• Title/Summary/Keyword: Early screening

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Clinical Significance of PCR-Based Rapid Detection of Mycobacterium tuberculosis DNA in Peripheral Blood (결핵 환자에서 말초혈액 결핵균 중합효소 연쇄반응 양성의 임상적 의의)

  • Kim, Gyu-Won;Lee, Jae-Myung;Kang, Min-Jong;Son, Jee-Woong;Lee, Seung-Joon;Kim, Dong-Gyu;Lee, Myung-Goo;Hyun, In-Gyu;Jung, Ki-Suck;Lee, Young-Kyung;Lee, Kyung-Wha
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.5
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    • pp.599-606
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    • 2001
  • Background : Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or inactive tuberculosis. In this study, the clinical significance of a PCR-based rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood was investigated. Materials and Methods : From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use within one year prior to this study were recruited and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. Results : 1) Forty five out of 59 patients had a final diagnosis of tuberculosis ; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinically diagnosed with pulmonary tuberculosis. The other 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood peR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and the diagnostic accuracy was 44%.3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. Conclusion : A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as a screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.

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A Study on the Administration for the Han River Water Quality Control (漢江 水質保全 行政에 관한 硏究)

  • Kim, Kwang Hyop
    • Journal of Environmental Health Sciences
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    • v.10 no.2
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    • pp.9-40
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    • 1984
  • This thesis purports to overview the diverse administrative and organizational factors and plannings developed by the government organizations, municipal or otherwise, to tackle the Han River water pollution issues in the past years. This thesis also looks into the ever-worsening Han River water pollution problems, in particular, in terms of the various government plans ostensibly designed to reduce the pollution level but with little success. Also dealt with are the efficiencies with which the laws and decrees on water pollution the administrative organizations put to use in the prosecution of the diverse antiwater pollution projects involving the Han River basin. From the early 1960's up to the 1970's the government had concentrated on the growth-oriented economic policy with the result that little attention had been paid to the water pollution and other environmental issues that are bound to arise from the massive economic growth. Belatedly, the five-year Hah River Development Project was initiated in 1982 with emphasis on reducing the water pollution level at Hah River to the minimum. The following are the gists of the thesis and recommendations for the future antiwater pollution plans by the administrative organizations: 1. Documents to date indicate that the irrigation projects along the Han River area had been the main focus of attention during the Yi Dynasty and under the Japanese rule of the country. 2. Despite that the water pollution issue became the subject of many debates among the academic and research institutions in the 1960's and in the 1970's, the administrative organizations in charge of the Han River water quality control failed to come up with a concrete plan for the river's water quality control. 3. Nevertheless, the water pollution of the Han River area in fact began in the 1950's, with the unprecedented concentration into Seoul of population and the industrial facilities on a larger scale, in particular, enforced by the government's strong growthoriented policy in its Economic Development plans in the 1960's. 4. Starting in the 1960's, the Han River water pollution level dramatically increased, but the government was reluctant to promulgate or put into effect strong measures to curb the many factors contributing to the river water pollution, thus worsening the environmental issues along the Han River basin. 5. The environmental protection law and other laws and decrees relating to the antiwater and air pollution issues that were subsequently put into effect underwent so many changes that efficient anti-water pollution policies could not be effected for the Han River basin. The frequent organizational reshuffle within the administrative units concerned with environmental problems has resulted in the undue waste in personnel management and finance. 6. The administration on the environmental protection could not be efficiently carried out due to the organizational overlapping. Under the existing law, frequent organizational frictions and inefficiency are bound to occur among the central government offices themselves, as well as between the central government and the Seoul city administration, and among the city's administrative offices over the conservation of the Han River basin and over the river's anti-water pollution issue. 7. In the planning and prosecution of the Han River project, political influences from the president down to the lower-level politicious appear to have been involved. These political influences in the past had certainly had negative influence on the project, nevertheless, it appears that in the recent years, these political influences are not all that negative in view of the fact that they serve as a positive contributing factor in developing a better water quality control project along the Han River basin. The following are a few recommendations based on the data from the thesis: First, officials in charge of the Han River water quality control should pay attention to a careful screening of the opinions and recommendations from the academic circles and from the public should be made so that the government could better grasp the core issues in the environmental problems that require preventive and other necessary measures. Second, vigorous redistribution policies of population and industrial facilities away from the Seoul area should be pursued. Third, the government should refrain from revising or revamping too frequently the laws and decrees on the anti-water pollution, which is feared to cause undue inconveniences in the environmental administration. Fourth, a large-scale streamlining should be made to the existing administrative organization in an effort to do away with the inter- and intra-organizational friction. It is recommended that a secretariat for the Hah River basis conservation be established. Fifth, High-level administrative officials, with a thorough knowledge and vision on the Han River water quality control, should be prepared to better deal with the budgeting and personnel management for the Han River water pollution control not only at the control government, but also at the Seoul city municipal government levels. Environmental issues should be kept distinct from political issues. Environmental issues should not serve as a window-dressing for sheer political purposes. Sixth, the Hah River proiect should also include, along with the main Han River basin, those areas covering North Han River, South Han River, and the tributaries to the main river basin. The 'Han River Basin Water Quality Control Board' should be established immediately as a means of strengthening the current Han River basin water quality control policy. Seventh, in drawing up the Han River proiect, the administrative officials should be aware that Han River basin is a life line for those people in the region, providing them with not only a sheer physical space, but with a psychological living space for their everyday life.

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Pilot and Feasibility Study of a Management Program for Elementary School Students with Asthma (우리나라에서 학교 중심의 소아천식관리사업의 적용가능성과 발전 방향: 일부 학교의 시범사업 평가결과를 중심으로)

  • Seo, He-Jin;Lee, Weon-Yong
    • Journal of the Korean Society of School Health
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    • v.22 no.1
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    • pp.1-16
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    • 2009
  • Purposes: The objective of this study was to develop a management program for Korean elementary school students suffering from asthma, which would be based on the Australian Asthma-Friendly Schools (AFS) program. Methods: On the basis of the AFS program, we designed a 6-month pilot project for asthmatic students in two elementary schools in a rural area and one elementary school in an urban area of Korea. The pilot project consisted of the following processes: identifying students with asthma in a school, educating school staffs and the parents of an asthmatic child, registering those with asthma, and installing emergency kits for asthma attacks in school health rooms. In order to evaluate these processes, group discussions were held between project team members and school staffs in each area. In addition, we conducted a postal survey of 144 households having an asthmatic child. Results: The screening process adopted in this program resulted in the early diagnosis in asthma; however, it needs to be evaluated economically due to expensive diagnostic test for asthma. For the school nurses, asthma lessons were evaluated as being very helpful for their tasks, while teachers tended to take less interest in the program with only 45% of all teachers attending these lessons. Almost all participating parents reported that such lessons would be beneficial for the care of their child, even though only 24.2% of the survey respondents (122 households) attended the lessons. Installing emergency kits in school health rooms was regarded as a key feature of this project. The introduction of a register card containing more specific health records of asthmatic students was considered necessary to replace the existing list of students with asthma. Conclusion: This study has merit in that a Korean asthma-friendly schools program was developed for the first time, despite the many obstacles to such programs becoming more common.

Integrated Rotary Genetic Analysis Microsystem for Influenza A Virus Detection

  • Jung, Jae Hwan;Park, Byung Hyun;Choi, Seok Jin;Seo, Tae Seok
    • Proceedings of the Korean Vacuum Society Conference
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    • 2013.08a
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    • pp.88-89
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    • 2013
  • A variety of influenza A viruses from animal hosts are continuously prevalent throughout the world which cause human epidemics resulting millions of human infections and enormous industrial and economic damages. Thus, early diagnosis of such pathogen is of paramount importance for biomedical examination and public healthcare screening. To approach this issue, here we propose a fully integrated Rotary genetic analysis system, called Rotary Genetic Analyzer, for on-site detection of influenza A viruses with high speed. The Rotary Genetic Analyzer is made up of four parts including a disposable microchip, a servo motor for precise and high rate spinning of the chip, thermal blocks for temperature control, and a miniaturized optical fluorescence detector as shown Fig. 1. A thermal block made from duralumin is integrated with a film heater at the bottom and a resistance temperature detector (RTD) in the middle. For the efficient performance of RT-PCR, three thermal blocks are placed on the Rotary stage and the temperature of each block is corresponded to the thermal cycling, namely $95^{\circ}C$ (denature), $58^{\circ}C$ (annealing), and $72^{\circ}C$ (extension). Rotary RT-PCR was performed to amplify the target gene which was monitored by an optical fluorescent detector above the extension block. A disposable microdevice (10 cm diameter) consists of a solid-phase extraction based sample pretreatment unit, bead chamber, and 4 ${\mu}L$ of the PCR chamber as shown Fig. 2. The microchip is fabricated using a patterned polycarbonate (PC) sheet with 1 mm thickness and a PC film with 130 ${\mu}m$ thickness, which layers are thermally bonded at $138^{\circ}C$ using acetone vapour. Silicatreated microglass beads with 150~212 ${\mu}L$ diameter are introduced into the sample pretreatment chambers and held in place by weir structure for construction of solid-phase extraction system. Fig. 3 shows strobed images of sequential loading of three samples. Three samples were loaded into the reservoir simultaneously (Fig. 3A), then the influenza A H3N2 viral RNA sample was loaded at 5000 RPM for 10 sec (Fig. 3B). Washing buffer was followed at 5000 RPM for 5 min (Fig. 3C), and angular frequency was decreased to 100 RPM for siphon priming of PCR cocktail to the channel as shown in Figure 3D. Finally the PCR cocktail was loaded to the bead chamber at 2000 RPM for 10 sec, and then RPM was increased up to 5000 RPM for 1 min to obtain the as much as PCR cocktail containing the RNA template (Fig. 3E). In this system, the wastes from RNA samples and washing buffer were transported to the waste chamber, which is fully filled to the chamber with precise optimization. Then, the PCR cocktail was able to transport to the PCR chamber. Fig. 3F shows the final image of the sample pretreatment. PCR cocktail containing RNA template is successfully isolated from waste. To detect the influenza A H3N2 virus, the purified RNA with PCR cocktail in the PCR chamber was amplified by using performed the RNA capture on the proposed microdevice. The fluorescence images were described in Figure 4A at the 0, 40 cycles. The fluorescence signal (40 cycle) was drastically increased confirming the influenza A H3N2 virus. The real-time profiles were successfully obtained using the optical fluorescence detector as shown in Figure 4B. The Rotary PCR and off-chip PCR were compared with same amount of influenza A H3N2 virus. The Ct value of Rotary PCR was smaller than the off-chip PCR without contamination. The whole process of the sample pretreatment and RT-PCR could be accomplished in 30 min on the fully integrated Rotary Genetic Analyzer system. We have demonstrated a fully integrated and portable Rotary Genetic Analyzer for detection of the gene expression of influenza A virus, which has 'Sample-in-answer-out' capability including sample pretreatment, rotary amplification, and optical detection. Target gene amplification was real-time monitored using the integrated Rotary Genetic Analyzer system.

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A New Short Growth-Duration Rice Cultivar, "Keumo 3" (소득작물 전후작용 단기성 벼 품종 "금오3호")

  • Kang, Jong-Rae;Lee, Jong-Hee;Kwack, Do-Yeon;Lee, Jeom-Sik;Park, No-Bong;Ha, Woon-Gu;Park, Dong-Soo;Yeo, Un-Sang;Lim, Sang-Jong;Oh, Byeong-Geun
    • Korean Journal of Breeding Science
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    • v.41 no.3
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    • pp.292-298
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    • 2009
  • A new rice cultivar "Keumo 3" was developed for adopting under double cropping system with after or before cash crop cultivation. It was selected from the cross-combination between YR17202 $F_2$/Shinkeumobyeo//YR15727-B-B-B-102. The parent, YR17202 $F_2$ individual plant, was used for tolerance to lodging, it derived from a cross between Nonganbyeo/Shinkeumobyeo. Nonganbyeo is well known to lodging tolerance cultivar, as well as biotic stress, because it was developed by crossing with Tongil type. And the YR15727-B-B-B-102 line used as another parent with short growth duration, likewise highly resistance to rice blast disease. The pedigree derived from the cross-combination YR17202 $F_2$/Shinkeumobyeo//YR15727-B-B-B-102 were generated to $F_7$, and a best line among them named as Milyang 201. After a series of yield trials, including local adaptability test conducted throughout the peninsular of Korea, Milyang 201 was registered with the name of "Keumo 3" in 2005. The cultivar belongs to a early maturing group and heads 4 days earlier than Keumobyeo, a standard cultivar. It has short culm, and less spikelet number per panicle than Keumobyeo. However, its milled rice yield grown under extremely late transplanting time, 10. July, over the 3 local sites for 2003-2005 years, averaged 4,48 MT/ha, which is 6% higher than the standard, Keumobyeo. "Keumo 3" has showed a durable resistance to leaf blast disease during fourteen blast nurseries screening covered from south to north in Korea for 2003-2007 years. And it was confirmed harbours pi-zt, a durable blast resistance gene. Moreover it was incompatible with 19 blast isolates under artificial inoculation, except one isolate, K1101. Additionally, "Keumo 3" exhibits resistance to $K_1$, $K_2$ and $K_3$ of bacterial blight pathogen, as well as strip virus disease resistance, and moderate resistance to dwarf virus disease. Consequently, the new rice cultivar "Keumo 3" would be well adopted where a bio stress makes a big problem annually.

A Study on Dongbu Hamchunwon in Hanyang during the Joseon Dynasty (조선시대 한양 동부(東部) 함춘원(含春苑)에 관한 연구)

  • Oh, Jun-Young;Kim, Young-Mo
    • Korean Journal of Heritage: History & Science
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    • v.50 no.3
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    • pp.110-125
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    • 2017
  • The purpose of this study is to investigate the constructional facts and the operational features of Hamchunwon(含春苑), a wonyu(苑?, a royal garden) constructed in Dongbu(Eastern District) of the capital city of Hanyang. As the living quarters of the queen dowagers were scheduled for relocation after the construction of Changgyeonggung Palace(昌慶宮) during the reign of King Seongjong(成宗), it is presumed that the screening tree planting project discussed around tongmangcheo(通望處, a place allowing open view) was the original form of Dongbu Hamchunwon. Dongbu Hamchunwon was a longitudinal royal garden built in the area across the section from Wolgeunmun Gate(月覲門) to Seoninmun Gate(宣仁門), which were both attached to the east side walls of Changgyeonggung Palace. The area corresponds to the west side area of the newly built main building of Seoul National University Hospital today. During the Joseon Dynasty, only royal gardens built within a palace were referred to as geumwon(禁苑, a palace garden). But Dongbu Hamchunwon which was built outside a palace was recognized as a symbolic and hierarchical space comparable to geumwon. The site location of Donbu Hamchunwon was an important place that corresponded to Naecheongnyong(內靑龍) according to Hanyang's geomancy, and large-scale public works were prohibited in order to protect the vein of Naecheongnyong. During the reign of King Injo(仁祖), part of Dongbu Hamchunwon was partitioned as a ranch. The area around the ranch was called Madongsan(馬東山) and Bangmawon(放馬苑) and was an open space used for rest and pleasure (amusement). In the early days of Hamchunwon's construction, fast growing trees were planted to screen the view to Changgyeonggung Palace. However, after the construction of Gyeongmogung Shrine(景慕宮), a broad scale tree planting project was undertaken to complement Naecheongnyong's vapor of the earth. In particular, after the construction of Yugeunmum Gate(?覲門) and Yucheommun Gate(?瞻門) during the reign of King Jeongjo(正祖), Dongbu Hamchunwon functioned as a key point on the King's progress for paying respects to the ancestors, which followed the route of Palace(Changgyeonggung)-Wonyu(Hamchunwon)-Ancestral Shrine(Gyeongmogung).

A Recidivism Prediction Model Based on XGBoost Considering Asymmetric Error Costs (비대칭 오류 비용을 고려한 XGBoost 기반 재범 예측 모델)

  • Won, Ha-Ram;Shim, Jae-Seung;Ahn, Hyunchul
    • Journal of Intelligence and Information Systems
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    • v.25 no.1
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    • pp.127-137
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    • 2019
  • Recidivism prediction has been a subject of constant research by experts since the early 1970s. But it has become more important as committed crimes by recidivist steadily increase. Especially, in the 1990s, after the US and Canada adopted the 'Recidivism Risk Assessment Report' as a decisive criterion during trial and parole screening, research on recidivism prediction became more active. And in the same period, empirical studies on 'Recidivism Factors' were started even at Korea. Even though most recidivism prediction studies have so far focused on factors of recidivism or the accuracy of recidivism prediction, it is important to minimize the prediction misclassification cost, because recidivism prediction has an asymmetric error cost structure. In general, the cost of misrecognizing people who do not cause recidivism to cause recidivism is lower than the cost of incorrectly classifying people who would cause recidivism. Because the former increases only the additional monitoring costs, while the latter increases the amount of social, and economic costs. Therefore, in this paper, we propose an XGBoost(eXtream Gradient Boosting; XGB) based recidivism prediction model considering asymmetric error cost. In the first step of the model, XGB, being recognized as high performance ensemble method in the field of data mining, was applied. And the results of XGB were compared with various prediction models such as LOGIT(logistic regression analysis), DT(decision trees), ANN(artificial neural networks), and SVM(support vector machines). In the next step, the threshold is optimized to minimize the total misclassification cost, which is the weighted average of FNE(False Negative Error) and FPE(False Positive Error). To verify the usefulness of the model, the model was applied to a real recidivism prediction dataset. As a result, it was confirmed that the XGB model not only showed better prediction accuracy than other prediction models but also reduced the cost of misclassification most effectively.

Biogenesis of Lysosome-related Organelle Mutant Silkworms by Direct Injection of a Cas9 Protein-guided RNA Complex into Bombyx mori Embryos (Cas9 단백질/ 가이드 RNA 복합체를 이용한 누에 BmBLOS 유전자 편집)

  • Kim, Kee Young;Yu, Jeong Hee;Kim, Su-Bae;Kim, Seong-Wan;Kim, Seong-Ryul;Choi, Kwang-Ho;Kim, Jong Gil;Park, Jong Woo
    • Journal of Life Science
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    • v.29 no.5
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    • pp.537-544
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    • 2019
  • Genome editing technology employing gene scissors has generated interest in molecular breeding in various fields, and the development of the third-generation gene scissors of the clustered, regularly interspaced short palindromic repeat (CRISPR) system has accelerated the field of molecular breeding through genome editing. In this study, we analyzed the possibility of silkworm molecular breeding using gene scissors by genomic and phenotypic analysis after editing the biogenesis of lysosome-related organelles (BmBLOS) gene of Bakokjam using the CRISPR/Cas9 system. Three types of guide RNAs (gRNA) were synthesized based on the BmBLOS gene sequence of Bakokjam. Complexes of the prepared gRNA and Cas9 protein were formed and introduced into Bombyx mori BM-N cells by electroporation. Analysis of the gene editing efficiency by T7 endonuclease I analysis revealed that the B4N gRNA showed the best efficiency. The silkworm genome was edited by microinjecting the Cas9/B4N gRNA complex into silkworm early embryos and raising the silkworms after hatching. The hatching rate was as low as 18%, but the incidence of mutation was over 40%. In addition, phenotypic changes were observed in about 70% of the G0 generation silkworms. Sequence analysis showed that the BmBLOS gene appeared to be a heterozygote carrying the wild-type and mutation in most individuals, and the genotype of the BmBLOS gene was also different in all individuals. These results suggest that although the possibility of silkworm molecular breeding using the CRISPR/Cas9 system would be very high, continued research on breeding and screening methods will be necessary to improve gene editing efficiency and to obtain homozygotes.

A Study on the Memory of the Korean War and the Representation of the Play-Focused on Shin Myung-soon's (한국 전쟁에 대한 기억과 연극의 재현 양상 -신명순의 <증인>을 중심으로)

  • Kim, Tae-hee
    • (The) Research of the performance art and culture
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    • no.43
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    • pp.145-172
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    • 2021
  • Shin Myung-soon's is based on the taboo 'bombing of the Han River Bridge'. The reality of the bombing of the Han River Bridge in 1950 and the shooting of Colonel Choi Chang-sik was known only as a word of mouth. At that time, the ruling class did not want to reveal the painful mistakes of the unfavorable war situation in the early days of the war and the false broadcasting of the president. The truth of the case, which was kept completely secret even to the bereaved family, could only be revealed after the regime change. After that, the bereaved family of Colonel Choi Chang-sik confirmed the innocence of the deceased through a request for retrial, and then the was born. However, the fate of was not so smooth. At the time, the performance officials vividly remember the difficulties they had with the text. Despite passing the pre-screening of the script, the performance was canceled just before the performance. The fact that the National Theater, officials from the Ministry of Culture and Education, and even military generals visited the practice room to stop the performance, on the contrary, was a testimony to the dangers of . It can be summarized as a crack in official history and a move to stop it. was later adapted into a special TV drama in 1981 and was first released to the public. This was a very meaningful step in terms of dealing with politically sensitive subjects on television, but the inconsistency of in the first place has largely disappeared. After that, in 1988, only after democracy entered the phase of appeasement, could be performed in its full form. In short, can be said to be an example of a process in which the history of the Korean War recorded from the standpoint of an established order and the counter-memory that crack it up are transformed according to the changes of the times and media.

A Study on the Characteristics and Consultation Type of Inpatients Referred for Delirium and Depressive Disorder (섬망 및 우울장애로 자문 의뢰된 입원환자의 임상적 특징 및 의뢰 형태에 관한 연구)

  • Seong min Lee;Seung-Ho Ryu;Jee Hyun Ha;Hong Jun Jeon;Doo-Heum Park
    • Korean Journal of Psychosomatic Medicine
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    • v.31 no.1
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    • pp.10-18
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    • 2023
  • Objectives : The purpose of this study is to investigate the characteristics of patients referred for delirium and depressive disorder and to find direction of improvement of consultation-liason psychiatry in general hospital. Methods : We performed a retrospective computed chart review of the 4,966 inpatients hospitalized at Konkuk University Hospital who were referred to the Department of Psychiatry from August 1, 2005 to December 31, 2011. Results : Depressive disorder shows the order of frequency of consultation type Parallel-Complementary-Mending. Delirium shows the order of frequency of consultation type Mending-Parallel-Complementary. When comparing 'follow up consultation' and 'without follow up consultation' group within the depressive disorder, the proportion of men in the 'follow up consultation' group was higher. In the analysis of the consultation type, the 'follow up consultation' group showed the order of consultation type Parallel-Mending- Complementary, and type Parallel-Complementary-Mending in the 'without follow up consultation' group. When comparing 'follow up consultation' and 'without follow up consultation' group within the delirium, the proportion of the surgical field in the 'follow up consultation' group was higher. In the analysis of the consultation type, both group showed the order of consultation type Mending-Parallel- Complementary. Conclusions : Doctors in each department and psychiatrists should pay attention to delirium symptoms that may occur in surgical inpatients and preventive measures should be taken. Screening tests should be conducted in medical patients to properly evaluate coexisting psychiatric diseases. Risk factors of Delirium and Depressive disorder should be identified from the time of hospitalization, and actively discussing treatment plans and early interventions could improve the quality of medical services.