For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders 

 

To Prepare

• Review the interactive media piece assigned by your Instructor. 
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

 Interactive media piece:  Alzheimer’s Disease 

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Assignment:  

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

 

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For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

To Prepare

• Review the interactive media piece assigned
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.   

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Rubric:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific. 

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. 

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples. 

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. 

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 

 

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For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

The Assignment:

Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis
  • Which Decision did you select?
  • Why did you select this Decision? Support your  response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. 
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
• Decision #2: Treatment Plan for Psychotherapy
•       Why did you select this Decision? Support your response with evidence and references to the Learning Resources.    
•       What were you hoping to achieve by making this Decision? Support your response with evidence and references to  
•       the Learning Resources. 
•       Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why   
•       were they different?
• Decision #3: Treatment Plan for Psychopharmacology
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. 
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
• Also include how ethical considerations might impact   your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. 

                                                                  Case #2
                              Anxiety disorder, OCD, or something else? 

BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for. 

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street. 

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.” 

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations. 

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders. 

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again. 

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation. 

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. 

                                                         Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 

                                 Generalized Anxiety Disorder (GAD)

                                 Obsessive Compulsive Disorder

                                 Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

 ANSWER CHOSEN: Obsessive Compulsive Disorder 

                                                               Decision Point Two

BASED ON THE ABOVE IN FORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

     

Begin Zoloft 50 mg orally daily

Begin Fluvoxamine immediate release 25 mg orally at bedtime

Begin Fluvoxamine controlled release 100 mg orally in the morning

  

ANSWER CHOSENBegin Fluvoxamine immediate release 25  

                                                  mg orally at bedtime 

    

         RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

· Upon return to the clinic, Tyrel’s mother reported that he has had some  

  decrease in his symptoms. She states that the frequency of the handwashing 

  has decreased, and Tyrel seems a bit more “relaxed” overall.

·  She also reports that Tyrel has not fully embraced returning to school, but that  

  his attendance has improved. She reported that over this past weekend, Tyrel    

  went outside to play with his friend from across the street, which he has not  

 done in a while.

 

                                                          Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

  

Increase Fluvoxamine to 50 mg orally at bedtime

Augment with an atypical antipsychotic such as Abilify

Augment treatment with cognitive behavioral therapy

ANSWER CHOSEN:  Increase Fluvoxamine to 50 mg orally at 

                                                     bedtime

Guidance to Student 

In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.

Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.

At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.

Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.

Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.  Chapter      31, “Child Psychiatry” (pp. 1253–1268)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author  “Anxiety Disorders”

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf 

McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Health Care, 29(5), 442–452. doi:10.1016/j.pedhc.2015.03.005

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

SEE ATTACHECD DECISION TREE ASSIGNMENT EXAMPLE 

  

 

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Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization.

To Prepare:

• Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.
• Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.
• Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs. 

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

• Identify and describe at least two competing needs impacting your selected healthcare issue/stressor. 
• Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
• Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
• Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
• Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

from module 1 paper

  

National Healthcare Issue – Technology Disruption

Silifat Jones-Ibrahim

Walden University

National healthcare issue/stressor you selected and its impact on the organization. 

The healthcare environment is complex, which means that there is a need to integrate critical processes that can help define a strong level of engagement. Making better decisions in healthcare focus on the ability to incorporate quality and high level of patient satisfaction. Different approaches are integrated within the healthcare context, which provides a diverse system to improve the level of commitment between healthcare service providers and patients. The current healthcare environment is defined based on the level of engagement among healthcare providers. A key issue in healthcare has been the integration of technology. Technology has been implemented in healthcare, which focuses on creating a reliable system that emphasis on a strong level of management.

My organization has been engaged in transforming the quality of healthcare through the integration of technology across different settings. The organization has adequately focused on protecting patient information, which emphasizes on a strong level of engagement within healthcare. Patient information is sensitive and thus, highly targeted by criminals. The use of technology has ensured that there is easy retrieval of patient information while also minimizing errors, which could lead to loss of patient information (Finck, 2018). Every healthcare provider within the organization has undertaken a training program in electric health records management to improve their knowledge and skills when using the latest technology.

The organization has also embraced technology in monitoring the quality of care across the facility. Different departments have been linked within the system, thus making it is possible to access information and the level of patient care from a central point. The integration of a highly diversified system means that better decision making requires a systematic process which provides a unique emphasis on essential processes that define change. It is easier to detect a lapse in care provision, which plays a central role in improving the quality of care because it is easy to monitor (Gao, Li, & Luo, 2015).

Management of critical care has also been improved due to the use of advanced machines within the intensive care unit. The sensitivity and the need to develop a reliable system provide a highly effective emphasis on essential processes that help implement better outcomes. Computerizing the whole unit has ensured that there is a reduced chance of medical error, which can have a detrimental influence on the healthcare outcome of a patient. The organization has one of the best success rates in recoveries from the Intensive care Unit. This highlights the importance of using technology in managing patient healthcare.

Summary of articles 

Different researches have been conducted to create an understanding of the existing focus on technology in healthcare. The emphasis on these researches helps in understanding the existing gaps in healthcare as well as how technology can help in transforming the current healthcare environment. Schwamm (2014) conducted a study aimed at assessing how telehealth can be implemented to transform healthcare based on seven strategies. Telehealth involves the use of electronic services to provide quality healthcare across different settings. Telehealth is a disruptive technology in healthcare that aims at cutting costs while emphasizing on quality healthcare delivery. The article highlights that the increasing cost of care can only be managed through the implementation of quality technology. Using telehealth in helping chronic patients in remote places is an important consideration to improve the quality of care.

In another article by Engelhardt (2017) which focussed on linking healthcare to blockchain technology. The article highlights that healthcare must be able to balance patient care with information management. This takes into consideration the existing diverse nature of technology embraced in creating a highly effective healthcare environment. The integration of blockchain technology ensures that there is a high level of privacy when sharing information. Management of information across different platforms requires a strong emphasis on essential changes which help define a strong level of organizational development. Solving the existing healthcare information establish a highly integrated system where it is easier to implement crucial measures that can help attain better outcomes. Improving the quality of healthcare includes different strategies which can be adequately evaluated through the management of the available technologies. 

The strategies used to address the organizational impact of national healthcare issues

The articles selected have provided focus on essential technologies that can be included in healthcare to develop a profoundly transformed system. Management of healthcare outcomes is defined through successful consideration of crucial elements that can be considered in ensuring that there is a strong level of organizational development. Telehealth and blockchain technology discussed have provided a unique understanding of crucial factors that can help define a well-organized system that improves healthcare outcomes. The processes that have been implemented are essential in creating a profoundly transformed healthcare context. Health integrates different processes which help define a reliable system where it would be possible to manage the needs of employees. 

The impact of technology within the organization can either be positive or negative. Technology is diverse, which means that new concepts are being developed daily. Different approaches that are embraced in this case helps define a highly successful environment where it would be possible to create a system that encompasses an improved level of care. The number of cybercriminals targeting sensitive patient information is many using sophisticated technology systems which remain mostly undetected.

Data management in the current technology environment has been a significant challenge in improving the quality of service delivery. Data loss preventions are aimed at ensuring that the organization has total control of its data and its safe from cyber-attacks and internet thieves. The sensitivity of the company data makes it a key target for cybercriminals. Thus, data loss prevention is aimed at creating a favorable setting where the organization can implement better systems to improve the level of data protection. Data loss prevention is a process that incorporates different techniques based on the needs of the company. 

Connecting devices for normal operations is a significant aspect which maintains a unique level of consideration. This makes it possible to implement better concepts that help manage organizational performance. Connections are different and employ a significant emphasis on a strategic level of focus on the underlying technologies. The links occur through wired or wireless networks. A higher level of engagement provides a strong necessary environment where it would be easier to manage the existing health needs.

References

Engelhardt, M. A. (2017). Hitching healthcare to the chain: An introduction to blockchain technology in the healthcare sector. Technology Innovation Management Review, 7(10).

Finck, M. (2018). Blockchain Technology. In Blockchain Regulation and Governance in Europe. https://doi.org/10.1017/9781108609708.001

Gao, Y., Li, H., & Luo, Y. (2015). An empirical study of wearable technology acceptance in healthcare. Industrial Management and Data Systems. https://doi.org/10.1108/IMDS-03-2015-0087

Schwamm, L. H. (2014). Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Affairs, 33(2), 200-206.

Rubric:

          

Add a section to the paper you submitted in Module 1. In 4–5 pages, address the following:

·   Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.–Levels of Achievement:Excellent 23 (23%) – 25 (25%·   Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)

 

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Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization.

To Prepare:

• Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.
• Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.
• Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

• Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.
• Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
• Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
• Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
• Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

 

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