Translation and validation of the CLEO tool in Vietnamese to assess the significance of pharmacist interventions.

BACKGROUND: There is currently no validated tool available for assessing the potential significance of pharmacist interventions in Vietnam. AIM: This study aimed to translate the CLEO tool from French into Vietnamese, validate the Vietnamese version, and demonstrate its feasibility in daily practice. METHOD: The CLEO tool was translated into Vietnamese (CLEOVN) using a 5-step process by bilingual experts. A total of 100 scenarios were compiled from clinical cases from nine hospitals evaluated by seven clinical pharmacists to determine inter-rater reliability and 30 out of 100 scenarios were re-evaluated one month later to determine test-retest reliability. Reliability was quantified using the intra-class correlation coefficient (ICC). A 20-item questionnaire on a 7-point Likert scale assessed the tool's appropriateness, acceptability, precision, and feasibility. RESULTS: Inter-rater reliability was good for clinical dimension (ICCA,1 = 0.71), excellent for economic dimension (ICCA,1 = 0.86), and fair for organizational/operational dimension (ICCA,1 = 0.56). Test-retest reliability scores were excellent for clinical (I̅C̅C̅A,1 = 0.79), excellent for economic (I̅C̅C̅A,1 = 0.84), and fair for organizational/operational (I̅C̅C̅A,1 = 0.56). The tool was rated as appropriate (mean = 5.86; SD = 1.03), acceptable (mean = 5.19; SD = 1.12), precise (mean = 5.71; SD = 1.17), and feasible (mean = 5.05; SD = 1.24). The maximum time required to evaluate an intervention was three minutes. CONCLUSION: The CLEOVN tool was successfully translated and validated for reliability, appropriateness, acceptability, precision, and feasibility. It will be suitable to evaluate the value of clinical pharmacy interventions.

Determinants of antibiotic prescribing in primary care in Vietnam: a qualitative study using the Theoretical Domains Framework.

BACKGROUND: To formulate effective strategies for antimicrobial stewardship (AMS) in primary care, it is crucial to gain a thorough understanding of factors influencing prescribers' behavior within the context. This qualitative study utilizes the Theoretical Domains Framework (TDF) to uncover these influential factors. METHODS: We conducted a qualitative study using in-depth interviews and focus group discussions with primary care workers in two provinces in rural Vietnam. Data analysis employed a combined inductive and deductive approach, with the deductive aspect grounded in the TDF. RESULTS: Thirty-eight doctors, doctor associates, and pharmacists participated in twenty-two interviews and two focus group discussions. We identified sixteen themes, directly mapping onto seven TDF domains: knowledge, skills, behavioral regulation, environmental context and resources, social influences, social/professional role and identity, and optimism. Factors driving unnecessary prescription of antibiotics include low awareness of antimicrobial resistance (AMR), diagnostic uncertainty, prescription-based reimbursement policy, inadequate medication supplies, insufficient financing, patients' perception of health insurance medication as an entitlement, and maintaining doctor-patient relationships. Potential factors facilitating AMS activities include time availability for in-person patient consultation, experience in health communication, and willingness to take action against AMR. CONCLUSION: Utilizing the TDF to systematically analyze and present behavioral determinants offers a structured foundation for designing impactful AMS interventions in primary care. The findings underscore the importance of not only enhancing knowledge and skills but also implementing environmental restructuring, regulation, and enablement measures to effectively tackle unnecessary antibiotic prescribing in this context.

Space-time scanning statistics in the prediction and evaluation of dengue epidemic clusters.

Objectives: To detect clusters of dengue hemorrhagic fever in an urbanized district of Hai Phong City, Vietnam using Poisson space-time retrospective and prospective analysis. Methods: A cross-sectional and retrospective study analyzed dengue surveillance data in the period from January 01, 2018, to December 31, 2022. Spatial-temporal scanning statistics were performed using the free software SatScan v10.1.2. Results: A total of 519 cases were recorded. The cumulative incidence per 100,000 inhabitants was 3.37, 127.36, 10.96, 0, and 296.04 in 2018, 2019, 2020, 2021, and 2022, respectively. By retrospective Poisson model-based analysis, seven clusters were detected. Six of these seven detected outbreaks occurred in November and December 2022. The largest cluster had a relative risk (RR) of 1539.5 (P <0.00001). The smallest cluster has a RR of 316.1 (P = 0.006). Prospective analysis using the Poisson model significantly detected four active case clusters at the time of the study. The largest cluster of cases with RR was 47.7 (P <0.00001) and the smallest cluster with RR was 18.2 (P <0.00001). Conclusions: This study provides a basis for improving the effectiveness of interventions and conducting further investigations into risk factors in the study area, as well as in other urban and suburban areas nationwide.

Three undescribed phenylbutenoids derivatives from Zingiber cassumunar Roxb. rhizomes and their biological activities.

Phenylbutenoids belong to polyphenolic compounds that have demonstrated distinctive biological activities and are primarily characterised in the genus Zingiber (Zingiberaceae) species. From the EtOAc extract of the rhizomes of Zingiber cassumunar Roxb., three phenylbutenoid-type compounds, cassudimin B (1), cassumunol O (2), and cassumunol P (3), were isolated, along with five known compounds (4-8). Their structures were characterised through spectroscopic evidence and reference data. Biological activity investigation revealed that compounds 4, 5, and 8 exhibited promising potential for anti-α-glucosidase with IC50 values of 151.5, 180.1, and 39.5 µM, respectively, surpassing the positive control acarbose (IC50, 190.6 µM). Additionally, compounds 3-8 displayed cytotoxic effects on HepG2 cells ranging from 12.0 to 293.2 µM.

Long-Range Ballistic Propagation of 80% Excitonic Fraction Polaritons in a Perovskite Metasurface at Room Temperature.

Exciton-polaritons, hybrid light-matter excitations arising from the strong coupling between excitons in semiconductors and photons in photonic nanostructures, are crucial for exploring the physics of quantum fluids of light and developing all-optical devices. Achieving room temperature propagation of polaritons with a large excitonic fraction is challenging but vital, e.g., for nonlinear light transport. We report on room temperature propagation of exciton-polaritons in a metasurface made from a subwavelength lattice of perovskite pillars. The large Rabi splitting, much greater than the optical phonon energy, decouples the lower polariton band from the phonon bath of the perovskite. These cooled polaritons, in combination with the high group velocity achieved through the metasurface design, enable long-range propagation, exceeding hundreds of micrometers even with an 80% excitonic component. Furthermore, the design of the metasurface introduces an original mechanism for unidirectional propagation through polarization control, suggesting a new avenue for the development of advanced polaritonic devices.

Correction: A target enrichment approach for enhanced recovery of Synchytrium endobioticum nuclear genome sequences.

[This corrects the article DOI: 10.1371/journal.pone.0296842.].

An artificial intelligence accelerated virtual screening platform for drug discovery.

Structure-based virtual screening is a key tool in early drug discovery, with growing interest in the screening of multi-billion chemical compound libraries. However, the success of virtual screening crucially depends on the accuracy of the binding pose and binding affinity predicted by computational docking. Here we develop a highly accurate structure-based virtual screen method, RosettaVS, for predicting docking poses and binding affinities. Our approach outperforms other state-of-the-art methods on a wide range of benchmarks, partially due to our ability to model receptor flexibility. We incorporate this into a new open-source artificial intelligence accelerated virtual screening platform for drug discovery. Using this platform, we screen multi-billion compound libraries against two unrelated targets, a ubiquitin ligase target KLHDC2 and the human voltage-gated sodium channel NaV1.7. For both targets, we discover hit compounds, including seven hits (14% hit rate) to KLHDC2 and four hits (44% hit rate) to NaV1.7, all with single digit micromolar binding affinities. Screening in both cases is completed in less than seven days. Finally, a high resolution X-ray crystallographic structure validates the predicted docking pose for the KLHDC2 ligand complex, demonstrating the effectiveness of our method in lead discovery.

Elucidation of toxic effects of 1,2-diacetylbenzene: an in silico study.

PURPOSE: We aimed to explore the metabolite products of 1,2-diacetylbenzene (DAB) and investigate their harmful effects, physicochemical properties, and biological activities, along with those of DAB itself. METHODS: Key approaches included MetaTox, PASS online, ADMESWISS, ADMETlab 2.0, molecular docking, and molecular dynamic simulation to identify metabolites, toxic effects, Lipinski's rule criteria, absorption, distribution, metabolism, and excretion properties, interactions with cytochrome (CYP) 450 isoforms, and the stability of the DAB-cytochrome complex. RESULTS: A total of 13 metabolite products from DAB were identified, involving Phase I reactions (aliphatic hydroxylation, epoxidation, oxidative dehydrogenation, and hydrogenation) and Phase II reactions (oxidative sulfation and methylation). Molecular dynamics and modeling revealed a stable interaction between CYP1A2 and DAB, suggesting the involvement of CYP1A2 in DAB metabolism. All studied compounds adhered to Lipinski's rule, indicating their potential as inducers or activators of toxic mechanisms. The physicochemical parameters and pharmacokinetics of the investigated compounds were consistent with their harmful effects, which included neurotoxic, nephrotoxic, endocrine disruptor, and hepatotoxic consequences due to their high gastrointestinal absorption and ability to cross the blood-brain barrier. Various CYP450 isoforms exhibited different functions, and the compounds were found to act as superoxide dismutase inhibitors, neuropeptide Y2 antagonists, glutaminase inhibitors, and activators of caspases 3 and 8. DAB and its metabolites were also associated with apoptosis, oxidative stress, and neuroendocrine disruption. CONCLUSION: The toxic effects of DAB and its metabolites were predicted in this study. Further research is warranted to explore their effects on other organs, such as the liver and kidneys, and to validate our findings.

Delayed bladder rupture following blunt trauma: A case report and literature review.

Delayed bladder rupture, rare condition following trauma, can result from primary laceration or secondary rupture at the lesion site in the bladder wall. Delayed treatment increases mortality. We report the case of a 43-year-old female who presented with an 8-day history of blunt trauma and a 2-day abdominal discomfort. After using point-of-care ultrasound for abdominal paracentesis to confirm the diagnosis, the patient was transferred to the operating room to suture the ruptured bladder. After nine days, she was discharged free of symptoms. This case report and literature review stress the importance of prompt and appropriate intervention for delayed bladder rupture.

Antimicrobial Susceptibility Profile of Methicillin-Resistant Staphylococcus Aureus Isolated from Clinical Samples at Bac Ninh Provincial General Hospital, Vietnam.

Purpose: Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA) strain, can become resistant to all classes of clinically available antibiotics and causes skin infections and severe infections in the lungs, heart, and bloodstream. The study aimed to evaluate antimicrobial susceptibility patterns and MRSA exhibiting multidrug resistance obtained through a microbiological culture of clinical specimens at Bac Ninh Provincial General Hospital in Bac Ninh Province, Vietnam. Methods: We employed a cross-sectional analysis at Bac Ninh Provincial General Hospital in Vietnam. 15,232 clinical samples from inpatients were examined. S. aureus isolates were identified using established protocols and tested for MRSA and antibiotic susceptibility. Data was analyzed using R software, with statistical calculations to assess associations between variables. Results: Staphylococcus aureus was isolated from 417 samples (2.7%), with 77.2% being MRSA and 22.8% methicillin-susceptible Staphylococcus aureus (MSSA). Significant sources of MRSA were wounds (64.6%) and the surgical unit (50%) according to sample types and hospital wards, respectively. S. aureus showed high resistance rates, the highest being azithromycin (83.2%), and was fully susceptible to vancomycin. Among 294 multidrug-resistant (MDR) strains, the prevalence was 82.0% in MRSA and 18.0% in MSSA. Conclusion: The study highlights widespread antimicrobial resistance among MRSA isolates from a provincial hospital in Vietnam, emphasizing the urgent need for antibiotic surveillance, formulation of antibiotic policies, and preventive measures to tackle the increasing prevalence of multidrug-resistant MRSA.

Exogenous expression of PGC-1α during in vitro maturation impairs the developmental competence of porcine oocytes.

Objectives of the current study were to examine the effects of exogenous expression of PGC-1α, which is a transcription factor responsive for controlling mitochondrial DNA (mtDNA) replication, mitochondria quantity control, mitochondrial biogenesis, and reactive oxygen species (ROS) maintenance, in porcine oocytes during in-vitro maturation (IVM) on the developmental competence, as well as mitochondrial quantity and function. Exogenous over-expression of PGC-1α by injection of the mRNA construct into oocytes 20 h after the start of IVM culture significantly increased the copy number of mtDNA in the oocytes, but reduced the incidences of oocytes matured to the metaphase-II stage after the IVM culture for totally 44 h and completely suppressed the early development in vitro to the blastocyst stage following parthenogenetic activation. The exogenous expression of PGC-1α also significantly induced spindle defects and chromosome misalignments. Furthermore, markedly higher ROS levels were observed in the PGC-1α-overexpressed mature oocytes, whereas mRNA level of SOD1, encoded for a ROS scavenging enzyme, was decreased. These results conclude that forced expression of PGC-1α successfully increase mtDNA copy number but led to increased ROS production, evidently by downregulation of SOD1 gene expression, inducement of spindle aberration/chromosomal misalignment, and consequently reduction in the meiotic and developmental competences of porcine oocytes.

Dirac exciton-polariton condensates in photonic crystal gratings.

Bound states in the continuum have recently been utilized in photonic crystal gratings to achieve strong coupling and ultralow threshold condensation of exciton-polariton quasiparticles with atypical Dirac-like features in their dispersion relation. Here, we develop the single- and many-body theory of these new effective relativistic polaritonic modes and describe their mean-field condensation dynamics facilitated by the interplay between protection from the radiative continuum and negative-mass optical trapping. Our theory accounts for tunable grating parameters giving full control over the diffractive coupling properties between guided polaritons and the radiative continuum, unexplored for polariton condensates. In particular, we discover stable cyclical condensate solutions mimicking a driven-dissipative analog of the zitterbewegung effect characterized by coherent superposition of ballistic and trapped polariton waves. We clarify important distinctions between the polariton nearfield and farfield explaining recent experiments on the emission characteristics of these long lived nonlinear Dirac polaritons.

Whole genome sequence analysis of Bacillus amyloliquefaciens strain S2.5 as a potential probiotic for feed supplement in livestock production.

BACKGROUND: Supplementing probiotics in livestock feed is increasing due to concerns over the potential harm caused by antibiotics and other chemical growth promoters. Several Bacillus sp. have been used as probiotic supplements for livestock. In this study, Bacillus amyloliquefaciens S2.5 was isolated from freshwater and its potential probiotic characteristics were evaluated in vitro. The whole genome of strain S2.5 was sequenced, and its probiotic traits were annotated using bioinformatic tools. RESULTS: Both vegetative cells and spores of strain S2.5 remained stable throughout the 1.5 h of gastric juice and 48 h of intestine simulation. The strain S2.5 harbored the ability to produce glucoamylase, carboxymethyl cellulase, protease, and chitinase. It is also susceptible to all six tested antibiotics. The complete genome sequence shows genes related to acid-bile tolerance, environmental stress resistance, hydrolases, and adhesion to gut mucosa, confirming probiotic traits in the in vitro experiments. CONCLUSIONS: B. amyloliquefaciens S2.5 demonstrated potential probiotic characteristics and its genetic profile in the in vitro experiments. Further in vivo assessments of B. amyloliquefaciens S2.5 on livestock and poultry should be performed to assess its practical application.

Alkaloids from Piper longum L and Their Anti-inflammatory Properties.

Piper longum L.(PL)  is considered one of the most important species traditionally used for treating various ailments and has indicated the presence of alkaloids, flavonoids, and steroids. In this study, we isolated the chemical compounds of PLleaves,andmeasuredNO, IL-6, iNOS, as well as COX-2 protein levels. In addition, molecular docking analysis were used to further understand anti-inflammation effect of the compounds. We identified one new alkaloid named piperlongumine A (1) with ten known compounds (2-11). The new compound (1) and two other alkaloids 2E)-3-(4-hydroxy-3-methoxyphenyl)-1-(pyrrol-1-yl)propanone (7) and piperchabamide A (8) significantlyreduced NO production in LPS-stimulated RAW 264.7 cells with the IC50 values of 0.97 ± 0.05 mM, 0.91 ± 0.07mM, 1.63 ± 0.14 mM, respectively. Moreover, at concentration of 2 mM, compound 1 inhibited approximately 98 ± 0.64 % of IL-6 secretion, and decreased  iNOS and COX-2 protein level by about 96 and 19 folds compared to LPS treatment alone, respectively. Furthermore, compounds 1, 7, and 8 were predicted to bind and inhibit IL-6, TNF-a, and iNOS, with compound 1 showing the highest binding energy of -7.09 kcal/mol. This study provides new insights for potential anti-inflammatory drug design and warrants further investigation.

Long-Term Trends in Access to Dental Care in Canada.

OBJECTIVES: Although routine dental care is essential for both oral and overall health, in Canada, access to such care is uneven. Those with low or medium income and no workplace dental coverage often face financial barriers in accessing dental care. However, the factors that affect access - income, employer-provided health benefits and public dental care subsidy programs - have changed over the decades. This study examines the net impact of these factors on long-term trends in dental care access among different groups in Canada over the past 5 decades. METHODS: Using data from 1 235 268 respondents to 20 Canadian cross-sectional surveys administered between 1972 and 2017, we estimated the proportion of people who had at least 1 consult with a dental professional over the past 12 months. Prevalence trends by region, age group, education and income level were compared. RESULTS: In each age group, the proportion of people consulting a dental professional at least annually gradually increased over the last 5 decades. During the recession of the early 1990s, a temporary drop in use occurred, particularly among younger age groups. We noted significant regional differences in use among individuals in the same age group: rates were highest in Ontario and British Columbia and lowest in Quebec and the Atlantic provinces. Marked differences in use by level of education and income persisted over the 5 decades. Dental care use was significantly higher among those with higher levels of education and higher incomes. The increase in overall rates of dental care use suggest that an increasing fraction of Canadians have higher incomes or are better educated, or both. Nevertheless, about a third of Canadians ≥ 15 years did not receive dental care in 2015. CONCLUSIONS: Given that dental care is almost wholly privately funded and displays a high degree of income-related inequity, there is an urgent need for policy action to address unequal access to dental care in Canada.

Essential oil and Waste Hydrosol of Ocimum Tenuiflorum L.: A Low-Cost Raw Material Source of Eugenol, Botanical Pesticides, and Therapeutic Potentiality.

In this study, essential oils and waste hydrosols of leaves of Ocimum tenuiflorum in four different geographical locations were extracted by hydrodistillation method and using gas chromatography/mass spectrometry (GC/MS) for chemical composition analysis. All four essential oil samples contained the main components (E)-ß-caryophyllene (27.8-49.0 %), trans-ß-elemene (20.3-37.1 %) and eugenol (9.0-44.0 %). Three of the four hydrosol samples had eugenol in absolute content (94.5-98.6 %), while the remaining hydrosol sample had two main components, elemicin (77.8 %) and eugenol (14.2 %). Essential oils and hydrosols demonstrated larvicidal activities against four important disease-transmitting mosquito species including Aedes aegypti, Aedes albopictus, Culex quinquefasciatus, and Culex fuscocephala with 24-h LC50 values in the range 15.42-56.01 µg/mL and 53.88-97.80 µg/mL for the essential oils and the hydrosols, respectively. Essential oils and hydrosols strongly inhibited the acetylcholinesterase (AChE) enzyme of electric eels with IC50 values in the range of 25.35-107.19 µg/mL. Microemulsion (ME) can be considered as a sustainable pesticide formulation over 300 days and has improved larvicidal activity compared to free essential oil. The O. tenuiflorum in Vietnam can be considered a low-cost source of eugenol, botanical pesticides that control disease-transmitting mosquitoes, as well as having therapeutic potential to be further investigated.

Streptococcus raffinosi sp. nov., isolated from human breast milk samples.

Novel Gram-positive, catalase-negative, α-haemolytic cocci were isolated from breast milk samples of healthy mothers living in Hanoi, Vietnam. The 16S rRNA gene sequences of these strains varied by 0-2 nucleotide polymorphisms. The 16S rRNA gene sequence of one strain, designated as BME SL 6.1T, showed the highest similarity to those of Streptococcus salivarius NCTC 8618T (99.4 %), Streptococcus vestibularis ATCC 49124T (99.4 %), and Streptococcus thermophilus ATCC 19258T (99.3 %) in the salivarius group. Whole genome sequencing was performed on three selected strains. Phylogeny based on 631 core genes clustered the three strains into the salivarius group, and the strains were clearly distinct from the other species in this group. The average nucleotide identity (ANI) value of strain BME SL 6.1T exhibited the highest identity with S. salivarius NCTC 8618T (88.4 %), followed by S. vestibularis ATCC 49124T (88.3 %) and S. thermophilus ATCC 19258T (87.4 %). The ANI and digital DNA-DNA hybridization values between strain BME SL 6.1T and other species were below the cut-off value (95 and 70 %, respectively), indicating that it represents a novel species of the genus Streptococcus. The strains were able to produce α-galactosidase and acid from raffinose and melibiose. Therefore, we propose to assign the strains to a new species of the genus Streptococcus as Streptococcus raffinosi sp. nov. The type strain is BME SL 6.1T (=VTCC 12812T=NBRC 116368T).

Effect of saponins in Panax notoginseng (Burkill) F. H. Chen on the steroid hormone levels in the chronic unpredictable mild stress model of depression in rats.

Recent research has indicated that Panax notoginseng saponins (PNS) extracted from the radix of Panax notoginseng (Burkill) F. H. Chen exert antidepressant effects. This study aimed to assess the antidepressive effects of ginsenoside Rg1 and PNS in a depression model induced by chronic unpredictable mild stress (CUMS). Over a period of three weeks, rats were administered ginsenoside Rg1 at a dose of 30 mg/kg and PNS at dosages ranging from 100 to 200 mg/kg body weight per day. To assess how ginsenoside Rg1 and PNS influence depression-like behaviours in rats, various assessments were conducted, including coat state evaluation, forced swim test, and elevated plus maze test. The levels of cortisol and testosterone in serum samples were analysed using the liquid chromatography-electrospray ionisation tandem mass spectrometry (LC-ESI-MS/MS) method. LC-ESI-MS/MS method provides precise and accurate results. The lower limit of quantification values for cortisol and testosterone were determined as 100 and 2 pg/mL, respectively. Our data demonstrated that both ginsenoside Rg1 and PNS significantly reversed depression-like behaviour in rats by improving coat condition, reducing immobility time in the forced swim test, and increasing time spent in the open arms of the elevated plus maze test. Furthermore, ginsenoside Rg1 and PNS exhibited a regulatory effect on cortisol and testosterone levels in plasma. These findings suggest that ginsenoside Rg1 and PNS may be potential antidepressants in clinical treatment.

Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence.

Background: AF is a global health concern, with systemic complications including renal dysfunction. This systematic review and meta-analysis compares the effects of rivaroxaban, a Factor Xa inhibitor, and vitamin K antagonists (VKAs) on renal outcomes in AF patients. Methods: The study protocol is registered in PROSPERO (ID: CRD42023462756). We systematically searched the PubMed, Embase and Cochrane Library databases from 1 January 2017 to 30 June 2023 for real-world studies comparing the effects of rivaroxaban and VKAs on renal outcomes in AF patients, including acute kidney injury, a .30% decrease in estimated glomerular filtration rate, doubling of serum creatinine and worsening renal function. Subgroup analyses targeted diabetes, pre-existing kidney disease, the elderly (age .65 years) and Asian populations. The risk of bias was assessed used the Robins-I tool. HRs and 95% CIs were synthesised through a random-effects model. Two sensitivity analyses were performed, using a fixed-effects model and excluding conference abstracts. Results: We identified 1,666 records. After screening, 14 studies comparing rivaroxaban and VKAs were included. Rivaroxaban exhibited superiority over VKAs in preventing: acute kidney injury (HR 0.68; 95% CI [0.61.0.77]; p<0.00001); a .30% decrease in estimated glomerular filtration rate (HR 0.71; 95% CI [0.60.0.84]; p<0.0001); doubling of serum creatinine (HR 0.50; 95% CI [0.36.0.70]; p<0.0001); and worsening renal function (HR 0.56; 95% CI [0.45.0.69]; p<0.00001). Subgroup and sensitivity analyses consistently confirmed rivaroxaban's favourable effects on renal outcomes in diabetes, pre-existing kidney disease, the elderly and Asian populations. Conclusion: Our findings support the preference of rivaroxaban over VKAs for renal outcomes in AF. The findings endorse rivaroxaban as the preferred anticoagulant to mitigate renal complications, offering clinicians valuable insights for tailored strategies.