TrialPanorama/TrialPanorama-database huggingface dataset:
Study: NCT04177368

Intervention type: DIETARY_SUPPLEMENT
Intervention: Theragran 60ml
Description: history,examination and biochemical values
Study: NCT00828035

Intervention type: PROCEDURE
Group type: OTHER
Intervention: laparoscopic surgery
Description: comparison of two different laparoscopic surgeries : robot versus human

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: laparoscopic surgery
Description: comparison of two different laparoscopic surgeries : robot versus human
Study: NCT00894283

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Enoxaparin
Description: Patients will receive enoxaparin 40mg subcutaneously twice daily during perioperative period of bariatric surgery. Patients will be encouraged to ambulate and compression stockings while in bed.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Fondaparinux
Description: Fondaparinux 5mg subcutaneously 6 hours following surgery, fondaparinux 5mg subcutaneously once daily during hospitalization. Patients will be encouraged to ambulate and compression stockings while in bed.
Study: NCT00147030

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Whole body mild induced hypothermia
Description: Target rectal temperature 33-34°C for 72 hours, commencing by 6 hours of age; followed by re-warming at 0.5°C to normothermia
Study: NCT01303848

Intervention type: OTHER
Intervention: Blood Sampling
Description: Blood Sampling over 24 hours
Study: NCT03867994

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Atorvastatin

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Carvedilol

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: saline

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: saline

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: saline
Study: NCT01183585

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: RO4917838 and Rosuvastatin
Description: multiple oral doses of RO4917838 and single oral dose of Rosuvastatin
Study: NCT01346397

Intervention type: DRUG
Intervention: cyclosporine or tacrolimus
Description: after alemtuzumab, cyclosporine or tacrolimus was administered

Intervention type: DRUG
Intervention: cyclosporine or tacrolimus
Description: after alemtuzumab, cyclosporine or tacrolimus was administered
Study: NCT03871920

Intervention type: OTHER
Intervention: physical therapy treatment
Description: any treatment chosen by treating physiotherapist
Study: NCT00759447

Intervention type: DEVICE
Intervention: Genesis and Gemini
Description: 3 dimensional breast mammography system

Intervention type: DEVICE
Intervention: Investigational 3D Mammography system
Description: 3 dimensional breast mammography system
Study: NCT03861065

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Tertiary Wound Closure
Description: The wound will be closed with what is considered tertiary wound closure. This means, rather than leaving the wound open, the wound will be partially closed after surgery, and then completely closed 4-7 days after surgery.

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Historical Wound Closure
Description: Participants wounds are left partially open to heal.
Study: NCT03749369

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Salvadora Persica Root
Description: Salvadora Persica Gel

Intervention type: PROCEDURE
Group type: PLACEBO_COMPARATOR
Intervention: Scaling and root planing
Description: Thorough scaling and root planing (SRP) will be performed by a single clinician. The SRP procedure will be carried out in two sittings, comprising of ultrasonic scaling in the first, and manual instrumentation and root debridement in the second.

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Scaling and root planing
Description: Thorough scaling and root planing (SRP) will be performed by a single clinician. The SRP procedure will be carried out in two sittings, comprising of ultrasonic scaling in the first, and manual instrumentation and root debridement in the second.
Study: NCT02581748

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: HLX02
Study: NCT02218229

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Shock wave
Description: Shock waves are defined a sequence of acoustic pulse characterized by a high peak pressure (100 MPa), fast pressure rise (\< 10 ns) and short duration (10 μs). Different studies and clinical experiments have demonstrated the efficacy of shock waves in the treatment of musculoskeletal system such as chronic tendinopathies or hypertrophic pseudoarthrosis
Study: NCT02198833

Intervention type: BIOLOGICAL
Group type: EXPERIMENTAL
Intervention: Urine Culture
Description: Obtain urine culture every third day
Study: NCT02581748

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: HLX02

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Herceptin
Study: NCT05070611

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: IPL-MGX
Description: One week after lesion incision, the E-Eye machine (E-SWIN company, France) IPL treatment was administered to the skin area below the lower eyelid.13 Before treatment, the eyes were protected with opaque goggles and ultrasound gel was applied on the patient's face from tragus to tragus including the nose to conduct the light.
Study: NCT01813006

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Omega-3

Intervention type: DRUG
Group type: PLACEBO_COMPARATOR
Intervention: placebo
Study: NCT02808702

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Cognitive-behavioral therapy
Description: Twelve weekly sessions of individual cognitive-behavioral therapy
Study: NCT02674477

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Therapeutic Education System (TES)
Description: The TES program is made of modules about ways to prevent substance use, such as how to refuse drugs and alcohol, how to cope with thoughts about using, and how to make the best possible decisions for a person's mental health. Each module takes less than 30 minutes to complete. Modules may contain videos or other interactive media. At the end of each module, there are questions about the material.

Intervention type: OTHER
Group type: OTHER
Intervention: Treatment as Usual (TAU)
Description: Standard treatment comprises a psychiatrist-led interdisciplinary team as well as face-to-face group counseling for substance use and skills for improving general mental health. There will be no change to the routine care (treatment at usual \[TAU\]) provided to patients on the service.
Study: NCT04879888

Intervention type: BIOLOGICAL
Group type: EXPERIMENTAL
Intervention: Peptide pulsed Dendritic cell
Description: Intradermal vaccination with peptide-pulsed autologous dendritic cells in 200 µL of patient's serum in six doses weekly after surgery.
Study: NCT01415700

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Functional electrical stimulator
Description: The stimulator is surgically implanted

Intervention type: DEVICE
Group type: ACTIVE_COMPARATOR
Intervention: feet orthosis
Description: feet orthosis specifically mold
Study: NCT00189293

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Imiquimod
Description: Imiquimod 5% cream three times per week for 4 weeks (1 sachet)~1 or 2 sachet(s)

Intervention type: OTHER
Group type: OTHER
Intervention: vehicle cream
Description: vehicle cream three times per week for 4 weeks (1 sachet)~1 or 2 sachet(s)
Study: NCT01544127

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: MI-SI+TAU
Description: MI-SI focuses on exploring and resolving ambivalence about living. It consists of 1 or 2 in-person MI-SI sessions (50 mins.) on an inpatient unit, plus a telephone follow-up MI-SI session (30-50 mins)

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: MI-SI-R+TAU
Description: MI-SI-R focuses on resolving ambivalence about living. It consists of 1 or 2 in-person MI-SI sessions (50 mins.) on an inpatient unit, plus a telephone follow-up MI-SI session (30-50 mins)

Intervention type: OTHER
Group type: OTHER
Intervention: TAU Alone
Description: Inpatient treatment includes medication management, case management, meals and a bed, milieu therapy consisting of creative and social activities, and a safety plan. Some families of veterans also received education to create a supportive home environment. As part of Veterans Health Administration (VHA) suicide prevention policy, the care of suicidal patients is also overseen by a local Suicide Prevention Coordinator and case managers.
Study: NCT04088773

Intervention type: DIAGNOSTIC_TEST
Intervention: blood biomarkers
Description: biomarkers to distinguish fibrotic vs non-fibrotic CD lesions

Intervention type: DIAGNOSTIC_TEST
Intervention: blood biomarkers
Description: biomarkers to distinguish fibrotic vs non-fibrotic CD lesions

Intervention type: DIAGNOSTIC_TEST
Intervention: blood biomarkers
Description: biomarkers to distinguish fibrotic vs non-fibrotic CD lesions

Intervention type: DIAGNOSTIC_TEST
Intervention: stool biomarkers
Description: fecal biomarkers of inflammation, mucosal inflammation

Intervention type: DIAGNOSTIC_TEST
Intervention: stool biomarkers
Description: fecal biomarkers of inflammation, mucosal inflammation

Intervention type: DIAGNOSTIC_TEST
Intervention: stool biomarkers
Description: fecal biomarkers of inflammation, mucosal inflammation

Intervention type: DIAGNOSTIC_TEST
Intervention: MRI imaging
Description: MRI imaging to detect bowel wall fibrosis and to detect inflamed, non-fibrotic from inflamed, fibrotic bowel

Intervention type: DIAGNOSTIC_TEST
Intervention: MRI imaging
Description: MRI imaging to detect bowel wall fibrosis and to detect inflamed, non-fibrotic from inflamed, fibrotic bowel
Study: NCT00005006

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Parathyroid Hormone
Description: Alendronate 70mg/week; Teriparatide 20mcg/ day
Study: NCT04598113

Intervention type: DEVICE
Group type: ACTIVE_COMPARATOR
Intervention: Cervical Traction Device
Description: While The patient is lie on the back his or her head is housed within the specific head portion of the device. The investigator inflate progressively the device using a valve and ensuring the patient's relaxation. The process of inflation is continued until the level of 12 Kg of pressure is reached. This maximum level of traction is maintained for 10 minutes then the process of deflation is started until the pressure decreased to 0 Kg. This maneuver is reproduced once again after 5 minutes of rest.~The balance assessment using the force plate-from is done just before the intervention and 5 minutes after its end.

Intervention type: DEVICE
Group type: SHAM_COMPARATOR
Intervention: Cervical Traction Device
Description: While The patient is lie on the back his or her head is housed within the specific head portion of the device. The investigator inflate progressively the device using a valve and ensuring the patient's relaxation. The process of inflation is continued until the level of 12 Kg of pressure is reached. This maximum level of traction is maintained for 10 minutes then the process of deflation is started until the pressure decreased to 0 Kg. This maneuver is reproduced once again after 5 minutes of rest.~The balance assessment using the force plate-from is done just before the intervention and 5 minutes after its end.
Study: NCT00992888

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Prometheus Liver Dialysis system (Fresenius Medical Care)
Description: 6 hour dialysis for 3 consecutive days
Study: NCT00005006

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Alendronate
Description: Alendronate 70mg/week

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Alendronate
Description: Alendronate 70mg/week

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Alendronate
Description: Alendronate 70mg/week

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Teriparatide
Description: Teriparatide 20mcg/day

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Teriparatide
Description: Teriparatide 20mcg/day
Study: NCT02932878

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: DSXS topical
Description: topical treatment
Study: NCT02262377

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Integrative Medicine Group Visits
Description: Patients with chronic pain and depression attend group medical visits and use website and virtual patient advocate as part of the curriculum.
Study: NCT03292653

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Sotagliflozin
Description: Pharmaceutical form: Tablet; Route of administration: Oral

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Sotagliflozin
Description: Pharmaceutical form: Tablet; Route of administration: Oral
Study: NCT02198833

Intervention type: BIOLOGICAL
Group type: ACTIVE_COMPARATOR
Intervention: Urine Culture
Description: Obtain urine culture every third day
Study: NCT01975324

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: dalfampridine
Description: dalfampridine 10 mgs or placebo twice a day for two weeks, wash out period of two weeks, dalfampridine 10mgs or placebo twice a day for two weeks

Intervention type: DRUG
Group type: PLACEBO_COMPARATOR
Intervention: Placebo
Description: placebo (sugar pill) twice a day for two weeks
Study: NCT02365142

Intervention type: BIOLOGICAL
Group type: ACTIVE_COMPARATOR
Intervention: 100 million Bone marrow mesenchimal stem cells
Description: 100 million Bone marrow mesenchimal stem cells with PRGF

Intervention type: BIOLOGICAL
Group type: ACTIVE_COMPARATOR
Intervention: Platelet Rich plasma (PRGF)
Description: 3 injections of PRGF

Intervention type: BIOLOGICAL
Group type: ACTIVE_COMPARATOR
Intervention: Platelet Rich plasma (PRGF)
Description: 3 injections of PRGF
Study: NCT00837733

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Endometrial biopsy
Description: Endometrial biopsy was done at luteal phase on the day 21-26 of spontaneous menstrual cycles, when GnRH agonist uses begun. Endometrial samples were taken by a biopsy catheter

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Endometrial Biopsy
Description: Biopsy catheter
Study: NCT02198833

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Foley Catheter Tip Culture
Description: Catheter Tip Roll Plate Culture

Intervention type: DEVICE
Group type: ACTIVE_COMPARATOR
Intervention: Foley Catheter Tip Culture
Description: Catheter Tip Roll Plate Culture

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Scanning Electron Microscopy
Description: Houston Site Only

Intervention type: DEVICE
Group type: ACTIVE_COMPARATOR
Intervention: Scanning Electron Microscopy
Description: Houston Site Only

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Device Specific Adverse Event Assessment
Description: Assessment will be made of catheter patency and/or trauma related to catheter placement

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Device Specific Adverse Event Assessment
Description: Assessment will be made of catheter patency and/or trauma related to catheter placement

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Foley Catheter Insertion
Description: Insert Foley catheter for 15 day duration

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Foley Catheter Insertion
Description: Insert Foley catheter for 15 day duration
Study: NCT01984515

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Referral Management System
Description: Referral Management System (RMS) will address patient-level barriers with the delivery of a 1-session cognitive behavioral therapy (CBT) intervention to identify and change treatment seeking beliefs that serve as an barrier to treatment engagement, including specific negative beliefs about EBP (e.g., talking about past trauma will be too difficult for me). RMS will address system-level barriers by tracking the progress of RMS referrals and contacting Veterans who have not followed thought on their chosen referral options. Primary Care staff will also be trained with simple scripts on how to address PTSD symptoms and make appropriate referrals based on VA/DoD Clinical Practice Guidelines for PTSD.
Study: NCT02324166

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Cefazolin
Description: cephalosporin antibiotic

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Cefazolin
Description: cephalosporin antibiotic

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Lidocaine
Description: local anesthetic
Study: NCT01756456

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: rhNGF 10 μg/ml
Description: rhNGF 10 μg/ml : one drop 6 times a day (one 35 μl drop equals to 0.35 μg of rhNGF)
Study: NCT03292653

Intervention type: DRUG
Group type: PLACEBO_COMPARATOR
Intervention: Placebo
Description: Pharmaceutical form: Tablet; Route of administration: Oral

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Placebo
Description: Pharmaceutical form: Tablet; Route of administration: Oral
Study: NCT04038710

Intervention type: DRUG
Intervention: Triple combination therapy
Description: Triple combination is compromised of the drugs ivacaftor, tezacaftor and Vertex's next generation modulator.
Study: NCT03478436

Intervention type: DRUG
Group type: OTHER
Intervention: Doxycycline
Description: Doxycycline 40 mg capsules

Intervention type: DRUG
Group type: OTHER
Intervention: Doxycycline
Description: Doxycycline 40 mg capsules
Study: NCT00366093

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Eszopiclone
Description: eszopiclone 3 mg
Study: NCT04262349

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: sleep education
Description: As a training program to increase sleep, pregnant women will be given 2 training sessions per week for two weeks and four sessions in total for 60 minutes.
Study: NCT00090103

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: dutasteride 0.5mg once daily for 4 years
Description: combination or single agent
Study: NCT00366093

Intervention type: DRUG
Group type: PLACEBO_COMPARATOR
Intervention: Placebo
Description: placebo tablet
Study: NCT02973373

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: MRI with High-frequency non-invasive ventilation
Description: MRI performed under high-frequency non-invasive ventilation

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: MRI without High-frequency non-invasive ventilation
Description: MRI performed without High-frequency non-invasive ventilation
Study: NCT03302182

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Ritonavir for cycle1 and NORVIR for cycle 2
Description: During the study session, healthy subjects will be administered a single dose of Ritonavir Tablet 100mg in cycle 1 and NORVIR tablet 100mg in cycle 2 .

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Ritonavir for cycle1 and NORVIR for cycle 2
Description: During the study session, healthy subjects will be administered a single dose of Ritonavir Tablet 100mg in cycle 1 and NORVIR tablet 100mg in cycle 2 .

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: NORVIR for cycle 1 and Ritonavir for cycle 2
Description: During the study session, healthy subjects will be administered a single dose of NORVIR Tablet 100mg in cycle 1 and Ritonavir tablet 100mg in cycle 2 .

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: NORVIR for cycle 1 and Ritonavir for cycle 2
Description: During the study session, healthy subjects will be administered a single dose of NORVIR Tablet 100mg in cycle 1 and Ritonavir tablet 100mg in cycle 2 .
Study: NCT02665403

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Play intervention
Description: participants received around 30 minutes of hospital play interventions each day, conducted by hospital play specialists. Such interventions consisted of structured and non-structured activities. All these activities were given at the patients' bedside, with or without parental supervision, either once or spreading over an hour, depending on the ward routine.

Intervention type: OTHER
Group type: PLACEBO_COMPARATOR
Intervention: control
Description: Children received standard medical and nursing care, such as vital signs observation, pharmacological treatment and wound and pain management as a control treatment
Study: NCT01576159

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Running exercise
Description: During this type of exercise intervention, subjects performed weight-bearing exercise. This group participated in sessions of 40-min per day, three days per week, for a period of 12 weeks

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Cycling exercise
Description: During this type of exercise intervention, subjects performed a partial weight-bearing exercise. This group participated in sessions of 40-min per day, three days per week, for a period of 12 weeks

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Swimming Exercise
Description: During this type of exercise intervention, subjects performed a non-weight bearing exercise. This group participated in sessions of 40-min per day, three days per week, for a period of 12 weeks
Study: NCT01756456

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: rhNGF 10 μg/ml
Description: rhNGF 10 μg/ml : one drop 6 times a day (one 35 μl drop equals to 0.35 μg of rhNGF)

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: rhNGF 20 μg/ml
Description: one drop 6 times a day (one 35 μl drop equals to 0.70 μg of rhNGF)

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: rhNGF 20 μg/ml
Description: one drop 6 times a day (one 35 μl drop equals to 0.70 μg of rhNGF)

Intervention type: OTHER
Group type: PLACEBO_COMPARATOR
Intervention: vehicle
Description: ophthalmic solution of the same composition as the test product without rhNGF

Intervention type: OTHER
Group type: PLACEBO_COMPARATOR
Intervention: vehicle
Description: ophthalmic solution of the same composition as the test product without rhNGF
Study: NCT03263559

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Haploidentical Bone Marrow Transplantation
Description: Eligible patients with a first degree Human Leukocyte Antigen (HLA)- haploidentical donor will undergo Haploidentical bone marrow transplantation at Day 0 with non T-cell depleted bone marrow. For Graft-vs-Host Disease (GVHD) prophylaxis, patients will be given sirolimus and mycophenolate mofetil beginning on Day +5.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Hydroxyurea
Description: HU will be given daily at 30mg/kg from Day -70 through Day -10.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Rabbit-ATG
Description: Rabbit-ATG (rATG) will be given at 0.5mg/kg on Day -9, and at 2.0mg/kg on Day -8 and Day -7.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Thiotepa
Description: Thiotepa will be given at 10mg/kg on Day -7

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Fludarabine
Description: Fludarabine will be given at 30mg/m2 from Day -6 to Day -2

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Cyclophosphamide
Description: Cyclophosphamide will be given at 14.5mg/kg on Day -6 and Day -5, and at 50 mg/kg on Days +3 and +4.

Intervention type: RADIATION
Group type: EXPERIMENTAL
Intervention: Total Body Irradiation
Description: Total Body Irradiation will be given at 200cGy on Day -1

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Mesna
Description: Mesna will be given at 40mg/kg on Days +3 and +4