Gives an overview of the present status of researches on grasp stability of multi fingered dexterous robot hands,presents the imaginary displacement method for evaluating the grasp stability, which is easy to realize...Gives an overview of the present status of researches on grasp stability of multi fingered dexterous robot hands,presents the imaginary displacement method for evaluating the grasp stability, which is easy to realize on computer,and has no limit on contact points for each finger. Analyses for grasping stability with single contact point of typical objects with different curvature proved the effectiveness of the method proposed and optimal grasp examples are given as well.展开更多
BACKGROUND During the coronavirus disease 2019(COVID-19)epidemic,the fever clinic is an important link for screening and diagnosing whether a patient is infected with the novel coronavirus.Blood collection from child...BACKGROUND During the coronavirus disease 2019(COVID-19)epidemic,the fever clinic is an important link for screening and diagnosing whether a patient is infected with the novel coronavirus.Blood collection from children’s fingertips is a commonly used detection method;however,in children,the blood collection process may cause discomfort and resistance.To address this problem,the use of heating gloves combined with hand swinging can be considered for fingertip blood collection in children.AIM To explore the application of fever gloves with the handshaking method for fingertip blood collection from children in fever clinics during the COVID-19 epidemic.METHODS A total of 100 children were selected for fingertip blood collection at the fever clinic of our hospital from June 2022 to June 2023 and were divided into two groups using a randomized numerical table method,with 50 cases in each group,including the control and observation groups.The patients in the control group followed the doctor's instructions to cooperate with the routine fingertip blood collection method,and the patients in the observation group followed the doctor's instructions to cooperate with the static fever gloves with the shaking hands method of children's fingertip blood collection.The level of the six blood routine and collection indexes,and the satisfaction of the examination of the patients in the peripheral blood group and the fever gloves with the shaking hands method of the children's fingertip blood collection group were compared.RESULTS The red and white blood cell count,hemoglobin,and red blood cell pressure volume in the observation group were higher than those in the control group(P<0.05);the platelet count in the control group was lower than that in the observation group(P<0.05);the number of times of squeezing the fingertip,the average time of blood collection,and the score of puncture pain in the observation group were significantly better than those in the control group(P<0.05);and satisfaction with the routine blood examination in the observation group was greater than that in the control group.CONCLUSION The application value of the fever gloves with shaking hands method for children's fingertip blood collection was better,the accuracy of examination indexes was higher,and patient satisfaction with the examination was greater.展开更多
Objective:To estimate the willingness to pay(WTP)of Ho Chi Minh City residents for the hand,foot,and mouth disease(HFMD)vaccine and its associated factors using the contingent valuation method.Methods:This cross-secti...Objective:To estimate the willingness to pay(WTP)of Ho Chi Minh City residents for the hand,foot,and mouth disease(HFMD)vaccine and its associated factors using the contingent valuation method.Methods:This cross-sectional study was conducted in 2024,involved face-to-face interviews with 423 participants in Ho Chi Minh City.The participants were divided into two groups:parents of children under six and individuals without young children.WTP for the HFMD vaccine was assessed using the Krinsky and Robb procedure and the double-bound dichotomous choice technique.A probit regression model was used to analyze factors influencing WTP.Results:The participants had a mean age of(34.0±10.3)years,and the majority of them were female,resided in urban areas,and held a university degree.54.6%had children under six years of age,and 63.8%had never heard of the EV71 vaccine.The mean WTP for two doses of the HFMD vaccine was VND 1240000(USD 51.66).Parents of children under six years old had a mean WTP of USD 49.16,while individuals without young children had a mean WTP of USD 56.25.Significant factors that were positively associated with WTP included vaccine price,younger age,higher income,and greater knowledge about vaccines.Conclusions:The study indicates a relatively high willingness to pay for HFMD vaccination in Ho Chi Minh City,suggesting strong potential for vaccine implementation.It is recommended that the government disseminate vaccine-related information to enhance public awareness and understanding.展开更多
BACKGROUND： Rheumatoid arthritis（RA） is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not sho...BACKGROUND： Rheumatoid arthritis（RA） is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine（TCM） diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.METHODS/DESIGN： We are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.DISCUSSION： The findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.TRIAL REGISTRATION NUMBER： Clinical Trials.gov Identifier NCT02553005.展开更多
Hand,foot and mouth disease(HFMD)is a major public health problem among children in the Asia-Pacific region.The optimal specimen for HFMD virological diagnosis remains unclear.Enterovirus A71(EV-A71)neutralizing antib...Hand,foot and mouth disease(HFMD)is a major public health problem among children in the Asia-Pacific region.The optimal specimen for HFMD virological diagnosis remains unclear.Enterovirus A71(EV-A71)neutralizing antibody titres detected in paired sera were considered the reference standard for calculating the sensitivity,specificity,positive and negative predictive value of throat swabs,rectal swabs,stool,blood samples and cerebrospinal fluid(CSF)by RT-PCR or ELISA assay.In this study,clinical samples from 276 HFMD patients were collected for analysing the sensitivity of different kind of specimens.Our results showed that stool had the highest sensitivity(88%,95%CI:74%–96%)and agreement with the reference standard(91%).The order of diagnostic yield for EV-A71 infection was stool samplerectal swab>throat swab>blood sample>CSF sample,and using a combination of clinical samples improved sensitivity for enterovirus detection.The sensitivity of ELISA for IgM antibody detection in sterile-site specimens was significantly higher than that of RT-PCR(serum/plasma:62%vs.2%,CSF:47%vs.0%)(P<0.002).In conclusion,our results suggest that stool has the highest diagnostic yield for EV-A71-infected HFMD.If stool is unavailable,rectal swabs can be collected to achieve a similar diagnostic yield.Otherwise,throat swabs may be useful in detecting positive samples.Although IgM in blood or CSF is diagnostically accurate,it lacks sensitivity,missing 40%–50%of cases.The higher proportion of severe cases and shorter interval between onset and sampling contributed to the increase in congruency between clinical testing and the serological reference standard.展开更多
The symmetric linear system gives us many simplifications and a possibility to adapt the computations to the computer at hand in order to achieve better performance. The aim of this paper is to consider the block bidi...The symmetric linear system gives us many simplifications and a possibility to adapt the computations to the computer at hand in order to achieve better performance. The aim of this paper is to consider the block bidiagonalization methods derived from a symmetric augmented multiple linear systems and make a comparison with the block GMRES and block biconjugate gradient methods.展开更多
Effects of the processing methods on the mechanical properties of treated bagasse fibre reinforced epoxy composite were evaluated. The composite materials were processed by employing hand lay-up and compression mouldi...Effects of the processing methods on the mechanical properties of treated bagasse fibre reinforced epoxy composite were evaluated. The composite materials were processed by employing hand lay-up and compression moulding methods and fibres were treated with NaOH solution. The composite samples were subjected to tensile, flexural and impact tests. Based on the findings, compression moulding method produced better mechanical properties compared to the composites manufactured by hand lay-up method. The results showed that the tensile strength and Young’s modulus of the samples produced by compression moulding method increased by 77 percent and 47 percent respectively (at optimal fibre loading) compared to those produced by the hand lay-up method. The results also showed noticeable improvements in the impact strength of the material produced by compression moulding method, with impact strength of 11.5 kJ/m2 against the samples produced by hand lay-up method, with impact strength of 7 kJ/m2.展开更多
The palm vein authentication technology is extremely safe, accurate and reliable as it uses the vascular patterns contained within the body to confirm personal identification. The pattern of veins in the palm is compl...The palm vein authentication technology is extremely safe, accurate and reliable as it uses the vascular patterns contained within the body to confirm personal identification. The pattern of veins in the palm is complex and unique to each individual. Its non-contact function gives it a healthful advantage over other biometric technologies. This paper presents an algebraic method for personal authentication and identification using internal contactless palm vein images. We use MATLAB image processing toolbox to enhance the palm vein images and employ coset decomposition concept to store and identify the encoded palm vein feature vectors. Experimental evidence shows the validation and influence of the proposed approach.展开更多
The characteristics of one kind of handset antenna are analyzed by the method of moments. By using the Pocklington equation and the Galerkin method, the current distribution on the handset antenna is calculated, the i...The characteristics of one kind of handset antenna are analyzed by the method of moments. By using the Pocklington equation and the Galerkin method, the current distribution on the handset antenna is calculated, the input impedance and radiation patterns are obtained. In addition, the characteristics of monopoles mounted on conducting chassis box with different sizes are analyzed. The results show that the size of the conducting chassis box has significant effect on the performance of the handset antenna. Therefore, appropriately changing the size of the conducting chassis box may improve the performance of the handset antenna.展开更多
This paper investigates the photon tunneling and transmittance resonance through a multi-layer structure including a left-handed material（LHM）. An analytical expression for the transmittance in a five-layer structur...This paper investigates the photon tunneling and transmittance resonance through a multi-layer structure including a left-handed material（LHM）. An analytical expression for the transmittance in a five-layer structure is given by the analytical transfer matrix method. The transmittance is studied as a function of the refractive index and the width of the LHM layer. The perfect photon tunneling results from the multi-layer structure, especially from the relation between the magnitude of the refractive index and the width of the LHM layer and those of the adjoining layers. Photons may tunnel through a much greater distance in this structure. Transmittance resonance happens, the peaks and valleys appear periodically at the resonance thickness. For an LHM with inherent losses, the perfect transmittance is suppressed.展开更多
In this paper the propagation of elegant Hermite-cosh-Gaussian, elegant Laguerre Gaussian, and Bessel Gaussian beams through a Kerr left-handed metamaterial （LHM） slab have been studied. A split-step Fourier method ...In this paper the propagation of elegant Hermite-cosh-Gaussian, elegant Laguerre Gaussian, and Bessel Gaussian beams through a Kerr left-handed metamaterial （LHM） slab have been studied. A split-step Fourier method is used to investigate the propagation of laser beams through this media. Numerical simulation shows that Gaussian beams have different focusing behaviors in a Kerr LHM slab with positive or negative nonlinearity. Beam focusing happens in slabs with positive nonlinearity and not in slabs with negative nonlinearity; however, negative nonlinearity is required for a Kerr LHM slab to act like a lens. Additionally, the focusing properties of beams can be controlled by controlling the thickness of the slab or the input power of the incident beam. A multilayer structure is also proposed to have beam focusing by thinner slabs and passing longer distances.展开更多
Finite-difference time-domain(FDTD) method is used to simulate the propagation of electromagnetic wave in left-handed material slab(LHMs) with cold plasma model The effects of optical propagation in the left-handed ma...Finite-difference time-domain(FDTD) method is used to simulate the propagation of electromagnetic wave in left-handed material slab(LHMs) with cold plasma model The effects of optical propagation in the left-handed material compared to convex lens are discussed.The wider the LHMs is,the stronger electric field of focusing image in left-handed material slab is confirmed by the simulation with various slab length.However,the outer image point location would slightly moves to the LHMs side when the length of LHMs is reduced.展开更多
Objective: To investigate the effect of surgical nursing on grade III Hand-Foot Syndrome (HFS) induced by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery. Method: From January 2019 to Decem...Objective: To investigate the effect of surgical nursing on grade III Hand-Foot Syndrome (HFS) induced by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery. Method: From January 2019 to December 2019, 10 patients with HFS grade III caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery in the Breast Department of Cancer Prevention and Treatment Center of Sun Yat-sen University were selected, and surgical nursing methods were used to intervene and observe the therapeutic effects of the patients. Results: One patient was cured within 7 days, the cure rate was 10% in 7 days, 8 patients were cured within 10 days, the cure rate was 80% in 10 days, 10 patients were cured within 15 days, the cure rate was 100% in 15 days. Conclusion: The surgical nursing method is effective for patients with grade III HFS caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery, shortening the treatment time of HFS, and is worthy of clinical promotion.展开更多
文摘Gives an overview of the present status of researches on grasp stability of multi fingered dexterous robot hands,presents the imaginary displacement method for evaluating the grasp stability, which is easy to realize on computer,and has no limit on contact points for each finger. Analyses for grasping stability with single contact point of typical objects with different curvature proved the effectiveness of the method proposed and optimal grasp examples are given as well.
基金Health Commission of Guangxi Zhuang Autonomous Region Application for Self Funded Research Projects,No.Z20210159.
文摘BACKGROUND During the coronavirus disease 2019(COVID-19)epidemic,the fever clinic is an important link for screening and diagnosing whether a patient is infected with the novel coronavirus.Blood collection from children’s fingertips is a commonly used detection method;however,in children,the blood collection process may cause discomfort and resistance.To address this problem,the use of heating gloves combined with hand swinging can be considered for fingertip blood collection in children.AIM To explore the application of fever gloves with the handshaking method for fingertip blood collection from children in fever clinics during the COVID-19 epidemic.METHODS A total of 100 children were selected for fingertip blood collection at the fever clinic of our hospital from June 2022 to June 2023 and were divided into two groups using a randomized numerical table method,with 50 cases in each group,including the control and observation groups.The patients in the control group followed the doctor's instructions to cooperate with the routine fingertip blood collection method,and the patients in the observation group followed the doctor's instructions to cooperate with the static fever gloves with the shaking hands method of children's fingertip blood collection.The level of the six blood routine and collection indexes,and the satisfaction of the examination of the patients in the peripheral blood group and the fever gloves with the shaking hands method of the children's fingertip blood collection group were compared.RESULTS The red and white blood cell count,hemoglobin,and red blood cell pressure volume in the observation group were higher than those in the control group(P<0.05);the platelet count in the control group was lower than that in the observation group(P<0.05);the number of times of squeezing the fingertip,the average time of blood collection,and the score of puncture pain in the observation group were significantly better than those in the control group(P<0.05);and satisfaction with the routine blood examination in the observation group was greater than that in the control group.CONCLUSION The application value of the fever gloves with shaking hands method for children's fingertip blood collection was better,the accuracy of examination indexes was higher,and patient satisfaction with the examination was greater.
文摘Objective:To estimate the willingness to pay(WTP)of Ho Chi Minh City residents for the hand,foot,and mouth disease(HFMD)vaccine and its associated factors using the contingent valuation method.Methods:This cross-sectional study was conducted in 2024,involved face-to-face interviews with 423 participants in Ho Chi Minh City.The participants were divided into two groups:parents of children under six and individuals without young children.WTP for the HFMD vaccine was assessed using the Krinsky and Robb procedure and the double-bound dichotomous choice technique.A probit regression model was used to analyze factors influencing WTP.Results:The participants had a mean age of(34.0±10.3)years,and the majority of them were female,resided in urban areas,and held a university degree.54.6%had children under six years of age,and 63.8%had never heard of the EV71 vaccine.The mean WTP for two doses of the HFMD vaccine was VND 1240000(USD 51.66).Parents of children under six years old had a mean WTP of USD 49.16,while individuals without young children had a mean WTP of USD 56.25.Significant factors that were positively associated with WTP included vaccine price,younger age,higher income,and greater knowledge about vaccines.Conclusions:The study indicates a relatively high willingness to pay for HFMD vaccination in Ho Chi Minh City,suggesting strong potential for vaccine implementation.It is recommended that the government disseminate vaccine-related information to enhance public awareness and understanding.
文摘BACKGROUND： Rheumatoid arthritis（RA） is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine（TCM） diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.METHODS/DESIGN： We are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.DISCUSSION： The findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.TRIAL REGISTRATION NUMBER： Clinical Trials.gov Identifier NCT02553005.
基金supported by the National Natural Science Fund for Distinguished Young Scholars of China(No.81525023)in whole or in part,by a Wellcome Trust fellowship awarded to LT[205228/Z/16/Z]supported by the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections(grant no.NIHR200907)at University of Liverpool in partnership with Public Health England(PHE),in collaboration with Liverpool School of Tropical Medicine and the University of Oxford.LT is based at the University of Liverpool.
文摘Hand,foot and mouth disease(HFMD)is a major public health problem among children in the Asia-Pacific region.The optimal specimen for HFMD virological diagnosis remains unclear.Enterovirus A71(EV-A71)neutralizing antibody titres detected in paired sera were considered the reference standard for calculating the sensitivity,specificity,positive and negative predictive value of throat swabs,rectal swabs,stool,blood samples and cerebrospinal fluid(CSF)by RT-PCR or ELISA assay.In this study,clinical samples from 276 HFMD patients were collected for analysing the sensitivity of different kind of specimens.Our results showed that stool had the highest sensitivity(88%,95%CI:74%–96%)and agreement with the reference standard(91%).The order of diagnostic yield for EV-A71 infection was stool samplerectal swab>throat swab>blood sample>CSF sample,and using a combination of clinical samples improved sensitivity for enterovirus detection.The sensitivity of ELISA for IgM antibody detection in sterile-site specimens was significantly higher than that of RT-PCR(serum/plasma:62%vs.2%,CSF:47%vs.0%)(P<0.002).In conclusion,our results suggest that stool has the highest diagnostic yield for EV-A71-infected HFMD.If stool is unavailable,rectal swabs can be collected to achieve a similar diagnostic yield.Otherwise,throat swabs may be useful in detecting positive samples.Although IgM in blood or CSF is diagnostically accurate,it lacks sensitivity,missing 40%–50%of cases.The higher proportion of severe cases and shorter interval between onset and sampling contributed to the increase in congruency between clinical testing and the serological reference standard.
基金The research of this author was supported by the National Natural Science Foundation of China,the JiangsuProvince Natural Science Foundation,the Jiangsu Province"333Engineering" Foundation and the Jiangsu Province"Qinglan Engineering" Foundation
文摘The symmetric linear system gives us many simplifications and a possibility to adapt the computations to the computer at hand in order to achieve better performance. The aim of this paper is to consider the block bidiagonalization methods derived from a symmetric augmented multiple linear systems and make a comparison with the block GMRES and block biconjugate gradient methods.
文摘Effects of the processing methods on the mechanical properties of treated bagasse fibre reinforced epoxy composite were evaluated. The composite materials were processed by employing hand lay-up and compression moulding methods and fibres were treated with NaOH solution. The composite samples were subjected to tensile, flexural and impact tests. Based on the findings, compression moulding method produced better mechanical properties compared to the composites manufactured by hand lay-up method. The results showed that the tensile strength and Young’s modulus of the samples produced by compression moulding method increased by 77 percent and 47 percent respectively (at optimal fibre loading) compared to those produced by the hand lay-up method. The results also showed noticeable improvements in the impact strength of the material produced by compression moulding method, with impact strength of 11.5 kJ/m2 against the samples produced by hand lay-up method, with impact strength of 7 kJ/m2.
文摘The palm vein authentication technology is extremely safe, accurate and reliable as it uses the vascular patterns contained within the body to confirm personal identification. The pattern of veins in the palm is complex and unique to each individual. Its non-contact function gives it a healthful advantage over other biometric technologies. This paper presents an algebraic method for personal authentication and identification using internal contactless palm vein images. We use MATLAB image processing toolbox to enhance the palm vein images and employ coset decomposition concept to store and identify the encoded palm vein feature vectors. Experimental evidence shows the validation and influence of the proposed approach.
文摘The characteristics of one kind of handset antenna are analyzed by the method of moments. By using the Pocklington equation and the Galerkin method, the current distribution on the handset antenna is calculated, the input impedance and radiation patterns are obtained. In addition, the characteristics of monopoles mounted on conducting chassis box with different sizes are analyzed. The results show that the size of the conducting chassis box has significant effect on the performance of the handset antenna. Therefore, appropriately changing the size of the conducting chassis box may improve the performance of the handset antenna.
基金Project supported by the National Natural Science Foundation of China (Grant Nos. 60877055 and 60806041)the Innovation Funds for Graduates of Shanghai University,China (Grant No. SHUCX102016)
文摘This paper investigates the photon tunneling and transmittance resonance through a multi-layer structure including a left-handed material（LHM）. An analytical expression for the transmittance in a five-layer structure is given by the analytical transfer matrix method. The transmittance is studied as a function of the refractive index and the width of the LHM layer. The perfect photon tunneling results from the multi-layer structure, especially from the relation between the magnitude of the refractive index and the width of the LHM layer and those of the adjoining layers. Photons may tunnel through a much greater distance in this structure. Transmittance resonance happens, the peaks and valleys appear periodically at the resonance thickness. For an LHM with inherent losses, the perfect transmittance is suppressed.
文摘In this paper the propagation of elegant Hermite-cosh-Gaussian, elegant Laguerre Gaussian, and Bessel Gaussian beams through a Kerr left-handed metamaterial （LHM） slab have been studied. A split-step Fourier method is used to investigate the propagation of laser beams through this media. Numerical simulation shows that Gaussian beams have different focusing behaviors in a Kerr LHM slab with positive or negative nonlinearity. Beam focusing happens in slabs with positive nonlinearity and not in slabs with negative nonlinearity; however, negative nonlinearity is required for a Kerr LHM slab to act like a lens. Additionally, the focusing properties of beams can be controlled by controlling the thickness of the slab or the input power of the incident beam. A multilayer structure is also proposed to have beam focusing by thinner slabs and passing longer distances.
基金Supported by the National Natural Science Foundation of China(60601028)
文摘Finite-difference time-domain(FDTD) method is used to simulate the propagation of electromagnetic wave in left-handed material slab(LHMs) with cold plasma model The effects of optical propagation in the left-handed material compared to convex lens are discussed.The wider the LHMs is,the stronger electric field of focusing image in left-handed material slab is confirmed by the simulation with various slab length.However,the outer image point location would slightly moves to the LHMs side when the length of LHMs is reduced.
文摘Objective: To investigate the effect of surgical nursing on grade III Hand-Foot Syndrome (HFS) induced by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery. Method: From January 2019 to December 2019, 10 patients with HFS grade III caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery in the Breast Department of Cancer Prevention and Treatment Center of Sun Yat-sen University were selected, and surgical nursing methods were used to intervene and observe the therapeutic effects of the patients. Results: One patient was cured within 7 days, the cure rate was 10% in 7 days, 8 patients were cured within 10 days, the cure rate was 80% in 10 days, 10 patients were cured within 15 days, the cure rate was 100% in 15 days. Conclusion: The surgical nursing method is effective for patients with grade III HFS caused by Doxorubicin hydrochloride liposome chemotherapy after breast cancer surgery, shortening the treatment time of HFS, and is worthy of clinical promotion.
