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Abstract Background Ophthalmology is a crucial aspect of primary care, often featuring prominently in both general practice and emergency settings. With over 2 billion individuals worldwide affected by visual impairment, proficiency in basic ophthalmology is essential for general practitioners and emergency physicians. Methods A cross-sectional study was conducted involving 624 medical students from six universities in Jordan. Data were collected using a questionnaire assessing knowledge, diagnostic abilities, and treatment skills in ophthalmology, alongside demographic information and student satisfaction with their ophthalmology rotations. Statistical analyses were performed using SPSS to identify significant associations between variables, with a p-value of less than 0.05 considered statistically significant. Informed consent was obtained from all participants. Results The majority of participants (44.6%) were 23 years old, and 59.8% were female. A significant proportion demonstrated proficiency in basic ophthalmic science, particularly in recognizing refractive problems and anatomical structures of the eye. Gaps were identified in understanding advanced topics such as aqueous regulation and the social-psychological impacts of visual impairment. Diagnostic abilities varied, with most students proficient in diagnosing common conditions like conjunctivitis and cataracts, but less so in identifying complex issues like intraocular foreign bodies. Treatment skills were generally lower, with significant disparities based on university affiliation and cumulative averages. Satisfaction with the ophthalmology rotation was positively correlated with better knowledge and diagnostic abilities. Conclusion The study highlights the variable proficiency in ophthalmic knowledge and skills among medical students, influenced by factors such as university affiliation and satisfaction with ophthalmology rotations.

Abstract The retina’s intricate interplay of forces and structures, with a focus on the retinal pigment epithelium (RPE) and photoreceptors, is essential for retinal health and function. Among these forces, electrostatic forces play a crucial role, working alongside van der Waals forces and oncotic pressure to maintain the retina’s attachment to the RPE and ensure the integrity of the blood-retina barrier (BRB). The composition of the interphotoreceptor matrix (IPM), influenced by molecules like Retbindin secreted by rod photoreceptors, further modulates these forces, affecting processes like visual pigment regeneration and metabolite exchange. In the context of retinal tissue engineering and new technologies for support and cells-based treatments, electrostatic forces are harnessed to optimize nutrient supply to transplanted RPE cells by reducing pore size in electrospun polymer membranes. Scaffold-based strategies for retinal repair also utilize electrostatic, hydrophobic, van der Waals, and hydrogen bonding forces to enhance cell adhesion and growth, mimicking the basement membrane. Understanding the complex dynamics of these forces in retinal-RPE interactions holds promise for innovative treatments for retinal disorders, emphasizing the intricate balance between electrostatic forces, van der Waals forces, oncotic pressure, and more. These insights open exciting avenues for research and therapeutic interventions in ophthalmology. Additionally, van der Waals forces are explored in the context of cell adhesion, and their potential role in retinal health is discussed, particularly in relation to melanin’s protective properties against blue light-induced damage. Tissue engineering approaches, both scaffold-free and scaffold-based, are discussed, highlighting the importance of physical surface treatments and adhesive forces in preserving engineered RPE tissue. Overall, this abstract provides a comprehensive overview of the multifaceted role of electrostatic and other forces in retinal biology and their implications for future research and clinical applications in ophthalmology.

Abdallah Damin Abukhalil, Sana Ali Muhanna,* Misk Najih Madi,* Ni’meh Al-Shami, Hani A Naseef, Abdullah K Rabba Department of Pharmacy, Faculty of Pharmacy, Nursing, and Health Professions, Birzeit University, Birzeit, Palestine*These authors contributed equally to this workCorrespondence: Abdallah Damin Abukhalil, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, Email adkhalil@birzeit.edu Ni’meh Al-Shami, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine, Email nemaashami86@gmail.comBackground: The prevalence of type 2 diabetes is a significant global public health concern. Adherence to established guidelines is essential for effective management of this metabolic disease.Objective: This study aimed to evaluate the current practices of physicians in Palestine regarding their adherence to ADA guidelines for type 2 diabetes management.Methods: A retrospective, cross-sectional, multicenter study was conducted by reviewing patients’ medical records. This study included 362 patients aged ≥ 18 years diagnosed with type 2 diabetes for at least one year and receiving treatment at multiple outpatient clinics in Palestine. Adherence to ADA guidelines was assessed by selecting an appropriate antidiabetic agent based on patient confounding factors and comorbidities, frequency of diabetes monitoring, screening, glycemic control, and optimization of hypertension and dyslipidemia medication.Results: Half of the participants were female. 53% of the participants did not achieve their A1c target goal. Adherence to ADA guidelines for selecting the preferred antidiabetic medication was only 32.22%. Very low adherence to prescribing GLP1 agonists (0.5%) and SGLT2 inhibitors (7%) when indicated. Biguanides were the most prescribed medications (83.1%), followed by sulfonylurea (35.1%), and insulin (28.2%). Only 43% and 66% of the patients were on appropriate lipid and hypertension medications, respectively, as recommended by ADA guidelines. Foot assessment and eye examinations were performed in only 27% and 55% of the patients, respectively. Age, atherosclerotic cardiovascular disease, and sulfonylurea use were significantly associated with lower glycemic control.Conclusion: This study demonstrated that Adherence to ADA guidelines for diabetes management is suboptimal in selecting appropriate antidiabetic medication based on patient confounding factors, potentially contributing to the high prevalence of complications and comorbidities observed in patients with diabetes in Palestine. Medical associations and health institutions must adopt programs to increase professional education and awareness of the current guidelines to improve outcomes.Keywords: diabetes, diabetes adherence, diabetes management, diabetic medications, diabetes clinical guidelines

Abstract Background Metabolic syndrome (MetS) is an important public health issue that has been lately linked as a growing concern worldwide. The objective To find out which anthropometric and body composition indices can prognosticate MetS in Jordanian adult females. Methods A sample of 656 Jordanian adult females was recruited (January–March 2024) in the middle of Jordan. Weight, height, waist and hip circumference, lipid profile (triglycerides and high-density lipoprotein), fasting plasma glucose, and blood pressure were measured. Fat mass index (FMI), body mass index (BMI), fat-to-muscle ratio, and waist-to-hip ratio (WHR) were calculated. The presence or absence of MetS was the outcome of interest. Receiver operating characteristic (ROC) analyses were used to examine the predictive accuracy of the indices, and the area under the curve (AUC) was measured. Results 40.6% had MetS, and their mean age was 45.5 years. 90.2% of the participants with MetS were obese based on body fat percentage. The MetS participants had significantly higher means of all the anthropometric indices except the fat-to-muscle ratio. None of the MetS participants were underweight, and 70.8% and 73.8% were obese based on BMI and WHR, respectively (p

The short article in hand introduces some amendments for the relationships and claims presented in [16] with the investigation of their correct forms. To elucidate those failures and to support the results obtained herein, we provide an illustrative example. We also elucidate that the rough set models proposed by [11] and [16] are incomparable. Moreover, we demonstrate that the observations, given in the application section of [16], contradict the computations of lower and upper approximations, boundary regions, and accuracy measures as well as violate some well-known properties of Pawlak approximation space.

Rough set theory serves as an effective method for managing complicated real-world data. Through rough approximation operators, it discerns both confirmed and possible data attainable through subsets. Earlier studies have presented several rough approximation models, drawing inspiration from neighborhood systems aimed at enhancing accuracy degree and satisfying the axioms of traditional approximation spaces (TAS) that were initiated by Pawlak. This article proposes an easy method to deal with information systems in most cases, wherein it introduces a new forming of generalized approximation spaces, namely, cardinality rough neighborhoods. It is defined depending on the cardinal number of the $ \mathcal{N}_\sigma $-neighborhoods of elements that are established under an arbitrary relation. Their main features are investigated and the connections between them, as well as their relationships with the preceding kinds of neighborhood systems, are uncovered with the aid of some examples. Then, novel rough set paradigms induced by cardinality rough neighborhoods are displayed that satisfy most properties of Pawlak's paradigm. Next, a topological method to study these paradigms is provided, wherein this method produces approximation operators similar to the given paradigms in six cases that are proved. Additionally, both paradigms in a practical example concerning books and the authors who authored them or participated in their authorship are applied. To illuminate the need for the current concepts, we elaborate on their advantages from different views. Finally, a summary of the obtained results and relationships and suggestions for some forthcoming work are offered.

Abstract One of the most common health concerns disturbing people within working years globally is diabetes mellitus (DM). One well-known consequence of DM is vascular damage, which can manifest as macro- and microangiopathy affecting the ocular retina. Therefore, Diabetic macular edema (DME) is a major sight-threatening complication of diabetic retinopathy (DR) worldwide. It is the most prevalent cause of significant vision impairment in diabetic patients. Long-term vision loss can be avoided by following early DME treatment guidelines in everyday life. Hence, there are various therapeutic approaches for DME management. Currently, the first-line treatment for DME is anti-VEGF family drugs, such as ranibizumab, brolucizumab, bevacizumab, and aflibercept. Nevertheless, relapses of the disease, inadequate response, and resistance during anti-VEGF therapy are still seen because of the intricate pathophysiological foundation of the disease. Consequently, there is an excellent requirement for therapeutic approaches to advance and become better at controlling diseases more satisfactorily and require fewer treatments overall. We conducted a thorough literature search in the current review to present a comprehensive overview of the primary data about the current DME therapeutic agents. We also covered the novel advances in DME management and probable future treatments being investigated and developed. This review recommended that Large clinical trials should afford sufficient evidence to support these innovative treatment modalities.

Background Early-life food consumption patterns may affect children’s health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood. Aims To evaluate Jordanian children and adolescents’ energy and macronutrient intake and how closely they adhere to dietary recommendations. Methods This cross-sectional study used data from Jordan’s Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines. Results The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake. Conclusion The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Background Early-life food consumption patterns may affect children’s health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood. Aims To evaluate Jordanian children and adolescents’ energy and macronutrient intake and how closely they adhere to dietary recommendations. Methods This cross-sectional study used data from Jordan’s Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines. Results The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake. Conclusion The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Abdallah Damin Abukhalil, Sally Amer Barakat,&ast; Aseel Mansour,&ast; Ni’meh Al-Shami, Hani Naseef Department of Pharmacy, Faculty of Pharmacy, Nursing, and Health Professions, Birzeit University, Birzeit, West Bank, State of Palestine&ast;These authors contributed equally to this workCorrespondence: Abdallah Damin Abukhalil, Department of Pharmacy, Faculty of Pharmacy, Nursing, and Health Professions, Birzeit University, Birzeit, West Bank, State of Palestine, Tel/Fax +970-2-2982017, Email adkhalil@birzeit.eduBackground: Antimicrobial resistance to ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp). remains a major challenge in hospital settings.Objective: This study aimed to determine the ESKAPE antimicrobial resistance patterns and associated factors with multi-drug resistance strains among hospitalized patients in a single tertiary care medical hospital in Palestine.Methods: A single-center retrospective cross-sectional study was conducted by reviewing patients’ electronic medical records and laboratory results from November 1, 2021, to November 30, 2022, at the Palestine Medical Complex in Palestine. The study included patients aged > 18 years who had been infected with ESKAPE pathogens 48 hours after hospital admission.Results: This study included 231 patients, of whom 90.5% had MDR infections. In total, 331 clinical samples of ESKAPE pathogens were identified. A. baumannii was the most prevalent MDR pathogen (95.6%) with Carbapenem-resistant exceeding 95%, followed by K. pneumoniae (83.8%) with extended-spectrum cephalosporin resistance exceeding 90%, S. aureus (68.2) with 85% oxacillin-resistance, E. faecium (40%) with 20% vancomycin resistance, P. aeruginosa (22.6%) with 30% carbapenem resistance. Furthermore, emergent colistin resistance has been observed in A. baumannii, K. pneumoniae, and P. aerogenesis. Risk factors for MDR infection included age (p< 0.035), department (p< 0.001), and invasive procedures such as IUC (p< 0.001), CVC (p< 0.000), and MV (p< 0.008). Patients diagnosed with MDR bacteria had increased 30-day mortality (p< 0.001).Conclusion: The findings of this study show alarming MDR among hospitalized patients infected with ESKAPE pathogens, with resistance to first-line antimicrobial agents and emerging resistance to colistin, minimizing treatment options. Healthcare providers and the Ministry of Health must take steps, adopt policies to prevent antimicrobial resistance, adhere to infection control guidelines, implement antimicrobial stewardship programs to prevent and limit the growing health crisis, and support research to discover new treatment options.Keywords: ESKAPE, antimicrobial resistance, nosocomial infections, hospital-acquired infections, Palestine

Sami Abdulsalam Ali Hasan,1 Ibrahim Zaid Al-Shami,1 Mohsen Ali Al-Hamzi,1 Ghadeer Saleh Alwadai,2 Nada Ahmad Alamoudi,2 Saleh Ali Alqahtani,2 Arwa Daghrery,3 Wafa H Alaajam,4,5 Mansoor Shariff,6 Hussain Mohammed Kinani,7 Mohammed M Al Moaleem8 1Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Sanaa, Yemen; 2Department: Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 3Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia; 4Department of Restorative Dental Science, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 5Department of Restorative Dentistry, Faculty of Dentistry, Sana’a University, Sana’a, Yemen; 6Prosthetic Department, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia; 7Ministry of Health, Sabya General Hospital, Department of Dentistry, Jazan, Saudi Arabia; 8Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi ArabiaCorrespondence: Mohammed M Al Moaleem, Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi Arabia, Email malmoaleem@jazanu.edu.saBackground: To evaluate the radiant power of the light cure units (LCUs) in relation to their type, radiant exitance, number of years in clinical use, and condition of LCUs tips in governmental and public clinics in Dental Faculties in Sana’a City.Materials and Methods: LCUs were collected from different colleges at Sanaa City, Yemen, then LCU data as type, clinical age (< 1 year, between 1– 5 and ˃ 5-years), tip condition was visually inspected for damage and adhering debris, and the radiant exitance values of the tested LCUs. Radiant exitance values were subcategorized into three groups: < 400, 400– 850, and > 850 mW/cm², labeled as inadequate, marginal, and adequate radiant exitances, respectively. A Woodpecker radiometer was used with a mode lasting of 20 seconds was used with each LCU. Descriptive statistics of the different parameters were evaluated with SPSS version 25. One-way ANOVA and Mann–Whitney tests were performed to determine the mean difference between the groups with a significance value of ˂ 0.05 was considered.Results: Two hundred twenty-three LCUs were surveyed, and the majority were Light–emitting diode (LED). Forty-nine (21.9%), 117 (52.4%), 57 (25.6%) recorded lesser than, 400– 850, and more than 850 mW/cm², respectively. Radiant exitances of < year-old units were found to be higher than those of units used for ˃ 5 years with significant differences (p=0.001). The ANOVA test showed significant differences between the radiant exitance with clinical age and LCU tip conditions and a strong correlation p ˃ 0.050.Conclusion: LED curing lights were the most used in the tested Dental Faculties. More than half of the used LCU offered sufficient radiant exitance. Clinical age, the presence or absence of composite buildups, and damage to curing tips showed significantly affect radiant exitance values.Keywords: dental light cure, radiant exitance, contaminated tip, radiometer

Abdallah Damin Abukhalil,&ast; Raya Riyad Abushehadeh,&ast; Sireen Sultan Shatat,&ast; Ni’meh Al-Shami,&ast; Hani A Naseef,&ast; Hosniyeh Ladadweh,&ast; Raed Madia&ast; Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine&ast;These authors contributed equally to this workCorrespondence: Abdallah Damin Abukhalil; Hosniyeh Ladadweh, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Email Adkhalil@birzeit.edu; hladadweh@birzeit.eduBackground: Coronavirus disease (COVID-19) vaccines play an essential role in boosting immunity, preventing severe diseases, and alleviating the Covid-19 health crisis.Objective: This study aimed to explore the type and severity of short-term adverse reactions associated with BNT162 (Pfizer-BioNTech), mRNA 1273 (Moderna), and viral vector vaccines and to compare the incidence of post-vaccination Covid-19 infection among the Birzeit University community in Palestine.Methods: This questionnaire-based retrospective cross-sectional study was conducted among individuals who were vaccinated with at least one dose of any COVID-19 vaccine offered in Palestine during the COVID-19 pandemic. The study included participants aged 18 years and older who were vaccinated with Pfizer, Moderna, Sputnik Light, or Sputnik v.Results: A total of 558 participants who were administered COVID-19 vaccine were included in the study. Sputnik (239), Pfizer vaccine recipients (236), and Moderna vaccine recipients (83). Of the viral vector vaccine recipients, 57 (23.8%) had a post-vaccination infection, compared to 30 (12.7%) for Pfizer and seven (8.4%) for Moderna. Furthermore, the reported adverse effects in the viral victor group were higher than those in the Moderna and Pfizer groups (71.7, 66.3, and 61.9%, respectively). Chills, headache, fatigue, abdominal pain, and joint pain were significantly higher in the Viral Vector vaccine group than the Moderna and Pfizer vaccine. Vomiting, tiredness, and fatigue were significantly less likely to be complained of by Pfizer vaccine recipients compared to Moderna and Viral Vector vaccine recipients (p < 0.05).Conclusions: Breakthrough infections were associated with both viral vectors and mRNA; however, the mRNA vaccine had less reported post-vaccine infection. Furthermore, the Pfizer/BioNTech COVID-19 vaccine group reported fewer commonly reported side effects (fever, chills, headache, fatigue, muscle pain, joint pain, nausea, and dizziness), followed by the Moderna and viral vector vaccines. Females and underweight participants experienced more adverse effects with both vaccines, and fewer common side effects were reported by all participants.Keywords: Covid-19 vaccine, viral vector vaccine, Sputnik, Moderna, Pfizer, breakthrough infection, adverse effects, Palestine

The aim of the present study was to observe the association between obesity indices, blood glucose, and lipid profiles as indicators for its levels. In a cross-sectional study, 491 Jordanian adults were included. Socio-demographic and anthropometric data were measured. Blood samples were collected and tested for fasting plasma glucose (FPG), insulin, and lipid profile. Obesity indices [Conicity Index (CI), Body adiposity index (BAI), Abdominal volume index (AVI), A Body Shape Index (ABSI), Body Roundness Index (BRI), and Weight-adjusted-waist index (WWI)] were calculated using standard formulas. AVI, BRI, and WWI had a higher impact on FPG and lipid profile. They explain 6.2%, 6.6%, and 4.1% of changes observed in FPG and explained 3.1%, 4.1%, and 3.5% of changes observed in total cholesterol (TC), respectively. In addition, they explain 9.9%, 9.7%, and 7.9% of changes in triglyceride (TG), 9.6%, 8.4%, and 6.0% of the variability observed in the high-density lipoprotein cholesterol (HDL), as well as 1%, 1.6%, and 1.5 of change in low-density lipoprotein cholesterol (LDL), and 7.0%, 8.6%, and 6.6% in LDL/HDL ratio; respectively (p

Zinc-Manganese spinel ferrites (Zn1-xMnxFe2O4) are nowadays very attractive magnetic materials for cancer diagnostic and therapy. With the help of intense ultrasonic waves, sonochemical synthesis method was used to prepare stoichiometric and chemically homogenous nanoparticles by varying the manganese content. The crystal structure along with the size and shape of the as-prepared nanoparticles were described using XRD, TEM and FT-IR techniques, while cations distribution was carefully investigated using XPS and Mössbauer spectroscopic techniques and supported with density functional theory calculations. The crystal structure study revealed the presence of a pure single cubic spinel phase, where the unit-cell and the size were observed to decrease as the manganese incorporation was increased with clear indication of cationic redistribution and degree of inversion variations. Due to the very small variation of the total energy between different configurations, the probability of formation of a mixed phase was found to be very high in such a way that the more mixed was the phase, the more stable it was. A relevant fact was the noticed quasi-systematic ionic exchange made possible by the very short reaction times and high energy offered by the ultrasonic waves. For manganese concentrations up to 60%, the systematic ionic process started by incorporating manganese ions into octahedral sites and pushing iron ions to migrate and replace those of zinc in tetrahedral sites. Such an ionic movement was of central importance for the improvement of the magnetic properties due to the establishment of super-exchange interactions. Such an ionic engineering should definitely open the way to promising applications in biomedical imaging.

Background The prevalence of elevated blood pressure (BP) has been raised worldwide. Food consumption, eating habits, and nutritional lifestyle related to meal timing, skipping meals, and meal contents have recently received more attention in studies on BP and metabolic syndrome. Purpose: This study evaluated the association between habitual food consumption, eating behavior, and meal timing with BP among Jordanian adults.Methods A cross-sectional study included 771 Jordanian adults. A food frequency questionnaire was completed. Data about eating habits, meal timing, and emotional eating were collected. BP was measured.Results The prevalence of less than recommended intake of vegetables, milk, protein, and fruits was higher in participants with elevated BP (69.2%, 90.2%, 58.9%, and 25.5%, respectively) as compared to the normal BP group (p

The purpose of this study is to analyze the impact of the EFQM excellence model in terms of the directional and executional excellence practices (the DEPs and EEPs) on organizational performance (OP). It also aims to analyze the mediation role of knowledge management processes (KMPs) between excellence practices and OP. A survey as an empirical data-collection instrument was deployed and distributed to mid and high-level management participants across four mobile network operators (MNOs) in Yemen. A dataset of 219 valid questionnaires were used for analysis. This paper employs the structural equation modelling (SEM) disjoint two-stage approach to validate the research model using SmartPLS software. The results showed a complementary mediation by KMPs in the relationship between the DEPs and OP, and interestingly, a full KMPs mediation between the EEPs and OP. The findings indicate that KMPs promote the impact of the DEPs on OP while they reduce the influence of the direct impact of the EEPs on OP. Furthermore, to the best of the authors knowledge, the study represents a distinctive investigation in the relationship between the DEPs, EEPs, and OP by inclusion of KMPs as a mediator in MNOs, which contributes to the underdeveloped literature pertaining to these constructs.