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The Analysis and Treatment of Rotator Cuff Tear After Shoulder Dislocation in Middle-Aged and Elderly Patients (중·장년층에서 견관절 탈구 후에 발생한 회전근 개 파열에 대한 분석과 치료)

  • Ji, Jong-Hun;Park, Sang-Eun;Kim, Young-Yul;Shin, Eun-Su;Park, Bo-Youn;Jeong, Jae-Jung
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.20-26
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    • 2010
  • Purpose: To evaluate clinical features and surgical results for rotator cuff tear secondary to shoulder dislocation in middle-aged and elderly patients. Materials and Methods: We reviewed 19 patients over 50 years of age who had rotator cuff tears combined with shoulder dislocation between October 2004 and October 2008. There were 7 males and 12 females with a mean age 64.7 years (range, 50 to 78 years). The average follow-up duration was 22 months (range, 8 to 56 months). We investigated the number of dislocations, the size of the cuff tear, the presence of Bankart lesions and the time interval from dislocation to surgery. We also investigated the ASES score, UCLA score, SST score, and shoulder range of motion before and after surgery. We analyzed clinical outcomes and contributing factors. Results: ASES scores improved from 30.2 preoperatively to 72.3 postoperatively; UCLA scores improved from 12.9 to 26.5; SST scores improved from 2.4 to 7.3. Range of motion improved significantly: forward flexion, abduction, external rotation and internal rotation were, respectively, $110.8({\pm}39.3)^{\circ}$, $107.7({\pm}40)^{\circ}$, $22.5({\pm}17.6)^{\circ}$ and L5 level preoperatively; postoperatively they were $153.6({\pm}20.6)^{\circ}$, $152.1({\pm}20.8)^{\circ}$, $36.4({\pm}22.7)^{\circ}$ and L1 level. Age, the presence of Bankart lesions and the number of dislocations were not correlated with clinical outcomes. But the size of the cuff tear was correlated with clinical results. Also, the duration from dislocation to surgery was correlated with postoperative UCLA and SST scores (p=0.039, p=0.038). Conclusion: For shoulder dislocation, it is important to achieve early diagnoses of rotator cuff tears in middle-aged and elderly patients. If these injuries are both present, early rotator cuff repair should be performed for better clinical results.

Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Corner with a Fresh Frozen Achilles Tendon Allograft (한 개의 신선동결 동종아킬레스건을 이용한 후방십자인대 및 후외방구조의 동시 재건술)

  • Kyung, Hee-Soo;Oh, Chang-Wug;Lee, Hyun-Joo;Ihn, Joo-Chul
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.8 no.2
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    • pp.102-108
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    • 2009
  • Purpose: The purpose of this study is to report a result of the technique that reconstruct posterior cruciate ligament (PCL) and posterolateral corner (PLC) simultaneously using a fresh-frozen Achilles tendon allograft. Materials and Methods: Forty two patients (45 legs) underwent PCL and PLC reconstruction were included. There were 38 males and 4 females. Mean age was 39 years. Used graft was a fresh frozen Achilles tendon allograft, which was divided by two size, larger one (${\emptyset}$ 10 mm) for PCL reconstruction and smaller one (${\emptyset}$ 8 mm) for PLC reconstruction. Arthroscopic reconstruction of the PCL was performed using transtibial, single incision, and single bundle technique with 10mm fresh frozen Achilles allograft tendon first. After PCL reconstruction, reconstruction procedure for posterolateral instability was performed using modified figure of "8" technique using smaller gtaft. For clinical evaluation, range of motion, posterior drawer test, varus stress test, prone external rotation (dial) test, Lysholm score, Tegner activity scale and posterior stress radiograph were used. Mean follow up period was 25 months. Results: Preoperatively posterior drawer test was 5 cases in grade II and 40 cases in grade III posterior instability. At final follow-up 22 cases returned within normal condition, 18 cases grade I and 5 cases grade II posterior instability. Though all patients showed positive result over 10 degrees in dial and varus stress test preoperatively, but only 9 cases showed positive both test at final follow-up. The range of motion deficit over $10^{\circ}$ flexion was 3 cases. Lysholm score was improved from mean 50 preoperatively to mean 83(p<0.05) and Tegner activity scale improved from mean 2.1 preoperatively to mean 4.6(p<0.05). In posterior stress radiographs, posterior displacement was improve from mean 16mm preoperatively to 4.1mm after treatment(p<0.05). All patients had improved compared to their pre-operative status as measured by physical examination such as posterior drawer test, varus stress test, dial test. Conclusion: We had successful results by combined reconstruction of the PCL & PLC with a fresh frozen Achilles tendon allograft in patients with PCL and posterolateral rotatory instability at a time.

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THE CURRENT STATUS OF BIOMEDICAL ENGINEERING IN THE USA

  • Webster, John G.
    • Proceedings of the KOSOMBE Conference
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    • v.1992 no.05
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    • pp.27-47
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    • 1992
  • Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

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Recognition and Enforcement of Foreign Arbitral Awards in Korea (한국에서의 외국중재판정의 승인과 집행)

  • Kim, Sang-Ho
    • Journal of Arbitration Studies
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    • v.17 no.3
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    • pp.3-30
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    • 2007
  • The New York Convention(formally called "United Nations Convention on the Recognition and Enforcement of Foreign Arbitral Awards") done in New York on June 10, 1958 has been adhered to by more than 140 States at the time of this writing, including almost all important trading nations from the Capitalist and Socialist World as well as many developing countries. The Convention can be considered as the most important Convention in the field of arbitration and as the cornerstone of current international commercial arbitration. Korea has acceded to the New York Convention since 1973. When acceding to the Convention, Korea declared that it will apply the Convention to the recognition and enforcement of awards made only in the territory of another Contracting State on the basis of reciprocity. Also, Korea declared that it will apply the Convention only to differences arising out of legal relationships, whether contractual or not, which are considered as commercial under the national law of Korea. The provisions relating to the enforcement of arbitral awards falling under the New York Convention begin at Article III. The Article III contains the general obligation for the Contracting States to recognize Convention awards as binding and to enforce them in accordance with their rules of procedure. The Convention requires a minimum of conditions to be fulfilled by the party seeking enforcement. According to Article IV(1), that party has only to supply (1) the duly authenticated original award or a duly certified copy thereof, and (2) the original arbitration agreement or a duly certified copy thereof. In fulfilling these conditions, the party seeking enforcement produces prima facie evidence entitling it to obtain enforcement of the award. It is then up to the other party to prove that enforcement should not be granted on the basis of the grounds for refusal of enforcement enumerated in the subsequent Article V(1). Grounds for refusal of enforcement are stipulated in Article V is divided into two parts. Firstly, listed in the first Para. of Article V are the grounds for refusal of enforcement which are to be asserted and proven by the respondent. Secondly, listed in Para. 2 of Article V, are the grounds on which a court may refuse enforcement on its own motion. These grounds are non-arbitrability of the subject matter and violation of the public policy of the enforcement country. The three main features of the grounds for refusal of enforcement of an award under Article V, which are almost unanimously affirmed by the courts, are the following. Firstly, The grounds for refusal of enforcement mentioned in Article V are exhaustive. No other grounds can be invoked. Secondly, and this feature follows from the first one, the court before which enforcement of the award is sought may not review the merits of the award because a mistake in fact or law by the arbitrators is not included in the list of grounds for refusal of enforcement set forth in Article V. Thirdly, the party against whom enforcement is sought has the burden of proving the existence of one or more of the grounds for refusal of enforcement. The grounds for refusal of enforcement by a court on its own motion, listed in the second Para. of Article V, are non-arbitrability of the subject matter and public policy of the enforcement country. From the court decisions reported so far at home and abroad, it appears that courts accept a violation of public policy in extreme cases only, and frequently justify their decision by distinguishing between domestic and international public policy. The Dec. 31, 1999 amendment to the Arbitration Act of Korea admits the basis for enforcement of foreign arbitral awards rendered under the New York Convention. In Korea, a holder of a foreign arbitral award is obliged to request from the court a judgment ordering enforcement of the award.

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Development of Acquisition and Analysis System of Radar Information for Small Inshore and Coastal Fishing Vessels - Suppression of Radar Clutter by CFAR - (연근해 소형 어선의 레이더 정보 수록 및 해석 시스템 개발 - CFAR에 의한 레이더 잡음 억제 -)

  • 이대재;김광식;신형일;변덕수
    • Journal of the Korean Society of Fisheries and Ocean Technology
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    • v.39 no.4
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    • pp.347-357
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    • 2003
  • This paper describes on the suppression of sea clutter on marine radar display using a cell-averaging CFAR(constant false alarm rate) technique, and on the analysis of radar echo signal data in relation to the estimation of ARPA functions and the detection of the shadow effect in clutter returns. The echo signal was measured using a X -band radar, that is located on the Pukyong National University, with a horizontal beamwidth of $$3.9^{\circ}$$, a vertical beamwidth of $20^{\circ}$, pulsewidth of $0.8 {\mu}s$ and a transmitted peak power of 4 ㎾ The suppression performance of sea clutter was investigated for the probability of false alarm between $l0-^0.25;and; 10^-1.0$. Also the performance of cell averaging CFAR was compared with that of ideal fixed threshold. The motion vectors and trajectory of ships was extracted and the shadow effect in clutter returns was analyzed. The results obtained are summarized as follows;1. The ARPA plotting results and motion vectors for acquired targets extracted by analyzing the echo signal data were displayed on the PC based radar system and the continuous trajectory of ships was tracked in real time. 2. To suppress the sea clutter under noisy environment, a cell averaging CFAR processor having total CFAR window of 47 samples(20+20 reference cells, 3+3 guard cells and the cell under test) was designed. On a particular data set acquired at Suyong Man, Busan, Korea, when the probability of false alarm applied to the designed cell averaging CFAR processor was 10$^{-0}$.75/ the suppression performance of radar clutter was significantly improved. The results obtained suggest that the designed cell averaging CFAR processor was very effective in uniform clutter environments. 3. It is concluded that the cell averaging CF AR may be able to give a considerable improvement in suppression performance of uniform sea clutter compared to the ideal fixed threshold. 4. The effective height of target, that was estimated by analyzing the shadow effect in clutter returns for a number of range bins behind the target as seen from the radar antenna, was approximately 1.2 m and the information for this height can be used to extract the shape parameter of tracked target..

Evaluation on the Accuracy of Targeting Error Correction Through the Application of Target Locating System in Robotic CyberKnife (로봇 사이버나이프에서 위치인식시스템을 이용한 Targeting Error값 보정의 정확성 평가)

  • Jeong, Young-Joon;Jung, Jae-Hong;Lim, Kwang-Chae;Cho, Eun-Ju
    • The Journal of Korean Society for Radiation Therapy
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    • v.21 no.1
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    • pp.1-7
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    • 2009
  • Purpose: The purpose is to evaluate the accuracy of correcting the targeting error through the Target Location System (TLS) for the location change error of the reference point which arises from the movement or motion of patient during the treatment using the CyberKnife. Materials and Methods: In this test, Gafchromic MD-55 film was inserted into the head and neck phantom to analyze the accuracy of the targeting, and then the 6 MV X-ray of CyberKnife (CyberKnife Robotic Radiosurgery System G4, Accuray, US) was irradiated. End to End (E2E) program was used to analyze the accuracy of targeting, which is provided by Accuray Corporation. To compute the error of the targeting, the test was carried out with the films that were irradiated 12 times by maintaining the distance within the rage of $0{\pm}0.2\;mm$ toward x, y, z from the reference point and maintaining the angle within the rage of $0{\pm}0.2^{\circ}$ toward roll, pitch, yaw, and then with the films which were irradiated 6 times by applying intentional movement. And the correlation in the average value of the reference film and the test film were analyzed through independent samples t-test. In addition, the consistency of dose distribution through gamma-index method (dose difference: 3%) was quantified, compared, and analyzed by varying the distance to agreement (DTA) to 1 mm, 1.5 mm, 2 mm, respectively. Results: E2E test result indicated that the average error of the reference film was 0.405 mm and the standard deviation was 0.069 mm. The average error of the test film was 0.413 mm with the standard deviation of 0.121 mm. The result of independent sampling t-test for both averages showed that the significant probability was P=0.836 (confidence level: 95%). Besides, by comparing the consistency of dose distribution of DTA through 1 mm, 1.5 mm, 2 mm, it was found that the average dose distribution of axial film was 95.04%, 97.56%, 98.13%, respectively in 3,314 locations of the reference film, consistent with the average dose distribution of sagittal film that was 95.47%, 97.68%, 98.47%, respectively. By comparing with the test film, it was found that the average dose distribution of axial film was 96.38%, 97.57%, 98.04%, respectively, at 3,323 locations, consistent with the average dose distribution of sagittal film which was 95.50%, 97.87%, 98.36%, respectively. Conclusion: Robotic CyberKnife traces and complements in real time the error in the location change of the reference point caused by the motion or movement of patient during the treatment and provides the accuracy with the consistency of over 95% dose distribution and the targeting error below 1 mm.

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A Study on Gardening Theories of Li, Yu in 'Xian Qing Ou Ji' (한정우기(閑情偶寄)를 통해 본 이어(李漁)의 조원(造園) 이론)

  • Zhang, Lin;Jung, Woo-Jin;Sung, Jong-Sang
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.36 no.3
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    • pp.137-148
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    • 2018
  • Li Yu's Xian Qing Ou Ji was written during the late Ming and early Qing Dynasty when material culture flourished due to the development of the commercial economy. Xian Qing Ou Ji is considered a retrospective work that reflects the rich material society at that time. This study focuses on his gardening theories through the interpretation and analysis of these two texts of 'Jushibu(居室部)' and 'Zhongzhibu(種植部)' in Xian Qing Ou Ji. The results are summarized as follows. First, he explained the method of garden configuration and orientation according to the topography utilizing the theory of 'suiting one's measures to local conditions(因地制宜)'. He emphasized the detailed understanding of topography as the starting point for all the gardening theories. It stated that he tried to adjust the height of the terrain artificially to create an ideal form of 'anterior high and posterior low(前低後高)'. The successful arrangement of houses, pavilions, rockery and waterways et al. was able to be achieved because of his accurate understanding of topography. Second, 'borrowing scenery(取景在借)' means 'borrowing the outside scenery to the inside'. He applied this theory by 'viewing in motion(動觀)' and 'viewing in repose(靜觀)'. 'Viewing in motion' is seen as a positive methodology for landscape enjoyment. For example, the view through a window changes with movements of the boat, and it can portray thousands of landscape paintings which can be seen through the windows. In the case of 'viewing in repose', the window is regarded as a means of attracting outside garden views to the inside. Third, he emphasized 'the firmness of objects(制體宜堅)', where the design of windows and railings must be considered ahead of others. Fourth, he interpreted the contents of 'the pursuit of novelty(創異標新)'. This generalizes the characteristics of his gardening theory. The contents included 'hall wall(廳壁)', 'variable sun visor(活?)', 'hanging boards and couplets(聯?)' and 'method of supporting vines with bamboo screen(竹屛扶植法)'.

Gait Analysis of a Pediatric-Patient with Femoral Nerve Injury : A Case Study (대퇴신경 손상 환아의 보행분석 : 사례연구)

  • Hwang, S.H.;Park, S.W.;Son, J.S.;Park, J.M.;Kwon, S.J.;Choi, I.S.;Kim, Y.H.
    • Journal of Biomedical Engineering Research
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    • v.32 no.2
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    • pp.165-176
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    • 2011
  • The femoral nerve innervates the quadriceps muscles and its dermatome supplies anteromedial thigh and medial foot. Paralysis of the quadriceps muscles due to the injury of the femoral nerve results in disability of the knee joint extension and loss of sensory of the thigh. A child could walk independently even though he had injured his femoral nerve severely due to the penetrating wound in the medial thigh. We measured and analyzed his gait performance in order to find the mechanisms that enabled him to walk independently. The child was eleven-year-old boy and he could not extend his knee voluntarily at all during a month after the injury. His gait analysis was performed five times (GA1~GA5) for sixteen months. His temporal-spatial parameters were not significantly different after the GA2 or GA3 test, and significant asymmetry was not observed except the single support time in GA1 results. The Lower limb joint angles in affected side had large differences in GA1 compared with the normal normative patterns. There were little knee joint flexion and extension motion during the stance phase in GA1 The maximum ankle plantar/dorsi flexion angles and the maximum knee extension angles were different from the normal values in the sound side. Asymmetries of the joint angles were analyzed by using the peak values. Significant asymmetries were found in GA1with seven parameters (ankle: peak planter flexion angle in stance phase, range of motion; ROM, knee: peak flexion angles during both stance and swing phase, ROM, hip: peak extension angle, ROM) while only two parameters (maximum hip extension angle and ROM of hip joint) had significant differences in GA5. The mid-stance valleys were not observed in both right and left sides of vertical ground reaction force (GRF) in the GA1, GA2. The loading response peak was far larger than the terminal stance peak of vertical ground reaction curve in the affected side of the GA3, GA4, GA5. The measured joint moment curves of the GA1, GA2, GA3 had large deviations and all of kinetic results had differences with the normal patterns. EMG signals described an absence of the rectus femoris muscle activity in the GA1 and GA2 (affected side). The EMG signals were detected in the GA3 and GA4 but their patterns were not normal yet, then their normal patterns were detected in the GA5. Through these following gait analysis of a child who had selective injuries on the knee extensor muscles, we could verify the actual functions of the knee extensor muscles during gait, and we also could observe his recovery and asymmetry with quantitative data during his rehabilitation.

Development and Analysis of COMS AMV Target Tracking Algorithm using Gaussian Cluster Analysis (가우시안 군집분석을 이용한 천리안 위성의 대기운동벡터 표적추적 알고리듬 개발 및 분석)

  • Oh, Yurim;Kim, Jae Hwan;Park, Hyungmin;Baek, Kanghyun
    • Korean Journal of Remote Sensing
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    • v.31 no.6
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    • pp.531-548
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    • 2015
  • Atmospheric Motion Vector (AMV) from satellite images have shown Slow Speed Bias (SSB) in comparison with rawinsonde. The causes of SSB are originated from tracking, selection, and height assignment error, which is known to be the leading error. However, recent works have shown that height assignment error cannot be fully explained the cause of SSB. This paper attempts a new approach to examine the possibility of SSB reduction of COMS AMV by using a new target tracking algorithm. Tracking error can be caused by averaging of various wind patterns within a target and changing of cloud shape in searching process over time. To overcome this problem, Gaussian Mixture Model (GMM) has been adopted to extract the coldest cluster as target since the shape of such target is less subject to transformation. Then, an image filtering scheme is applied to weigh more on the selected coldest pixels than the other, which makes it easy to track the target. When AMV derived from our algorithm with sum of squared distance method and current COMS are compared with rawindsonde, our products show noticeable improvement over COMS products in mean wind speed by an increase of $2.7ms^{-1}$ and SSB reduction by 29%. However, the statistics regarding the bias show negative impact for mid/low level with our algorithm, and the number of vectors are reduced by 40% relative to COMS. Therefore, further study is required to improve accuracy for mid/low level winds and increase the number of AMV vectors.

Arthroscopic Rotator Cuff Repair For Partial Articular-Surface Tendon Avulsion (PASTA) Lesion (회전근 개 관절내 부분 파열 환자의 관절경적 봉합술)

  • Lee, Bong-Gun;Cho, Nam-Su;Park, Keun-Ho;Moon, Seong-Cheol;Rhee, Yong-Girl
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.3
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    • pp.242-248
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    • 2009
  • Purpose: To evaluate the clinical and radiologic results of the arthroscopic rotator cuff repair for partial articular surface tendon avulsion lesion. Materials and Methods: Twelve patients with symptomatic, partial articular surface tendon avulsion underwent arthroscopic rotator cuff repair between Mar. 2006 and Sep. 2008. The mean follow-up period was 18.3 months(12~36 months), and the mean age at the time of surgery was 46.9-year-old(19~64 years). Three cases had underwent rotator cuff repair after conversion to full-thickness tear and nine cases had transtendon repair with preserving bursal side cuff. Results: The mean VAS during motion was 6.2 before treatment and 2.0 at final follow-up (p<0.001). The passive forward flexion improved from $163.3^{\circ}$ preoperatively to $169.8^{\circ}$ postoperatively (p=0.038). The mean UCLA score improved from 18.4 preoperatively to 30.1 with 2 excellent, 8 good and 2 fair results at final follow-up. The mean KSS improved from 61.8 preoperatively to 76.8 at final follow-up. By examining the postoperative MR images of 5 patients, complete healing was observed in all of them. Conclusion: Arthroscopic rotator cuff repair may be an effective procedure for partial articular surface tendon avulsion in pain relief and improvement of the range of motion. If the remaining bursal side cuff fibers are intact, transtendon repair procedure with preserving the intact bursal layer of the tendon can be considered. If the remaining bursal side cuff fibers are friable or little, completion from partial-thickness to full-thickness tears with subsequent cuff repair can be considered.

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