Psychiatry and Psychology Commons^™

Ropinirole-Induced Sleep-Related Behavioral Disturbances And Psychotic Symptoms In Parkinson's Disease: A Case Report, Kareena Arora, Akshatha C. J, Rajesh Raman, Vikrant Arora, Bindu Annigeri, Megha Sadashiv

Digital Journal of Clinical Medicine

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms such as bradykinesia, rigidity, and tremor. Though commonly associated with motor symptoms but can also present with significant non-motor symptoms such as sleep disturbances, psychosis, and cognitive decline. These symptoms may arise spontaneously or be medication-induced. We present the case of a 53-year-old male with Parkinson’s disease who developed nocturnal behavioural disturbances and psychotic features, likely secondary to dopaminergic agonist medication. Symptom resolution followed adjustment of antiparkinsonian medications and the introduction of antipsychotic medication

Unusual Case Of Pelvic Fracture Urethral Distraction Defect, Varuni Pragya, Madhukesh Rudramurthy, Siddalinga Murthy G

Digital Journal of Clinical Medicine

INTRODUCTION

Urinary bladder ruptures are an uncommon injury, occurring in less than 1% of all blunt abdominal trauma. Extraperitoneal bladder ruptures are generally associated with pelvic fractures and usually managed nonoperatively but open surgery is required when these injuries are associated with additional trauma to structures like prostate and urethra.

CASE PRESENTATION

We report our experience with a 32-year-old male who suffered a head on collision with a four-wheeler while driving a two-wheeler in a road traffic accident. He presented to the hospital with abdominal and pelvic pain, difficulty in passing urine and swelling of the scrotum. His X Ray …

Comparison Of Post Operative Analgesia Between Dexmedetomidine Versus Clonidine As Adjuvant To Ropivacaine In Ultrasound Guided Adductor Canal Block In Arthroscopic Knee Surgeries: A Randomized Controlled Study, Shwetha Arun, Archana B N, Dr. Shivakumar G Pofessor And Hod, Devika Lekshmi S

Digital Journal of Clinical Medicine

The current study evaluated the analgesic efficacy of dexmedetomidine versus clonidine as adjuvants to 0.2% ropivacaine in ultrasound-guided adductor canal block. Effective postoperative pain management is essential for early mobilization and improved recovery following arthroscopic knee surgeries. Sixty ASA I–II patients aged 20–60 years undergoing elective arthroscopic knee procedures were randomized into two groups: Group D received ropivacaine 0.2% 30ml with dexmedetomidine 100 mcg, and Group C received ropivacaine 0.2% 30ml with clonidine 150 mcg. Duration of analgesia, pain scores, sedation levels, hemodynamic changes, and rescue analgesic requirements were recorded. Group D demonstrated significantly prolonged analgesia (18.08 ± 0.514 h) …

Pulmonary Hemosiderosis In A Young Child Presenting With Recurrent Respiratory Illness And Refractory Anemia: A Case Report, Praveen Das, Ratnapriya Chowdhry, Neha Bhongale, Poonam Wade

Digital Journal of Clinical Medicine

Pulmonary hemosiderosis (PH) is a rare cause of diffuse alveolar hemorrhage in children and often presents with nonspecific respiratory symptoms and refractory iron‑deficiency anemia. We report a 2.5‑year‑old girl with recurrent lower respiratory tract infections, severe transfusion‑dependent anemia, failure to thrive, and persistent bilateral pulmonary infiltrates since infancy. Bronchoalveolar lavage demonstrated hemosiderin‑laden macrophages, confirming pulmonary hemosiderosis. Further evaluation revealed C‑ANCA positivity and PR3‑ANCA negativity, raising suspicion for an ANCA‑associated vasculitis; however, there was no renal, ear‑nose‑throat, or other systemic involvement, and a lung biopsy could not be performed. The child was managed with systemic corticosteroids with clinical improvement. This case …

State Social Benefit Schemes For Women In Continuity Of Psychiatric Care: A Case Report, Mathumitha A, Kishor M. Manohar Rao Professor

Digital Journal of Clinical Medicine

Mental health disorders are a major global public health challenge. The disorders affect over a billion people worldwide, while depressive and bipolar spectrum disorders also contribute substantially to disability and reduced quality of life. According to the World Health Organization, major depression alone affects more than 300 million people globally and is considered a leading cause of years lived with disability. Beyond clinical morbidity, mental illnesses exert a profound economic impact, with depression and anxiety accounting for an estimated USD 1 trillion annually in lost productivity worldwide, while the overall global economic burden of mental disorders is projected to reach …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

Stress Dynamics Between Clinical Supervisors And Allied Health Students: A Scoping Review, Piao Wang, Laurie Peebles, Aine O'Connor, Xinrong Li, Yongsheng Wang

Funded Scholarship

Stress within clinical supervision in allied health education functions as a reciprocal and relational process that shapes both learning and professional development. This scoping review synthesizes findings from 54 studies published between 1980 and 2024 to examine how stress is experienced, transmitted, and managed between students and clinical supervisors. Four interconnected domains were identified through the synthesis: the supervisory relationship, systemic and contextual pressures, personal factors, and the placement environment. Together these domains illustrate how organizational demands and supervisory strain influence student engagement, feedback processes, and educational outcomes. The literature provides valuable descriptive insight but remains fragmented, methodologically inconsistent, and …

Psych Assessment In The Er, Bailey J. Thompson, Addie Cowger, Hailie Hollis

Scholars Week

An immense amount of patients who enter the emergency department, whether for a psychiatric illness or not, struggle with mental health challenges. By creating a standardized routine and checklists for the care of high-risk psychiatric patients, the new quality and consistency can enhance patient experiences. This process will start at the triage stage and continue throughout their stay. Presenting the supportive research to the emergency department staff and introducing these changes gradually will help with staff buy-in and become a more sustainable process. Finally, with a structured approach, psychiatric patient outcomes will benefit significantly.

Developing Empathy In Paramedic Students Using Didactic And Deliberate Practice Education Programs: A Mixed-Methods Study, Nick J. Waltrich, Jade Sheen Phd, Mathew Ling, Melissa O'Shea

Internet Journal of Allied Health Sciences and Practice

Purpose: Paramedics often attend to patients presenting with a mental illness, however research suggests paramedics have difficulties when attending to this patient cohort. Conversely, clinical psychologists receive training that focuses on developing strong therapeutic relationships with their patients through the use of empathy. As research has highlighted that paramedic students are known to demonstrate low levels of empathy, this study aimed to investigate the utility of two education methods used in clinical psychology training, didactic teaching and deliberate practice (DP), to develop the skill of empathy in paramedic students. Method: Students currently enrolled in an Australian paramedic university degree were …

Undifferentiated Embryonal Sarcoma Of Liver In A Child : A Case Report, Neha Devendra Bhongale, Sumeet Baheti, Poonam Wade, Omkar Khandkar, Meenakshi Balasbramanian

Digital Journal of Clinical Medicine

Background: Undifferentiated Embryonal Sarcoma of liver (UESL) is a rare malignancy of liver originating from primary mesenchymal tissue with overall poor prognosis. Around 220 pediatric cases of UESL have been reported in the literature. The lack of characteristic clinical manifestations, laboratory tests and imaging studies pose a diagnostic challenge and the preoperative misdiagnosis rate is high. Historically, treatment was limited to surgical resection with poor survival rate. In recent times, combination of chemotherapy and surgical resection has improved survival.

Case Presentation: We report a case of undifferentiated embryonal sarcoma of liver in a 6 years old boy who presented …

Psychiatric Associations With Barriers To Use Of Mental Health Services In Medical Students, E. Cadence Rarity, Nora Newcomb, Aishwarya Vuppala, Jade Brunicardi, Kim Van, Amelia C. Phillips

Journal of Wellness

Introduction: Medical students experience stress, anxiety, and depression at rates greater than those of the general population. Medical students also underutilize mental health services. There exists a need for a comprehensive, multivariate analysis of the reasons medical students do not pursue mental health services, and the undesirable mental health outcomes that are associated with these barriers. This study associates psychiatric phenomena of stress, anxiety, and depression within the context of barriers to use of mental health services in medical students.

Methods: In this cross-sectional study, medical students (N = 128) from the University of South Florida engaged with …

Grit, A Component Of Resident Well-Being, Nathan W. Olson, Kelly Williamson, Nicholas Hartman, Navneet Cheema, Adriana S. Olson

Journal of Wellness

Introduction: Trainees experiencing burnout, depression, or career dissatisfaction challenge educators and may have patient care consequences. Grit, defined as the “perseverance and passion for long-term goals,” buffers against hopelessness and quantifies an aspect of personality shown to predict fewer career changes. Higher grit has been associated with positive outcomes in physicians, including lower burnout rates. Our objective was to determine the correlation between emergency medicine (EM) resident Short Grit Scale (Grit-S) scores and components of well-being: burnout, a positive depression screen, and career satisfaction.

Methods: This was a prospective, multicenter trial involving ten urban/suburban EM residencies. The subjects …

Study Of Clinical And Bacteriological Profile Of Culture-Positive Neonatal Sepsis At A Tertiary Care Hospital, Qudsiya Ansari, Vaibhav Pawar, Kailas Randad, Poonam Wade

Digital Journal of Clinical Medicine

Background: Neonatal sepsis is a significant global health challenge, leading to substantial morbidity and mortality among neonates. Its clinical manifestations and causative agents show regional and temporal variations, necessitating localized studies to guide effective management. This study aimed to assess the clinical features, bacteriological profile, and antimicrobial resistance patterns in culture-positive neonatal sepsis at a tertiary NICU. Methods: This retrospective observational study analyzed records of 131 inborn neonates with culture-proven sepsis admitted between April 2019 and March 2020. Data on demographic characteristics, clinical presentations, causative organisms, and treatment outcomes were examined. Antibiotic susceptibility patterns were also evaluated. Results: Of the …

Knowledge, Attitude, And Practice Towards Cervical Cancer Screening Among Women Aged 20 Years And Above In Mysuru, India, Sneha Manosh Kumar, Rashmi S, Amogha Shree

Digital Journal of Clinical Medicine

Background: Cervical cancer remains the fourth most common cancer among women globally and a leading cause of cancer-related mortality in India. Despite being largely preventable through screening, uptake remains suboptimal due to socio-cultural and systemic barriers.

Methods: A community-based cross-sectional study was conducted among 300 women aged ≥20 years residing in urban and rural areas of Mysuru. Data were collected using a pre-tested, semi-structured questionnaire and analyzed with SPSS version 30.

Results: Awareness of cervical cancer was reported by 90% of participants and of screening methods by 80%. However, only 21% had ever undergone screening and 17% within the preceding …

Personalised Learning In Medical Education – A Futuristic Model For Individual Learning Styles, Sujatha Mahadevarao Premnath, Ashwin Chand Ravichandran, Sivaa Rajendran

Digital Journal of Clinical Medicine

Medical education is transitioning from the traditional teacher-centred to a student-centred model, and an approach that caters to the diverse needs of the learner is necessary to meet these needs. Personalised learning is one such strategy that offers learning content based on individual profiles, learning styles, pace, and competency gaps. Here, the individual student receives content based on their preference, where the content can be created by educators leveraging technology, an adaptive learning platform, and artificial intelligence. It provides an inclusive and efficient learning platform that helps in creating more efficient medical graduates. This article explores the concept of personalized …

Knowledge, Attitude And Practice Of Artificial Intelligence Among Healthcare Professionals: An Online Cross-Sectional Survey, Nikhil R, Divya K L, Mahabaleshwar Mamadapur, Harshwardhan S Patil, Shashirekha B, Hema Sameera Pinnam, Purna Bansal

Digital Journal of Clinical Medicine

Background: Deep learning-powered Artificial Intelligence-driven assistance offers enormous potential to improve healthcare by facilitating administrative work, diagnosis, and the treatment of chronic diseases. The gap between clinical values and the day-to-day realities of primary care practice might widen if AI is not successfully incorporated.

Methods: A cross-sectional design was used to evaluate healthcare professionals' perceptions and understanding of AI within a clinical setting. The study was conducted among 456 Health care Workers from May to November 2024.

Results: Among 456 participants, 55.7% were MBBS students/interns, and 37.9% were postgraduates/professionals. More than 50% supported AI integration, and 62.3% of MBBS …

Reimagining The Counseling Profession: Preparing Counselors For Ai And Digital Health Integration, Carl J. Sheperis, Dusti L. Annan-Coultas, Caronne C. C. Rush

Journal of Counselor Preparation and Supervision

Digital health technologies including artificial intelligence (AI) are transforming mental healthcare delivery, creating new opportunities and challenges for counseling practice. This article examines digital health applications in counseling, including telehealth, mobile apps, digital therapeutics, virtual reality, and AI-powered tools. We explore key implications for practice, including enhanced accessibility, impacts on therapeutic relationships, and ethical considerations. The article presents a six-domain competency framework covering privacy and security, technical proficiency, ethical literacy, clinical integration, therapeutic adaptability, and administrative management. A case study illustrates the practical application of hybrid digital care, while a discussion of counselor education highlights the need for curriculum updates. …

Increasing Implementation Of The Comfortable Cafeteria Program To Promote School-Age Children’S Mental Health And Well-Being, Reinecka Mondesir, Angela Labrie Blackwell Phd, Otr

Summer 2025 OTD Capstone Symposium

Every Moment Counts (EMC) is a positive mental health promotion initiative that offers several initiatives to create inclusive environments that support student participation and emotional well-being throughout the school day. Comfortable Cafeteria, part of EMC, fosters positive mealtime experiences supporting peer interaction, emotional regulation, and inclusion. Many SBOT practitioners lack the resources to implement Comfortable Cafeteria, despite its benefits. This capstone project addresses the need for practical tools to help school-based occupational therapy (SBOT) practitioners integrate the Comfortable Cafeteria program into daily practice. Using the Multi-Tiered System of Supports (MTSS) framework, the project developed and disseminated an interactive, evidence-based video …

Delusional Parasitosis With Depression, Hypertension And Migraine, Mouli Mandal, M Kishor, Mr Murali

Digital Journal of Clinical Medicine

Delusional Parasitosis (DP) , also known as Ekbom Syndrome, is a psychiatric disorder characterised by the unshakeable belief of infestation by parasites, insects or other organisms, despite the absence of objective medical evidence.
This case report presents a 49 year old female with a history of chronic headaches, progressively worsening insect crawling sensations. She was initiated on treatment and supportive psychotherapy.
This case highlights the importance of a thorough multidisciplinary approach in managing Delusional Parasitosis, emphasising the need to differentiate between primary and secondary forms, address the potential medical and psychiatric comorbidities, and implement appropriate pharmacological and psychotherapeutic interventions.

The Impact Of Gender, Training Year, Medical Specialty And The Covid-19 Pandemic On Resident Wellness, Sara Beachy, Jessica Luzier, Chantel Weisenmuller, Kathleen Bors, Mary Ann Maurer, Amna Anees, Tiffany Lasky, Lisa Calderwood

Department of Family & Community Medicine Faculty Papers

INTRODUCTION: Data are limited as to which factors most strongly impact medical trainees' well-being, and few studies have assessed trainee's wellness at multiple time points during the COVID-19 pandemic. Additionally, much research has not taken an intersectional approach to understanding the ways in which different facets of a resident's identity impact their wellness. Thus, more person-centred, probability-driven statistical approaches that can produce distinct heterogenous groups of individuals are warranted to understand the way in which different identities are associated with resident wellness scores.

METHODS: A latent profile analysis was conducted using institutional data from resident surveys administered from 2019 to …

Adult Congenital Heart Disease As A Career? Examining Encouraging And Deterring Factors In The Global Achd Survey, Katia Bravo-Jaimes, M. H. D. Osama Srour, Petra Jenkins, Raquel Luna-Lopez, Oktay Tutarel, Geetha Kandavello, Carlos-Eduardo Guerrero-Chalela, Edgar García-Cruz, Judith Ackerman, Amalia Elizari, Miriam Valdez-Ramos, Blanche Cupido, Dominica Zentner, Murad Almasri, Sabrina Phillips, Christopher Mcleod, Luke Burchill, Celia Kamath, Renee Bullock-Palmer, Jonathan Windram

Department of Medicine Faculty Papers

BACKGROUND: There is a global mismatch between the number of adults with congenital heart disease and adult congenital heart disease (ACHD) cardiologists, potentially impacting patient outcomes. This survey explores factors influencing trainees and cardiologists' career choices in ACHD.

METHODS: An online, anonymous global survey on demographics, ACHD as a career choice, encouraging and deterring factors assessed via a 5-point Likert scale and open-ended questions on recommending ACHD was distributed through targeted emails and social media. Responses meeting a 75% completion criterion were analyzed using descriptive statistics and thematic analysis.

RESULTS: Among 811 included responses, most were from women (53.5%), aged …

Academic Stress Among Jss High School Students In Mysuru And Chamarajanagar Districts: A Cross-Sectional Study, Lathika R, Dr Sunil Kumar D, Krishnamurthy K V, Dr Rakshitha J

Digital Journal of Clinical Medicine

Background

In today's world, students face academic stress which leading to anxiety, poor performance in academics and many other issues like nervousness, panic attacks and depression mainly derived from grades, parental pressure, and competition between the students. With the above background study aims to estimate the prevalence and assess the associated factors of academic stress among high school adolescents.

Method

A cross-sectional study was conducted to explore the academic stress among JSS high school students of Mysuru and Chamarajanagar districts. A total of 379 were selected through Probability proportional to size (PPS) sampling. Structured questionnaire was used to assess the …

Incidence And Clinical Profile Of Cardiovascular Abnormalities In Infants Of Diabetic Mother, Kailas Randad, Praveen Das, Akash Dnyandeo Sarkate, Qudsiya Ansari

Digital Journal of Clinical Medicine

Background: Maternal diabetes is associated with adverse pregnancy outcomes, notably congenital heart disease (CHD) in infants of diabetic mothers (IDMs). This study evaluated the prevalence and spectrum of CHDs in IDMs and the effect of maternal glycemic control.

Materials and Methods: A prospective observational study was conducted over 18 months at a tertiary care centre in Mumbai. A total of 112 IDMs were enrolled. Maternal glycemic status was assessed using HbA1c and random blood sugar. All infants underwent clinical examination, oxygen saturation measurement, and echocardiography.

Results: CHDs were identified in 26.7% of infants. The most frequent lesions …

Educating Healthcare Providers To Prevent And Mitigate The Effects Of Zoom Fatigue, Andrea Lima

Doctor of Nursing Practice Scholarly Projects

Zoom Fatigue (ZF), or physical and neuropsychological responses to excessive videoconferencing (VC), increased during the COVID-19 pandemic. Like burnout, ZF can compromise patient safety by causing decreased job satisfaction, social isolation, disrupted focus, and difficulty empathizing with patients. This Plan-Do-Study-Act quality improvement project aimed to assess feelings about VC, raise awareness of the adverse effects of overuse, and empower primary care providers (PCPs) to improve their work experiences. A group of on-site PCPs at a tertiary care medical center in the Southwest, who continued holding exclusive virtual team meetings after the pandemic, was asked to complete the 15-question Zoom Exhaustion …

A Rare Cause Of Severe Bleeding In Neonate: Congenital Afibrogenemia Case Report, Abdul Azeem Hulkoti, Qudsiya Ansari, Kailas Randad, Akash Dnyandeo Sarkate Dr

Digital Journal of Clinical Medicine

Background- Congenital afibrinogenemia is a rare autosomal recessive disorder characterized by the complete absence of fibrinogen, a critical factor for clot formation in the blood. This deficiency leads to significant bleeding tendencies from birth. Patients typically present with severe haemorrhagic symptoms early in the neonatal period.

Case presentation- We describe a case of a neonate presenting with umbilical bleeding diagnosed with congenital afibrinogenemia. Initial clinical manifestations included active umbilical bleeding and pallor, while hematological workup revealed a lack of detectable fibrinogen. The diagnosis was confirmed by coagulation assays and genetic testing. The infant was managed with Fresh Frozen Plasma (FFP) …

"The Growing Burden: Overweight And Obesity Prevalence And Risk Factors Among Medical College Students In Mysuru: A Cross-Sectional Study", Akansha ., Nayanabai Shabadi, Anchu R Nath, Ravipati Manogna

Digital Journal of Clinical Medicine

ABSTRACT:

Background:

The transition from adolescence to adulthood is often accompanied by significant lifestyle changes, including changes in dietary habits, physical activity levels, and stress, which can contribute to unhealthy weight gain. In India, the prevalence of overweight and obesity among youth has shown an upward trend, raising concerns about early onset of non-communicable diseases. This study aims to assess the prevalence of overweight and obesity among degree college students in Mysuru and to identify the associated socio-demographic and lifestyle factors contributing to these conditions.

Methodology:

A cross-sectional study was conducted over three months, from January to March 2025, among …

Potential Effect Of Statins As Adjuvant Anti‑Tuberculosis Agents: A Short Communication, Mehwish Hanif, Ayesha Tariq, Laiba Zahoor

Digital Journal of Clinical Medicine

Tuberculosis is a chronic pulmonary infectious disease caused by Mycobacterium tuberculosis and can affect other parts of the body such as bones, brain, and lymph nodes (extra pulmonary Tb). Statins, primarily used for hyperlipidemia, have demonstrated anti-inflammatory and immunomodulatory properties that may help prevent and manage TB. They inhibit HMG-CoA reductase, reduce cholesterol synthesis and interfere with phagocytosis crucial for TB infection. Given the rise in resistance to first-line anti-tubercular therapies, Statins have shown promise as adjunctive agents by potentially shortening treatment duration, reducing adverse effects, and improving outcomes, particularly in immunocompromised and diabetic patients. Based on these findings, Statins …

Interprofessional Education: A Geriatric Immersion Experiential, Emily J. Balog, Jennifer Degennaro, Lisa Bodenheimer, Stephanie Berdugo-Hernandez, Isabella Berdugo-Hernandez, Matthew Mclaughlin, Kevin Overbeck, Elyse Perweiler

Rowan-Virtua SOM Faculty Teaching & Learning Seminar

The Geriatric Interprofessional Education Immersion (GIPEI) course was developed using a mixed methods design guided by the Knowledge-to-Action (KTA) Framework and embedded data-driven decision-making (DDDM). The eight-week, tri-weekly immersion integrates Experiential and Adult Learning Theories, the 4Ms Framework, IPEC competencies, and TeamSTEPPS to foster age-friendly clinical decision-making. Quantitative and qualitative data, including pre/post-tests, rubrics, observations, and student interviews, inform iterative improvement. The somato-psycho-socio-semiotic model of health further anchors student reflection and care planning. Findings aim to demonstrate improved learner ability to recognize and apply age-friendly care, while supporting evidence-informed curriculum refinement. The course is funded by the geriatric workforce enhancement …

Insights On Human Papillomavirus Among Medical Students And Professionals, Fathima Thansiha, Amogha Shree, Rashmi S

Digital Journal of Clinical Medicine

Background: As per World Health Organization, in 2022, 660000 women were diagnosed with cervical cancer worldwide and 350000 women died from the disease. Sexual behaviour is the major risk factor and exposure to Human Papillomavirus has been established as a causative agent in 70-80% of the cases for development of cervical cancer. Most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women. Effective primary (HPV vaccination) and secondary prevention approaches (screening and treating precancerous lesions) will prevent most cervical cancer cases. Thus, study was conducted with the objective of assessing the knowledge …

Cultivating Workplace Wellness: An Evaluation Of Gratitude Card Interventions Among University Faculty, Jeffrey Druck, Patrick Ockerse, Jamal Jones

Journal of Wellness

Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention.

Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to …