Friday, January 18, 2019

(LML) Early detection is the critical part

Leprosy Mailing List – January 18,  2019
Ref.:  (LML) Early detection is the critical part
From:  Umerov Zhaudat, Moscow, Russia

Dear Pieter,

I would like to react to the LML message of Geeske Zijp. When there are funds, employees, but there is no motivation to support the most vulnerable the result is unfortunate. Motivation is most likely a consequence, not a cause. The reasons can be many.

The most important reason, in my opinion, is the safety of life in the regions where our patients live. According to reports, team members on the survey and provision of medical care might be the target of armed groups not subordinates to the government. This reason can be solved only together with the security service of the government.

The next important step is to appoint a team leader. A "weak" leader (without motivation) will not have motivated employees. You can invite "strong" leaders from other team for a short time in the "weak" team.

The next reason is the lack of attention to these employees. Probably, rewarding with diplomas, participation in television programs etc. of popular medical workers will help to awaken motivation of other workers.

There are many different ways to improve the organization of service in addition to the above. Use the experience of the staff of the Regional  WHO office for the fight against leprosy. Good luck. Remember-there are no unresolvable problems.

Kind regards,


LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) Early detection is the critical part

Leprosy Mailing List – January 18,  2019
Ref.:   (LML) Early detection is the critical part
From:  Arry Pongtiku, Papua, Indonesia

Dear Pieter,

Thank you so much facilitating this discussion. I would like to comment LML January 10,2019, Geeske Zijp has a question how can we motivate the appropriate staff to get or to stay interested and to take on their responsibility to search case detection, treat and follow up patients without extra external stimulation/financial incentives?. I would like to share as follows:
1. My experience learned leprosy, I got a confidence after receiving a training and   handled about 20 cases in the beginning of my career in Central Sulawesi as well as actively supported/mentored by old/senior supervisor (nurse). I could diagnose leprosy, giving classification for MB / PB cases, and treatment. When we work more in the field more skilful and motivated/inspired we are.

2. Nurses/ leprosy field workers would be more motivated when he/she has more knowledge and experience to handle the cases. With role leadership by supervisor/advisor/consultant, we will grow self confidence of leprosy field workers. When he/she was able or succeed to treat the case, she/he wished to handle more. Leprosy is a treatable and curable disease. Leprosy staff will be curious when they know the process of disease transmission is. They will do contact tracing for those the index cases/family/close friends, they may get new /more cases. They will understand something beyond such as stigma of patients, ether the patient is accepted or not accepted by his/her family. If leprosy field worker can help reaction cases that supported by supervisor or able to handle disability and wound cases would be great motivation. Difficult cases such as reaction and DDS allergy may be demotivating if failed to treat therefore better communication and easy access to supervisor/consultant /experienced doctor/dermatologist are important. An illustrative book of leprosy (atlas) may be also as a friend for them in the field.

3. Meeting of leprosy field workers did not only share new information, knowledge and experience but also place to keep competitive feeling among them. " I can do this, what are you doing friends? it is the way."

4. Sharing knowledge and experience among peer of leprosy field workers will grow self motivation. In Jayapura and Biak in Papua, all leprosy field workers arranged certain time and go together to villages voluntary in examining community and giving health education including door to door/ from house to house approach. This innovation recently got an appreciation from government.

5. Routinely supervised by district supervisors and ensure availability of MDT keep the leprosy field workers motivated particularly during active case findings.

6. A leprosy field worker from one health center supported in active case findings (Rapid Village survey) at other health center areas, they will feel more appreciated. Exchange and send them in a special training would be good.

6. Beyond practice, our values can make a change and motivate to do efforts for elimination of leprosy. God will count leprosy workers efforts. In many cases, leprosy field workers' family /children are blessed. It is motivating them.

7. Financial incentive is important to keep their motivation and help for their own family. The incentive is not too high but enough for sustainability of the program. Some times they can use their incentive for transportation and share food for leprosy patients. They are not only talk but they want to give more.

Geeske, despite many struggling in leprosy program, I believe many leprosy workers are very dedicated. In few cases, I am also wondering why do those people keep working for long, until their retirement or after retirement.

Thank you so much,

Arry Pongtiku from Papua,Indonesia

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) InfoNTD monthly e-newsletter on NTDs and cross-cutting issues - January 2019

Leprosy Mailing List – January 18,  2019
Ref.:  (LML)   InfoNTD monthly e-newsletter on NTDs and cross-cutting issues - January 2019
From:  Ilse Egers, Amsterdam, the Netherlands

Dear colleagues,
This newsletter provides you with a selection of news items and recent publications on cross-cutting issues in NTDs. Our starting point is to add articles covering a wide variety of issues. Unfortunately, this is not always possible due to a limited diversity in and shortage of articles on cross-cutting issues and NTDs.

Feel free to contact us with any questions or to receive the PDF if a link to the full text is not included.
Our document delivery service is free!

Ilse Egers,
InfoNTD Coordinator
New publications
PP116 Health utilities and neglected conditions: A Chagas disease study.
Miguel S, Bagattini Â, Cruz L, et al. Int J Technol Assess Health Care. 2019:110-111.
Abstract Chagas disease (ChD), also known as American trypanosomiasis, is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi. About 6 to 7 million people worldwide are estimated to be infected, most in Latin America. Health-related quality of life (HRQoL) and utility measures are still poorly employed for assessment of ChD lifetime impairments. The present study aims to assess quality of life (QoL), as utility scores, of patients with chronic Chagas Disease.
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Revisiting area risk classification of visceral leishmaniasis in Brazil.
Machado G, Alvarez J, Bakka HC, et al. BMC Infect. Dis. 2019; 19(1):2.
Abstract Visceral leishmaniasis (VL) is a neglected tropical disease of public health relevance in Brazil. To prioritize disease control measures, the Secretaria de Vigilância em Saúde of Brazil's Ministry of Health (SVS/MH) uses retrospective human case counts from VL surveillance data to inform a municipality-based risk classification. In this study, we compared the underlying VL risk, using a spatiotemporal explicit Bayesian hierarchical model (BHM), with the risk classification currently in use by the Brazil's Ministry of Health.
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Elimination within reach: A cross-sectional study highlighting the factors that contribute to persistent lymphatic filariasis in eight communities in rural Ghana.
Minetti C, Tettevi EJ, Mechan F, et al. PLoS Negl Trop Dis. 2019; 13(1):e0006994.
Abstract Despite the progress achieved in scaling-up mass drug administration (MDA) for lymphatic filariasis (LF) in Ghana, communities with persistent LF still exist even after 10 years of community treatment. To understand the reasons for persistence, we conducted a study to assess the status of disease elimination and understand the adherence to interventions including MDA and insecticide treated nets.
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GEOFIL: A spatially-explicit agent-based modelling framework for predicting the long-term transmission dynamics of lymphatic filariasis in American Samoa.
Xu Z, Graves PM, Lau CL, et al. Epidemics. 2018.
Abstract In this study, a spatially-explicit agent-based modelling framework GEOFIL was developed to predict lymphatic filariasis (LF) transmission dynamics in American Samoa. GEOFIL included individual-level information on age, gender, disease status, household location, household members, workplace/school location and colleagues/schoolmates at each time step during the simulation.
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A longitudinal systems immunologic investigation of acute Zika virus infection in an individual infected while traveling to Caracas, Venezuela.
Carlin AF, Wen J, Vizcarra EA, et al. PLoS Negl Trop Dis. 2018; 12(12):e0007053.
Abstract Zika virus (ZIKV) is an emerging mosquito-borne flavivirus linked to devastating neurologic diseases. Immune responses to flaviviruses may be pathogenic or protective. Our understanding of human immune responses to ZIKV in vivo remains limited. Therefore, we performed a longitudinal molecular and phenotypic characterization of innate and adaptive immune responses during an acute ZIKV infection.
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Economic impact of dengue in Mexico considering reported cases for 2012 to 2016.
Zubieta-Zavala A, López-Cervantes M, Salinas-Escudero G, et al. PLoS Negl Trop Dis. 2018; 12(12):e0006938.
Abstract Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited.
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Neglected tropical diseases and mental health: Progress, partnerships, and integration.
Bailey F, Eaton J, Jidda M, et al. Trends Parasitol. 2018; 35(1):23-31.
Abstract Neglected tropical diseases (NTDs) are increasingly recognised as major drivers of psychosocial morbidity in affected individuals and their caregivers. In our article, we highlight the progress in understanding the scope of the mental health impact of NTDs and the innovative practice emerging in this area. Finally, we examine opportunities for integration of mental and physical health for individuals with NTDs.
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Spatial analysis of dengue, cysticercosis and Chagas disease mortality in Ecuador, 2011-2016.
Núñez-González S, Gault C, Simancas-Racines D. Trans. R. Soc. Trop. Med. Hyg. 2018; 113(1):44-47.
Abstract Neglected tropical diseases (NTDs) continue to be an important cause of disability and mortality in the poorest tropical and subtropical areas. This is an ecological study. We included all death certificates with dengue, cysticercosis and Chagas disease in Ecuador from 2011 to 2016. The spatial autocorrelation was evaluated by GeoDa software through the Global Moran's I index and the formation of clusters by the local index of spatial association.
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Snakebite burden in Sub-Saharan Africa.
Halilu S, Iliyasu G, Hamza M, et al. Toxicon. 2018; 159:1-4.
Abstract There is no reliable estimate of burden of snakebite-envenoming (SBE) in Sub-Saharan Africa (SSA). We derived from a meta-analysis the burden of SBE related deaths, amputations and Post-Traumatic Stress Disorder (PTSD) in 41 countries in SSA. The annual burden was estimated at 1.03 million DALYs (95% Confidence Interval: 0.80-1.28 million DALYs). This is similar to or higher than the burden of many Neglected Tropical Diseases (NTDs) and the finding advocates for a commensurate resources allocation towards control of SBE.
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In silico repositioning of approved drugs against Schistosoma mansoni energy metabolism targets.
Calixto NM, Dos Santos DB, Bezerra JCB, et al. PLoS ONE. 2018; 13(12):e0203340.
Abstract Schistosomiasis is a neglected parasitosis caused by Schistosoma spp. Praziquantel is used for the chemoprophylaxis and treatment of this disease. Although this monotherapy is effective, the risk of resistance and its low efficiency against immature worms compromises its effectiveness. Therefore, it is necessary to develop new schistosomicide drugs. However, the development of new drugs is a long and expensive process.
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Helminth infection in primary school children and characteristics of settlement in the coastal village of Kusan Hilir subdistrict Tanah Bumbu District, South Kalimantan Province, Indonesia.
Hairani B, Hidayat S, Juhairiyah, et al. International journal of engineering technology and sciences. 2018; 5(3):66-72.
Abstract Environmental factors are very influential in the transmission of helminthiasis. This study aimed to determine the prevalence of helminthiasis in primary school-aged children living in villages with coastal ecosystem types in Kusan Hilir Sub-district, Tanah Bumbu District. Furthermore, we ought to identify and compare the characteristics of settlement areas that may increase the risk of transmission.
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Knowledge and practices of health practitioners on treatment of Buruli ulcer in the Mbonge, Ekonko Titi and Muyuka Health Districts, South West Region, Cameroon.
Nsai FS, Cumber SN, Nkfusai NC, et al. Pan Afr Med J. 2018; 31.
Abstract after tuberculosis and leprosy, Buruli ulcer (BU) is the third most common mycobacterial infection. Buruli ulcer begins as a localized skin lesion that progresses to extensive ulceration thus leading to functional disability, loss of economic productivity and social stigma. This study is aimed at assessing the knowledge and practices among health practitioners on the treatment of BU in the Mbonge, Ekondo Titi and Muyuka Health Districts of the South West Region of Cameroon.
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Community-based surveillance and control of chagas disease vectors in remote rural areas of the Argentine Chaco: A five-year follow-up.
Cecere MC, Rodríguez-Planes LI, Vazquez-Prokopec GM, et al. Acta Trop. 2018; 191:108-115.
Abstract Prevention of Chagas disease vector-borne transmission mostly relies on the residual application of pyrethroid insecticide. Persistent or recurrent house infestation after insecticide spraying remains a serious challenge. Here we use generalized estimating equations and multimodel inference to model the fine-scale, time-lagged effects of a community-based vector surveillance-and-response strategy on house infestation and abundance of Triatoma infestans in four rural communities of the Argentine Chaco over a five-year period.
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Risk factors, symptoms and effects of urinary schistosomiasis on anthropometric indices of school children in Zaria, Kaduna state, Nigeria.
Bishop HG, Akoh RI. Open Access J Sci. 2018; 2(1):61-65.
Abstract Nigerian children suffer a great burden of parasitic infections. Urinary schistosomiasis is associated with children's daily indulgence in uncontrolled water activities in unsafe water bodies. The study was aimed at assessing the level of urinary schistosomiasis among school children in Zaria-Nigeria, as well as the risk factors, signs/symptoms and effects associated with it.
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General contextual effects on neglected tropical disease risk in rural Kenya.
de Glanville WA, Thomas LF, Cook EAJ, et al. PLoS Negl Trop Dis. 2018; 12(12):e0007016.
Abstract The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya.
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Trachoma in 3 Amerindian communities, Venezuelan Amazon, 2018.
Noya-Alarcón O, Bevilacqua M, Rodriguez-Morales AJ. Emerging Infect. Dis. 2019; 25(1):182-183.
Abstract Trachoma is among the most common infectious causes of blindness. During January-May 2018, a total of 4 trachoma cases were diagnosed among Amerindians of the Yanomami ethnic group in 3 communities of southern Venezuela. This country has social and environmental conditions conducive to the endemicity of this neglected tropical disease.
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First report of an autochthonous human visceral leishmaniasis in a child from the South of Minas Gerais State, Brazil.
Narciso TP, Carvalho RC, Campos LC, et al. Rev. Inst. Med. Trop. Sao Paulo. 2018; 61:e1.
Abstract American visceral leishmaniasis (VL) is a vector-borne disease transmitted by some species of phlebotomine sandflies from the genus Lutzomyia. After the emergence of foci of the disease in urban areas, VL has assumed an important role in public health. Although VL is widely prevalent in several parts of the world, diagnosing the illness is still difficult. We present a case of a 12-year-old girl with a history of recurrent fever, anorexia, cachexia, chronic fatigue, weight loss, left palpebral unilateral edema, persistent cough and pancytopenia.
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Health, financial, and education gains of investing in preventive chemotherapy for schistosomiasis, soil-transmitted helminthiases, and lymphatic filariasis in Madagascar: A modeling study.
De Neve J-W, Andriantavison RL, Croke K, et al. PLoS Negl Trop Dis. 2018; 12(12):e0007002.
Abstract Neglected tropical diseases (NTDs) account for a large disease burden in sub-Saharan Africa. While the general cost-effectiveness of NTD interventions to improve health outcomes has been assessed, few studies have also accounted for the financial and education gains of investing in NTD control.
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Achieving the endgame: Integrated NTD case searches.
Buyon L, Slaven R, Emerson PM, et al. PLoS Negl Trop Dis. 2018; 12(12):e0006623.
Abstract Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases (NTD) slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last cases becomes an urgent priority. In 2010, Ghana Health Services, along with The Carter Center, Sightsavers, and other partners, conducted integrated case searches for both GWD and the last stage of trachoma disease, trachomatous trichiasis (TT), as well as providing surgical treatment for TT to meet elimination.
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Interventions to treat cutaneous leishmaniasis in children: A systematic review.
Uribe-Restrepo A, Cossio A, Desai MM, et al. PLoS Negl Trop Dis. 2018; 12(12):e0006986.
Abstract Case management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children.
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A comprehensive approach to managing a neglected, Neglected Tropical Disease; the Myanmar Snakebite Project (MSP).
White J, Mahmood MA, Alfred S, et al. Toxicon: X. 2018.
Abstract Snakebite is predominantly an occupational disease affecting poor rural farmers in tropical regions and was recently added to the World Health Organisation list of Neglected Tropical Diseases (NTD). We document an overview of methodologies developed and deployed in the Myanmar Snakebite Project, a foreign aid project largely funded by the Australian Government, with the core aim to "improve outcomes for snakebite patients".
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Integrating ecological approaches to interrupt schistosomiasis transmission: opportunities and challenges.
Liang S, Abe EM, Zhou X-N. Infect Dis Poverty. 2018; 7(1):124.

Abstract The development of agenda for global schistosomiasis elimination as a public health problem generates enthusiasms among global health communities, motivating great interests in both research and practice. Recent China-Africa schistosomiasis control initiatives, aiming to enhance collaboration on disease control in African countries, reflect in part that momentum. Yet there is a pressing need to know whether the Chinese experiences can be translated and applied in African settings.
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The disabling consequences of Mycetoma.
Abbas M, Scolding PS, Yosif AA, et al. PLoS Negl Trop Dis. 2018.
Abstract Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications. In this descriptive cross-sectional study, we characterise the disabling consequences of mycetoma.
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Monitoring the elimination of human African trypanosomiasis: Update to 2016.
Franco JR, Cecchi G, Priotto G, et al. PLoS Negl Trop Dis. 2018; 12(12):e0006890.
Abstract Human African trypanosomiasis (HAT) is a neglected tropical disease targeted for elimination 'as a public health problem' by 2020. The indicators to monitor progress towards the target are based on the number of reported cases, the related areas and populations exposed at various levels of risk, and the coverage of surveillance activities. The World Health Organization (WHO) provides here an update to 2016 for these indicators, as well as an analysis of the epidemiological situation.
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The elimination of human African trypanosomiasis is in sight: Report from the third WHO stakeholders meeting on elimination of gambiense human African trypanosomiasis.
Barrett MP. PLoS Negl Trop Dis. 2018; 12(12):e0006925.
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Prioritizing surveillance activities for certification of yaws eradication based on a review and model of historical case reporting.
Fitzpatrick C, Asiedu K, Solomon AW, et al. PLoS Negl Trop Dis. 2018; 12(12):e0006953.
Abstract The World Health Organization (WHO) has targeted yaws for global eradication. Eradication requires certification that all countries are yaws-free. We reviewed the literature and developed a model of case reports to identify countries in which passive surveillance is likely to find and report cases if transmission is still occurring, with the goal of reducing the number of countries in which more costly active surveillance will be required.
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Challenges of schistosomiasis control and elimination and the Way Forward in sub-Saharan Africa: Literature review and status.
Assefa A, Berhe N. International invention of scientific journal. 2018; 2(12):375-384.
Abstract There are more than 200 million people infected worldwide and 20 million of these suffer serious health consequences, mostly children and adolescents in Sub-Saharan Africa (SSA). A literatures review was conducted to look for challenges for control and elimination of schistosomiasis and the ways forward in Sub-Saharan Africa (SSA).
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WHO data show unprecedented treatment coverage for bilharzia and intestinal worms
14 December 2018 | Geneva −− The latest data on treatment for schistosomiasis (bilharzia) and soil-transmitted helminthiases (intestinal worms) show encouraging trends towards the goal of attaining a minimum target of treating at least 75% of school-aged children in areas endemic for these parasitic infections, making it technically feasible to achieve the global targets set for 2020.
Read more:
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LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<

(LML) Early detection is the critical part

Ref.:   (LML) Early detection is the critical part
From:  Geeske Zijp, Mongo, Chad

Dear Pieter,

Our best wishes for a happy and blessed New Year. May many leprosy affected patients heal without disability with or without leprosy reaction.
Thank you so much Dr. Cairn and Dr. Arry.

We are having the same vision: early detection and treatment and we add: early detection of leprosy reaction and treatment.

Many patients are still not detected and treated, and worse, many leprosy reaction patients are not detected and treated correctly. Our experience in the republic of Chad is that motivation overrules all other components of support to leprosy control and disability prevention. We can train (and pay!) that many nurses and doctors in leprosy and its consequences but there is no result when there is no motivation to do the work. Whatever financial input we offer for training and management we still see patients (and especially reaction cases) being misdiagnosed and becoming disabled and rejected for that.

Fortunately, some patients start seeking help where the staff is motivated, receives the patients in a friendly manner, assures follow up and carries out nerve assessments so as to detect and treat leprosy reaction early, but this kind of staff is rare, distances are enormous and patients most often poor.

Yes, when a patient with severe leprosy reaction gets healed, he or she will become a perfect example for the community and new patients will come forwards through that example. This is a very good opportunity to implicate leprosy affected persons in the awareness process (and this is to be recommended). But it is not enough. We need staff to do their work.  
Our question is: how can we motivate the appropriate staff to get (or stay) interested and to take on their responsibility to search (case detection), treat and follow up patients without extra external stimulation (read: financial incentives)? And continue to do so?

It is a question we are struggling with and it would be good to develop some thoughts together.

Geeske Zijp, Programme Manager for TLM-Chad

LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder <<