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Objective:To investigate the utilization of health management services and its influencing factors among new urban population.Methods:It is a cross-sectional study. From July 2020 to March 2021, a stratified random sampling method was used to extract 1978 new urban population in Jining city, and an anonymous self-administered questionnaire survey was conducted using a self-made questionnaire ′Residents Health Questionnaire′. The survey included general demographic characteristics, personal behavior lifestyle and medical care status. The χ2 test and binary logistic regression were used to analyze the factors influencing the utilization of health management services by new urban population. Results:The overall utilization of health management services in the new urban population was 47.22%. There were significant differences in utilization of health management services among new urban population with different gender, age, education level, occupation and monthly income. Binary logistic regression analysis showed that female ( OR=1.354, 95% CI: 1.094-1.676), people aged over 60 years ( OR=1.873, 95% CI: 1.413-2.483), people with a mean monthly income over 3 000 yuan ( OR=1.498, 95% CI: 1.123-1.997), people engaged in light manual labor ( OR=1.596, 95% CI: 1.003-2.539), people who exercise regularly( OR=2.400, 95% CI: 2.028-2.841) and people having social basic medical insurance ( OR=2.633, 95% CI: 2.042-3.394) had better utilization of health management projects. People who sat more than 3 hours a day ( OR=0.630, 95% CI: 0.532-0.745) had lower utilization of health management care. Conclusion:The utilization of health management projects in the new urban population is low. Gender, age, monthly income, physical exercise, sedentary time, daily labor intensity and social basic medical insurance status are the main influencing factors.
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Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.
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Humanos , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Pronóstico , Diagnóstico Precoz , Medicina de PrecisiónRESUMEN
As the most complicated and challenging operation in general surgery, pancreaticoduodenectomy is also a classic operation for the treatment of pancreatic head and periampullary tumors. With the continuous improvement of medical technology and medical instruments, minimally invasive technology is increasingly widely used in pancreaticoduodenectomy, but there are many controversies. In this paper, the clinical application and research progress of open, laparoscopic and robotic pancreaticoduodenectomy were reviewed based on the experience of author′s team and domestic and foreign literatures, so as to provide reference for grasping surgical indications and formulating individualized treatment strategies.
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In recent years, the existence of the Laennec′s capsule has been histologically confirmed and contributes to the Laennec′s approach based on Laennec′s capsule for anatomic hepatectomy. With the deep understanding of liver surgery, the importance of Laennec′s approach based on Laennec′s capsule could be recognized. Better use of Laennec′s capsule would be beneficial to the standardization of surgical technique, facilitate safe and precise anatomical liver resection.The application of Laennec′s capsule in hepatic inflow occlusion and intrahepatic segmentation was summarized in this study. The natural gap between Laennec′s capsule, the liver pedicle and hepatic veins can reduce the destruction of liver parenchyma and intraoperative hemorrhage, simplify surgical steps, shorten the time of Hilar occlusion and surgery.
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Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.
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Pancreatic cancer has a poor prognosis, systemic comprehensive therapy including chemotherapeutic and molecular targeted therapy is the key to improve the postoperative prognosis of pancreatic cancer, as well as to prolong the survival time of advanced pancreatic cancer. However, due to the drug resistance and heterogeneity of pancreatic cancer cells, systemic comprehensive treatment still does not reach the ideal effect, and personalized therapy will be an important approach to solve this problem. The personalized therapy for pancreatic cancer will become possible with the application of patient-derived tumor xenograft (PDX) models. Here, this article will review the progress of the application of PDX models in comprehensive therapy of pancreatic cancer based on reviewing the methods of establishing pancreatic cancer PDX models, aiming to provide new ideas for personalized therapy of pancreatic cancer.
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Objective:To investigate the turnover intention and its influencing factors in rural general practitioners in southwest Shandong province.Methods:In May 2020, a survey with self-designed questionnaire was conducted among 2 805 rural general practitioners in southwest Shandong province selected by multi-stage sampling method. Pearson chi square test (χ2) and binary logistic regression were used to analyze the factors influencing the turnover intention of rural general practitioners.Results:A total of 2 805 questionnaires were sent out, 2 693 were collected and 2 272 were valid, with an effective rate of 84.4%. Among 2 272 participants, 1 076 (47.4%) had medium to high level turnover intention. Binary logistic regression showed that part-time job ( OR=1.443, 95% CI: 1.105-1.884, P<0.01), average monthly night shifts ≥20 times ( OR=1.340, 95% CI: 1.106-1.623, P<0.01), daily working time ≥13 hours ( OR=1.358, 95% CI: 1.107-1.666, P<0.01), insomnia ( OR=2.075, 95% CI: 1.755-2.454, P<0.01), feeling depressed at work ( OR=2.987, 95% CI: 2.516-3.546, P<0.01), degree of emotional exhaustion ( OR=3.801, 95% CI: 3.188-4.533, P<0.01) and degree of de-personalization tendencies ( OR=2.493, 95% CI: 2.086-2.981, P<0.01) were the significant factors influencing the turnover intention of rural general practitioners. Conclusions:Rural general practitioners in southwest Shandong have a high-level turnover intention, part-time jobs, average number of night shift per month, working time, insomnia, depression and job burnout are the main factors affecting the turnover intention. Necessary measures should be taken by relevant departments to enhance the stability of rural general practitioners.
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In order to improve teachers' teaching ability and manage teachers effectively, we try to organize teachers to carry out a series of activities in the form of "teaching club". We set up six teaching clubs according to the key points of teaching work and teaching hot spots. We explore the formation of "teaching club" as a means of modern teacher management model, through the implementation of the teacher-centered concept, establish an efficient and flexible management system, and establish and improve the active development of behavior and other strategies. Through a period of practice and exploration, we have gained benefits and even made breakthroughs in many aspects, such as the construction of teaching team, curriculum construction and teaching competition. The management strategies mentioned above provide new ideas for the development of teacher management.
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The fifth generation wireless systems (5G technology) has the characteristics of high system capacity, high data transmission rate, massive device connectivity, extremely low latency, and ultra-reliability. With the advent of 5G technology, modern surgery has made new progress in telesurgery, tele-consultation, remote instruction and teaching, remote monitoring and ambulance. "5G+ surgery" is still in its infancy, and with the gradual improvement of 5G technology, its application in the surgical field will continuously deepen and expand.
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Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis.Surgical treatment combined with adjuvant therapy including chemotherapy,radiotherapy,molecular targeted drug therapy,local liver damage therapy,interventional therapy,antiviral therapy can have complementary effects to prevent its recurrence after surgery.We will review the latest advances in surgery and adjuvant therapy for ICC,and provide new ideas for the comprehensive treatment and clinical research of ICC.
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Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis. Surgical treatment combined with adjuvant therapy including chemotherapy, radiotherapy, molecular targeted drug therapy, local liver damage therapy, interventional therapy, antiviral therapy can have complementary effects to prevent its recurrence after surgery. We will review the latest advances in surgery and adjuvant therapy for ICC, and provide new ideas for the comprehensive treatment and clinical research of ICC.
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Portal vein tumor thrombus is one of the most common complications of advanced hepatocellular carcinoma and greatly affects the treatment and prognosis of such patients. With the development and advances in surgical treatment methods, local interventional treatment, radiation therapy, targeted drug therapy, and immunotherapy in recent years, advanced hepatocellular carcinoma with portal vein tumor thrombus is no longer a dilemma in clinical treatment. Both single and combined treatments have achieved good clinical effects. This article reviews the current status, difficulties, and future treatment methods for advanced liver cancer with portal vein tumor thrombus.
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Objective Toevaluatetheinterventionaltherapeuticefficacyoflowerureteralstricturesandobstructionbyimplantation of"doubleGJ"stentsbytheguidewiretrackwithtwowaysjointofpercutaneousnephrocentesisandurethra.Methods 45caseswith malignanttumoroflowerureteralstrictureorobstructionweretreatedwithballooncatheterdilatation,andthenthe"doubleJ"tube wasimplantedusingpercutaneousnephrostomyandurethradoublepathguidedwireorbit.Postoperativeurinevolume,renalfunction, colordopplerultrasoundandCTfollowGupwereobservedandreviewedfor3－12monthsaftersurgery.Results Thesuccessfulrate oftheoperationwas100%(45/45),withtheureteralobstructionrelievedandtheclinicalsymptomsimproved.After7days,renal functionfullyrecoveredtonormalin39patients,andsignificantlyimprovedin6patients.Conclusion Implantationof "doubleGJ"stentsbytheguidewiretrackwithpercutaneousnephrocentesisandtransurethraldoublepathisasimple,effectiveandminimallyinvasive treatmentformalignantureteralstrictureandobstruction.
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To establish a simple, quick and effective method to get a large amount of spider toxin JZTX-26 (35 aa) and JZTX-51 (27 aa) with 3 disulfide bonds each, the mature peptides coding gene fragments were constructed and fused with maltose-binding protein (MBP) tag in an Escherichia coli expression vector pMAL-p2x. The recombinant constructs pMAL-jz26 and pMAL-jz51 were transformed and cultured in E. coli TB1 and BL21 (DE3). After being induced by isopropyl-β-d-thiogalactoside (IPTG), the periplasmic proteins were purified by amylose affinity chromatography and analyzed by SDS-PAGE. The fusion proteins were digested with factor X, and purified by Sizes-Exclusion chromatography and Reversed Phase HPLC. Molecular weights of the purified peptides were obtained by using a MALDI-TOF-TOF mass spectrometer, which were consistent with the theoretical molecular weights. Five milligram of target protein could be purified from 1 L of culture medium. The results indicate that the peptides with three disulfide bonds can be expressed by using the prokaryotic expression system with MBP tag. Our findings suggest the possibility of genetic engineering to obtain large amount of spider peptide toxins.
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Objective To investigate the application value of pancreaticojejunostomy with double-layer continuous suture in total laparoscopic pancreaticoduodenectomy (TLPD).Methods The retrospective crosssectional study was conducted.The clinicopathological data of 21 patients who underwent TLPD with pancreaticojejunostomy using double-layer continuous suture in the Second Hospital of Jilin University between January and December 2017 were collected.The anastomosis used Child method,and pancreaticojejunostomy,choledochojejunostomy and gastroenteric anastomosis in turn were done.Observation indicators:(1) surgical and postoperative recovery;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (P25,P75).Results (1) Surgical and postoperative recovery:21 patients underwent successful TLPD with pancreaticojejunostomy with double-layer continuous suture.The operation time,time of pancreaticojejunostomy and volume of intraoperative blood loss were respectively (352±25)minutes,(46±8)minutes and (168±34) mL.There was no intraoperative blood transfusion.The time of postoperative abdominal drainage-tube removal was (10.1±4.4)days.Of 21 patients,12 were complicated with biochemical fistula,and 3 with grading B of pancreatic fistula (pancreatic duct in type Ⅱ),and they were improved by inhibiting pancreatic secretion and drainage patency.There was no occurrence of biliary fistula,chylous fistula,postoperative bleeding,abdominal infection and delayed gastric emptying.The duration of postoperative hospital stay of 21 patients was (11.3± 2.0) days.(2) Postoperative pathological examination:surgical margins of 21 patients were negative.The pathological type:8,6,4,2 and 1 patients were diagnosed as distal bile duct cancer,ampulla cancer,duodenal papilla and duodenal cancer,pancreatic head cancer and neuroendocrine cancer of ampulla,respectively.(3) Follow-up and survival situations:21 patients were followed up for 3-12 months,with a median time of 7 months.During the follow-up,all the patients survived,and there was no tumor recurrence and metastasis.Conclusion Pancreaticojejunostomy with double-layer continuous suture is safe and feasible for TLPD,with advantages of exact anastomosis effect and good application value.
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Objective To explore the present human resources and problems at community health centers in Shandong province .Methods PPS sampling method was used to extract data of 333 community health centers in 17 cities in Shandong province in 2015 .Then the human resource status was analyzed and evaluated by descriptive research indexes .Results Data showed that 333 community health centers had 19809 employees ,and 12271 of them having staffing quota. These employees include 6355 physicians ,5169 nurses ,and 3064 medical and pharmaceutical technicians .For the physicians ,4841 of them are medical practitioners ,1313 were assistant medical practitioners ,while the numbers of obstetricians and gynecologists ,general practitioners ,and TCM practitioners were 756 , 2124 and 432 respectively .Conclusions These community health service centers are faced with such problems as lack of human resources ,irrational personnel makeup ,and obvious shortage of public health ,general practitioners and medical/pharmaceutical professionals. It is recommended to increase and optimize manpower by means of motivating existing personnel ,introducing new manpower and training opportunities for the retention.Medical alliances are expected to encourage more high-end professionals to the primary institutions .
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Objective To investigate and analyze the cognition, utilization, and influencing factors of the health management project of basic public health services in urban pregnant woman, in order to promote the smooth implementation of equal access of basic public health services. Methods A multi-stage random sampling method was used to recruit participants. First, eight streets under the jurisdiction of the survey area were divided into three levels, high, medium, and low according to the level of economic development using the stratified random sampling method. One street was selected from each of the three levels as a sample street, and then using the cluster sampling method, a questionnaire survey was administered to 290 urban pregnant women in the three streets. Pregnant women's awareness of service items and utilization status were described and analyzed by statistical rate indicators. The possible factors affecting the utilization of service items were analyzed by χ2analysis and logistic regression. Significant differences were observed between the two methods (P<0.05). Results The 282 urban pregnant women were between 22-44 years, and had an average age of 29.19±4.05 years. Among them, 72.7% were primipara, 12.4% had an abnormal birth history and 65.6% were at 28 weeks of pregnancy. The highest awareness rate of basic public health services was found in medical examinations during pregnancy (81.6%), and the lowest awareness rate was found in two follow-up visits (30.1%) during 28-40 weeks of pregnancy. There were significant differences in the establishment of maternal health handbook (χ2=12.075, P=0.034), accepting assessment of maternal health and fetal growth (χ2=11.154, P=0.048), and accepting prenatal guidance (χ2=19.878, P=0.001) among pregnant women who held different jobs. Additionally, there were significant differences in the establishment of maternal health handbook (χ2=6.211, P=0.045) and prenatal guidance (χ2=13.175, P=0.001) among pregnant women at different gestation periods. The awareness of basic public health services for pregnancy, the enthusiasm of service utilization, and the degree of attention were also important factors affecting the utilization of health services among pregnant women. Conclusion There are apparent deficiencies in cognition and utilization of the health management project among pregnant women in Jining city, which indicates the need to improve the implementation of the project. The government should strengthen promotion and education, increase funding, expand the scope of services, and promote the effective implementation of maternal health management projects. Fundamentally, the equal access of basic public health services should be realized, which would benefit the public and particularly relevant groups.
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Objective To analyze the cognition, utilization and satisfaction on pregnancy health management of basic public health services. and to find out potential problems and provide suggestions for promoting equality in rural basic public health. The Weishan Lake area was selected as the sample point and the left behind pregnant women in the countryside as control. Methods In the period from May 2016 to July, questionnaires were designed for the pregnancy health management of basic public health services, 330 left-behind pregnant women and 300 rural immigrating pregnant women were selected as our target interviewees. The average age of rural immigrating pregnant women and the left-behind pregnant women was (28.6 ± 3.7) years, and (28.3 ± 3.4) years old, respectively; the degree of education of rural immigrating pregnant women and the left-behind pregnant women was secondary specialized school or high school and junior middle school, respectively. The occupation of rural immigrating pregnant women was mainly workers;accounting for 31.4%, while the occupation of the left-behind pregnant women was farming, accounting for 36.7%. Results The awareness rate ofgeneral pregnancy examination and gynecological examinationin health management items of rural immigrating pregnant women and left-behind pregnant women was the highest, which were 77.7% and 78.3%, respectively, and the lowest awareness rate of the 2 prenatal follow-up was the lowest in the third trimester, which was 22.6% and 23.0%, respectively. The difference was not statistically significant. The maternal health management service understanding rate of rural immigrating pregnant women and left-behind pregnant women were 24.7% and 17.9% respectively , the difference was statistically significant (Z=-1.993, P=0.046);the awareness rate of delivery and breastfeeding in late pregnancy were 36.2% and 47.6% respectively, and the difference was statistically significant (χ2=7.933, P=0.005). The rate of the registering of the maternal health care handbook of rural immigrating pregnant women and left-behind pregnant women were 40.4%and 54%respectively, and the difference was statistically significant (χ2=11.065, P=0.001), Among them, the rate of registering in township hospitals was 46.6% and 73.3% respectively, and the difference was statistically significant (χ2=21.104, P=0.0000); the utilization rate of 3 or more antepartum examination and follow-up services was 8.4%and 23%respectively, and the difference was statistically significant (χ2=23.878, P=0.000). The growth and development of the health of pregnant women and fetal assessment and utilization rates were 9.8% and 23.6%, the difference was statistically significant (χ2=20.460, P=0.000); prenatal guidance (childbirth preparation, breastfeeding) utilization rate were 8%, 13.7%, the difference was statistically significant (χ2=5.011, P=0.027);abnormal or critical maternal referral utilization rate were 22%and 34.8%, the difference was statistically significant (χ2=12.133, P=0.001). Conclusion Imbalance exists in acquiring basic public health services of the two pregnant women cohort, the left-behind pregnant women are better than the rural immigrating pregnant women. Therefore, the government should propagate this service by multi-channel to improve their cognition and utilization of this policy implemented, and to promote the development of the services.
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Objective To investigate the relationship between serum matrix metalloproteinase(MMP-9) and tumor necrosis factor alpha(TNF-α) with bone turnover markers and bone mineral density(BMD) in the patients with chronic obstructive pulmonary disease(COPD) complicating osteoporosis.Methods Eighty-four cases of stable stage of COPD admitted to our hospital were selected and divided into the osteoporosis group(28 cases),low bone mass group(26 cases) and normal bone mass group(30 cases) according to the BMD detection results.ELISA was adopted to detect the MMP-9,TNF-α,bone turnover biochemical markers sBAP,sOC and sCTX levels.Results Serum MMP-9,TNF-α levels in the osteoporosis group and low bone mass group were higher than those in the normal bone mass group,which in the osteoporosis group were higher than those in the low bone mass group,the differences were statistically significant(P<0.05);the sBAP and sOC levels in the osteoporosis group was lower than those in the normal bone mass group,while the sCTX level was higher than that of the normal bone mass group;the sBAP and sOC levels in the low bone mass group were lower than those in the normal bone mass group,the sBAP level in the osteoporosis group was lower than that in the low bone mass group,the sCTX level was higher than that of low bone mass group,the differences were statistically significant(P<0.05);the lumbar vertebral BMD and its T value,femoral neck BMD and its T value in the osteoporosis group and low bone mass group were lower than those in the normal bone mass group(P<0.05),which in the osteoporosis group were lower than those in the low bone mass group(P<0.05);serum MMP-9 was negatively correlated with bone turnover biochemical markers and BMD level(P<0.05);TNF-α was negatively correlated with bone turnove biochemical markers(P<0.05).Conclusion MMP-9 and TNF-α are highly expressed in the patients with COPD complicating osteoporosis,and negatively correlated with the bone bone turnove biochemical markers,meanwhile have a certain relationship with BMD.
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<p><b>OBJECTIVE</b>To investigate the effect of Cdc42-shRNA plasmid to proliferation, migration, invasion and other malignant biological behavior in hepatoma SMMC-7721 cells.</p><p><b>METHODS</b>Cdc42-shRNA interfering vector transfected to SMMC-7721 cells with liposome method. The growth curve of transfected cells SMMC-7721, U6-control, Cdc42-shRNA2 was detected by MTT. The cells mobility was detected by wound healing experiment. Transwell chamber experiments to observe the cell migration and invasion. Detected AFP and PCNA expression level by Western blot.Human hepatoma SMMC-7721 transplanted subcutaneously in nude mouse, detected the expression of Cdc42 of the tumor by immunohistochemistry.t test was used to analyze the data between two groups.</p><p><b>RESULTS</b>The doubling time of Cdc42-shRNA2, U6-control and SMMC7721 was 42.7 h, 34.9 h and 35.1 h. The relative migration distance of Cdc42-shRNA2 and U6-control on 36 h was (47.1 ± 4.1)% and (86.6 ± 5.3)% (t=-10.21, P<0.05). Transwell chamber experimental methods showed the numbers of permeating cells were 18.2 ± 2.1(Cdc42-shRNA2) and 41.0 ± 3.5 (U6-control) (t=-9.67, P<0.05) on 24 h. The AFP and PCNA expression of hepatoma cells is significantly inhibited after the Cdc42-shRNA2 was transfected compared with U6-control group.The tumor average weight of group Cdc42-shRNA2 was (335.1 ± 178.2) mg, which was much lighter than that of SMMC-7721 group ((925.3 ± 241.4) mg) and U6-control group ((910.5 ± 225.6) mg) (t=-4.47, -4.39; P<0.05) and the Cdc42 expression was also weak positive.</p><p><b>CONCLUSION</b>Cdc42 interfere with plasmid significant changes in human malignant biological behavior of hepatocellular carcinoma cells, and reduces liver cancer cell growth, invasion and metastasis of capacity.</p>