TrialPanorama/Dataset huggingface dataset:
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: The Effects of Resveratrol Supplement on Lipid Profile, Liver Enzymes, Inflammatory Factors and Hepatic Fibrosis in Patients With Nonalcoholic Steatohepatitis
Brief Summary: To study the effects of Resveratrol supplement on lipid profile, liver enzymes, inflammatory factors and hepatic fibrosis in patients with Nonalcoholic Fatty Liver (NAfLD), 50 patients who referred to Gastrointestinal (GI) clinic with steatosis grade 1 or more will be randomly allocated to receive 1 Resveratrol capsules or placebos for 12 weeks; both groups will be advised to adherence our diet and exercise program too. At the first and the end of the intervention, lipid profiles, liver enzymes, some inflammatory cytokines, and liver fibrosis will be assessed and compared between groups.


Options:
A: Arm Label: Pentoxifylline; Type: EXPERIMENTAL; Interventions: Drug: Pentoxifylline | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Pentoxifylline; Assigned to Arm(s): Pentoxifylline | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo
B: Arm Label: udca003; Type: EXPERIMENTAL; Interventions: Drug: Ursodeoxycholic acid, thiamine, riboflavin | Arm Label: placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Ursodeoxycholic acid, thiamine, riboflavin | Intervention Type: DRUG; Name: Ursodeoxycholic acid, thiamine, riboflavin; Assigned to Arm(s): placebo, udca003
C: Arm Label: Resveratrol; Type: ACTIVE_COMPARATOR; Interventions: Dietary Supplement: Resveratrol | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Other: placebo | Intervention Type: DIETARY_SUPPLEMENT; Name: Resveratrol; Assigned to Arm(s): Resveratrol | Intervention Type: OTHER; Name: placebo; Assigned to Arm(s): Placebo
D: Arm Label: 25 mg INT-747; Type: ACTIVE_COMPARATOR; Interventions: Drug: INT-747 | Arm Label: 50 mg INT-747; Type: ACTIVE_COMPARATOR; Interventions: Drug: INT-747 | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: INT-747; Assigned to Arm(s): 25 mg INT-747, 50 mg INT-747 | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo

Answer: C
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Effect of Very Low Protein Diet Supplemented With Ketoanalogues of the Essential Amino Acids on the Progression of Chronic Kidney Disease
Brief Summary: This is a prospective single center randomized controlled trial with a total duration of 18 months aiming to evaluate the effectiveness and the safety of a very low protein diet supplemented with ketoanalogues of essential aminoacids in reducing the progression of chronic kidney disease (CKD) in patients with advanced CKD.


Options:
A: Arm Label: Standard Treatment Arm; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Diet, Behavioral: Exercise, Behavioral: Stop smoking, Drug: Glucose lowering therapy, Drug: Blood pressure lowering therapy, Drug: Lipid lowering therapy | Arm Label: Intensive Treatment Arm; Type: EXPERIMENTAL; Interventions: Behavioral: Diet, Behavioral: Exercise, Behavioral: Stop smoking, Drug: Glucose lowering therapy, Drug: Blood pressure lowering therapy, Drug: Lipid lowering therapy | Intervention Type: BEHAVIORAL; Name: Diet; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: BEHAVIORAL; Name: Exercise; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: BEHAVIORAL; Name: Stop smoking; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Glucose lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Blood pressure lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm | Intervention Type: DRUG; Name: Lipid lowering therapy; Assigned to Arm(s): Intensive Treatment Arm, Standard Treatment Arm
B: Arm Label: Keto-diet (KD); Type: EXPERIMENTAL; Interventions: Dietary Supplement: Very low protein diet supplemented with Ketosteril | Arm Label: Low Protein Diet group (LPD); Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Conventional low protein diet | Intervention Type: BEHAVIORAL; Name: Conventional low protein diet; Assigned to Arm(s): Low Protein Diet group (LPD) | Intervention Type: DIETARY_SUPPLEMENT; Name: Very low protein diet supplemented with Ketosteril; Assigned to Arm(s): Keto-diet (KD)
C: Intervention Type: BEHAVIORAL; Name: low protein diet; Assigned to Arm(s): N/A
D: Arm Label: VLPD diet; Type: EXPERIMENTAL; Interventions: Behavioral: Very low protein diet | Arm Label: LPD diet; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Low protein diet | Intervention Type: BEHAVIORAL; Name: Very low protein diet; Assigned to Arm(s): VLPD diet | Intervention Type: BEHAVIORAL; Name: Low protein diet; Assigned to Arm(s): LPD diet

Answer: B
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Impact of Preoperative Treatment of Anemia and Iron Deficiency in Cardiac Surgery on Outcome.
Brief Summary: We are performing the above prospective randomized trial in 1'000 patients undergoing cardiac surgery. The study will answer the question of whether preoperative treatment of anemia or iron deficiency indeed improves transfusion needs (primary outcome) and important clinical outcomes (secondary outcome) in a large group of cardiac surgical patients. The list of inclusion and exclusion criteria was deliberately chosen short so that this patient group largely reflects today's clinical practice .

* Trial with medical product


Options:
A: Intervention Type: DRUG; Name: Iron Sucrose IV 200mg, once a week, for 5 weeks; Assigned to Arm(s): N/A | Intervention Type: DRUG; Name: Ferrous sulfate 200mg PO TID, for 8 weeks; Assigned to Arm(s): N/A
B: Arm Label: Anemia; Type: ACTIVE_COMPARATOR; Interventions: Drug: Erythropoietin/Ferric carboxymaltose/Vitamin B12/Folic Acid | Arm Label: Iron deficiency; Type: ACTIVE_COMPARATOR; Interventions: Drug: Erythropoietin/Ferric carboxymaltose/Vitamin B12/Folic Acid | Arm Label: Natural comparison group; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DRUG; Name: Erythropoietin/Ferric carboxymaltose/Vitamin B12/Folic Acid; Assigned to Arm(s): Anemia, Iron deficiency
C: Arm Label: Iron Dextran; Type: ACTIVE_COMPARATOR; Interventions: Drug: Iron dextran | Arm Label: Iron Sucrose; Type: ACTIVE_COMPARATOR; Interventions: Drug: Iron sucrose | Intervention Type: DRUG; Name: Iron dextran; Assigned to Arm(s): Iron Dextran | Intervention Type: DRUG; Name: Iron sucrose; Assigned to Arm(s): Iron Sucrose
D: Arm Label: Single oral iron supplement per day (120 mg); Type: EXPERIMENTAL; Interventions: Dietary Supplement: Single oral iron dose of 120 mg per day for 3 consecutive days | Arm Label: B.i.d. oral iron supplement (2x 60 mg); Type: ACTIVE_COMPARATOR; Interventions: Dietary Supplement: Two oral iron doses of 60 mg per day (morning + afternoon) for 3 consecutive days | Intervention Type: DIETARY_SUPPLEMENT; Name: Single oral iron dose of 120 mg per day for 3 consecutive days; Assigned to Arm(s): Single oral iron supplement per day (120 mg) | Intervention Type: DIETARY_SUPPLEMENT; Name: Two oral iron doses of 60 mg per day (morning + afternoon) for 3 consecutive days; Assigned to Arm(s): B.i.d. oral iron supplement (2x 60 mg)

Answer: B
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Women, Infant, and Children (WIC) Infant-Toddler Feeding Practices Study - II (ITFPS-2)
Brief Summary: The goal of the study is to be a current examination of infant and toddler feeding practices among families receiving WIC services. It has been more than 10 years since the last study of such feeding practices, and in the interim important changes have taken place in the WIC program, in society, and in the science of nutrition. The study will include exploration of breastfeeding practices and support, more general feeding practices, nutritional intake of infants and toddlers, transitions in infant and toddler feeding practices, early precursors of obesity, and family factors that may influence all of these nutrition-related issues. It will also explore characteristics of the WIC program in selected sites, and how these relate to infant and toddler feeding decisions and practices. This study is important both to update knowledge about the WIC population, and to uncover possible new avenues of inquiry regarding early childhood obesity.

Update on November 25, 2020:

The WIC ITFPS-2 will now follow participants through child age 9 years. This unprecedented opportunity will provide FNS with a better understanding of the impact of WIC participation on health and nutrition outcomes in childhood.


Options:
A: Arm Label: WIC Program Participants; Type: N/A; Interventions: N/A
B: Arm Label: Immediate Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Healthy Eating and Physical Activity | Arm Label: Delayed Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Healthy Eating and Physical Activity | Intervention Type: BEHAVIORAL; Name: Healthy Eating and Physical Activity; Assigned to Arm(s): Delayed Intervention, Immediate Intervention
C: Arm Label: Control group; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: Intervention group; Type: EXPERIMENTAL; Interventions: Behavioral: Lifestyle intervention | Intervention Type: BEHAVIORAL; Name: Lifestyle intervention; Assigned to Arm(s): Intervention group
D: Arm Label: Home-based promotora intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Home-based promotora family intervention | Arm Label: Delayed treatment control; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Home-based promotora family intervention; Assigned to Arm(s): Home-based promotora intervention

Answer: A
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: SATISFY-SOS: Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys
Brief Summary: Based on limited published epidemiological data, up to an alarming 1 in 50 surgical inpatients die within 30 postoperative days. Based on our own data from the B-Unaware (NCT00281489) and BAG-RECALL (NCT00682825) clinical trials, 30-day postoperative mortality among high-risk surgical patients is comparable to this at Barnes-Jewish Hospital, and 1-year mortality among high-risk surgical patients may be as high as 10%. Short- and intermediate-term postoperative mortality is therefore a pressing public health concern. Similarly, postoperative major morbidity - including delirium, stroke, myocardial infarction, atrial fibrillation, blood clots, renal dysfunction, wound infection, pneumonia, respiratory failure, loss of functionality, and chronic pain - occurs commonly and affects a substantial proportion of surgical patients, critically ill patients and patients undergoing procedures for chronic pain. Many factors associate strongly and independently with postoperative mortality and major morbidity: patient age, functional status, comorbid medical conditions, and duration and invasiveness of surgery, among others. It is a strategic priority to identify pre- and intraoperative risk factors that are subject to modification.


Options:
A: N/A
B: Arm Label: Rivaroxaban; Type: EXPERIMENTAL; Interventions: Drug: Rivaroxaban, Drug: Matching placebo for Rivaroxaban arm (Warfarin placebo) | Arm Label: Warfarin; Type: ACTIVE_COMPARATOR; Interventions: Drug: Warfarin, Drug: Matching placebo for Warfarin arm (Rivaroxaban placebo) | Intervention Type: DRUG; Name: Rivaroxaban; Assigned to Arm(s): Rivaroxaban | Intervention Type: DRUG; Name: Warfarin; Assigned to Arm(s): Warfarin | Intervention Type: DRUG; Name: Matching placebo for Rivaroxaban arm (Warfarin placebo); Assigned to Arm(s): Rivaroxaban | Intervention Type: DRUG; Name: Matching placebo for Warfarin arm (Rivaroxaban placebo); Assigned to Arm(s): Warfarin
C: Arm Label: patients with hip fracture; Type: N/A; Interventions: Other: observation | Intervention Type: OTHER; Name: observation; Assigned to Arm(s): patients with hip fracture
D: Arm Label: Inhalational anesthetic; Type: ACTIVE_COMPARATOR; Interventions: Drug: Inhalational anesthetic | Arm Label: Intravenous anesthetic, propofol; Type: ACTIVE_COMPARATOR; Interventions: Drug: Intravenous anesthetic, propofol | Intervention Type: DRUG; Name: Inhalational anesthetic; Assigned to Arm(s): Inhalational anesthetic | Intervention Type: DRUG; Name: Intravenous anesthetic, propofol; Assigned to Arm(s): Intravenous anesthetic, propofol

Answer: A
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Effects of Lifestyle Education Programs on Diabetes Control Among Diabetic Patients at Kigali University Teaching Hospital Rwanda
Brief Summary: Strategies to reduce the burden of diabetes in Rwanda, like in other resource poor settings, include involving diabetic patients in their own care and targeting modifiable risk factors through adopting appropriate dietary and lifestyle habits. According to previous research carried out in developed countries, lifestyle modifications may have effect on the development of diabetes and prevention of its complications.

However, direct evidence to show whether lifestyle intervention is beneficial for diabetic patients in resources limited countries like Rwanda is an open question. Though in these countries, access to healthy diet is claimed to be the barrier of implementation of therapeutic lifestyle based initiatives, we hypothesize that knowledge gaps are more important barriers than access to healthier diets and other lifestyle habits. We therefore would like to carry out this intervention to assess the effects of lifestyle education programs on glycemic control among people with diabetes followed up at CHUK.


Options:
A: Arm Label: The Education Health Program; Type: EXPERIMENTAL; Interventions: Behavioral: The Education Health Program | Intervention Type: BEHAVIORAL; Name: The Education Health Program; Assigned to Arm(s): The Education Health Program
B: Arm Label: ATSM Intervention; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: ATSM Intervention | Arm Label: GMV Intervention; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: GMV Intervention | Arm Label: Usual Care; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: ATSM Intervention; Assigned to Arm(s): ATSM Intervention | Intervention Type: BEHAVIORAL; Name: GMV Intervention; Assigned to Arm(s): GMV Intervention
C: Arm Label: lifestyle counselling; Type: EXPERIMENTAL; Interventions: Behavioral: lifestyle counselling | Intervention Type: BEHAVIORAL; Name: lifestyle counselling; Assigned to Arm(s): lifestyle counselling
D: Intervention Type: BEHAVIORAL; Name: Lifestyle Counselling; Opinion Leader Influence Statements; Assigned to Arm(s): N/A

Answer: C
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Randomized Clinical Trial of Oral Magnesium Supplementation In Pregnancy for the Prevention of Preterm Birth and Perinatal and Maternal Morbidity
Brief Summary: The investigators propose a preventive strategy that may reduce the risk of placental vascular disease and its negative consequences for both the fetus (e.g., poor fetal growth or stillbirth)and mother (e.g., the hypertensive disorders of pregnancy), and which, in turn, should reduce the need for indicated preterm delivery. This strategy is a multicenter, randomized double-blind, placebo-controlled clinical trial (RCT) comparing magnesium citrate supplementation with placebo, each starting at 12 to 20 weeks gestation and continued until delivery. Magnesium citrate is a safe and inexpensive compound that is easily absorbed by the intestinal tract. The results of this RCT may be especially relevant in low and middle income countries that have high rates of prematurity, and limited resources for acute newborn and maternal care.


Options:
A: Arm Label: Low molecular weight heparin; Type: N/A; Interventions: Drug: low molecular weight heparin (enoxeparine) | Intervention Type: DRUG; Name: low molecular weight heparin (enoxeparine); Assigned to Arm(s): Low molecular weight heparin
B: Intervention Type: DRUG; Name: Low dose steroids; Assigned to Arm(s): N/A
C: Arm Label: Mg++; Type: EXPERIMENTAL; Interventions: Drug: Magnesium citrate | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Magnesium citrate | Intervention Type: DRUG; Name: Magnesium citrate; Assigned to Arm(s): Mg++, Placebo
D: Arm Label: ASA; Type: ACTIVE_COMPARATOR; Interventions: Drug: Aspirin | Arm Label: Klexane; Type: ACTIVE_COMPARATOR; Interventions: Drug: Klexane | Arm Label: Aspirin and Enoxaparine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Klexane and ASA | Intervention Type: DRUG; Name: Aspirin; Assigned to Arm(s): ASA | Intervention Type: DRUG; Name: Klexane; Assigned to Arm(s): Klexane | Intervention Type: DRUG; Name: Klexane and ASA; Assigned to Arm(s): Aspirin and Enoxaparine

Answer: C
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Evaluation of the Efficacy of Next Generation Sequencing in Predicting Embryonic Karyotype and Subsequent Pregnancy Outcomes in in Vitro Fertilization Cycles (IVF)
Brief Summary: To evaluate the benefits of using next generation sequencing to assess embryonic aneuploidy. All viable blastocysts will be biopsied and cryopreserved for future transfer. After the final embryo is cryopreserved, patients will be randomized to either the intervention group or the control group. Patients and doctors are blinded to the randomization until study completion. A Double Embryo Transfer (DET) will be performed with either screened or unscreened embryos depending on randomization. A Single Embryo Transfer (SET) may occur in cases where only one embryo is available for transfer.


Options:
A: Arm Label: PGS (genetic screening); Type: EXPERIMENTAL; Interventions: Diagnostic Test: Preimplantation Genetic Screening | Arm Label: no PGS (no genetic screening); Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DIAGNOSTIC_TEST; Name: Preimplantation Genetic Screening; Assigned to Arm(s): PGS (genetic screening)
B: Arm Label: Comprehensive Chromosome Screening; Type: EXPERIMENTAL; Interventions: Other: Comprehensive Chromosome Screening | Arm Label: No Comprehensive Chromosome Screening; Type: PLACEBO_COMPARATOR; Interventions: Other: Morphologically Best | Intervention Type: OTHER; Name: Comprehensive Chromosome Screening; Assigned to Arm(s): Comprehensive Chromosome Screening | Intervention Type: OTHER; Name: Morphologically Best; Assigned to Arm(s): No Comprehensive Chromosome Screening
C: Arm Label: Endometrial biopsy arm; Type: EXPERIMENTAL; Interventions: Procedure: Endometrial biopsy, Device: Transvaginal ultrasound | Arm Label: Control group; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: PROCEDURE; Name: Endometrial biopsy; Assigned to Arm(s): Endometrial biopsy arm | Intervention Type: DEVICE; Name: Transvaginal ultrasound; Assigned to Arm(s): Endometrial biopsy arm
D: Arm Label: PGS-FET; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Trophectoderm biopsy, Procedure: Cryopreservation, Procedure: Embryo Transfer | Arm Label: FET; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Cryopreservation, Procedure: Embryo Transfer | Arm Label: Fresh; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Embryo Transfer | Intervention Type: PROCEDURE; Name: Trophectoderm biopsy; Assigned to Arm(s): PGS-FET | Intervention Type: PROCEDURE; Name: Cryopreservation; Assigned to Arm(s): FET, PGS-FET | Intervention Type: PROCEDURE; Name: Embryo Transfer; Assigned to Arm(s): FET, Fresh, PGS-FET

Answer: B
Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: N/A
Brief Summary: Uraemic pruritus (UP) remains a frequent and distressing problem in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Calmmax is a new topical cream that was introduced recently by Calmmax Pharma, an Israeli pharmaceutical company developed a topical cream based on active plant extracts for treatment of skin inflammation. We intend to conduct a prospective, double blind, placebo controlled, randomized trial that will assess the therapeutic effect of Calmmax cream on UP in a cohort of CKD and ESRD patients.


Options:
A: Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Arm Label: Senna; Type: ACTIVE_COMPARATOR; Interventions: Drug: Senna | Intervention Type: DRUG; Name: Senna; Assigned to Arm(s): Senna | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo
B: Arm Label: MT-9938 2.5μg; Type: ACTIVE_COMPARATOR; Interventions: Drug: Nalfurafine hydrochloride(MT-9938) 2.5μg | Arm Label: MT-9938 5μg; Type: ACTIVE_COMPARATOR; Interventions: Drug: Nalfurafine hydrochloride(MT-9938) 5μg | Arm Label: MT-9938 10μg; Type: ACTIVE_COMPARATOR; Interventions: Drug: Nalfurafine hydrochloride(MT-9938) 10μg | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Nalfurafine hydrochloride(MT-9938) 2.5μg; Assigned to Arm(s): MT-9938 2.5μg | Intervention Type: DRUG; Name: Nalfurafine hydrochloride(MT-9938) 5μg; Assigned to Arm(s): MT-9938 5μg | Intervention Type: DRUG; Name: Nalfurafine hydrochloride(MT-9938) 10μg; Assigned to Arm(s): MT-9938 10μg | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo
C: Arm Label: hemodialysis+hemoperfusion (HA330); Type: EXPERIMENTAL; Interventions: Other: hemodialysis only, Other: hemodialysis plus hemoperfusion(HA330) | Arm Label: hemodialysis+hemoperfusion (HA130); Type: EXPERIMENTAL; Interventions: Other: hemodialysis only, Other: hemodialysis plus hemoperfusion(HA130) | Arm Label: hemodialysis only; Type: ACTIVE_COMPARATOR; Interventions: Other: hemodialysis only | Intervention Type: OTHER; Name: hemodialysis only; Assigned to Arm(s): hemodialysis only, hemodialysis+hemoperfusion (HA130), hemodialysis+hemoperfusion (HA330) | Intervention Type: OTHER; Name: hemodialysis plus hemoperfusion(HA330); Assigned to Arm(s): hemodialysis+hemoperfusion (HA330) | Intervention Type: OTHER; Name: hemodialysis plus hemoperfusion(HA130); Assigned to Arm(s): hemodialysis+hemoperfusion (HA130)
D: Arm Label: Callmax cream; Type: ACTIVE_COMPARATOR; Interventions: Drug: Callmax cream application over affected skin | Arm Label: Placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Callmax cream application over affected skin; Assigned to Arm(s): Callmax cream | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo

Answer: D