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Wednesday, October 15, 2008

At least 10% of the increase in Medicare expenditures since the mid-1990s is due to increased rates of one type of elective surgery, according to a recent study, and many of the patients may not need it. University of California, San Francisco found that only 44% of patients who undergo an elective cardiac surgery called angioplasty get the recommended test to determine whether the procedure is appropriate.

As a result, patients may be receiving a procedure that they either do not need or for which the risk outweighs the benefit. The operation opens partially clogged arteries in patients with heart disease and the annual rate of elective angioplasties has tripled in the United States during the last decade.

Angioplasties are currently being performed at a rate of over 800,000 per year in the U.S. The average cost was $44,110 per procedure in 2004. Since the operation tends to be performed on older Americans, Medicare covers most patients and compensates US$10,000 to $15,000 for each case.

Reuters reporter Julie Steenhuysen writes that angioplasty is “big business for medical device makers including Boston Scientific Corp, Medtronic Inc, Abbott Laboratories Inc and Johnson & Johnson”. Dr. Raymond Gibbons, a professor of medicine who specializes in cardiology at the Mayo Clinic in Rochester, Minnesota, criticizes the current U.S. health care system for compensating doctors based upon procedures performed rather than for following recommended practices.

A stress test in which the patient walks on a treadmill is recommended to determine whether a partial obstruction impairs heart function. Although not all patients who need angioplasty are strong enough to undergo the stress test, UC San Francisco researchers were surprised that testing preceded so few of the surgeries.

Professor of medicine Dr. Rita F. Redberg told U.S. News and World Report, “We didn’t expect to find 100 percent, but we expected a much higher percentage than 44”. Dr. Redberg co-authored a report on the findings for the Journal of the American Medical Association this month.

Dr. Grace Lin, another co-author of the study, noted: “What really matters is whether or not that blockage is affecting blood flow to the heart. That is why the stress test is important.” Their research analyzed over 23,000 Medicare cases and over 1,600 commercial insurance cases.

American Heart Association president Timothy Gardner called the study “a good wake-up call” to remind medical doctors to make sure they do not perform unnecessary procedures. Dr. Gardner regards the study as evidence that many unnecessary angioplasties are being performed.

The study found great variation in the rate of stress testing. Geographic areas ranged from 22% to 76% with the highest rate of testing in the Northeastern and Midwestern states. Testing rates also varied by gender, with men more likely to receive a stress test than women, and by other factors including the age of the physician. Dr. Gibbons points to some of these variances as indications that some physicians may be performing angioplasties indiscriminately.

Not all physicians agree. Although the various types of stress testing usually cost a few hundred dollars instead of tens of thousands, the chief cardiologist at University of Wisconsin Hospital and Clinics Dr. Matthew Wolff notes that stress tests yield false negative results in about 10% of cases. In his opinion, doctors who rely on stress tests “are going to be missing people with severe disease.” Although he agrees that some angioplasties are unnecessary, he contends that the new study does not offer a solution to the dilemma.

The American College of Cardiology plans to release new guidelines soon to help doctors determine when a stress test is appropriate, yet the payment system lacks a financial incentive to abide by testing guidelines. Dr. Eric Topol of Scripps Translational Science Institute in La Jolla, California noted the underuse of stress tests in a study of private insurance records 14 years ago. Dr. Topol agrees that testing guidelines “should be much more clear-cut”, and adds that stress tests ought to be performed annually. “You can do a stress test every year to be sure things are normal. That is an important baseline that is being ignored all too frequently.”

Cardiologist, Dr. Anthony DeFranco of Aurora St. Luke’s Medical Center, considers stress testing to be appropriate in at most 65% of cases, since a substantial minority of patients have other health problems that prevent them from undergoing the test.

Thursday, September 15, 2005

Among its many ongoing research studies, the Natural Resources Conservation Service (NRCS) National Plant Materials Center (NPMC), in Beltsville, Maryland, is researching native, ornamental, perennial plants which are tolerant of hot, droughty conditions. The end result of this research is to promote city gardening in the Washington/Baltimore metro area and to eventually expand to the entire mid-Atlantic region.

“The use of native plants are beneficial to the region in that they are already adapted to the cultural conditions present in city environments and are unlikely to displace other native-plant communities,” said Shawn Belt, Horticulturalist at the NPMC. “And, not only do these native plants add to the diversity of inner-city plant materials they encourage wildlife as well.”

Working with NRCS conservationists for Washington, DC, the NPMC has recently installed a “butterfly garden” a native-plant garden at the Myrtilla Miner Elementary School in NE Washington DC. According to Belt, Washington, DC typically has poor soils so this site will be a good evaluation for hot, dry conditions.

“Since there are no farms in DC to award contracts for the various NRCS cost share programs, NRCS does award cost share for schools in order to educate students to the benefits of using native plants in city landscapes,” said Belt.

NRCS conservationists have been encouraging teachers to install butterfly gardens with cost-share money from the Environmental Quality Incentives Programs (EQIP) to help with the costs of installing these gardens.

While working with the school to install the native-plant garden, NRCS employees will evaluate the performance of the plants over the next 3 years. Additionally, evaluations will be continued in other areas of Washington, DC in order to replicate the “experiment” in differing locations.

Wednesday, December 27, 2006

At least 68 different pieces of luggage has been found behind a pet store inside a garbage dumpster in Houston, Texas. The luggage came from several different international flights and authorities do not know how they got there or if the contents of the luggage have been stolen.

“We’re going to be investigating and the authorities are going to be investigating,” said spokeswoman for Continental Airlines, Mary Clark. All luggage was handed over to Continental Airlines.

The luggage is reported to have been sifted through, and most pieces have come from all over the world. The luggage is reported to have come from Bush Intercontinental Airport. Some pieces of the luggage have name tags and Clark states that “we’re trying to reach whoever we need to let them know the bags are there.”

Officers with the Houston Police Department are in charge of the investigation. The luggage was found by individuals who own the pet store.

The FBI has stated that the bags do not pose any danger.

Sunday, May 18, 2008

A man who hijacked a domestic flight over Afghanistan has been found to be working for British Airways.

34-year-old Nazamuddin Mohammidy was one of nine men who forced the Ariana Airlines airliner to divert to the United Kingdom’s Stansted Airport in 2000. A standoff followed for the next 70 hours with the men, who had guns and hand grenades, threatening to kill all 160 on board unless asylum was granted to them. The men ultimately gave themselves up to police and SAS.

Mohammidy was jailed for 30 months but he and the other eight had their convictions overturned by the Court of Appeal, claiming the Taliban was subjecting them to “medieval and brutal tyranny” forcing them to flee. They went on to win a High Court case to prevent their deportation.

It has since emerged that British Airways have employed Mohammidy to clean their offices, including a training center one mile from Terminal 4 at Heathrow Airport. It came to light when police officers stopped him near Terminal 5 believing he may be an unlicensed taxi driver, but he was able to suppply a worker’s pass. He is now facing unrelated charges concerning an alleged assault on his landlord.

The Conservatives have used this as an opportunity to attack the current Labour government. Shadow home secretary David Davis said “It would be an outrageous and potentially devastating breach of security if a former hijacker had access to British Airways property near the airport and a pass allowing him access to secure areas. Days after it was revealed that foreign airside workers at our airports do not have to pass proper security checks it is clear the Government do not have a grip on airport security.”

British Airways say he did not have a pass to allow him onto the tarmac at Heathrow and did not work inside the airport, but he could get into some secure company areas.

Thursday, April 24, 2008

In a unanimous 95-0 vote Thursday, the United States Senate passed a bill that would forbid employers and health insurance companies from discriminating against someone based on information learned through genetic testing.

The Genetic Information Nondiscrimination Act, described by Massachusetts Senator Ted Kennedy as “the first major new civil rights bill of the new century,” will now be sent back to the House of Representatives, where it could be approved as early as next week. President George W. Bush, who would have to sign the bill for it to become law, has voiced his support for the legislation.

The bill forbids employers from firing, refusing to hire, or otherwise discriminating against employees based on genetic information, such as a family history of a hereditary disease. It also makes it illegal for employers to request genetic information of an employee or the employee’s family.

Health insurance companies are also addressed in the bill, which forbids them from requesting genetic information or using such information to set premium rates or determine enrollment eligibility. However, insurance companies would still have the right to base one’s health coverage on the actual presence of a genetic disease.

“For the first time we act to prevent discrimination before it has taken firm hold and that’s why this legislation is unique and groundbreaking,” said Maine Senator Olympia Snowe, who sponsored the bill along with Sen. Kennedy and Sen. Mike Enzi. Snowe fears the threat of discrimination may discourage people from undergoing genetic testing, which can help to diagnose a wide range of diseases and lead to lifesaving therapy.

Kathy Hudson, director of the Genetics and Public Policy Center, reports that 92 percent are worried that information gained in genetic testing may be used against them. “After a very long wait,” she says, “Americans can now be confident that their genetic information cannot be used by health insurers or employers in harmful or hurtful ways.”

One part of the bill addresses this concern. “Federal legislation establishing a national and uniform basic standard is necessary to fully protect the public from discrimination and allay their concerns about the potential for discrimination,” the bill reads, “thereby allowing individuals to take advantage of genetic testing, technologies, research, and new therapies.”

Oklahoma Senator Tom Coburn initially blocked Senate action on the bill, warning that it could potentially lead to excessive lawsuits against employers and insurers. But after changes were made to the bill to ease his concerns earlier this week, he supported the legislation and allowed the Senate to vote on it. “We certainly improved the bill from a liability standpoint,” said Coburn, an obstetrician.

Similar bills were unanimously passed by the Senate in 2003 and 2005, but in both years the bill stalled in the House. The current bill was passed in the House of Representatives a year ago by a 420-3 vote. A genetic nondiscrimination bill was first introduced 13 years ago by New York Representatives Louise Slaughter, who says the House will “get it out to the White House as quickly as we can.”

Wednesday, January 13, 2010

A massive earthquake, registering 7.0 on the moment magnitude scale, struck Haiti yesterday, destroying many buildings, disrupting communications, and burying an unknown number of people underneath rubble. Thousands of people are feared to have been killed by the tremors, which were felt as far away as Venezuela.

Witnesses say bodies were lining the streets of the capital, Port-au-Prince, after the quake struck on Tuesday afternoon, sending a cloud of dust from falling buildings into the sky. The quake was centered about sixteen kilometers from the capital, and struck at a depth of just ten kilometers, exacerbating the damage. At least 27 aftershocks were also recorded, the strongest of which came in at 5.5 and 5.9 magnitude. A tsunami alert was initially issued following the tremor, but it was retracted shortly afterwards.

Buildings across the capital have collapsed, including the presidential palace and the headquarters of the United Nations peacekeeping mission in Haiti. However, the president, René Préval, and his wife reportedly survived the collapse of the building. The country’s envoy to the United States believed damage costs could reach billions of dollars.

UN peacekeeping chief Alain Le Roy said many people were in the UN building when it went down and they remain unaccounted for. A Brazilian military official later said four Brazilian soldiers who were part of the UN mission were killed.

UN Peacekeeping Chief Alain LeRoy said the organisation is working to learn the fate of its personnel. “As we speak there are still over 100 people unaccounted for under the rubble. We do not know about their fate […] some people have been extracted out of the building – but only less than 10 for the time being. Some dead, some alive. So we do not know for the time being the fate of the others. But of course, we are extremely, extremely concerned.”

The Notre Dame of the Assumption Cathedral in Port-au-Prince was also destroyed, killing Joseph Serge Miot, the Archbishop of Port-au-Prince.

“[…] It would appear that all those who were in the building, including my friend [UN mission head] Hedi Annabi […] and all those who were with him and around him are dead,” said French Foreign Minister Bernard Kouchner. In a statement released yesterday, the UN remarked that “[f]or the moment, a large number of personnel remain unaccounted for.”

Hospitals in Port-au-Prince were reported to have collapsed, raising fears that the injured would not be able to receive treatment easily. “We have reports of some of the most important hospitals in Port-au-Prince have been severely impacted by the earthquake,” said Paul Conneally, the Head of Media for the International Federation of Red Cross and Red Crescent Societies.

“I saw dead bodies, people are screaming, they are on the street panicking, people are hurt. There are a lot of wounded, broken heads, broken arms,” recounted Raphaelle Chenet, the administrator of the Mercy and Sharing charity, in a telephone interview with the Wall Street Journal from the Haitian capital.

UN officials reported that communications and power are out across the city, making it difficult to get accurate details regarding the full extent of casualties and damage.

The UN also noted that the main prison in Port-au-Prince collapsed, and there were reports of inmates escaping. Spokeswoman Elisabeth Byrs, however, said she had no further details about that.

Efstathios Daras, the Greek ambassador to Venezuela who also represents Greece in Haiti, described the situation. “We fear major loss of life, maybe in the thousands or tens of thousands. Survivors are using their hands to help get trapped people out. There are fears of big aftershocks which could make the situation even worse. There is huge damage to the infrastructure. We can’t get through anymore. All phone lines are down.”

Joseph Guyler Delva, a reporter for Reuters, was in the area when the tremors struck. “Everything started shaking, people were screaming, houses started collapsing. It’s total chaos.”

Rachmani Domersant, an employee for Food for the Poor charity described the conditions on Port-au-Prince’s streets. “The whole city is in darkness, you have thousands of people sitting in the streets, with nowhere to go. I’ve seen seven to eight buildings, from office buildings to hotels and shopping stores, collapsed […] I think hundreds of casualties would be a serious understatement.”

President Rene Preval told the Miami Herald today that the aftermath of the disaster was “unimaginable”. “Parliament has collapsed. The tax office has collapsed. Schools have collapsed. Hospitals have collapsed […] There are a lot of schools that have a lot of dead people in them,” he said, adding that he believes thousands of people died.

The Red Cross in Geneva says that up to 3 million people have been affected. The international aid agency added that there is an urgent need for search and rescue volunteers as well as field hospitals, emergency health, water purification and telecommunications.

The World Food Program (WFP), which has a large staff on the ground, says the level of destruction indicates many of these people have been affected and will require help. The Director of the WFP office in Geneva, Charles Vincent, remarked that the first priority is to save lives. “To rescue people that are buried, that are trapped, etc. […] followed very rapidly by a big problem of water, sanitation, epidemic-problems of diseases that might be bred in that kind of situation,” he noted.

The Haitian ambassador to the United States, Raymond Joseph, told CNN the Caribbean nation is seeking US assistance, and called the quake a catastrophe of major proportions. “I’m quite sure we’re going to face a disaster of major proportion,” he said.

Separately, the Inter-American Development Bank said it will immediately approve a $200,000 grant for emergency assistance to Haiti. The funds will be used to provide food, water, medicine and temporary shelter for victims of the massive quake.

The US Agency for International Development is dispatching a disaster assistance response team to Haiti and commented that it will continue to provide additional support as needed.

The UN, meanwhile, dispatched approximately 37 search and rescue teams to assist Haitians from a global network. UN General Secretary Ban Ki-moon said that US$10 million worth of emergency funds would be used. “I have spoken with Mr. Clinton and we have agreed to mobilize our best assistance and rescue teams and try to reconstruct the Haitian economy. The UN will do whatever possible to help the Haitian people to overcome these difficulties,” Ban stated.

Ban noted that 3,000 UN peacekeepers were in Haiti, and that they secured the seaport and airport. They are trying to rescue people buried underneath rubble, he said, but were severely hampered by lack of heavy equipment. “Brazilian forces have been working through the night to rescue but because of the darkness and destruction of infrastructure not much progress has been made. We hope it will be better this morning,” Ban said.

The aid group Oxfam added that its emergency response team for Latin America is based in Haiti and is well prepared, with a public health, water and sanitation team in Port-au-Prince. Oxfam says it is preparing to send in emergency supplies as soon as possible from Panama.

The American Red Cross pledged US$500,000 to help the country, and would send out people to assess damage. “As with most earthquakes, we expect to see immediate needs for food, water, temporary shelter, medical services and emotional support,” it said yesterday evening in a statement.

A number of other nations, including the UK and Venezuela, are also planning to send aid.

A reporter for the Al Jazeera news agency, however, said there might be difficulties delivering aid. “We are about 300km from the epicentre of the earthquake, and we know that the UN agencies and the humanitarian groups here are trying to get together some kind of strategy to get aid over to Haiti. We know that there are trucks loaded with supplies ready to go but the difficulty is that no-one really knows how to get that aid to the people [effectively].”

This quake is said to have been the strongest in Haiti in over two hundred years; the last time an earthquake of comparable magnitude was recorded was in 1770.

Haiti is the Western Hemisphere’s poorest country. Recent development efforts have suffered severe setbacks because of political violence, crime, corruption and natural disasters. Seventy percent of the population lives on the equivalent of less than US$2 per day.

Thursday, December 20, 2007

Wikinews reporter David Shankbone is currently, courtesy of the Israeli government and friends, visiting Israel. This is a first-hand account of his experiences and may — as a result — not fully comply with Wikinews’ neutrality policy. Please note this is a journalism experiment for Wikinews and put constructive criticism on the collaboration page.

Dr. Yossi Vardi is known as Israel’s ‘Father of the Entrepreneur’, and he has many children in the form of technology companies he has helped to incubate in Tel Aviv‘s booming Internet sector. At the offices of Superna, one such company, he introduced a whirlwind of presentations from his baby incubators to a group of journalists. What stuck most in my head was when Vardi said, “What is important is not the technology, but the talent.” Perhaps because he repeated this after each young Internet entrepreneur showed us his or her latest creation under Vardi’s tutelage. I had a sense of déjà vu from this mantra. A casual reader of the newspapers during the Dot.com boom will remember a glut of stories that could be called “The Rise of the Failure”; people whose technology companies had collapsed were suddenly hot commodities to start up new companies. This seemingly paradoxical thinking was talked about as new back then; but even Thomas Edison—the Father of Invention—is oft-quoted for saying, “I have not failed. I have just found ten thousand ways that won’t work.”

Vardi’s focus on encouraging his brood of talent regardless of the practicalities stuck out to me because of a recent pair of “dueling studies” The New York Times has printed. These are the sort of studies that confuse parents on how to raise their kids. The first, by Carol Dweck at Stanford University, came to the conclusion that children who are not praised for their efforts, regardless of the outcome’s success, rarely attempt more challenging and complex pursuits. According to Dweck’s study, when a child knows that they will receive praise for being right instead of for tackling difficult problems, even if they fail, they will simply elect to take on easy tasks in which they are assured of finding the solution.

Only one month earlier the Times produced another story for parents to agonize over, this time based on a study from the Brookings Institution, entitled “Are Kids Getting Too Much Praise?” Unlike Dweck’s clinical study, Brookings drew conclusions from statistical data that could be influenced by a variety of factors (since there was no clinical control). The study found American kids are far more confident that they have done well than their Korean counterparts, even when the inverse is true. The Times adds in the words of a Harvard faculty psychologist who intoned, “Self-esteem is based on real accomplishments. It’s all about letting kids shine in a realistic way.” But this is not the first time the self-esteem generation’s proponents have been criticized.

Vardi clearly would find himself encouraged by Dweck’s study, though, based upon how often he seemed to ask us to keep our eyes on the people more than the products. That’s not to say he has not found his latest ICQ, though only time—and consumers—will tell.

For a Web 2.User like myself, I was most fascinated by Fixya, a site that, like Wikipedia, exists on the free work of people with knowledge. Fixya is a tech support site where people who are having problems with equipment ask a question and it is answered by registered “experts.” These experts are the equivalent of Wikipedia’s editors: they are self-ordained purveyors of solutions. But instead of solving a mystery of knowledge a reader has in their head, these experts solve a problem related to something you have bought and do not understand. From baby cribs to cellular phones, over 500,000 products are “supported” on Fixya’s website. The Fixya business model relies upon the good will of its experts to want to help other people through the ever-expanding world of consumer appliances. But it is different from Wikipedia in two important ways. First, Fixya is for-profit. The altruistic exchange of information is somewhat dampened by the knowledge that somebody, somewhere, is profiting from whatever you give. Second, with Wikipedia it is very easy for a person to type in a few sentences about a subject on an article about the Toshiba Satellite laptop, but to answer technical problems a person is experiencing seems like a different realm. But is it? “It’s a beautiful thing. People really want to help other people,” said the presenter, who marveled at the community that has already developed on Fixya. “Another difference from Wikipedia is that we have a premium content version of the site.” Their premium site is where they envision making their money. Customers with a problem will assign a dollar amount based upon how badly they need an answer to a question, and the expert-editors of Fixya will share in the payment for the resolved issue. Like Wikipedia, reputation is paramount to Fixya’s experts. Whereas Wikipedia editors are judged by how they are perceived in the Wiki community, the amount of barnstars they receive and by the value of their contributions, Fixya’s customers rate its experts based upon the usefulness of their advice. The site is currently working on offering extended warranties with some manufacturers, although it was not clear how that would work on a site that functioned on the work of any expert.

Another collaborative effort product presented to us was YouFig, which is software designed to allow a group of people to collaborate on work product. This is not a new idea, although may web-based products have generally fallen flat. The idea is that people who are working on a multi-media project can combine efforts to create a final product. They envision their initial market to be academia, but one could see the product stretching to fields such as law, where large litigation projects with high-level of collaboration on both document creation and media presentation; in business, where software aimed at product development has generally not lived up to its promises; and in the science and engineering fields, where multi-media collaboration is quickly becoming not only the norm, but a necessity.

For the popular consumer market, Superna, whose offices hosted our meeting, demonstrated their cost-saving vision for the Smart Home (SH). Current SH systems require a large, expensive server in order to coordinate all the electronic appliances in today’s air-conditioned, lit and entertainment-saturated house. Such coordinating servers can cost upwards of US$5,000, whereas Superna’s software can turn a US$1,000 hand-held tablet PC into household remote control.

There were a few start-ups where Vardi’s fatherly mentoring seemed more at play than long-term practical business modeling. In the hot market of WiFi products, WeFi is software that will allow groups of users, such as friends, share knowledge about the location of free Internet WiFi access, and also provide codes and keys for certain hot spots, with access provided only to the trusted users within a group. The mock-up that was shown to us had a Google Maps-esque city block that had green points to the known hot spots that are available either for free (such as those owned by good Samaritans who do not secure their WiFi access) or for pay, with access information provided for that location. I saw two long-term problems: first, WiMAX, which is able to provide Internet access to people for miles within its range. There is already discussion all over the Internet as to whether this technology will eventually make WiFi obsolete, negating the need to find “hot spots” for a group of friends. Taiwan is already testing an island-wide WiMAX project. The second problem is if good Samaritans are more easily located, instead of just happened-upon, how many will keep their WiFi access free? It has already become more difficult to find people willing to contribute to free Internet. Even in Tel Aviv, and elsewhere, I have come across several secure wireless users who named their network “Fuck Off” in an in-your-face message to freeloaders.

Another child of Vardi’s that the Brookings Institution might say was over-praised for self-esteem but lacking real accomplishment is AtlasCT, although reportedly Nokia offered to pay US$8.1 million for the software, which they turned down. It is again a map-based software that allows user-generated photographs to be uploaded to personalized street maps that they can share with friends, students, colleagues or whomever else wants to view a person’s slideshow from their vacation to Paris (“Dude, go to the icon over Boulevard Montmartre and you’ll see this girl I thought was hot outside the Hard Rock Cafe!”) Aside from the idea that many people probably have little interest in looking at the photo journey of someone they know (“You can see how I traced the steps of Jesus in the Galilee“), it is also easy to imagine Google coming out with its own freeware that would instantly trump this program. Although one can see an e-classroom in architecture employing such software to allow students to take a walking tour through Rome, its desirability may be limited.

Whether Vardi is a smart parent for his encouragement, or in fact propping up laggards, is something only time will tell him as he attempts to bring these products of his children to market. The look of awe that came across each company’s representative whenever he entered the room provided the answer to the question of Who’s your daddy?

Sunday, May 8, 2005

In order to save the lives of seabirds, the government of New Zealand has ordered the recall from sub-Antarctic waters of the entire fleet of New Zealand’s 35 squid fishing boats. Once at port, the boats are to take on independent observers to ensure that they follow codes of practice. Violators of the new rules face a fine of up to NZ$100,000.

Fisheries Minister David Benson-Pope said that “blatant bad behaviour” on the part of the boats, flouting a voluntary code of practice set up a year ago, demanded immediate action.

An Air Force aeroplane was sent on a tour of inspection last month. Benson-Pope reported that observations from the inspection revealed that, contrary to the agreed code of practice:

• 46% of the fishing fleet were not using equipment to scare sea birds away from vessels, with a further 8% only using it intermittently.
• 30% of the fishing fleet were discharging offal (which attracts seabirds) while trawling or hauling nets, with a further 25% doing so intermittently.
• Only 30% of the fishing fleet actually complied with both mitigation and offal management requirements.

Mr Benson-Pope referred to a voluntary code of practice adopted in the tuna fishing industry which he said had reduced death of seabirds by 95%.