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Background: Pokémon Go is a mobile app that offers both continuous and intermittent (gamified) gameplay, but no previous research in adolescents is known to have addressed changes in physical activity and body composition according to playing style. For this reason, the aims of the present investigation were (1) to establish the differences in the level of physical activity, and its influence on the kinanthropometric and body composition, of the adolescent population, considering their Pokémon Go playing style; and (2) to analyze whether the practice of previous physical activity has an influence on the effects of the use of Pokémon Go on the level of physical activity and changes in kinanthropometric and body composition variables. Methods: A total of 94 adolescents (50 males and 44 females; mean age: 13.66 [1.17] years-old; mean body mass index: 20.82 [4.03] kg/m2) whose physical activity level and body composition were measured, participated in the investigation. Two groups of adolescents completed a 10-week intervention using Pokémon Go continuously (n = 30) or intermittently (n = 31), while the control group (n = 33) did not use any after-school app. A one-way analysis of variance (ANOVA), a multivariate analysis of variance, and 2 repeated-measures ANOVA were performed to analyze the data. Results: Inactive adolescents in the continuous use group increased their physical activity between the pretest and posttest (P =.038), but this did not occur in the active group. Regarding body composition variables, the increase in body mass (P <.001) and body mass index (P =.006) in the control group was significantly higher than in the continuous use group of adolescents who were inactive, but not in the active group, while the decrease in fat mass (P <.001–.036) and sum of 3 skinfolds (P <.001–.003) was significantly higher in both Pokémon Go use groups as compared to the control group, regardless of the previous physical activity level. Conclusions: The continuous style of play seems to be more effective in increasing physical activity in adolescents, but the changes in body composition and kinanthropometric variables occur similarly with continuous and intermittent gameplay. Therefore, the playful use of Pokémon Go can be used in educational and health fields to produce changes in body composition in this population. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is incredibly harmful, even for people who do not smoke every day. This study aimed to estimate trends in non-daily smoking in England between 2006 and 2024, how these differed across population subgroups, and to explore changes in the profile of non-daily smokers in terms of their sociodemographic and smoking characteristics and vaping and alcohol consumption. Methods: Data were collected monthly between November 2006 and April 2024 as part of a nationally representative, repeat cross-sectional survey of adults (≥ 18 years; n = 353,711). We used logistic regression to estimate associations between survey wave and non-daily smoking and used descriptive statistics to characterise the profile of non-daily smokers across 3-year periods. Results: The proportion who smoked non-daily was relatively stable between November 2006 and November 2013, at an average of 10.5% [10.1–10.9%] of cigarette smokers, then increased to 27.2% [26.0–28.4%] of cigarette smokers (4.0% [3.7–4.2%] of adults) by April 2024. This increase was particularly pronounced among younger adults (e.g. reaching 52.8%, 20.4%, and 14.4% of 18-, 45-, and 65-year-old cigarette smokers by April 2024) and those who vape (reaching 34.2% among vapers vs. 23.1% among non-vapers). Over time, there were reductions in non-daily smokers' mean weekly cigarette consumption (from 34.3 in 2006–2009 to 21.1 in 2021–2024), urges to smoke (e.g. the proportion reporting no urges increased from 29.2 to 38.0%), and motivation to stop smoking (e.g. the proportion highly motivated to quit within the next 3 months decreased from 30.8 to 21.0%). Conclusions: An increasing proportion of adults in England who smoke cigarettes do not smoke every day, particularly younger adults. Although non-daily smokers report smoking fewer cigarettes and weaker urges to smoke than they used to, which may make it easier for them to stop smoking, they appear to be decreasingly motivated to quit. [ABSTRACT FROM AUTHOR]

When field observations are lacking or are difficult to obtain, streamflow intermittency is usually assessed from the frequency of zeroes in streamflow time series, using some (often arbitrary) definition of the zero-count threshold signaling an intermittent flow regime. This research proposes alternative and robust indicators for differentiating between perennial and intermittent flow regimes from discharge time series. We perform inductive hydrologic classification of 136 rivers and streams in Greece and Cyprus at daily and monthly scales, using selected hydrologic signatures. PCA is used to reduce the dimensionality of the input data, followed by classification using hierarchical clustering to group rivers into classes of similar hydrological characteristics. Two superclusters are defined, interpreted as corresponding to perennial and intermittent river regimes respectively. A subset of monthly hydrological signatures explaining most of the variance in the flow record is used with univariate clustering to cluster the data into two groups with maximum homogeneity. The resulting cluster membership is validated by assessing similarity with the clusters from the multivariate hydrologic classifications. Seven signatures are identified (entropy of flow volumes, entropy of flow distribution, CV of mean annual flow, index of flow variability, variability of mean monthly flows, average maximum monthly flow, and 10th percentile of monthly flows) as the most useful in differentiating between perennial and intermittent river regimes; cluster separation is also assessed visually on scatterplots between signature pairs. Overall, the entropy-based signatures outperform the others. Finally, threshold values of the proposed hydrologic signatures are identified for streamflow intermittency assessment. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of multimedia visual function training on visual function reconstruction and perceptual eye position in postoperative patients with intermittent exotropia. Methods A total of 80 patients who underwent surgical treatment for intermittent exotropia between July 2021 and June 2022 were enrolled. The patients were randomly assigned to a control group (40 patients) and an observation group (40 patients) using a random number table method. All patients underwent surgical treatment for intermittent exotropia. The control group did not receive binocular visual function training postoperatively, while the observation group received multimedia visual function training. Both groups were followed up for 3 months after surgery. Visual function, Titmus near stereopsis, perceptual eye position, and strabismus degree were compared before and 3 months after surgery. Results Compared to preoperative measurements, at 3 months postoperative, the proportions of patients with strabismus ≤10°, simultaneous vision, visual fusion, and stereopsis increased in both groups, with higher proportions in the observation group compared to the control group. The pro- portions of patients with strabismus > 10° and ≤20°, horizontal deviation (pixels), and vertical deviation (pixels) decreased, with lower values in the observation group compared to the control group. At 3 months postoperative, the proportion of patients with macular stereopsis and macular foveal stereopsis increased in the observation group, and these were higher than those in the control group. The proportion of patients without stereopsis decreased and was lower in the observation group compared to the control group. The proportion of patients with orthotropia was higher and those with under correction was lower in the observation group compared to the control group (P<0.05). Conclusion Multimedia visual function training effectively reduces the degree of strabismus in postoperative intermittent exotropia patients, increases the rate of orthotropia, and significantly improves postoperative binocular visual function, Titmus near stereopsis, and perceptual eye position [ABSTRACT FROM AUTHOR]

Abstract Objectives To assess the effect of bilateral orchidopexy in preventing future torsion and testicular loss in patients with intermittent testicular torsion. Secondarily, this study aims to assess the rate of pain improvement following orchidopexy. Methods This is a prospective cohort of patients. Participants were men who underwent elective bilateral orchidopexy for intermittent testicular torsion. All consecutive cases were treated by a single surgeon in a single centre between 2015 and 2023. The primary outcomes were prevention of torsion and testicular loss. The secondary outcome was the resolution or improvement in pain. Results The success rate of bilateral orchidopexy in preventing testicular loss due to torsion was 100%, at a follow‐up of mean 33.5 months. Of the 50 patients, 88% were pain‐free following orchidopexy, and 12% had an improvement in their pain. There were no cases of hydrocoele or haematoma in this series. To our knowledge, this is the largest series reported in the literature. Conclusions Elective bilateral orchidopexy prevents torsion and preserves testicular viability. Pain is resolved in most but not all cases. This is important in counselling men who are considering surgical management of intermittent torsion of the testicle.

Abstract Background Cigarette smoking is incredibly harmful, even for people who do not smoke every day. This study aimed to estimate trends in non-daily smoking in England between 2006 and 2024, how these differed across population subgroups, and to explore changes in the profile of non-daily smokers in terms of their sociodemographic and smoking characteristics and vaping and alcohol consumption. Methods Data were collected monthly between November 2006 and April 2024 as part of a nationally representative, repeat cross-sectional survey of adults (≥ 18 years; n = 353,711). We used logistic regression to estimate associations between survey wave and non-daily smoking and used descriptive statistics to characterise the profile of non-daily smokers across 3-year periods. Results The proportion who smoked non-daily was relatively stable between November 2006 and November 2013, at an average of 10.5% [10.1–10.9%] of cigarette smokers, then increased to 27.2% [26.0–28.4%] of cigarette smokers (4.0% [3.7–4.2%] of adults) by April 2024. This increase was particularly pronounced among younger adults (e.g. reaching 52.8%, 20.4%, and 14.4% of 18-, 45-, and 65-year-old cigarette smokers by April 2024) and those who vape (reaching 34.2% among vapers vs. 23.1% among non-vapers). Over time, there were reductions in non-daily smokers’ mean weekly cigarette consumption (from 34.3 in 2006–2009 to 21.1 in 2021–2024), urges to smoke (e.g. the proportion reporting no urges increased from 29.2 to 38.0%), and motivation to stop smoking (e.g. the proportion highly motivated to quit within the next 3 months decreased from 30.8 to 21.0%). Conclusions An increasing proportion of adults in England who smoke cigarettes do not smoke every day, particularly younger adults. Although non-daily smokers report smoking fewer cigarettes and weaker urges to smoke than they used to, which may make it easier for them to stop smoking, they appear to be decreasingly motivated to quit.

Methane is one of the long-lived greenhouse gases, with a global warming potential 28 times that of carbon dioxide, accounting for about 16% of the global warming effect. Coal production activities are one of the main sources of methane emissions in China. As one of the main coal production bases in China, Shanxi Province’s coal industry emits a large amount of methane. Using the high-resolution remote sensing data to estimate the methane emission from the coal industry in Shanxi Province can lay a data foundation for establishing a refined methane emission inventory of the coal industry and provide scientific basis for formulating effective emission reduction measures. Using the Advanced Hyperspectral Imager (AHSI) carried by China’s GF–5–02 satellite, 838 methane plumes from 408 factories and mines in Shanxi Province’s coal mining areas were detected and their emission rates were calculated using data from October 2021 to March 2023. The results show that: ① the methane plume emission rate in Shanxi Province’s coal mining areas shows asymmetry, with 84% of the plumes having emission rates between 0.5−3.0 t/h, but there are also a few extreme cases, with the highest emission rate exceeding 10.0 t/h.② Shanxi Province has six dense areas of point source emissions of methane, five of which correspond to the high-value areas of XCH4. ③ Methane emission point sources are detected, with coal mines and coking enterprises being the majority of emission sources. The average emission rate of different types of emission sources differs greatly, and the emission rate fluctuates with time and source changes. Methane emissions may occur in all stages of the coal mining. ④ Highly persistent emission sources account for only 13% of all point sources, but contribute 41% of the total emission rate. Conversely, highly intermittent emission sources account for 59%, but contribute only 25% of the total emission rate. The comprehensive methane emission rate of the coal industry in Shanxi Province is 177.17±56.35 t/h, mainly contributed by the methane emissions from coal mines, coking and thermal power enterprises.

Trung N Tran,1 Heath Heatley,2 Arnaud Bourdin,3 Andrew Menzies-Gow,4,5 David J Jackson,6 Ekaterina Maslova,5 Jatin Chapaneri,5 William Henley,2,7 Victoria Carter,2 Jeffrey Shi Kai Chan,2 Cono Ariti,2 John Haughney,8,9 David Price2,9 1BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA; 2Observational and Pragmatic Research Institute, Singapore; 3Department of Respiratory Diseases, PhyMedExp, University of Montpellier, Montpellier, France; 4Royal Brompton & Harefield Hospitals and School of Immunology & Microbial Sciences, King’s College London, London, UK; 5BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK; 6Guy’s Severe Asthma Centre, Guy’s and St Thomas’ Hospitals, School of Immunology & Microbial Sciences, King’s College London, London, UK; 7Department of Health and Community Sciences University of Exeter Medical School, Exeter, UK; 8NHS Clinical Research Facilities, Glasgow, UK; 9Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UKCorrespondence: David Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, &num;06-76, Midview City, 573969, Singapore, Tel +65 3105 1489, Email dprice@opri.sgPurpose: Oral corticosteroid (OCS) use for asthma is associated with considerable healthcare resource utilization (HCRU) and costs. However, no study has investigated this in relation to patterns of intermittent OCS prescription.Methods: This historical UK cohort study used primary care medical records, linked to Hospital Episode Statistics, from 2008 to 2019, of patients (≥ 4 years old) with asthma prescribed intermittent OCS. Patients were categorized by OCS prescribing pattern (one-off [single], less frequent [≥ 90-day gap] and frequent [< 90-day gap]) and matched 1:1 (by sex, age and index date) with people never prescribed OCS with/without asthma. HCRU (reported as episodes, except for length of hospital stay [days] and any prescription [records]) and associated costs were compared between intermittent OCS and non-OCS cohorts, and among intermittent OCS prescribing patterns.Results: Of 149,191 eligible patients, 50.3% had one-off, 27.4% less frequent, and 22.3% frequent intermittent OCS prescribing patterns. Annualized non-respiratory HCRU rates were greater in the intermittent OCS versus non-OCS cohorts for GP visits (5.93 vs 4.70 episodes, p < 0.0001), hospital admissions (0.24 vs 0.16 episodes, p < 0.0001), and length of stay (1.87 vs 1.58 days, p < 0.0001). In the intermittent OCS cohort, rates were highest in the frequent prescribing group for GP visits (7.49 episodes; p < 0.0001 vs one-off), length of stay (2.15 days; p < 0.0001) and any prescription including OCS (25.22 prescriptions; p < 0.0001). Mean per-patient non-respiratory related and all-cause HCRU-related costs were higher with intermittent OCS than no OCS (£ 3902 vs £ 2722 and £ 8623 vs £ 4929, respectively), as were mean annualized costs (£ 565 vs £ 313 and £ 1526 vs £ 634, respectively). A dose–response relationship existed; HCRU-related costs were highest in the frequent prescribing cohort (p < 0.0001).Conclusion: Intermittent OCS use and more frequent intermittent OCS prescription patterns were associated with increased HCRU and associated costs. Improved asthma management is needed to reduce reliance on intermittent OCS in primary care.Keywords: asthma, costs, healthcare resource utilization, intermittent, oral corticosteroids

Surface water drying challenges the persistence of lotic biological assemblages in non‐perennial streams and rivers. However, the effects of natural hydrological disturbances on an assemblage depend on individual species characteristics. In this study, we investigated the structure and association of fish and macroinvertebrate assemblages during two phases in non‐perennial streams (flowing vs. disconnected pools). We sampled fish and macroinvertebrate assemblages in five non‐perennial stream reaches located in the Caatinga (Brazilian semi‐arid region). Fish species were resistant to hydrological dynamics in the streams. On the other hand, some macroinvertebrate taxa from the flowing phase disappeared, and new taxa colonized the disconnected pools. The absence of lotic insects following flow cessation and the colonization of disconnected pools by lentic taxa facilitated macroinvertebrate assemblages persistence in these dynamic streams. Our study showed that fish and macroinvertebrate assemblages respond differently to the same natural flow cessation, which leads us to predict that flow changes will yield different assemblages, depending on the taxa. Thus, it is crucial to consider multi‐assemblage responses to effectively manage and conserve non‐perennial stream ecosystems in a tropical semi‐arid region. We investigated the structure and association of fish and macroinvertebrate assemblages with two aquatic phases in non‐perennial streams (flowing vs. disconnected pools). Our study showed that fish and macroinvertebrate assemblages respond differently to the same natural flow cessation, which leads us to predict that flow changes will yield completely different assemblages, depending on the taxa. [ABSTRACT FROM AUTHOR]

Ephemeral waters (EW) are sensitive and vulnerable ecosystems that, although the numerous ecosystem services provided, are poorly investigated and properly managed. Diatoms represent an important biological model largely used in aquatic permanent habitats but underused in ephemeral waters. The aim of this review is to address the knowledge gap, examining the current state of knowledge regarding the health of EW, with a focus on diatoms as bioindicators, specially (i) presenting research trends on EW ecosystem types investigated (ii) analysing the methodological approach, (iii) providing the influence of abiotic factors on the diatom assemblages in EW. A bibliographic search yielded a total of 512 papers. After removing duplicate records, 118 were eliminated. The screening of abstracts resulted in the selection of 48 articles on diatoms and EW since 1982. To avoid discrepancy between terminology we decided to classify the EW found in 3 different categories: Intermittent Running Waters (IRW: rivers, streams, creek, springs), Temporary Large Wetlands (TLW: wetlands, lakes, lagoons) and Temporary Small Waters (TSW: ponds, pools, ventaroles, ditches, thermal waters, troughs, pans). Studies are reported in all continents including Antarctic. IRW are the most investigated ecosystem (n = 683), followed by TSW (239) and TLW (96). Furthermore, studies were mainly conducted on sites located below 1000 m a.s.l. of altitude (n = 27). Studies mainly focus on epilithic diatoms (52 %). Electrical conductivity (80 %), pH (77 %) and water temperature (75 %) are the principal physical–chemical parameters considered. Moreover, electrical conductivity, pH, temperature, nitrate and nitrite resulted the best diatom community drivers. Future research is encouraged (1) to achieve a standardised protocol for monitoring EW using diatoms, (2) to focus on conservation projects for high-altitude temporary waters, and (3) to investigate the main driving forces influencing diatom diversity on EW.

Introduction: Improving bone healing by various methods is one of the research areas of oral and maxillofacial surgery, as in the surgical branches dealing with hard tissue in medicine. Many methods, such as bone grafts, drugs, hormones, and tissue engineering applications, are used in bone reconstruction and rehabilitation. Moreover, improving bone healing is critical for better surgical outcomes. This study aimed to compare early and late period effects of intermittent teriparatide application on bone graft and local simvastatin application from histopathological, histomorphometric analysis, and biochemical aspects. Materials and Methods: 24 New Zealand rabbits were divided into four groups. While experimental groups received intermittent teriparatide (30µg/kg), control groups were given sterile distilled water. A total of 3 defects were created on each rabbit’s right and left tibia. Bone graft and local simvastatin were randomly applied to the opened defects, and one defect was left blank for control purposes. Rabbits were sacrificed on days 15 and 30 to examine early and late bone healing. Blood was drawn for biochemical analysis. Results: The healing score and new bone development in teriparatide applied and grafted defects were statistically significant compared to all groups (p0.05). Conclusion: Better bone healing and bone graft healing in rabbits treated with teriparatide may encourage improved surgical outcomes in clinical practice. Keywords: Teriparatide; Intermittent; Bone healing; Bone graft; Simvastatin.

Intermittent data, characterized by sporadic and irregular occurrences, have successive zero values in time series, had present unique challenges for modeling and analysis. Forecasting using intermittent data is not easy to do. This paper presents an application of the Group Method of Data Handling (GMDH) in modeling and forecasting intermittent data. GMDH models excel in capturing non-linear patterns, handling missing or sparse data, and adapting to changing dynamics. By iteratively selecting the most informative variables and estimating their coefficients, GMDH constructs a hierarchical network of interconnected models that can effectively handle intermittent data. The forecasting results show that GMDH is able to follow the pattern of actual data. The mean deviation accuracy analysis shows a value of 72.22%. The findings showcase the potential of GMDH as a valuable tool in addressing the challenges associated with intermittent data and offer insights into its application across various domains. [ABSTRACT FROM AUTHOR]

No studies have reported therapies for the treatment of patients with refractory Mycobacterium abscessus pulmonary disease (MAB-PD). We implemented intermittent multidrug IV therapy (IMIT) through repeated hospitalizations for patients with MAB-PD who were refractory to antibiotics for more than 12 months. What are the effects of IMIT on patients with refractory MAB-PD? The IV antibiotics administered for IMIT included amikacin, imipenem, and tigecycline, and the outcomes for 36 patients who underwent IMIT for refractory MAB-PD were evaluated. Patients were repeatedly hospitalized and administered IMIT on recurrent symptoms or radiographic evidence of deterioration, while maintaining oral/inhaled antibiotics. Of the 36 patients, 26 (72%) had M abscessus subspecies abscessus (herein, M abscessus)-PD, and 10 (28%) had M abscessus subspecies massiliense (herein, M massiliense)-PD. The median number of hospitalizations for IMIT was two (interquartile range, 1-3) for patients with M abscessus -PD and one (interquartile range, 1-2) for patients with M massiliense -PD. At least one negative culture result and culture conversion were observed in 62% and 12% of patients with M abscessus -PD, and in 80% and 60% of patients with M massiliense -PD, respectively. Symptomatic improvement was observed in all patients, and radiologic improvement, including cavity amelioration or no deterioration, was observed in 42% and 70% of patients with M abscessus -PD and with M massiliense -PD, respectively. No resistance to clarithromycin or amikacin was acquired. IMIT with intermittent hospitalization can be a beneficial palliative treatment for patients with refractory MAB-PD. This therapy alleviated symptoms, slowed radiologic progression, and reduced the bacterial burden in some patients. However, radiologic and microbiological responses to IMIT were more apparent in M massiliense -PD than in M abscessus -PD. [ABSTRACT FROM AUTHOR]

Introduction: Improving bone healing by various methods is one of the research areas of oral and maxillofacial surgery, as in the surgical branches dealing with hard tissue in medicine. Many methods, such as bone grafts, drugs, hormones, and tissue engineering applications, are used in bone reconstruction and rehabilitation. Moreover, improving bone healing is critical for better surgical outcomes. This study aimed to compare early and late period effects of intermittent teriparatide application on bone graft and local simvastatin application from histopathological, histomorphometric analysis, and biochemical aspects. Materials and Methods: 24 New Zealand rabbits were divided into four groups. While experimental groups received intermittent teriparatide (30µg/kg), control groups were given sterile distilled water. A total of 3 defects were created on each rabbit's right and left tibia. Bone graft and local simvastatin were randomly applied to the opened defects, and one defect was left blank for control purposes. Rabbits were sacrificed on days 15 and 30 to examine early and late bone healing. Blood was drawn for biochemical analysis. Results: The healing score and new bone development in teriparatide applied and grafted defects were statistically significant compared to all groups (p<0.05). A statistically significant difference was obtained in grafted defects compared to the control group in teriparatide-applied defects. Local simvastatin caused necrosis in both experimental and control groups. Teriparatide administration does not cause a statistically significant change in calcium, potassium, and parathyroid hormone biomarkers (p>0.05). Conclusion: Better bone healing and bone graft healing in rabbits treated with teriparatide may encourage improved surgical outcomes in clinical practice. [ABSTRACT FROM AUTHOR]

River fragmentation by drying and damming is occurring more frequently in the Anthropocene era, yet there is limited knowledge of how this fragmentation influences greenhouse gas (GHG) fluxes in river networks. River networks have the potential to be important sources of GHGs to the atmosphere through both similar and dissimilar mechanisms associated with temporary (drying) and permanent (damming) fragmentation.We conducted a review of the literature and found 49, 43 and six studies about GHGs (CO2, CH4 and N2O) in rivers impacted by damming, drying and their interaction, respectively.We found research lacking in non‐arid climates and in small water‐retention structures for studies regarding drying and damming, respectively. The major factors directly influencing GHG fluxes in river networks impacted by drying were sediment moisture, temperature, organic matter content and texture. In networks impacted by damming, the most influential factors were water temperature, dissolved oxygen, and phytoplankton Chlorophyll‐a.Based on our literature review and meta‐ecosystem theory, we propose that the spatial distribution of fragmentation strongly influences GHG fluxes at the river‐network scale.The actionable future research directions identified here will help to improve our understanding of the effects of fragmentation by drying and damming on GHG fluxes, with the potential to inform river management and climate change mitigation strategies. [ABSTRACT FROM AUTHOR]

Purpose: To identify different types of exotropia in children less than 16 years and their clinical presentation. The secondary objective is to identify the age of onset, age of presentation, birth history, and ocular and systemic associations as well as to evaluate their motor and sensory status. Methods: This hospital-based descriptive observational study was conducted from September 2018 to December 2019. Patients with a clinical diagnosis of exotropia of age less than 16 years, and exotropia of ≥10 PD were included in the study. Data were collected using a structured proforma. All statistical calculations were performed using Microsoft Excel Office version 2016 and R version 4.0.2. Results: Two hundred eighty-six (286) consecutive children with exotropia were analyzed. Intermittent exotropia (72%) was the most common form of exotropia, followed by exotropia with a neurological association (11%), infantile (8%), sensory (6%), restrictive (2%), and paralytic (1%) types. Exotropia with neurological association had a significantly earlier age of presentation (median = 42months) as compared to other types (P = 0.039). Conclusion: We recorded a huge amount of cases of exotropia associated with neurological abnormalities and this group of patients had significantly more number of preterm and low birth weight children. This study has its limitations as it is not a population-based study and prevalence rates could not be calculated. [ABSTRACT FROM AUTHOR]

Background: Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes. Objective: We sought to describe the evolution and trajectory of intermittent OCS prescription patterns in patients with asthma and investigate risk factors independently associated with transitioning to a frequent prescription pattern. Methods: This historical cohort study included patients with active asthma managed in UK primary care and included in the Optimum Patient Care Research Database (OPCRD; opcrd.co.uk). Intermittent OCS prescription patterns were categorized as sporadic, infrequent, moderately frequent, or frequent. Prescription pattern sequences were described for those who had a frequent sequence in their final year of prescribing. We examined associations between OCS prescription pattern and the hazard of transitioning into a frequent intermittent OCS prescription pattern using multivariable Cox regression with a 10-year look-back period. Results: Of 105,229 patients with intermittent OCS prescriptions, 57.1% (n = 60,083) had a frequent OCS prescription pattern at some point. Irrespective of baseline pattern, most patients transitioned to frequent prescription during the look back. The strongest risk factors were a more frequent prescription pattern at the start of look-back period, a lower percentage peak expiratory flow rate, and higher Global Initiative for Asthma treatment step. Older age, female sex, obesity, and active smoking were also associated with a higher risk of transitioning. Conclusion: Our findings help identify those most at risk of transitioning to frequent intermittent OCS receipt and encourage earlier intervention with OCS-sparing treatments.

Vitamin D is commonly used to prevent and treat osteoporosis, with studies indicating its potential to reduce fractures, falls, and mortality. However, meta-analyses present inconsistent findings regarding its efficacy, particularly reflecting significant variability in data and outcomes related to various dosing regimens. In this meta-analysis, we assessed the impact of high-dose intermittent oral administration of vitamin D3 on serum 25(OH)D levels, fractures, falls, and mortality among elderly individuals. We included 14 randomized controlled trials and employed Review Manager 5.4 for statistical analysis. Our findings indicate that intermittent monthly administration of vitamin D3 (over 800 IU per day) significantly raised serum 25(OH)D levels at all timepoints after six months, maintaining levels above 75 nmol/L throughout the year. This regimen showed no increase in all-cause mortality, with a risk ratio (95% CI) of 0.95 (0.87-1.04). Likewise, it did not significantly reduce the risks of falls and fractures, with risk ratios of 1.02 (0.98-1.05) and 0.95 (0.87-1.04) respectively. Although one-year intermittent administration significantly increased the concentration of 25(OH)D in serum, further research is needed to determine if this method would increase the incidence of falls. Therefore, it is not recommended at this stage due to the lack of demonstrated safety in additional relevant RCTs. This study had been registered on PROSPERO (CRD42022363229).

Central nervous system (CNS) lesions can repeatedly be de-and remyelinated during demyelinating diseases such as multiple sclerosis (MS). Here, we designed an intermittent demyelination model by 0.3 % Cuprizone feeding in C57/BL6 mice followed by two weeks recovery. Histochemical staining of luxol fast blue (LFB) was used for study of remyelination, detection of glial and endothelial cells was performed by immunohistochemistry staining for the following antibodies: anti Olig2 for oligodendrocyte progenitor cells, anti APC for mature oligodendrocytes, anti GFAP for astrocytes, and anti Iba-1 for microglia/macrophages, anti iNOS for M1 microglia/macrophage phenotype, anti TREM-2 for M2 microglia/macrophage phenotype and anti CD31 for endothelial cells. Also, real-time polymerase chain reaction was performed for assessment of the expression of the targeted genes. LFB staining results showed enhanced remyelination in the intermittent cuprizone (INTRCPZ) group, which was accompanied by improved motor function, increased mature oligodendrocyte cells, and reduction of astrogliosis and microgliosis. Moreover, switching from M1 to M2 polarity increased in the INTRCPZ group that was in association with downregulation of pro-inflammatory and upregulation of anti-inflammatory genes. Finally, evaluation of microvascular changes revealed a remarkable decrease in the endothelial cells in the cuprizone (CPZ) group which recovered in the INTERCPZ group. The outcomes demonstrate enhanced myelin content during recovery in the intermittent demyelination model which is in association with reshaping macrophage polarity and modification of glial and endothelial cells.

Small lowland watercourses, strongly exposed to anthropogenic activities and climate change, have received negligible odonatological attention. This study provides a revised checklist of three typical lowland small watercourses (Kállai-főfolyás, Konyári-Kálló and Ölyvös) within the Pannonian Lowland and presents the changes in their diversity over the past decades. Results revealed a significant biodiversity loss, with a 31.6% decline in Odonata fauna over the last 53 years. The upper and middle sections degraded the most, where the habitats have dried out or become intermittent. However, a diverse Odonata assemblage (1,277 individuals of 27 species) was observed at the 14 sampling sites of the three watercourses, containing protected and sensitive species (Somatochlora flavomaculata, Orthetrum brunneum, Aeshna isoceles, Libellula fulva). However, the low abundance of larval and exuvial forms (59 individuals of 13 species) suggests that the majority of the observed adults were developed in other watercourses. While recolonisation from nearby habitats is still possible, a parallel degradation of adjecent waterbodies could lead to an irreversible biodiversity loss.

A universal water supply system was the subject of numerous studies in an effort to help designers create more reliable systems for long-term operation. These efforts also target the convenience of the systems in use in the Kurdistan Region of Iraq as well as the optimization of the region's entire construction distribution networks. This research aims to find out how people think about the quality, quantity, and problems with the water distribution systems (in Sulaimani City). The data was collected through a questionnaire by asking people various questions, and their opinions about the water distribution systems in the region, as well as the convenience of the systems used (continuous or intermittent) to deliver water. For accessing water in the intermittent water distribution system, around 44%, 28%, and 3% of the respondents have access to water once in three days, once in two days, and have no watering schedule for accessing water, respectively. During the week, the water is distributed in a continuous system. As it’s obvious from the duration of water distribution, in most of the intermittent water distribution systems, 56.2% of respondents have 2–3 hours of access to water. According to the frequency of water availability, approximately 25% and 7.5% have access to water for only one hour and less than one hour, respectively. Respondents with continuous systems don’t have any major problems with the drinking water's odor, taste, or color. Results show that 72% of them accept the provided water as safe, and the breakdown of the water pipelines is confirmed by all.

Abstract Background Orthopedic surgeries lead to moderate to severe postoperative pain, treating which is a challenge to the anesthesiologist. The present prospective, randomized study was carried out to compare the efficacy of postoperative pain relief between patient controlled epidural analgesia (PCEA) and conventional intermittent bolus epidural analgesia (IBEA) \with very low concentration of bupivacaine plus fentanyl in 60 ASA I and ASA II patients for orthopedic lower limb surgeries. Following variables like heart rate, mean arterial pressure, oxygen saturation, visual analogue scale (VAS) score, total analgesic consumption, patient satisfaction (Likert scale) and side effects were assessed for 24 h postoperatively. Results The hemodynamic parameters were comparable in both the groups at various time intervals. There was a significant decrease in VAS score, less analgesic consumption, less rescue analgesia requirement and more patient satisfaction in PCEA group as compared to IBEA group. Conclusions Patient controlled epidural analgesia (PCEA) with a combination of bupivacaine and fentanyl has more efficacy and safety than intermittent bolus epidural analgesia (IBEA) so it should be used more often.

Diabetes Mellitus incidence and its negative outcomes have dramatically increased worldwide and are expected to further increase in the future due to a combination of environmental and social factors. Several methods of measuring glucose concentration in various body compartments have been described in the literature over the years. Continuous advances in technology open the road to novel measuring methods and innovative measurement sites. The aim of this comprehensive review is to report all the methods and products for non-invasive glucose measurement described in the literature over the past five years that have been tested on both human subjects/samples and tissue models. A literature review was performed in the MDPI database, with 243 articles reviewed and 124 included in a narrative summary. Different comparisons of techniques focused on the mechanism of action, measurement site, and machine learning application, outlining the main advantages and disadvantages described/expected so far. This review represents a comprehensive guide for clinicians and industrial designers to sum the most recent results in non-invasive glucose sensing techniques' research and production to aid the progress in this promising field. [ABSTRACT FROM AUTHOR]

Small lowland watercourses, strongly exposed to anthropogenic activities and climate change, have received negligible odonatological attention. This study provides a revised checklist of three typical lowland small watercourses (Kállai-főfolyás, Konyári-Kálló and Ölyvös) within the Pannonian Lowland and presents the changes in their diversity over the past decades. Results revealed a significant biodiversity loss, with a 31.6% decline in Odonata fauna over the last 53 years. The upper and middle sections degraded the most, where the habitats have dried out or become intermittent. However, a diverse Odonata assemblage (1,277 individuals of 27 species) was observed at the 14 sampling sites of the three watercourses, containing protected and sensitive species (Somatochlora flavomaculata, Orthetrum brunneum, Aeshna isoceles, Libellula fulva). However, the low abundance of larval and exuvial forms (59 individuals of 13 species) suggests that the majority of the observed adults were developed in other watercourses. While recolonisation from nearby habitats is still possible, a parallel degradation of adjecent waterbodies could lead to an irreversible biodiversity loss. [ABSTRACT FROM AUTHOR]

Streamflow-duration assessment methods (SDAMs) are rapid, indicator-based tools for classifying streamflow duration (e.g., intermittent vs perennial flow) at the reach scale. Indicators are easily assessed stream properties used as surrogates of flow duration, which is too resource intensive to measure directly for many reaches. Invertebrates are commonly used as SDAM indicators because many are not highly mobile, and different species have life stages that require flow for different durations and times of the year. The objectives of this study were to 1) identify invertebrate taxa that can be used as SDAM indicators to distinguish between stream reaches having intermittent and perennial flow, 2) to compare indicator strength across different taxonomic and numeric resolutions, and 3) to assess the relative importance of season and habitat type on the ability of invertebrates to predict streamflow-duration class. We used 2 methods, random forest models and indicator species analysis, to analyze aquatic and terrestrial invertebrate data (presence/absence, density, and biomass) at the family and genus levels from 370 samples collected from both erosional and depositional habitats during both wet and dry seasons. In total, 36 intermittent and 53 perennial reaches were sampled along 31 forested headwater streams in 4 level II ecoregions across the United States. Random forest models for family- and genus-level datasets had stream classification accuracy ranging from 88.9 to 93.2%, with slightly higher accuracy for density than for presence/absence and biomass datasets. Season (wet/dry) tended to be a stronger predictor of streamflow-duration class than habitat (erosional/depositional). Many taxa at the family (58.8%) and genus level (61.6%) were collected from both intermittent and perennial reaches, and most taxa that were exclusive to 1 streamflow-duration class were rarely collected. However, 23 family-level or higher taxa (20 aquatic and 3 terrestrial) and 44 aquatic genera were identified as potential indicators of streamflow-duration class for forested headwater streams. The utility of the potential indicators varied across level II ecoregions in part because of representation of intermittent and perennial reaches in the dataset but also because of variable ecological responses to drying among species. Aquatic invertebrates have been an important field indicator of perennial reaches in existing SDAMs, but our findings highlight how including aquatic and terrestrial invertebrates as indicators of intermittent reaches can further maximize the data collected for streamflow-duration classifications. [ABSTRACT FROM AUTHOR]

In response to the problem of frequent leakage and false alarm of partial discharge insulation defects in GIS, this paper conducts experimental research on intermittent discharge characteristics of common solid insulation defects in GIS. Using true GIS to build amulti-source testing platform for intermittent discharge of solid insulation defects, and using pulse current method, ultra-high frequency method, ultrasonic method, and gas characteristic component detection method to study the variation law of intermittent discharge characteristics of solid insulation defects. The results showthat: the intermittent discharge state of metal fouling defects on the solid insulation surface decreases with the extension of the discharge time, the discharge time interval as a whole shows an increasing trend, and the metal fouling defects on the solid insulation surface in the intermittent discharge state is difficult to develop into a breakdown discharge fault. The overall discharge amount of air gap defects inside solid insulation also shows the law of increasing first and then decreasing, and the discharge amount of air gap defects inside solid insulation stays at a large level for a long time during intermittent discharge, and there is a risk of breakdown, and the discharge will gradually evolve into continuous discharge; ultrasonic method and characteristic component detection method cannot realize the effective perception of intermittent discharge of metal fouling. The 50-period mapping information commonly used in the power field cannot reflect the intermittent discharge variation law of solid insulation, and the 200-period UHF mapping composed of four groups of 50-period UHF mapping data can initially derive the intermittent discharge distribution law of solid insulation defects. The research results of this paper are of great significance to expand the knowledge of intermittent discharge characteristics and the detection of GIS discharge defects in the field. [ABSTRACT FROM AUTHOR]

Urban water utilities in Ethiopia, including Debre Tabor Town, commonly suffer from an intermittent water supply, water quality issues, poor service delivery, and other problems. Thus, the main focus of this study was to evaluate the actual performance level of the water supply system of the town based on hydraulic efficiency, quality, cost recovery and customer satisfaction. The water distribution system status was measured by using reliability, resilience, and vulnerability as performance indicators. Weightage Arithmetic Water Quality Index (WAWQI) and household-based questionnaires were used to evaluate the water quality and customer satisfaction, respectively. Pressure and velocity-based sustainability index of 0.614 and 0.132 showed acceptable and unacceptable water supply status, respectively, and overall moderate sustainability. Results of the WAWQI revealed that more than half of the sampled tap waters were either poor or unfit for drinking purposes. The comparison of income collected from customers and the water production costs of the utility showed that only 34.31% of production cost is covered by customers. Generally, 62.6% of the society confirmed that they are unsatisfied with the existing water supply system. Thus, to improve the performance, it is recommended to address all the major social, economic, environmental and technical problems. HIGHLIGHTS In this study, Debre Tabor Town's water supply performance level was assessed.; The system hydraulic performance and water quality are not to the required standard.; Customer satisfaction with the existing system and utility cost recovery are considerably low.; To upgrade the utility performance, attention is needed to pump operation, supply equitability, and loss management, among others.;

Context: Combat sports are composed of high-intensity actions (eg, attacks, defensive actions, and counterattacks in both grappling and striking situations depending on the specific sport) interspersed with low-intensity actions (eg, displacement without contact, stepping) or pauses (eg, referee stoppages), characterizing an intermittent activity. Therefore, high-intensity interval training (HUT) is at the essence of combat-sport-specific training and is used as complementary training, as well. HUT prescription can be improved by using intensity parameters derived from combat-sport-specific tests. Specifically, the assessment of physiological indexes (intensity associated with the maximal blood lactate steady state, maximal oxygen consumption, and maximal sprint) or of time-motion variables (high-intensity actions, low-intensity actions, and effort:pause ratio) is a key element for a better HIIT prescription because these parameters provide an individualization of the training loads imposed on these athletes. Purpose: To present a proposal for HIIT prescription for combat-sport athletes, exemplifying with different HIIT protocols (HIIT short intervals, HIIT long intervals, repeated-sprint training, and sprint interval training) using combat-sport-specific actions and the parameters for the individualization of these protocols. Conclusions: The use of combat-sport-specific tests is likely to improve HIIT prescription, allowing coaches and strength and conditioning professionals to elaborate HIIT short intervals, HIIT long intervals, repeated-sprint training, and sprint interval training protocols using combat-sport actions, providing more specificity and individualization for the training sessions. [ABSTRACT FROM AUTHOR]

The radiation hardness of commercial 4H-SiC Schottky barrier diodes (STPSC1006D) has been investigated in this study. Primarily, intermittent irradiation at 0.5 Hz and continuous irradiation were analyzed and compared. Current–voltage (I – V), capacitance–voltage transform deep-level transient spectroscopy (FT-DLTS) were used to characterize the devices before and after irradiation. The devices show stability in their I – V characteristics upon irradiation. The free carrier concentration of the devices obtained from the C – V results decreased with the increasing of electron fluence. Additionally, new defects were observed after irradiation, which was the reason for the degradation in the electrical properties of the devices. The comparison of the devices irradiated intermittently and those irradiated continuous reveals that intermittent irradiation causes greater changes in electrical properties than continuous irradiation. These characteristics show the impact of STPSC1006D in space applications. [ABSTRACT FROM AUTHOR]

The performance of the modified upflow anaerobic sludge blanket (MUASB)-static granular bed reactor (SGBR) series in the intermittent mode for the treatment of wastewater containing copper (8 mg/L) was analyzed. The reactor series was found to be capable of copper removal besides chemical oxygen demand (COD) removal. The maximum COD removal of the reactor series was 98.5±0.29%. The corresponding copper removal and overall biogas production were 80.38±1.61% and 0.232 m³/kg CODdigested, respectively. Intermittent operation enhanced the robustness of the SGBR downstream. The copper and COD concentrations of the effluent were well within the discharge standards throughout the operational period. Biogas production of the reactor series in the present study was reduced by 44.67% when compared to the control operation without copper. Reactor height was also found to influence copper removal. One-way analysis of variance (ANOVA) showed that the biogas production and copper removal of the reactor series in intermittent operation increased significantly when compared to the continuous operation with a hydraulic retention time (HRT) of 24 h. [ABSTRACT FROM AUTHOR]

Background: Orthopedic surgeries lead to moderate to severe postoperative pain, treating which is a challenge to the anesthesiologist. The present prospective, randomized study was carried out to compare the efficacy of postoperative pain relief between patient controlled epidural analgesia (PCEA) and conventional intermittent bolus epidural analgesia (IBEA) \with very low concentration of bupivacaine plus fentanyl in 60 ASA I and ASA II patients for orthopedic lower limb surgeries. Following variables like heart rate, mean arterial pressure, oxygen saturation, visual analogue scale (VAS) score, total analgesic consumption, patient satisfaction (Likert scale) and side effects were assessed for 24 h postoperatively. Results: The hemodynamic parameters were comparable in both the groups at various time intervals. There was a significant decrease in VAS score, less analgesic consumption, less rescue analgesia requirement and more patient satisfaction in PCEA group as compared to IBEA group. Conclusions: Patient controlled epidural analgesia (PCEA) with a combination of bupivacaine and fentanyl has more efficacy and safety than intermittent bolus epidural analgesia (IBEA) so it should be used more often. [ABSTRACT FROM AUTHOR]

Purpose: The effects of 8 weeks of bodyweight exercise-based, high-intensity interval training (BWHIIT) on body composition and blood-based markers of metabolic health were investigated in overweight and obese, sedentary young men. Methods: In a parallel group, PRE-POST design, n = 30 men (age, 25.7 ± 4.3 y; body mass index, 27.7 ± 2.1 kg m−2; 26.1 ± 5.2% body fat) were randomized to BWHIIT (n = 20) or a control group (CON; n = 10). BWHIIT consisted of supervised, group-based training sessions (~30 minutes) performed 3 times weekly. Each session consisted of 6 high-intensity bodyweight-based exercises, with each exercise being performed for 4 minutes in the manner of 8 sets of 20 seconds of exercise, 10 seconds of rest. Prior to commencing training (PRE), and 36 h after the final training session (POST), an overnight fasted blood sample was drawn, and body composition was assessed by dual-energy X-ray absorptiometry. Eighteen participants completed the intervention (CON, n = 9; BWHIIT, n = 9). Results: Lean body mass (LBM) was increased at POST in BWHIIT compared to CON (P =.011, η2p =.359), with the mean (95% confidence limits) increase in LBM from PRE to POST within BWHIIT being 1.23 (0.55, 1.92) kg. Body mass and fat mass were unchanged in both groups from PRE to POST. BWHIIT had no effect on serum concentrations of total cholesterol, HDL-C, LDL-C, triglycerides, NEFA, hsCRP, or glucose. Conclusion: Eight weeks of bodyweight exercise-based high intensity interval training by overweight and obese sedentary young men increased LBM by ~2%, but fat mass and blood-based markers of metabolic health were unchanged. [ABSTRACT FROM AUTHOR]

Rivers that cease to flow are globally prevalent. Although many epithets have been used for these rivers, a consensus on terminology has not yet been reached. Doing so would facilitate a marked increase in interdisciplinary interest as well as critical need for clear regulations. Here we reviewed literature from Web of Science database searches of 12 epithets to learn (Objective 1-O1) if epithet topics are consistent across Web of Science categories using latent Dirichlet allocation topic modeling. We also analyzed publication rates and topics over time to (O2) assess changes in epithet use. We compiled literature definitions to (O3) identify how epithets have been delineated and, lastly, suggest universal terms and definitions. We found a lack of consensus in epithet use between and among various fields. We also found that epithet usage has changed over time, as research focus has shifted from description to modeling. We conclude that multiple epithets are redundant. We offer specific definitions for three epithets (non-perennial, intermittent, and ephemeral) to guide consensus on epithet use. Limiting the number of epithets used in non-perennial river research can facilitate more effective communication among research fields and provide clear guidelines for writing regulatory documents.

Purpose: To identify different types of exotropia in children less than 16 years and their clinical presentation. The secondary objective is to identify the age of onset, age of presentation, birth history, and ocular and systemic associations as well as to evaluate their motor and sensory status. Methods: This hospital-based descriptive observational study was conducted from September 2018 to December 2019. Patients with a clinical diagnosis of exotropia of age less than 16 years, and exotropia of ≥10 PD were included in the study. Data were collected using a structured proforma. All statistical calculations were performed using Microsoft Excel Office version 2016 and R version 4.0.2. Results: Two hundred eighty-six (286) consecutive children with exotropia were analyzed. Intermittent exotropia (72%) was the most common form of exotropia, followed by exotropia with a neurological association (11%), infantile (8%), sensory (6%), restrictive (2%), and paralytic (1%) types. Exotropia with neurological association had a significantly earlier age of presentation (median = 42months) as compared to other types (P = 0.039). Conclusion: We recorded a huge amount of cases of exotropia associated with neurological abnormalities and this group of patients had significantly more number of preterm and low birth weight children. This study has its limitations as it is not a population-based study and prevalence rates could not be calculated.

This study aims to assess the therapeutic potentials of novel serotonergic compounds in treating alcohol use disorders by investigating the effects of SB242084 and buspirone on intermittent and continuous alcohol consumption in male and female mice. Adult male and female C57BL/6J mice were given two-bottle choice to 20% ethanol and water on an intermittent or continuous availability schedule. Drug testing consisted of intraperitoneal injections of 0.3, 1, 3 mg/kg SB242084 or 1, 3, 10 mg/kg buspirone, and subsequent alcohol and water consumption were measured. To monitor the drug effects on anxiety-like and locomotor behavior, the highest dose of each compound was administered before free activity in an open field. SB242084 dose-dependently attenuated alcohol drinking for intermittent alcohol drinking in male mice but did not significantly alter alcohol drinking in mice given continuous access. Two-hour and four-hour female drinking behavior was unaffected by SB242084. In comparison, buspirone not only suppressed intermittent and continuous alcohol drinking in both males and females but also reduced distance traveled in the open field test. Observed differences in responses to SB242084 between drinking groups may imply differing neural mechanisms between episodic and continuous drinking driven by serotonin. Reductions in drinking after buspirone treatment may be related to non-specific properties. These findings suggest the therapeutic potential of compounds blocking the 5-HT2C receptor for alcohol use disorders. [ABSTRACT FROM AUTHOR]

In this observational study, we aimed to evaluate whether bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) administered 5 or 4 days a week is able to maintain viral suppression in people living with HIV (PLHIV). We enrolled 85 patients who initiated intermittent B/F/TAF between 28 November 2018 and 30 July 2020: median (IQR) age 52 years (46–59), duration of virological suppression 9 years (3–13), CD4 633/mm3 (461–781). Median follow-up was 101 weeks (82–111). The virological success rate (no virological failure [VF]: confirmed plasma viral load [pVL] ≥ 50 copies/mL, or single pVL ≥ 200 copies/mL, or ≥50 copies/mL with ART change) was 100% (95%CI 95.8–100) and the strategy success rate (pVL < 50 copies/mL with no ART regimen change) was 92.9% (95%CI 85.3–97.4) at W48. Two VF occurred at W49 and W70, in 2 patients self-reporting poor compliance. No resistance mutation emerged at time of VF. Eight patients presented strategy discontinuation for adverse events. There was no significant change in the CD4 count, residual viraemia rate, neither body weight during follow-up, but a slight increase in CD4/CD8 ratio (p = 0.02). In conclusion, our findings suggest that B/F/TAF administered 5 or 4 days a week could maintain the control of HIV replication in virologically suppressed PLHIV while reducing cumulative exposition of ART. [ABSTRACT FROM AUTHOR]