Aged Care Services Research Articles

Smart Elderly Care: An Intelligent e-Procurement System for Elderly Supplier Selecting

(1) Objective: to accelerate the digitalization of the elderly care service industry and the construction of the smart elderly care industry, this paper designs an intelligent e-procurement system for elderly suppliers selecting from the perspective of smart elderly care, which can enhance the efficiency of elderly care supply chains and assist manufacturers of elderly products in choosing a reliable, high-quality supplier during trades. (2) Methods: the e-procurement system, including six modules, is built with an improved dynamic Markov Decision Process selection model combined with an Analytic Network Process, bringing dynamic evolution of both inventory cost and purchasing cost into long-term reward calculation, and taking into account 15 common indexes and 7 specific indexes when evaluating suppliers’ competitiveness. (3) Results: a real sample shows that when facing 50 suppliers with 50 different quotations, the e-procurement system selects a stable and reliable supplier that brings the best long-term profits for demand enterprises in ten purchase periods, and it makes the selecting process more efficient and more prompt. (4) Conclusions: the model can be used in the circumstance where an elderly product producer is forced to decide on a long-term strategy or reselect a new stable supplier since it is focused on choosing long-term and high-quality suppliers over numerous periods.

Impact of a Comprehensive Intervention Bundle Including the Drug Burden Index on Deprescribing Anticholinergic and Sedative Drugs in Older Acute Inpatients: A Non-randomised Controlled Before-and-After Pilot Study.

Implementation of the Drug Burden Index (DBI) as a risk assessment tool in clinical practice may facilitate deprescribing. The purpose of this study is to evaluate how a comprehensive intervention bundle using the DBI impacts (i) the proportion of older inpatients with at least one DBI-contributing medication stopped or dose reduced on discharge, compared with admission; and (ii) the changes in deprescribing of different DBI-contributing medication classes during hospitalisation. This before-and-after study was conducted in an Australian metropolitan tertiary referral hospital. Patients aged ≥75 years admitted to the acute aged care service for ≥48h from December 2020 to October 2021 and prescribed DBI-contributing medication were included. During the control period, usual care was provided. During the intervention, access to the intervention bundle was added, including a clinician interface displaying DBI score in the electronic medical record. In a subsequent 'stewardship' period, a stewardship pharmacist used the bundle to provide clinicians with patient-specific recommendations on deprescribing of DBI-contributing medications. Overall, 457 hospitalisations were included. The proportion of patients with at least one DBI-contributing medication stopped/reduced on discharge increased from 29.9% (control period) to 37.5% [intervention; adjusted risk difference (aRD) 6.5%, 95% confidence intervals (CI) -3.2 to 17.5%] and 43.1% (stewardship; aRD 12.1%, 95% CI 1.0-24.0%). The proportion of opioid prescriptions stopped/reduced rose from 17.9% during control to 45.7% during stewardship (p = 0.04). Integrating a comprehensive intervention bundle and accompanying stewardship program is a promising strategy to facilitate deprescribing of sedative and anticholinergic medications in older inpatients.

Who cares about Aboriginal Aged Care? Evidence of home care support needs and use in rural South Australia.

To assess awareness, needs and use of Australian Government-funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. Mixed-method study. Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). Fifty Aboriginal peoples aged 50-89 years (68% females) interviewed between August 2020 and October 2021. Participant awareness, needs and unmet needs. 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2-6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision-making.

For all seasons? Exploring the policy-context for co-creation

IMPACT ‘Co-creation’ is a major buzzword in contemporary governance. A range of public sector organizations nowadays declare co-creation as an overall strategy for their policies and actions. However, what co-creation should mean in operational terms often remains less clear. This article explores what co-creation could look like within three significantly different policy contexts: the exercise of authority, service delivery and regulation. To illustrate the argument, the article also explores the extent to which co-creation as a practice already exists in three Norwegian policy fields which resemble the three policy contexts. These three policy fields are child welfare and protection (authority), elderly care (service delivery) and climate policy (regulation). Although the illustrative examples are derived from a single country, they will be relevant to other countries as well.

An Australian aged care home for people subject to homelessness: health, wellbeing and cost–benefit

BackgroundOlder people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited.MethodsThis study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents’ physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived.ResultsThirty-five residents enrolled in the study between March 2020 – April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission.ConclusionWhile this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.

The Impact of Population Ageing on Rural Aged Care Needs in Australia: Identifying Projected Gaps in Service Provision by 2032.

This observational study examines and estimates the trends and impact of population ageing on rural aged care needs in Australia. With its universal health system and subsidised aged care system, Australia is among those countries with a long life expectancy. Being a geographically large country with a relatively small and dispersed population presents challenges for equitable access to aged care service provision. While this is widely acknowledged, there is little empirical evidence to demonstrate the magnitude and location of the aged care service provision gaps in the next decade. We performed time series analyses on administrative data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare GEN databases. The Aged Care Planning Regions (ACPR) were classified according to geographical remoteness using the Modified Monash Model scale. There is currently a shortfall of 2000+ places in residential aged care in rural and remote areas of Australia based on 2021 data. By 2032, population ageing will mean that an additional 3390 residential care places and around 3000 home care packages will be required in rural and remote communities alone. Geographical disparities in aged care exist in Australia and continue to worsen, requiring immediate action.

Research on innovative design of community mutual aid elderly care service platform based on Kano model

The mutual aid elderly care model is important to solve the world population's current aging problem. However, although mutual aid elderly care has been developing in China for more than 20 years, there is still a lack of a systematic way to participate in mutual aid elderly care services, which has led to a slow development of mutual aid elderly care. Therefore, in order to promote the development of mutual aid elderly care and the transition of social elderly care towards sustainability, this study analyzes the actual elderly care service needs and proposes new design strategies for mutual aid elderly care service platforms. In this study, first, the actual elderly care needs were obtained through interview methods and offline questionnaire surveys. The results showed that the elderly have a high demand for health, daily life, entertainment, and spiritual needs, which can be used to establish a comprehensive Kano model. Based on the priority of the needs hierarchy, mutual aid elderly care resources can be allocated rationally. For example, when applying the research results to the design of mutual aid elderly care service platforms, the “Must-be quality” is first satisfied, followed by the “One-dimensional quality” and the “Attractive quality” according to the actual situation. Furthermore, the mutual aid elderly care service platform is divided into a basic version and a professional version to promote the actual needs of different groups of elderly people. In conclusion, the study aims to promote the development of mutual aid elderly care and the transition of social elderly care towards sustainability. The research value of this study lies in its potential to alleviate the slow development of the current mutual aid elderly care model in China and provide a reference for solving the problem of global aging population.

Construction of smart older adults care service model driven by primary health care.

In recent years, with the arrival of an overall aging population, how to provide for the elderly has become the focus of government departments and society. The traditional elderly care service model has problems such as backward construction of information platforms, low quality of elderly care services, and "digital divide". For this reason, based on grassroots medical and health care, this paper improves the quality of elderly care services by establishing a smart elderly care service model. Through experiments, it can be found that compared with the traditional elderly care service model, the intelligent elderly care service model has an absolute advantage in the identification of nursing data. The recognition accuracy rate of the smart elderly care service model for all kinds of daily care data is above 94%, while the recognition accuracy rate of the traditional elderly care service model is below 90%. Therefore, it is of great significance to study the smart elderly care service model driven by primary medical care and health.

Steps to implementation: Understanding barriers and enablers for implementing Arts on Prescription at Home for people impacted by dementia.

Arts on Prescription at Home (AoP@Home) involves a professional artist visiting a person with dementia and their informal carer(s) in their own home to engage them in participatory art making. While there is evidence for the use of these programs, more work is needed to facilitate effective implementation. This study explored contextual barriers and enablers to implementation of AoP@Home within a real-world community aged care service. Two remote focus groups were conducted at a community aged care provider in Sydney, Australia. Key stakeholders (n = 14) were recruited, representing: people with dementia, informal (family) carers, AoP artists, service referrers and community service managers. Focus group transcripts were analysed using qualitative content analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). Outcomes were reviewed against the Expert Recommendations for Implementing Change (ERIC) strategy compilation to inform development of a tailored implementation strategy. Four overarching themes described the range of barriers and enablers to AoP@Home implementation: (1) "I don't know enough about it" (awareness and engagement within the sector), (2) artists delivering programs, (3) awareness and engagement of people impacted by dementia, (4) practicalities of implementation. All five domains of the CFIR were represented across the four themes. The ERIC compilation provided a list of practical strategies for implementation of AoP@Home. The implementation of psychosocial interventions for people living with dementia within a community aged care service is complex and multifactorial. So what?: Organisations planning implementation should consider conducting their own pre-implementation analysis to identify context-specific strategies.

Optimising the quality of clinical data in an Australian aged care and disability service to improve care delivery and clinical outcomes (OPTIMISE): Protocol for an Agile Lean Six Sigma study.

In Australia, aged care and disability service providers are legally required to maintain comprehensive and accurate clinical documentation to meet regulatory and funding requirements and to support safe and high quality care provision. However, evidence suggests poor quality clinical data and documentation is widespread across the sector and can significantly affect clinical decision-making and care delivery and increase business costs. The OPTIMISE study uses an Agile Lean Six Sigma framework to: 1) identify opportunities for optimisation of clinical documentation processes and clinical information systems, 2) implement and test optimisation solutions, and 3) evaluate outcomes post-optimisation, in a large post-acute community-based health service providing aged care and disability services in Western Australia. A three-stage prospective optimisation study will be undertaken. Stage 1 (Baseline) will measure existing clinical data quality, identify root causes of data quality issues across services, and generate optimisation solutions. Stage 2 (Optimisation) will implement and test changes to clinical documentation processes and information systems using incremental Agile sprints, and Stage 3 (Evaluation) will evaluate change in primary and secondary outcomes from baseline to 12 months post-optimisation. The primary outcome is data quality measured in terms of Defects Per Unit (DPU), Defects Per Million Opportunities (DPMO) and Sigma level. Secondary outcomes are care delivery (direct care time), clinical incidents, business outcomes (cost of quality, workforce productivity), and user satisfaction. Case studies will be analysed to understand impacts of optimisation on clinical outcomes and business processes. As of 1 June 2022, Stage 1 commenced with baseline data quality audits conducted to measure current data quality. Baseline data quality audits will be followed by user consultations to identify root causes of data quality issues. Optimisation solutions will be developed by January 2023 to inform optimisation (Stage 2) and evaluation (Stage 3). Study findings will be of interest to individuals and organisations in the healthcare sector seeking novel solutions to improve the quality of clinical data and support high quality care delivery and reduce business costs. N/A.

Smart Pension System Based on Big Data Mining Algorithm

With the increasingly prominent problem of aging in our country, it has become an urgent task for our society to establish and improve a good old-age care system. At present, a new type of community smart elderly care model is gradually emerging, and has been actively explored and improved. In order to meet the needs of community elderly care services, big data mining algorithms are used to process data, and the smart elderly care system is connected with mobile APP and computer server equipment. Open source WebGIS technologies such as OpenLayers/Cesium, PostgreSQL/PostGIS, GeoServer, etc. are used as core supports, combined with front-end And back-end development technologies such as Vue and SpringBoot, etc., developed a mobile smart pension app and a web smart pension system based on open source WebGIS. This system can be more in line with my country's current smart elderly care service system, and accelerate the construction process of my country's intelligent elderly care.

Hospital congestion: a market solution to address delayed transfers of care from hospital beds.

Hospital congestion: a market solution to address delayed transfers of care from hospital beds.

Community home elderly care services, multidimensional health and social participation of chronically ill elderly-Empirical analysis based on propensity score matching and multiple mediation analysis.

In recent years, China's aging process has deepened rapidly, the disease spectrum of the population has undergone major changes, the proportion and scale of elderly patients with chronic diseases are growing rapidly, and the multidimensional health problems of the chronically ill elderly are prominent, seriously affecting the participation of the chronically ill elderly in family, community, and social development. In response, China has implemented the "active response to population aging strategy," accelerated the development of community home elderly care services, and encouraged the chronically ill elderly to continue to play a role through social participation. So how does the community-based home-based medical care service affect the social participation of the chronically ill elderly? Is an important subject. Based on the 2018 China Longitudinal Aging Social Survey and the propensity score matching method to measure the impact of community home elderly care services on the four types of social participation of chronically ill elderly, including economic participation, family participation, voluntary participation, and political participation, and group differences, and uses the multiple mediation analysis method to explore the mechanism and effect of community home elderly care services on the four types of social participation of chronically ill elderly. (1) Community home elderly care services have an asymmetric impact on the social participation of the chronically ill elderly, and have generally promoted the level of social participation of the chronically ill elderly. (2) Community home elderly care services change the social participation arrangements of the chronically ill elderly by driving and inhibiting effects, so that it has a tendency to reduce economic participation and increase voluntary participation and political participation as a whole. This feature shows group differences among the chronically ill elderly of different ages, education levels, living arrangements and community types. (3) Community home elderly care services have an asymmetric impact on various social participation of the chronically ill elderly through the multidimensional health mediation mechanism. (1) With the continuous deepening of the interweaving between the growth of chronic diseases and the aging of the population in China, the development of a positive aging society must attach great importance to the important role of social participation for the chronically ill elderly. (2) Strengthen the development of physical, psychological, and social adaptation and other health abilities of the chronically ill elderly, shape their awareness of social participation, and give the chronically ill elderly a reasonable social role orientation. (3) Through policy incentives, promote the realization of fairness, justice, adequacy, and sustainability of community home elderly care services. (4) Pay special attention to the penetration, integration, and application of digital technology into the field of community home elderly care services to effectively protect the health of chronically ill elderly, ensure that the elderly with different chronic diseases participate in social activities of high quality, enjoy a high-quality happy life, and promote the high-quality development of the aging society.

Medication-Related Complaints in Residential Aged Care.

Complaints reflect a person's or family's experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: 'pain management', 'sedation', and 'infectious disease/infection control'. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision.

Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants.

Older people experiencing homelessness (PEH) are a rapidly growing population at risk of accelerated aging and the early onset of geriatric conditions. One construct that shows promise in predicting age-related decline is frailty. Better understanding the rates and causes of frailty in PEH may improve understanding of its antecedents, thereby facilitating more targeted health and aged care service interventions. The aim of this study was to conduct a rapid review on the prevalence and determinants of frailty in adult PEH. We conducted a rapid review of primary research papers studying PEH and frailty or frailty-related concepts. Fourteen studies were included, which indicate that frailty presents earlier and at higher rates in PEH than community-dwelling cohorts. A notable difficulty for many aging PEH was early-onset cognitive impairment which was associated with a range of negative functional outcomes. Another recurrent theme was the negative impact that drug and alcohol use and dependence can have on the health of PEH. Further, psychosocial and structural determinants such as loneliness, living in an impoverished neighborhood and being female had statistically significant associations with frailty and functional decline in PEH. PEH in their 40s and 50s can be frail and experience geriatric conditions, including cognitive impairment. Factors that have important relationships to frailty and functional decline in PEH include cognitive deficits, drug and alcohol dependence and loneliness, as well as upstream determinants such as gender and ethnicity. More targeted data and research on these factors, including cohort studies to better investigate their potentially causal effects, is important for researchers and practitioners assessing and treating frailty in PEH, particularly those interested in early intervention and prevention. CRD42022292549.

The association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services: 2008 ~ 2018

BackgroundThe changes in demographic and family structures have weakened the traditional norms of filial piety and intergenerational relationships dramatically. This study aims to examine the dynamic association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services.MethodsData was derived from the 2008–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a longitudinal survey of a nationally representative sample of individuals aged 60 and over. Random effects model was used to assess the association between financial support and informal care provision of adult children to their parents.ResultsIt was found that financial support showed an upward trend while informal care provision showed a download trend from 2008 to 2018. The result indicated a significant and negative association between financial support and informal care provision of adult children to their parents (B = -0.500, 95% confidence interval (CI) = -0.761 to -0.239). And the association was significant among elderly people who were from urban areas (B = -0.628, 95% CI = -0.970 to -0.287), co-resided with adult children (B = -0.596, 95% CI = -0.939 to -0.253), and had community-based services (B = -0.659, 95% CI = -1.004 to -0.315).ConclusionFinancial support was negatively associated with informal care provision of adult children to their parents in China, and the association has differences in household registration, residence arrangement and community-based care services. It is suggested that policymakers should prioritize planning interventions for elderly care services and establish a family caregiver support system.

Effectiveness of clinical mentorship program for students of long-term aged care: A mixed-methods study

BackgroundInternationally, the population is rapidly aging with a strong demand for aged care services. In Taiwan, both recruiting and retaining staff to aged care poses difficulties. Good clinical role models can positively impact students' confidence and professional development and influence their willingness to enter the long-term aged care workforce. ObjectivesTo clarify clinical mentors' roles and competencies and assess the effectiveness of a mentorship program for improving students' professional commitment and self-efficacy in long-term aged care. DesignA mixed-methods study with a quasi-experimental research design and qualitative interviews. SettingsPurposive sampling was used to recruit long-term aged care professional clinical mentors with preceptor qualifications and nursing and aged care students enrolled in a two-year technical program in a Taiwanese university's gerontology care department. ParticipantsFourteen mentors and 48 students participated. The student control group received regular education; the experimental group received mentorship guidance. MethodsThis study included three phases. Phase one involved qualitative interviews to identify clinical mentors' roles and competencies. Phase two involved expert panel meetings to establish the clinical mentorship program's content and implementation. Phase three involved the program's evaluation. Quantitative questionnaires were administered before the program and subsequently at 6, 12, and 18 months to assess mentors' effectiveness and students' professional commitment and self-efficacy in long-term aged care. Qualitative focus groups solicited participants' feelings and suggestions for the program. ResultsClinical mentors' roles and competencies centered on two themes: professional role model and establishing good rapport. Quantitative analysis showed that mentoring effectiveness initially recorded a decline, followed by a subsequent increase. Both groups' professional self-efficacy and commitment followed an increasing trend. While the experimental group's professional commitment score was significantly higher than the control groups, their professional self-efficacy scores did not differ significantly. ConclusionsThe clinical mentorship program improved students' long-term aged care professional commitment and self-efficacy.

“We Will Never be The Same”: Photovoice Reports From Social Workers of Aged Care During COVID-19

Using photovoice methodology, this study aimed to capture the perspectives of social workers from aged care services on how the pandemic impacted them at a professional level. This study comprised 12 social workers (aged 22–41 years; 11 females) who worked in aged care facilities during the first year of the COVID-19 pandemic. Based on photovoice methodology, as a participatory visual research method focused on individual and community assets and co-creation of knowledge, participants were asked to take photographs and then share the photos and associated narratives in a group session on the topic “Me as a professional: One year of pandemic”. From the thematic analysis, four themes emerged: personal and professional growth (increased resilience, with new perspectives on life), responding to the pandemic (implementation of immediate actions to prevent the virus propagation), teamwork (union among staff), and eyes on the future (with a sense of uncertainty, yet supported by the good lessons learned). The coronavirus disease (COVID-19) pandemic has had a significant impact on aged care facilities, with social workers becoming frontline professionals in a public health crisis. These professionals faced “forced growth” during the pandemic that has transformed them both professionally and personally.

Factors and Mechanism Influencing Client Experience of Residential Integrated Health and Social Care for Older People: A Qualitative Model in Chinese Institutional Settings

An emerging service delivery model of integrating health and social care for older people has been actively promoted by the Chinese government since 2016, but the client experience and influencing mechanism still remain unclear. this study adopts a qualitative methodology to delve deeper into the factors and mechanism shaping the client experience of residential integrated health and social care for older people in the Chinese context, so as to understand the experiences of older residents during the whole process of receiving integrated care services, and on this basis, put forward suggestions for the improvement of a high-quality aged care service system. We coded and analyzed the in-depth interview data of twenty older adults and six staff members from June 2019 to February 2020, recruited from six institutions in Changsha, one of the ninety pilot cities for integrated health and social care in China. the findings showed that the client experience of older adults is mainly affected by factors in three dimensions (scene construction, individual minds, and interaction and communication), which are comprised of six sub-categories (social foundation, institutional functions, perception and emotion, cognition and understanding, intimacy and trust, and participation). Based on the factors and mechanism (consisting of six influencing paths), we constructed a model of the client experience of integrated health and social care for older people in the Chinese population. the factors and mechanism influencing the client experience of integrated health and social care for older people are complex and multifaceted. Attention should be paid to the direct effects of perception and emotion, institutional functions, intimacy and trust in the client experience, and the indirect effects of social foundation and participation on the client experience.

The Forecasted Prospects of the Return of Investment in Elderly Care Service Industry Based on the Analysis of the Market and YADA

With the slow increase in birth rate, China has stepped into an aging society and the aging population will continue to grow, and the burden on young people to support the elderly is becoming heavier and heavier. The elderly care service has become a hot issue. Therefore, this paper is based on an in-depth study of the financial statements and market research of Beijing Yada Senior Living Group Co., Ltd., and analyzes the current market situation of the elderly care service industry in China using a combination of macro and microenvironment analysis and the internal and external competitiveness of the company and give recommendations for its development. The study shows that although people's social cognition has become part of the obstacles, the increasing demand for senior care services in the country according to the company's operating data in recent years shows that senior care currently belongs to a window period for investment and is highly likely to bring huge returns to investors in the future. As a result, it is recommended that more investors should focus on the senior care market and consider providing more capital as a solid foundation for its development.