Search Results (26,153)

Background and Objective: This study aimed to evaluate the impact of early functional rehabilitation on clinical outcomes and tuberosity healing in older patients undergoing reverse shoulder arthroplasty for proximal humeral fractures. We hypothesized that early functional rehabilitation would not compromise tuberosity healing and would result in comparable or improved outcomes versus postoperative immobilization. Methods: This retrospective matched-pair analysis included patients aged 70 years or older who underwent reverse shoulder arthroplasty for proximal humeral fractures, with 12 to 24 months of follow-up. Group allocation was time-based: earlier patients received immobilization and later patients underwent early rehabilitation. Matching was based on sex, age, body mass index, fracture classification (Neer), and glenosphere size. Outcomes included patient-reported scores, range of motion, and radiographic assessment of tuberosity healing using standardized imaging. Results: Forty patients (20 per group) with a mean age of 80.7 years and a mean follow-up of 16.1 months were included. The early rehabilitation group demonstrated significantly higher Constant scores (p = 0.044), age- and sex-adjusted Constant scores (p = 0.033), and greater active external rotation (p = 0.002). Anatomical tuberosity healing was seen in 28 of 40 patients (70%). Greater tuberosity healing occurred in 75% and lesser tuberosity healing in 85% of patients with available axial imaging. One deep infection occurred in the early rehabilitation group and was successfully managed. Conclusions: Early functional rehabilitation after reverse shoulder arthroplasty in older adults with proximal humerus fractures improved functional outcomes without compromising tuberosity healing. Full article

Artmaking is recognized as an effective means of supporting emotional regulation and reducing stress, yet little empirical work has directly compared the psychological and physiological effects of digital versus traditional art materials. Guided by the Expressive Therapies Continuum (ETC), this study examined whether drawing with oil pastels on paper or drawing on a digital tablet differentially influenced emotional state, physiological stress, and subjective creative experience following a validated group stress induction. Forty-eight healthy adult women were randomly assigned to create art for 45 min using either oil pastels or a tablet with a digital stylus. Measures included state anxiety, salivary cortisol, emotional valence, arousal, dominance, flow experience, and artmaking experience. Both modalities produced significant reductions in state anxiety, with no differences between groups. Emotional responses also changed significantly from pre- to post-artmaking, again without between-group differences. Cortisol levels did not significantly decrease in either condition, and no differences emerged across flow dimensions or artmaking experience scales. These findings indicate that tablet-based and traditional oil pastel drawing generate comparable emotional and experiential benefits following acute stress. Interpreted through the ETC, results suggest that therapeutic mechanisms of artmaking may be activated across a wider range of media than previously assumed. Digital tools appear capable of facilitating sensory–affective and integrative processes often attributed to traditional materials, thereby supporting their integration into trauma-informed practice. Full article

Background and Objectives: Head and neck cancer (HNC) frequently necessitates reconstructive surgery due to defects following oncologic resection. The influence of age on reconstructive outcomes in head and neck cancer remains controversial. This study aimed to evaluate the impact of age on oncologic characteristics, reconstructive strategies, and functional outcomes following microvascular free flap reconstruction. Materials and Methods: A retrospective review was conducted on 286 patients who underwent free flap reconstruction for head and neck cancer between 2016 and 2020. Patients were stratified into three age groups: <40 years, 40–60 years, and >60 years. Demographic characteristics, tumor features, reconstructive approaches, complications, and functional outcomes—including postoperative dietary tolerance and tube feeding dependency—were analyzed. Results: The oral cavity was the most common tumor site across all age groups. Advanced-stage tumors (T4) were more frequently observed in older patients (>60 years), although the difference was not statistically significant (p = 0.0575). The overall flap survival rate was 98.6%. The mean hospital stay was 24.6 ± 15.86 days and was significantly longer in the >60-years group (p < 0.001). Postoperative dietary tolerance was comparable across age groups, with 56.8% of patients resuming a regular diet. Tube feeding dependency was slightly higher in the >60-years group but did not reach statistical significance (p = 0.1599). Conclusions: Age alone does not significantly affect reconstructive outcomes following microvascular free flap reconstruction for head and neck cancer. Despite a higher prevalence of comorbidities in and longer hospital stays for older patients, flap success rates and functional outcomes were comparable across age groups. Full article

This study investigates the determinants of GDP per capita across 26 European Union member states over the period of 2006–2024, with a particular focus on entrepreneurship, institutional quality, and macroeconomic factors. Given the presence of long-run income differences across EU countries, the analysis explicitly accounts for structural heterogeneity in economic development and institutional capacity. To ensure robust estimation in the presence of cross-sectional dependence and slope heterogeneity, the study employs advanced panel econometric techniques, including tests for cross-sectional dependence, unit roots, and cointegration. Long-run relationships and short-run dynamics are estimated using the Cross-Sectionally Augmented Autoregressive Distributed Lag (CS-ARDL) model, complemented by robustness checks based on the Augmented Mean Group (AMG) and Common Correlated Effects Mean Group (CCEMG) estimators. In addition, the Method of Moments Quantile Regression (MMQR) is applied to capture heterogeneity across different points of the income distribution, thereby reflecting long-run income disparities among EU member states. The empirical results confirm the existence of a stable long-run equilibrium relationship among the variables. The baseline CS-ARDL estimates indicate that institutional quality, entrepreneurial activity, trade openness, and government expenditure exert positive and statistically significant effects on GDP per capita, while financial development exhibits a negative effect and foreign direct investment remains insignificant. In the short run, entrepreneurship and trade openness contribute positively to GDP per capita, whereas government expenditure and credit expansion generate contractionary effects. The robustness analysis using AMG and CCEMG estimators largely supports these findings, as the direction of the coefficients remains consistent across alternative specifications, although some variation in statistical significance is observed due to differences in the treatment of cross-sectional dependence and unobserved common factors. The MMQR results further reveal substantial heterogeneity across the income distribution, indicating that the effects of key determinants vary depending on countries’ long-run income levels. In particular, trade openness and institutional quality exert stronger positive effects in lower-income quantiles, while the adverse effects of excessive financial development are more pronounced in higher-income quantiles. Overall, the findings underscore the importance of promoting productive entrepreneurship, strengthening institutional frameworks, facilitating trade integration, and ensuring efficient financial intermediation to enhance GDP per capita within the European Union. The results also highlight the need for differentiated policy approaches that explicitly account for long-run income heterogeneity, structural differences, and varying institutional capacities across EU member states. Full article

Impact craters are among the most abundant geological structures on solid planetary surfaces and provide valuable information about impact processes and surface evolution. However, the systematic characterization of crater morphology remains challenging due to dataset heterogeneity, measurement uncertainty, and gradual transitions between morphological classes. This study proposes FAS-XAI, an interpretable framework for the comparative analysis of planetary crater datasets that combines fuzzy clustering and explainable artificial intelligence (XAI). The methodology combines exploratory data analysis, measurement-uncertainty assessment, unsupervised learning, supervised consistency analysis, and interpretable machine learning to identify and characterize crater morphologies through a structured workflow. The framework is applied to the Moon Crater Database v1 and the Robbins Mars Crater Database, two large-scale crater catalogs sharing a common geometric parameterization of crater properties. Using the variables available in both datasets, Fuzzy C-Means identifies morphological crater groups, while XGBoost assesses how consistently the resulting dominant cluster labels can be reconstructed from the same descriptor space. XAI techniques are then used to explain the contribution of each variable to the identified groups. The results reveal distinct structural patterns in the organization of lunar and Martian crater populations. Full article

Aortic valve stenosis (AS) is assessed by echocardiography in clinical practice. Conventionally, the aortic valve area, peak transaortic valve velocity/gradient and the mean transvalvular gradient determine if the AS is categorized as mild, moderate or severe. Recently, the entity of paradoxical low-flow, low-gradient AS despite normal left ventricular ejection fraction (LVEF) was described and flow (as determined by stroke volume indexed to body surface area) was used to further categorize AS. The new European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) guidelines in 2025 recommended a new phenotype-based classification, which improved the prognostication of AS. There are now five phenotypes: (1) concordant high-gradient AS; (2) low-flow, low-gradient AS with reduced LVEF; (3) low-flow, low-gradient AS with preserved LVEF; (4) normal-flow, low-gradient AS with preserved LVEF; and (5) discordant high-gradient AS. These appear to have different underlying pathophysiology, and hence prognostication and therapy. In addition, categories of AS in the setting of reduced LVEF are further divided based on their responses to dobutamine or exercise stress, which may result in different therapeutic strategies. In the transaortic valvular replacement (TAVR) versus the surgical aortic valve replacement (SAVR) era, the classification of these AS groups may have differing implications on the appropriate interventions. Furthermore, there are investigations on the effect of AS on the left ventricle and other chambers and stages of AS based on the extent of cardiac damage, which may have important prognostic value post-AVR. On the other spectrum, there are new developments in imaging analysis, such as using artificial intelligence. This state-of-the-art paper will comprehensively review the important updates in AS and its clinical implications. Full article

Ovarian tissue cryopreservation is the primary fertility preservation strategy for prepubertal girls and patients requiring urgent gonadotoxic therapy. However, the risk of reintroducing malignant cells has prompted the development of safer alternatives, including follicle isolation followed by three-dimensional scaffold encapsulation for transplantation. Fibrin is a promising biomaterial for bioengineered ovary construction, although its ability to support early human follicle maintenance remains unclear. Follicles isolated from cryopreserved ovarian tissues of six patients were encapsulated within fibrin scaffolds of graded concentrations (high, medium, low). After 7 days of in vitro culture, follicle survival and diameter change were quantified. A total of 282 follicles (45.4 ± 10.1 µm) were embedded into fibrin scaffolds. After culture, 237 viable follicles were detected, yielding an overall survival of 84%. Follicle diameter increased to 58.8 ± 12.0 µm. Follicle survival rates were comparable across groups, while mean follicle diameter was 56.3 ± 12.5 µm (high), 61.9 ± 13.4 µm (medium), and 57.4 ± 9.3 µm (low). Follicles cultured in medium-concentration fibrin demonstrated significantly larger diameters compared with both high and low groups (p < 0.05), with no difference between high and low groups. Fibrin-based bioprosthetic ovary scaffolds support short-term in vitro maintenance of isolated human follicles, preserving spherical morphology and granulosa cell layer integrity. Medium-concentration fibrin was associated with greater follicle diameter expansion compared with higher and lower concentrations, indicating that scaffold composition influences early morphometric changes during in vitro follicle culture. Full article

Background: Health-related behaviors often cluster during young adulthood, potentially increasing the risk of long-term adverse health outcomes. Understanding how lifestyle risk behaviors co-occur among university students is essential for developing targeted health promotion strategies. Objective: This study aimed to identify lifestyle risk profiles among university students based on the co-occurrence of smoking behavior, alcohol consumption, sedentary behavior, and body weight status. Methods: A cross-sectional study was conducted with 147 university students enrolled in a physical education and sport undergraduate program (mean age: 20.58 ± 2.94 years; 80.3% male). Physical activity and sedentary behavior were assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), while smoking and alcohol consumption were self-reported. Body mass index was used to classify weight status. Lifestyle risk profiles were identified using two-step cluster analysis based on regular smoking, alcohol consumption, sedentary behavior, and overweight/obesity. Differences in cluster distribution according to sex and federated athlete status were examined using chi-square tests. A two-step cluster analysis based on the Bayesian Information Criterion (BIC) and silhouette measure was used to identify lifestyle risk profiles. Results: Overall, 46.9% of participants had experimented with tobacco, 11.6% were current smokers, and 74.8% reported alcohol consumption. Participants accumulated an average of 3772.25 ± 1957.99 MET-min/week of physical activity. Three distinct lifestyle risk profiles were identified. Cluster 1 (46.9%), labeled the alcohol profile, was characterized by alcohol consumption without smoking and no prevalence of being overweight. Cluster 2 (20.4%), the multiple-risk profile, included participants who reported regular smoking, with nearly half presenting sedentary behavior and overweight/obesity. Cluster 3 (32.7%), the overweight profile, was characterized by overweight/obesity combined with alcohol consumption but no smoking. No significant differences were observed in the distribution of lifestyle profiles according to sex (p = 0.111) or federated athlete status (p = 0.087). Conclusions: Lifestyle risk behaviors cluster into distinct profiles among university students, with alcohol consumption appearing across multiple profiles and smoking concentrated in a specific high-risk group. These findings highlight the need for targeted health promotion strategies addressing multiple co-occurring behaviors within university populations. Full article

Background: Intraventricular central nervous system (CNS) lymphoma is an atypical presentation of extranodal lymphoma, whether primary or secondary. The most commonly diagnosed subtype of lymphoma is diffuse large B-cell lymphoma (DLBCL). There is a documented relation of HIV, EBV and KSHV infections with lymphomagenesis. AIDS-related lymphomas (ARLs) are described as a defining illness of the acquired immunodeficiency syndrome (AIDS). This study presents a novel case and systematic review of clinical, radiographic and histopathological features of intraventricular lymphomas. Methods: We report on a 27-year-old woman with a left lateral ventricle DLBCL with surrounding edema treated with steroids. A systematic review of 147 additional cases (1977–2025) was conducted, analyzing patient demographics, tumor characteristics, clinical features, imaging, treatment, and outcomes. The tumor locations were divided into three groups depending on the extent of ventricular involvement. Descriptive statistics summarized findings. Findings: 147 cases (mean age, 54.2 years; range, 3–87; 63.3% male) were analyzed. Immunodeficiency in patients was unusual (6.1%). Fully intraventricular lesions were the most common presentation (52.4%), with systemic involvement solely in 10 cases (6.8%). The lesions were predominantly located in the lateral ventricles or fourth ventricles (46 times each), and bilateral involvement was noted 37 additional times. DLBCL was diagnosed in 101 cases (78.9%). Interpretation: Intraventricular involvement in central nervous system lymphoma poses a diagnostic and therapeutic challenge due to non-specific symptoms and atypical locations. Adding to the diagnostic difficulty of intraventricular masses in young patients, we wish to highlight that immunocompromised patients are a notably insignificant subgroup of patients in our study. Full article

Thailand is facing a rapidly aging society, raising concerns about how retiring workers will maintain their quality of life. Insured persons in the social security system—especially voluntary members under Section 40 of the Social Security Act B.E. 2533 (1990), who are often informal workers—frequently lack formal retirement plans, underscoring the need for interventions that address financial security and subjective well-being (SWB) in later life. This study aimed to develop and evaluate a retirement planning program designed to enhance subjective well-being and improve the quality of life for pre-retirees in Songkhla Province. A Research and Development (R&D) design was employed in four phases. Phase 1 (R1) involved a needs assessment: survey data from 500 insured individuals (ages 40–60) were collected to identify gaps between current and desired retirement preparedness. Phase 2 (D1) utilized the needs assessment results and theoretical frameworks to design a Subjective Well-being Retirement Planning Program, encompassing financial, health, and psychosocial components. Content-relevance experts validated the draft program. Phase 3 (R2) involved implementing the program with 15 volunteer participants over four weekly workshops (each 3 h long) and evaluating its short-term pilot outcomes using pretest-posttest measures of subjective well-being. Phase 4 (D2) refined the program based on evaluation findings and expert feedback. Results indicated that following participation in the program, participants’ overall subjective well-being and all sub-dimensions (life satisfaction, positive and negative affect balance, sense of meaning, social connectedness, security, and health) were significantly higher than before (p < 0.001). Additionally, the proportion of participants classified as inadequately prepared for retirement (high-risk due to low planning) decreased markedly, suggesting increased readiness within the pilot group. Expert evaluations of the program design reflected a high content validity index and strong agreement on the program’s accuracy, appropriateness, and usefulness for the target group. In conclusion, the developed retirement planning program was associated with short-term improvements in subjective well-being and quality-of-life indicators among insured pre-retirees. This theory-informed program, developed through an R&D process, offers a model for supporting aging workers in the social security system, with implications for policymakers and practitioners seeking to promote healthy, happy, and secure retirements in an aging society. Full article

This study evaluated how the addition of 5 wt% bioactive glass and 15 wt% short glass fibers to EQUIA Forte HT affects the microhardness, micromorphology, and elemental composition of demineralized dentin. Class I cavities in 28 human third molars were demineralized with 37% phosphoric acid and restored with: (1) Filtek Universal composite, (2) EQUIA Forte HT, (3) EQUIA Forte HT + 5wt% BAG, or (4) EQUIA Forte HT + 15wt% short glass fibers. After 4 weeks of storage in phosphate-buffered saline at 37 °C, the teeth were cut in half, obtaining two samples from each tooth (n = 14). Vickers microhardness (HV0.1) was measured on demineralized dentin 50–100 μm apical to the restoration interface. Representative specimens (n = 2) were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Data were analyzed with one-way ANOVA (α = 0.05). Unmodified EQUIA Forte HT showed the highest mean dentin microhardness recovery (25.06 ± 1.42 HV0.1), followed by composite (17.31 ± 0.66 HV0.1), BAG-modified (23.74 ± 1.37 HV0.1) and fiber-reinforced (22.15 ± 1.06 HV0.1) groups (p < 0.001, all pairwise comparisons p ≤ 0.039). Glass hybrids showed prominent Ca/P peaks; modified groups had elevated Si (BAG) and Al (fibers). SEM revealed smoother surfaces with fewer cracks in modified materials. Unmodified EQUIA Forte HT produced the highest short-term microhardness recovery, while BAG and fiber additions altered surface morphology and elemental composition but slightly reduced early hardness. Full article

Background/Objectives: Vilaprisan and ulipristal acetate (UPA) have demonstrated efficacy in treating uterine fibroids (UFs). However, a direct comparison of vilaprisan and UPA has been restricted, to date, to a small phase 2 study. Here, we compare the efficacy of vilaprisan and UPA in reducing heavy menstrual bleeding and inducing amenorrhea in women with symptomatic UFs. Methods: ASTEROID 5 (NCT03240523) was planned as a randomized, active-controlled, multicenter phase 3 study comparing three vilaprisan 2 mg/day regimens against the approved regimen of UPA 5 mg/day for the treatment of symptomatic UFs. Participants were initially randomized 1:1:1:1 to one of four treatment arms: VPR-3/1 (vilaprisan for a 3-month treatment period [TP] followed by one menstrual bleeding episode); VPR-6/2 (vilaprisan for a 6-month TP followed by two menstrual bleeding episodes); VPR-3/2 (vilaprisan plus matching UPA placebo for a 3-month TP followed by two menstrual bleeding episodes); and UPA-3/2 (UPA plus matching vilaprisan placebo for a 3-month TP followed by two menstrual bleeding episodes). Results: Treatment was received as planned by 271 (95.4%), 266 (94.0%), 90 (90.0%) and 89 (89.9%) women in the VPR-3/1, VPR-6/2, VPR-3/2, and UPA-3/2 groups, respectively; 109 women in the VPR-3/1 (n = 44, 15.5%) and VPR-6/2 (n = 65, 23.0%) groups and none in the VPR-3/2 and UPA-3/2 groups completed treatment. Vilaprisan (total VPR group) demonstrated non-inferiority but not superiority versus UPA in inducing amenorrhea (82.9% [520/627] vs. 74.2% [66/89]; difference: 8.8% [95% confidence interval: −0.78, 18.34]; p = 0.0553), whereas vilaprisan (VPR-3/1 arm) showed superiority versus UPA in reducing total menstrual blood loss (least squares mean total MBL: 44.2 mL vs. 80.3 mL; difference: −36.1 mL; p = 0.0010). Conclusions: Vilaprisan (VPR-3/1 regimen) was superior to UPA in reducing total MBL, and it was non-inferior (total VPR group) to UPA in inducing amenorrhea. Full article

Mesenchymal stromal/stem cells (MSCs) are increasingly explored for immune-mediated diseases, yet standardized analytical readouts that capture coordinated immunomodulatory output across complementary secretory pathways remain limited. Here, we report the feasibility of an HPLC-based multi-analyte secretome characterization panel that quantifies two small-molecule outputs—adenosine and kynurenine—alongside two immunomodulatory proteins—interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β)—in conditioned media from canine adipose-derived MSCs (cAD-MSCs). Canine immune-mediated hemolytic anemia (IMHA) was used as a disease context to motivate the selection of these analytes, given the pro-inflammatory cytokine environment characteristic of this condition. Three independent cAD-MSC lines were evaluated under baseline conditions and following cytokine stimulation with recombinant interferon-gamma (IFN-γ; 100 ng/mL) and tumor necrosis factor-alpha (TNF-α; 50 ng/mL), referred to herein as inflammatory priming or licensing. Conditioned media were collected at 72 h for metabolite analysis and 48 h for protein analysis, and quantified by HPLC using external calibration and peak integration. Across all three lines, licensing produced directionally consistent increases: mean adenosine increased 2.3-fold, mean kynurenine increased 3.1-fold, mean IL-10 increased 1.6-fold, and mean TGF-β increased 1.7-fold compared with unlicensed controls. Metabolite measurements for adenosine and kynurenine are reported with full chromatographic selectivity data; IL-10 and TGF-β measurements by reversed-phase HPLC with UV detection are presented as exploratory/semi-quantitative outputs and will require orthogonal confirmation (e.g., immunoassay) in future work. These findings are preliminary, derived from three independent donor lines with no comparator group, and are intended to support feasibility of the analytical framework rather than establish definitive performance specifications. Collectively, the data support the potential of a multi-analyte HPLC-based characterization panel to capture licensing-responsive secretory shifts across mechanistically complementary pathways, providing a foundation for expanded development and validation. Full article

Voice cloning enables realistic fake speech in which a speaker’s identity is preserved while the spoken message is semantically altered. This paper asks whether such meaning-level manipulation leaves detectable traces in transcripts alone. To study this problem, we introduce FakeSpeech+, a paired real–fake dataset built from authentic speech clips and their matched semantically altered counterparts, re-embedded into cloned voices while preserving speaker identity. Using this dataset, we conduct a transcript-first analysis based on interpretable text-only features from two groups: (i) linguistic content organization and discourse dynamics, and (ii) compact production-related proxy cues, including hesitation and disfluency markers. We evaluate these cues under transcript-length control through residualization and compare authentic and manipulated transcripts using statistical and experimental analyses. The results show that only a limited subset of features retains strong separation after length control, with coordination-related structure and emotion anchoring emerging as the clearest cues, while several production-related and discourse-variability features show weaker but still informative differences. In contrast, a number of syntactic, lexical-diversity, and other discourse-level features show substantial overlap after residualization. These findings indicate that transcript-level structure and selected production-related cues remain informative under realistic content-manipulation threats, supporting the value of transcript-based analysis for identity-preserving fake speech. Full article

Background/Objectives: This study analyzes the relationship between obesity phenotypes and sleep apnea risk in the Korean population. Methods: This study utilized data from the Korean National Health and Nutrition Examination Survey (KNHANES) collected between 2019 and 2021 (n = 10,970 adults; age ≥ 40 years). Obesity phenotypes were classified into four groups based on body mass index (BMI) and the presence of metabolic syndrome: metabolically healthy normal weight (MHNW), metabolically abnormal normal weight (MANW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). Sleep apnea risk was assessed using the STOP-Bang questionnaire, and multivariate logistic regression analyses were performed to evaluate the association between obesity phenotypes and sleep apnea. Results: Among the 10,970 participants, the phenotypes were as follows: MHNW, 51.1%; MANW, 10.3%; MHO, 15.8%; and MAO, 21.8%. Baseline characteristics differed significantly across phenotypes, with the metabolically unhealthy groups (MANW and MAO) being older and exhibiting more cardiometabolic risk factors than the metabolically healthy groups. The prevalence of STOP-Bang questionnaire components differed significantly across phenotypes (all p < 0.001), and the mean STOP-Bang score increased from MHNW to MAO. In multivariate logistic regression analyses, the odds (adjusted odds ratio [95% CI]) of high sleep apnea risk were significantly elevated in all non-MHNW phenotypes: MAO (10.27 [7.71–13.68]), MHO (6.17 [4.35–8.75]), and MANW (1.91 [1.22–2.98]). Notably, MAO conferred a significantly higher risk than MHO (OR 1.69 [1.34–2.13]), highlighting the synergy of obesity and metabolic dysfunction. Obesity phenotypes, defined by BMI and metabolic health status, were differentially associated with sleep apnea risk in Korean adults. The highest risk was observed in individuals with both obesity and metabolic syndrome, while metabolically abnormal normal-weight adults also showed a significantly increased risk. Conclusions: Metabolic dysfunction may contribute to sleep apnea risk beyond body size alone and may be considered in risk stratification strategies. Full article