Doctor's Job Research Articles

Assessment of knowledge about the doping in the rehabilitation assistance of performance and recreational athletes

Background: During the activity of performance and recreational athletes can arise critical situations that imply medical rehabilitation treatments. In the process of functional recovery, the applied methods can be sometimes aggressive and intense. The lack of knowledge of forbidden substances may pose a threat for the athlete’s health and performance. It is of utmost importance that the medical personnel that care for athletes take into consideration the risks and effects of doping substances. Methods: A group of 53 physicians - specialists in the field of physical medicine and sports medicine participated in the written study. The investigation was carried out according to the Questionnaire for the evaluation of anti-doping knowledge. By means of 14 categories of simple introductory questions, the questionnaire allowed the collection of data on the doctor's seniority and job, age, gender and general knowledge about substances and methods of interest in sports. The data of the participants in the questionnaires were collected and entered into a Microsoft Excel database and were analyzed in the MEDCALC statistical software program version 12.7.0. The data were analyzed using the SPSS program, version 21. Descriptive analysis was performed using the means and standard deviations of PEAS Instrument variables and mean difference tests were performed on two-response variables along with analysis of variance (ANOVA). Results: The majority of doctors (40/75.48%) do not have information about test procedures for inert substances and almost half of them (25/47.17%) do not know the anti-doping rules and standards developed within World Anti-Doping Agency (WADA). Of the people surveyed all (53/100%) positively noted the effectiveness of anti-doping programs, but 18 (33.96%) of the respondents distinguished exaggerated actions in the mass media regarding the issue of doping and 35 (66.04%) of the respondents did not have accusations against mediating the issue of doping. Of all the people investigated, the majority (49/92.45%) are ready to report on cases of doping in the anti-doping organization or the sports federation. 24 (45.28%) marked agreement in these actions and total agreement - 25 (47.17%) physicians. Conclusion: In the evaluation of the knowledge of specialist doctors involved in the assistance of people who practice performance and recreational sports, a discrepancy in the knowledge about doping was determined. The development of strategies and policies by informing doctors from medical rehabilitation and sports medicine in the field of sports doping will offer athletes access to quality medical services and safe professional activity. Keywords: medical rehabilitation of athletes, doping substances, World Anti-Doping Code

Chemical Castration in Perpetrators of Sexual Violence

Regulations on chemical castration for perpetrators of sexual violence have been stipulated in the legislation in Indonesia, Law 17 of 2016. Then followed up with Government Regulation (PP) NO 70 OF 2020 which regulates in more detail the chemical castration procedure. However, at the level of implementation, medical and bioethical perspectives, there are still pros and cons. The paradigm of the group that agrees to perform chemical castration on perpetrators, the act of chemical castration causes a decrease in sex hormone (testosterone) levels, thus helping perpetrators manage sex drive more controllable. The paradigm of the group that does not agree on the act of chemical castration, from the aspect of low levels of sex hormones, will cause discomfort or health problems in the perpetrator. On the other hand, the performing physician believes that the doctor's job is to help, not cause discomfort. Medical studies and bioethical studies of chemical castration in perpetrators of sexual violence can improve the understanding of holistic management

Research on the improvement path of job satisfaction of doctors in a tertiary public hospital in Yinchuan city from the perspective of psychological contract

research purpose: This study aims to explore the relationship between doctors' psychological contract and job satisfaction, and to further explore the impact of the four dimensions of hospital responsibility and doctor responsibility on overall satisfaction and interpersonal relationships, work itself, working conditions, training and promotion, compensation and benefits , The specific impact of the six dimensions of leadership and management. Research methods: Using the public hospital doctor's psychological contract scale and doctor's job satisfaction scale, Spss software was used to conduct multiple linear regression analysis to explore the relationship between the psychological contract and its various dimensions and the various dimensions of doctor's job satisfaction. Analysis conclusion:(1) Hospital development, relationship, and concept responsibility have a significant positive predictive effect on "interpersonal relationship", and the impact of hospital relationship responsibility is greater; (2) Hospital development, relationship, and concept responsibility have a significant positive effect on "work itself" (3) Hospital transaction and development responsibilities have a significant positive impact on "working conditions", and hospital transaction responsibilities have a greater impact on working conditions; (4) Hospital development and relationship responsibilities have a significant impact on "working conditions" "Training and promotion" has a significant positive impact, and hospital development responsibilities have a greater impact; (5) Hospital responsibilities and only hospital transaction responsibilities have a significant impact on "remuneration and benefits"; (6) Hospital development, relationship, and concept responsibilities , doctor's conceptual responsibility has a significant positive predictive effect on "leadership and management", and hospital relationship responsibility has the greatest impact on leadership and management.

The Effect of Servant Leadership and Remuneration on Doctor Job Satisfaction Mediated by Work Motivation at UPT RSUD RAA Soewondo Pati

This study aims to analyze the influence of servant leadership on the work motivation of doctors. This research was conducted at UPT RSUD RAA Soewondo Pati with a total population of 66 respondents and a sample of 40 respondents using the proportional random sampling technique. Data collection techniques using a questionnaire instrument The data analysis technique uses PLS (partial least squares). The results of this study indicate that servant leadership has a significant effect on the work motivation of doctors. Remuneration has a significant effect on the work motivation of doctors. Servant leadership has a significant effect on doctors' job satisfaction. Remuneration has a significant effect on a doctor's job satisfaction. Work motivation has a significant effect on a doctor's job satisfaction. Servant leadership and remuneration had a significant effect on a doctor's job satisfaction, which was mediated by work motivation.

고대 일본 의사(醫師)의 기능과 역할

In this paper, the role of doctors who worked in ancient Japan was examined in detail by dividing them into domestic and overseas. First of all, the Tengyoryo doctor was in charge of the treatment and examination of the imperial family and management, and was dispatched to Daigakuryo and Kuraryo. In addition, doctors were installed in departments that escorted the emperor or defended the palace, and strategic points such as Dazaifu and Tsushima. In addition, doctors were trained in the provinces to treat the people affected by the epidemic. Looking at this, it can be seen that domestic doctors faithfully performed the role of “examining and treating all diseases” as stipulated in the Ritsuryo.
 Subsequently, Engishiki lists the combination drugs and herbal medicines paid to the envoys, and the doctors in the envoys judged that they would have used these drugs to treat other envoys who were sick. Doctors dispatched to Bokkai took a lot of medicine compared to doctors dispatched to Tang and Silla because the voyage between Japan and Bokkai was so rough. And it could be seen that it was the doctor's main job to treat a group of envoys suffering from various diseases caused by a rough voyage. And it was found that the doctor's medical skills at the time were very excellent in that even highly toxic herbicides were used.
 In conclusion, ancient Japanese doctors were very active in various ways, not only in the central government and provinces but also abroad, and were very actively engaged in treatment.

Gummy smile - causes and modern treatment methods

Introduction and purpose: Nowadays, patients come to doctors and dentists not only with pain complaints, but also to improve their appearance. Gummy smile, or overexposure of the gums when smiling, is one of the most common aesthetic problems they report. Gummy smile occurs primarily in young people and more often affects women. 
 Brief description of the state of knowledge: A gummy smile is a condition in which a patient exposes more than 2 mm of gum during smiling. There are many causes of excessive gum exposure during smiling. These include gingival hypertrophy, hyperactive muscles, a disproportionately long upper lip, altered passive eruption, or excessive vertical growth of the jaw. Examination of the patient is aimed at determining the cause of the condition and choosing the appropriate treatment method. In cases of gingival hyperplasia and altered passive eruption, a gingivectomy or excision of part of the gingiva is used. Muscle hyperactivity is an indication for treatment with botulinum toxin or hyaluronic acid. The long lip can be treated with surgical methods, while vertical hypertrophy of the jaw requires orthodontic treatment or orthognathic surgery. Depending on the treatment method chosen, the patient's appearance can change to varying degrees. The most striking changes are seen when orthognathic surgery is performed. Not only the patient's smile is changed, but also the facial features. 
 Summary: It is the doctor's job to thoroughly examine the patient, make an appropriate diagnosis and choose the treatment method that will bring the best results. The multitude of treatment methods for gummy smiles allows them to be combined to achieve the best results. The choice of therapy should be based directly on the source of the problem. The patient should be informed about the course of treatment and possible side effects and take informed consent to the treatment.

Analysis of the Associated Factors of Doctor Job Satisfaction at Covid-19 Pandemic

The Covid-19 pandemic has caused doctors to have lower job satisfaction compared to the previous period. Preliminary survey conducted at Unand Hospital on health workers, doctor job satisfaction is lower than other health workers. Low job satisfaction among doctors can cause a decrease in hospital service quality. The purpose of this research is to analyze the factors related to the job satisfaction of doctors during the Covid-19 pandemic. The research method used is the quantitative method. Dependent variable in this study is overall job satisfaction, the independent variables are salary, promotion, fringe benefit, supervision, contingent reward, operating conditions, co-workers, nature of work, and communication. The sampling using census conducted on all doctors at Unand Hospital, where 71 doctors met the inclusion criteria. Data was collected by distributing job satisfaction survey (JSS) questionnaires. Univariate and bivariate analysis was used in this study. The result of this study is salary, fringe benefits, and operating procedure has the lowest average of the nine factors of job satisfaction, hospital management should pay attention for this aspect to maintain doctor job satisfaction.

A Residual Fusion Network for Osteosarcoma MRI Image Segmentation in Developing Countries.

Among primary bone cancers, osteosarcoma is the most common, peaking between the ages of a child's rapid bone growth and adolescence. The diagnosis of osteosarcoma requires observing the radiological appearance of the infected bones. A common approach is MRI, but the manual diagnosis of MRI images is prone to observer bias and inaccuracy and is rather time consuming. The MRI images of osteosarcoma contain semantic messages in several different resolutions, which are often ignored by current segmentation techniques, leading to low generalizability and accuracy. In the meantime, the boundaries between osteosarcoma and bones or other tissues are sometimes too ambiguous to separate, making it a challenging job for inexperienced doctors to draw a line between them. In this paper, we propose using a multiscale residual fusion network to handle the MRI images. We placed a novel subnetwork after the encoders to exchange information between the feature maps of different resolutions, to fuse the information they contain. The outputs are then directed to both the decoders and a shape flow block, used for improving the spatial accuracy of the segmentation map. We tested over 80,000 osteosarcoma MRI images from the PET-CT center of a well-known hospital in China. Our approach can significantly improve the effectiveness of the semantic segmentation of osteosarcoma images. Our method has higher F1, DSC, and IOU compared with other models while maintaining the number of parameters and FLOPS.

Undergraduate Medical Students' and Interns' Knowledge and Perception of Artificial Intelligence in Medicine.

PurposeArtificial intelligence (AI) is playing an increasingly important role in healthcare and health professions education. This study explored medical students’ and interns’ knowledge of artificial intelligence (AI), perceptions of the role of AI in medicine, and preferences around the teaching of AI competencies.MethodsIn this cross-sectional study, the authors used a previously validated Canadian questionnaire and gathered responses from students and interns at KIST Medical College, Nepal. Face validity and reliability of the tool were assessed by administering the questionnaire to 20 alumni as a pilot sample (Cronbach alpha = 0.6). Survey results were analyzed quantitatively (p-value = 0.05).ResultsIn total 216 students (37% response rate) participated. The median AI knowledge score was 11 (interquartile range 4), and the maximum possible score was 25. The score was higher among final year students (p = 0.006) and among those with additional training in AI (p = 0.040). Over 49% strongly agreed or agreed that AI will reduce the number of jobs for doctors. Many expect AI to impact their specialty choice, felt the Nepalese health-care system is ill-equipped to deal with the challenges of AI, and opined every student of medicine should receive training on AI competencies.ConclusionThe lack of coverage of AI and machine learning in Nepalese medical schools has resulted in students being unaware of AI’s impact on individual patients and the healthcare system. A high perceived willingness among respondents to learn about AI is a positive sign and a strong indicator of futuristic successful curricula changes. Systematic implementation of AI in the Nepalese healthcare system can be a potential tool in addressing health-care challenges related to resource and manpower constraints. Incorporating topics related to AI and machine learning in medical curricula can be a useful first step.

From family incivility to satisfaction at work: role of burnout and psychological capital

PurposeBuilding on the work-home resources model and the conservation of resources (COR) theory, this study proposes and explores a moderated mediation model on the effect of doctor's family incivility and burnout on doctor's job satisfaction as a function of psychological capital (PsyCap) at dual stages.Design/methodology/approachThis study obtained data in two phases, using a time-lagged methodological design. The final sample comprised 324 emergency medicine doctors working in hospitals across India, and statistical analysis of the above-said relationships was carried out using PROCESS macro in SPSS 23.0.FindingsFindings indicate strong evidence supporting the mediation effect of burnout, which means doctors facing family incivility at home experienced burnout at work, which influences doctors' job satisfaction. Also, the indirect effect of family incivility on job satisfaction through burnout gets attenuated at both stages when emergency physicians possess high PsyCap.Practical implicationsThis study adds to the work-family literature by delving into the underlying mechanisms that link family incivility to various job outcomes. Despite procedural remedies, there remains a possibility of common method bias. Longitudinal research and validating the model across different samples are suggested.Originality/valueThis study expands the limited domain of knowledge on the work consequences of uncivil family behavior. This study is among the primary to empirically substantiate the long-term adverse consequences of family incivility as burnout. The implications of these findings for applications and applications' extension of the work-home resources model to the family domain are elaborated in detail.

Automatic Heart Sound Segmentation and Murmur Detection in Phonocardiogram

This article aimed to design a software system for partial heart sound and define the problem to facilitate the doctor's primary job of diagnosing the normal or abnormal voice. The dataset was taken from Kaggle online site. The system was designed on several steps. The first step was to remove the noise by the use of a second-order bandpass filter, and the cutoff frequency was close to the heart sound frequency. The second step was to remove the spike by spike removal, and the final step was to use downsampling to normalize the amplitude of the signal to facilitate using the artificial neural network. The step that followed the signal processing was the segmentation and was done using Hilbert envelop, and then wavelet and PCA for feature extraction were used; finally, classification and training were done by feed forward neural network. All of these steps were implanted in MATLAB, and tests have shown that the accuracy is 97.639%. The number of data used in the training was 138 signal.

A Quality Improvement Project on Improving Electronic Prescribing System in an Adult Mental Health unit

AimsMedication tasks are an integral part of a junior doctor's job. However, these can often be timely and use hours that could be spent doing other therapeutic work, especially due to the cumbersome nature of SystmOne. Our aim was to review the amount, type, and time spent on medication tasks and evaluate ways in which the system could be made more efficient and time effective, to release doctors to complete other clinical ward activities.MethodsWe used prospective data collection, with two ten-day cycles carried out across the 46 bedded adult mental health unit (AMHU). Data were collected by all junior doctors working on the AMHU and every medication task was recorded on a designated document at the time of completion. This included data such as time the task was created, related ward, sender, type of task, amount of medications per task and minutes taken to complete.ResultsDuring the first ten-day cycle of data collection, we found that collectively we spent 21.5 hours completing medication related tasks. 10 hours were spent ordering medications, seven of which were ordering ward stock. Tasks involving completely re-prescribing the medication for the action to be completed took 12.6 hours. The data showed that 42% of tasks were completed on Mondays.Following cycle one we discussed the data with the AMHU pharmacy team, ward managers and consultants. Subsequent alterations were made to the stocklists for the wards, ward timings were aligned and a collective tasks system created to reduce duplication of tasks.During the second cycle of data, in total 16 hours were spent on medication tasks. There was a total of 7.45 hours spent ordering medications, 3.35 hours were ordering ward stock. Re-prescribing tasks took 9.7 hours.ConclusionFrom the results of the second cycle of data we can see the recommendations from cycle one have been effective in reducing the amount of time spent ordering medications by 25.8%. This highlights the importance of regularly updating the stocklists and utilising MDT working to maximise efficiency. We also confirmed that Monday was the heaviest day for tasks, which should be considered for staffing. As 46% of overall time was still spent ordering medications, we presented this data at the medicines management committee. Following this, recommendations have been taken to SystmOne for IT system alterations to improve efficiency of the system and allow junior/trainee doctors to focus more time on the clinical care of patients and learning.

Analysis of the Effect of Perceptions on The Distribution of Medical Services for BPJS Patients and Organizational Climate on Job Satisfaction of Doctors at Royal Prima Medan Hospital

Job satisfaction among doctors is the main key to getting better health services. Changes in payment methods in the JKN era led to the dissatisfaction of specialists and general practitioners with the medical services received in BPJS patient care. This study analyzes the effect of perceptions about the distribution of medical services for BPJS patients on the job satisfaction of doctors. The research design used in this study was a descriptive analytic non-experimental study with a cross-sectional approach. The study was conducted at the Royal Prima General Hospital located in Medan City from May 2021 to August 2021. The sample in this study was selected using the purposive sampling method so that a sample of 77 people was obtained with the inclusion criteria of having worked for at least 2 years. Data were analyzed using the Chi-Square test and multiple logistic regression. The results showed that the total medical services received by general practitioners per month was 10 million rupiah. Meanwhile, the total number of medical visits and services received by specialist doctors per month is 25 million rupiah. Based on the results of the Chi-Square test, it can be seen that doctors' perceptions of medical services (number of medical services (p = 0.000), timeliness of delivery (p = 0.000), suitability of medical services with performance (p = 0.003), distribution system (p = 0.004), and transparency (p=0.011)) had a significant effect on doctor's job satisfaction. The results of multiple logistic regression test show that the variable with the greatest influence is the number of medical services. The variable number of medical services has a value of Exp(B) = 29,830 (95% CI 3,037-293,034) that means that respondents who state the number of good medical services are 29 times more likely to be satisfied than those who state that the number of medical services is less. Doctor's job satisfaction can be increased by the management's efforts to be more open to doctors regarding doctor's medical services, giving doctors the opportunity to improve their career paths, and conducting periodic evaluations of doctor's satisfaction through questionnaires.

Knowledge and attitude of physicians toward child abuse and reporting in a tertiary hospital in Riyadh.

Child abuse is a common global devastating issue for the patient and physician. It can lead to much unpleasant and danger and even death. One of the most essential parts of a doctor's job is to help people in need and a child should be top priority as they are dependent for protection and care. To analyze the experience and knowledge of Saudi residents from both specialty family medicine and pediatrics working in Riyadh city toward the recognition and diagnosis of child abuse and neglect and spot the light on the barriers that prevent its reporting and to assess the need for further training. A cross-sectional study was conducted in four major tertiary hospitals in Riyadh (KKUH, National Guard Hospital, King Fahad Medical City, Prince Sultan Medical City) from March 2019 to January 2020. Most participants did not have sufficient knowledge regarding the physical assessment of suspected child abuse and neglect. The result showed no significant difference in terms of knowledge and attitude between family physicians and pediatrics working in tertiary centers in Riyadh. The study concluded that the Saudi residents from both specialties, that is, family medicine and pediatrics, had insufficient knowledge regarding child abuse. In addition, the residents had positive attitudes toward child abuse prevention. Finally, the study recommends conducting awareness campaigns to increase the knowledge of physicians about child abuse and the predictive factors.

Brain Tumor Detection and Segmentation Using RCNN

Brain tumors are considered as most fatal cancers. To reduce the risk of death, early identification of the disease is required. One of the best available methods to evaluate brain tumors is Magnetic resonance Images (MRI). Brain tumor detection and segmentation are tough as brain tumors may vary in size, shape, and location. That makes manual detection of brain tumors by exploring MRI a tedious job for radiologists and doctors’. So an automated brain tumor detection and segmentation is required. This work suggests a Region-based Convolution Neural Network (RCNN) approach for automated brain tumor identification and segmentation using MR images, which helps solve the difficulties of brain tumor identification efficiently and accurately. Our methodology is based on the accurate and efficient selection of tumorous areas. That reduces computational complexity and time. We have validated the designed experimental setup on a standard dataset, BraTS 2020. We used binary evaluation matrices based on Dice Similarity Coefficient (DSC) and Mean Average Precision (mAP). The segmentation results are compared with state-of-the-art methodologies to demonstrate the effectiveness of the proposed method. The suggested approach attained an average DSC of 0.92 and mAP 0.92 for 10 patients, while on the whole dataset, the scores are DSC 0.89 and mAP 0.90. The following results clearly show the performance efficiency of the proposed methodology.

CBSN: Comparative measures of normalization techniques for brain tumor segmentation using SRCNet

The segmentation of tumors in the brain MRI scans is a difficult job for doctors and radiologists. The segmentation done by different medical experts may also have differences in their opinion for the segmented region, which is popularly known as regions of interest (ROIs). To date, researchers and academicians have proposed several approaches and frameworks for semi- and full-automatic segmentation techniques to identify ROIs accurately. It is prevalent that automatic segmentation gives comparable or even better results compared to human experts for several publicly known and privately collected datasets. Additionally, these are beneficial in those areas where doctors and radiologists’ availability is either uneven or scarce because of geographical dispersion. The convolutional neural networks (CNN) are considered for segmentation for ROIs due to their wide popularity. They have outperformed humans over tasks like object identification and image classification. The publicly available datasets or those collected from different medical institutions may have different statistics, resolution, and properties. Therefore, pre-processing has an essential role in achieving better and accurate delineation and segmentation of tumors. In the proposed work, CBSN, we consider well-known normalization techniques such as Gaussian Mixture Models (GMM), Fuzzy C-Means (FCM), and Z-score normalization for pre-processing the BraTS (Brain Tumor Segmentation Challenge) 2018 dataset. We utilized three variants of U-Net architecture, convolutional block attention module (CBAM), squeeze and excitation module (SEM), and refinement module (RM) for the segmentation of the ROIs. Utilizing Z-score performs better than other normalization techniques for tumor core (TC) and whole tumor (WT) segmentation. In contrast, FCM performs superior to the other two normalization techniques on enhancement tumor (ET) segmentation.

Relationship between Training Intensity and Doctor’s Job Satisfaction at Primary Health Care in Indonesian

A doctor’s job satisfaction is important because it will improve the quality of health services. This study aimed to determine the relationship between intensity training and doctors satisfaction. This research was a cross-sectional study using data from Risnakes 2017. The sample was 5,140 doctors primary health care with civil servant status in Indonesia that was randomly selected. The data were analyzed using the Spearman correlation. This study showed that mean job satisfaction was 70.07 and intensity of the training was 3.98. There is a positive correlation between the training intensityand the doctor's job satisfaction of primary health care in Indonesia (p-value <0.000 and r = 0.063). More doctor's training will improve the ability of doctors to care for the patient's clinical according to the standards of competence.

Migration, Retention and Return Migration of Health Professionals Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

Medical education and training of health professionals are linked with their recruitment and retention. Practising as a competent health professional requires life-long continuous training and therefore training structures in health systems appear to influence doctors job satisfaction, their well-being and their intentions to remain in that health system. The commentary critiques aspects of the paper on doctors retention in Ireland, while drawing some parallels with the United Kingdom. There appears to be an emerging type of health professional migrants ‘education tourists’ who travel to other countries to obtain medical education creating new routes of migration and this presents new challenges to source and destination countries. The global shortage of doctors and other health professionals further exacerbates health inequalities as seen in the present pandemic and therefore the increased need for research into health professionals’ migration and their integration.

A SWOT analysis of implementation of continuous professional development for medical doctors in Sri Lanka

Introduction: Continuous Professional Development (CPD) is “A continuing process, outside formal undergraduate and postgraduate training, that allows individual doctors to maintain and improve standards of medical practice through the development of knowledge, skills, attitudes, and behaviour. However, CPD is not popular for Sri Lankan health professionals. The aim of this article is to conduct a SWOT analysis aiming at formulation of implementation strategies of CPD for medical doctors in Sri Lanka. Methods: The root causes analysis on CPD was done using Ishikawa diagram aided by the literature. SWOT and TOWS matrix analysis was performed to identify the strengths, weaknesses, opportunities and threats using literature and formulated CPD implementation strategies. Results: Lack of financial incentives, CPD infrastructure and training programs by professional collages, remoteness of doctors from main education centres, lack of time for doctors, CPD being none compulsory by law have been identified as leading causes against CPD implementation. Availability of considerable fund allocation at Ministry of Health, good perception towards lifelong learning among doctors as strengths; availability of international jobs for doctors, SLMA initiative to establish island wide CPD, availability of funding agencies and political influence as opportunities were identified to overcome threat and weaknesses. Conclusion: The MOH should start a National CPD steering committee with a representation of SLMC, SLMA, all professional collages, Medical faculties, Provincial directors, institutional heads and representation of government medical officers association to ensure an implementation of compulsory CPD in Sri Lanka.

Understanding the role of Foundation doctors through a self-reported time-mapping pilot study

IntroductionThere is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the...