Study of structural properties and defects of Ni-doped SnO2 nanorods as ethanol gas sensors.

An ethanol gas sensor with enhanced sensor response was fabricated using Ni-doped SnO2 nanorods, synthesized via a simple hydrothermal method. It was found that the response (R = R 0/R g) of a 5.0 mol% Ni-doped SnO2 (5.0Ni:SnO2) nanorod sensor was 1.4 × 104 for 1000 ppm C2H5OH gas, which is about 13 times higher than that of pure SnO2 nanorods, (1.1 × 103) at the operating temperature of 450 °C. Moreover, for 50 ppm C2H5OH gas, the 5.0Ni:SnO2 nanorod sensor still recorded a significant response reading, namely 2.0 × 103 with a response time of 30 s and recovery time of 10 min. To investigate the effect of Ni dopant (0.5-5.0 mol%) on SnO2 nanorods, structural characterizations were demonstrated using field emission scanning electron microscopy, high-resolution transmission electron microscopy, Fourier transform infrared spectroscopy, x-ray diffraction (XRD) analysis, x-ray photoelectron spectroscopy and an ultraviolet-visible spectrometer. XRD results confirmed that all the samples consisted of tetragonal-shaped rutile SnO2 nanorods. It was found that the average diameter and length of the nanorods formed in 5.0Ni:SnO2 were four times smaller (∼6 and ∼35 nm, respectively) than those of the nanorods formed in pure SnO2 (∼25 and 150 nm). Interestingly, both samples had the same aspect ratio, ∼6. It is proposed that the high response of the 5.0Ni:SnO2 nanorod sensor can be attributed to the particle size, which causes an increase in the thickness of the charge depletion layer, and the presence of oxygen vacancies within the matrix of SnO2 nanorods.

Unusual Case Report of Headache in 10-Year-Old Female Child.

According to the literature, transverse sinus hypoplasia is not a normal variant and has a serious potential effect on cerebral blood flow. We are presenting a rare case of chronic headache due to severe hypoplasia of the left transverse and sigmoidal sinus. A 12-year-old female girl was admitted with a complaint of gradual progressive severe headache, throbbing in nature, confined to a bitemporal and frontal region in the last 4-5 months. Headache is not associated with fever, vomiting, photophobia, or vision problems. The child had no history of recurrent running nose, refractory vision, ear discharge, head trauma, exanthemata rash, or any drug history. On examination, the child was conscious and oriented. Vital signs are normal. The child was neurologically normal and had no focal signs. Other systemic examinations were normal. Based on History and examination, differential diagnosis was made, like Pseudo tumor cerebri, migraine, deep vein sinus thrombosis, and functional and Posterior fossa tumor. The child had normal routine investigations like complete blood count, electrolyte, and D-dimer. The fundoscopy was normal. In MRI, brain hypoplasia of the left transverse and sinusoidal sinus was suspected and confirmed by MRI venography. Thus, for any patient in an emergency with a chronic headache without focal signs and normal fundoscopy, one deferential should be considered for transverse and sigmoid sinus hypoplasia.

Review of acute pancreatitis in children in India.

In the last two decades, the incidence of a cute pancreatitis (AP) in children has increased. Knowing different aspects of this condition like incidence, etiology, and severity is essential for the prevention and management of AP. There is a paucity of well-defined research in India on this topic. Hence, this review was done to evaluate the incidence, etiology, complications, and outcome of a cute pancreatitis. The key findings can aid the pediatrician to be aware of the epidemiology and etiology, which would help in the early diagnosis and treatment to decrease the morbidity and mortality. We have conducted an independent search in PubMed and Google Scholar and analyzed articles by Indian authors on this issue from 1990 onwards. The range of incidence of acute pancreatitis is12-20 cases per year and idiopathic is the most common cause ranging from 21 to 82.25%. Necrotizing pancreatitis (2.5-22.5%) is the most common complication which is high compared to Western countries and the mortality rate is in the range of 1.6% to 3.6%. This highlights the findings of researches in India regarding the epidemiology, etiology, complication, and mortality rate of pediatric acute pancreatitis; the incidence of which has increased considerably over the past few decades.

Assessment of awareness and knowledge regarding nuclear medicine and appropriate use of Nuclear medicine modalities, among medical students and faculty members in two academic medical institutes in North India: A Cross sectional Study.

Objectives: Despite significant progress in the field of nuclear medicine, basic nuclear medicine awareness and understanding among clinicians remains unsatisfactory, leading to under utilization of nuclear medicine modalities. To evaluate the awareness and knowledge regarding nuclear medicine and appropriate use of Nuclear medicine modalities, among medical students and faculty members. Method: In this descriptive cross sectional study, a self timer limited objective questionnaire based on Google forms was distributed to the study population and scores obtained by the participants were analyzed. Results: Percent scores range for intern, residency trainees, and senior resident/faculty groups for general awareness were 16-46%, 37-58% and 62-91% and for knowledge and appropriate use were 7-21%, 28-43%, and 35-85% respectively. Overall, 61% of the participants had poor awareness and knowledge regarding nuclear medicine modalities. None of the participants had received nuclear medicine exposure or education during their academics or training. Only 49% of the participants considered utilizing nuclear medicine modalities for their patient management. Conclusion: Undergraduate interns and residency trainees had a poor to fair level of awareness and knowledge regarding nuclear medicine. Hence creating more awareness in early stages of their career by incorporating Nuclear medicine basic education in medical undergraduate curriculum is required. The senior residents/faculty members had a moderate to good level of awareness and knowledge but still improvement in their knowledge would lead to a more appropriate and better utilization of nuclear medicine modalities for optimum patient management in a variety of clinical settings.

Kissing Carotids: A Rare Anatomical Aberration with Clinical Significance.

Kissing Carotids is a term given for an anatomical variation in which bilateral internal carotid arteries are medially placed in the retropharyngeal space and are juxtaposed to each other. Though this condition is asymptomatic it can lead to abrupt catastrophic bleeding during oral surgical procedures and tracheal intubation. This variation can be diagnosed with a contrast enhanced computed tomography and can alert the surgical team. We present here a case of 55 year old asymptomatic female diagnosed with bilateral retropharyngeal internal carotid artery aberration. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04654-3.

Risk factors and etiology of early-onset neonatal sepsis in Northeastern part of India: Case-control study.

Background: Sepsis, the second most common cause of neonatal mortality, causes more than one million deaths annually. India has the highest incidence of clinical sepsis (17000/100000 live birth). Objective: This study aimed to determine the risk factors and organisms of early-onset neonatal sepsis (EONS) in a tertiary care hospital in Northeast India. Materials and Methods: It was a case-control study conducted in the neonatal unit of MGM Medical College, Kishanganj, Bihar, from January 2022 to April 2023. All neonates admitted to the neonatal intensive care unit (NICU) within 72 hours of life constituted the study population. Neonates diagnosed as EONS by clinical and laboratory parameters were considered as cases and those not diagnosed for EONS as controls. Maternal and newborn information and laboratory parameters were collected and analyzed. For risk factor identification, the bivariate logistic regression was used. Result: An equal number of cases (78) and control (78) were enrolled in the study. Maternal age >30 years (adjusted odds ratio [aOR] = 3.017, confidence interval [CI]: 1.238 to 7.352; P < 0.015), maternal urinary tract infection (UTI) in the third trimester (aOR = 5.435, CI: 2.647 to 11.158; P < 0.0001), and premature rupture of membranes (PROM) (aOR = 2.918, CI: 4.61 to 33.73, P < 0.004) were significant predictors of EONS. Pseudomonas (41.02%), Klebsiella (16.66%), and coagulase-negative Staphylococcus aureus (20.51%) were commonly isolated organisms, which were highly resistant to cephalosporin, meropenem, aminoglycosides, and quinolones. Conclusion: Proper and adequate antenatal screening for diagnosis and treatment of maternal infection and high-risk pregnancies for perinatal management of newborn is recommended to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics may minimize the hazard of antibiotic resistance.

High Altitude Head and Neck Paragangliomas: A First Sub-Himalayan Experience.

Objectives: High-altitude natives have a high incidence of parangangliomas (PGL) of the head and neck, especially the carotid body tumor. The aim of this study is to describe the clinical presentation, pattern, altitude of residence, distribution, management, and follow-up of head and neck paragangliomas (HNPGL) in our sub-Himalayan population. Study Design: Retrospective cohort study. Setting: Academic tertiary care hospital. Methods: Hospital records of 20 patients of HNPGL diagnosed from December 2017 to December 2021 were retrieved for analysis. Results: Twenty patients with 23 HNPGL, with a mean age of 41.74 years were managed in our institute. The female-to-male ratio was 2.3: 1 and the mean follow-up was 29.95 months. Nine had carotid body (CBPGL), 7 had tympanic (TPGL), 2 had jugular (JPGL), and 2 had vagal paragangliomas (VPGL). Multiple PGL were seen in 4 patients (20%). Majority of cases (all CBPGL and 57.14% of TPGL) were residents of the high altitude, and the rest were from the low altitude. Fifteen patients (8 CBPGL, 7 TPGL) were operated. There were no major complications except in a patient with large carotid body tumor required anastomosis of carotid artery. Five patients received stereotactic radiotherapy, and 1 malignant PGL received chemoradiotherapy. Conclusion: In this study, JPGL and VPGL are common at low altitudes, whereas carotid body and tympanic PGL were the most common tumor at high altitudes. Being a retrospective and study small sample size, a definite conclusion is not established, however, a genetic analysis and inclusion of a wider population in a future prospective study may establish the hypothesis.

Cloning and expression analysis of multiple proteins encoding P gene of Newcastle disease virus.

Viral gene oncotherapy is emerging as a biotherapeutic cancer treatment modality based on targeted killing of cancer cells by viral genes. Newcastle disease virus (NDV) has the property to cause selective oncolysis of tumor cells sparing normal cells. NDV has a single stranded negative sense RNA genome, which is 15,186 nucleotide long and consists of six genes, which codes for eight proteins. NDV like other paramyxoviruses has the ability to generate multiple proteins from the P gene. P protein is encoded by an unedited transcript of the P gene, whereas the V and W protein are the results of RNA editing event in which one and two G residues are inserted at a conserved editing site within the P gene mRNA resulting in V and W transcripts, respectively. Although NDV is known to cause oncolysis by triggering apoptosis, the role of different viral proteins in selective oncolysis is still unclear. P gene edited products are known for its anti-apoptotic property in homologous host. In the present study, NDV P gene and its RNA edited products were amplified, cloned, sequenced and in vitro expression was done in HeLa cells. Further constructs were assayed for their apoptosis inducing ability in HeLa cells. Preliminary study suggested that P, V and W proteins are not apoptotic to HeLa cells.

Endoscopic Assisted Infracochlear Approach for Excision of a Large Congenital Hypotympanic Cholesteatoma: A Case Report.

Congenital cholesteatoma is a rare lesion resulting from failed involution of epidermoid rest cells, which take part in the formation of the mucosa of the middle ear cleft during embryonic development. We report the first case report of a large congenital hypotympanic cholesteatoma with extension to the jugular foramen and carotid canal, in a 13-year-old girl, which was excised successfully by endoscopic-assisted hypotympanotomy infra-cochlear approach.

Ventilator-Associated Pneumonia in Paediatric Intensive Care Unit Patients: Microbiological Profile, Risk Factors, and Outcome.

Introduction Ventilator-associated pneumonia (VAP) is one of the dreaded events in sick children who are ventilated in the paediatric intensive care unit (PICU) and has a high mortality rate. So, there is a need to know the causative organisms, risk factors, and possible predictors in a particular PICU for prevention, early identification, and treatment to decrease morbidity and mortality. This study was planned with the objectives to determine the microbiological profile, associated risk factors, and outcome of VAP in children. Methods In this observational cross-sectional study conducted at Dr. B C Roy Post Graduate Institute of Paediatric Science, Kolkata, India, 37 VAP cases were diagnosed using clinical pulmonary infection score >6 and confirmed by tracheal culture and X-ray. Results The number of paediatric patients suffering from VAP was 37 (36.2%). The commonest age group involvement was one to five years. The microbiological profile included Pseudomonas aeruginosa (29.8%) and Klebsiella pneumoniae (21.6%) as the commonest organisms followed by Staphylococcus aureus (18.9%) and Acinetobacter (13.5%). The factors significantly associated with the increased frequency of VAP were the use of steroids, sedation, and reintubation. The mean duration of mechanical ventilation (MV) in VAP was 15 days compared to non-VAP (seven days), and the longer duration of ventilation was significantly associated with VAP (p=0.00001). Mortality in VAP was 48.54% compared to non-VAP (55.84%) with no significant association (p=0.0843) of VAP with death occurrence. Conclusion The present study showed that VAP occurrence is associated with prolonged duration of MV, PICU stay, and hospital stay but is not significantly associated with mortality. It also indicated that gram-negative bacteria were the most common VAP causative organisms in this cohort.

Delineation of partial melts and crustal heterogeneities within the crust beneath Kumaon Himalaya, India from Lg wave attenuation.

The crustal seismic attenuation or the Q structure is studied by using the Fourier spectra of Lg-wave along the Tanakpur- Dharchula- Dharma transect in the Kumaon Himalaya. The 1 Hz Lg Q (Q0) values are computed between different pairs of two stations and the observed values are later utilized to calculate the lateral variation in the Q0 values by following a back projection algorithm. This computation of Q0 values utilizes five regional distance earthquakes having moment magnitude (Mw) ≥ 4.0, which lie along the great circle path of the transect. Three of the five earthquakes occurred in the Tibetan plateau and the and the others occurred to the southwest on the Indian shield and are well recorded at all the 32 broadband seismographs operated between September 2018 and March 2022. The estimate Qo values range from 63 ± 2 and 203 ± 25, with the lowest value in the Lesser Himalaya and the highest across part of the Indo Gangetic Plain and Siwalik Himalaya. The Q0 model has low values ∼200 along the profile in the Indo Gangetic Plain and the Siwalik Himalaya, and are correlated with 2-5 km thick sedimentary layers below the Himalaya and the adjoining Indo-Gangetic Plain. We observe two distinctly different Q0 values to the northeast in the Lesser Himalaya tectonic unit. The region lying between the South Almora Thrust (SAT) and the Berinag Thrust (BT) shows extremely low Q0 values (∼60) but increases further north towards the Vaikrita Thrust (VT) to ∼200. The possible explanation for observing such huge variation of the Q0 values within a single tectonic unit may be the presence of fluid rich ramp structures, which introduces crustal heterogeneities and traps the aqueous fluids or partial melts lying within the crust. The Lg Q0 values decrease to the North and become ∼166 for station pairs in the Higher Himalaya and Tethys Himalaya tectonic units. The low Q0 values observed in this region may be correlated with low viscous partial melts in the form of Miocene leucogranite plutons, which resulted out of the Indo-Asian collision. The attenuation structure along the profile in the Kumaon Himalaya can be used to estimate ground motions of future earthquakes in the area and can contribute to seismic hazard assessment in the Himalaya and neighbouring regions.

Pelizaeus-Merzbacher Disease in a 4-Year-Old Female Child: "A Rare Case Report".

Pelizaeus-Merzbacher disease, a rare X-linked recessive disease occurring predominantly in males, is a disorder of proteolipid protein expression in myelin formation in the central nervous system. The disease is clinically manifested by neurodevelopmental delay, ataxia, hypotonia, and pendular eye movement. It is best confirmed by genetic study. A 4-year female child presented with ataxia, neuroregression, decreased scholastic performance, slurred speech, loss of bladder and bowel control, and hypotonia. MRI brain showed generalized hypomyelination and atrophy of the cerebrum and cerebellum. This case highlights that Pelizaeus-Merzbacher disease can be considered even in a female child who presented with neurodevelopmental delay and neuro regression, ataxia, and decreased scholastic performance and further confirmed by MRI showing diffuse demyelination along with cerebral and cerebellar atrophy.

Generalized Dystonia as Presenting Feature of Wilson Disease: A Case Report.

Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B gene leading to decreased secretion of serum ceruloplasmin in blood and decrease biliary excretion of copper leading to toxic level accumulation in the liver, brain, kidney, and cornea, resulting in development of characteristic liver disease and neuropsychiatric symptoms. Our case presented with mainly clumsiness and gait abnormality without any psychiatric component and any history of liver disease. A 13-year old male, born out of non-consanguineous marriage, presented with clumsy walking and slurring of speech. The child also complained of poor handwriting and slipping of slipper from foot, without any history of abnormal behavior and poor scholastic performance. On examination gait was abnormal with sidewise swaying, increased muscle tone with rigidity and bilateral flexor plantar reflex. Slit lamp examination of eyes revealed bilateral Kayser-Fleischer rings. Serum ceruloplasmin was low (0.03 g/L) and 24-hour urinary copper was high (119.64 µg/day). MRI brain showed B/L putamen hyperintensity and panda sign suggestive of Wilson disease. After the diagnosis of Wilson disease was made, patient was treated with penicillamine and zinc. Child was also followed-up and re-examination showed slight improvement. Though not rare, Wilson disease is an uncommon entity with varied presentations and disabling consequences. Hence high index of suspicion and clinical correlation is required to diagnose it. Early initiation of treatment and good compliance ensure a better outcome.

Prokaryotic expression of chicken infectious anemia apoptin protein and characterization of its polyclonal antibodies.

In the present study recombinant VP3 (rVP3) was expressed in E. coli BL21 (DE3) (pLysS) and its polyclonal antibodies were characterized. SDS-PAGE analysis revealed that the expression of recombinant protein was maximum when induced with 1.5 mM IPTG for 6 h at 37 degrees C. The 6xHis-tagged fusion protein was purified on Ni-NTA and confirmed by Western blot using CAV specific antiserum. Rabbits were immunized with purified rVP3 to raise anti-VP3 polyclonal antibodies. Polyclonal serum was tested for specificity and used for confirming expression of VP3 in HeLa cells transfected with pcDNA.cav.vp3 by indirect fluorescent antibody test (IFAT), flow cytometry and Western blot. Available purified rVP3 and polyclonal antibodies against VP3 may be useful to understand its functions which may lead to application of VP3 in cancer therapeutics.

In vitro expression studies of non structural 1 protein of Canine Parvo virus 2 by polyclonal antiserum raised against CPV2-NS1 protein expressed in Escherichia coli as an antigen.

The canine Parvovirus 2, non-structural 1 (NS1) is a novel candidate tumor suppressor gene. To confirm the expression of the NS1 in HeLa cells after transfection there was a need to raise antiserum against CPV2- NS1. Therefore, this study was carried out to express and purify the recombinant NS1 (rNS1), and characterize the polyclonal serum. CPV2-NS1, complete coding sequence (CDS) was amplified, cloned in pET32a+ and expressed in BL21 (DE3) (pLysS). SDS-PAGE analysis revealed that the expression of the recombinant protein was maximum when induced with 1.5 mM IPTG. The 6 x His tagged fusion protein was purified on Ni-NTA resin under denaturing conditions and confirmed by western blot using CPV2 specific antiserum. The rabbits were immunized with the purified rNS1 to raise anti-NS1 polyclonal antiserum. The polyclonal serum was tested for specificity and used for confirming the expression of NS1 in HeLa transfected with pcDNA.cpv2.ns1 by indirect fluorescent antibody test (IFAT), flow cytometry and western blot. The polyclonal antiserum against NS1 could be very useful to establish functional in vitro assays to explore role of NS1 in cancer therapeutics.

Waardenburg syndrome: A rare genetic disorder, a report of two cases.

Waardenburg syndrome (WS) is a rare genetic disorder. Patients have heterochromia or eyes with iris of different color, increased inter-canthal distance, distopia canthorum, pigmentation anomalies, and varying degree of deafness. It usually follows autosomal dominant pattern. In this report, two cases have been discussed but no familial history of WS has been found. Counseling of the patient is necessary and cases of irreversible deafness have been treated.

Landscape heterogeneity affects diurnal raptor communities in a sub-tropical region of northwestern Himalayas, India.

Raptors are highly sensitive to environmental and human-induced changes. In addition, several species of raptors exist in considerably small numbers. It is thus critical to conserve raptors and their habitats across relatively larger landscapes. We examined the diurnal raptor assemblages and seasonality in a subtropical habitat in India's northwestern Himalayas. Quantitative data on diurnal birds of prey and their habitat features across six distinct habitat types were collected from 33 sample sites. We observed 3,434 individuals of 28 diurnal raptors belonging to two orders and three families during a two-year survey from December 2016 to November 2018. A significant variation in bird species richness and abundance was found across habitats and seasons, with farmlands and winters being the most diverse and speciose. The generalized linear model, used to determine raptor community responses, indicated that elevation and proximity to dumping sites significantly affected the raptor abundance. The non-metric multidimensional scaling (NMDS) revealed significant differences in raptor assemblages across the habitat types. The study concluded that raptors' persistence is largely determined by their preference for favourable feeding, roosting, and nesting opportunities. The presence of protected and habitat-exclusive species validates the high conservation importance of these ecosystems, particularly the forest patches and farmlands, necessitating robust conservation and management measures in this part of northwestern Himalaya.

Risk Factors, Clinical Features, and Outcomes of Acute Pancreatitis in Children in Endemic Zone of Ascariasis in Eastern Bihar: A Hospital-Based Study.

Objective This study aims to describe the etiology, clinical features, and outcomes of acute pancreatitis (AP) in children in an endemic area of hepatobiliary ascariasis. Methods This retrospective observational study included acute pancreatitis (AP) patients in the age group of 2-15 years from January 2019 to January 2022. Demographic profile, risk factors, clinical features, laboratory imaging, and outcome data were collected and analyzed. Results A total of 40 patients comprising of 21 males (52.5%) and 19 females (47.5%) were included. The median age of the diagnosis of AP was 8.3 years (range: 4-14 years). Biliary ascariasis was the most frequent etiology of AP (n=18, 45%), followed by gallbladder (GB) stone (n=6, 12%), trauma (n=1, 2.5%), hepatitis (n=1, 2.5%), valproate drug (n=1, 2.5%), and GB sludge (n=1, 2.5%). In clinical features, all cases had pain in the abdomen (n=40, 100%), followed by fever (n=9, 22.5%), nausea/vomiting (n=33, 82.5%), jaundice (n=2, 5%), and anemia (n=2, 5%). Three (7.5%) patients developed complications such as shock, pseudocyst, and necrotizing pancreatitis, respectively. The average median hospital stay was nine days (range: 4-20 days). No mortality occurred in our study. Conclusions This study revealed a high prevalence (12-13 cases/year) of AP in children in this area. Biliary ascariasis (45%) emerged as the commonest risk factor. Most of the cases suffered from mild AP (92%) and so recovered completely without any complication.

Infantile Tremor Syndrome With Movement Disorder: Current Perspective.

Although infantile tremor syndrome is considered a rare entity, we present a typical case of this disorder. This case reinforces the association of infantile tremor syndrome with exclusive breastfeeding in infants and the absence of proper complementary feeding. A nine-month-old, irritable, listless, exclusively breastfed female presented with grade 2 malnutrition, tremors, hyperpigmentation, scarce scalp hair, and delayed developmental milestones. Laboratory investigations revealed macrocytic anemia and a low serum vitamin B12 value of 205 pg/dL. Cerebral and mild cerebellar atrophy were noted on the MRI brain scan. Accordingly, the patient was diagnosed with infantile tremor syndrome and treated with vitamin B12 and nutrient supplementation with zinc, magnesium, folic acid, and iron. The tremors improved and the child became responsive and interested in her surroundings. It is essential to recognize this condition at the earliest and initiate treatment. Basic interventions such as the promotion of proper nutrition, timely introduction of complementary feeding, and weaning practices are key factors in decreasing the incidence of this condition.

Characterization and in vitro expression of non-structural 1 protein of canine parvovirus (CPV-2) in mammalian cell line.

Parvoviruses are small, 260-A-diameter, icosahedral, non-enveloped, single-stranded DNA viruses with a genome of approximately 5 kb. Non structural protein, (NS-1) is especially relevant, being both essential for virus replication and the main factor responsible for virus pathogenicity and cytotoxicity. This protein has also been reported to possess the property of killing of transformed cells. The present study was carried out to clone, characterize and express the NS-1 gene of canine parvovirus. NS-1 complete CDS 2020bp was amplified, cloned into eukaryotic expression vector pcDNA 3.1(+), sequenced and characterized by in vitro expression analysis. Functional activity of recombinant construct, pcDNA.cpv.NS-1, was evaluated by RT-PCR and flow cytometry for the expression of NS-1 specific mRNA and NS-1 protein, respectively, in transfected HeLa cells. This recombinant plasmid may serve as an important tool to evaluate the apoptotic potential of NS-1 protein of canine parvovirus in cultured HeLa cells.