INTRODUCTION

The outbreak of a novel coronavirus tentatively named 2019 novel coronavirus (2019-nCoV) was reported by the World Health Organization (WHO) on January 12, 2020 in Wuhan, Hubei Province, China. The virus spread rapidly to all Chinese provinces and the majority of other countries[1]. The WHO declared the 2019-nCoV pandemic a public health emergency of international concern on January 30, 2020, and on February 11, 2020, the disease was officially named coronavirus disease 2019 (COVID-19)[2].

Zhao SX formulated research directions, guided the writing of the paper, reviewed and revised the first draft, and provided funding for the project; Li XF and Zhou XL wrote the first draft; Li XF reviewed and revised the first draft; Zhou XL and Li YM contributed to the data collection; Zhou XL and Pan SQ analyzed the data; Zhou XL submitted and revised the manuscript.

MATERIALS AND METHODS

Study design

This study is a descriptive study. Throughout the COVID-19 outbreak, occupational experiences of frontline medical staff in Wuhan city and Qinghai province, China, was evaluated. Study subjects were selected with the aid of random numbers. The research team included staff from Wuhan Xizhou Hospital, Qinghai Provincial People’s Hospital and Qinghai Provincial Fourth People’s Hospital. Before the start of formal surveying, 20 research subjects were selected for pre-experimental preparation; response scales were defined at the same time. Data were collected using Questionnaire Star (an online survey tool). If response time was less than 30 s or the same score was provided more than five times in a row, the questionnaire was regarded as invalid. Questionnaire recovery rate was 100%. The mean total work experience score (± SD) of these 20 front-line medical staff was 50.34 (12.51); their mean occupational protection, occupational value, work environment, support/safety and social relationships scores were 1.98 (0.54), 2.61 (0.59), 1.32 (0.64), 2.03 (0.49) and 1.56 (0.71), respectively.

Sample size estimation

According to values in reference literature and our pre-experimental sample size estimation, the required sample size was found required to be 5-10 times the number of questionnaire items[13]. Considering a sample loss rate of 10%, target sample size was determined to be 176-352; a total of 178 questionnaires were finally distributed.

Participants

Data were collected using Questionnaire Star (an online survey tool). If response time was less than 30 s or the same score was given more than five times in a row, the questionnaire was considered invalid.

Study instruments

This part of the questionnaire evaluated for hospital level, work area, workplace, sex, occupation, age, education level, and years of work experience (Table 1).

This part of the questionnaire was developed based on relevant prior literature as well as expert opinion[15-20]. The questionnaire comprised five dimensions and a total of 36 items; questionnaire data were evaluated by nine experts including an intensive care unit medical specialist (chief physician), a hospital infection specialist (deputy chief nurse) and seven nursing experts (five deputy chief nurses and two chief nurses). The Delphi technique consisted of two rounds. In the first round, experts were asked to rank the importance of features for work experiences using a fivepoint Likert-type scale (essential; important but not essential; regular; not important; not required). The experts were also encouraged to provide further information regarding the proposed list of features

free text responses. In the second round, the drafted set of criteria was evaluated along with analysis of round one data. Experts indicated their agreement with each aspect of the criteria as well as overall questionnaire structure using a four-point Likert-type scale (strongly disagree; disagree; agree; strongly agree). The expert positive coefficient of the two rounds was 100%. In the first round, six experts put forth suggestions for revision and two items were deleted. In the second round, there was general agreement among experts regarding questionnaire items. First and second round scores were as follows: Expert consultation, 0.870 and 0.890; maturity coefficients, 0.779 and 0.842; authority coefficients, 0.810 and 0.862; coefficients of variation among experts, 0.287 and 0.254; and number of co-adjustment systems, 0.303 and 0.154. Kendall’s

test indicated that the difference between the latter two coeffi-cients was statistically significant (

< 0.001). The questionnaire was subjected to exploratory factor analysis and the principal component of the characteristic root > 1 was extracted (Table 2); this leads to the deletion of two items. The Kaiser-Meyer-Olkin value was determined to be 0.899, which explained 69.60% of the total variance. Coefficients of Cronbach’s

for different dimensions were 0.929 for support/security, 0.913 for working conditions, 0.823 for occupational protection, 0.897 for social relationships, and 0.732 for occupational value. The Cronbach’s

coefficient for the entire questionnaire was 0.925, indicating good reliability and validity. The final version of the questionnaire included five dimensions (support/security; working conditions; occupational protection; social relationships; and occupational value) and a total of 32 items. The support/safety dimension was assessed by evaluating whether pre-job training, guaranteed rest periods and support of human resources were reasonable; the working condition dimension was assessed by evaluating whether a reasonable management process was effected and materials complete; the occupational safety dimension was assessed by evaluating whether protective equipment provided at work met protection requirements; the social relationships dimension was assessed by evaluating the attitude of family and friends regarding staff in a unique work environment; and the professional value dimension was assessed by evaluating how staff perceived the value of their professional duties during the pandemic. A four-level Likert scale was used to score each item in the questionnaire. The support/security and occupational value dimensions had positive scores (not true = 0; somewhat true = 1; true = 2; and very true = 3), while the work environment, occupational protection and social relationships dimensions were scored in reverse (not true = 3; somewhat true = 2; true = 1; and very true = 0). Higher scores indicated better work experiences; a total score of 128 was possible. The mean total work experience score (± SD) of the 20 front-line medical staff was 50.34 points (12.51); mean scores for occupational protection, professional value, work environment, support/safety and social relationships were 1.98 (0.54), 2.61 (0.59), 1.32 (0.64), 2.03 (0.49) and 1.56 (0.71), respectively.

李叔和聽到這個(gè)消息，有點(diǎn)心驚肉跳。捻船的時(shí)候，李老鬼對(duì)他說，我早就知道，這個(gè)娘們屬是非窩子，我不讓你給她有來往，是看她面相上有殺氣哩，還好，你早給她斷了，這事兒粘不到咱身上。

Data collection

A total of 178 frontline health care workers from hospitals in the city of Wuhan and two designated hospitals in Qinghai province who worked in fever, observation and isolation wards were enrolled. Frontline medical personnel involved in the diagnosis, treatment, and care of patients with confirmed or suspected COVID-19 who provided informed consent and volunteered to participate in this study met our inclusion criteria. Health care workers who had been involved in such medical work for less than one week were excluded from analysis[14].

Ethical considerations

“地者，政之本也！”土地資源是農(nóng)民賴以生存的物質(zhì)保證，是生活生產(chǎn)中不可或缺的重要組成部分，土地政策更是盤活土地資源，帶領(lǐng)農(nóng)民脫貧致富的保證，是精準(zhǔn)扶貧工作穩(wěn)步前行，各項(xiàng)政策落地的物質(zhì)保障。做好土地政策研究、制定與落實(shí)，是盤活土地資源，釋放土地價(jià)值，助推其他精準(zhǔn)扶貧政策有效實(shí)施的基礎(chǔ)性工作。

Data analyses

Data analyses were performed using SPSS v20.0 (IBM, United States); frequency, composition ratio, and mean ± SD were considered descriptive statistics. Either the independent samples test or analysis of variance was used to analyze differences between and across different subgroups of health care workers according to demographics and work experiences. Tests were two-tailed with a significance level of

< 0.05.

1.5 試劑性能驗(yàn)證及結(jié)果判讀標(biāo)準(zhǔn) 選擇上述不同IHC級(jí)別的標(biāo)本，共25例，按照優(yōu)化后條件行FISH檢測(cè)。結(jié)果判讀參照乳腺癌HER2檢測(cè)指南(2014版)[2]選擇至少2個(gè)視野，隨機(jī)計(jì)數(shù)至少20個(gè)浸潤(rùn)細(xì)胞。①當(dāng)HER-2/CEP17比值≥2.0時(shí)，HER-2為陽性；HER-2/CEP17比值<2.0，但平均HER-2拷貝數(shù)≥6.0時(shí)，HER-2陽性；HER-2信號(hào)連接成簇時(shí)，可不計(jì)數(shù)，直接視為基因擴(kuò)增。②當(dāng)HER-2/CEP17比值<2.0，且平均拷貝數(shù)/細(xì)胞<4.0時(shí)，HER-2陰性。③當(dāng)HER-2/CEP17比值<2.0，平均HER-2拷貝數(shù)在4.0～6.0之間，結(jié)果判為不確定。

RESULTS

General characteristics of the study population

A total of 178 participants were contacted; five dropped out and 173 completed the questionnaire (including 72 from secondary and 101 from tertiary hospitals). A total of 65 respondents worked in Qinghai while 108 worked in Wuhan; 15 worked with patients suffering fever in outpatient departments, 15 in observation wards, 67 in general isolation wards, 53 in critical isolation wards, 23 in temporary (field) hospitals, and four in other settings. The general characteristics of the study population are presented in Table 1.

Comparison of frontline health care worker work experience scores

Total work experience scores varied according to workplace. The mean score was lowest for staff working in fever outpatient departments and highest for those in field and other such hospitals. Support/security dimension mean score was higher for staff working in tertiary hospitals as compared to secondary hospitals, and for staff in the Wuhan area as compared to those in the Qinghai region (

< 0.01). Staff in Wuhan had a lower mean work environment dimension score than those in Qinghai (

< 0.05). Work experience scores varied across workplaces in regards to the social relationships dimension; fever outpatient department staff had the lowest mean score while observation ward staff had the highest (

< 0.05). Work experience scores similarly differed according to workplace in regards to the occupational value dimension; fever clinic staff had the lowest mean score while those in temporary hospitals and other such workplaces had the highest (

< 0.01). The total score also differed significantly across workplaces, being lowest for fever outpatient department staff (

< 0.01). Medical workers in Wuhan worked longer hours (

< 0.01), as did those with an undergraduate degree, who were aged 30-45 years, and had 5-20 years of work experience (

< 0.05; Table 1).

公告送達(dá)本質(zhì)上屬于擬制送達(dá)。 其最終送達(dá)的事實(shí)是一種法律事實(shí)，而非以客觀真實(shí)為基礎(chǔ)的客觀事實(shí)。 法院審判程序順利進(jìn)行依靠的是推定的法律事實(shí)，這是司法效益與程序公正兩個(gè)方面相沖突的情況下相互讓步的結(jié)果。[7] 同理，公告送達(dá)作為一種特別之送達(dá)方式，也是審判效益和審判公正相互博弈和相互妥協(xié)下的無奈之舉。 由上文可見，《民事訴訟法》司法解釋在該方向上已然取得一定的成效，也為公告送達(dá)司法制度的完善與發(fā)展指明了方向：

Work experiences of frontline health care workers in all dimensions and scores for specific items

The maximum possible score for each dimension was three (Table 3). The occupational value dimension had the highest mean score of 2.61 (0.59), followed by the support/security dimension score of 2.30 (0.74). The occupational protection dimension had the lowest score of 1.44 (0.75), followed by the work environment dimension score of 1.97 (0.81). The social relationships dimension had an intermediate score at 2.06 (0.80).

DISCUSSION

Here, a self-reported questionnaire was used to assess the work experiences of frontline health care workers in Wuhan and Qinghai during the COVID-19 pandemic. The discomfort of wearing PPE, fear of infection, stress of inadequate occupational support services, medical supply shortage, guilt of not being able to adequately help patients, exhaustion from managing doctor-patient relationships and being unable to take care of family needs were major factors contributing to poor work experiences reported by frontline medical personnel. The occupational protection dimension had the lowest mean score, followed by scores of the work environment and social relationships dimensions. Medical staff were motivated by a sense of social responsibility and carried strong convictions concerning their mission to heal the sick and contribute to fighting the pandemic. Importantly, frontline health care workers were proud of being able to provide high-quality care and perform their duties during the pandemic[21,22]. This is likely why the occupational value dimension had the highest mean score. National health authorities and medical institutions have placed great importance not only on the treatment of COVID-19, but on the occupational protection of health care workers, providing various types of support including human resources services, supply of materials and occupational protection training[23]. Medical staff thus gave high scores for the support/security dimension.

This study investigated the work experiences of frontline medical staff treating COVID-19 patients in China. Findings underscore the future necessity for hospital managers of all levels to fully address concerns and needs of health care workers by ensuring an adequate number of team members and supply of PPE. Improvements in communication strategies will ensure the provision of high-quality nursing care in future disease outbreaks. Strengthening medical personnel training regarding occupational protection and establishing a supportive and safe work environment is also critical. Public health emergencies such as the ongoing COVID-19 pandemic can be better managed by ensuring an adequate supply of emergency equipment, improving the emergency preparedness of medical personnel and providing frontline workers with appropriate psychological support.

Total scores concerning work experience and working hours differed significantly according to workplace, with the lowest mean score for staff noted to be among those working in the fever outpatient department and highest among those working in temporary and other such settings. Conditions in fever outpatient departments, which include a large number of patients requiring treatment and the need to communicate with/manage both patients and their families, imposed a heavy burden on medical personnel, who simultaneously had to contend with PPE shortages and fear of infection. Compared to other clinical workplace settings, self-perceived occupational value was relatively low among outpatient department staff[24]. Patients in the temporary hospital in Wuhan tended to exhibit mild illness; staff had adequate PPE and worked in a relatively low-pressure environment while receiving considerable social support. As such, medical staff in this group experienced a strong sense of occupational value. Health care staff in Wuhan worked long hours, a feature found to be associated with an undergraduatelevel education, age of 30-45 years and 5-20 years of prior work experience. Because of geographic constraints, medical personnel from Qinghai providing medical assistance in Wuhan could not be employed for long periods of time; these individuals were selected for their strong skills and successfully complete undergraduate degrees, were aged 30-45 years and had 5-20 years of work experience[25].

Health care workers deployed to Wuhan hospitals from Qinghai were unfamiliar with the work environment and had a heavy workload that involved care of a large number of COVID-19 patients. These personnel were from various hospitals and clear standardization of clinical activities was lacking, making work more difficult and adding to pressures they had experienced by health care workers in such settings. In addition to practical problems such as PPE shortages, unsuitable medical equipment and fear of infection, frontline health care workers had to overcome significant cultural differences[26].

Experience scores characterizing the social relationships dimension varied significantly across workplaces. The fever clinic had the lowest score in this dimension while the observation ward had the highest. This may be because the fever outpatient department is a unique work environment where treatment of COVID-19 patients remains an onerous task[27]. In such conditions, medical staff are required to collect extensive clinical information, thus becoming exhausted and having to manage both patients and visitors. For example, patients and their families do not always understand the need for isolation and vent their anger on medical staff. Caring for patients in an isolation ward often feels lonely and staff members may even feel discriminated against or bullied[28]. Family members feared that frequent contact with patients suspected of being infected with COVID-19 could lead to infection and were not supportive of the medical staff[16]. As there was less patient contact in the observation ward, doctor-patient conflict was less common overall and work pressure remained relatively light; this explains the higher mean social relationships score for staff still working under such difficult circumstances.

Health care workers in different workplaces also showed significant differences in occupational value scores. The lowest mean score was for fever clinic staff, while personnel in the temporary and other such hospitals had the highest score. As fever outpatient department health care workers treated only patients with fever, COVID-19 infection was frequently suspected. No sense of accomplishment on patient discharge or cure was apparent and little support to medical staff was provided. This undoubtedly undermined support for occupational safety[29]. A relatively large number of patients diagnosed with COVID-19 were successfully treated, and staff received greater attention from society and public leaders of all levels[20].Occupational protection dimension scores were generally very low and no significant differences among medical staff with different characteristics were found. The vast majority of personnel lacked hands-on experience using PPE and implementing infection prevention measures; as such, these individuals encountered difficulties in properly wearing appropriate protective equipment[17]. Furthermore, medical staff were required to wear suitable PPE for long periods of time; this could result in headaches, sweating, pressure ulcer formation, eczema and other adverse reactions. The wearing of PPE also made it more difficult for staff to function as it often blocked sound, thus creating a communication barrier in doctor-patient interactions. As there are many types of PPE, it remains unclear whether the equipment used by participants of our study met protection requirements. There were concerns that masks worn were not tight-fitting, raising significant concerns whether they could suitably protect against COVID-19 infection[30].

Limitations

This study was not without limitations. Firstly, participants from Qinghai province may not have been representative of the general health care worker situation throughout China. Secondly, the self-reported questionnaire did not provide objective measures. Thirdly, questionnaire items were developed based on prior literature and expert opinions which may not have represented the actual concerns of medical staff. Finally, this study evaluated a small sample. In cross-sectional studies, evaluation of a large sample size can more accurately estimate causal relationships among variables. Similar studies with a larger sample size are thus warranted. From its design to completion of all investigation, this study adhered to the principle of randomization. Research subjects were thus selected strictly in accordance with the designed sampling plan; reasons for non-response were analyzed in a timely manner. Study protocols were standardized and investigators thoroughly trained in relevant experimental methods.

2.1.3 混播禾草種類對(duì)混播植物MDA含量的影響 A3、A4處理禾草MDA含量極顯著(P<0.01)低于A1和A2處理，其中,A3處理低50.35%和51.53%，A4處理低67.29%和68.06%；A4處理禾草MDA含量又極顯著低于A3處理(P<0.01)；A2和A1處理之間沒有顯著性差異。不同禾草種類處理對(duì)苜蓿葉片中MDA含量沒有顯著影響(表1，2)。

the Qinghai Province Science and Technology Department Project, No. 2020-SF-154.

CONCLUSION

Support/security dimension scores were higher for staff in tertiary as compared to secondary hospitals and for staff in Wuhan as compared to those in Qinghai. These data can be explained by the fact that tertiary hospitals have better access to various medical resources including PPE as compared to secondary facilities, which contributes to a better work environment. Training concerning COVID-19 treatment and protection was conducted over a short period of time in China; preparations for addressing the viral outbreak were urgently made. When PPE shortages arose, supply priority was given to medical personnel in Wuhan, who received considerable support from all sectors of the community including hospital leaders. Thus, support/security scores for medical staff in the Wuhan area were high.

ARTICLE HIGHLIGHTS

Research conclusions

In an emergency situation, medical staff have a low sense of professional value, and work material support and psychological counseling are particularly important.

Research perspectives

Provide effective treatment outcomes for large-scale catastrophic emergencies.

FOOTNOTES

This virus is transmitted by contact with respiratory droplets from an infected individual[3]. The incubation period usually lasts 3-7 d and does not exceed 14 d[4]. The main symptoms are fever, dry cough and fatigue[5]. Because of its strong infectivity, COVID-19 has been listed as a Category B infectious disease by the National Center for Disease Control and Prevention, although prevention and control measures used for Category A infectious diseases are currently recommended[6,7]. Since February, health care workers from Qinghai have voluntarily traveled to Hubei to help treat the rising number of infected patients. In order to slow the spread of COVID-19 and care for patients confirmed or suspected to be infected with the virus, additional services such as fever clinics and infectious isolation units have been established at many hospitals[6]. Frontline health care workers have faced enormous challenges including an overwhelming workload, shortage of personal protective equipment (PPE) and an uncertain course of the pandemic. Multiple studies have shown that frontline medical staff treating COVID-19 patients have a high risk of developing mental health conditions including anxiety, stress and feeling that they are inadequately prepared for their duties[8-11]. Occupational experiences of staff working in different hospital departments during the COVID-19 outbreak have not been evaluated in detail. Poor occupational experience is not only detrimental to the physical and mental state of medical staff but also affects the quality of services provided to patients[12]. Here, we developed a questionnaire according to the Delphi method to evaluate work experiences of frontline health care staff treating COVID-19 inpatients in the city of Wuhan and province of Qinghai. Our analysis of factors affecting medical staff work experience provides guidance concerning the establishment of services and policies that ensure safe and productive clinical work environments. This cross-sectional survey details both environmental and human resources hazards faced by medical staff in this unprecedented emergency that has tested health systems worldwide. It is critical for medical staff, especially trainees, to receive appropriate guidance regarding emergency response practices in order to enhance public health capabilities and preparedness. As grassroots medical workers face challenges of increasing severity with the outbreak of COVID-19, many previously neglected issues have been brought into the spotlight including those concerning basic medical care, preventive medicine and psychological counseling for both patients and medical staff. Even with ample manpower, not all hospitals take sufficient precautions in dealing with emergency situations. This study aims to detail a certain theoretical basis for structuring future approaches to mass medical emergencies and at the same time call on health care staff to actively take care of their mental health for better service of the public good.

由于徑向波導(dǎo)的空間軸向?qū)ΨQ結(jié)構(gòu),因此各支路具有良好的相位和幅度一致性,所以我們將24波導(dǎo)輸出口均勻地分布在四周。其主要結(jié)構(gòu)包括輸出波導(dǎo)端口,波導(dǎo)同軸轉(zhuǎn)換,多節(jié)阻抗過度變換,輸入波導(dǎo)支路,功率合成器整體結(jié)構(gòu)示意圖及關(guān)鍵結(jié)構(gòu)剖面圖如圖1(a)及圖1(b)所示。

3.前奏與尾聲的乏味性。這是我們教師缺乏對(duì)教材、教法的深入研究。這樣的準(zhǔn)備活動(dòng)與結(jié)束部分：一是內(nèi)容枯燥、一般化，不能很好地體現(xiàn)出每個(gè)教材類型的特點(diǎn)；二是形式單一化，不能適應(yīng)不同年段學(xué)生的身心特點(diǎn)。因此被視為前奏與尾聲的乏味性。

After review by the ethics committee of the hospital, this project complies with the Ministry of Health’s “Measures for the Ethical Review of Biomedical Research Involving People (Trial)” and the relevant provisions of the Declaration of Helsinki on biological human trials, and it is agreed to conduct research.

Written informed consent was obtained from all participants who were also informed that study participation was voluntary and that their refusal to participate would have no negative consequences.

There is no conflict of interest.

The findings of this study is openly available for other studies but not commercial activities.

ACS的主要發(fā)生機(jī)制為易損斑塊破裂，導(dǎo)致血管痙攣和（或）血栓形成，引起冠狀動(dòng)脈狹窄程度急劇加重或閉塞［3］。ACS伴嚴(yán)重心力衰竭多為老年、女性或大面積心肌梗死患者，且多合并糖尿病、冠脈多支病變。與藥物治療相比，ACS患者及時(shí)進(jìn)行血運(yùn)重建治療，盡早恢復(fù)心肌血液供應(yīng)，能夠減少不良心血管事件的發(fā)生，提高患者術(shù)后1年和3年生存率，改善患者預(yù)后［4］。

The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

近日，IMF發(fā)布《財(cái)政透明度、借貸成本與外國(guó)持有主權(quán)債券》報(bào)告，以33個(gè)新興經(jīng)濟(jì)體為對(duì)象，從預(yù)算過程的公開度、財(cái)政數(shù)據(jù)透明度和財(cái)政問責(zé)制三個(gè)維度，分析財(cái)政透明度對(duì)借貸成本以及國(guó)外對(duì)其主權(quán)債券需求的影響。結(jié)果顯示，財(cái)政透明度降低了各主權(quán)債券利差，提高了投資者對(duì)新興經(jīng)濟(jì)體債券的配置意愿。對(duì)于新興經(jīng)濟(jì)體而言，推動(dòng)預(yù)算過程公開可以降低主權(quán)借貸成本，而財(cái)政數(shù)據(jù)的透明度則有助于提高投資者對(duì)其主權(quán)債券的需求。報(bào)告還指出，統(tǒng)一標(biāo)準(zhǔn)的財(cái)政數(shù)據(jù)和較高的對(duì)比便利度（尤其是資產(chǎn)負(fù)債表），可以便利國(guó)外投資者進(jìn)行決策，增加其對(duì)新興經(jīng)濟(jì)體主權(quán)債務(wù)的配置意愿。

China

Xiao-Fang Li 0000-0002-4777-2062; Xuan-Lin Zhou 0000-0002-6007-2802; Sheng-Xiu Zhao 0000-0002-6783-1533; Yue-Mei Li 0000-0002-5157-6806; Shi-Qin Pan 0000-0002-5634-2865.

通過以上分析，建構(gòu)主義文化給我們展現(xiàn)了人類社會(huì)發(fā)展過程中的文化影響下的社會(huì)狀態(tài)，使我們了解到了現(xiàn)代世界的穩(wěn)定性，同時(shí)也向人類指明了光明的前景，雖然存在一定的主體性，但我依然相信在未來世界體系的發(fā)展過程中會(huì)誕生出新的更為合理的國(guó)際關(guān)系理論。

Wang JJ

A

Wang JJ

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