scholarly journals Hypnotherapy Effectiveness in Bronchoscopy to Control Anxiety, Breathlessness and Cough

2019 ◽  
Vol 39 (1) ◽  
pp. 21-30
Author(s):  
Teguh Budi Santosa ◽  
Yusup Subagio Sutanto ◽  
Debree Septiawan
Keyword(s):  
Lung Tumor ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Hospital Anxiety ◽  
Control Groups ◽  
Analog Scale ◽  
Group Approach ◽  
Before And After ◽  
Quasi Experimental

Background: Patient’s comfort during bronchoscopy is important, as it affects its success and the whole outcome. The short comings of bronchoscopy with general anesthesia are long procedure, high cost, and its complication in respiratory failure patient’s. Hypnosis in various surgery procedures can reduce anxiety. Hypnosis can also be used as a therapy for shortness of breath and chronic cough. This study aimed to analyze the effectiveness of hypnotherapy in controling anxiety, breathing shortness a cough of patient’s undergoing bronchoscopy. Methods: This research is a clinical trial with a quasi-experimental design using the pretest-posttest control group approach using consecutive sampling was performed in patients with lung tumor undergoing bronchoscopy in dr. Moewardi Hospital from July to August 2018. The study subjects were randomized in to hypnotized and non-hypnotized (control groups). Scores of Hospital Anxiety and Depression Scale (HADS), modified Borg, and cough Visual Analog Scale (VAS) were measured before and after bronchoscopy. Results: Thirtyseven lung tumor patient’s undergoing bronchoscopy were included in our study. The intervention groups showed decreased HADS (6,68+8,28) and different significantly compared to control group (p

scholarly journals Improvement of Anxiety, Coughing, Breathlessness and Pain Control in The Management of Bronchoscopy by Adding Alprazolam

2019 ◽  
Vol 39 (4) ◽  
pp. 245-255
Author(s):  
Yanny Octavia Sally Ride ◽  
Yusup Subagio Sutanto ◽  
Debree Septiawan
Keyword(s):  
Lung Tumor ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Control Group Design ◽  
Before And After ◽  
Post Test ◽  
Vas Scores ◽  
And Control ◽  
Test Control

Background: Anxiolytic premedication can reduce anxiety, improving procedural tolerance, and reduce postbronchoscopic complications. There was ongoing debate about the safety of bronchoscopist-administered sedation. Alprazolam as a surgical premedication can reduce anxiety. Alprazolam can be used as an adjuvant analgesic, to reduce anxiety-related breathlessness, and to reduce coughing as adjuvant antitussive. The study aimed to evaluate the effectiveness of alprazolam in patients undergoing bronchoscopy. Methods: A clinical study with experimental quasi pre-post test control group design, using consecutive sampling was performed in patients with lung tumor undergoing bronchoscopy in dr.Moewardi Hospital from February to March 2019. The study subjects were divided in experimental (alprazolam) and control groups (without alprazolam). The Hospital Anxiety and Depression Scale (HADS), VAS for pain score, modified Borg score, and VAS for cough were measured in baseline, before, and after bronchoscopy. Results: Thirty two lung subjects were included in this study. The intervention groups showed decreased HADS score pre and post bronchoscopy (6.56±2.83 and 6.88±2.63), pain VAS scores (15.00±10.95 and 9.69±11.61), cough VAS score (11.56±8.89 and 27.19±17.89), and these were different significantly compared to control group. We found decreased mean of modified Borg in the study group though they were not significant compared to the control group. Conclusion: Alprazolam controlled anxiety, coughing, and pain in patients undergoing bronchoscopy. Alprazolam minimized breathlessness after bronchoscopy. (J Respir Indo. 2019; 39(4): 245-55)

Benefit to Family Members of Delivering Hand Massage With Essential Oils to Critically Ill Patients

2015 ◽  
Vol 24 (5) ◽  
pp. 446-449 ◽  
Author(s):  
Charlsea Prichard ◽  
Patricia Newcomb
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Essential Oils ◽  
Family Members ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Hospital Anxiety ◽  
Quasi Experimental ◽  
Hand Massage

BackgroundIn intensive care environments, patients’ families are often encouraged to participate in their loved one’s care; however, many family members feel anxious, depressed, and unsure about how to help patients.ObjectivesTo determine (1) the feasibility of teaching family members a simple intervention combining hand massage with essential oils in a trauma intensive care unit and (2) an effect size for use in designing a more powerful trial.MethodA quasi-experimental pilot study of the effect of a family-delivered touch treatment on anxiety and depression of family members of patients. Fifteen family members were assigned to a treatment group, and 15 family members were assigned to a control group. The treatment consisted of the application of hand massage with essential oils for 6 sessions. Each session lasted 5 minutes and was presented twice a day for 3 days.ResultsThe 5-minute intervention was associated with positive change in anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS) among family members visiting patients. The magnitude of change (improvement) in anxiety scores within the group of treated family members was significantly greater than within family members in the control group.ConclusionAdministering a brief hand massage using pleasant-smelling oils to patients in an intensive care unit may reduce anxiety of family members who administer the treatment.

scholarly journals Effectiveness of Sedoanalgesia in Percutaneous Liver Biopsy Premedication

2017 ◽  
Vol 7 (2) ◽  
pp. 146-149 ◽  
Author(s):  
Orhan Sezgin ◽  
Serkan Yaras ◽  
Fehmi Ates ◽  
Engin Altintas ◽  
Bunyamin Saritas
Keyword(s):  
Liver Biopsy ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Percutaneous Liver Biopsy ◽  
Hospital Anxiety ◽  
Analog Scale ◽  
Number Of Patients ◽  
Gender And Age ◽  
Needle Liver Biopsy

ABSTRACT Aim Percutaneous needle liver biopsy (PLB) is frequently associated with pain and anxiety. This may discourage the patients for biopsy, and rebiopsies, if needed. We planned a study to investigate the efficacy of additional analgesia or sedation for PLB. Materials and methods The study has been designed as a single-center, prospective study. The PLB was planned for 18- to 65-year-old consecutive patients who were included in the study. The patients were divided into three premedication groups as control, Meperidine, and Midazolam. Hospital Anxiety and Depression Scale (HADS) was used to measure each subject's anxiety level. Fifteen minutes before the biopsy, 1 mL 0.9% NaCl subcutaneously (sc), 1 mg/kg (max 100 mg) Meperidine sc, or 0.1 mg/kg (max 5 mg) Midazolam intravenously was administered to patients respectively. Then PLB was done with 16 G Menghini needle. The day after, the patients were asked about feelings regarding biopsy. Results Groups were similar by gender and age. The HADS scores prior to PLB and on visual analog scale (VAS, 1—10 points) score during PLB were similar. In the three groups, 7, 12, and 7 patients, respectively, experienced no pain. Other patients explained pain as mild or moderate or severe. The number of patients who agreed for possible rebiopsy was higher in Meperidine and Midazolam groups than in the control group. Conclusion Premedication with Meperidine or Midazolam in PLB would improve patients' tolerance, comfort, and attitude against a possible repeat PLB. How to cite this article Sezgin O, Yaras S, Ates F, Altintas E, Saritas B. Effectiveness of Sedoanalgesia in Percutaneous Liver Biopsy Premedication. Euroasian J Hepato-Gastroenterol 2017;7(2):146-149.

scholarly journals The Effectiveness of Spiritual Intervention in Overcoming Anxiety and Depression Problems in Gynecological Cancer Patients

2021 ◽  
Vol 24 (2) ◽  
pp. 99-109
Author(s):  
Lina Anisa Nasution ◽  
Yati Afiyanti ◽  
Wiwit Kurniawati
Keyword(s):  
Cancer Patients ◽  
Gynecological Cancer ◽  
Intervention Group ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Control Groups ◽  
Quasi Experimental ◽  
The Mean ◽  
Spiritual Intervention

Anxiety and depression are psychological distress that often occurs in gynecological cancer patients. However, there are few studies related to interventions to overcome these problems. The purpose of this study was to determine the effect of a spiritual intervention on anxiety and depression in such cancer patients. The research design was quasi-experimental, employing pretest and posttest on the intervention and the control groups. The total number of respondents was 108 patients, consisting of 54 in each group. The instrument used in the study was the Hospital Anxiety and Depression Scale (HADS). The spiritual intervention consisted of four sessions, namely an introduction and relaxation session, a control session, an identity session, and a relationship and prayer therapy session, held over two weeks. The data analysis showed a change in the mean score of anxiety and depression in the intervention group after the spiritual intervention (p = 0.001). Also, there were differences in the mean scores of anxiety and depression between the intervention and control groups (p = 0.001). The result implies that spiritual intervention can be applied as part of holistic nursing care for cancer patients, especially gynecological ones.Abstrak Efektifitas Intervensi Spiritual dalam Mengatasi Masalah Kecemasan dan Depresi pada Pasien Kanker Ginekologi. Kecemasan dan depresi merupakan gangguan psikologis yang sering terjadi pada pasien kanker ginekologi. Namun, penelitian terkait intervensi dalam mengatasi masalah tersebut belum banyak dilakukan. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh intervensi spiritual terhadap kecemasan dan depresi pada pasien kanker ginekologi. Desain penelitian ini adalah quasi eksperimen menggunakan kelompok intervensi dan kontrol dengan pre-test dan post-test. Jumlah responden sebanyak 108 pasien yang terdiri dari 54 orang di setiap kelompok. Instrumen yang digunakan dalam penelitian ini adalah Hospital Anxiety and Depression Scale (HADS). Intervensi spiritual terdiri dari empat sesi: sesi pengenalan dan relaksasi, sesi kontrol, sesi identitas, dan sesi terapi hubungan dan doa, yang diberikan selama dua minggu. Analisis data menunjukkan adanya perubahan rerata skor kecemasan dan depresi pada kelompok intervensi setelah diberikan intervensi spiritual (p = 0,001). Selain itu, terdapat perbedaan rerata skor kecemasan dan depresi antara kelompok intervensi dan kontrol (p = 0,001). Penelitian ini mengimplikasikan bahwa intervensi spiritual dapat diterapkan sebagai bagian dari asuhan keperawatan holistik pada pasien kanker, terutama yang ginekologi. Kata Kunci: depresi, intervensi spiritual, kanker, kecemasan

scholarly journals PENGARUH BACAAN MUROTTAL AL-QUR’AN YANG DIPERDENGARKAN PADA PASIEN STROKE ISKEMIK AKUT TERHADAP LUARAN KLINIS

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Susi Ifati ◽  
Dodik Tugasworo ◽  
Dwi Pudjonarko
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Hospital Anxiety ◽  
Control Groups ◽  
Chi Square ◽  
Control Group Design ◽  
And Control

    THE EFFECT OF HOLY QUR’AN HEARING ON CLINICAL OUTCOMES IN ACUTE ISCHEMIC STROKEABSTRACTIntroduction: Qur’an recitation has a high spiritual and religious value and effect to Islam believer, and also has beautiful and regular tone, so that it is believed to be useful to cure various diseases. Depression and anxiety are common, and add to worsening outcomes of stroke. There was spiritual correlation between decreased emotional distress and depression associated with poor outcome of stroke. Qur’an recitation could be used as spiritual relaxation technique, thus improve the effect of mental health.Aims: To determine effect of Qur’an recitation audio on anxiety, depression and National Institute of Health Stroke Scale (NIHSS) in acute ischemic stroke in Medical Faculty of Diponegoro University/dr. Kariadi Hospital, Semarang, Central Java Indonesia.Method: This was an intended to treat research with randomized pretest-posttest with control group design. Subjects were acute ischemic stroke patients with onset less than 72 hours, divided into treatment and control groups. Treatment was carried out for 7 days by playing Juz ‘Amma Qur’an recitation through headphone twice a day for 30 minutes at 06.00 am and 06.00 pm. Demographic data, risk factors, and Hospital Anxiety and Depression Scale (HADS) and NIHSS before and after treatment were assessed. The correlation of HADS and NIHSS between treatment and control were analyzed with Chi-square/Fisher test. Multivariate analysis was used to analyzed other factors affecting clinical outcomes.Result: Forty subjects were randomized into treatment or control groups. There was significant correlation between listening Juz ‘Amma Qur’an recitation with improvement of anxiety HADS and NIHSS. There was no correlation with improvement of depression HADS. Logistic regression analysis showed improvement of NIHSS after listening Juz ‘Amma Qur’an recitation.Discussion: Listening to the Qur’an recitation improved anxiety symptoms, improved clinical outcomes by 9.025 times compared to controls in acute ischemic stroke, thus can be considered to support the recovery of stroke patients.Keywords: Acute ischemic stroke, HADS, NIHSS, Qur’an recitationABSTRAKPendahuluan: Bacaan Al-Qur’an memiliki nilai spiritualitas dan religiositas yang tinggi serta memberikan efek ketenangan selain nadanya indah dan teratur, sehingga dapat digunakan untuk penyembuhan berbagai penyakit. Depresi maupun ansietas sering terjadi pada stroke yang menambah perburukan luaran. Terdapat hubungan spiritual pada penurunan ansietas dan depresi yang dihubungkan dengan luaran stroke yang buruk. Bacaan Al-Qur’an dapat digunakan sebagai teknik relaksasi spiritual sehingga didapatkan efek meningkatkan kesehatan mental.Tujuan: Untuk mengetahui pengaruh murottal Al-Qur’an yang diperdengarkan pada pasien stroke iskemik akut terhadap luaran klinis neurologis menggunakan skor National Institute of Health Stroke Scale (NIHSS), gangguan depresi dan ansietas di Fakultas Kedokteran Universitas Diponegoro/RSUP dr. Kariadi, Semarang, Jawa Tengah, Indonesia.Metode: Penelitian ini merupakan penelitian perlakuan randomized pretest-posttest control group design. Subjek adalah pasien stroke iskemik akut awitan kurang 72 jam, dibagi menjadi kelompok perlakuan dan kontrol. Perlakuan dilaksanakan 7 hari dengan memperdengarkan murottal Al-Qur’an Juz ‘Amma melalui headphone sehari 2 kali, durasi30 menit pukul 06.00 dan 16.00. Data yang diambil meliputi data demografi, faktor risiko stroke serta penilaian Hospital Anxiety and Depression Scale (HADS), dan NIHSS sebelum dan setelah perlakuan. Pengaruh perlakuan terhadap HADS, NIHSS menggunakan uji Chi-square/Fisher. Faktor-faktor lain yang berpengaruh pada luaran klinis juga dianalisis secara multivariat.Hasil: Sebanyak 40 subjek dilakukan random alokasi sebagai kelompok perlakuan berjumlah 20 subjek dan kelompok kontrol berjumlah 20 subjek. Terdapat hubungan bermakna antara memperdengarkan murottal Al-Qur’an dengan perbaikan HADS ansietas, dan perbaikan NIHSS. Tidak terdapat hubungan antara memperdengarkan murottal Al-Qur’an dan perbaikan HADS depresi. Analisis logistik regresi menunjukkan, memperdengarkan murottal Al-Qur’an berpengaruh pada perbaikan NIHSS pasien stroke iskemik akut.Diskusi: Memperdengarkan murottal Al-Qur’an memperbaiki gejala ansietas, memperbaiki luaran klinis sebesar 9,025 kali dibanding kontrol pada stroke iskemik akut sehingga dapat dipertimbangkan untuk menunjang pemulihan pasien stroke.Kata kunci: Murottal Al-Qur’an, NIHSS, skor HADS, stroke iskemik akut 

OP08 Levels and sources of stress reported by first year paramedic students associated with their first ambulance placement

2021 ◽  
Vol 38 (9) ◽  
pp. A4.2-A4
Author(s):  
Matthew Warren-James ◽  
Julie Hanson ◽  
Belinda Flanagan ◽  
Mary Katsikitis ◽  
Bill Lord
Keyword(s):  
Death And Dying ◽  
Educational Interventions ◽  
Fear Of Failure ◽  
Anxiety And Depression ◽  
Control Group ◽  
First Year ◽  
Before And After ◽  
Quasi Experimental ◽  
And Control ◽  
Experimental Group

BackgroundWhilst there is evidence to suggest paramedics experience significant stress when working in the ambulance setting little is known about the experiences of first year paramedic students. This research aimed to: (i) identify whether levels of stress, anxiety and depression experienced by first year paramedic students changed after ambulance placement compared to a control group, and (ii) identify the main perceived and actual sources of stress around ambulance placement.MethodsA before-and-after quasi-experimental design was used to compare whether the experience of ambulance placement altered the levels of stress, anxiety and depression in an experimental group that attended an ambulance placement (n = 20) and the control group who did not (n = 10). Online surveys encompassing the Depression, Anxiety and Stress Scale (DASS-21) and qualitative questions about sources of stress were concurrently deployed to both the experimental and control groups before and after the ambulance placement. Participants were first year paramedic students working in Queensland Ambulance Service, Australia.ResultsThere was a significant reduction in levels of stress in participants after undertaking their first ambulance placement (Mdn = -4.00) when compared to a control group (Mdn = 0.00), U = 52.5, p = .035, n2 = 0.15. Responses to survey questions suggest anticipation about experiencing death and dying of patients was the most frequently reported stressor of student paramedics before undertaking ambulance placements, however insecurity about knowledge, competence and fear of failure was the most frequently experienced stressor reported after completing ambulance placements.ConclusionsThe findings from this study suggest that the fear of the unknown may be worse than the reality. Anticipatory stress is the foremost problem for first year paramedic students attending their first ambulance placement. Placement pre-briefing should focus on educational interventions to build knowledge and skills competency to reduce stress levels and fear of failure.

THE EFFECT OF DHIKR ON ANXIETY AND DEPRESSION LEVEL IN HEMODIALYSIS PATIENTS AT PURWOKERTO ISLAMIC HOSPITAL

2021 ◽  
Vol 2 (1) ◽  
pp. 15-25
Author(s):  
Muhammad Anggun ◽  
Titik Kusumawinakhyu ◽  
Irma Finurina Mustikawati ◽  
Wiharto Wiharto
Keyword(s):  
Intervention Group ◽  
Depression Scale ◽  
Sampling Technique ◽  
Hemodialysis Patients ◽  
Anxiety And Depression ◽  
Control Group ◽  
Control Group Design ◽  
Hemodialysis Unit ◽  
Before And After ◽  
The Mean

Hemodialysis is a routinely performed therapy on chronic kidney patients, leading to psychological problems among subjects who undergo hemodialysis, such as anxiety and depression. One of the efforts to overcome anxiety and depression is with the dhikr intervention. Dhikr presents hearts to remember and be obedient to Allah followed by the words and actions in various conditions.  Discover dhikr's influence on the level of anxiety and depression in patients on hemodialysis in  Purwokerto Islamic Hospital. It was a quantitative study using quasi experiment with a non-quivalent control group design. The number of samples was 12 subjects consisting of 6 subjects in the control group and six subjects in the intervention group with the purposive sampling technique. Instruments were used to measure anxiety and depression are the HADS ( Hospital Anxiety and Depression Scale ) before and after dhikr intervention as much as 12 times. Research is carried out in Hemodialysis Unit of  Purwokerto Islamic Hospital. Test statistics on research are used paired t-test and independent t-tests. This study showed a decrease in the mean level of anxiety from 5, 83 to 1.67 in the experimental group ( p = 0.003). The mean level of depression experienced a decline of 9, 67 becomes 4.67 on a group experiment ( p = 0.003). Dhikr reduces the level of anxiety and depression in hemodialysis patients at the Purwokerto Islamic Hospital.

scholarly journals Nursing consultation protocol for patients after myocardial revascularization: influence on anxiety and depression

2010 ◽  
Vol 18 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Francisca Elisângela Teixeira Lima ◽  
Thelma Leite de Araújo ◽  
Edilma Casimiro Gomes Serafim ◽  
Ires Lopes Custódio
Keyword(s):  
Clinical Trial ◽  
Outpatient Clinic ◽  
Public Hospital ◽  
Intervention Group ◽  
Myocardial Revascularization ◽  
Depression Scale ◽  
Lower Percentage ◽  
Anxiety And Depression ◽  
Control Group ◽  
Hospital Anxiety

The objective was to evaluate the influence of the Nursing Consultation Protocol in aspects of anxiety and depression in patients after myocardial revascularization using the Hospital Anxiety and Depression scale (HAD). A randomized clinical trial developed in the outpatient clinic of a public hospital in Fortaleza-Ceará. One hundred and forty six patients, who underwent myocardial revascularization, composed the population, providing the sample of 39 patients in the control group (CG) and 39 in the intervention group (IG). The results were presented in tables. Anxiety had a mean of 5.41 in the CG and a median of 5 and a mean in the IG of 5.21 and a median of 4. Depression predominated in the CG, with a mean 4.82 and a median of 4, while the IG had a mean of 3.79 and a median of 3. It was found that people monitored in accordance with the Nursing Consultation Protocol had a lower percentage of anxiety and depression after six months.

scholarly journals Psychological Effects of Foldable Capsular Vitreous Body Implantation in Patients with Impending Eye Atrophy

2021 ◽  
Author(s):  
Zheyi Shao ◽  
Chao Huang ◽  
Ying Zhang ◽  
Shanshan Li ◽  
Donglin Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Interpersonal Communication ◽  
Ocular Trauma ◽  
Depression Scale ◽  
Vitreous Body ◽  
Interpersonal Sensitivity ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Before And After ◽  
Baseline Demographic

Abstract Purpose: To investigate whether the FCVB could help improve the mental health of patients with impending eye atrophy. Methods: Fifty-five patients who underwent FCVB implantation from 2017 to 2019 were screened to take part in this retrospective study. The researchers used independent third parties to distribute questionnaires, including the Hospital Anxiety and Depression Scale and the interpersonal sensitivity part of the Symptom Checklist 90 (SCL-90) scale to score the patients' depression, anxiety, and interpersonal sensitivity before and after surgery. Finally, 52 responses were collected.Results: After FCVB implantation, patients had significantly better mental health and less depression, anxiety, and interpersonal sensitivity levels. Before FCVB implantation, 44.23% of patients with ocular trauma and retinal detachment were depressed, 48.08% were anxious, and 19.23% were sensitive to interpersonal communication. After FCVB implantation, 17.31% were depressed, 15.38% were anxious, and 9.62% were sensitive to interpersonal communication. However, baseline demographic and clinical data, such as age, gender, occupation, finance, pre-FCVB-implantation vision, number of surgeries before FCVB implantation, postoperative period length, and surgical satisfaction, had no significant effects on psychological scores of mental health before and after surgery (P> 0.05). Conclusion: Mental health (depression, anxiety, and interpersonal sensitivity) significantly improved in patients after FCVB implantation.

scholarly journals Effect of relaxation on stress, anxiety and depression level of the caregivers' of cancer patients

2017 ◽  
Vol 26 (2) ◽  
pp. 151-158
Author(s):  
Zinnatul Borak ◽  
Shahjahan Ali ◽  
Sabrina Mahmood
Keyword(s):  
Cancer Patients ◽  
Life Stress ◽  
Intervention Group ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Test Results ◽  
Before And After ◽  
Scale Levels ◽  
Depression Level

The study was carried out to explore the outcome of relaxation on stress, anxiety and depression level of the caregivers of cancer patients. Fifty caregivers of cancer survivors were randomly assigned to two groups. In intervention group, participants received relaxation once a week for five consecutive weeks while control group received no intervention. Stress (life‐stress questionnaire), anxiety (anxiety scale) and depression (depression scale) levels were assessed before and after the intervention. Data were analyzed by independent sample t test. Results showed that relaxation helped the caregivers of cancer patients to reduce their stress and anxiety. But relaxation did not reduce the level of depression. Implication of the research and future guideline are also discussed. Dhaka Univ. J. Biol. Sci. 26(2): 151-158, 2017 (July)

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