Purpose: Since the coronavirus disease 2019 (COVID-19) pandemic began, new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged, and distinct epidemic waves of COVID-19 have occurred for an extended period. This study aimed to analyze the clinical and epidemiological characteristics of children with COVID-19 from the third wave to the middle of the fourth epidemic wave in Korea. Methods: We retrospectively reviewed the medical records of hospitalized patients aged ≤18 years with laboratory-confirmed COVID-19. The study periods were divided into the third wave (from November 13, 2020 to July 6, 2021) and the fourth wave (from July 7 to October 31, 2021). Results: Ninety-three patients were included in the analysis (33 in the third and 60 in the fourth waves). Compared with the third wave, the median age of patients was significantly older during the fourth wave (6.7 vs. 2.8 years, P=0.014). Household contacts was reported in 60.2% of total patients, similar in both periods (69.7 vs. 55.0%, P=0.190). Eighty-one (87.1%) had symptomatic SARS-CoV-2 infection. Among these, 10 (12.3%) had no respiratory symptoms. Anosmia or ageusia were more commonly observed in the fourth epidemic wave (10.7 vs. 34.0%, P=0.032). Most respiratory illness were upper respiratory tract infections (94.4%, 67/71), 4 had pneumonia. The median cycle threshold values (detection threshold, 40) for RNA-dependent RNA polymerase (RdRp) and envelope (E) genes of SARS-CoV-2 were 21.3 and 19.3, respectively. There was no significant difference in viral load during 2 epidemic waves. Conclusions: There were different characteristics during the two epidemic waves of COVID-19.
In the late Joseon Dynasty, when the bride would ride a palanquin when she went to live with her in-laws, it was a custom to cover the palanquin with tiger skin to ward off misfortunes that may come her way. The higher classes used tiger skin or leopard skin for this purpose, but the common people had to substitute this expensive item with a tiger pattern painted on a blanket. Such blankets were called hotanja, hogu, hoguyok and the like. The term "hotanja" is a pure Korean word. It is not known when the cover for the bridal palanquin was first used, but it was popular from the end of the 19th century and then gradually disappeared. This is due to the introduction of new Western style weddings that eliminated the need for a bridal palanquin. The tiger print blanket was used not only to cover the bride's palanquin but also to cover a table or floor during the wedding ceremony. This study ran a material analysis on nine pieces of tiger print blankets. All of the blanket artifacts examined in this study had an outer cover and a lining made of fabric that used cotton thread for the warp and wool thread for the weft. Two kinds of wool were found in the weft thread in the outer covers: fat-tailed sheep hair from China and goat hair for carpets from the Hebei province, China. Records show that "blankets with painted tiger patterns" were imported from Russia, and the imported blankets were from Russia and China. The outer cover can be categorized into six types, and the lining into three types depending on the weave and direction of the thread twist. The hem facing can be divided into four types. The lining and outer cover use the full width of the fabric, which was woven in wide widths of 135 cm or wider. The tiger pattern on the blanket was made by stenciling. The stencil design of the body and tail of the tiger were placed on a red blanket to be painted in white, and then the background color of the tiger, which is yellow, would be painted over the white, and then black stripes would be added. The pattern of the tiger varies, which shows that the blankets were made by various craftspeople. The pattern of the tiger print blanket is usually of a tiger lying down, but there were tiger print blankets with a tiger standing up. The pattern of the tiger grew smaller over time, and flower patterns were added in the background. Decorative elements were gradually added to the tiger print blanket patterns, but its function as a palanquin cover became lost. By taking the features of tiger print blankets into consideration, it can be assumed that there are imported pieces among the remaining pieces, and were produced in various places because it was popular at that time.
According to the Samguk Yusa, the nine-story wooden pagoda at Hwangnyongsa Temple was built by a Baekje artisan named Abiji in 645. Until the temple was burnt down completely during the Mongol invasion of Korea in 1238, it was the greatest symbol of the spiritual culture of the Korean people at that time and played an important role in the development of Buddhist thought in the country for about 700 years. At present, the only remaining features of Hwangnyongsa Temple, which is now in ruins, are the pagoda's stylobate and several foundation stones. In the past, many researchers made diverse inferences concerning the restoration of the original structure and the overall architecture of the wooden pagoda at Hwangnyongsa Temple, based on written records and excavation data. However, this information, together with the remaining external structure of the pagoda site and the assumption that it was a simple wooden structure, actually suggest that it was a rectangular-shaped nine-story pagoda. It is assumed that such ideas were suggested at a time when there was a lack of relevant data and limited knowledge on the subject, as well as insufficient information about the technical lineage of the wooden pagoda at Hwangnyongsa Temple; therefore, these ideas should be revised in respect of the discovery of new data and an improved level of awareness about the structural features of large ancient Buddhist pagodas. This study focused on the necessity of raising awareness of the lineage and structure of the wooden pagoda at Hwangnyongsa Temple and gaining a broader understanding of the structural system of ancient Buddhist pagodas in East Asia. The study is based on a reanalysis of data about the site of the wooden pagoda obtained through research on the restoration of Hwangnyongsa Temple, which has been ongoing since 2005. It is estimated that the wooden pagoda underwent at least two large-scale repairs between the Unified Silla and Goryeo periods, during which the size of the stylobate and the floor plan were changed and, accordingly, the upper structure was modified to a significant degree. Judging by the features discovered during excavation and investigation, traces relating to the nine-story wooden pagoda built during the Three Kingdoms Period include the earth on which the stylobate was built and the central pillar's supporting stone, which had been reinstalled using the rammed earth technique, as well as other foundation stones and stylobate stone materials that most probably date back to the ninth century or earlier. It seems that the foundation stones and stylobate stone materials were new when the reliquaries were enshrined again in the pagoda after the Unified Silla period, so the first story and upper structure would have been of a markedly different size to those of the original wooden pagoda. In addition, during the Goryeo period, these foundation stones were rearranged, and the cover stone was newly installed; therefore, the pagoda would seem to have undergone significant changes in size and structure compared to previous periods. Consequently, the actual structure of the original wooden pagoda at Hwangnyongsa Temple should be understood in terms of the changes in large Buddhist pagodas built in East Asia at that time, and the technical lineage should start with the large Buddhist pagodas of the Baekje dynasty, which were influenced by the Northern dynasty of China. Furthermore, based on the archeological data obtained from the analysis of the images of the nine-story rock-carved pagoda depicted on the Rock-carved Buddhas in Tapgok Valley at Namsan Mountain in Gyeongju, and the gilt-bronze rail fragments excavated from the lecture hall at the site of Hwangnyongsa Temple, the wooden pagoda would appear to have originally been an octagonal nine-story pagoda with a dual structure, rather than a simple rectangular wooden structure.
Inflammatory process leads to the well-known mucosal damage and therefore a further disturbance of the epithelial barrier function, resulting abnormal intestinal wall function, even further accelerating the inflammatory process[1]. Despite of the records, etiology and pathogenesis of IBD remain rather unclear. There are many studies over the past couple of years have led to great advanced in understanding the inflammatory bowel disease(IBD) and their underlying pathophysiologic mechanisms. From the current understanding, it is likely that chronic inflammation in IBD is due to aggressive cellular immune responses including increased serum concentrations of different cytokines. Therefore, targeted molecules can be specifically eliminated in their expression directly on the transcriptional level. Interesting therapeutic trials are expected against adhesion molecules and pro-inflammatory cytokines such as TNF-
Background: Accurate staging is important to determine treatment modalities and to predict prognosis for the patients with lung cancer. The simple two-stage system of the Veteran's Administration Lung Cancer study Group has been used for staging of small cell lung cancer(SCLC) because treatment usually consists of chemotherapy with or without radiotherapy. However, this system does not accurately reflect segregation of patients into homogenous prognostic groups. Therefore, a variety of new staging system have been proposed as more intensive treatments including either intensive radiotherapy or surgery enter clinical trials. We evaluate the prognostic importance of TNM staging, which has the advantage of providing a uniform detailed classification of tumor spread, in patients with SCLC. Methods: The medical records of 166 patients diagnosed with SCLC between January 1989 and December 1996 were reviewed retrospectively. The influence of TNM stage on survival was analyzed in 147 patients, among 166 patients, who had complete TNM staging data. Results: Three patients were classified in stage I / II, 15 in stage III a, 78 in stage IIIb and 48 in stage IV. Survival rate at 1 and 2 years for these patients were as follows: stage I / II, 75% and 37.5% ; stage IIIa, 46.7% and 25.0% ; stage III b, 34.3% and 11.3% ; and stage IV, 2.6% and 0%. The 2-year survival rates for 84 patients who received chemotherapy(more than 2 cycles) with or without radiotherapy were as follows: stage I / II, 37.5% ; stage rna, 31.3% ; stage IIIb 13.5% ; and stage IV 0%. Overall outcome according to TNM staging was significantly different whether or not received treatment. However, there was no significant difference between stage IIIa and stage IIIb though median survival and 2-year survival rate were higher in stage IIIa than stage IIIb. Conclusion: These results suggest that the TNM staging system may be helpful for predicting the prognosis of patients with SCLC.
As Internet and information technology (IT) continues to develop and evolve, the issue of big data has emerged at the foreground of scholarly and industrial attention. Big data is generally defined as data that exceed the range that can be collected, stored, managed and analyzed by existing conventional information systems and it also refers to the new technologies designed to effectively extract values from such data. With the widespread dissemination of IT systems, continual efforts have been made in various fields of industry such as R&D, manufacturing, and finance to collect and analyze immense quantities of data in order to extract meaningful information and to use this information to solve various problems. Since IT has converged with various industries in many aspects, digital data are now being generated at a remarkably accelerating rate while developments in state-of-the-art technology have led to continual enhancements in system performance. The types of big data that are currently receiving the most attention include information available within companies, such as information on consumer characteristics, information on purchase records, logistics information and log information indicating the usage of products and services by consumers, as well as information accumulated outside companies, such as information on the web search traffic of online users, social network information, and patent information. Among these various types of big data, web searches performed by online users constitute one of the most effective and important sources of information for marketing purposes because consumers search for information on the internet in order to make efficient and rational choices. Recently, Google has provided public access to its information on the web search traffic of online users through a service named Google Trends. Research that uses this web search traffic information to analyze the information search behavior of online users is now receiving much attention in academia and in fields of industry. Studies using web search traffic information can be broadly classified into two fields. The first field consists of empirical demonstrations that show how web search information can be used to forecast social phenomena, the purchasing power of consumers, the outcomes of political elections, etc. The other field focuses on using web search traffic information to observe consumer behavior, identifying the attributes of a product that consumers regard as important or tracking changes on consumers' expectations, for example, but relatively less research has been completed in this field. In particular, to the extent of our knowledge, hardly any studies related to brands have yet attempted to use web search traffic information to analyze the factors that influence consumers' purchasing activities. This study aims to demonstrate that consumers' web search traffic information can be used to derive the relations among brands and the relations between an individual brand and product attributes. When consumers input their search words on the web, they may use a single keyword for the search, but they also often input multiple keywords to seek related information (this is referred to as simultaneous searching). A consumer performs a simultaneous search either to simultaneously compare two product brands to obtain information on their similarities and differences, or to acquire more in-depth information about a specific attribute in a specific brand. Web search traffic information shows that the quantity of simultaneous searches using certain keywords increases when the relation is closer in the consumer's mind and it will be possible to derive the relations between each of the keywords by collecting this relational data and subjecting it to network analysis. Accordingly, this study proposes a method of analyzing how brands are positioned by consumers and what relationships exist between product attributes and an individual brand, using simultaneous search traffic information. It also presents case studies demonstrating the actual application of this method, with a focus on tablets, belonging to innovative product groups.
Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.
This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However,