Intermediate Services Research Articles

The Impact of Agglomeration Economies on Hospital Input Prices

This paper examines the extent to which agglomeration of the hospital service industry enhances the productivity of producing health care. Specifically, we use a large set of private insurance claims from the FAIR Health database to show that an increasing spatial concentration of hospital services results in a decreased cost of obtaining intermediate medical services. We explicitly test whether the reduced cost at concentrated locations arises from the ability to share intermediate service providers. The identification relies on state variation in medical lab technician licensure requirements, which influence the cost of intermediate services only through the cost of running a lab. Our findings suggest that agglomeration of the hospital service industry attracts specialized medical labs, which in turn help to reduce the cost of producing laboratory tests.

Aquatic biodiversity in forests: a weak link in ecosystem services resilience

The diversity of aquatic ecosystems is being quickly reduced on many continents, warranting a closer examination of the consequences for ecological integrity and ecosystem services. Here we describe intermediate and final ecosystem services derived from aquatic biodiversity in forests. We include a summary of the factors framing the assembly of aquatic biodiversity in forests in natural systems and how they change with a variety of natural disturbances and human-derived stressors. We consider forested aquatic ecosystems as a multi-state portfolio, with diverse assemblages and life-history strategies occurring at local scales as a consequence of a mosaic of habitat conditions and past disturbances and stressors. Maintaining this multi-state portfolio of assemblages requires a broad perspective of ecosystem structure, various functions, services, and management implications relative to contemporary stressors. Because aquatic biodiversity provides multiple ecosystem services to forests, activities that compromise aquatic ecosystems and biodiversity could be an issue for maintaining forest ecosystem integrity. We illustrate these concepts with examples of aquatic biodiversity and ecosystem services in forests of northwestern North America, also known as Northeast Pacific Rim. Encouraging management planning at broad as well as local spatial scales to recognize multi-state ecosystem management goals has promise for maintaining valuable ecosystem services. Ultimately, integration of information from socio-ecological ecosystems will be needed to maintain ecosystem services derived directly and indirectly from forest aquatic biota.

Intermediate Services After Behavioral Health Hospitalization: Effect on Rehospitalization and Emergency Department Visits.

This study examined the effect of intermediate service use on behavioral health inpatient readmissions and subsequent emergency department (ED) visits among Medicaid enrollees. Data were from fee-for-service inpatient admissions from the 2008 Medicaid Analytic eXtract files for adults with a primary diagnosis of a mental or substance use disorder. A multivariate survival analysis estimated the association between posthospital services-particularly intermediate services (residential, partial hospital, intensive outpatient, and other rehabilitative services)-and time to readmission or ED visit. A propensity score-matched sample was used to examine the relationship between time to readmission and ED visit in the nondisabled and disabled populations more closely. The sample included 32,037 adults (nondisabled, 27.6%; disabled, 72.4%). Only 2.5% of nondisabled adults and 5.4% of disabled adults used intermediate services within seven days of hospital discharge. In the multivariate analysis, significant associations were found between intermediate service use and readmissions and ED visits in the nondisabled population (hazard ratio [HR]=.71, p=.04, and HR=.68, p<.01, respectively), but not in the disabled population. Significant associations were also found between use of other health care in the seven-day posthospitalization period and decreased time to readmission and ED visits in the nondisabled population and increased time to readmission and ED visits in the disabled population. In the propensity score--matched analysis, use of intermediate services was not significant in either population. The low use of intermediate services may reflect limited availability as well as Medicaid coverage limits. Research is needed to determine the optimal number and type of intermediate services for this population to minimize the need for additional hospital services.

The role of the intermediate care team in detecting and responding to loneliness in older clients.

The intermediate care team supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how intermediate care team professionals perceive, detect or respond to loneliness in their clients. This study explores intermediate care team professionals' attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data were analysed thematically using framework analysis, applying the theory of planned behaviour as an interpretive framework. Intermediate care team professionals see loneliness as a significant issue for many of their older clients but a low priority for intermediate care team services. They believe that loneliness often goes undetected because it is difficult to measure objectively. Barriers to managing loneliness included high workloads, unsatisfactory referral systems and lack of close working with social care and independent sector services. Brief but reliable loneliness assessments into routine practice, receiving training on detecting and managing loneliness, and improving working relationships with social care and independent sector services were highlighted as strategies that could improve the detection and management of loneliness in intermediate care team clients.

Optimizing intermediate ecosystem services in agriculture using rules based on landscape composition and configuration indices

Important intermediate ecosystem services (ES) such as crop pollination and biological control of pests, which underpin the final ES agricultural yields, are mediated by mobile organisms that depend on availability of habitat and its arrangement in the landscape. It has been suggested that landscape-scale management (LSM) of habitat in a multi-farm setting results in higher provisioning of such ES compared to farm-scale management (FSM). However, to achieve the LSM solution, farmers' land-use decisions need to be coordinated. To this end, we develop rules based on novel landscape composition and configuration indices. We model farmers' interdependencies through ES in an agent-based model (ABM) and optimize land use at both the farm and landscape scales for comparison. Our analysis is based on a simple artificial landscape with homogeneous soil quality and uses crop pollination as an illustrative ecosystem service. We consider habitat configuration at the field scale. Our rules demonstrate that the coordinated solution is characterized by a higher degree of habitat availability and a configuration of habitat that is dispersed rather than agglomerated. We tested these rules over a range of assumptions about ecological parameter values and suggest that such rules could be used to improve governance of ES in agricultural landscapes.

The (strong) interdependence between intermediate producer services' attributes and manufacturing location

The empirical evidence shows that a high degree of co-location exists between intermediate producer services and manufacturers. This paper develops a theoretical model based on the Footloose Entrepreneur Model of the New Economic Geography in which intermediate producer services play an essential role in characterizing the industrial landscape. Our results show that the concentration of manufacturing is favored when the service sector has high price elasticity for any variety and is a very efficient sector in production and when the mobile-fixed factor, skilled workers, is important in the production of manufacturing. In a nutshell, to promote economic activity, the industrial policy and service sector policy should be coordinated.

Labour Demand, Offshoring and Inshoring: Evidence from Swedish Firm‐level Data

AbstractThe objective of this paper was to analyse effects on firm–level relative demand for skilled labour due to imports of intermediates (offshoring) and exports of intermediates (inshoring). The study is based on a data set of Swedish manufacturing firms, 1997–2002, using trade flows in intermediate goods and services, respectively. Descriptive data show that goods inshoring is much larger than goods offshoring, while the reverse is true for services. There is, however, a strong increase in services inshoring over the study period. Controlling for potential endogeneity in offshoring and inshoring, our results indicate that there is a positive effect of services offshoring on the skill composition of workers in Swedish firms, while no such causality can be established from inshoring.

Termination of Resuscitation Rules to Predict Neurological Outcomes in Out-of-Hospital Cardiac Arrest for an Intermediate Life Support Prehospital System

Aim: Futile resuscitation can lead to unnecessary transports for out-of-hospital cardiac arrest (OHCA). The Basic Life Support (BLS) and Advanced Life Support (ALS) termination of resuscitation (TOR) guidelines have been validated with good results in North America. This study aims to evaluate the performance of these two rules in predicting neurological outcomes of OHCA patients in Singapore, which has an intermediate life support Emergency Medical Services (EMS) system. Methods: A retrospective cohort study was carried out on Singapore OHCA data collected from April 2010 to May 2012 for the Pan-Asian Resuscitation Outcomes Study (PAROS). The outcomes of each rule were compared to the actual neurological outcomes of the patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and predicted transport rates of each test were evaluated. Results: A total of 2,193 patients had cardiac arrest of presumed cardiac etiology. TOR was recommended for 1,411 patients with the BLS-TOR rule, with a specificity of 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.7, 100.0), sensitivity 65.7% (63.6, 67.7), NPV 5.6% (4.1, 7.5), and transportation rate 35.6%. Using the ALS-TOR rule, TOR was recommended for 587 patients, specificity 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.4, 100.0), sensitivity 27.3% (25.4, 29.3), NPV 2.7% (2.0, 3.7), and transportation rate 73.2%. BLS-TOR predicted survival (any neurological outcome) with specificity 93.4% (95% CI 85.3, 97.8) versus ALS-TOR 98.7% (95% CI 92.9, 99.8). Conclusion: Both the BLS and ALS-TOR rules had high specificities and PPV values in predicting neurological outcomes, the BLS-TOR rule had a lower predicted transport rate while the ALS-TOR rule was more accurate in predicting futility of resuscitation. Further research into unique local cultural issues would be useful to evaluate the feasibility of any system-wide implementation of TOR.

Borderline personality disorder in an intermediate psychological therapies service

ABSTRACTThe intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n = 63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.

Characteristics and Outcomes of Patients with Prolonged Stays in an Intensive Care Unit

Objective:To determine the characteristics and outcomes of patients with prolonged stay in a tertiary-care ICU.Method:Electronic database records of patients 18 years or older and hospitalized in the ICU from March 2010 to March 2013 were enrolled. Age, gender, main reason for ICU admission, length of mechanical ventilation and ICU stay, in-hospital and one year mortality were noted.Results:Electronic database records of patients 18 years or older and hospitalized in the ICU from March 2010 to March 2013 were enrolled. Age, gender, main reason for ICU admission, length of mechanical ventilation and ICU stay, in-hospital and one year mortality were noted.Conclusion:Patients with a prolonged ICU stay constituted a small percentage of all ICU admissions but they proportionally used many more ICU bed days than short-stay patients. The mortality of prolonged ICU stay patients was very high. Very few survivors were living independently at one year. Thus, development of intermediate care units, palliative care and home care services are emerging necessities, to decrease the LOS in ICUs.

Wetland economic valuation approaches and prospects in China

Ecosystem services valuation seeks to increase the social relevance of ecosystem characteristics, the underlying biological mechanisms that support services, by making the contribution of ecosystems to human well-being explicit. Economic valuation can help management by clarifying the full range of benefits and costs of proposed management actions. In the past two decades, economic valuation of wetland ecosystem services has become one of the most significant scientific priorities for wetland protection. In this paper, we provide an overview of ecosystem services, and summarize the main interdisciplinary approaches to measure and value wetland ecosystem services. We identified four main methodological gaps preventing progress on wetland valuation of ecosystem services in China, which are: 1) confusion on terminology like intermediate and final ecosystem services, 2) lack of ecological production functions to link ecosystem characteristics to final ecosystem services, 3) static valuation making it difficult to evaluate the trade-offs and synergies among ecosystem services, and 4) lack of clear guidance on relating ecological compensation programs to conservation targets. Overcoming these gaps is important to inform wetland compensation mechanisms and conservation policies. We propose future research on wetland ecosystem services in China should be focused on: 1) defining final ecosystem services based on beneficiary preferences and underlying biophysical mechanisms, 2) establishing wetland monitoring programs at specific sites to collect data on final ecosystem service indicators and ecosystem characteristic metrics to create ecological production functions for economic valuation and rescaling techniques, and 3) incorporating wetland ecosystem service values into decision-making processes to inform wetland management.

Support and preferences for intermediate health care services for back and neck pain: a survey among members of the Dutch patient association for spinal pain.

Recent health care reforms in the Netherlands have led to the introduction of intermediate health care. Intermediate health care combines features of primary care and secondary (hospital) care. It is characterized by a task shift from hospital care to primary care. The initial experiences of medical specialists and general practitioners with intermediate health care are positive. However, the patients' perspectives regarding this reform are unknown. This study aimed to evaluate the level of support from patients with back and/or neck pain for intermediate health care services and to provide insight into their preferences how this care should be organized. A cross-sectional survey was conducted in which members of the patient association for spinal pain in the Netherlands completed electronic questionnaires to measure the level of support and preferred organization of intermediate health care services. Questionnaires were returned by 367 patients (response rate: 51%). Respondents supported the concept of intermediate health care (numeric rating scale: 7/10). Aspects considered important for intermediate health care included knowledge and expertise of staff, multidisciplinary cooperation, patient contact time, reimbursement via health insurance, quality control of care, evidence-based treatments and electronic medical records. Although intermediate care is a health care reform, patients continued to think according to traditional primary and secondary care constitutions. Patients with neck and/or back pain support the introduction of intermediate health care services and have explicit preferences regarding its organization, but may need to be better informed when intermediate care is introduced.

Geriatric medicine and geriatricians in the UK. How they relate to acute and general internal medicine and what the future might hold?

The Royal College of Physicians and its Future Hospitals Commission has a renewed focus on general internal medicine. But in 2015, most is in effect either acute medicine or geriatric medicine. Acute physicians and 'organ specialists' looking after inpatients on specialty wards or at the acute hospital 'front door' will need sufficient skills in geriatric medicine, rehabilitation, discharge planning and palliative care, as frailty, dementia and complex comorbidities may complicate the care of older patients with predominant speciality-defining complaints. In an era where we are urged to focus on patient-centred care, patients' preference for continuity and 'whole-stay', consultants must be recognised and respected. Ideally, this will require increasing numbers of geriatricians and acute physicians, more age attuned training for all; a shift in values and status. This should be backed by adequate capacity and rapid access to social and intermediate care services outside hospital, as well as adequate multidisciplinary staff and skills within the acute hospital to ensure that older patients' needs beyond the immediate complaints are not neglected. Meanwhile, geriatric medicine itself has diversified into specialised, community and interface roles, aligned with the integration agenda, and continues to contribute substantially to acute, general and stroke medicine. These developments are described here.

International R&amp;D Spillovers and Business Service Innovation

AbstractA major international transmission channel of productivity increases is trade in intermediate products and services. This paper follows existing literature to analyse international spillovers at the industry level, extending the analysis to investigate the importance of spillovers from services sector in this framework. The analysis makes use of newly available data on international input–output linkages between industries. Our results indicate significant positive productivity effects from innovation in knowledge‐intensive, high‐technology business services and confirm the productivity effects from international manufacturing spillovers found in recent literature.

扎龙湿地生态系统服务价值评价

PDF HTML阅读 XML下载 导出引用 引用提醒 扎龙湿地生态系统服务价值评价 DOI: 10.5846/stxb201405161006 作者: 作者单位: 中国林业科学研究院湿地所 作者简介: 通讯作者: 中图分类号: 基金项目: 林业公益性行业科研专项(201204201) Evaluation of ecosystem services in the Zhalong wetland Author: Affiliation: Institute of Wetland Research, Chinese Academy of Forestry Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:从避免重复计算的角度出发,将湿地生态系统服务分为最终服务和中间服务两部分,以最终服务的价值作为湿地生态系统服务的总价值。以扎龙湿地为例,其最终服务包括物质生产、土壤保持、水质净化、气候调节、固碳、调蓄洪水、大气调节、休闲旅游、科研教育和授粉服务,中间服务包括净初级生产力、营养循环、涵养水源、地下水补给和生物多样性维持服务,采用市场价值法、替代成本法和旅行费用法等生态经济学方法对扎龙湿地的生态系统服务进行了评价。结果表明,2011年扎龙湿地生态系统服务总价值为679.4亿元,中间服务价值为471.5亿元,各项最终服务的价值大小为气候调节>调蓄洪水>大气调节>固碳>休闲旅游>授粉服务>物质生产>水质净化>科研教育>土壤保持。扎龙湿地不仅是重要的蓄洪区和泥碳储存地,在区域气候调节方面也起着巨大的作用。针对扎龙湿地的管理,应该保护和恢复湿地面积,同时注意适当的增加旅游。 Abstract:Ecosystem service evaluations play an important role in the management and conservation of wetlands. However, current evaluation methods may count some services twice, and may not reflect the actual value of an ecosystem. In order to avoid the repeat accounting, this study divides wetland ecosystem services into ultimate services and intermediate services, and then uses ultimate services as the gross value of ecosystem services provided by the wetland. Here, we present a case study on the Zhalong wetland. The ultimate services accounted for include substance production, soil conservation, water purification, climate regulation, carbon fixation, flood regulation, gas regulation, recreation, science and education, and pollination. Intermediate services include net primary production (NPP), nutrient cycling, water conservation, groundwater recharge, and biodiversity maintenance. The methods employed in evaluating ecosystem services include the market value method, the replacement cost method, and the travel cost method. The results indicate the gross value of ecosystem services provided by Zhalong wetland is 67.94 billion Yuan RMB, and the value of the intermediate services is 47.15 billion Yuan RMB. The ranking of ultimate services in the decreasing order is as follows:climate regulation (420.00 × 108 Yuan RMB), flood regulation (226.00 × 108 Yuan RMB), gas regulation (17.35 × 108 Yuan RMB), carbon fixation (8.6 × 108 Yuan RMB), recreation (3.86 × 108 Yuan RMB), pollination (1.74 × 108 Yuan RMB), substance production (1.43 × 108 Yuan RMB), water purification (0.3 × 108 Yuan RMB), science and education (0.08 × 108 Yuan RMB), and soil conservation (0.03 × 108 Yuan RMB). The findings suggest Zhalong wetland is not only essential for regulating floods and storing carbon dioxide, but also plays an important role in regulating climate change. We suggest wetland management should aim to conserve wetland areas and increase tourism development in a balanced manner. 参考文献 相似文献 引证文献

湖泊生态服务受益者分析及生态生产函数构建

PDF HTML阅读 XML下载 导出引用 引用提醒 湖泊生态服务受益者分析及生态生产函数构建 DOI: 10.5846/stxb201410192051 作者: 作者单位: 中国科学院生态环境研究中心,亚利桑那州立大学,中国科学院生态环境研究中心 作者简介: 通讯作者: 中图分类号: 基金项目: 国家林业公益性行业科研专项(201204201) Beneficiary analysis and ecological production function to measure lake ecosystem services for decision-making in China Author: Affiliation: Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences,Arizona State University,Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:生态系统服务管理作为生态系统管理的优化方式,是生态学研究的前沿方向。湖泊生态系统服务管理是指综合利用生态学、经济学、社会学和管理学等学科知识,对影响湖泊生态系统结构、过程、功能的关键因子进行调控,提高湖泊生态系统服务供给水平和供给能力的过程。近年来国内外学者针对湖泊生态系统服务内涵、分类、经济价值评估等方面开展了大量研究,极大地促进了湖泊生态系统服务从认知走向管理实践。然而,现有研究在开展湖泊生态系统服务价值评估时多忽略生态系统服务受益者和生态系统特征对生态系统服务的边际影响分析,无法揭示生态系统服务空间流动和转移特征及生态系统服务时空权衡关系,制约了生态系统服务研究与管理决策和政策设计结合。在综述湖泊生态系统服务定量评估方法的基础上,认为通过生态系统服务受益者分析确定湖泊生态系统最终服务,并通过构建生态生产函数确定湖泊生态系统服务权衡关系及湖泊生态系统特征对生态系统最终服务的边际影响,是生态系统服务走向管理实践和政策设计的科学依据,可以确保生态、社会、经济可持续发展。 Abstract:Lakes provide important resources to sustain human livelihoods and economic development. Lakes have significant ecological, cultural, and economic value in China as they supply drinking water, valuable fish species, regulate local climates, and provide scenic landscapes for leisure and tourism. However, they are one of the most extensively and rapidly altered ecosystems in China. Ecosystem services offer a holistic framework to link ecological and economic outcomes to manage the interconnectivity between ecosystems and human welfare. The ecosystem services concept seeks to clarify tradeoffs among ecosystem services and other social demands to improve lake ecosystem management. In recent decades, scientists have increasingly recognized the relevance of ecosystem services in policy analysis. In China, policy makers want to use ecosystem services in ecological compensation programs where consumers of ecosystem services pay suppliers for the benefits. However, technical challenges in separating intermediate ecosystem services from final ecosystem services to quantify tradeoffs are hindering the measurement and valuation of ecosystem services for lake management. Chinese scientists are confronted with the challenge of creating credible and legitimate ecosystem service values to inform policy makers on designing effective ecological compensation programs. A transdisciplinary approach is fundamental to measuring ecosystem services to understand how biological mechanisms of lake ecosystems support final ecosystem service flows. In the present study, we identify methods to measure lake ecosystem services and the gaps in current methods, and propose using ecosystem service flow mechanisms and beneficiary analysis to identify final ecosystem services, and ecological production functions to characterize the relationships between management choices, ecological characteristics, and economically valuable final ecosystem services. Ecological production function can help advance ecosystem services quantification to clarify tradeoffs for incorporating ecosystem services into lake management in China. 参考文献 相似文献 引证文献

The impact of agglomeration economies on hospital input prices

This paper examines the extent to which agglomeration of the hospital service industry enhances the productivity of producing health care. Specifically, we use a large set of private insurance claims from the FAIR Health database to show that an increasing spatial concentration of hospital services results in a decreased cost of obtaining intermediate medical services. We explicitly test whether the reduced cost at concentrated locations arises from the ability to share intermediate service providers. The identification relies on state variation in medical lab technician licensure requirements, which influence the cost of intermediate services only through the cost of running a lab. Our findings suggest that agglomeration of the hospital service industry attracts specialized medical labs, which in turn help to reduce the cost of producing laboratory tests.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-015-0075-1) contains supplementary material, which is available to authorized users.

How a rapid response team is supporting people to remain at home.

This article explores the work of a rapid response team (RRT) in an English city. The RRT is a multiprofessional intermediate care team that is able to support patients to remain at home during clinical crises and changes to their social care needs. The service is popular with patients and cost effective. The National Audit of Intermediate Care is in its fourth year and benchmarks how intermediate care services are delivered across England. RRT data are compared with the national data, and show that keeping the team as a crisis intervention service has enabled it to maintain capacity to support patients at home without requiring hospital admission.

Measuring total social income of a stone pine afforestation in Huelva (Spain)

We apply an experimental ecosystem accounting approach aimed at estimating the contribution of ecosystem services to total social income accrued from a Stone pine (Pinus pinea L.) forest as the result of afforestation in Huelva Province, Spain. The study encompasses private market products such as timber, pine cones, and forest conservation intermediate services; and non-market final services that include private amenities and public services such as landscape, free-access recreation and carbon sequestration services. We show how the total income of each single product is distributed amongst the factorial rewards to labor, and environmental and manufactured assets. Private products account for 46% of the average total income that the Stone pine forest would yield over its rotation, while public services comprise the remaining 54%. Our results also suggest that the production of public non-market services would offset the government compensation payments to support Stone pine afforestation and management. Finally, the results show that, on average, 7% of the estimated total income would be captured by the current System of National Accounts for forestry if applied to our case study (including only the net value added from timber and pine cone production and from plantation investment) and that 14% of this income would be dislocated into the government institutional accounts.

Servitization and Competitive Advantage: The Importance of Organizational Structure and Value Chain Position

OVERVIEW:Servitization represents a business-model change and organizational transformation from selling goods to selling an integrated combination of goods and services. Competitive advantage is one outcome of this shift. During servitization, companies follow stages to realize services as an opportunity to differentiate from goods and achieve higher customer satisfaction. This study analyzes this transition from base, intermediate, and advanced services by presenting results from 102 senior executives in multinational companies. Our results suggest increasing interest in service-led strategies in manufacturing companies. The results also show that increasing differentiation and high customer satisfaction are fundamental to achieving competitive advantage and superior performance with services. The analysis also indicates the importance of a company's position in the value chain and the organizational structure it selects to support services in successful servitization.