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More people have died as a result of disease transmission than have died in genuine wars. Despite being a naturally occurring disease, the great influenza epidemic of 1918 killed 20 million people globally during World War I. However, genetic engineering is employed to develop bioweapon agents. Bioweapons are weapons that involve the deliberate use of chemicals and microorganisms to cause sickness and death in people. Because biological agents are readily available and are easy to carry from one location to another, they are less likely to be detected during routine security checks and they are inexpensive to produce. This weapon is both deadly and appealing to use. This paper discusses various bioweapon systems as well as computer-based techniques used in the medical and agricultural fields to detect and counter any disease spread by bioweapons. A mathematical model (SEIR) for the prediction of infectious diseases has been described and modelled, and it can be used to predict cases in certain areas. © 2023 selection and editorial matter, Preeti Nagrath, Jafar A. Alzubi, Bhawna Singla, Joel J. P. C. Rodrigues and A. K. Verma;individual chapters, the contributors.
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Introduction: COVID-19 infection has been associated with right ventricular (RV) dysfunction and poor prognosis. This association is thought to be due to either a direct effect of COVID-19 infection on the myocardium or indirect damage to the lung parenchyma or vasculature. Limited echocardiography protocols for operator protection against COVID-19 has made the evaluation of the RV challenging. The purpose of this study is to evaluate if RV dysfunction by qualitative assessment can be used to predict all-cause mortality. Method(s): This is a single-center retrospective analysis from March 2020 to August 2021. Patients who were older than 18 years old, hospitalized with a positive RT-PCR for COVID-19, and had an echocardiogram while inpatient were included in the study. RV parameters, including RV dilation and dysfunction, were obtained by qualitative assessment. Data analysis was performed with STATA and SPSS. Result(s): A total of 223 patients were included in the analysis. 59.6% were male with a mean age of 64.3 years (SD +/- 16). 67.7% were Hispanic, 11.7% were non-Hispanic White, and 20.6% were Black. Severe COVID-19 infection requiring intensive care unit level of care made up 54.7% of cases (n=122) and the mortality rate was 27.8% (n=62). RV dysfunction and dilation was present in 13.5% (n=28) and 15.2% (n=33) of patients, respectively and occurred more often in patients with severe COVID-19 infection (p<0.01). Logistic binomial correlation showed an exponential increase in the probability of mortality related to RV dysfunction (OR 2.03, p=0.270;graph 1) and a mild decrease in mortality in patients with RV dilation (OR 0.88, p=0.794). However, both associations were not statistically significant. Conclusion(s): RV dysfunction by qualitative assessment could be a potential marker of mortality in patients with COVID-19 infection. The association may be stronger in studies with more power. Interestingly, RV dilation was associated with a mild decrease in mortality in this patient population;however, this may be a biased result due to the small sample size.Copyright © 2022
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Andrographolide (AG-1) is identified as an attractive scaffold based on in silico/in vitro/in vivo (preclinical and clinical) studies against COVID-19 infection, for which hardly any effective drug is available to date. Due to complexity of its chemical structure, stereoselective and regioselective Heck arylation reactions at C-17 exocyclic double bond of AG-1 is a major challenge and we stepped forward to generate a small focused library of compounds. Among all the molecules, AG-12 and AG-13 were predicted to have better pharmacokinetic profiles than AG-1. Upon evaluation of in vivo efficacy of AG-12 and AG-13 in comparison to AG-1 using an LPS-induced acute lung injury model, AG-13 showed promising action towards reduction of the neutrophil count, minimization of oxidative stress, and inhibition of inflammatory cytokines. Further, lead optimization should be carried out towards developing potential natural product-driven therapeutics to combat acute respiratory distress syndrome (ARDS) situations during COVID-19. © 2023 Elsevier B.V.
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As we can see, only a select few gadgets, such as PCs and smartphones, are internet-connected in the modern world and since governments across the world instituted lockdowns to stop the spread of COVID-19, interest in home gardening has exploded. Internet of Things (IoT) and the internet have completely taken over today's world. All humans utilize the internet to fulfill basic needs. The network of actual items is known as the Internet of Things (IOT). Simply put, it refers to the process of keeping an eye on a physical machine or object. It can also refer to the interconnection of physical objects that have been implanted with electronics, sensors, software, and network connectivity. The foundation of our nation is agriculture. The main issue in agriculture is water scarcity. The water resource is not used in an effective manner, so the water is wasted. To overcome this problem, we proposed plant monitoring approach. © 2022 IEEE.
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Chest X-ray images provide critical information for the diagnosis of COVID-19. Machine learning techniques for COVID-19 detection require substantial amounts of chest images to discover correct patterns. However, concerns over confidentiality and privacy have limited access to patients' data. The distribution of samples across normal/abnormal classes is typically biased or skewed due to unavailability of sufficient data because of COVID-19 recency. Existing synthetic COVID-19 data generation approaches fail to generate high-resolution and diverse images. Moreover, there is a lack of research identifying whether synthetic images represent patients at high risk of severe disease, which is critical for making treatment decisions. We propose a High-Resolution COVID-19 X-Ray Generator (HRCX) framework based on a combination of a generative adversarial network and a predictive learning model that uses limited available chest images to generate balanced diverse high-resolution COVID-19 images with their severity scores. We use StyleGAN2 with adaptive discriminator augmentation, which controls generated images' style and generates diverse patterns. In addition, we provide a COVID-19 severity index to aid in predicting illness severity. We generated 3300 high-quality and diverse COVID-19 X-Ray images with a resolution of 512x512, which we further increased to 1024x1024 with the help of Super-Resolution. Additionally, severity scores of 300 images are calculated and demonstrated to be effective in both normal and infected cases. © 2023 ACM.
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The COVID-19 epidemic has caused an unprecedented level of difficulty for the entire world, stopping life and taking thousands of lives. Since COVID-19 has spread to 212 countries and territories and has resulted in 5,212,172 infected cases and 334,915 fatalities, it continues to pose a serious threat to public health. This study proposes a solution to battle the infection using Artificial Intelligence. It has been shown that some Deep Learning techniques, including Long-Short Term Memory, Extreme Learning Machines, and Generative Adversarial Networks, can accomplish this goal. It is informatics techniques in various informational facets from numerous structured & unstructured Data-Sources are combined to produce user-friendly platforms for medical professionals & researchers. The primary benefit of these AI-based platforms is that they speed up the process of diagnosing and treating COVID-19 illness. The most recent related publications and medical reports were examined in order to identify network sources & objectives that might assist in the construction of a feasible Artificial Neural Network based solution for COVID-19 issues. © 2022 IEEE.
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Background: SARS-CoV-2 has a high mutation rate, resulting in the emergence of multiple variants in a shorter time frame, starting with Wuhan strain during first wave, then Delta during second wave and Omicron during third wave. World faced distressing spread of novel corona virus. The reason for this study was to look at the third flood of SARS-CoV-2, clinical highlights and risk factors in northern India. Method(s): This study involved 1,43,983 individuals for testing the presence of SARS-CoV-2 infection during January 2022 by RT-PCR. The epidemiological record was collected as per the guidelines of ICMR from the patient forms. Result(s): A total of 12.24% individuals were found positive with mean age of 29+/-10 years. Large portion of positive population (63.87%) was asymptomatic. Among the positive population, higher positivity rate was observed in males (57.51%) with age band of 21-40 years (51.17%). Significant association (p value = <0.00001) was found between positivity rate with age, gender and status (symptomatic/ asymptomatic). SARS-CoV-2 was shown to be more prevalent in Patiala, (49.66%) district followed by Ludhiana (24.24%), Sangrur (10.06%), Mansa (7.06%), Shaheed Bhagat Singh Nagar (6.90%) and Malerkotla (2.08%) during second and third week of January 2022. Hypertension and bronchial asthma were the most well-known comorbidities found in the current study. Conclusion(s): In totality, current study showed positivity rate of 12.24% from large population size for SARS CoV-2 from period of 1st January 2022 to 31 January 2022. Current findings include younger age group (21-40 years), high percent of asymptomatic individuals, less disease severity and a little need of hospitalization.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
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Background: Hospitals are the most frequent place of death in Germany (47%), but at the same time, the least preferred one - for both patients and their relatives. To optimize care in the dying phase by using a bottom-up approach, the StiK-OV project aims to implement and evaluate specific measures on different non-palliative wards at two university hospitals. In the first phase of the project, we assess the current state of care in the dying phase on different wards. Method(s): We conducted an online survey with national health care professionals consisting of seven open questions on important aspects, facilitators, barriers and needs for improvement as well as Covid-19 pandemic specifics regarding care in the dying phase. Qualitative data was analyzed thematically. Result(s): Of 67 participants, 66% work in clinical practice as nursing staff (52%) and physicians (30%) and 34% in management or administration. As relevant topics of care in the dying phase, we identified involvement of relatives, symptom control, patient-centeredness, professional competencies, as well as time, space and human resources. Participants state a need for improvement regarding these topics. During the pandemic, involvement of relatives and patient-centeredness were difficult to maintain due to visiting restrictions and higher workload, resulting in patient isolation and dying in loneliness. Discussion(s): The survey revealed common topics of importance which should be targeted by ward-specific measures. Difficulties due to the pandemic have to be accounted for to achieve optimal care in the dying phase under exceptional circumstances. Conclusion(s): The survey gave insights on care in the dying phase from the perspective of health care professionals that can help to develop and implement situation-specific measures to significantly improve the quality of care during the dying phase in hospitals. A bottom-up approach aims to increase the staff motivation to implement respective measures.
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The COVID-19 pandemic has impacted almost all companies and people across all sectors. Working from home (WFH) has become the new norm in many countries and companies since the COVID-19 pandemic. There is a growing trend around the globe for having more people working from home, particularly in the current COVID-19 pandemic. The present review-based paper is mainly collected from important databases like Scopus and Web of Science from the years 2020, 2021, and 2022. The main aim of this paper is to understand the concept of Working from home and to study various Working from home (WFH) associated opportunities and challenges during the period of pandemic. Increased work productivity, increased job satisfaction, and greater flexibility were some of the opportunities whereas increased levels of stress, longer working hours, and lack of designated office space were foundsome challenges related to Working from home (WFH) during the pandemic. Despite many challenges and operational difficulties in WFH, many organizations are still positive and developing a new hybrid model which provides high employee productivity and also provides an effective way to deal with future uncertainties or pandemic-like crises.Mindfulness, proper designated office space at home, and Organisation based supportive policies were some of the main recommendations given for employees' better productivity and work-life balance. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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The Internet has enormously expanded the domain of technology for diverse ages. The Internet poses enormous technological expansion potential. It can change not just how people accept and adopt knowledge, but also the traditional methodology and architecture of education systems. During the COVID-19 pandemic, e-learning is expanding and being recognized by higher education institutes for the benefit of society. Although e-learning has some shortcomings, it also has numerous benefits. Web-based education has made lifetime learning easier and erased geographical barriers by providing international-standard education. This improves the opportunity to learn and stay current with technology in a competitive environment. © The Author(s) 2022.
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The bioinformatics discipline seeks to solve problems in biology with computational theories and methods. Formal concept analysis (FCA) is one such theoretical model, based on partial orders. FCA allows the user to examine the structural properties of data based on which subsets of the dataset depend on each other. This article surveys the current literature related to the use of FCA for bioinformatics. The survey begins with a discussion of FCA, its hierarchical advantages, several advanced models of FCA, and lattice management strategies. It then examines how FCA has been used in bioinformatics applications, followed by future prospects of FCA in those areas. The applications addressed include gene data analysis (with next-generation sequencing), biomarkers discovery, protein-protein interaction, disease analysis (including COVID-19, cancer, and others), drug design and development, healthcare informatics, biomedical ontologies, and phylogeny. Some of the most promising prospects of FCA are identifying influential nodes in a network representing protein-protein interactions, determining critical concepts to discover biomarkers, integrating machine learning and deep learning for cancer classification, and pattern matching for next-generation sequencing.
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The Covid - 19 upsurge has materially affected the operating abode of the banking sector worldwide. Its restrictions have interrupted its economic activities and caused grave commercial fallout for this sector. The present study evaluates the effect of Covid - 19 on the governance constitution and the firm performance of the Indian banking sector for the period 2019-2020. It compares the Covid - 19 impacts on the board's governance structures and the bank's performance in the pre and post-pandemic period. It also empirically examines their interrelationship during uncertain times. The results of the study establish that the board size is the sole prominent governance parameter that exerted a pragmatic influence on the bank's performance during the pandemic. The study's outcomes propound policymakers in designing a congruous governance framework for the corporate sectors during the pandemic. It proposes that the right balance of the stakeholder interests with effective risk strategies is essential in developing an effective governance framework. The study is pre-eminent in providing the empiric Covid - 19 repercussions on the governance procedures and corporate performance. It demonstrates the contemporary governance issues during the pandemic and unveils the avenues for subsequent research. © 2022 SCMS Group of Educational Institutions. All rights reserved.
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Ethics as applied to medico-dental practice and associated research is called bioethics. From the Journal's inception, contributing authors have explored recurrent themes pertaining to bioethics. This early interest is a tribute to the keen foresight and enduring pride in professionalism that has persisted throughout the evolution of orthodontics. Copyright © 2022 Ubiquity Press. All rights reserved.
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Aim: The aim of this study was to evaluate the need for analgesia in patients undergoing single-visit root canal treatment, within 2 days after COVID-19 immunisation. Method(s): Two days after receiving the COVID-19 vaccination, 50 patients undergoing Single visit root canal treatments for acute pulpits in molar teeth were divided into two groups of 25 each (Group M for males and Group F for females). Each patient was given a prescription for 650 mg of acetaminophen (Dolo 650 mg) tablets to be taken eight hours a day, with instructions to use the same only if needed for pain. They were instructed to keep a record of the number of tablets consumed as per record sheet 1, and if the pain did not subside then a stronger analgesic, Ketorolac DT 10 mg twice a day, had to be taken and recorded. Result(s): In Group M, the mean number of analgesic tablets required was 0.44+/-0.64 and in Group F, the mean number of analgesic tablets required was 0.80+/-1.09. Although the mean analgesic requirement was higher in females as compared to males, the difference of 0.80+/-1.09 between the two groups was not significant statistically (0.360). Conclusion(s): Within the limitations of this study, it is concluded that acetaminophen is effective in relieving post-obturation pain after a single-visit RCT in patients recently vaccinated against the CoVid-19. Copyright © 2022 Ubiquity Press. All rights reserved.
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Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and s to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%];P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020). © 2022, College of Intensive Care Medicine. All rights reserved.
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The use of social media has grown significantly in the last few years. Social media refers to "the websites and online tools that facilitate interactions between users by providing them opportunities to share information, opinions, and interest " (Swar and Hameed, 2017, p. 141). Adolescents have been found to be more vulnerable to addiction and crimes related to social media. Hence, the study has tried to understand the association of social media with the well being of adolescents. The first part of the paper deals with the role and relevance of social media.Further, the literature review depicts a strong connection between social media and individuals' well-being. For the quantitative analysis, various statistical techniques are used. In order to evaluate the association between variables, the composite index has been prepared. Further, the ranking has been given to reflect social media's impact on adolescents' well-being. Lastly, a few recommendations have been made for the state government regarding the well being of the adolescents.
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Background: Clinician emotion regulation (ER), self and the patient's, likely moderates successful prognostic discussions with patients, yet challenges around its evaluation limit its investigation. We performed a pilot study to develop and assess an experimental framework that uses multimodal assessment (self-report, observer, and biometric data) to measure clinician ER during a simulated, serious illness conversation (SIC). Method(s): We developed our experimental framework in four steps: 1) drafted a patient case and assessment framework;2) refined the data collection strategy using a multidisciplinary research team;3) trained our actor;and 4) iteratively piloted the case to optimize data collection. For the assessment, we conducted a cross-sectional, case series pilot study with physicians trained in SIC to assess its feasibility and acceptability, defined a priori as an enrollment rate >60% of approached clinicians, > 90% completion rate of survey items, < 20% missing data from wearable heart rate variability (HRV) sensors. To characterize clinician ER strategies, we analyzed the visit dialogue, physician interviews performed while watching the visit back, and physician SIC documentation generated post visit. We used a hybrid approach of inductive and deductive coding and theme development based on preexisting ER theory. Result(s): The development phase yielded two major modifications: 1) abandoned use of AppleWatch since it did not provide continuous HRV measurement;and 2) used telehealth with video given context of COVID-19 pandemic. We approached 12 physicians and 11 enrolled, of which 5 were female and 10 white, 5 were medical oncologists, and 6 specialty palliative care physicians. All participants completed all study survey items. The results of our three HRV sensors were as follows: Empatica E4 and Polar H10 met our pre-specified HRV collection in all 11 resting tasks and SIC encounters, and the Scoche R24 the benchmark in 7/11 resting tasks and 4/11 of simulated encounters. Preliminary qualitative analysis suggests investigators can characterize clinician use of intrapersonal and interpersonal ER strategies. Conclusion(s): The use of multimodal assessment of clinician ER in a simulated, telehealth SIC visit was acceptable and feasible.
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SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: COVID-19 associated morbidity and mortality are largely related to hypercoagulability events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), with right ventricular (RV) dysfunction playing a likely role in the severity of outcomes. The purpose of this study is to correlate right ventricular parameters on echocardiography in patients who developed DVT and PE while admitted with COVID-19 infection, and to determine if PE and DVT were related to a higher incidence of adverse outcomes. METHODS: Single-center retrospective study from March 2020 to August 2021 including patients older than 18 years old hospitalized with confirmed COVID-19 by RT-PCR, who had an echocardiogram performed while inpatient. Right ventricular parameters were obtained mostly by linear measurements, with a limited COVID-19 protocol determined by the institution. The presence of PE and DVT were confirmed by chest CT angiography and venous ultrasound, respectively. RESULTS: A total of 223 patients were included in the study (mean age 64.3 +/- 16, 59.6% male, 67.4% Hispanic). Baseline characteristics did not differ when stratified for the outcomes of interest. DVT occurred in 9.4% (n=21) and PE in 19.6% (n=44) patients. PE and DVT were related to a higher rate of ARDS, ICU admission, non-fatal stroke and prolonged length of stay (38.9 vs 16.9 days, p<0.05). Although there was a higher rate of intubation in patients admitted with DVT (p<0.05), it was non-significant for patients with PE. Mortality was similar to patients without thromboembolic events. For PE and DVT, RV dilation was present on 25% (p<0.05) and 14%, and RV dysfunction on 21% and 11%, respectively. CONCLUSIONS: PE and DVT in patients with COVID-19 were related to higher morbidity, but not mortality in this patient population. Interestingly, these events were related to a higher rate of non-fatal stroke, suggesting that hypercoagulability plays a major role in the development of some adverse outcomes. Despite only finding RV dilation as a statistically significant marker present in patients who developed PE, the study was potentially underpowered to find significant differences between groups. CLINICAL IMPLICATIONS: Development of PE and DVT in patients admitted with COVID-19 infection are markers of increased morbidity and higher length of stay. RV dilation might be used as a marker of potential thromboembolic events in this patient population, but more studies with controlled variables are needed to determine it's utility. DISCLOSURES: No relevant relationships by Sharon Andrade-Bucknor No relevant relationships by Mikayla Bowen No relevant relationships by Alexis Jones No relevant relationships by Sukhpreet Kaur No relevant relationships by Neal Olarte No relevant relationships by Beatriz Rivera Rodriguez No relevant relationships by Crystal Yan
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SESSION TITLE: Drug-Induced Lung Injury and Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Lomustine, a nitrosurea, inhibits DNA, RNA, and protein synthesis by carbamylation and alkylation, leading to cytotoxic effects 1, 3. Its concentration is high in the central nervous system (CNS) and therefore is commonly used for the management of CNS tumors including recurrent glioblastoma. While known side effects include pancytopenia, few pulmonary toxicities have been reported. This case is a rare example of lomustine induced pneumonitis. CASE PRESENTATION: A 54-year-old female with a history of glioblastoma, treated with a combination of surgical resection, radiation therapy, and temozolomide followed by stereotactic surgery and bevacizumab after disease recurrence, developed progressive dyspnea after initiating lomustine. She had received one dose of lomustine 90 mg/m2 two months prior to developing dyspnea upon exertion. At baseline, she was an active individual who played sports. A chest computed tomography (CT) scan preformed ten months prior was without any parenchymal abnormalities, and pulmonary function tests (PFTs) two months prior were normal with an adjusted DLCO of 15.4 mL/mmHg/min (88%). Repeat chest CT revealed diffuse ground glass opacities, and repeat PFTs showed a moderately impaired adjusted DLCO of 10.4 mL/mmHg/min (60%). Other lab evaluation, CBC, BNP, troponin, and COVID PCR, were negative. After receiving six weeks of steroids, there was resolution of CT findings, improvement of DLCO, and relief from symptoms. DISCUSSION: More common adverse effects of lomustine are GI discomfort and pancytopenia. It is less widely documented to cause pulmonary toxicity compared to its chemical relative carmustine 1, 3. This is perhaps due to decreased alkylation ability and penetration into the lung tissue by lomustine7. There have been few case reports revealing pneumonitis and pulmonary fibrosis. Lomustine induced pneumonitis induces acute parenchymal changes of the lung demonstrated by characteristic symptoms and imaging/biopsies abnormalities after initiation of a drug. 2 Findings include breathlessness, dyspnea upon exertion, cough, hypoxia, crackles upon lung auscultation. PFT's may show a restrictive pattern with decreased FEV1/FVC ratio and DLCO. Imaging may reveal diffuse groundglass opacities, traction bronchiectasis, interlobular septal thickening, and honeycombing. Bronchoscopy with lavage would rule out infection. Management involves discontinuation of culprit medication, immunosuppression, and supportive therapies to alleviate respiratory discomfort. Lack of treatment may produce complications of acute respiratory distress syndrome and fibrosis. CONCLUSIONS: Lomustine is an essential treatment drug for recurrent CNS tumors. Toxicities such as pneumonitis have been rarely demonstrated. Timely recognition of pneumonitis features is key to treat this complication, improve quality of life, and prevent permanent lung compromise. Reference #1: Dent RG. Fatal pulmonary toxic effects of lomustine. British medical journal. 1982;DOI:10.1136/thx.37.8.627 Reference #2: Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton, C, et al. Drug-Induced Interstitial Lung Disease: A Systemic Review. Journal of Clinical Medicine. 2018;doi 10.3390/jcm7100356 Reference #3: Weiss RB, Issell BF. The nitrosureas: carmustine and lomustine. Cancer treatment reviews. 1982;https://doi.org/10.1016/S0305-7372(82)80043-1 DISCLOSURES: No relevant relationships by Sukhdeep Kaur No relevant relationships by Chelsea Kennedy-Snodgrass No relevant relationships by Sarun Thomas