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Communication & NegotiationAzienda Ospedaliera San Camillo Forlanini Ufficio Governo Clinico 2.
Obiettivo e Strumenti Advocacy HealthCommunication NegotiationIntrodurre il concetto di comunicazione sanitaria, dove nasce, quando nasce e perchè, e degli strumenti o metodi utilizzati nell’ambito della Health Communucation 3.
Health Communication - Deﬁnizione• “L’arte e la tecnica di informare, inﬂuenzare e motivare individui, istituzioni e l’opinione pubblica su importanti tematiche sul tema salute. L’health communication include prevenzione delle malattie, promozione della salute, politiche di benessere, e promuove il business della salute come miglioramento della qualità della vita e la salute dell’individuo nella comunità” - Healthy People 2010• “Area teorica, di ricerca e pratica legata alla comprensione e all’inﬂuenza delle interdipendenze tra la comunicazione (interazione simbolica nella forma di messaggi e signiﬁcati) e credenze, comportamenti e atteggiamenti nell’ambito sanitario.” Cline, R. 2003• “La Health communication è un approccio multiaspetto e multidisciplinare per raggiungere differenti contesti e per condividere le informazioni legate alla salute con l’obiettivo di inﬂuenzare, promuovere e supportare l’individuo, le comunità, le professioni sanitarie, gruppi speciali, politici, e il pubblico per introdurre, adottare, sostenere un comportamento o una pratica o una politica che possa migliorare la salute.” Schiavo, R. 2007 4.
Cosa è la Health Communication?• Comunicazione, nella quale il contenuto è salute• Il modo in cui parliamo, e condividiamo informazioni sulla salute• La combinazione di esperienze e insegnamenti che portano ad adottare dei comportamenti spontanei in tema salute e sanità• Elemento cruciale nella prevenzione delle malattie e nella promozione di campagne di benessere e salute 4 5.
La Health Communication è…• “Where good health promotion and good communication practice meet.” Da: Rootman, I., & Hershﬁeld, L. (1994). “Health Communication Research: Broadening the Scope” Health Communication, 6(1), 69-72.Health Promotion HC Communication 5 6.
L’importanza della Health Communication• Potenziale per ridurre i costi della sanità• Aiuta nelle operazioni di organizzazione sanitaria• Informa il pubblico su benessere e salute• Contribuisce alla scelta di decisione per un cambio di atteggiamento volontario 7.
Healthy People 2010 Capitolo 11: Health Communication• Le 6 aree principali: • Diffusione di Internet • Qualità di siti Internet sulla salute • Health Literacy • Provider-patient communication • Ricerca e valutazione di programmi di HC • Centri di eccellenza in HC 8.
Un pò di storia...• Anni ’70 • ICA-division of health communication • Social marketing campaigns • U.S. academic programs • Federal and private funding 9.
Un pò di storia...• Anni ’80 • Reﬁnement of social marketing campaigns • Academic journals dedicated to health communication issues 10.
Un pò di storia...• Anni ’90 • CDC Ofﬁce of Communication • NCI Health Communication Branch • Increase in health communication journals • MPH health communication courses • MS/PhD programs, specialization in health communication 11.
Un pò di storia...• XXI Secolo... • Health Communication/Health Informatics streams/ concentrations added to MPH programs • Health Communication Units • Health Communication Research Laboratory at the Saint Louis University School of Public Health • NCI Centers of Excellence in Cancer Communication Research • University of Toronto’s The Health Communication Unit • Etc. 12.
Forme di Health CommunicationINTERPERSONALE• Tra chi fornisce assistenza e pazienti - Medici, Infermiere, Farmacisti, Nutrizionisti, etc.MEDIA• Social Marketing - Annunci di servizio pubblico su salute e benessere• Media Advocacy - Supporto sull’importanza della attività ﬁsica (e.g., increase recess time; improve trail safety)• Risk Communication - Etichette di avvertimento su mix di farmaci• Education Entertainment / Interactive Media - messaggi tramite media e internet 13.
I livelli della comunicazione 13 14.
Advocacy Indica linsieme di azioni con cui un soggetto si fa promotore e sostiene attivamente la causa di un altro. Nel campo della salute in particolare, consiste nello sforzo di indirizzare o modiﬁcare le politiche pubbliche e la destinazione di risorse in una direzione favorevole alla salute dei singoli cittadini e della comunità. Il Ciclo dell’Advocacy1- Identiﬁcare il problema:2- Ricerca ed Analisi3- Pianiﬁcare4- Agire5- Valutare e Controllare 15.
Il ciclo dell’Advocacy1- Identiﬁcazione del problema Strumenti:- Chatting e Listening- Semi-structured interviewing (con KOL)- Focus Group- Comunity Mapping- Prioritaze need 16.
Il ciclo dell’Advocacy2- Ricerca ed Analisi (info) Strumenti:- Force Field Analysis (Positive & Negative): Politico, Economico, Sociale, Tecnologico- Timeline of Key Events- Analisi Contestuale (Force+Timeline)- Economic and Political PowerTriangle-Problem tree and why analysis-Assessing Information (bias, usefull...) 17.
Il ciclo dell’Advocacy 3- Pianiﬁcazione Strumenti:- Identiﬁcare il traguardo- S.M.A.R.T.- Stakeholder Analysis e Mapping- Allies & Opponents Matrix- Scegliere il Metodo di Advocacy- Risk Management- Gantt Diagramm- SWOT/BEEM Analysis 18.
C3 Planning ADVOCACY TOOLKIT PRACTICAL ACTION IN ADVOCACY Metodi di AdovocacyAdvocacy methods METHOD EXPLANATION COMMON USE EXAMPLES Networking Building alliances with as For any long-term Meeting other (SECTION C4.2) many people as possible advocacy activity to make community leaders it sustainable Creating a movement for Sharing information via change When you do not have email the skills or strength in Joint conferences numbers Lobbying Speaking directly to the When target is open and Meetings (SECTION C4.3) target to explain in detail will listen to facts and Phone calls the problem and the careful argument proposed solution Briefing document Public meetings Raising awareness Informing people of the When information is Training (SECTION C4.4) situation so that they are hidden Community meetings aware of the issues When issues are complex Church services Often the first step in an To build confidence advocacy process Posters and leaflets Mobilising Closely connected with When policy-maker can Letter writing by public (SECTION C4.5) awareness raising and be swayed by public Marches and rallies media opinion Involves harnessing To show strength of ‘public pressure’ so that feeling as many people as To use strength in possible will contact numbers and decision-makers and call organisation for change Media Using the radio, When you cannot get Radio phone-in (SECTION C4.6) newspapers and direct access to policy Press release to television (owned by makers newspaper others as opposed to To reach those outside using your own media, Briefing a journalist the local area eg: newsletter) 19.
Il ciclo dell’Advocacy 4- Azione Strumenti:- Networkig- Lobbyng- Raising Awareness- Mobilising- Media 20.
Il ciclo dell’Advocacy 5- Valutazione e ControlloC5 Evaluation ADVOCACY TOOLKIT PRACTICAL ACTION IN ADVOCACY Un A basic procedure for evaluation valutazione: TOOL 35semplice metodo di START Did we achieve our objectives?1 NO YES Why not?2 Why?2 Is there more work to do? NO YES What changes need to be made FINISH to the strategy?3 21.
Negotiation - Deﬁnizione È un processo di risoluzione di un conflitto Tra due o più soggetti In cui si cerca di stabilire cosa ognuno dovrebbe dare e ricevere In una transazione specifica finalizzata al raggiungimento di un accordo mutuamente vantaggiosoRubin, Brown, 1975 22.
Negotiation - ProcessoLa negoziazione: il processoPRIMA- deﬁnire SET DI OBIETTIVI min/max- cercare TERRENO COMUNE- VANTAGGI DA ACCORDO- COSTI DA DISACCORDODURANTE- evitare di trasformare ASPETTI RELAZIONALI in obiettivi negoziali- cercare convergenze di interessi/di valori a monte delle posizionidivergenti- cercare soluzioni innovative-costruite per deﬁnire accordi comuni/espliciti realizzabili (evitare accordi apparenti/compromessi)DOPO- trasferire in co-responsabilità accordi/vantaggi comuni- imparare dalle difﬁcoltà incontrate (fare analisi di problema)- controllare/ipotizzare effetti immediati/futuri dell’accordo GESTITO sulrapporto 23.
Il Dilemma del Prigioniero 24.
Il Dilemma del Prigioniero(VonNeumann e Morgenstern 1944)  2 persone, sospettate di aver commesso un grave crimine insieme, vengono arrestate  la polizia non ha sufﬁcienti prove per dimostrare la loro colpevolezza  e quindi può solo incriminarli per reati minori … a meno che uno dei due confessi! 25.
Una PropostaChiusi in celle separate a ciascuno dei due prigionieri viene fatta una proposta: “se confessi il crimine ed accetti di testimoniare contro il tuo compagno, ti libereremo!” 26.
Prospettiva Interessante ma... seentrambi accettano la proposta, si discrediteranno a vicenda agli occhi del giudice, ed incapperanno in una dura condanna; ma non massima (visto che entrambi confessano) se nessuno dei due accetta, la pena sarà molto lieve per entrambi. 27.
Il Problema è plurisoggettivo Prigioniero B Confessa contro il Non parla compagno Pena molto Scarcerazione Pri lieve per per B, massima gi Non parla entrambi pena per A on ier Confessa Scarcerazione Pena o contro il per A, massima piuttosto A compagno pena per B severa per entrambi 28.
Ma la scelta è individuale... Nel 90% dei casi, la strategia che minimizza il rischio risulta essere quella di tradire.si viene scarcerati, nel caso in cui il compagno non confessi a sua volta;si evita la pena massima, nel caso in cui il compagno tradisca. 29.
Case Studies• Female Genital Cutting in Nigeria• Inﬂuenza Aviaria in Egitto• XDR-TB in Sud Africa 30.
identifies and explores health priorities and on the elim then leads inprocess of community-wide hamlet a the Nimbo community “Health is betterhigh: 67.1% of the program focused relatively than wealth”), men and 61.4% of vagina. House State planning and action to achieve This women in the program LGAs reported celebrate at a yam festival. improvements three local government areas (LGAs) in Enugu on About 30 group of women participated in assisted State: Uzo-Uwani, at least one programSouth. After exposure to Isi-Uzo, and Enugu activity. The Most i and meet community needs. WARO experienced F areas becam the formative in identifying their health one year, researchers found that both support for a core groups research health data further showed while the attitudinal Demographic discontinuing FGC in Enugu State and the situation analysis for the on community and behavioral indicators relevant to FGC agents on h priorities, provided information common in th Communit mobilization,Project in Enugu Ndukaka and conducted technical sessions intention notbecame worse or remained stagnant in either to perform FGC on daughters 1999 survey r State, Nigeria increased significantly when compared to a in Enugu. Ebonyi, they improved significantly control themselves FGC* in Nigeria where FGC and other maternal health issues Enugu State a area. For example, the proportion of women that acquired a l were discussed and analyzed. Core group common form them in a r members then developed action plans for the FGC is the collectiveare benefitsto refer to any believed that there term used to FGC and Ebonyi St declined significantly (from 42.1% at baseline actively aga elimination of FGC in their communities with practice that involves the partial removal, total removing the CAC in oth activities that included meeting with traditional to 24.6% at follow-up) in Enugu, while this or total excisio indicator did not change much in Ebonyi leaders and ruling councils to garner their !"#$%&() *&%+&,-%&./%-",#-0&",-&,-"/,,/--/ and II are the In Nigeria l’ FGC è una pratica culturale: si crede dia To learn more contact: support as well as organizing larger community (from 33.9% to 28.4%). Similarly, while .&%1/%2!34/,56$#0-&%78 9:#&,5&%8 health and soc meetingsHelland Anna to discuss the dangers of FGC. The perceived social support for FGC 7-6-&8 6,57$%;&: complications “Who s meno problemi dal punto di vista igienico, oltre ad core group disseminated information learned !"#$"%&())*+,"-%.,//%0123.4++56#"$ discontinuation either declined or stagnated in such trained? as severe #" during the WARO technical sessions through Ebonyi, this perception became more termwillingn complica essere un segno di bellezza Stella Babalola their community and traditional leader widespread in Enugu (see Table 1). The data pregnancy or they’ve l meetings and through health seminars and peer further showed the following improvements in 77!8,0*#"9,:,%"+.())*+," :;%;%/#/23.4++56#"$ Enugu but not in Ebonyi: decreased personal health education sessions. Circa 30 Milioni di donne hanno avuto un FGC, con approval for FGC, increased perceived self- Challengin Activities at the LGA level included the efficacy to resist the pressure to perform FGC, Health Communication Partnership The Ndukaku effetti patologici a lungo e breve termine viewing of Communicating for Change’s ;%:,1%<=#.0:>#5?*0:@/##&;,"$ documentary film, Uncut - Playing with Life, a decline in the belief that FGC is a religious number of fam 8+.##/#)!4;/*+>,%/<.7,0<,")#" obligation, and increased personal advocacy in at community gatherings and conducting 7#&&40*+%<*#0!"#$"%&: that practice F favor of FGC abandonment. Furthermore, the COMM approach to th advocacy visits to traditional leaders. NAWOJ In seguito a programmi di HC, circa il 65% è venuto a AAAB%"?,<!/%+,-84*<,CAD implemented statewide activities, including @%/<*&#",-B%"E/%01FAFDF-G8H data showed the intention not to perform FGC confrontation 5911"3/I$ on daughters increased considerably in Enugu. 73*1&($&,$ dialogue on F regular KLADMNOPQNCDD I,/J newspaper columns, radio call-in shows,conoscenza degli effetti, le donne che non credono più negli In Ebonyi, the situation remained the same as R%SJ KLADMNOPQNFNN andT,;:*<,J forums on FGC. Additional public .<<5JUUVVV63.4++56#"$ educated deci at the baseline (Figure 1). effetti del FGC è sceso dal 41% al 24% activities included anti-FGC discussions at the WQ&%*/J #"1,":23.4++56#"$ !"#$%&( )%*+%,-&-."-&#%$/%0/,1&-."-&234-&2%,&",5&632%,&/,&-.%/*&+3227,/-8&9"03*& 5/4+3,-/,7"-/3,&39&:;<= #8&4-"-%&",5&#8&47*0%8 l t h C o m m u n i c a t i o n P a r t n e r s Hea !"#$%&" *7&8920/6& 83*43"1# 7*3&?%96" ;(/0%3$+< "+%&D90"+ "+%&D3*-/ ,;8&*Female Genital Cutting Commu 31.
MOHP’s 5000+ clinics, outreach workers from an estimated 38 million people—were able to the government and NGOs, and the national recall messages from the campaign. Seventy-eight “Ask, Consult” network of 13,000 private percent of those—nearly 30 million people— pharmacies. e materials are available on the reported taking at least one protective action, CHL website (www.healthcom-egypt.info). including avoiding contact with birds, keeping children and the elderly away from poultry, andon AI. rough these meetings, volunteer RESULTS could recall tw washing their hands and utensils more carefully committees were to screen allMobilization set up to disseminate AI even more like Inﬂuenza Aviaria in Egitto Community the households Knowledge “Your Health, Your Wealth”— health messages, behaviors. Communication for Healthy Living and after preparing poultry. breeding domestic birds, and to facilitate e EHCS 2006 data showed that three Volunteers in CHL’s community programs used national the closing of shops that sold live birds months after the launch of the Egypt Ministry of Health & Population in their villages as per government policy. AI campaign, the vast majority (86%) of An Integrate Pharmacies, existing program structure, including regular the often the front-line health respondents could recall a message from Response TV Spots service community meetings, to mobilize communities is in turn delivery venue for the majority the TV spots and programs. Egypt was in a To learn more contact: of Egyptians, also proved to be a critical helped produce an impressive increase in swiftly and eﬀ In addition to the initial TV spot, CHL source of public information on AI. e knowledge concerning the disease. Eighty Program Ofﬁcer Figure 1: Percentage of respondents that program distributed hundreds of thousands to ninety percent of respondents reported because of the mechanisms es collaborated on the production of three other of AI informational ﬂyers for providers that they had learned about modes of bsaﬁ@jhuccp.org learned about Avian Flu transmission and MOHP and th A seguito del primo caso di TV spots on tutti more speciﬁc messages or H5N1, AI with i maggiori and consumers through the Ask-Consult symptoms from the CHL Campaign pharmacies, and pharmacists received transmission, symptoms in humans, and symptoms in birds of avian inﬂuenza CHL Project, Hopkins Bloo Doug Storey on modes of transmission, hygiene and safe 30,000 informational posters to display on (Figure 1). Health/Centercanali televisivi sono intervenuti per poultry for consumption, safe Associate Director for preparation of spiegare come their storefronts. Programs (CC Communicati Communication Science and handling of live poultry, keeping children safe, 100 Protective Behavior Research dstorey@jhuccp.org proteggersi and promoting a national AI hotline. e AI The Egypt Health Communication Survey 90 84 90e campaign messages also increased the 88 All of thes mobilize their hotline received close to 300,000 calls in the CHL had already scheduled a national practice of protective behaviors against AI. practical comm Percent Seventy-eight percent of respondents who 80 ﬁrst three months. CHL also produced a publicsurvey (the Egypt Health Communication could recall campaign messages reported by CHL unde AI committee, Health Communication Partnership service announcement on AI as a joint activity Survey or and70 for of its 2006 tohealth the reach EHCS) impact May family assess that they had taken at least one action to protect themselves or their family from with represent comunicazione Alam Simsim (the Egyptian versionkeepingcommunicationsurvey to assess program avian ﬂu, compared to 55 percent of with tramite special messages on of augmented the activities. e the reach those who could not recall any campaign national bodie Imponente of Public Health/ based at the Johns Hopkins Bloomberg School Sesame Street), with attività 60 the Ministry o international p Center for Communication Programs of the AI campaign and its impact on messages. Respondents who could recall a divulgative, Media, e materiale stampatoese spots were knowledge of50 protective and of eSymptomsthe following protective behaviors: 111 Market Place Suite 310 children safe from exposure. aired regionally via satellite. transmission and initiation of Mode symptoms, practices. message were signiﬁcantly more likely to report in Symptoms in WHO). Because th Baltimore, Maryland 21202, USA survey used a nationally representative in Egypt indeﬁ Tel: (410) 659-6300 transmission humans poultry diﬀerently, washing their handling birds CHL and its p sample (n=4052) of 15- to 49-year-old cooking utensils more thoroughly, washing Fax: (410) 659-6266 adults in 21 governorates. Type of their hands after handling birds, avoiding knowledge reﬁning and ad Website: http://www.jhuccp.org birds, and keeping children and the elderly plan to identif E-mail:orders@jhuccp.org away from birds (Figure 2). People who that exist or m 86 % della popolazione raggiunta dal messaggio; Figure 2: Protective behaviors reported in past three months, 38 Milioni di persone raggiunte; by number of campaign messages recalled 90Il 78% di queste, circa 30 Milioni di persone, hanno 80 0 messages 1 message 2 or more messages COMMUN Summarizes r 70 from the Healt adottato almeno un metodo di prevenzione 60 51 52 52 and other bilat Percent 50 39 39 41 42 40 35 30 27 30 28 29 27 20 14 16 Based at the of Public Hea 10 Programs. HC for Education 0 Children, the and Tulane Un efu ils ult r bir ly en r bir ct po fte fer y o and Tropical M ar ns m der th ta lly ry ds tly ds g a wi con dif ultr e c te fro el lin ds or u ay & gs o nd an m hed ed eg led p aw kids ha ed h CHL Communication for Healthly Living oid as nd Av W h pt as Ha Ke W Source: MOHP/SIS/CHL Egypt National Health Communication Survey 2006, HCP is supp n=4052 Chi-square (df=4,4048), p<.0001, Controlling for respondent’s education, employment, for I urban/rural residence, age, and whether or not live birds are kept in the household 32.
Il ruolo dei media sulproblema xdr-tb* in sud africa *Estensively drug-resistance tubercolosis 33.
La risposta del OMS sul tema XDR-TB nota del WHO precedente al “meeting di esperti consulenti sulla XDR-TB”in sud Africa TB “virtualmente intrattabili” 34.
XDR-TBI maggiori settimanali Newsweek Sept. 13, 2006 – WHO recently issued a warning that deadly new strains of tuberculosis appear to be spreading around the globe… HIV sufferers are particularly vulnerable because of their weakened immune systems. TB, already the world’s fourth most fatal infectious disease, could wreak havoc with AIDS treatment programs 35.
XDR-TBI maggiori settimanali 36.
XDR-TB...e le maggiori testate africane: New TB strain in SA: No time to wait 07 September 2006 The extreme drug-resistant tuberculosis (XDR-TB) in KwaZulu-Natal must be dealt with urgently, international health experts said in Johannesburg on Thursday. "There is no time to wait before we embark on decisive action," said the World Health Organisations Dr Ernesto Jaramillo, explaining that an epidemic could have a deadly impact. 37.
XDR-TBtestate internazionali: 38.
XDR-TB Titoli in Testate Internazionali:Deadly TB strain spreading across globe Africa: "Extreme" TB Bug Prompts Calls for Rapid Action Experts call for urgent steps to battle virulent TB strain South Africa: Action plan developed to combat drug resistant TB WHO urges South Africa to curb TB killer super-bug Global alert over deadly new TB strains TB strain with extreme resistance to drugs creates nightmare scenario TB experts will grapple with deadly new strains: WHO 39.
XDR-TB New York Times & Int. Herald Tribune EXTREME TUBERCULOSIS SEPTEMBER 14, 2006 TB is outrunning us. In the last few months, 53 patients in the South African province of KwaZulu-Natal were found to have a form of thedisease resistant to enough existing drugs that it is virtually incurable. All but one of those patients have died… Stinginess created this problem. Generosity is needed to fix it. 40.
!"#$%&#()*%+,-% xdr-tb in africa !"#$%&#()*%+,-% In numero di messaggi e campagne è aumentato )"#""" ("#"""!"#$"%&"()**+ negli ultimi anni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urtroppo il problema rimane tutt’ora critico... 41.
Grazie dell’attenzione 42.
Risorse di Health Communication• WHO Internet Site: http://www.who.int/management/general/communication/en/ index.html• Journal of Health Communication: http://www.gwu.edu/~cih/journal/• http://www.action.org/ 43.
In Italia... 44.
Ministero salute - Novartis• acquisto diretto di 24 milioni di dosi di vaccino. Costo: 184 milioni di euro, iva inclusa.• art. 1: vengono definiti i cosiddetti "sforzi commercialmente ragionevoli" attorno ai quali ruota lintero contratto; Novartis è sì obbligata a produrre e a rispettare il contratto ma solo fino a quando ciò sia "ragionevole". Se ci riesce bene; altrimenti lo Stato paga ugualmente:• art. 2.2 e 2.7: Il ministero riconosce di non acquisire alcun diritto sui marchi commerciali e Novartis non concede alcuna licenza sui diritti di proprietà intellettuale; il ministero non è altresì autorizzato ad apportare modifiche alla confezione né a oscurare marchi su di essa;• art. 3.3: qualora il ministero si trovi nellimpossibilità a ritirare il prodotto Novartis potrà rivenderlo ad altri clienti o fatturare al ministero quanto non ritirato, con la possibilità di rivenderlo comunque dopo 90 giorni;• rt. 4.2, 4.3, 4.5: la responsabilità di Novartis è limitata al difetto di fabbricazione: escluso il danno di altro tipo derivante dalla semplice assunzione del vaccino;• rt. 4.6: il ministero è tenuto a indennizzare Novartis in conseguenza di danni provocati dal vaccino, salvo ove tali danni siano provocati da un difetto di fabbricazione;• art. 5.2 e 5.5: il prezzo per ciascuna dose di vaccino è pari a 7 euro. Totale: 168 milioni di euro più iva. Il ministero dovrà pagare entro 60 giorni dallemissione della fattura, su un conto corrente del Monte dei Paschi di Siena;• art. 8.3: le cause di "forza maggiore" che limitano le responsabilità di Novartis vengono estese a situazioni che dovrebbero invece essere garantite da Novartis, come "epidemie e pandemie", "atti di qualsiasi autorità pubblica", "atti di enti sopranazionali (ivi compreso lOms");• art. 9.3: nel caso in cui il vaccino non sia consegnato per mancato ottenimento dellautorizzazzione allimmisione al commercio e/o di prove cliniche positive, il ministero riconosce forfettariamente a Novartis a titolo di partecipazione ai costi la cifra (al netto dellIva) di 24 milioni di euro;• art. 10.1: le parti si impegnano a mantenere assoluto riserbo sulle informazioni riservate; Recommended
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