{"id":2463,"date":"2020-04-16T13:27:28","date_gmt":"2020-04-16T13:27:28","guid":{"rendered":"https:\/\/www.q-bital.com\/?p=2463"},"modified":"2020-04-16T13:27:28","modified_gmt":"2020-04-16T13:27:28","slug":"the-role-of-mobile-healthcare-during-the-covid-19-crisis","status":"publish","type":"post","link":"https:\/\/www.q-bital.com\/hu_hu\/the-role-of-mobile-healthcare-during-the-covid-19-crisis\/","title":{"rendered":"A mobil eg\u00e9szs\u00e9g\u00fcgy szerepe a COVID-19 v\u00e1ls\u00e1g idej\u00e9n"},"content":{"rendered":"

M\u00edg jelenleg a nagyszab\u00e1s\u00fa, ideiglenes helysz\u00edni k\u00f3rh\u00e1zak \u00e9p\u00edt\u00e9se kapja a legt\u00f6bb \u00fajs\u00e1got, a sz\u00ednfalak m\u00f6g\u00f6tt is hatalmas munka folyik a vil\u00e1g k\u00fcl\u00f6nb\u00f6z\u0151 r\u00e9szein l\u00e9tez\u0151 k\u00f3rh\u00e1zakban az ellen\u00e1ll\u00f3 k\u00e9pess\u00e9g jav\u00edt\u00e1sa \u00e9rdek\u00e9ben, \u00e9s bizonyos esetekben a Q-bital flott\u00e1j\u00e1nak jav\u00edt\u00e1sa \u00e9rdek\u00e9ben. mobil eg\u00e9szs\u00e9g\u00fcgyi int\u00e9zm\u00e9nyek<\/a> kulcsszerepet j\u00e1tszottak.<\/p>\n

Vil\u00e1gszerte arra k\u00e9rt\u00e9k a k\u00f3rh\u00e1zakat, hogy szabad\u00edts\u00e1k fel kapacit\u00e1sukat a nem kritikus betegek elbocs\u00e1t\u00e1s\u00e1val \u00e9s minden tervezett \u00e9s v\u00e1laszthat\u00f3 elj\u00e1r\u00e1s le\u00e1ll\u00edt\u00e1s\u00e1val, hogy felk\u00e9sz\u00fcljenek a koronav\u00edrussal \u00f6sszef\u00fcgg\u0151 felv\u00e9telek v\u00e1rhat\u00f3 megugr\u00e1s\u00e1ra.<\/p>\n

Sok k\u00f3rh\u00e1znak \u00fajra kellett rendelnie a bels\u0151 teret, \u00e9s k\u00fcl\u00f6nf\u00e9le m\u00f3dokon \u00e1t kell csoportos\u00edtania az er\u0151forr\u00e1sokat annak \u00e9rdek\u00e9ben, hogy a k\u00f3rh\u00e1zon bel\u00fcl ter\u00fcleteket szabad\u00edtson fel a koronav\u00edrussal fert\u0151z\u00f6tt betegek sz\u00e1m\u00e1ra. A megl\u00e9v\u0151 helyis\u00e9gek erre a c\u00e9lra alkalmas k\u00f3rteremm\u00e9 vagy l\u00e9tes\u00edtm\u00e9nny\u00e9 alak\u00edt\u00e1sa azonban nem felt\u00e9tlen\u00fcl olyan egyszer\u0171 \u00e9s gyors. Mindenekel\u0151tt gondos tervez\u00e9st ig\u00e9nyelt, figyelembe v\u00e9ve a teljes k\u00f3rh\u00e1z l\u00e9tes\u00edtm\u00e9nyeit \u00e9s er\u0151forr\u00e1sait.<\/p>\n

V\u00e1lasz a kih\u00edv\u00e1sra<\/strong><\/p>\n

B\u00e1r egyes esetekben enyh\u00edtett\u00e9k a szab\u00e1lyokat, hogy lehet\u0151v\u00e9 tegy\u00e9k az ideiglenes k\u00f3rh\u00e1zak, oszt\u00e1lyok \u00e9s egy\u00e9b l\u00e9tes\u00edtm\u00e9nyek gyors telep\u00edt\u00e9s\u00e9t, azoknak az ingatlancsapatoknak, amelyek egy megl\u00e9v\u0151 l\u00e9tes\u00edtm\u00e9nyt ideiglenes Covid-19-oszt\u00e1lyt\u00e1 szeretn\u00e9nek \u00e1talak\u00edtani intub\u00e1lt betegek elhelyez\u00e9s\u00e9re, k\u00f6vetni\u00fck kell a hivatalos \u00fatmutat\u00e1st. P\u00e9ld\u00e1ul a k\u00f3rh\u00e1zakon bel\u00fcli megfelel\u0151 helyek meghat\u00e1roz\u00e1sakor figyelembe kell venni a megl\u00e9v\u0151 forgalmi \u00e1raml\u00e1sokat, \u00e9s el kell ker\u00fclni a nem koronav\u00edrusos forgalom minden \u00e1tmen\u0151 \u00fatvonal\u00e1t. Figyelembe kell venni a logisztikai \u00e1raml\u00e1sokat, a tiszta \u00e9s piszkos hullad\u00e9kkezel\u00e9st is.<\/p>\n

Egy m\u00e1sik kulcsfontoss\u00e1g\u00fa k\u00f6vetelm\u00e9ny a megfelel\u0151 szell\u0151ztet\u00e9s \u00e9s elsz\u00edv\u00e1s, mivel a haszn\u00e1latban l\u00e9v\u0151 szell\u0151z\u0151k nagy sz\u00e1ma oxig\u00e9nnel d\u00fas\u00edthatja a leveg\u0151t, n\u00f6velve ezzel az \u00e9g\u00e9si kock\u00e1zatot. Sz\u00e1mos egy\u00e9b tervez\u00e9si szempontot is figyelembe kell venni, mint p\u00e9ld\u00e1ul a t\u0171zbiztons\u00e1got az elrendez\u00e9s \u00e9s a haszn\u00e1lat megv\u00e1ltoz\u00e1sa miatt, k\u00fcl\u00f6n\u00f6sen, ha \u00e9p\u00edt\u00e9si munk\u00e1kra van sz\u00fcks\u00e9g a t\u00e9r \u00e1talak\u00edt\u00e1s\u00e1hoz. Az orvosi g\u00e1z \u00e9s oxig\u00e9n csatlakoz\u00e1sai mellett az \u00e1gyterekhez tov\u00e1bbi csatlakoz\u00e1sokra \u00e9s k\u00f6r\u00fcl\u00f6tt\u00fck l\u00e9v\u0151 helyekre is sz\u00fcks\u00e9g van az \u00e1gyter\u00fcleten id\u0151szakosan haszn\u00e1lt berendez\u00e9sek sz\u00e1m\u00e1ra.<\/p>\n

Egyes orsz\u00e1gokban, p\u00e9ld\u00e1ul az Egyes\u00fclt Kir\u00e1lys\u00e1gban, azt javasolj\u00e1k, hogy a koronav\u00edrussal fert\u0151z\u00f6tt betegek kezel\u00e9s\u00e9re \u00e9s gondoz\u00e1s\u00e1ra az eg\u00e9szs\u00e9g\u00fcgyi int\u00e9zm\u00e9ny kijel\u00f6lt, z\u00e1rt ter\u00fclet\u00e9t vagy sz\u00e1rny\u00e1t haszn\u00e1lj\u00e1k. Ennek a ter\u00fcletnek ide\u00e1lis esetben k\u00fcl\u00f6n bej\u00e1rattal \u00e9s kij\u00e1rattal kell rendelkeznie, \u00e9s m\u00e1s betegek, l\u00e1togat\u00f3k vagy szem\u00e9lyzet nem haszn\u00e1lhatja \u00e1tj\u00e1r\u00f3k\u00e9nt, bele\u00e9rtve az \u00e1thelyezett betegeket, valamint az \u00e9p\u00fcletbe bel\u00e9p\u0151 \u00e9s kil\u00e9p\u0151 szem\u00e9lyzetet \u00e9s l\u00e1togat\u00f3kat.<\/p>\n

Rugalmas eg\u00e9szs\u00e9g\u00fcgyi megold\u00e1sok alkalmaz\u00e1sa<\/strong><\/p>\n

Mint a Q-bital mobilja sz\u00ednh\u00e1zak<\/a> \u00e9s k\u00f3rtermek<\/a> \u00f6n\u00e1ll\u00f3 egys\u00e9gek, k\u00fcl\u00f6n\u00f6sen alkalmasak az elk\u00fcl\u00f6n\u00edt\u00e9st ig\u00e9nyl\u0151 fert\u0151z\u00f6tt betegek kezel\u00e9s\u00e9re, vagy kritikus m\u0171t\u00e9tek vagy kezel\u00e9sek elv\u00e9gz\u00e9s\u00e9re a k\u00f3rh\u00e1z Covid-19 ter\u00fcletein k\u00edv\u00fcl. Ezen t\u00falmen\u0151en, m\u00e1r megfelelnek a vonatkoz\u00f3 szabv\u00e1nyok t\u00f6bbs\u00e9g\u00e9nek, \u00edgy gyorsan \u00fajra felhaszn\u00e1lhat\u00f3k tov\u00e1bbi \u00e1gyterek biztos\u00edt\u00e1s\u00e1ra.<\/p>\n

Az elm\u00falt hetekben azonban kider\u00fclt, hogy azok a k\u00f3rh\u00e1zvezet\u0151k, akik m\u00e1r rendelkeznek mobil m\u0171t\u0151vel, kezel\u0151hellyel vagy oszt\u00e1llyal a helysz\u00ednen, ezt az egys\u00e9get saj\u00e1t klinikai telephely\u00fck l\u00e9tfontoss\u00e1g\u00fa kiterjeszt\u00e9s\u00e9nek, valamint a k\u00f3rh\u00e1zon bel\u00fcli koronav\u00edrus-kapacit\u00e1s-tervez\u00e9s kulcsfontoss\u00e1g\u00fa elem\u00e9nek tekintik. Az egys\u00e9g tov\u00e1bbi k\u00fcls\u0151 kapacit\u00e1sa lehet\u0151v\u00e9 tette egyes k\u00f3rh\u00e1zak sz\u00e1m\u00e1ra, hogy jobban megszervezz\u00e9k a v\u00e1ltoztat\u00e1sokat az eg\u00e9sz telephelyen, hogy megszak\u00edt\u00e1s n\u00e9lk\u00fcli ell\u00e1t\u00e1st biztos\u00edtsanak a betegek sz\u00e1m\u00e1ra egy naponta v\u00e1ltoz\u00f3 helyzetben.<\/p>\n

Az elm\u00falt hetekben a Q-bital mobil k\u00f3rtermekb\u0151l, m\u0171t\u0151kb\u0151l \u00e9s... endoszk\u00f3pos lakoszt\u00e1lyok<\/a> a k\u00f3rh\u00e1zak koronav\u00edrus-tervez\u00e9se, a reziliencia n\u00f6vel\u00e9s\u00e9re ir\u00e1nyul\u00f3 \u00e1tfog\u00f3 terv r\u00e9szek\u00e9nt sz\u00e1mos k\u00fcl\u00f6nb\u00f6z\u0151 m\u00f3don \u00fajrahasznos\u00edtott\u00e1k. Az \u00edgy l\u00e9trej\u00f6tt megold\u00e1s \u00e9s a mobil l\u00e9tes\u00edtm\u00e9ny esetleges felhaszn\u00e1l\u00e1sa az egyes k\u00f3rh\u00e1zak egyedi ig\u00e9nyeit\u0151l, az egys\u00e9g telephelyen bel\u00fcli elhelyezked\u00e9s\u00e9t\u0151l \u00e9s egyes oszt\u00e1lyokhoz val\u00f3 k\u00f6zels\u00e9g\u00e9t\u0151l f\u00fcgg\u00f6tt.<\/p>\n

S\u00fcrg\u0151ss\u00e9gi m\u0171t\u00e9t \u00e9s alapvet\u0151 kezel\u00e9s<\/strong><\/p>\n

Mivel a gyorsas\u00e1g a l\u00e9nyeg, a k\u00f3rh\u00e1zakat arra \u00f6szt\u00f6nzik, hogy azonos\u00edts\u00e1k azokat a ter\u00fcleteket, amelyek minim\u00e1lis m\u00f3dos\u00edt\u00e1ssal hat\u00e9konyan \u00e1talak\u00edthat\u00f3k, p\u00e9ld\u00e1ul a megl\u00e9v\u0151 oszt\u00e1lyokat, m\u0171t\u0151ket \u00e9s kat\u00e9terez\u0151 laborat\u00f3riumokat, bele\u00e9rtve az el\u0151k\u00e9sz\u00edt\u0151 \u00e9s a j\u00e1r\u00f3beteg-ell\u00e1t\u00f3 ter\u00fcleteket is. A vezet\u00e9kes orvosi g\u00e1zok \u00e9s a tov\u00e1bbi oxig\u00e9n ir\u00e1nti ig\u00e9ny miatt sok k\u00f3rh\u00e1z \u00fagy tal\u00e1lja, hogy a Covid-19 kapacit\u00e1s b\u0151v\u00edt\u00e9s\u00e9nek optim\u00e1lis helysz\u00edne egy megl\u00e9v\u0151 m\u0171t\u0151.<\/p>\n

Ennek eredm\u00e9nyek\u00e9nt sz\u00e1mos olyan k\u00f3rh\u00e1z, ahol m\u00e1r van mobil m\u0171t\u0151 vagy oszt\u00e1ly a helysz\u00ednen, a l\u00e9tes\u00edtm\u00e9nyt haszn\u00e1lja a megl\u00e9v\u0151 bels\u0151 seb\u00e9szeti vagy klinikai terek \u00e1tereszt\u00e9s\u00e9re. A Q-bital mobil egys\u00e9geiben jelenleg v\u00e9gzett elj\u00e1r\u00e1sok k\u00f6z\u00e9 tartozik a s\u00fcrg\u0151ss\u00e9gi m\u0171t\u00e9t, a s\u00fcrg\u0151ss\u00e9gi ell\u00e1t\u00e1s, p\u00e9ld\u00e1ul a r\u00e1kkezel\u00e9s, valamint a traum\u00e1s betegek kezel\u00e9se.<\/p>\n

Az egyik k\u00f3rh\u00e1z s\u00fcrg\u0151ss\u00e9gi plasztikai m\u0171t\u00e9tekre \u00e9s b\u0151rgy\u00f3gy\u00e1szati beavatkoz\u00e1sokra haszn\u00e1lja a m\u0171t\u0151j\u00e9t, m\u00edg egy m\u00e1sik s\u00fcrg\u0151ss\u00e9gi sz\u00fcl\u00e9szeti ell\u00e1t\u00e1sra. Ennek kulcsa a l\u00e9tes\u00edtm\u00e9nyek rugalmass\u00e1ga, mivel a k\u00edv\u00e1nt felhaszn\u00e1l\u00e1si m\u00f3dt\u00f3l f\u00fcgg\u0151en nagyon gyorsan \u00e1talak\u00edthat\u00f3k.<\/p>\n

Tov\u00e1bbi el\u0151ny az egys\u00e9gek mobil jellege, mivel viszonylag k\u00f6nnyen \u00e1thelyezhet\u0151k oda, ahol a legnagyobb sz\u00fcks\u00e9g van r\u00e1juk. Sk\u00f3ci\u00e1ban p\u00e9ld\u00e1ul az egyik eg\u00e9szs\u00e9g\u00fcgyi tan\u00e1cs fontolgatja, hogy mobil m\u0171t\u0151j\u00e9t ugyanazon tan\u00e1cson bel\u00fcl egy m\u00e1sik k\u00f3rh\u00e1zi helysz\u00ednre helyezi \u00e1t, ahol nagyobb a sz\u00fcks\u00e9g.<\/p>\n

COVID-19 \u00e9s a betegek elk\u00fcl\u00f6n\u00edt\u00e9se<\/strong><\/p>\n

Egy mobil vagy modul\u00e1ris k\u00f3rterem \u00e1talak\u00edthat\u00f3 1. szint\u0171 l\u00e9gz\u00e9st\u00e1mogat\u00f3 oszt\u00e1lly\u00e1, m\u00edg a mobil m\u0171t\u0151k \u00e1talak\u00edthat\u00f3k nagy hat\u00e9konys\u00e1g\u00fa drog\u00e9ri\u00e1kk\u00e1 vagy intenz\u00edv oszt\u00e1lyokk\u00e1, vagy olyan elj\u00e1r\u00e1sokhoz \u00e9s kezel\u00e9sekhez, amelyek profit\u00e1lnak a fokozott izol\u00e1ci\u00f3b\u00f3l.<\/p>\n

N\u00e9h\u00e1ny egys\u00e9get olyan betegek elk\u00fcl\u00f6n\u00edt\u00e9s\u00e9re is haszn\u00e1lnak, akikn\u00e9l felt\u00e9telezhet\u0151en koronav\u00edrus-t\u00fcnetek jelentkeznek, de tov\u00e1bbi vizsg\u00e1latra v\u00e1rnak. Egy nagyobb region\u00e1lis k\u00f3rh\u00e1z ideiglenesen \u00e1talak\u00edtotta mobil l\u00e9tes\u00edtm\u00e9ny\u00e9t seb\u00e9szeti megfigyel\u0151helyis\u00e9gg\u00e9, hogy enyh\u00edtse a k\u00f3rh\u00e1z m\u00e1s ter\u00fcletein a nyom\u00e1st, m\u00edg m\u00e1sok mobil m\u0171t\u0151ket \u00e9s oszt\u00e1lyokat haszn\u00e1lnak kritikus nappali seb\u00e9szeti beavatkoz\u00e1sokhoz, hogy t\u00e1vol tarts\u00e1k a betegeket a f\u0151 k\u00f3rh\u00e1zon bel\u00fcli Covid-19 z\u00f3n\u00e1kt\u00f3l.<\/p>\n

Hozz\u00e1adott rugalmass\u00e1g<\/strong><\/p>\n

Mivel ezek a mobil eg\u00e9szs\u00e9g\u00fcgyi l\u00e9tes\u00edtm\u00e9nyek m\u00e1r most is megfelelnek a vonatkoz\u00f3 szabv\u00e1nyok t\u00f6bbs\u00e9g\u00e9nek, a helyzet v\u00e1ltoz\u00e1saival p\u00e1rhuzamosan \u00fajra felhaszn\u00e1lhat\u00f3k, hogy alkalmazkodjanak a haszn\u00e1lat megv\u00e1ltoz\u00e1s\u00e1hoz, legyen sz\u00f3 ak\u00e1r ITU-\u00e1gyak b\u0151v\u00edt\u00e9s\u00e9r\u0151l, ak\u00e1r tov\u00e1bbi kezel\u00e9si kapacit\u00e1sr\u00f3l, an\u00e9lk\u00fcl, hogy szembes\u00fcln\u00e9nek az \u00e1talak\u00edt\u00e1sokkal kapcsolatos sz\u00e1mos szok\u00e1sos probl\u00e9m\u00e1val. megl\u00e9v\u0151 l\u00e9tes\u00edtm\u00e9ny vagy \u00faj \u00e9p\u00fclet vagy r\u00e9szleg \u00e9p\u00edt\u00e9se.<\/p>\n

Egyes k\u00f3rh\u00e1zak meg\u00e1llap\u00edtott\u00e1k, hogy tov\u00e1bbi helyekre van sz\u00fcks\u00e9g m\u00e1s c\u00e9lokra, p\u00e9ld\u00e1ul a szem\u00e9lyzet t\u00e1mogat\u00e1s\u00e1ra az\u00e1ltal, hogy nagyon sz\u00fcks\u00e9ges pihen\u0151helyeket biztos\u00edtanak, vagy olyan \u00f6lt\u00f6z\u0151ket biztos\u00edtanak, amelyeket a fert\u0151z\u00f6tt vagy nem fert\u0151z\u00f6tt betegekt\u0151l elk\u00fcl\u00f6n\u00edtve kell elhelyezni.<\/p>\n

Sok esetben a k\u00fcls\u0151 egys\u00e9gen dolgoz\u00f3 tapasztalt klinikai t\u00e1mogat\u00f3 szem\u00e9lyzetet is \u00e1tcsoportos\u00edtott\u00e1k, ak\u00e1r az egys\u00e9gen bel\u00fcl, ak\u00e1r a k\u00f3rh\u00e1z m\u00e1s ter\u00fcletein, bele\u00e9rtve a Covid-19 z\u00f3n\u00e1kat is, hogy ott ny\u00fajtsanak t\u00e1mogat\u00e1st a k\u00f3rh\u00e1znak, ahol a legnagyobb sz\u00fcks\u00e9g van r\u00e1. Amennyiben a seb\u00e9szeti kapacit\u00e1s n\u00f6vel\u00e9se \u00e9rdek\u00e9ben \u00e1talak\u00edtott m\u0171t\u0151re van sz\u00fcks\u00e9g, azt nagyon gyorsan vissza lehet alak\u00edtani egy teljes szem\u00e9lyzettel ell\u00e1tott m\u0171t\u0151v\u00e9.<\/p>\n

J\u00f6v\u0151beli kapacit\u00e1s<\/strong><\/p>\n

Elker\u00fclhetetlen, hogy az azonnali v\u00e1ls\u00e1g elm\u00falt\u00e1val a betegek hossz\u00fa v\u00e1r\u00f3list\u00e1kkal n\u00e9zzenek szembe a v\u00e1ls\u00e1g idej\u00e9n elhalasztott vagy lemondott elj\u00e1r\u00e1sokra. Ez\u00e9rt m\u00e1r sz\u00e1mos k\u00f3rh\u00e1zban m\u00e9rlegelik, hogyan kezelj\u00e9k a seb\u00e9szeti, diagnosztikai \u00e9s k\u00fcl\u00f6nf\u00e9le kezel\u00e9si form\u00e1k ir\u00e1nti kereslet v\u00e1rhat\u00f3 megugr\u00e1s\u00e1t.<\/p>\n

C\u00e9lszer\u0171 el\u0151re megtervezni a rugalmas eg\u00e9szs\u00e9g\u00fcgyi l\u00e9tes\u00edtm\u00e9nyek haszn\u00e1lat\u00e1t, amelyek gyorsan telep\u00edthet\u0151k a t\u00f6bbletkapacit\u00e1s biztos\u00edt\u00e1sa \u00e9s a k\u00f3rh\u00e1zakon bel\u00fcli ellen\u00e1ll\u00f3 k\u00e9pess\u00e9g jav\u00edt\u00e1sa \u00e9rdek\u00e9ben, \u00e9s amelyek elt\u00e1vol\u00edthat\u00f3k vagy \u00e1thelyezhet\u0151k, ha m\u00e1r nincs sz\u00fcks\u00e9g r\u00e1juk, hogy tov\u00e1bbra is ott ny\u00fajthass\u00e1k a t\u00e1mogat\u00e1st, ahol a legnagyobb sz\u00fcks\u00e9g van r\u00e1.<\/p>","protected":false},"excerpt":{"rendered":"

Vil\u00e1gszerte arra k\u00e9rt\u00e9k a k\u00f3rh\u00e1zakat, hogy szabad\u00edts\u00e1k fel kapacit\u00e1sukat a nem kritikus betegek elbocs\u00e1t\u00e1s\u00e1val \u00e9s minden tervezett \u00e9s v\u00e1laszthat\u00f3 elj\u00e1r\u00e1s le\u00e1ll\u00edt\u00e1s\u00e1val, hogy felk\u00e9sz\u00fcljenek a koronav\u00edrussal \u00f6sszef\u00fcgg\u0151 felv\u00e9telek v\u00e1rhat\u00f3 megugr\u00e1s\u00e1ra.<\/p>","protected":false},"author":1,"featured_media":2346,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2,119],"tags":[5],"class_list":["post-2463","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","category-products-and-services","tag-mobile"],"acf":[],"yoast_head":"\nThe role of mobile healthcare during the COVID-19 crisis - Q-bital Healthcare Solutions<\/title>\n<meta name=\"description\" content=\"How mobile healthcare facilities are providing vital increase in capacity and flexibility during the Covid 19 crisis.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.q-bital.com\/hu_hu\/the-role-of-mobile-healthcare-during-the-covid-19-crisis\/\" \/>\n<meta property=\"og:locale\" content=\"hu_HU\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The role of mobile healthcare during the COVID-19 crisis - 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