Table of Contents
Introduction (About me)
Strength and weakness analysis test.
Reflection from the sources.
Additional learning sources.
This portfolio is a reflection of my work wherein I will reflect on my career goals and actions are taken for it. In this portfolio, I wished to include everything that has helped me to become what I always wanted to be, that is a sonographer. I am a trainee sonographer and I undertook this course of “Introduction to ultrasound and sonography” and then the series of events of learning took place. There were many things that I wanted to achieve as a sonographer and here I am living all of them as a pre-step that is as a trainee sonographer. I always aimed to be a successful sonographer as when I looked at people suffering from complexities, I wanted to help them. I always had an interest in becoming a sonographer and I worked hard to be the one. This is just a small piece of my learnings and I aim to come back to add to my artefacts and learnings as I progress in my career. I am looking forward to learning a lot more on sonography and each time comes back to add those artefacts and my learning experience in this portfolio.
I hereby attach my CV for giving a detailed description of my educational qualifications and other interests that will best define my interest in sonography thus this course.
I am going to analyze my strengths and weakness based on my CV using a personality test. I would say that I was a good student at my graduation time but now after following my passion for becoming a successful sonographer, I have learned new skills and have enhanced my knowledge. This has not only improved my professional identity but a personal identity as well. As reflected by my CV, I have improved a lot in terms of my academics and my personality after my service as a dental assistant.
I am Hamsa Nadir a trainee sonographer who always aimed to become a trained sonographer. I have experience with the dental assistant and I am an undergraduate researcher. My reflection of learnings based on CV includes my learnings during my work as a dental assistant. I had a great experience working there as I developed my competency skills when I worked with the patients and when I assisted the dentist. I assisted the dentist in carrying medical procedures and also helped in making personalized care plans. This gave me practical learning with the patients and their health concerns. I am a graduate in Biomedical Science and a Certificate holder in Dental Assisting and I offer a broad range of skills and competencies that allowed me to contribute significantly in an ultrasound/imaging in the clinic. During my placement as a dental assistant, I am skilled in diligently to clean instruments and work areas according to disinfection and sterilization protocol. I am also skilled in carrying out sophisticated research focusing on human anatomy, physiology as well as cell and molecular biology. As an undergraduate researcher, I am skilled in using techniques that are for the people’s welfare and I am also skilled in interpreting and analyzing the reports with my supervisors.
The experience as a dental assistant was great as I learned the protocol with which a clinic works. The learning started from the room preparation to carrying out the dental protocol on them it all furnished my learnings and I had a great experience working with the patients. I am adept at scheduling appointments with the patients, managing their records and also maintaining an efficient and pleasurable work environment within the clinic. Overall, my academics and training experiences were great learning opportunities for me that will definitely help me in my future actions.
In this portfolio, I am writing Comprehensive Reflective Statements (CRS) for 9 artefacts that I have collected over the course of my studies. The selection of artefacts was not done at once but over the time period of my course. I aimed to collect the best evidence sources for my learning and tried to collect the artefacts that cover all the parts of my course of ultrasound to sonography. These artefacts played a very important part in my learning career as most of my theoretical learning comes from these artefacts.
Journal article 1- Fetal cardiac screening sonography
Journal article 2- Fetal Anomaly Detection in Pregnancies with Pregestational Diabetes
Journal article 3- Virtual Sonographic Hysterosalpingoscopy for Ectopic Pregnancy Detection
Journal article 4- Doppler Sonography during Pregnancy-DEGUM Quality Standards and Clinical Applications
Journal article 5- Hysterosalpingo‐foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post‐procedure
Journal article 6- Frequency and importance of incomplete screening fetal anatomic sonography in pregnancy
Journal article 7- Evaluation of First Trimester Vaginal Bleeding in Early Pregnancy by Transvaginal Sonography
Journal article 8- Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography
Webinar – 1 - Abdominal ultrasound question and answers webinar by Ulrike Handler and Christian Aiginger
Khurana, A., Burt, A., Beck, G., Anton, T., Perez, M., Levy, D., & Pretorius, D. (2017). Fetal cardiac screening sonography: Methodology: Women’s imaging. RadioGraphics, 37(1), 360-361.
This article was selected because it gave an insight into fetal cardiac screening that is an important part of sonography. The complete screening of the fetal cardiac part is difficult but this article helped me in learning the steps through an easy methodology. It taught me that the selection of a correct high- frequency transducer and patient positioning is very important for the successful examination. Firstly, the situs of the fetus is examined followed by a four-chamberr view of the heart of the fetus. This involves the evaluation of atria, ventricles and the atrioventricular valves. I have learned a very important thing through this paper that the sonographers that are involved in the ultrasonographic screening of pregnant women play an important role in diagnosing congenital heart disease in the fetus. I learned a proper technique that a sonographer should follow while carrying out this procedure that is from the four-chamber view, the sonographer must rotate the thumb towards the fetus left shoulder elongating the left ventricle until the left ventricular outflow tract is seen. These procedural details from this article have changed my work practice as I now more concentrate on the procedure and the rotation of thumb for a better view of the four chambers. After reading and learning this paper, I am able to identify the four cardiac screening sonographic views and I am also capable of describing the scanning technique that is suitable for fetal cardiac screening sonography.
The learnings from this article changed my work practice in a way that I started to observe the difference in the sonography procedure done normally and when done for screening of cardiac abnormalities. This article was my best choice because the side- by- side videos helped in easier comprehension and facilitated effective learning.
Martin, R. B., Duryea, E. L., Mcintire, D. D., Twickler, D. M., &Dashe, J. S. (2020). Fetal anomaly detection in pregnancies with pregestational diabetes. Journal of Ultrasound in Medicine, 1-10.
This article aims to provide detailed descriptions of the fetal anomaly detection in pregnancies with pregestational diabetes. The women in their pregnancy phase suffer from pregestational diabetes that makes the process complicated. The process of sonography is an initial detailed examination that is successful in identifying approximately three- fourths of anomalous fetuses. This paper helped me in learning the effectiveness of sonography and the manner in which it is used for a detailed examination of the fetus. The detection of anomalies is very important and the sonographer must put in extra efforts to detect the anomalies when performing sonography. This is specialized sonography that has taken over the place in the clinics and imaging centers and also helps in the detection of anomalies that keeps the pregnant woman updated of their fetus.
This specialized sonography is in demand and the sonographers must always be ready to perform such procedures. This paper helped me in studying details about pregestational diabetes and also the details of the specialized sonography that helps in the detection of anomalies in the fetus. This paper also gives detailed explanations on the use of follow- up sonography and the importance of it for both the sonographer and the pregnant women. The follow- up sonography is very important to maintain the good health of the mother as sonographers keep informing them about the updates of complications or no complications of the fetus thus the health status of the mother is maintained. The pregnant women with pregestational diabetes may have complicated anomalies in the child so a sonographer using specialized sonography helps in detecting and diagnosing it thus sonographers play a very important role in this aspect.
Tesarik, J., Mendoza-Tesarik, R., & Mendoza, N. (2017). Virtual Sonographic Hysterosalpingoscopy for Ectopic Pregnancy Detection. Journal of Gynaecology Obstetrics, 1, 002.
This selected article aims to describe a novel non- invasive diagnostic technique that assists in the detection of ectopic tubal pregnancy. This novel non- invasive diagnostic technique is virtual sonographic hysterosalpingoscoy is the novel technique which is proving its worth. I selected this article for enhancing my knowledge because this gives a detailed description of this novel technique that is emerging in the novel world. This article gives a detailed sonographic procedure and teaches a method that is performed using a fly-through technology in the pregnant women in whom the ecotopic pregnancy as suspected. The women that are pregnant in whom ecotopic pregnancy is suspected, they face a lot of difficulties. This novel non- invasive sonographic procedure is highly effective and this article also describes the sonography procedure for identifying the embryonic structures also.
This sonography procedure results in the 2- dimensional recordings that are transferred to three- dimensional recordings so that the results can be best interpreted. The three- dimensional virtual endoscopy images were produced and the results were obtained from that. This paper best describes the sonography procedure in which the protocol was performed by a vaginal ultrasound probe and the results were obtained in either yes or no terms. The results were stated as ecotopic tubal pregnancy was confirmed in few cases and in the other cases, ecotopic tubal pregnancy was not confirmed. The probable causes for bleeding like the presence of endometrial polyps were detected using this non- invasive novel technique of sonography. This paper helped me in learning the advancements in the sonography procedures and also the update in sonography procedures. Thus, I learned that the virtual sonographic hysterosalpingoscopy is a highly precise method and this method is also helpful in detecting the sources of uterine bleeding using fly- through sonographic techniques.
Faber, R., Heling, K. S., Steiner, H., &Gembruch, U. (2019). Doppler Sonography during Pregnancy-DEGUM Quality Standards and Clinical Applications. Ultraschall in der Medizin (Stuttgart, Germany: 1980), 40(3), 319-325.
The selected article is on the Doppler sonography technique that is used during pregnancy. I selected this article because I had knowledge about this Doppler sonography technique but I wanted to learn in deep about this technique. This technique of Doppler sonography is established in prenatal medicine as a source of screening aneuploidy and preeclampsia that is done during the first trimester. Doppler sonography is the sonography technique that is used in the first trimester, second trimester and the third trimester. The difference is that the Doppler sonography is used for the assessment of fetal health and underlying different conditions of the poor health of the fetus like anemia and IUGR in the second and third trimester. I have learned that the correct method of sonography plays a very important role in the interpretation of the report's data and also in clinical decision making.
The correctly performed sonography procedure only results in the correct reports and this does ensure patient and fetal safety. Thus the correct method of performing sonography is very vital for the surveillance of underlying fetal conditions that will have a great impact on the clinical decision-making process. The Doppler sonography performers that are the sonographers and the users that are the pregnant women must meet the required quality standards. This article provides the Doppler sonography users with the required quality standards guidelines based on the DEGUM- certified training courses. This article has helped me in learning the technical principles of the method of Doppler sonography and the vascular disciplines on which these methods can be applied. This helped me in enhancing my knowledge of Doppler sonography and also I have learned various required quality standards that ensure patient safety and also detects the potential error sources. Thus the need for requirements for successful certification is very important.
Tanaka, K., Chua, J., Cincotta, R., Ballard, E. L., & Duncombe, G. (2018). Hysterosalpingo‐foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post‐procedure. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(1), 114-118.
The selected article is very important for studying about infertility evaluation. In the infertility evaluation, fallopian tube patency testing is very important part. In this context, the contemporary methods were laproscopy, dye test and hysterosalpingography. This has taken a turn because this article is on the use of Hysterosalpingo‐contrast sonography (HyCoSy) method in the place of above mentioned contemporary methods. This is a new foam contrast agent that is used as an alternative in contrast to the previously used methods. Hysterosalpingo‐contrast sonography (HyCoSy)
Method of sonography was tested using primary study in Queensland and the results of this study state that this technique of sonography is well tolerated and is the safe method to be used in women in relation to pregnancy. This article was very important for my learnings and for enhancing my knowledge of the infertility evaluation. Thus, Hysterosalpingo‐contrast sonography (HyCoSy) method of sonography has proved it is worth and has proved to be safer to use in women so I would like to extend its use in the practice all over the world. Hysterosalpingo‐contrast sonography (HyCoSy) technique is not acceptable in the women who face difficulty in the introduction of the intracervical catheter as it causes severe discomfort which may lead to episodes of vasovagal in some women. This article has helped me in learning about the efficacy of sonography techniques and the extent to which these sonography techniques like Hysterosalpingo‐contrast sonography (HyCoSy) proves its worth. This technique helped me in learning about this technique in-depth, its tolerance among the women of Australia and its safety on use among the women. The articles like these update the knowledge on sonography techniques and set the new standards for the sonographers to achieve thus making them successful in practice. Hysterosalpingo‐contrast sonography (HyCoSy) technique was read by me for theoretical knowledge by this paper and I would like to perform it in practice to help many infertile ladies so that my knowledge can help me in serving to the patients.
Silvestri, M. T., Pettker, C. M., Raney, J. H., Xu, X., & Ross, J. S. (2016). Frequency and importance of incomplete screening fetal anatomic sonography in pregnancy. Journal of Ultrasound in Medicine, 35(12), 2665-2673.
This is the article selected on “the frequency and importance of incomplete screening fetal anatomic sonography in pregnancy”. The main objectives of this article were to determine the frequency of routine screening fetal anatomic sonography that fails to completely see fetal anatomy and also to determine the efficacy of repeated sonography on the detection of abnormal fetal anatomy. I selected this article because I wanted to learn the frequency of repeat sonography that helps in the detection of abnormal fetal anatomy. The results of this article helped me in learning that incomplete visualization was the most common aspect of the screening of fetal anatomic ultrasound examinations. When the fetal is screened for the detection of anatomy, there are a higher number of reported causes of incomplete visualizations thus this requires the demand for repeated imaging.
The recommendation of repeated imaging was universal as per this study which means that the rate of incomplete visualization is higher in many cases. I think then this requires the research on the reason for incomplete visualization of the screening of fetal anatomic ultrasound examinations. The results of this study also state that the abnormal fetal anatomy on repeat screening was infrequently discovered. The third objective of this article was to determine the proportion of women that are recommended for repeat screening and repeat sonography procedures due to incomplete ultrasound examinations. I have learned that the recommendation for repeat sonography is universal and the recommendations are made many times due to incomplete visualization and the incomplete ultrasound examinations. This study has helped me to learn insights that are the reason for higher repeated sonography requests that are made by the doctor and the patients to the sonographers.
Kathuria, S., Lolge, S., &Lakhkar, D. (2019). Evaluation of first trimester vaginal bleeding in early pregnancy by Transvaginal sonography. Journal of Dental and Medical Sciences, 18(11), 14-20.
This is the article on transvaginal sonography in which the first trimester vaginal bleeding in the early pregnancy stage is evaluated. This is a common obstetric condition in which pregnant women in the first trimester that is early pregnancy stage experiences vaginal bleeding. This can lead to the life-threatening emergency in these women if not addressed timely. There are many examined reasons for this like ectopic, abortion and molar pregnancy. One of the best diagnostic procedures for the diagnosis of this condition in pregnant women in their early pregnancy stage is ultrasonography. This article describes the ultrasonography procedure that helped the patients in diagnosing this condition in the first trimester. The ultrasonography is a procedure that is effective in learning the common causes of bleeding that is through the vagina in the first trimester.
The transvaginal sonography is the far accepted sonography technique because of its high effectivity that it identifies the common causes of first trimester vaginal bleeding in pregnant women in the early pregnancy phase. The most common cause identified in this article was missed abortion and then the second most common reason was threatened abortion that is followed by anembryonic pregnancy. This article helped me in learning yet another type of sonography technique that is transvaginal sonography and its effectivity that can be best used in evaluating the reasons for vaginal bleeding among pregnant women in their early pregnancy phase. This is a primary study and this study, various images of the uterus and adnexa and shown that it shows a gestational sac characterizing the ruptured ectopic pregnancy. All the images of sonography in this paper have enhanced my knowledge of ecotopic pregnancy, fetal pole with and without fetal cardiac activity that characterizes a missed abortion. Thus this article was very helpful for me in learning the process of transvaginal sonography and is a useful source of information for every sonographer.
Chunyan, G., Bin, P., Ping, Y., Yue, Z., Yang, X., Hongju, T., & Xi, X. (2018). Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography. BioMed Research International, 2018.
This article is again on the hysterosalpingo-contrast sonography (HyCoSy) which is a method of sonography to test its effectivity on the pregnancy rate. The hysterosalpingo-contrast sonography (HyCoSy) method of sonography was assessed on the influence of spontaneous pregnancy. In this observational study, the expected time for spontaneous pregnancy was kept at least 180 days and this time was fixed after hysterosalpingo-contrast sonography (HyCoSy) examinations. In this study, hysterosalpingo-contrast sonography (HyCoSy) examination was performed and the movement of ovaries, contrast agent venous intravasation and injective resistance were recorded in the females. This paper was selected by me because the earlier paper on hysterosalpingo-contrast sonography (HyCoSy) was very interesting and I wanted to learn more about this sonography technique because it is highly helpful for the females.
I wanted to double-check the efficacy of this technique for its influence on spontaneous pregnancy. The results of this study state that some of the infertile women conceived successfully and naturally after hysterosalpingo-contrast sonography (HyCoSy) treatment and this did not take much time that is this happened almost within the first month after the examination. The ability of the women to conceive after hysterosalpingo-contrast sonography (HyCoSy) examination is independently linked with factors like fallopian tubes and the absence of injective resistance. This has enhanced my knowledge to the next level and now I am more confident in my knowledge towards hysterosalpingo-contrast sonography (HyCoSy) examination. Thus, it can be concluded that hysterosalpingo-contrast sonography (HyCoSy) examination can be used as a therapeutic tool for enhancing the change of spontaneity conception in the infertile and subfertile couples. This statement was the inspiration for this present study and this statement brought me to learn from this selected article.
Webinar-1 – Abdominal ultrasound question and answers webinar by Ulrike Handler and Christian Aiginger
This is a webinar based on the question and answers on the abdominal ultrasound. This was held in 2018 for all the sonographers where I have learned new skills from the questions. This webinar showed many images and the video clips of ultrasound and sonography telling the details of the structures. I learned that when the person has vomited several times or has fasted then the case of the empty stomach then there is a sign of suspect for intestinal obstruction and it is important to know before the operation to give the patient a gastric fluid sample to avoid further complications. In another example, dilated intestinal bowel loops and back and forth movement of fecal matter were observed and there was no movement that characterizes the advanced stage of peristalsis. The dilated power loops, peristalsis and fluid fill contents are characteristics of the ileus.
The ultrasound of abdominal without a baby that is in the cases of non- pregnant women helps in knowing the condition of the ileus that is important in women who are about to conceive. In ileus ultrasound, if the diameter of dilated bowel loops is greater than 4 centimeter then there is a risk of perforation and this is quite a high risk. In the cases of carcinoma of the colon in the abdominal scan of colon, there is a gas-filled power loop and the gas-filled portion of the colon and high thickened wall. The lumen gets narrowed and there is no gas in between the walls then there is a colon carcinoma. Pseudo kidney signs are when hypoechoic rings and hypoechoic gas power that looks like the colon is a kidney that characterizes the colon abnormalities. This webinar helped me in learning about different images and the abnormalities that can be detected from the abdominal ultrasound.
I have not contributed to the discussion forum but I keep a track of all the comments from my batchmates. As I was going through the discussion section, I crossed a discussion section where one of the batch mates had written about the ultrasound social and ethical issues in pregnancy. He provided a link where it was stated that “It is a moral obligation for a sonographer to inform their patient on what is going on during their pregnancy”. I hereby would like to critically investigate this statement as per my learning. I believe that this falls within a sonographer’s scope of practice to inform the patients and to provide counselling. It is very well their duty to inform the pregnant women on what is happening with them and inside their body so that relevant counselling sessions could be held so as to take holistic care of the patient. There are many social and ethical issues in pregnancy and the sonographers should not hide anything from the pregnant woman because it is their right to learn about the current condition of their womb. The ethical issues should be well addressed and all the sonographers should be given a training session in which these social and ethical issues in the pregnancy and ultrasound should be discussed and they should be trained to inform the same to the pregnant women (Thomas, O’ Loughlin & Clarke, 2019). It is a moral concern if a sonographer is not doing so because informing the pregnant women and giving them counselling sessions are very important for their health. It is thus a moral duty for a sonographer to inform their patients on what is going on during their pregnancy. They should maintain confidentiality and privacy and should only inform the patients about their complications (Cárdenas et al., 2018).
There was one more discussion forum in which the topic of 3D fetal ultrasound was discussed. I would like to extend my views on 3D fetal ultrasound that is its use in the medical background over the commercial background is very important. The medical importance is that it helps in displaying the birth defects which a child may already have. The normal ultrasound fails to do so 3D fetal ultrasound is an excellent technology that is highly beneficial in this aspect (Li et al., 2018). It’s the advantage of giving information in birth defects to have a long future because this helps in diagnosing the congenital anomalies and it is worth being used for the obstetric purpose.
There are some additional learning sources that have shaped my learning experience and also shape my learning from this course. Once I was having a discussion with my senior sonographer, she told me the most basic learning which I have not come across in any of the learning sources like journal articles and webinars. While we were having a discussion, I asked her what the most basic thing a sonographer should know is. To this, she told me that most of the sonographers are not aware of their scope of practice as a result of which the patient suffers. It is the duty of a sonographer to inform the patient on the technique of ultrasound like it is a painless procedure and on the details of sonography. A patient should always be well- prepared and well informed before commencing the procedure (Mitchell, Nightingale & Reeves, 2019). The patients that are the pregnant women who present for the first time for sonography are generally scared and are anxious before the procedure. It is the duty of a sonographer to inform the patient of all the outcomes and the medical procedure of sonography so that they are relaxed when they present for the same.
This additional learning was a must for me because these are small things that are rarely mentioned in the journal articles. The experienced medical professionals that have already performed sonography and have worked in clinics and imaging centers are well aware of the patient’s consequences. These procedures like 3D ultrasounds and sonography have no potential risks on the body of pregnant women but it should always be performed with extra precautions (Thomas et al., 2019). Thus, this learning of informing the patients and giving them counselling sessions is within their scope of practice. They should also be pre-informed of the new techniques like 3D ultrasound and 4D fetal ultrasound so that the patients do not fear while getting it done.
Chunyan, G., Bin, P., Ping, Y., Yue, Z., Yang, X., Hongju, T., & Xi, X. (2018). Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography. BioMed Research International, 2018
Faber, R., Heling, K. S., Steiner, H., &Gembruch, U. (2019). Doppler Sonography during Pregnancy-DEGUM Quality Standards and Clinical Applications. Ultraschall in der Medizin (Stuttgart, Germany: 1980), 40(3), 319-325
Handler, U.,& Christian, A. (2018). Abdominal ultrasound question and answers. Retrieved from https://www.123sonography.com/webinars
Kathuria, S., Lolge, S., &Lakhkar, D. (2019). Evaluation of first trimester vaginal bleeding in early pregnancy by Transvaginal sonography. Journal of Dental and Medical Sciences, 18(11), 14-20.
Khurana, A., Burt, A., Beck, G., Anton, T., Perez, M., Levy, D., & Pretorius, D. (2017). Fetal Cardiac Screening Sonography: Methodology:Women’sImaging. RadioGraphics, 37(1), 360-361.
Li, Y., Khanal, B., Hou, B., Alansary, A., Cerrolaza, J. J., Sinclair, M., &Rueckert, D. (2018, September). Standard plane detection in 3d fetal ultrasound using an iterative transformation network. In International Conference on Medical Image Computing and Computer-Assisted Intervention (pp. 392-400). Springer, Cham.
Martin, R. B., Duryea, E. L., Mcintire, D. D., Twickler, D. M., &Dashe, J. S. (2020). Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes. Journal of Ultrasound in Medicine.
Mitchell, P., Nightingale, J., & Reeves, P. (2019). Competence to capability: An integrated career framework for sonographers. Radiography, 25(4), 378-384.
Silvestri, M. T., Pettker, C. M., Raney, J. H., Xu, X., & Ross, J. S. (2016). Frequency and importance of incomplete screening fetal anatomic sonography in pregnancy. Journal of Ultrasound in Medicine, 35(12), 2665-2673
Tanaka, K., Chua, J., Cincotta, R., Ballard, E. L., & Duncombe, G. (2018). Hysterosalpingo‐foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post‐procedure. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(1), 114-118
Tesarik, J., Mendoza-Tesarik, R., & Mendoza, N. (2017). Virtual Sonographic Hysterosalpingoscopy for Ectopic Pregnancy Detection. Journal of Gynaecology Obstetrics, 1, 002
Thomas, S., O'Loughlin, K., & Clarke, J. (2019). Sonographers’ communication in obstetrics: Challenges to their professional role and practice in Australia. Australasian Journal of Ultrasound in Medicine.
Cárdenas, R., Labandera, A., Baum, S. E., Chiribao, F., Leus, I., Avondet, S., & Friedman, J. (2018). “It’s something that marks you”: Abortion stigma after decriminalization in Uruguay. Reproductive Health, 15(1), 150.
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