The Construction of Integrated Nursing Model Prevention of Oxaliplatin Chemotherapy-Induced Peripheral Nerve Injury

Objective: To investigate the effect of the integrated nursing model in the prevention of chemotherapy-induced peripheral injury. Methods: A total of 60 tumor patients receiving oxaliplatin for 1 - 6 cycles of chemotherapy from January to September 2023 were selected. 30 patients were selected from January to March and divided into the control group, and 30 patients were selected from July to 9 as the experimental group. The control group received conventional chemotherapy nursing, while the experimental group received integrated nursing. Anxiety, peripheral nerve toxicity stage and quality of life score were compared between the two groups before and after intervention. Results: After intervention, the scores of the self-rating Anxiety Scale (SAS) and the total scores of the oxaliplatin Levi specific sensory neurotoxicity scale in the experimental group were significantly lower than those in the control group, and the differences were statistically significant (P< 0.05);The Quality of Life Scale (FACT-G) score of cancer patients was higher than that of control group, and the difference was statistically significant (P< 0.05). Conclusion: The integrated nursing model can effectively reduce the anxiety of patients, reduce the incidence of peripheral nerve injury and improve the quality of life of patients.

The Impact of Patient Education on the Nursing Care of Perioperative Patients in the Interventional Catheterization Room

Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.

Nursing model of midwifery and postural and psychological interventions:Impact on maternal and fetal outcomes and negative emotions of primiparas

BACKGROUND Primiparas are usually at high risk of experiencing perinatal depression,which may cause prolonged labor,increased blood loss,and intensified pain,affecting maternal and fetal outcomes.Therefore,interventions are necessary to improve maternal and fetal outcomes and alleviate primiparas’negative emotions(NEs).AIM To discusses the impact of nursing responsibility in midwifery and postural and psychological interventions on maternal and fetal outcomes as well as primiparas’NEs.METHODS As participants,115 primiparas admitted to Quanzhou Maternity and Child Healthcare Hospital between May 2020 and May 2022 were selected.Among them,56 primiparas(control group,Con)were subjected to conventional midwifery and routine nursing.The remaining 59(research group,Res)were subjected to the nursing model of midwifery and postural and psychological interventions.Both groups were comparatively analyzed from the perspectives of delivery mode(cesarean,natural,or forceps-assisted),maternal and fetal outcomes(uterine inertia,postpartum hemorrhage,placental abruption,neonatal pulmonary injury,and neonatal asphyxia),NEs(Hamilton Anxiety/Depressionrating Scale,HAMA/HAMD),labor duration,and nursing satisfaction.RESULTS The Res exhibited a markedly higher natural delivery rate and nursing satisfaction than the Con.Additionally,the Res indicated a lower incidence of adverse events(e.g.,uterine inertia,postpartum hemorrhage,placental abruption,neonatal lung injury,and neonatal asphyxia)and shortened duration of various stages of labor.It also showed statistically lower post-interventional HAMA and HAMD scores than the Con and pre-interventional values.CONCLUSION The nursing model of midwifery and postural and psychological interventions increase the natural delivery rate and reduce the duration of each labor stage.These are also conducive to improving maternal and fetal outcomes and mitigating primiparas’NEs and thus deserve popularity in clinical practice.

Interventional effect of hirudin on the expression of microtubule-associated protein 2 in peripheral tissue of hematom of model rats with acute intracerebral hemorrhage

BACKGROUND： It is suspected that dissociation, destruction or synthetic disorder of microtubule-associated protein 2 （MAP-2） may participate in secondary injury of intracerebral hemorrhage （ICH）, and the reason may be related to thrombin in high concentration after ICH; therefore, the mechanism should be studied further. OBJECTIVE： To explore the effect of hirudin on expression of MAP-2 in peripheral tissue of hematom after ICH and changes of water content in brain tissue and analyze pathogenesis of thrombin in secondary injury after ICH. DESIGN ： Completely randomized grouping design and controlled animal study SEn-ING ： Department of Neurology, the First Affiliated Hospital of Jilin University MATERIALS ： The experiment was carried out in the Neurological Laboratory of the First Affiliated Hospital of Jilin University from April 2003 to April 2004. A number of 80 healthy Wistar rats, of both genders, aged 3-4 months, weighing 250-350 g, were randomly divided into 8 groups： normal control group, 6-hour ICH group, 1-day ICH group, 2-day ICH group, 3-day ICH group, 7-day ICH group, 3-day hirudin group and 7-day hirudin group with 10 in each group. Five rats from each group were selected to measure their water content, and the others were undertaken immunohistochemical stain. Hirudin was produced by Sigma Company, USA, and MAP-2 rabbit-rat polyclonal antibody was provided by Fuzhou Maixin Biotechnology Company Limited. METHODS： ① Model establishing and grouping intervention： Rats in simple ICH group were collected their blood from tails and then inserted with 50 μL non-anticoagulant auto-arterial blood into the cauda of the putamen in right brain within 5 minutes. Rats in hirudin groups were inserted with 10 U hirudin （which was diluted with saline to 20 μL） into local hematom regions within 5 minutes, and the needle was pulled out after 10 minutes. Rats in normal control group were untouched. ② Water content in peripheral tissue of hematom： Based on the ratio between dry weight and wet weight, brain tissue at bleeding side and in right frontal lobe was selected to measure dry and wet weights so as to calculate the water content [（wet weight - dry weight） /wet weight] × 100%.③ Positive expression of MAP-2： Based on immunohistochemical stain, positive MAP-2 cells were regarded as neurons and they were buffy morphological. Positive rate of MAP-2 was calculated, i.e., percentage of positive cells in each sight to total cells in all sights. ④ Statistical analysis： Data among groups were compared with one-way analysis of variance, averages were compared with SNK-q test by each other, and relation between water content and MAP-2 was analyzed with linear regression technique. MAIN OUTCOME MEASURES： Changes of water content and MAP-2 expression in peripheral tissue of hematorn at various time points after ICH and intervention of hirudin. RESULTS： All 80 rats were involved in the final analysis. ①Water content： Water content was increased at day 1, reached peak at day 3 and decreased at day 7. It was （72.31±0.32）%, （77.42±0.53）%, （78.44±0.28）%, （74.10±0.13）%, （74.85±0.51）% and （70.07±0.36）%, respectively in 1-day, 2-day, 3-day and 7-day ICH groups and 3-day and 7-day hirudin groups, which was higher than that in normal control group （63.85±0.41, q=-4.684 3 to -7.262 0, P〈 0.05）; that in 2-day and 3-day ICH groups was higher than that in 7-day ICH group （q=-3.053 4, -3.727 0, P 〈 0.05）; and that in 3-day and 7-day ICH groups was higher than that in hirudin groups at the same time points （q=-2.965 6, -2.726 4, P 〈 0.05）. ②Positive expression of MAP-2： Positive expression of MAP-2 was decreased at 6 hours after ICH, reached the lowest value at day 3 and increased at day 7. Positive rate was （78.60±0.42）%, （60.56±0.74）%, （44.60±0.26）%, （25.45±0.85）%, （32.55±0.64）%, （37.69＋0.76）%, （41.75±0.68）%, respectively in 6-hour, 1-day, 2-day, 3-day and 7-day ICH groups and 3-day and 7-day hirudin groups, which was lower than that in normal control group [（96.50±0.33）%, q= -3.074 5 to -8.128 5, P 〈 0.05]. In addition, positive cells of MAP-2 disappeared plentifully at 3-7 days after ICH, stain of positive cells were light, and only stain of plasma was positive. That in 3-day and 7-day hirudin groups was higher than that in ICH groups at the same time points （q= -3.391 8, -2.967 9, P 〈 0.05）. Moreover, positive cells of MAP-2 was formed slightly but deeply stained. ③ Results of linear regression： Water content was negatively related to MAP-2 changes at 7 days after ICH （r= -0.894 9, P〈 0.01）, i.e., water content was increased with decrease of MAP-2 expression. CONCLUSION ： The deterioration of MAP-2 may be involved in the pathogenesis of thrombin within the first week after ICH, and the local administration of hirudin can protect neurons.

Does knowledge of physical activity recommendations increase physical activity among Chinese college students？ Empirical investigations based on the transtheoretical model

Background: Based on the transtheoretical model, the current study investigated whether awareness of physical activity(PA) recommendations had an impact on the stages of PA behavior change and levels of PA among Chinese college students.Methods: In Study 1, with a cross-sectional study design, 9826 students were recruited, and their knowledge of international PA recommendations,PA stage distribution, and self-reported PA level were surveyed. Pearson's χ2 test was used to test whether those participants who were aware and not aware of PA guidelines were equally distributed across the stages of PA behavior, and independent t test was conducted to test the group difference in the actual levels of PA. In Study 2, 279 students who were not aware of the PA recommendations were randomly allocated to either an intervention group or a control group, and only those in the intervention group were presented with international PA guidelines. In both groups,students' PA stages and PA level were examined before the test and then 4 months post-test. Mc Nemar's test for correlated proportions and repeated-measures analysis of variance were conducted to examine the changes in PA stage membership and PA level after the intervention.Results: Study 1 results revealed that only 4.4% of the surveyed students had correct knowledge of PA recommendations. Those who were aware of the recommendations were in later stages of PA behavior(χ~2(4) = 167.19, p < 0.001). They were also significantly more physically active than those who were not aware of the recommendations(t(443.71) = 9.00, p < 0.001, Cohen's d = 0.53). Study 2 results demonstrated that the intervention group participants who were at the precontemplation and contemplation stages at the pre-test each progressed further in the PA stages in the post-test(χ~2(1) = 112.06, p < 0.001; χ~2(1) = 118.76, p = 0.03, respectively), although no significant change in PA level was observed(t(139) < 1, p = 0.89).Conclusion: The results showed that awareness of the PA recommendations was associated with higher stages and levels of PA behavior, and a brief educational exposure to PA recommendations led to improved stages of PA behavior but no change in the levels of PA among Chinese college students. More effective public health campaign strategies are needed to promote the dissemination of the PA recommendations and to raise the awareness of the Chinese student population.

Evaluating the effect of price and non-price policy intervention on rice cultivation in Sierra Leone: A supply response model approach

Rice is the main food for over 95 percent of the Sierra Leonean populace. It accounts for the largest portion of the agricultural GDP of the country. On the contrary, its cultivation has been shrinking over the past decades. Consequently, importation now becomes the main source of supplying the grain for local needs since its cultivation or production could no longer meet domestic request. The deterioration in the local cultivation of rice has had severe socio-economic implications such as higher consumer prices and balance of payment burden. Therefore, the main objective of this study is to evaluate the effect of price and other related nonprice policy intervention on rice cultivation in the country. The tools utilized for analyzing the problem comprise, a coefficient of protection analysis as well as a supply response analysis by means of a time series regression (for the period 1980-2011). Major limitations established negatively affecting rice output are price disincentives to cultivators, public expenditure and fertilizer consumption. From the above findings, rice cultivators should be accorded the necessary incentives to keep them more effective in the rice cultivation career. The food policy approach that had over the years depended on huge importation of rice should be reviewed in favor of domestic cultivation. Increasing local cultivation through a meaningful protection of cultivators can independently reduce the price of rice to the advantage of the final consumers. This study also recommends that public funds should be redirected away from rice import toward investments in its domestic cultivation.

Advancing critical care recovery:The pivotal role of machine learning in early detection of intensive care unit-acquired weakness

This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.

Optimization of nursing interventions for postoperative mental status recovery in patients with cerebral hemorrhage

BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizing the postoperative mental status recovery phase and to provide clinical value for future rehabilitation of patients with HCH.METHODS This randomized controlled study included 120 patients with cerebral HCH who were contained to our neurosurgery department between May 2021–May 2023 as the participants.The participants have randomly sampled and grouped into the observation and control groups.The observation group received the rehabilitation nursing model,whereas the control group have given conventional nursing.The conscious state of the patients was assessed at 7,14,21,and 30 d postoperatively.After one month of care,sleep quality,anxiety,and depression were compared between the two groups.Patient and family satisfaction were assessed using a nursing care model.RESULTS The results showed that the state of consciousness scores of the patients in both groups significantly increased(P<0.05)after surgical treatment.From the 14th day onwards,differences in the state of consciousness scores between the two groups of patients began to appear(P<0.05).After one month of care,the sleep quality,anxiety state,and depression state of patients were significantly better in the observation group than in the control group(P<0.05).Satisfaction with nursing care was higher in the observation group than in the control group(P<0.05).CONCLUSION The rehabilitation nursing model has a more complete system compared to conventional nursing,which can effectively improve the postoperative quality of life of patients with cerebral hemorrhage and improve the efficiency of mental state recovery;however,further analysis and research are needed to provide more scientific evidence.

Exploring the Experiences of Personal Recovery among Mental Health Consumers and Their Caregivers Receiving Strength- Based Family Interventions

Background:This study explored the personal recovery of consumers and their caregivers receiving the strength-based family intervention.Method:A three-year project was implemented with 43 dyads from 5 community psychiatric rehabilitation agencies in northern,central,and Southern Taiwan.This paper presents qualitative analysis with a focus on describing the experiences of personal recovery.To gain a deeper understanding of the participants’personal experiences and perspectives,semi-structured in-depth interviews were conducted on three occasions(six months after the inception of the experiment,18 months after,and when the participants left the services of this study).Over the three occasions,a total of 27 consumers and 28 caregivers were interviewed.Data analysis was conducted based on grounded theory.Results:Consumers expressed positive experiences in the domain of the recovery process(positive sense of self,taking responsibility,and better coping)and on the objective indicators of recovery(functioning,interpersonal interaction,and family relationship).Caregivers experienced lessened psychological burdens.They also revealed improvements to their sense of self(recovery process)and subjective indicators of recovery outcomes,including feeling empowered and having a better quality of life.Moreover,they had better interaction with consumers(objective domain of recovery).Conclusion:These findings suggest that the strength-based perspective is an acceptable,culturally-compatible approach among Chinese mental health consumers and their caregivers.The investigators suggest that additional resources would be necessary to support a change in the service system in Taiwan so that family-based services can be provided to promote the recovery of mental health consumers and their family caregivers.

Global Analysis of an SEIR Epidemic Model with Infectious Force under Intervention Strategies

In this paper, we investigate the global stability of an SEIR (Susceptible-Exposed-Infected-Remove) epidemic model with infectious force under intervention strategies. To address this issue, we prove that the basic reproduction number R0 plays an essential role in determining whether the disease extincts or persists. If , there is a unique disease-free equilibrium point of the model which is globally asymptotically stable and the disease dies out, and if , there exists a unique endemic equilibrium point which is globally asymptotically stable and the disease persists.

Neurodevelopmental disorders:An innovative perspective via the response to intervention model

Neurodevelopmental disorders are a group of conditions classified together by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders which include intellectual disability,communication disorders,autism spectrum disorder,attention-deficit/hyperactivity disorder,specific learning disorder(SLD),and motor disorders.SLD is present in many students,who exhibit significant difficulties in the acquisition of reading,written expression,and mathematics,mostly due to problems with executive functions(EF).The present study is a review of the current situation of neurodevelopmental disorders and SLD focusing on the benefits of the response to intervention model(RtI),which allows the combination of evaluation and intervention processes.It also addresses the key role of EF.The importance of adapting RtI to new possibilities such as the use of virtual reality is discussed and a theoretical framework for carrying that out is provided.

Application of causal model to maternal smoking cessation intervention in pregnancy

The adverse effects of maternal smoking during pregnancy on both the offspring and women are well known. The main objective of this research article is to provide health professional causal modelling approach to make a more comprehensive assessment of major determinants of smoking behaviour during and after pregnancy and consequently the outcomes of pregnant women smoking which are adversely affecting both the offspring and pregnant women. The causal model based on theory and evidence was modified and applied to material smoking cessation intervention to control the adverse effects of smoking on offspring obesity and neurodevelopment. In this approach a generic model links behavioural determinants, causally through behaviour, to physiological and biochemical variables, and health outcomes. It is tailored to context, target population, behaviours and health outcomes. The model provides a rational guide to appropriate measures, intervention points and intervention techniques, and can be tested quantitatively. The causal modelling approach showed promising results which can be used to help maternal smoking women to understand the risk of smoking and help them to quit smoking. The regression analysis of maternal smoking women BMI (n = 1000) on offspring BMI was statistically significant, p 0.05). This supported the hypothesis that maternal smoking women BMI during pregnancy is an important determinant of offspring obesity and consequently the risk factors of cardiovascular development. The causal modelling approach is unique as it provides an incentive to health professional to use these models to target any important and modifiable determinants of the maternal smoking behaviour and decrease the risk of adverse pregnancy outcomes for the offspring and the mother.

Mid-Term Preliminary Results for Safety and Patency of the Occlutech Atrial Flow Regulator in an Animal Model

Objective:The Atrial Flow Regulator(AFR)is a double disc device made of self-expanding Nitinol wire mesh,structured around a central lumen.Once deployed via the transfemoral route,the device stents the atrial septum leaving a preselected fixed diameter atrial communication.We sought to evaluate the mid-term performance of the AFR by implanting the device in 5 healthy porcine hearts to assess safety and patency of the device fenestration over a period of 150 days.Method:Five AFR devices were implanted in 5 female Yucatan adult minipigs.The animals were survived to 150 days with periodic assessments at days+3,+30,+60,+90,+120,and+150.These assessments consisted of transesophageal echocardiography and fluoroscopic evaluation.The animals were sacrificed at day+150.Histological and pathological assessments were carried out to characterize neointimal tissue growth,inflammation,thrombus formation,endothelial coverage,endothelial maturity,and the presence of any luminal thrombus.Result:There were no unscheduled deaths.Patency was maintained in all 5 animals across the 150-day study.There was no statistically significant difference in the lumen diameter over the study duration.Neointimal growth was mild to moderate in all specimens and occurred mostly on the surfaces of the device in direct contact with the atrial septum.There was no evidence of any significant inflammatory response on routine blood work or by imaging or histological assessment.Scanning electron microscope(SEM)examination showed nearly complete surface coverage with endothelial tissue.The animals were in a healthy condition for the duration of the study with no attributable pathology and no adverse effects noted on distant organs in any of the 5 animals.Conclusion:As a continuation of our earlier work,this 150-day midterm animal study provides important safety and feasibility information.Our preliminary results show that the AFR is both safe and effective in maintaining a sustainable atrial level communication for the duration of the study.

A more consistent intraluminal rhesus monkey model of ischemic stroke

Endovascular surgery is advantageous in experimentally induced ischemic stroke because it causes fewer cranial traumatic lesions than invasive surgery and can closely mimic the pathophysiology in stroke patients. However, the outcomes are highly variable, which limits the accuracy of evaluations of ischemic stroke studies. In this study, eight healthy adult rhesus monkeys were randomized into two groups with four monkeys in each group： middle cerebral artery occlusion at origin segment （M1） and middle cerebral artery occlusion at M2 segment. The blood flow in the middle cerebral artery was blocked completely for 2 hours using the endovascular microcoil placement technique （1 mm × 10 cm） （undetachable）, to establish a model of cerebral ischemia. The microcoil was withdrawn and the middle cerebral artery blood flow was restored. A reversible middle cerebral artery occlusion model was identified by hematoxylin-eosin staining, digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, and neurological evaluation. The results showed that the middle cerebral artery occlusion model was successfully established in eight adult healthy rhesus monkeys, and ischemic lesions were apparent in the brain tissue of rhesus monkeys at 24 hours after occlusion. The rhesus monkeys had symptoms of neurological deficits. Compared with the M1 occlusion group, the M2 occlusion group had lower infarction volume and higher neurological scores. These experimental findings indicate that reversible middle cerebral artery occlusion can be produced with the endovascular microcoil technique in rhesus monkeys. The M2 occluded model had less infarction and less neurological impairment, which offers the potential for application in the field of brain injury research.

Epidemic threshold influenced by non-pharmaceutical interventions in residential university environments

The control of highly contagious disease spreading in campuses is a critical challenge.In residential universities,students attend classes according to a curriculum schedule,and mainly pack into classrooms,dining halls and dorms.They move from one place to another.To simulate such environments,we propose an agent-based susceptible–infected–recovered model with time-varying heterogeneous contact networks.In close environments,maintaining physical distancing is the most widely recommended and encouraged non-pharmaceutical intervention.It can be easily realized by using larger classrooms,adopting staggered dining hours,decreasing the number of students per dorm and so on.Their real-world influence remains uncertain.With numerical simulations,we obtain epidemic thresholds.The effect of such countermeasures on reducing the number of disease cases is also quantitatively evaluated.

Nursing team management and construction from the perspective of psychological contract

The psychological contract is a set of personal beliefs about the reciprocal obligations and rights established in an exchange relationship,and high-level fulfillment of psychological contract helps the development of a team.This study summarizes the concept and theoretical basis of psychological contract,the influencing factors and intervention status of nurse psychological contract,and constructs a psychological contract intervention model to provide reference and reference for better construction and management of nursing teams.

Effect of Nursing Intervention Based on Caprini Risk Assessment Scale for Venous Thromboembolism in Perioperative Patients with Liver Cancer

Objective:To explore the effect of nursing intervention based on Caprini risk assessment scale for venous thromboembolism(VTE)in perioperative patients with liver cancer.Methods:A total of 128 hepatocellular cancer(HCC)patients who were hospitalized in our department from January 2021 to March 2022 and met the research criteria were selected.According to odd and even numbers in the order of inclusion,64 cases were divided into two groups:a control group and an observation group.The control group received routine nursing intervention during perioperative period,while the observation group received nursing intervention based on Caprini risk assessment scale for VTE.The incidence of VTE and complications were compared between the two groups.Results:The incidence of VTE and postoperative complications in the observation group were lower than those in the control group(P<0.05).Conclusion:Nursing intervention based on Caprini risk assessment scale for VTE can reduce the incidence of perioperative deep vein thrombosis and complications in patients with liver cancer;thus,it is worthy of clinical application.

Assessment of the Benefits of Targeted Interventions for Pandemic Control in China Based on Machine Learning Method and Web Service for COVID-19 Policy Simulation

Taking the Chinese city of Xiamen as an example,simulation and quantitative analysis were performed on the transmissions of the Coronavirus Disease 2019(COVID-19)and the influence of intervention combinations to assist policymakers in the preparation of targeted response measures.A machine learning model was built to estimate the effectiveness of interventions and simulate transmission in different scenarios.The comparison was conducted between simulated and real cases in Xiamen.A web interface with adjustable parameters,including choice of intervention measures,intervention weights,vaccination,and viral variants,was designed for users to run the simulation.The total case number was set as the outcome.The cumulative number was 4,614,641 without restrictions and 78 under the strictest intervention set.Simulation with the parameters closest to the real situation of the Xiamen outbreak was performed to verify the accuracy and reliability of the model.The simulation model generated a duration of 52 days before the daily cases dropped to zero and the final cumulative case number of 200,which were 25 more days and 36 fewer cases than the real situation,respectively.Targeted interventions could benefit the prevention and control of COVID-19 outbreak while safeguarding public health and mitigating impacts on people’s livelihood.