an inflammatory disease of unknown etiology that commonly involves multiple organ systems, with the lungs and lymph nodes most frequently affected. Osseous involvement, although recognized, is considered uncommon and often overlooked due to its nonspecific clinical and radiographic features. Patients may be asymptomatic or present with pain, swelling, and functional limitations of the affected limb. Imaging can reveal findings such as bone lesions that mimic malignancy, including lytic or sclerotic changes. Diagnosis relies on histopathological confirmation of non-caseating granulomas. Treatment is directed at symptom relief and preservation of limb function. Here, we present a rare case of isolated …

Radiologic Technology 50th Year Celebration, Hailey Gaines

A with Honors Projects

Presentation detailing the Radiologic Technology 50th anniversary celebration at Parkland College.

Ultrasound-Guided Percutaneous Needle Barbotage And Ultrasonic Tenotomy For Rotator Cuff Calcific Tendinopathy, Toru Omodani

Rehabilitation Practice and Science

Rotator cuff calcific tendinopathy (RCCT) is a common source of shoulder pain caused by calcium deposits within the rotator cuff tendons. Ultrasound-guided interventions have emerged as effective, minimally invasive alternatives to surgery for symptomatic cases unresponsive to conservative treatments. This review summarizes two primary techniques: percutaneous needle barbotage and percutaneous ultrasonic tenotomy. In needle barbotage, one or two needles are inserted under ultrasound guidance to inject and aspirate saline, thereby fragmenting and removing the calcific deposit. This method yields rapid pain relief and improved shoulder function, with follow-up imaging often demonstrating near-complete deposit resolution. For particularly hard or recalcitrant deposits, …

Automated Segmentation Of The Ulnar Nerve In Mri Using Deep Learning Techniques, Akhil Nagulapalli

Theses

Cubital Tunnel Syndrome (CuTS), a condition caused by compression of the ulnar nerve, results in numbness, tingling, pain, and even muscle atrophy, affecting fine motor skills and diminishing patient quality of life. Accurate diagnosis of CuTS is challenging, as current diagnostic methods—including clinical exams, nerve conduction studies, and unaided MRI—often lack the precision to reliably identify the nerve and detect compression in its early stages. Deep learning-based segmentation offers a promising solution, enabling precise and automated identification of nerve structures in MRI images, which could significantly improve diagnostic accuracy and support timely intervention.

A novel deep learning model for segmenting …

Navigating Rarity: A Case Report On Primary Splenic Lymphoma, Santosh Pv Rai, Skand Rastogi, Anshuman Senapati, Jyoti Kini, Salama Yasmeen

Manipal Journal of Medical Sciences

Primary Splenic Lymphoma (PSL) is a rare condition, which complicates its understanding and definition. The rarity of PSL has led to varied definitions: some consider it primary only if splenomegaly is predominant, while others include spleen involvement with hilar lymph nodes. Documentation on PSL is sparse in Indian literature. This case report of a 48-year-old woman, presenting with fever, weight loss, and left hypochondrium pain, and diagnosed with PSL through CECT abdomen and USG-guided biopsy, contributes to better understanding of the condition.

Unravelling An Unusual Blastoma In An Infant With Confusing Radiological Diagnosis, Arun Viswanathan Dr, Santosh Rai, Harsha Prasad Lashkari, Jayateertha Joshi

Manipal Journal of Medical Sciences

We report an unusual case of an 8-month-old child, who presented to us with a mass per abdomen with confusing imaging characteristics reported as a germ cell tumour / Neuroblastoma.

Patient presented with a large mass per abdomen which had both retroperitoneal and intraperitoneal components and was compressing the adjacent structures and was appearing heterogenous with calcifications within. The more favoured diagnosis on imaging was a peritoneal or retroperitoneal germ cell tumor / Neuroblastoma. Repeated imaging revealed that the mass was abutting / compressing the left lobe of the liver and high AFP beta HCG and LDH values were noted. …

High-Intensity Focused Ultrasound Ablation For Primary Or Salvage Prostate Cancer Therapy: Initial Outcomes In The Veteran Healthcare Setting, Sagar Patel, Ali Antar, Aly Alrabaa, Gal Saffati, Broderick Fleming, Neel Srikishen, Jeremy Slawin, Jennifer Taylor, Jeffrey Jones

Faculty, Staff and Students Publications

High-Intensity Focused Ultrasound (HIFU) provides comparable oncologic, erectile, and urinary outcomes to standard-of-care options for localized prostate cancer. This study reports the largest United States series of HIFU in veterans for both primary and salvage therapies. We retrospectively analyzed the outcomes of 43 veterans treated at the Michael E. DeBakey Veterans Affairs Medical Center from 2018 to 2022. Primary endpoints included prostate-specific antigen (PSA) reduction and local recurrence rates. Secondary endpoints included 30-day complications, Sexual Health Inventory for Men (SHIM), and American Urological Association Symptom Score (AUASS). In our study, 31 veterans (72.1%) received primary treatment and 12 (27.9%) received …

Feasibility Of Large Language Models For Ceus Li-Rads Categorization Of Small Liver Nodules In Patients At Risk For Hepatocellular Carcinoma, Jiayan Huang, Rui Yang, Xiaotong Huang, Keyu Zeng, Yan Liu, Jun Luo, Andrej Lyshchik, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Large language models (LLMs) offer opportunities to enhance radiological applications, but their performance in handling complex tasks remains insufficiently investigated.

PURPOSE: To evaluate the performance of LLMs integrated with Contrast-enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) in diagnosing small (≤20mm) hepatocellular carcinoma (sHCC) in high-risk patients.

MATERIALS AND METHODS: From November 2014 to December 2023, high-risk HCC patients with untreated small (≤20mm) focal liver lesions (sFLLs), were included in this retrospective study. ChatGPT-4.0, ChatGPT-4o, ChatGPT-4o mini, and Google Gemini were integrated with imaging features from structured CEUS LI-RADS reports to assess their diagnostic performance for sHCC. …

Neurofeedback: New Territories And Neurocognitive Mechanisms Of Endogenous Neuromodulation, James Sulzer, T Dorina Papageorgiou, Rainer Goebel, Talma Hendler

Faculty, Staff and Students Publications

Neurofeedback (NF) is endogenous neuromodulation of circumscribed brain circuitry. While its use of real-time brain activity in a closed-loop system is similar to brain-computer interfaces, instead of controlling an external device like the latter, the goal of NF is to change a targeted brain function. In this special issue on NF, we present current and future methods for extracting and manipulating neural function, how these methods may reveal new insights about brain function, applications, and rarely discussed ethical considerations of guiding and interpreting the brain activity of others. Together, the articles in this issue outline the possibilities of NF use …

Discrepancy Between Hyaluronic Acid Levels And Mri-Based Measurements Of Hepatic Fat And Fibrosis, Daniel Aaron Borman, Rachel Chevalier, Jonathan Wagner, Michele T. Pritchard, Sherwin S. Chan, Nathan S. Artz, Johnston Fite, Yoon Cho, Valentina Shakhnovich, Veronica Williams, Voytek Slowik

Posters

Introduction Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease in children in the United States and, when left untreated, can progress to liver fibrosis. Clinicians currently utilize imaging and biopsy to assess fibrosis in this patient population as there is no validated serum biomarker available for detecting fibrosis. Previous research suggests that serum hyaluronic acid levels are predictive of hepatic fibrosis in children with MASLD. Methods Retrospective data were obtained from the Children’s Mercy Hospital Liver Lab study. Pediatric subjects with both hyaluronic acid (HA) samples and MRI evaluation within a month were identified and included for …

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Laura Oh, Rahul Bhat, Michael J Carr, Aditi U Joshi, Bruce M Lo, Ashley C Rider, Lulu Wang, Michael C Wadman, Samuel D Luber

Faculty, Staff and Student Publications

Emergency physicians are well‐positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Polarimetry Terahertz Imaging Of Human Breast Cancer Surgical Specimens, Nikita Gurjar, Keith Bailey, Magda O. El-Shenawee

Electrical Engineering and Computer Science Faculty Publications and Presentations

Purpose

We investigate terahertz (THz) polarimetry imaging of seven human breast cancer surgical specimens. The goal is to enhance image contrast between adjacent tissue types of cancer, healthy collagen, and fat in excised breast tumors. Based on the biological perception of random growth of cancer and invasion of surrounding healthy tissues in the breast, we hypothesize that cancerous cells interact with the THz electric field in a different manner compared with healthy cells. This difference can be best captured using multiple polarizations instead of single polarization.

Approach

Time domain pulsed signals are experimentally collected from each pixel of the specimen …

Synthesis Of Photocleavable Molecules For Neurological Applications, Nishal Madujith Egodawaththa Arachchilage Don

Theses and Dissertations

In recent biomedical research, the precise control of molecular dynamics through light activation has emerged as a powerful tool, particularly in the field of neurobiology. This approach involves the use of photocleavable cages or photoprotective groups (PPGs) that are chemically tethered to biologically active molecules such as neurotransmitters or calcium chelators. These cages remain inert until exposed to specific wavelengths of light, typically in the visible range, triggering the release of the active compound with high spatiotemporal precision.

For neurotransmitter systems, such as glutamate (Glu), which plays a critical role in synaptic transmission and memory formation, researchers have developed novel …

Labrad : Vol 49, Issue 2 - December 2024, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• EDITORIAL
• ARTICLES
• Anti-Glomerular Basement Membrane (GBM) Disease: Pathogenesis, Presentation, and Diagnostic Insights
• Advanced Total Laboratory Automation (TLA) Workflow: A Comprehensive Approach towards High-Throughput Analyzers in Clinical Chemistry
• Precision Under Pressure: Challenges in Therapeutic Drug Monitoring for Immunosuppressants
• Frozen Section: Diagnostic Accuracy, Pitfalls and Use of Digital Pathology
• Working Environment Perspective of a Learner
• AI Training: A Must-Have Skill for Tomorrow’s Radiologists
• Challenges in Blood Supply: Importance of Voluntary Donations
• Leadership Skills and Emotional Intelligence For Professional Capacity Building in Histopathology – A Broad Perspective
• Factor VIII and XI Deficiency; A Finding That Could Have Been Missed-A Case Report
• Accelerated Phase …

Development Of A New Peyronie’S Disease Self-Assessment Screening App, Gregory A Broderick, Jesse N Mills, Lisa Bathish, Christopher Davis, Mohit Khera

Faculty, Staff and Students Publications

Peyronie's disease (PD) is an underdiagnosed and undertreated fibroproliferative disorder associated with the formation of plaques that results in penile curvature and discourages some men from seeking medical consultation. The PD self-assessment app, a digital application (app), was developed to increase PD awareness, provide men with a self-screening and educational tool for PD, and help eliminate barriers to seeking consultation with a physician. Prior to deployment, 4 board-certified urologists provided qualitative reviews on the app's usability and utility as a screening tool. The PD self-assessment app features a questionnaire that addresses penile curvature, challenges with penetration, partner distress, and the …

Impact Of Chatgpt And Large Language Models On Radiology Education: Association Of Academic Radiology-Radiology Research Alliance Task Force White Paper, David H. Ballard, Alexander Antigua-Made, Emily Barre, Elizabeth Edney, Emile B. Gordon, Linda Kelahan, Taha Lodhi, Jonathan G. Martin, Melis Ozkan, Kevin Serdynski, Bradley Spieler, Daphne Zhu, Scott J. Adams

School of Medicine Faculty Publications

Generative artificial intelligence, including large language models (LLMs), holds immense potential to enhance healthcare, medical education, and health research. Recognizing the transformative opportunities and potential risks afforded by LLMs, the Association of Academic Radiology-Radiology Research Alliance convened a task force to explore the promise and pitfalls of using LLMs such as ChatGPT in radiology. This white paper explores the impact of LLMs on radiology education, highlighting their potential to enrich curriculum development, teaching and learning, and learner assessment. Despite these advantages, the implementation of LLMs presents challenges, including limits on accuracy and transparency, the risk of misinformation, data privacy issues, …

Fragile Foundations: Unravelling Osteogenesis Imperfecta, From The Womb To The Afterlife, Santosh Rai, Shreya Matele Dr., Sharada Rai Dr., Urvi Ahlawat, Sunita Hegde Dr., Arvind Natarajan Dr.

Manipal Journal of Medical Sciences

Abstract: We report the case of a 36-year-old multiparous woman whose routine antenatal ultrasound at 28 weeks gestation raised suspicion of severe skeletal dysplasia. At 38 weeks, she presented with decreased fetal movements, and intrauterine fetal demise was confirmed. An emergency cesarean section revealed a stillborn fetus with craniofacial deformities, large head with soft scalp bones, and blackish skin discoloration.

Post-mortem imaging, including CT and X-ray, showed severe skeletal abnormalities, including pneumocephalus, pneumothorax, wormian skull bones, extensive demineralization, spina bifida, and multiple fractures with bowing of long bones. Based on antenatal ultrasound and postnatal radiological findings, a diagnosis of …

Association Between Various Types Of Corticosteroids And Mortality For Severe Community-Acquired Pneumonia In Adults: A Systematic Review And Network Meta-Analysis, Peng Wang, Jun Wan, Qiaoyu You, Yuxin Zheng, Wenhao Xu, Jialing He, Liyuan Peng, Cuyubamba Dominguez Jorge Luis, Yuning Feng, Ping Xu, Xinrong Li, Weelic Chong, Yang Hai, Lu Jia, Fang Fang, Yu Zhang

Department of Medical Oncology Faculty Papers

OBJECTIVE: This study aims to conduct a systematic review and network meta-analysis to evaluate the efficacy and safety of specific corticosteroids, including but not limited to hydrocortisone, methylprednisolone, prednisolone, and dexamethasone, in the treatment of severe community-acquired pneumonia (SCAP). Efficacy will be assessed using specific outcomes, such as 30-day mortality and the requirement for mechanical ventilation. Safety evaluations will include adverse events like gastrointestinal bleeding and healthcare-associated infections. The study seeks to address the gaps identified in the latest guidelines regarding the optimal use of different corticosteroid types and to provide recommendations for clinical practice.

DATA SOURCES: This study conducted …