Test Instrument Research Articles

Differences in Patient-Reported Outcome Measures in Patients With Cancer Six Months Before Death.

Patient-reported outcome measures (PROMs) provide a direct report of the patient's perspective, complementary to clinician assessment. Currently, understanding the real-time changes in PROM scores near the end of life remains limited. This study evaluated differences in mean PROM scores between patients with cancer within 6 months before death compared with surviving patients with cancer. This retrospective case-control study uses the National Institutes of Health's Patient-Reported Outcomes Measurement Information System computer adaptive testing instruments to assess pain interference, physical function, fatigue, and depression. Patients dying within 6 months of PROM completion were selected as cases and matched to controls 1:3 by age at PROM completion, sex, cancer disease site, and cancer stage at diagnosis. Generalized estimating equation models assessed the difference in mean PROM score in cases compared with controls. A total of 461 cases and 1,270 controls from September 2020 to January 2023 were included. After adjustment for ethnicity, Charlson Comorbidity Index, and census tract median household income, significant differences in mean scores were demonstrated. Physical function domain showed the largest difference, with cases averaging 6.52 points lower than controls (95% CI, -8.25 to -4.80). Fatigue and pain interference domains showed a rise in PROMs scores by 4.83 points (95% CI, 2.94 to 6.72) and 4.33 points (95% CI, 2.53 to 6.12), respectively. Compared with controls, patients dying within 6 months of PROM completion demonstrated worse PROM scores in the four domains assessed. These findings suggest the utility of routinely collected PROMs as a real-time indicator of the terminal stage of life among patients with cancer to allow for earlier intervention with supportive oncology services.

Implementation of Discovery Learning Model with Window Shopping Approach to Improve Mathematical Communication Ability of High School Students

The low ability of students' mathematical communication in learning mathematics, especially in expressing mathematical situations or problems in the form of pictures, diagrams, language or mathematical symbols, or mathematical models makes students less active in learning and their learning motivation decreases. This study aims to determine the achievement of students' mathematical communication skills through the discovery learning model with a window shopping approach. The method in this study is a quasi-experimental research type consisting of 2 classes, namely the experimental class that uses the discovery learning model with the window shopping approach and the control class that uses ordinary learning at school with a total of 70 students from class XI SMA in one of the public high schools in Bandung. The research test instrument was in the form of a test that would be analyzed using SPSS 21 to compare learning outcomes between the experimental class and the control class. The result of the study was that the achievement of the students' mathematical communication skills in the experimental class was better than that of the control class at a significance level of 0.05 where the average communication ability of the experimental class was 81.74 and that of the control class was 77.31. The effectiveness of learning in the experimental class showed that it was more active in group discussions as indicated by the interaction and creativity of students in presenting learning material in each group, and almost 85% of students enjoyed learning using the discovery learning model with the window shopping approach.

ANALISIS EMPLOYEE ENGAGEMENT DAN JOB SATISFACTION TERHADAP TURNOVER INTENTION KARYAWAN PADA UMANA BALI, LXR HOTELS & RESORTS

This study aims to determine between the variables of Employee engagement and Job Satisfaction, partially or simultaneously on Turnover Intention. In this study, the population is all employees of Umana Bali, LXR Hotels & Resorts, totaling 245 employees. Data collection from samples was carried out using a cross-sectional design method by distributing online questionnaires in the form of google forms. Sampling technique using Proportionate Stratified Random Sampling technique. So that the sample used in this study amounted to 72 respondents. This type of research uses explanatory research with a quantitative approach. This research analysis is processed using SPSS software to analyze data and determine the relationship between variables. The data collection techniques used are questionnaires, literature study and observation. The data that has been collected will be analyzed in the form of quantitative numbers. The analysis technic used are Instrument Test, Descriptive Statistics, Classical Assumption Test and Hypothesis. The results that will be obtained later, the company will know whether there is a partial or simultaneous relationship to the variables studied. Conclusion Employee engagement and Job Satisfaction have a positive and significant influence on Turnover Intention.

The effects of fingerprinting agents on the stable isotope ratios of polyethylene films

Traditional forensic chemical comparisons of polymeric materials are often affected by fingerprinting agents that enhance and visualise finger-marks. This can inhibit detailed analysis used to provide an association or discrimination between two samples. In this study, we have demonstrated that the method for polymer comparisons using isotope ratio mass spectrometry analysis is not affected by fingerprinting matter on the surface in contrast to other forensic instrumental tests. A selection of resealable bags was analysed for carbon and hydrogen isotope ratio values of bags that had been subject to various fingerprinting agents and compared to values of untreated bags. The results showed no significant difference between samples that had been fingerprinted from those that were untreated.

Characterization of a copper matrix composite reinforced with nano/submicron-sized boron fabricated via spark plasma sintering

The addition of various reinforcing phases can improve the mechanical properties of copper. This study investigates the enhancement of the mechanical properties of copper by adding boron, focusing on overcoming the challenges associated with the homogeneous distribution of submicron/nanoscale secondary phases in metal matrix composites. Employing a combination of mechanical alloying and spark plasma sintering, a copper-boron composite containing 3 wt% boron was prepared. Scanning electron microscopy equipped with an electron backscatter diffraction detector and energy-dispersive X-ray spectroscopy was utilized to characterize the structure of the sintered samples and mechanically alloyed powder. A two-phase structure containing nano/submicron-sized boron distributed uniformly in the copper matrix was formed in the sintered sample. Instrumented micro-indentation tests were performed to characterize the mechanical behavior of the samples. The sintered composite sample exhibits significantly higher hardness than the sintered copper. The enhanced mechanical performance of the composite is primarily attributed to grain boundary strengthening and microstructural refinement, where nano/submicron-sized boron particles prevent grain growth and refine the microstructure, enhancing hardness and strength. Additionally, dispersion strengthening from hard boron particles and the presence of a high density of twin boundaries within the copper matrix increase resistance to dislocation motion and deformation, and further improving the material's mechanical properties. On the other hand, the composite sample exhibits increased electrical resistivity due to the boron’s role as electron scattering centers. Overall, this study provides a valuable strategy for the design and optimization of advanced copper-based composites with tailored mechanical and electrical properties.

Experimental assessment of strength characteristics of anthropogenic soils in a given mining area for justification of tractor propulsion type

BACKGROUND: In mining, there is a need to develop tractors as special robotic vehicles of the robotic mining facility that can efficiently move and work on soils with low bearing capacity, in waterlogged areas and in the underwater position. A preliminary evaluation of the strength characteristics of such a heterogeneous surface of the exploitation area helps to choose an effective concept and technical characteristics of the propulsor of the tractor. AIM: Formation of the database of the physical condition and mechanical properties of the environment in which the tractor will move and operate. METHODS: In order to achieve the aim, preliminary experiments were conducted on the terrain. Typical kinds of soil sites and watered areas, including those of anthropogenic origin, of a given mining area were identified. Full-scale instrumental tests were conducted to determine: granulometric composition of soils; physical and mechanical parameters of these soils at the selected sites using the developed original types of a penetrometer and a shear rig. RESULTS: The database of numerical values of measured strength characteristics of one of the soil types (as an example) as a possible supporting surface for vehicle motion in the area of mining facility operation is presented in a graphical form. The basis of this database is the graphs according to the results of experiments on free settlement and shear with the help of dies of two types of configuration (the round die and the original caterpillar track respectively); the granulometric composition of the selected soils has been evaluated. CONCLUSION: The methodology of preliminary assessment of the soil condition by two indicators of soil strength (the rut depth z depending on the average pressure under the die) and shear (average tangential stresses τ in the contact patch on the motion of the die relative to the soil, depending on the ratio of the normal force and the traction force in the contact plane) has been developed. The 3D model of the coastal and bottom area of the technogenic mining zone has been developed. Design variants of highly efficient types of tractor propulsors are selected on the basis of prediction of maximum allowable stresses in the contact patch with the ground for the bearing surface areas of the considered area of operation.

Psychometric Testing of an Instrument Assessing Family Knowledge, Contemplation, Confidence and Readiness for Engaging in Early Mobilisation of Critically Ill Patients: A Multi-Site Cross-Sectional Design.

Early mobilisation is beneficial to support recovery among critically ill patients. The literature highlights the benefits of family engagement in early mobilisation, yet this practice remains underutilised. Effective implementation depends on understanding the key antecedents that influence family engagement in early mobilisation, specifically families' knowledge, contemplation, confidence and readiness. However, no measurement tools currently exist to assess these. Therefore, developing a psychometrically supported instrument is essential to understanding and enhancing families' factors influencing their engagement in early mobilisation. To develop and evaluate the psychometric properties of an instrument to assess families' knowledge, contemplation, confidence and readiness to engage in early mobilisation. A multi-site cross-sectional survey design. Based on established psychological theory (Social Cognitive Theories and Behaviour Change Theories), an item pool was developed to assess families' knowledge, contemplation, confidence and readiness to participate in early mobilisation. To psychometrically evaluate the new tool, a multi-site cross-sectional survey was undertaken from May 2020 to June 2022 across five intensive care units in Australia. Data from 370 families of critically ill patients were used to evaluate the structural, convergent and discriminant validity as well as the reliability of the new instrument. Confirmatory factor analysis indicated good model fit, supporting the proposed structure. All items displayed high standardised factor loadings except one, which improved upon freeing an error covariance. Positive inter-factor correlations were moderate to strong and were substantially lower than the square root of the average variance extracted, supporting both convergent and discriminant validity, respectively. Additionally, all subscales demonstrated well to excellent reliability. The findings provide preliminary support for the multiple types of validity evidence and the reliability of the instrument. This new instrument is suitable for use in clinical and research applications to assess families' knowledge, contemplation, confidence and readiness for their engagement in early mobilisation. Family engagement in early mobilisation activities may have multiple benefits but it is not commonly implemented in the ICU. Factors influencing family engagement in early mobilisation are poorly understood. Influential psychological theories highlight the likely importance of knowledge, contemplation, confidence and readiness. A readily available instrument designed to assess these constructs among family members is needed to deepen research understanding and guide clinical practice. The proposed instrument is designed to measure factors influencing family engagement in early mobilisation, which may support healthcare professionals and health services to identify and tailor strategies to support family engagement in early mobilisation. Recommendations for reporting the results of studies of instrument and scale development and testing was followed to report this study. Family members of adult critically ill patients participated in this study, and they provided the data through the survey.

Assessing Data Literacy Competencies in Mathematics Among Junior High School Students in Yogyakarta City

This research aims to assess students' data literacy skills, focusing on their ability to translate data from one format to another, comprehend data-related problems, analyze strategies for data-driven problem-solving, predict outcomes based on data, draw conclusions, and construct arguments grounded in data. The study employs a survey methodology with both quantitative and qualitative approaches. A total of 362 students from various educational levels in Yogyakarta's state junior high schools were surveyed and selected through stratified and proportionate random sampling techniques. Data were collected using a test instrument comprising six questions designed to measure different aspects of data literacy, alongside interview results. The students' data literacy was categorized into high, medium, and low levels. The findings indicate that a significant majority (95%) of students exhibited low data literacy, particularly struggling with drawing conclusions and constructing arguments based on data. Students with high data literacy skills successfully met all the indicators. Those with medium-level skills performed well on most indicators but faced difficulties in choosing strategies for data problem-solving and drawing conclusions, often due to insufficient time for deeper reflection. Conversely, students with low data literacy struggled to meet any of the indicators effectively.

Analysis of miRNA Expression Profiles in Traumatic Brain Injury (TBI) and Their Correlation with Survival and Severity of Injury.

Traumatic brain injury (TBI) is the leading cause of traumatic death worldwide and is a public health problem associated with high mortality and morbidity rates, with a significant socioeconomic burden. The diagnosis of brain injury may be difficult in some cases or may leave diagnostic doubts, especially in mild trauma with insignificant pathological brain changes or in cases where instrumental tests are negative. Therefore, in recent years, an important area of research has been directed towards the study of new biomarkers, such as micro-RNAs (miRNAs), which can assist clinicians in the diagnosis, staging, and prognostic evaluation of TBI, as well as forensic pathologists in the assessment of TBI and in the estimation of additional relevant data, such as survival time. The aim of this study is to investigate the expression profiles (down- and upregulation) of a panel of miRNAs in subjects deceased with TBI in order to assess, verify, and define the role played by non-coding RNA molecules in the different pathophysiological mechanisms of brain damage. This study also aims to correlate the detected expression profiles with survival time, defined as the time elapsed between the traumatic event and death, and with the severity of the trauma. This study was conducted on 40 cases of subjects deceased with TBI (study group) and 10 cases of subjects deceased suddenly from non-traumatic causes (control group). The study group was stratified according to the survival time and the severity of the trauma. The selection of miRNAs to be examined was based on a thorough literature review. Analyses were performed on formalin-fixed, paraffin-embedded (FFPE) brain tissue samples, with a first step of total RNA extraction and a second step of quantification of the selected miRNAs of interest. This study showed higher expression levels in cases compared to controls for miR-16, miR-21, miR-130a, and miR-155. In contrast, lower expression levels were found in cases compared to controls for miR-23a-3p. There were no statistically significant differences in the expression levels between cases and controls for miR-19a. In cases with short survival, the expression levels of miR-16-5p and miR-21-5p were significantly higher. In cases with long survival, miR-21-5p was significantly lower. The expression levels of miR-130a were significantly higher in TBI cases with short and middle survival. In relation to TBI severity, miR-16-5p and miR-21-5p expression levels were significantly higher in the critical-fatal TBI subgroup. Conclusions: This study provides evidence for the potential of the investigated miRNAs as predictive biomarkers to discriminate between TBI cases and controls. These miRNAs could improve the postmortem diagnosis of TBI and also offer the possibility to define the survival time and the severity of the trauma. The analysis of miRNAs could become a key tool in forensic investigations, providing more precise and detailed information on the nature and extent of TBI and helping to define the circumstances of death.

Pengaruh Pemahaman Akuntansi, Tingkat Pendidikan dan Ukuran Usaha terhadap Kualitas Laporan Keuangan Umkm di Kecamatan Teluk Jambe Timur

This study aims to look at the effect of accounting understanding, education level and business size on the quality of MSME financial reports in the Teluk Jambe Timur sub-district. Questionnaires were used to obtain primary data for this quantitative research. In Teluk Jambe Timur sub-district, a sample of 93 MSMEs was selected using the puposive sampling technique. There are four types of tests in this study, namely, multiple linear regression analysis, instrument test, classical assumption test, and hypothesis testing. The findings of this study indicate that the three variables of accounting understanding, education level and business size have an impact on the quality of financial statements. This means that any variable used has the potential to affect how well MSMEs produce their financial reports.

Analisis kemampuan komunikasi matematis peserta didik ditinjau dari perbedaan gender

Mathematical communication skills are the basic abilities that students must have in learning mathematics. This research aims to analyze students' mathematical communication skills in terms of gender differences. This type of research is qualitative descriptive research. The subjects in this research were class VIII students at MTs Hasanah Pekanbaru consisting of 3 male students and 3 female students with the categories of high, medium and low ability students. The data collection technique in this research is a test technique using a mathematical communication ability test instrument and a non-test technique, namely an interview guide. The data analysis technique is carried out using the stages of data reduction, data presentation, and drawing conclusions. The results of this study showed that in the high category, male subjects met 3 indicators and less than 1 indicator, while female subjects met 4 indicators. Then in the medium category, male subjects meet 3 indicators and do not meet 1 indicator, while female subjects meet 2 indicators and do not meet 2 indicators. Furthermore, in the low category, male subjects did not meet 1 indicator and did not meet 3 other indicators, while female subjects did not meet 3 indicators and did not meet 1 indicator.

Analisis Perilaku terhadap Niat Berinvestasi

This study aims to determine and analyze the influence of behavior on investor intentions. This study uses primary data. The sample used was 100 respondents, namely people who have invested, have worked and have a fixed income. The sampling technique used nonprobability sampling, precisely the respondent accidental technique by distributing questionnaires. This type of research is quantitative research, then the data was analyzed using research instrument tests (validity and reliability tests), multicollinearity tests, multiple regression analysis (regression models, determination coefficients, F tests, t tests), and classical assumption tests (heteroscedasticity tests, normality, assistance and autocorrelation) with the SPSS software program version 25.0. The results showed that financial behavior has a positive and significant effect on investment intentions. This shows that the better a person's level of financial behavior, the better their investment intentions will be. Investment knowledge has a positive and significant effect on investment intentions. This shows that the better a person's level of investment knowledge, the better their investment intentions will be. Financial literacy has a positive and significant effect on investment intentions. This shows that the better a person's level of financial literacy, the better their investment intentions will be.

Analytical HPLC Method for Determination of Miconazole Nitrate and Eugenol in Formulated Emulgel

A diabetic foot ulcer (DFU) is the prime cause of poor quality of life among diabetic patients. DFU leads to physical disability and an enormous economic burden on diabetic patients. The development and prognosis of DFU are preventable in most patients by modifying the risk factors for DFU. Programs intervened by clinical pharmacists can enhance rational drugs use and improve the early identification and prevention of DFU. This study intended to prove the beneficial outcome in identifying the risk factors and the provision of patient-tailored referral advice regarding DFU among diabetic patients. This cross-sectional study assessed the neuropathy through Michigan Neuropathy Screening Instrument (MNSI), Monofilament and Vibration test using Tuning Fork and Handheld Doppler for assessing the lower limb vascular disease as per NICE guideline among 137 diabetic patients. 64% of patients were found to have symptoms of neuropathy through the neuropathy assessment test whereas 36% did not have the symptoms. Foot sensory using monofilament test was found to be normal in 49.64% of DFU patients, reduced in 43.80%, and absent in 6.57% of DFU patients. The Ankle Brachial Index (ABI) was found to be normal in 48% of patients, mild in 34% of patients, moderate in 12% of patients, and incompressible in 6% of patients. Clinical Pharmacist intervened risk assessment through Hand-held Doppler, MNSI instrument, and Vibration test helped in screening the DFU patients for Neuropathy, and implementation of effective per patient-tailored education was found to be beneficial in the early identification of DFU and referral to specialty hospitals

Peran Servant Leadership dan Burnout terhadap Perilaku Kerja Inovatif

In this highly competitive era, whether Servant Leadership and burnout are sufficient to address challenges in the workplace, corporate leaders need to master complex leadership skills to survive in the intense competition. This research aims to determine the impact of servant leadership and burnout on the innovative work behavior of employees at PT Triconville - Demak Factory. The study is designed using a quantitative method; the sample used for this research is purposive sampling, with a total of 101 respondents. Data collection techniques involve the use of a questionnaire, and the stages of testing in this research include descriptive test, instrument test, model test, and hypothesis test using the SPSS program. The results of this research indicate that servant leadership has a positive and significant impact on innovative work behavior, while burnout has a negative and non-significant impact on innovative work behavior.

Acute Myocarditis, the Dilemma in the General Practice Setting in the Years of the Coronavirus Pandemic Era: An Italian Experience

Myocarditis is inflammation of the muscle tissue of the heart (myocardium) and unlike most heart disease it tends to affect young people more often. Myocarditis can go almost unnoticed, frequently heals without results, but can sometimes be very serious and life threatening. However, many symptoms are non-specific and difficult to evaluate in the general practice setting. In order to diagnose myocarditis it is necessary to carry out some instrumental tests, too. Very important are the EKG and the dosage of cardiac markers in the blood. The echocardiogram allows you to highlight the valvular and muscle alterations that occur during inflammation and the same thing can be done by myocardial magnetic resonance. For those reasons, myocarditis is difficult to diagnose in the setting of General Practitioner (GP) and therefore it is underdiagnosed or misdiagnosed. The presence of nonspecific symptoms, fatigue and dyspnea, especially in a young person, it can lead the GP to suspect a myocarditis. We present a case of myocarditis in a young person. The patient, without a clinical history of important pathologies, presented asthenic and respiratory symptoms with progressive worsening of the clinical picture. We described the reasons of the diagnostic and therapeutic procedures. The general medicine setting is currently unsuitable for taking care of patients of this type, as the waiting times for the necessary examinations. The evaluation and follow-up are not within the reach of local doctors in Italy or with too long waiting times, so monitoring and optimizing therapies remain difficult outside the hospital.

A Robust Test for Weak Instruments for 2SLS with Multiple Endogenous Regressors

A Robust Test for Weak Instruments for 2SLS with Multiple Endogenous Regressors

Application of instrument indentation test for residual stress characterization of 5083 aluminium alloy

Abstract An abnormal cracking phenomenon occurred at the corner of a ventilation window on the 5083 aluminum alloy wallboard used in certain transportation equipment. The residual stresses of the wallboard were measured using an instrumented indentation test. Initially, stress loading was applied to the 5083 specimens using a residual stress loading device to verify the effectiveness of the instrument indentation test (IIT) for testing the residual stresses of 5083 aluminum alloy. Subsequently, IIT was conducted under static conditions at the serving site of the equipment, and the working stresses under dynamic conditions were detected using a strain monitor. The results indicate that the total tensile stress at the uncracked corner of the ventilation window has exceeded the 5083 yield strength, so excessive tensile stress is the main cause of the abnormal cracking of the wallboard.

Development of Student Worksheets Based on Problem Based Learning (PBL) Assisted by PhET Simulations to Improve Mastery of High School Physics Concepts

This development research aims to produce a product in the form of a Student Workshees (known LKPD) based on a problem-based learning model that is feasible, practical and effective for improving students' mastery of concepts. This research is included in Research and Development (R&D) with a 4D model, which consists of defining, designing, developing, and disseminating. The product developed is Newton's Law LKPD supported by other independent curriculum tools: Learning Outcomes, Learning Goal Flow, Teaching Modules, and concept mastery test instruments. Data collection techniques use validation sheets, learning implementation observation sheets, student response questionnaires, and test instruments. The validity of the product was assessed by three expert validators, who were physics lecturers, and three practitioner validators, who were physics subject teachers. Their evaluations were performed using a Likert scale. Practicality is obtained from the teacher's observation sheet and student response questionnaires regarding learning. Effectiveness was obtained from the results of limited product trials in the form of an increase in pretest and posttest scores, which were analyzed using the n-gain test. The results of the validity of the product developed have a percentage, namely LKPD 92.12%; Learning Achievement 92.08%; Flow of Learning Objectives 92.60%; Teaching modules 89.78% and test instruments 91.15% with very valid and reliable categories above 75%, so the product can be said to be suitable for use. The results of the product's practicality were in the form of an implementation sheet by the teacher. Student responses of 92.08% and 82.10% were written in the convenient category. The results of the n-gain test for students' concept mastery were 0.74 in the medium category and included in the very effective criteria. Thus, the LKPD, Learning Outcomes, Learning Goal Flow, Teaching Modules and test instruments produced are feasible, practical and effective in improving students' mastery of concepts.

Validity of Project Model Science Learning Tools Assisted by Augmented Reality to Improve Students' Literacy and Creative Thinking Abilities

The development of project model science learning tools assisted by augmented reality has been carried out to improve students' literacy and creative thinking abilities. This development research aims to produce a valid product and describe the results of the validation of the learning device so that it is suitable for use in the learning process. This type of research is research and development with 4D model design which consists of the definition, design, development and dissemination stages. Validation of learning tools was carried out by three competent expert validators at Mataram University. The development of augmented reality-assisted project model science learning tools developed consists of a syllabus, lesson plans, teaching materials, LKPD, augmented reality media as well as scientific literacy test instruments and creative thinking ability test instruments. The results of the research show that the project model science learning tools assisted by augmented reality have very valid and reliable criteria so that they are suitable for use in the science learning process in schools to improve students' scientific literacy and creative thinking abilities.

The Influence of Physical Fitness, Motor Skills, and Learning Motivation on Cartwheel Skills in Physical Education

Background Problems: During the observation, many students were unable to perform cartwheel skills. This research is important so that students can pass the minimum completion criteria so that their physical education learning outcomes are not low. Research Objectives: This study aims to determine the factors that influence the skills of cartwheel. Methods: This type of research is quantitative. The population amounted to 392 students in class XI. The technique used to obtain the sample is simple random sampling using the slovin formula with an error rate of 10%. Based on this, the sample amounted to 80 students. The physical fitness test instrument used the Indonesian Student Fitness Test, the motor ability test instrument used the Barrow Motor Ability Test, the learning motivation data was collected using a questionnaire, and the cartwheel skill data used an observation sheet which contained the criteria for implementing the cartwheel movement. Path analysis was used as a data analysis technique. Finding/Results: The results of the study consist of: 1. Physical fitness and motor skills have a significant influence on cartwheel skills. 2. Learning motivation has no significant effect directly on cartwheel skills. 3. Physical fitness indirectly through learning motivation has no significant effect on cartwheel skills. 4. Motor ability indirectly through learning motivation has no significant effect on cartwheel skills. Conclusion: Physical fitness and motor skills have a significant influence on cartwheel skills. Students need to do it outside of PJOK class hours. For Further Researchers Conduct research on other gymnastic movements.