An ambipolar PEDOT-perfluorinated porphyrin electropolymer: application as an active material in energy storage systems.

The development of functional organic materials is crucial for the advancement of various fields, such as optoelectronics, energy storage, sensing, and biomedicine. In this context, we successfully prepared a stable ambipolar perfluoroporphyrin-based polymeric film by electrochemical synthesis. Our strategy involved the synthesis of a novel tetra-pentafluorophenyl porphyrin covalently linked to four 3,4-ethylenedioxythiophene (EDOT) moieties. The resulting monomer, EDOT-TPPF16, was obtained through a straightforward synthetic approach with a good overall yield. The unique molecular structure of EDOT-TPPF16 serves a dual function, with EDOT moieties allowing electropolymerization for polymeric film formation, while the electron-acceptor porphyrin core enables electrochemical reduction and electron transport. The electrochemical polymerization permits the polymer (PEDOT-TPPF16) synthesis and film formation in a reproducible and controllable manner in one step at room temperature. Spectroelectrochemical experiments confirmed that the porphyrin retained its optoelectronic properties within the polymeric matrix after the electrochemical polymerization. The obtained polymeric material exhibited stable redox capabilities. Current charge-discharge cycles and electrochemical impedance spectroscopy of the electrochemically generated organic film demonstrated that the polymer could be applied as a promising active material in the development of supercapacitor energy storage devices.

Ningalins, Pyrrole-Bearing Metabolites Isolated from Didemnum spp. Synthesis and MDR-Reversion Activity in Cancer Therapy.

Multi-Drug Resistance (MDR) is one of the most frequent problems observed in the course of cancer chemotherapy. Cells under treatment, tend to develop survival mechanisms to drug-action thus generating drug-resistance. One of the most important mechanism to get it is the over expression of P-gp glycoprotein, which acts as an efflux-pump releasing the drug outside of the cancer cell. A strategy for a succesfull treatment consists in the co-administration of one compound that acts against P-gp and another which acts against the cell during chemotherapy. Ningalins are pyrrole-containing naturally occurring compounds isolated mainly from the marine tunicate Didemnum spp and also they are some of the top reversing agents in MDR treatment acting on P-gp. Considering the relevance displayed for some of these isolated alkaloids or their core as a drug for co-administration in cancer therapy, all the total synthesis described to date for the members of ningalins family are reviewed herein.

Metabolomics as a tool for geographic origin assessment of roasted and green coffee beans.

Coffee is widely consumed across the globe. The most sought out varieties are Arabica and Robusta which differ significantly in their aroma and taste. Furthermore, varieties cultivated in different regions are perceived to have distinct characteristics encouraging some producers to adopt the denomination of origin label. These differences arise from variations on metabolite content related to edaphoclimatic conditions and post-harvest management among other factors. Although sensory analysis is still standard for coffee brews, instrumental analysis of the roasted and green beans to assess the quality of the final product has been encouraged. Metabolomic profiling has risen as a promising approach not only for quality purposes but also for geographic origin assignment. Many techniques can be applied for sample analysis: chromatography, mass spectrometry, and NMR have been explored. The data collected is further sorted by multivariate analysis to identify similar characteristics among the samples, reduce dimensionality and/or even propose a model for predictive purposes. This review focuses on the evolution of metabolomic profiling for the geographic origin assessment of roasted and green coffee beans in the last 21 years, the techniques that are usually applied for sample analysis and also the most common approaches for the multivariate analysis of the collected data. The prospect of applying a wide range of analytical techniques is becoming an unbiased approach to determine the origin of different roasted and green coffee beans samples with great correlation. Predictive models worked accurately for the geographic assignment of unknown samples once the variety was known.

Antibiotic Resistance Rates for Helicobacter pylori in Rural Arizona: A Molecular-Based Study.

Helicobacter pylori (H. pylori) is a common bacterial infection linked to gastric malignancies. While H. pylori infection and gastric cancer rates are decreasing, antibiotic resistance varies greatly by community. Little is known about resistance rates among rural Indigenous populations in the United States. From 2018 to 2021, 396 endoscopy patients were recruited from a Northern Arizona clinic, where community H. pylori prevalence is near 60%. Gastric biopsy samples positive for H. pylori (n = 67) were sequenced for clarithromycin- and metronidazole-associated mutations, 23S ribosomal RNA (23S), and oxygen-insensitive NADPH nitroreductase (rdxA) regions. Medical record data were extracted for endoscopic findings and prior H. pylori history. Data analysis was restricted to individuals with no history of H. pylori infection. Of 49 individuals, representing 64 samples which amplified in the 23S region, a clarithromycin-associated mutation was present in 38.8%, with T2182C being the most common mutation at 90%. While the prevalence of metronidazole-resistance-associated mutations was higher at 93.9%, the mutations were more variable, with D95N being the most common followed by L62V. No statistically significant sex differences were observed for either antibiotic. Given the risk of treatment failure with antibiotic resistance, there is a need to consider resistance profile during treatment selection. The resistance rates in this population of American Indian patients undergoing endoscopy are similar to other high-risk populations. This is concerning given the high H. pylori prevalence and low rates of resistance testing in clinical settings. The mutations reported are associated with antibiotic resistance, but clinical resistance must be confirmed.

Photoactive antimicrobial coating based on a PEDOT-fullerene C60 polymeric dyad.

A photostable and photodynamic antimicrobial surface was successfully obtained and applied to photoinactivate microorganisms. This approach was based on the synthesis of a fullerene C60 derivative (EDOT-C60) where fullerene C60 is covalently linked to 3,4-ethylenedioxythiophene (EDOT) through a 1,3-dipolar cycloaddition reaction. This dual-functional monomer bears an EDOT center connected via an alkyl chain to a fullerene C60 moiety. In this structure, EDOT acts as an electropolymerizable unit that allows the film formation over conducting substrates, while fullerene C60 performs the photodynamic antimicrobial activity. Electrochemical polymerization of EDOT was used to obtain stable and photodynamic polymeric films (PEDOT-C60) in a controllable procedure. Cyclic voltammetry and UV-visible spectroscopy studies showed that the fullerene C60 units were not altered during the electropolymerization process, obtaining surfaces with high fullerene content. Photobleaching measurements demonstrated that the electropolymerized films were highly photostable. Moreover, photodynamic properties of PEDOT-C60 were compared with fullerene C60 and showed that electrodeposited films were able to generate reactive oxygen species (ROS) through the two photomechanisms, producing singlet molecular oxygen (type II) and superoxide radical anion (type I). All studies demonstrated that fullerene C60 moieties covalently attached to the polymeric matrix mainly conserve the photodynamic characteristics. Hence, photodynamic action sensitized by PEDOT-C60 was assessed in vitro against Staphylococcus aureus. The photosensitized inactivation by the electropolymerized films on bacteria suspensions produced >99.9% reduction in S. aureus survival. Fluorescence microscopy experiments with S. aureus adhered to the PEDOT-C60 surface showed a complete microbe annihilation. Also, the eradication of biofilms formed on PEDOT-C60 surfaces resulted in a photokilling >99.9% after visible light irradiation. Our results demonstrated that these antimicrobial photodynamic polymeric films are a promising and versatile platform to photoinactivate microorganisms and to obtain photostable self-sterilizing surfaces.

Prevalencia de embarazos con infección por virus Zika en una Unidad de Primer Nivel de Atención en Coatzacoalcos Veracruz México del Instituto Mexicano del Seguro Social / PREVALENCE OF PREGNANCIES WITH ZIKA VIRUS INFECTION IN A FIRST LEVEL CARE UNIT IN COATZACOALCOS VERACRUZ MEXICO OF THE MEXICAN INSTITUTE OF SOCIAL SECURITY

El virus Zika, es un arbovirus del género flavivirus (familia Flaviviridae), muy cercano filogenéticamente al del dengue, fiebre amarilla, la encefalitis japonesa, o el virus del Nilo Occidental. El presente estudio exploratorio busca identificar los casos confirmados y sugestivos de infección por virus Zika en mujeres embarazadas en la Unidad de Medicina Familiar N° 60 del IMSS de Coatzacoalcos, Veracruz. México como primera aproximación epidemiológica en esta región.

The Zika virus is an arbovirus of the genus flavivirus (family Flaviviridae), very closely phylogenetically a virus such as dengue fever, yellow fever, Japanese encephalitis, or West Nile virus. According to the Epidemiological Surveillance System for Zíka Virus Disease, until November 4th, 2016, in Mexico there were 6,094 confirmed cases of infection and 3,167 suspected cases of Zika virus infection in pregnant women in 24 states of the Mexican Republic, with a higher prevalence in Veracruz, Chiapas, Colima, Campeche, Yucatan and Quintana Roo. This is an original study that focuses on identifying the confirmed and suggestive cases of Zika virus infection in pregnant women in the Family Medicine Unit No. 60 of the IMSS in Coatzacoalcos, Veracruz. Mexico; It is an exploratory study in the registry of cases of pregnant women with Zika virus infection in the Family Medicine Unit No. 60 of Coatzacoalcos, Veracruz, Mexico as epidemiological basis

The Use of Insecticide-Treated Curtains for Control of Aedes aegypti and Dengue Virus Transmission in "Fraccionamiento" Style Houses in México.

Dengue, chikungunya, yellow fever, and Zika viruses transmitted by Aedes aegypti mosquitoes are major public health threats in the tropical and subtropical world. In México, construction of large tracts of "fraccionamientos" high density housing to accommodate population growth and urbanization has provided fertile ground for Ae. aegypti-transmitted viruses. We investigated the utility of pyrethroid-treated window curtains to reduce both the abundance of Ae. aegypti and to prevent dengue virus (DENV) transmission in fraccionamiento housing. Windows and doors of fraccionamiento homes in urban/suburban areas, where Ae. aegypti pyrethroid resistance associated with the Ile1016 knock down resistance (kdr) mutation in the voltage gated sodium channel gene was high, and in rural areas, where kdr resistance was low, were fitted with either insecticide-treated curtains (ITCs) or non-treated curtains (NTCs). The homes were monitored for mosquito abundance and DENV infection. ITCs reduced the indoor abundance of Ae. aegypti and the number of DENV-infected mosquitoes in homes in rural but not in urban/suburban study sites. The presence of non-treated screens also was associated with reduced numbers of mosquitoes in homes. "Super-infested" homes, yielding more than 50 mosquitoes, including DENV-infected mosquitoes, provide a significant public health risk to occupants, visitors, and people in neighboring homes.

A phase I, randomized, controlled, dose-ranging study of investigational acellular pertussis (aP) and reduced tetanus-diphtheria-acellular pertussis (TdaP) booster vaccines in adults.

Despite high vaccination coverage worldwide, pertussis has re-emerged in many countries. This randomized, controlled, observer-blind phase I study and extension study in Belgium (March 2012-June 2015) assessed safety and immunogenicity of investigational acellular pertussis vaccines containing genetically detoxified pertussis toxin (PT) (NCT01529645; NCT02382913). 420 healthy adults (average age: 26.8 ± 5.5 years, 60% female) were randomized to 1 of 10 vaccine groups: 3 investigational aP vaccines (containing pertussis antigens PT, filamentous hemagglutinin [FHA] and pertactin [PRN] at different dosages), 6 investigational TdaP (additionally containing tetanus toxoid [TT] and diphtheria toxoid [DT]), and 1 TdaP comparator containing chemically inactivated PT. Antibody responses were evaluated on days 1, 8, 30, 180, 365, and approximately 3 years post-booster vaccination. Cell-mediated immune responses and PT neutralization were evaluated in a subset of participants in pre-selected groups. Local and systemic adverse events (AEs), and unsolicited AEs were collected through day 7 and 30, respectively; serious AEs and AEs leading to study withdrawal were collected through day 365 post-vaccination. Antibody responses against pertussis antigens peaked at day 30 post-vaccination and then declined but remained above baseline level at approximately 3 years post-vaccination. Responses to FHA and PRN were correlated to antigen dose. Antibody responses specific to PT, toxin neutralization activity and persistence induced by investigational formulations were similar or significantly higher than the licensed vaccine, despite lower PT doses. Of 15 serious AEs, none were considered vaccination-related; 1 led to study withdrawal (premature labor, day 364; aP4 group). This study confirmed the potential benefits of genetically detoxified PT antigen. All investigational study formulations were well tolerated.

Direct Hydrogen Evolution from Saline Water Reduction at Neutral pH using Organic Photocathodes.

Here, we have developed an organic photocathode for water reduction to H2 , delivering more than 1 mA cm-2 at 0 V versus RHE and above 3 mA cm-2 at -0.5 V versus RHE with moderate stability under neutral pH conditions. The initial competitive reduction of water to H2 and ZnO to metallic Zn is responsible for the dynamic behaviour of both photocurrent and Faradaic efficiency of the device, which reaches 100 % Faradaic efficiency after 90 min operation. In any case, outstanding stable H2 flow of approximately 2 µmol h-1 is measured over 1 h at 0 V versus RHE and at neutral pH, after equilibrium between the Zn2+ /Zn0 concentration in the AZO film is reached. This achievement opens new avenues for the development of allsolution-processed organic photoelectrochemical cells for the solar generation of H2 from sea water.

[Perception of users about an Integral Model of Family and Community Health care in Santiago, Chile]. / Principios orientadores del Modelo Integral de Salud Familiar y Comunitario desde la perspectiva de los usuarios.

BACKGROUND: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. AIM: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. MATERIAL AND METHODS: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. RESULTS: Seven issues emerged from the description of patients’ experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. CONCLUSIONS: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

Principios orientadores del Modelo Integral de Salud Familiar y Comunitario desde la perspectiva de los usuarios / Perception of users about an Integral Model of Family and Community Health care in Santiago, Chile

Background: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. Aim: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. Material and Methods: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. Results: Seven issues emerged from the description of patients’ experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. Conclusions: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

Household use of insecticide consumer products in a dengue-endemic area in México.

OBJECTIVES: To evaluate the household use of insecticide consumer products to kill mosquitoes and other insect pests, as well as the expenditures for using these products, in a dengue-endemic area of México. METHODS: A questionnaire was administered to 441 households in Mérida City and other communities in Yucatán to assess household use of insecticide consumer products. RESULTS: A total of 86.6% of surveyed households took action to kill insect pests with consumer products. The most commonly used product types were insecticide aerosol spray cans (73.6%), electric plug-in insecticide emitters (37.4%) and mosquito coils (28.3%). Mosquitoes were targeted by 89.7% of households using insecticide aerosol spray cans and >99% of households using electric plug-in insecticide emitters or mosquito coils. Products were used daily or every 2 days in most of the households for insecticide aerosol spray cans (61.4%), electric plug-in insecticide emitters (76.2%) and mosquito coils (82.1%). For all products used to kill insect pests, the median annual estimated expenditure per household that took action was 408 Mexican pesos ($MXN), which corresponded to approximately 31 $US. These numbers are suggestive of an annual market in excess of 75 million $MXN (>5.7 million $US) for Mérida City alone. CONCLUSION: Mosquitoes threaten human health and are major nuisances in homes in the study area in México. Households were found to have taken vigorous action to kill mosquitoes and other insect pests and spent substantial amounts of money on insecticide consumer products.

Energy and electron transfer processes in polymeric nanoparticles.

We report herein a study on photoinduced electron transfer (eT) and energy transfer (ET) processes occurring between 9-methylanthracene-acrylate (A) and N,N-dimethylaniline-acrylate (D) derivatives incorporated into polymeric nanoparticles (NP). Five types of NPs were synthesized: PAD0, PAD25, PAD75, PD25, and PD75. All NPs are composed of a crosslinked polymer matrix of methyl methacrylate and ethylene glycol dimethacrylate. In addition, PAD0, PAD25 and PAD75 contain low doping levels of A. For PAD25 and PAD75, 25% and 75% of the mole fraction of methyl methacrylate is replaced by D, respectively. PD25 and PD75 were prepared as above but without A. NPs (diameter 6-9 nm) dispersed in organic solvents were characterized based on their UV-visible absorption, emission, excitation, and excitation anisotropy spectra and time dependent absorption and emission spectroscopy techniques. The emission decay profiles of A and D were always complex. Results indicate that A senses two distinct environments in all NPs. The emission quenching of PAD0 by DMA in DCM solutions is dynamic, and it is apparent that a significant fraction of A is inaccessible to the quencher. The emission of A is efficiently quenched by the presence of D in PAD25 and PAD75. The intra-NP photoinduced eT quenching mechanism has static and dynamic components. Selective excitation of D in PAD25 and PAD75 leads to the formation of the excited state of A via a singlet-singlet ET Föster type mechanism. Results indicate that both intra-NP eT and ET processes are more efficient in PAD75 due to the reduced average D*-A separation in these NPs.

Estimation of the solvent reorganization energy and the absolute energy of solvation of charge-transfer states from their emission spectra.

We report herein the solvent and temperature effects on the emission of the intermolecular exciplexes 1-cyanonaphthalene/triethylamine and 1-methylnaphthalene/triethylamine and the intramolecular exciplexes formed by the bichromophoric compounds diethyl-(3-naphthalen-1-yl-propyl)-amine (I), diethyl-(2-naphthalen-1-yl-ethyl)-amine (II), 3-[ethyl-(2-naphthalen-1-yl-ethyl)-amino]-propionitrile (III) and 3-[(2-cyano-ethyl)-(2-naphthalen-1-yl-ethyl)-amino]-propionitrile (IV). The results are interpreted within the formalism of the semiclassical Marcus theory for radiative back electron transfer (BET) reactions. We show that, following a few simple assumptions, reliable values of the Gibbs free energy changes (DeltaG(epsilon)(-et)) and the solvent reorganization energies (lambda(epsilon)(s)) associated to the BET reactions (and their corresponding enthalpic and entropic contributions) can be estimated directly from the emission of the CT states. We also show that for the 1-cyanonaphthalene/triethylamine exciplex, which exhibits emission in the vapour phase, the experimental calculation of the absolute energy of solvation of the CT state (DeltaG(epsilon)(s)) is also possible. The calculated DeltaG(epsilon)(-et) correlate quite satisfactorily with the corresponding values obtained from independent electrochemical and kinetics experiments. The temperature effects on DeltaG(epsilon)(-et), lambda(epsilon)(s) and DeltaG(epsilon)(s) are discussed qualitatively using different solvation models. The limitations of the present approach for the estimation of DeltaG(epsilon)(-et) and lambda(epsilon)(s) and its possible application to more complex A/D systems are also examined.

Choline intake, plasma riboflavin, and the phosphatidylethanolamine N-methyltransferase G5465A genotype predict plasma homocysteine in folate-deplete Mexican-American men with the methylenetetrahydrofolate reductase 677TT genotype.

We previously showed that provision of the folate recommended dietary allowance and either 300, 550, 1100, or 2200 mg/d choline for 12 wk resulted in diminished folate status and a tripling of plasma total homocysteine (tHcy) in men with the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype. However, the substantial variation in tHcy within the 677TT genotype at wk 12 implied that several factors were interacting with this genotype to affect homocysteine. As an extension of this work, the present study sought to identify the main predictors of wk-12 plasma tHcy, alone and together with the MTHFR C677T genotype (29 TT, 31 CC), using linear regression analysis. A basic model explaining 82.5% of the variation (i.e. adjusted R(2) = 0.825) was constructed. However, the effects of the variables within this model were dependent upon the MTHFR C677T genotype (P for interaction < or = 0.021). Within the 677TT genotype, serum folate (P = 0.005) and plasma riboflavin (P = 0.002) were strong negative predictors (inversely related) explaining 12 and 15%, respectively, of the variation in tHcy, whereas choline intake (P = 0.003) and serum creatinine (P < 0.001) were strong positive predictors, explaining 19 and 25% of the variation. None of these variables, except creatinine (P = 0.021), correlated with tHcy within the 677CC genotype. Of the 8 additional polymorphisms tested, none appeared to influence tHcy. However, when creatinine was not in the model, the phosphatidylethanolamine N-methyltransferase 5465G-->A variant predicted lower tHcy (P < 0.001); an effect confined to the MTHFR 677TT genotype. Thus, in folate-deplete men, several factors with roles in 1-carbon metabolism interact with the MTHFR C677T genotype to affect plasma tHcy.

Adequate Intake levels of choline are sufficient for preventing elevations in serum markers of liver dysfunction in Mexican American men but are not optimal for minimizing plasma total homocysteine increases after a methionine load.

BACKGROUND: An adequate intake of 550 mg choline/d was established for the prevention of liver dysfunction in men, as assessed by measuring serum alanine aminotransferase concentrations. OBJECTIVE: This controlled feeding study investigated the influence of choline intakes ranging from 300 to 2200 mg/d on biomarkers of choline status. The effect of the methylenetetrahydrofolate reductase (MTHFR) C677T genotype on choline status was also examined. DESIGN: Mexican American men (n = 60) with different MTHFR C677T genotypes (29 677TT, 31 677CC) consumed a diet providing 300 mg choline/d plus supplemental choline intakes of 0, 250, 800, or 1900 mg/d for total choline intakes of 300, 550, 1100, or 2200 mg/d, respectively, for 12 wk; 400 mug/d as dietary folate equivalents and 173 mg betaine/d were consumed throughout the study. RESULTS: Choline intake affected the response of plasma free choline and betaine (time x choline, P < 0.001); the highest concentrations were observed in the 2200 mg/d group. Phosphatidylcholine (P = 0.026) and total cholesterol (P = 0.002) were also influenced by choline intake; diminished concentrations were observed in the 300 mg/d group. Phosphatidylcholine was modified by MTHFR genotype (P = 0.035; 677TT < 677CC). After a methionine load (100 mg/kg body wt), choline intakes of 1100 and 2200 mg/d attenuated (P = 0.016) the rise in plasma homocysteine, as did the MTHFR 677TT genotype (P < 0.001). Serum alanine aminotransferase was not influenced by the choline intakes administered in this study. CONCLUSIONS: These data suggest that 550 mg choline/d is sufficient for preventing elevations in serum markers of liver dysfunction in this population under the conditions of this study; higher intakes may be needed to optimize other endpoints.

Folate intake at RDA levels is inadequate for Mexican American men with the methylenetetrahydrofolate reductase 677TT genotype.

Since the establishment of the 1998 folate recommended dietary allowance (RDA), the methylenetetrahydrofolate reductase (MTHFR) 677C-->T variant has emerged as a strong modifier of folate status. This controlled feeding study investigated the adequacy of the RDA, 400 microg/d as dietary folate equivalents (DFE), for Mexican American men with the MTHFR 677CC or TT genotype. Because of the interdependency between folate and choline, the influence of choline intake on folate status was also assessed. Mexican American men (n = 60; 18-55 y) with the MTHFR 677CC (n = 31) or TT (n = 29) genotype consumed 438 microg DFE/d and total choline intakes of 300, 550 (choline adequate intake), 1100, or 2200 mg/d for 12 wk. Folate status response was assessed via serum folate (SF), RBC folate, plasma total homocysteine (tHcy), and urinary folate. SF decreased (P < 0.001) 66% to 7.9 +/- 0.7 nmol/L (means +/- SEM) in men with the 677TT genotype and 62% to 11.3 +/- 0.9 nmol/L in the 677CC genotype. Plasma tHcy increased (P < 0.0001) 170% to 31 +/- 3 micromol/L in men with the 677TT genotype and 18% to 11.6 +/- 0.3 micromol/L in the 677CC genotype. At the end of the study, 34% (677TT) and 16% (677CC) had SF concentrations <6.8 nmol/L and 79% (677TT) and 7% (677CC) had tHcy concentrations >14 micromol/L. Choline intake did not influence the response of the measured variables. These data showed that the folate RDA is not adequate for men of Mexican descent, particularly for those with the MTHFR 677TT genotype, and demonstrated a lack of influence of choline intake on the folate status variables measured in this study.