Search results for: Medical Coding

Authors: F. Sarabchi, M. E. Kalantari

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In this paper, Optimum adaptive loading algorithms are applied to multicarrier system with Space-Time Block Coding (STBC) scheme associated with space-time processing based on singular-value decomposition (SVD) of the channel matrix over Rayleigh fading channels. SVD method has been employed in MIMO-OFDM system in order to overcome subchannel interference. Chaw-s and Compello-s algorithms have been implemented to obtain a bit and power allocation for each subcarrier assuming instantaneous channel knowledge. The adaptive loaded SVD-STBC scheme is capable of providing both full-rate and full-diversity for any number of transmit antennas. The effectiveness of these techniques has demonstrated through the simulation of an Adaptive loaded SVDSTBC system, and the comparison shown that the proposed algorithms ensure better performance in the case of MIMO.

Keywords: OFDM, MIMO, SVD, STBC, Adaptive Loading.

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Authors: M. Das Gupta, S. Banerjee

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Content Based Image Retrieval (CBIR) coupled with Case Based Reasoning (CBR) is a paradigm that is becoming increasingly popular in the diagnosis and therapy planning of medical ailments utilizing the digital content of medical images. This paper presents a survey of some of the promising approaches used in the detection of abnormalities in retina images as well in mammographic screening and detection of regions of interest in MRI scans of the brain. We also describe our proposed algorithm to detect hard exudates in fundus images of the retina of Diabetic Retinopathy patients.

Keywords: Case based reasoning, Exudates, Retina image, Similarity based retrieval.

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Authors: Muhammad Sheikh Sadi, D. G. Myers, Cesar Ortega Sanchez

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This paper proposes the use of metrics in design space exploration that highlight where in the structure of the model and at what point in the behaviour, prevention is needed against transient faults. Previous approaches to tackle transient faults focused on recovery after detection. Almost no research has been directed towards preventive measures. But in real-time systems, hard deadlines are performance requirements that absolutely must be met and a missed deadline constitutes an erroneous action and a possible system failure. This paper proposes the use of metrics to assess the system design to flag where transient faults may have significant impact. These tools then allow the design to be changed to minimize that impact, and they also flag where particular design techniques – such as coding of communications or memories – need to be applied in later stages of design.

Keywords: Criticality, Metrics, Real-Time Systems, Transient Faults.

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Authors: Gurung S., Yadav B. N., Budhathoki SS.

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Problem based learning is one of the highly acclaimed learning methods in medical education since its first introduction at Mc-Master University in Canada in the 1960s. It has now been adopted as a teaching learning method in many medical colleges of Nepal. B.P. Koirala Institute of Health Sciences (BPKIHS), a health science deemed university is the second institute in Nepal to establish problem-based learning academic program and need-based teaching approach hence minimizing teaching through lectures since its inception. During the first two years of MBBS course, the curriculum is divided into various organ-systems incorporated with problem-based learning exercise each of one week duration.

Keywords: PBL, medical education.

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Authors: Ibtissem Daoudi, Raoudha Chebil, Wided Lejouad Chaari

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Serious games constitute actually a recent and attractive way supposed to replace the classical boring courses. However, the choice of the adapted serious game to a specific learning environment remains a challenging task that makes teachers unwilling to adopt this concept. To fill this gap, we present, in this paper, a multi-agent-based simulator allowing to predict the impact of a serious game integration in a learning environment given several game and players characteristics. As results, the presented tool gives intensities of several emotional aspects characterizing learners reactions to the serious game adoption. The presented simulator is tested to predict the effect of basing a coding course on the serious game ”CodeCombat”. The obtained results are compared with feedbacks of using the same serious game in a real learning process.

Keywords: Emotion, learning process, multi-agent simulation, serious games.

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Authors: Sana Ktata, Kaïs Ouni, Noureddine Ellouze

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Electrocardiogram (ECG) data compression algorithm is needed that will reduce the amount of data to be transmitted, stored and analyzed, but without losing the clinical information content. A wavelet ECG data codec based on the Set Partitioning In Hierarchical Trees (SPIHT) compression algorithm is proposed in this paper. The SPIHT algorithm has achieved notable success in still image coding. We modified the algorithm for the one-dimensional (1-D) case and applied it to compression of ECG data. By this compression method, small percent root mean square difference (PRD) and high compression ratio with low implementation complexity are achieved. Experiments on selected records from the MIT-BIH arrhythmia database revealed that the proposed codec is significantly more efficient in compression and in computation than previously proposed ECG compression schemes. Compression ratios of up to 48:1 for ECG signals lead to acceptable results for visual inspection.

Keywords: Discrete Wavelet Transform, ECG compression, SPIHT.

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Authors: Masaharu Isshiki, Kenji Murakami, Shun Ido

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This paper describes a proposed support system which enables applications designers to effectively create VR applications using multiple haptic APIs. When the VR designers create applications, it is often difficult to handle and understand many parameters and functions that have to be set in the application program using documentation manuals only. This complication may disrupt creative imagination and result in inefficient coding. So, we proposed the support application which improved the efficiency of VR applications development and provided the interactive components of confirmation of operations with haptic sense previously. In this paper, we describe improvements of our former proposed support application, which was applicable to multiple APIs and haptic devices, and evaluate the new application by having participants complete VR program. Results from a preliminary experiment suggest that our application facilitates creation of VR applications.

Keywords: VR application, Support system, Haptic devices, Haptic APIs.

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Authors: Olga A. Berillo, Gaukhar K. Baidildinova, Аnatoliy Т. Ivashchenko

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Tumour suppressors are key participants in the prevention of cancer. Regulation of their expression through miRNAs is important for comprehensive translation inhibition of tumour suppressors and elucidation of carcinogenesis mechanisms. We studies the possibility of 1521 miRNAs to bind with 873 mRNAs of human tumour suppressors using RNAHybrid 2.1 and ERNAhybrid programmes. Only 978 miRNAs were found to be translational regulators of 812 mRNAs, and 61 mRNAs did not have any miRNA binding sites. Additionally, 45.9% of all miRNA binding sites were located in coding sequences (CDSs), 33.8% were located in 3' untranslated region (UTR), and 20.3% were located in the 5'UTR. MiRNAs binding with more than 50 target mRNAs and mRNAs binding with several miRNAs were selected. Hsa-miR-5096 had 15 perfectly complementary binding sites with mRNAs of 14 tumour suppressors. These newly indentified miRNA binding sites can be used in the development of medicines (anti-sense therapies) for cancer treatment.

Keywords: Exonic miRNA, intergenic miRNA, intronic miRNA, tumor suppressor.

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Authors: Morteza Moazami-Goudarzi, Ali Taheri, Mohammad Pooyan, Reza Mahboobi

Abstract:

In this paper we are to find the optimum multiwavelet for compression of electrocardiogram (ECG) signals and then, selecting it for using with SPIHT codec. At present, it is not well known which multiwavelet is the best choice for optimum compression of ECG. In this work, we examine different multiwavelets on 24 sets of ECG data with entirely different characteristics, selected from MIT-BIH database. For assessing the functionality of the different multiwavelets in compressing ECG signals, in addition to known factors such as Compression Ratio (CR), Percent Root Difference (PRD), Distortion (D), Root Mean Square Error (RMSE) in compression literature, we also employed the Cross Correlation (CC) criterion for studying the morphological relations between the reconstructed and the original ECG signal and Signal to reconstruction Noise Ratio (SNR). The simulation results show that the Cardinal Balanced Multiwavelet (cardbal2) by the means of identity (Id) prefiltering method to be the best effective transformation. After finding the most efficient multiwavelet, we apply SPIHT coding algorithm on the transformed signal by this multiwavelet.

Keywords: ECG compression, Prefiltering, Cardinal Balanced Multiwavelet.

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Authors: Muhammad Abrar, Xiang Gui, Amal Punchihewa

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In this paper we study the resource allocation problem for an OFDMA based cooperative two-way relaying (TWR) network. We focus on amplify and forward (AF) analog network coding (ANC) protocol. An optimization problem for two basic resources namely, sub-carrier and power is formulated for multi-user TWR networks. A joint optimal optimization problem is investigated and two-step low complexity sub-optimal resource allocation algorithm is proposed for multi-user TWR networks with ANC protocol. The proposed algorithm has been evaluated in term of total achievable system sum-rate and achievable individual sum-rate for each userpair. The good tradeoff between system sum-rate and fairness is observed in the two-step proportional resource allocation scheme.

Keywords: Relay Network, Relay Protocols, Resource Allocation, Two –way relaying.

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Authors: G. Schirripa Spagnolo, M. De Santis

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The protection of the contents of digital products is referred to as content authentication. In some applications, to be able to authenticate a digital product could be extremely essential. For example, if a digital product is used as a piece of evidence in the court, its integrity could mean life or death of the accused. Generally, the problem of content authentication can be solved using semifragile digital watermarking techniques. Recently many authors have proposed Computer Generated Hologram Watermarking (CGHWatermarking) techniques. Starting from these studies, in this paper a semi-fragile Computer Generated Hologram coding technique is proposed, which is able to detect malicious tampering while tolerating some incidental distortions. The proposed technique uses as watermark an encrypted image, and it is well suitable for digital image authentication.

Keywords: Asymmetric cryptography, Semi-Fragile watermarking, Image authentication, Hologram watermark, Public- Key Cryptography, RSA.

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Authors: Chuen-Ching Wang, Yao-Tang Chang, Yu-Chang Hsu

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A simple but effective digital watermarking scheme utilizing a context adaptive variable length coding (CAVLC) method is presented for wireless communication system. In the proposed approach, the watermark bits are embedded in the final non-zero quantized coefficient of each DCT block, thereby yielding a potential reduction in the length of the coded block. As a result, the watermarking scheme not only provides the means to check the authenticity and integrity of the video stream, but also improves the compression ratio and therefore reduces both the transmission time and the storage space requirements of the coded video sequence. The results confirm that the proposed scheme enables the detection of malicious tampering attacks and reduces the size of the coded H.264 file. Therefore, the current study is feasible to apply in the video applications of wireless communication such as 3G system

Keywords: 3G, wireless communication, CAVLC, digitalwatermarking, motion compensation

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Authors: Salim Ouchtati, Jean Sequeira, Mouldi Bedda

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In the context of the handwriting recognition, we propose an off line system for the recognition of the Arabic handwritten words of the Algerian departments. The study is based mainly on the evaluation of neural network performances, trained with the gradient back propagation algorithm. The used parameters to form the input vector of the neural network are extracted on the binary images of the handwritten word by several methods. The Distribution parameters, the centered moments of the different projections of the different segments, the centered moments of the word image coding according to the directions of Freeman, and the Barr features applied binary image of the word and on its different segments. The classification is achieved by a multi layers perceptron. A detailed experiment is carried and satisfactory recognition results are reported.

Keywords: Handwritten word recognition, neural networks, image processing, pattern recognition, features extraction.

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Authors: Olugbara O.O., Adebiyi A.A.

Abstract:

Most standard software development methodologies are often not applied to software projects in many developing countries of the world. The approach generally practice is close to what eXtreme Programming (XP) is likely promoting, just keep coding and testing as the requirement evolves. XP is an agile software process development methodology that has inherent capability for improving efficiency of Business Software Development (BSD). XP can facilitate Business-to-Development (B2D) relationship due to its customer-oriented advocate. From practitioner point of view, we applied XP to BSD and result shows that customer involvement has positive impact on productivity, but can as well frustrate the success of the project. In an effort to promote software engineering practice in developing countries of Africa, we present the experiment performed, lessons learned, problems encountered and solution adopted in applying XP methodology to BSD.

Keywords: Requirements engineering, Requirements elicitation, Extreme programming, Mobile Work force

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Authors: Muhammad Y.K. Barozai, Ifthikhar A. Baloch, M. Din

Abstract:

MicroRNAs (miRNAs) are small, non-coding and regulatory RNAs about 20 to 24 nucleotides long. Their conserved nature among the various organisms makes them a good source of new miRNAs discovery by comparative genomics approach. The study resulted in 21 miRNAs of 20 pre-miRNAs belonging to 16 families (miR156, 157, 158, 164, 165, 168, 169, 172, 319, 390, 393, 394, 395, 400, 472 and 861) in evergreen spruce tree (Picea). The miRNA families; miR 157, 158, 164, 165, 168, 169, 319, 390, 393, 394, 400, 472 and 861 are reported for the first time in the Picea. All 20 miRNA precursors form stable minimum free energy stem-loop structure as their orthologues form in Arabidopsis and the mature miRNA reside in the stem portion of the stem loop structure. Sixteen (16) miRNAs are from Picea glauca and five (5) belong to Picea sitchensis. Their targets consist of transcription factors, growth related, stressed related and hypothetical proteins.

Keywords: BLAST, Comparative Genomics, Micro-RNAs, Spruce

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Authors: Blaise Fyama, Elie Museng, Grace Mukoma

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In this article we present a java implementation of video telephony using the SIP protocol (Session Initiation Protocol). After a functional analysis of the SIP protocol, we relied on the work of Italian researchers of University of Parma-Italy to acquire adequate libraries for the development of our own communication tool. In order to optimize the code and improve the prototype, we used, in an incremental approach, test techniques based on a static analysis based on the evaluation of the complexity of the software with the application of metrics and the number cyclomatic of Mccabe. The objective is to promote the emergence of local start-ups producing IP video in a well understood local context. We have arrived at the creation of a video telephony tool whose code is optimized.

Keywords: Static analysis, coding, complexity, mccabe metrics, Sip, uml.

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Authors: A. Kumar, G. K. Singh, R. S. Anand

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In this paper, various algorithms for designing quadrature mirror filter are reviewed and a new algorithm is presented for the design of near perfect reconstruction quadrature mirror filter bank. In the proposed algorithm, objective function is formulated using the perfect reconstruction condition or magnitude response condition of prototype filter at frequency (ω = 0.5π) in ideal condition. The cutoff frequency is iteratively changed to adjust the filters coefficients using optimization algorithm. The performances of the proposed algorithm are evaluated in term of computation time, reconstruction error and number of iterations. The design examples illustrate that the proposed algorithm is superior in term of peak reconstruction error, computation time, and number of iterations. The proposed algorithm is simple, easy to implement, and linear in nature.

Keywords: Aliasing cancellations filter bank, Filter banks, quadrature mirror filter (QMF), subband coding.

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Authors: G. Gürsel, K. H. Gülkesen, N. Zayim, A. Arifoğlu, O. Saka

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User satisfaction is one of the most used success indicators in the research of information system (IS). Literature shows user expectations have great influence on user satisfaction. Both expectation and satisfaction of users are important for Hospital Information Systems (HIS). Education, IS experience, age, attitude towards change, business title, sex and working unit of the hospital, are examined as the potential determinant of the medical users’ expectations. Data about medical user expectations are collected by the “Expectation Questionnaire” developed for this study. Expectation data are used for calculating the Expectation Meeting Ratio (EMR) with the evaluation framework also developed for this study. The internal consistencies of the answers to the questionnaire are measured by Cronbach´s Alpha coefficient. The multivariate analysis of medical user’s EMRs of HIS is performed by forward stepwise binary logistic regression analysis. Education and business title is appeared to be the determinants of expectations from HIS.

Keywords: Evaluation, Fuzzy Logic, Hospital Information System, User Expectation.

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Authors: Oke Oktavianty, Tadayuki Kyoutani, Shigeyuki Haruyama, Junji Kaneko, Ken Kaminishi

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Modelica has many advantages and it is very useful in modeling and simulation especially for the multi-domain with a complex technical system. However, the big obstacle for a beginner is to understand the basic concept and to build a new system model for a real system. In order to understand how to solve the simple circuit model by hand translation and to get a better understanding of how modelica works, we provide a detailed explanation about solver ordering system in horizontal and vertical sorting and make some proposals for improvement. In this study, some difficulties in using modelica software with the original concept and the comparison with Finite Element Method (FEM) approach is discussed. We also present our textual modeling approach using FEM concept for acausal and causal model construction. Furthermore, simulation results are provided that demonstrate the comparison between using textual modeling with original coding in modelica and FEM concept.

Keywords: FEM, acausal model, modelica, horizontal and vertical sorting.

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Authors: P. Prudtikul, S. Pathomsiri

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Most, if not all, public hospitals in Thailand have encountered a common problem regarding the increasing demand for medical services. The increasing number of patients causes so much strain on the hospital-s services, over-crowded, overloaded working hours, staff fatigue, medical error and long waiting time. This research studied the characteristics of operational processes of the medical care services at the medicine department in a large public university hospital. The research focuses on details regarding methods, procedures, processes, resources, and time management in overall processes. The simulation model is used as a tool to analyze the impact of various improvement strategies.

Keywords: Patient flow, medicine department, simulation, outpatient department.

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Authors: Cleto J. Sauer Jr

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Introduction: Brazil’s new national curriculum guidelines (NCG) for medical education were published in 2014, presenting active learning methodologies as a cornerstone. Simulation was initially applied for aviation pilots’ training and is currently applied in health sciences. The high-fidelity simulator replicates human body anatomy in detail, also reproducing physiological functions and its use is increasing in medical schools. Realistic Simulation (RS) has pedagogical aspects that are aligned with Brazil’s NCG teaching concepts. The main objective of this study is to carry on a narrative review on RS’s aspects that are aligned with Brazil’s new NCG teaching concepts. Methodology: A narrative review was conducted, with search in three databases (PubMed, Embase and BVS) of studies published between 2010 and 2020. Results: After systematized search, 49 studies were selected and divided into four thematic groups. RS is aligned with new Brazilian medical curriculum as it is an active learning methodology, providing greater patient safety, uniform teaching, and student's emotional skills enhancement. RS is based on reflective learning, a teaching concept developed for adult’s education. Conclusion: RS is a methodology aligned with NCG teaching concepts and has potential to assist in the implementation of new Brazilian medical school’s curriculum. It is an immersive and interactive methodology, which provides reflective learning in a safe environment for students and patients.

Keywords: Curriculum, high-fidelity simulator, medical education, realistic simulation.

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Authors: J. L. Liu, L. Wang, B. Zhu, J. Zhou, W. D. Gao

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Fabric textures are very common in our daily life. However, the representation of fabric textures has never been explored from neuroscience view. Theoretical studies suggest that primary visual cortex (V1) uses a sparse code to efficiently represent natural images. However, how the simple cells in V1 encode the artificial textures is still a mystery. So, here we will take fabric texture as stimulus to study the response of independent component analysis that is established to model the receptive field of simple cells in V1. We choose 140 types of fabrics to get the classical fabric textures as materials. Experiment results indicate that the receptive fields of simple cells have obvious selectivity in orientation, frequency and phase when drifting gratings are used to determine their tuning properties. Additionally, the distribution of optimal orientation and frequency shows that the patch size selected from each original fabric image has a significant effect on the frequency selectivity.

Keywords: Fabric Texture, Receptive Filed, Simple Cell, Spare Coding.

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Authors: Y. Y. Su, K. T. Win, H. C. Chiu

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This study used Item Analysis, Exploratory Factor Analysis (EFA) and Reliability Analysis (Cronbach-s α value) to exam the Questions which selected by the Delphi method based on the issue of “Socio-technical system (STS)" and user-centered perspective. A structure questionnaire with seventy-four questions which could be categorized into nine dimensions (healthcare environment, organization behaviour, system quality, medical data quality, service quality, safety quality, user usage, user satisfaction, and organization net benefits) was provided to evaluate EMR of the Taiwanese healthcare environment.

Keywords: Instrument development, Reliability test, Validity test, Electronic Medical Record Evaluation.

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Authors: Bin Cai, Shilong Wang, Haibo Hu

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The job shop scheduling problem (JSSP) is a notoriously difficult problem in combinatorial optimization. This paper presents a hybrid artificial immune system for the JSSP with the objective of minimizing makespan. The proposed approach combines the artificial immune system, which has a powerful global exploration capability, with the local search method, which can exploit the optimal antibody. The antibody coding scheme is based on the operation based representation. The decoding procedure limits the search space to the set of full active schedules. In each generation, a local search heuristic based on the neighborhood structure proposed by Nowicki and Smutnicki is applied to improve the solutions. The approach is tested on 43 benchmark problems taken from the literature and compared with other approaches. The computation results validate the effectiveness of the proposed algorithm.

Keywords: Artificial immune system, Job shop scheduling problem, Local search, Metaheuristic algorithm

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Authors: Siau-Chuin Liew, Siau-Way Liew, Jasni Mohd Zain

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Digital watermarking in medical images can ensure the authenticity and integrity of the image. This design paper reviews some existing watermarking schemes and proposes a reversible tamper detection and recovery watermarking scheme. Watermark data from ROI (Region Of Interest) are stored in RONI (Region Of Non Interest). The embedded watermark allows tampering detection and tampered image recovery. The watermark is also reversible and data compression technique was used to allow higher embedding capacity.

Keywords: data compression, medical image, reversible, tamperdetection and recovery, watermark.

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Authors: Swadhin Kumar Mishra, Sidhartha Panda, C. Ardil

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Multiple-Input-Multiple-Output (MIMO) is one of the most important communication techniques that allow wireless systems to achieve higher data rate. To overcome the practical difficulties in implementing Dirty Paper Coding (DPC), various suboptimal MIMO Broadcast (MIMO-BC) scheduling algorithms are employed which choose the best set of users among all the users. In this paper we discuss such a sub-optimal MIMO-BC scheduling algorithm which employs antenna selection at the receiver side. The channels for the users considered here are not Identical and Independent Distributed (IID) so that users at the receiver side do not get equal opportunity for communication. So we introduce a method of applying weights to channels of the users which are not IID in such a way that each of the users gets equal opportunity for communication. The effect of weights on overall sum-rate achieved by the system has been investigated and presented.

Keywords: Antenna selection, Identical and Independent Distributed (IID), Sum-rate capacity, Weighted sum rate.

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Authors: Amudha Kadirvelu, Sunil Gurtu, Sivalal Sadasivan

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Pharmacology curriculum plays an integral role in medical education. Learning pharmacology to choose and prescribe drugs is a major challenge encountered by students. We developed pharmacology applied learning activities for first year medical students that included realistic clinical situations with escalating complications which required the students to analyze the situation and think critically to choose a safe drug. Tutor feedback was provided at the end of session. Evaluation was done to assess the students- level of interest and usefulness of the sessions in rational selection of drugs. Majority (98 %) of the students agreed that the session was an extremely useful learning exercise and agreed that similar sessions would help in rational selection of drugs. Applied learning sessions in the early years of medical program may promote deep learning and bridge the gap between pharmacology theory and clinical practice. Besides, it may also enhance safe prescribing skills.

Keywords: Medical education, pharmacology curriculum, applied learning, safe prescribing.

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Authors: Ayman M. Mansour

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In this paper, we propose an intelligent system that is used for monitoring the health conditions of patients. Monitoring the health condition of patients is a complex problem that involves different medical units and requires continuous monitoring especially in rural areas because of inadequate number of available specialized physicians. The proposed system will improve patient care and drive costs down comparing to the existing system in Jordan. The proposed system will be the start point to faster and improve the communication between different units in the health system in Jordan. Connecting patients and their physicians beyond hospital doors regarding their geographical area is an important issue in developing the health system in Jordan. The ability of making medical decisions, the quality of medical is expected to be improved.

Keywords: GSM, SMS, Patient, Monitoring system, Fuzzy Logic, Multi-agent system.

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Authors: Alina Trifan, António J. R. Neves

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Although most digital cameras acquire images in a raw format, based on a Color Filter Array that arranges RGB color filters on a square grid of photosensors, most image compression techniques do not use the raw data; instead, they use the rgb result of an interpolation algorithm of the raw data. This approach is inefficient and by performing a lossless compression of the raw data, followed by pixel interpolation, digital cameras could be more power efficient and provide images with increased resolution given that the interpolation step could be shifted to an external processing unit. In this paper, we conduct a survey on the use of lossless compression algorithms with raw Bayer images. Moreover, in order to reduce the effect of the transition between colors that increase the entropy of the raw Bayer image, we split the image into three new images corresponding to each channel (red, green and blue) and we study the same compression algorithms applied to each one individually. This simple pre-processing stage allows an improvement of more than 15% in predictive based methods.

Keywords: Bayer images, CFA, losseless compression, image coding standards.

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Authors: H. Al-Khalaifa, A. Al-Nasser

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The viewpoint towards the use of drugs or vaccines against avian parasitic diseases is one of the most striking challenges in avian medical parasitology. This includes many difficulties associated with drug resistance and in developing prophylactic vaccines. In many instances, the potential success of a vaccination in controlling parasitic diseases in poultry is well-documented. However, some medical, technical and financial limitations are still paramount. On the other hand, chemotherapy is not very well-recommended due to a number of medical limitations. But in the absence of an effective vaccine, drugs are used against parasitic diseases. This paper sheds light on some the advantages and disadvantages of using vaccination and drugs in controlling parasitic diseases in poultry species. The usage of chemotherapeutic drugs is discussed with some examples. Then, more light will be shed on using vaccines as a potentially effective and promising control tool.

Keywords: Drugs, parasitology, poultry, vaccines.

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