Skip header and navigation

Refine By

24 records – page 1 of 3.

[Important to evaluate screening for abdominal aortic aneurysm in Sweden].

https://arctichealth.org/en/permalink/ahliterature184725
Source
Lakartidningen. 2003 May 28;100(22):2001-2
Publication Type
Article
Date
May-28-2003
Author
Jesper Swedenborg
Author Affiliation
Kärlkirurgiska kliniken, Karolinska sjukhuset, Stockholm. jesper.swedenborg@ks.se
Source
Lakartidningen. 2003 May 28;100(22):2001-2
Date
May-28-2003
Language
Swedish
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - diagnosis - mortality
Cost-Benefit Analysis
Humans
Mass Screening
Sweden - epidemiology
Notes
Comment On: Lakartidningen. 2003 May 22;100(21):1874-612815871
PubMed ID
12833737 View in PubMed
Less detail

Regarding "Screening for abdominal aortic aneurysm in Canada".

https://arctichealth.org/en/permalink/ahliterature156926
Source
J Vasc Surg. 2008 Jun;47(6):1376-7
Publication Type
Article
Date
Jun-2008
Author
Hisato Takagi
Norikazu Kawai
Takuya Umemoto
Source
J Vasc Surg. 2008 Jun;47(6):1376-7
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - diagnosis - mortality
Canada - epidemiology
Humans
Mass Screening
Odds Ratio
Risk assessment
Notes
Comment On: J Vasc Surg. 2007 Dec;46(6):1311-2; author reply 131218155011
Comment On: J Vasc Surg. 2007 Jun;45(6):1268-127617543696
PubMed ID
18514854 View in PubMed
Less detail

[Abdominal aortic aneurysm screening--the same criteria should be applied in the country].

https://arctichealth.org/en/permalink/ahliterature139608
Source
Lakartidningen. 2010 Sep 22-28;107(38):2226
Publication Type
Article
Author
Jesper Swedenborg
Author Affiliation
Karolinska institutet, Stockholm. jesper.swedenborg@ki.se
Source
Lakartidningen. 2010 Sep 22-28;107(38):2226
Language
Swedish
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - diagnosis - mortality
Evidence-Based Medicine
Health Policy
Humans
Mass Screening
Sweden - epidemiology
PubMed ID
21043164 View in PubMed
Less detail

[Abdominal aortic aneurysm screening in Uppsala. Good experiences from the first four years--the rest of Sweden on its way].

https://arctichealth.org/en/permalink/ahliterature100154
Source
Lakartidningen. 2010 Sep 22-28;107(38):2232-6
Publication Type
Article
Author
Anders Wanhainen
Sverker Svensjö
Martina Tillberg
Kevin Mani
Martin Björck
Author Affiliation
Kärlkirurgiska sektionen, VO kirurgi, Akademiska sjukhuset, Uppsala. andwan@algonet.se
Source
Lakartidningen. 2010 Sep 22-28;107(38):2232-6
Language
Swedish
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - mortality
Aortic Rupture - mortality - prevention & control
Humans
Male
Mass Screening - methods
Outcome Assessment (Health Care)
Sweden - epidemiology
PubMed ID
21043165 View in PubMed
Less detail

A Population-Based Study of Abdominal Aortic Aneurysm Treatment in Finland 2000 to 2014.

https://arctichealth.org/en/permalink/ahliterature286852
Source
Circulation. 2017 Oct 31;136(18):1726-1734
Publication Type
Article
Date
Oct-31-2017
Author
Matti T Laine
Sani J Laukontaus
Reijo Sund
Pekka S Aho
Ilkka Kantonen
Anders Albäck
Maarit Venermo
Source
Circulation. 2017 Oct 31;136(18):1726-1734
Date
Oct-31-2017
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Registries
Sex Factors
Abstract
In the event of rupture of an abdominal aortic aneurysm (AAA), mortality is very high. AAA prevalence and incidence of ruptures have been reported to be decreasing. The treatment of AAA has also undergone a change in recent decades with a shift toward endovascular aneurysm repair (EVAR). Our aim was to evaluate how these changes have affected the elective and emergency treatment of AAA and their results in Finland.
All patients treated for AAA in Finland, a country with a population of 5.5 million, during 2000 to 2014 were searched from the registry of the Finnish Institute for Health and Welfare. Data on all patients who had died of AAA during the same time period were obtained from Statistics Finland. The data were combined and analyzed.
The annual incidence of ruptured AAA was 16.4 per 100 000 population over 50 years and decreased significantly during the study period. Over half of the 4949 patients who had a ruptured AAA died outside the hospital. Thirty-day mortality after emergency repair was 39.4%. Intact AAA repairs numbered 4956. The absolute number of annual repairs increased during the study period, and the use of EVAR became the dominant method of elective repair. Thirty-day mortality in elective AAA repair dropped significantly from 6.3% in 2000 to 2004 to 2.7% in 2010 to 2014 mostly because of the increased number of EVAR procedures with lower mortality. Long-term mortality in patients treated with EVAR was higher than in patients treated with open repair. Mortality after elective AAA repair was primarily attributable to cardiovascular causes, but there was a slightly higher proportion of AAA-related late deaths in patients treated with EVAR.
Ruptured AAA incidence for men >65 years has declined by nearly 30% in Finland, likely because of the decrease in AAA prevalence. The treatment results have improved as well for both elective and emergency repair. Increased use of EVAR has resulted in a decrease of mortality after elective AAA repair, but results of open repair have improved as well. However, late mortality from elective EVAR is surprisingly high in comparison with open repair, which may have been exaggerated by patient selection.
PubMed ID
28802250 View in PubMed
Less detail

[Screening for abdominal aortic aneurysm on a steady ground].

https://arctichealth.org/en/permalink/ahliterature135368
Source
Lakartidningen. 2011 Feb 23-Mar 1;108(8):392-4
Publication Type
Article

[Screening for abdominal aortic aneurysm saves lives at a reasonable cost].

https://arctichealth.org/en/permalink/ahliterature184853
Source
Lakartidningen. 2003 May 22;100(21):1886-91
Publication Type
Article
Date
May-22-2003
Author
Jesper Swedenborg
Martin Björck
Anders Wanhainen
David Bergqvist
Author Affiliation
Kärlkirurgiska kliniken, Karolinska sjukhuset, Stockholm. jesper.swedenborg@ks.se
Source
Lakartidningen. 2003 May 22;100(21):1886-91
Date
May-22-2003
Language
Swedish
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Aortic Rupture - diagnosis - mortality - prevention & control - surgery
Cost-Benefit Analysis
Female
Humans
Male
Mass Screening - economics - organization & administration
Primary Prevention - economics
Program Development
Sweden - epidemiology
Abstract
Ruptured abdominal aortic aneurysms (AAA) cause 600 deaths per year in Sweden. As most patients are without symptoms prior to rupture, and about half the patients with a ruptured AAA die before arrival to hospital, the only way to reduce mortality substantially would be by screening and prophylactic treatment. The article reviews experience of screening for AAA from other European countries, data from the Swedish vascular registry (Swedvasc) and from the official registry of the causes of death in Sweden. With these data as input, a theoretical model of inviting all 65-year-old men in Sweden to take part in a screening programme for AAA is created. When the programme is fully developed after ten years, assuming an attendance rate of 75%, mortality in AAA would decrease from 630 to 346 per year. The total cost would increase from 154 to 161 million SEK (9 SEK = 1 Euro). The reason for the relatively minor increase in cost is explained by the fact that expensive emergency operations for ruptured AAA decrease by 50%. The cost per life saved would be 3,000-4,000 SEK. In conclusion, available data suggest that screening for AAA in Sweden would save many lives at a low cost.
Notes
Comment In: Lakartidningen. 2003 May 22;100(21):1874-612815871
PubMed ID
12815873 View in PubMed
Less detail

Screening for abdominal aortic aneurysms in men: a Canadian perspective using Monte Carlo-based estimates.

https://arctichealth.org/en/permalink/ahliterature158989
Source
Can J Surg. 2008 Feb;51(1):23-34
Publication Type
Article
Date
Feb-2008
Author
Bernard Montreuil
James Brophy
Author Affiliation
Department of Surgery, Maisonneauve-Rosemont Hospital, University of Montréal, Canada. bernard.montreuil@umontreal.ca
Source
Can J Surg. 2008 Feb;51(1):23-34
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Abdominal - ultrasonography
Aortic Aneurysm, Abdominal - diagnosis - mortality
Aortic Rupture - diagnosis - surgery
Canada
Cohort Studies
Cost-Benefit Analysis
Humans
Male
Mass Screening - economics
Models, Economic
Monte Carlo Method
Quality-Adjusted Life Years
Abstract
Recently generated randomized screening trial data have provided good evidence in favour of routine screening for abdominal aortic aneurysm (AAA) to reduce AAA-related deaths in men aged 65 years and older. We developed an economic model that assessed the incremental cost-utility of AAA screening to help decision makers judge the relevance of a national screening program in Canada.
We constructed a 14 health state Markov model comparing 2 cohorts of 65-year-old men, where the first cohort was invited to attend screening for AAA using ultrasonography (US) and the second cohort followed the current practice of opportunistic detection. Lifetime outcomes included the life-years gained, AAA rupture avoided, AAA-related mortality, quality-adjusted life years (QALYs) and costs. Transition probabilities were derived from a systematic review of the literature, and a probabilistic sensitivity analysis was carried out to examine the effect of joint uncertainty in the variables of our analysis. The perspective adopted was that of the health care provider.
Invitations to attend screening produced an undiscounted gain in life expectancy of 0.049 years and a gain in discounted QALY of 0.019 for an estimated incremental lifetime cost of CAN$118. The estimated incremental cost-utility ratio was CAN$6194 per QALY gained (95% confidence interval [CI] 1892-10 837). The numbers needed to invite to attend screening, and the numbers needed to screen to prevent 1 AAA-related death were 187 (95% CI 130-292) and 137 (95% CI 85-213), respectively. The acceptability curve showed a greater than 95% probability of the program's being cost-effective, and the model was robust to changes in the values of key parameters within plausible ranges.
Our results support the economic viability of a national screening program for men reaching 65 years of age in Canada. More clinical studies are needed to define the role of screening in subgroups at high risk, especially in the female population.
Notes
Cites: Br J Surg. 1995 Aug;82(8):1066-707648155
Cites: Eur J Vasc Endovasc Surg. 1995 Aug;10(2):207-107655973
Cites: Am J Epidemiol. 1995 Dec 15;142(12):1291-97503049
Cites: Int J Technol Assess Health Care. 1995 Fall;11(4):796-78567213
Cites: J Med Screen. 1994 Oct;1(4):226-88790525
Cites: Arch Intern Med. 1997 Oct 13;157(18):2064-89382661
Cites: Eur J Vasc Endovasc Surg. 1997 Dec;14(6):499-5019467527
Cites: Health Technol Assess. 2004 Sep;8(36):iii-iv, ix-xi, 1-15815361314
Cites: N Engl J Med. 2004 Oct 14;351(16):1607-1815483279
Cites: J Vasc Surg. 1984 Mar;1(2):290-96481877
Cites: J Vasc Surg. 1988 Jan;7(1):69-813275808
Cites: J Vasc Surg. 1989 Mar;9(3):437-472646460
Cites: Br J Surg. 1989 May;76(5):479-802660948
Cites: World J Surg. 1989 May-Jun;13(3):266-712500780
Cites: N Engl J Med. 1989 Oct 12;321(15):1009-142674715
Cites: Angiology. 1990 Jan;41(1):53-82407154
Cites: J Cardiovasc Surg (Torino). 1990 Mar-Apr;31(2):170-22187882
Cites: Eur J Vasc Surg. 1991 Feb;5(1):53-72009986
Cites: BMJ. 2005 Apr 2;330(7494):75015757960
Cites: Curr Med Res Opin. 2005 Jan;21(1):19-2615881472
Cites: J Vasc Surg. 2005 May;41(5):741-51; discussion 75115886653
Cites: Vasc Endovascular Surg. 2005 May-Jun;39(3):213-915920649
Cites: N Engl J Med. 2005 Jun 9;352(23):2398-40515944424
Cites: Lancet. 2005 Jun 25-Jul 1;365(9478):2179-8615978925
Cites: Br J Surg. 2005 Aug;92(8):937-4616034817
Cites: Br J Surg. 2005 Aug;92(8):960-716034841
Cites: Br J Surg. 2005 Aug;92(8):976-8316034844
Cites: J Vasc Surg. 2005 Sep;42(3):410-416171580
Cites: J Vasc Surg. 2005 Nov;42(5):912-816275447
Cites: Eur J Vasc Endovasc Surg. 1996 Feb;11(2):183-908616650
Cites: Ann Vasc Surg. 1999 Nov;13(6):613-710541616
Cites: Am Heart J. 2000 Mar;139(3):423-910689256
Cites: Arch Intern Med. 2000 Apr 24;160(8):1117-2110789604
Cites: Int J Technol Assess Health Care. 2000 Winter;16(1):22-3410815351
Cites: Br J Surg. 2000 Jun;87(6):750-310848852
Cites: J Am Soc Echocardiogr. 2000 Jul;13(7):674-910887352
Cites: Eur J Vasc Endovasc Surg. 2000 Jul;20(1):79-8310906303
Cites: Aust N Z J Surg. 2000 Sep;70(9):660-610976896
Cites: Eur J Vasc Endovasc Surg. 2000 Oct;20(4):369-7311035969
Cites: Med J Aust. 2000 Oct 2;173(7):345-5011062788
Cites: Cardiovasc Surg. 2001 Jun;9(3):219-2411336844
Cites: J Med Screen. 2001;8(1):46-5011373850
Cites: Eur J Vasc Endovasc Surg. 2001 Jun;21(6):535-4011397028
Cites: Br J Surg. 2001 Jul;88(7):941-411442524
Cites: J Vasc Surg. 2001 Aug;34(2):229-3511496273
Cites: Stroke. 2001 Sep;32(9):2131-611546907
Cites: Eur J Vasc Endovasc Surg. 2002 Jan;23(1):55-6011748949
Cites: Br J Surg. 2002 Mar;89(3):283-511872050
Cites: Chest. 1998 Mar;113(3):681-69515843
Cites: Br J Surg. 1998 Aug;85(8):1090-49718003
Cites: Ann Vasc Surg. 1998 Nov;12(6):544-99841684
Cites: Lancet. 1998 Nov 21;352(9141):1649-559853436
Cites: Br J Surg. 1998 Dec;85(12):1674-809876073
Cites: Pharmacoeconomics. 1999 Apr;15(4):369-7610537955
Cites: J Vasc Surg. 1999 Aug;30(2):203-810436439
Cites: Health Technol Assess. 1999;3(2):1-13410448202
Cites: Ann Surg. 1999 Sep;230(3):289-96; discussion 296-710493476
Cites: Eur J Public Health. 2004 Dec;14(4):343-915542867
Cites: J Am Coll Surg. 2004 Dec;199(6):946-6015555979
Cites: BMJ. 2004 Nov 27;329(7477):125915545293
Cites: Ann Intern Med. 2005 Feb 1;142(3):198-20215684208
Cites: Ann Intern Med. 2005 Feb 1;142(3):203-1115684209
Cites: Stroke. 2003 Aug;34(8):1842-612843343
Cites: J Vasc Surg. 2003 Oct;38(4):762-514560227
Cites: Arch Intern Med. 2003 Nov 10;163(20):2500-414609787
Cites: J Vasc Surg. 2004 Jan;39(1):267-914718853
Cites: BMJ. 2004 May 8;328(7448):1122-415130983
Cites: J Vasc Surg. 2004 Jun;39(6):1253-6015192566
Cites: J Vasc Surg. 2004 Jun;39(6):1261-715192567
Cites: ScientificWorldJournal. 2004 Aug 27;4:746-5715349514
Cites: Lancet. 2004 Sep 4-10;364(9437):843-815351191
Cites: J Med Screen. 2002;9(1):40-211943797
Cites: N Engl J Med. 2002 May 9;346(19):1437-4412000813
Cites: N Engl J Med. 2002 May 9;346(19):1445-5212000814
Cites: JAMA. 2002 Jun 12;287(22):2968-7212052126
Cites: Br J Surg. 2002 Jul;89(7):861-412081734
Cites: Surgery. 2002 Aug;132(2):399-40712219041
Cites: Clin Invest Med. 2002 Aug;25(4):127-3312220039
Cites: BMJ. 2002 Nov 16;325(7373):113512433761
Cites: Lancet. 2002 Nov 16;360(9345):1531-912443589
Cites: Can J Surg. 2002 Dec;45(6):420-412500916
Cites: J Vasc Surg. 2003 Feb;37(2):280-412563196
Cites: Eur J Vasc Endovasc Surg. 2003 Apr;25(4):350-312651174
Cites: Ann Vasc Surg. 2003 Mar;17(2):171-912616362
Cites: J Vasc Surg. 2003 May;37(5):1106-1712756363
Cites: Eur J Vasc Endovasc Surg. 2003 Jul;26(1):74-8012819652
Cites: Am J Kidney Dis. 2003 Jul;42(1 Suppl):49-5512830444
Cites: J Vasc Surg. 2003 Jul;38(1):72-712844092
Cites: J Vasc Surg. 2003 Aug;38(2):329-3412891116
Cites: Eur J Vasc Surg. 1991 Apr;5(2):125-302037082
Cites: CMAJ. 1991 Oct 1;145(7):783-91913408
Cites: J Vasc Surg. 1991 Oct;14(4):540-81920652
Cites: Br J Surg. 1991 Sep;78(9):1122-51933203
Cites: Am J Surg. 1991 Nov;162(5):481-31951914
Cites: J Vasc Surg. 1992 Jan;15(1):21-5; discussion 25-71728677
Cites: CMAJ. 1992 Feb 15;146(4):473-811306034
Cites: Br J Surg. 1992 Jul;79(7):641-21643472
Cites: Br J Surg. 1992 Oct;79(10):1014-61306660
Cites: Eur J Surg. 1992 Oct;158(10):527-301360823
Cites: Ann Vasc Surg. 1993 Mar;7(2):113-68518126
Cites: Ann Intern Med. 1993 Sep 1;119(5):411-68338295
Cites: J Public Health Med. 1993 Jun;15(2):154-608353005
Cites: Eur J Vasc Surg. 1993 Jul;7(4):397-4018359295
Cites: Br J Surg. 1993 Nov;80(11):1406-98252350
Cites: J Vasc Surg. 1994 May;19(5):888-9008170044
Cites: Br J Surg. 1994 Mar;81(3):3768173903
Cites: Eur J Vasc Surg. 1994 Mar;8(2):156-608181607
Cites: J Vasc Surg. 1994 Jun;19(6):980-90; discussion 990-18201717
Cites: J Vasc Surg. 1994 Aug;20(2):163-708040938
Cites: Br J Surg. 1994 May;81(5):710-28044555
Cites: J Vasc Surg. 1994 Oct;20(4):598-604; discussion 604-67933261
Cites: Br J Surg. 1994 Aug;81(8):1112-37953333
PubMed ID
18248702 View in PubMed
Less detail

[Surgery for ruptured abdominal aneurysm assisted by vascular unit team at the primary receiving hospital]

https://arctichealth.org/en/permalink/ahliterature72185
Source
Ugeskr Laeger. 1999 Aug 30;161(35):4868-70
Publication Type
Article
Date
Aug-30-1999
Author
S. Vammen
H. Fasting
E W Henneberg
J S Lindholt
Author Affiliation
Karkirurgisk afdeling, og, Viborg Sygehus.
Source
Ugeskr Laeger. 1999 Aug 30;161(35):4868-70
Date
Aug-30-1999
Language
Danish
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Aortic Rupture - diagnosis - mortality - surgery
Case-Control Studies
Comparative Study
Denmark
Emergencies
English Abstract
Female
Hospital Units - manpower
Humans
Male
Middle Aged
Mobile Health Units - manpower
Patient care team
Patient Selection
Postoperative Complications - diagnosis
Prognosis
Retrospective Studies
Abstract
The objective of the study was to compare emergency operations for ruptured abdominal aortic aneurysm (RAAA) by a mobile operation team, with operation for RAAA carried out at our vascular unit. During a five year period (1993-1998), 18 emergency operations were carried out for abdominal aortic aneurysm (AAA) with rupture at the primary receiving hospital with assistance from a mobile operation team. In the same period 82 aneurysms with rupture were resected at our vascular surgical unit. Preoperatively, patients operated at the primary receiving hospitals had significantly lower blood pressure (P
PubMed ID
10778314 View in PubMed
Less detail

Outcomes of endovascular abdominal aortic aneurysm repair compared with open surgical repair in high-risk patients: results from the Swedish Vascular Registry.

https://arctichealth.org/en/permalink/ahliterature91804
Source
J Vasc Surg. 2008 Dec;48(6):1382-8; discussion 1388-9
Publication Type
Article
Date
Dec-2008
Author
Wahlgren Carl Magnus
Malmstedt Jonas
Author Affiliation
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden. carl.wahlgren@karolinska.se
Source
J Vasc Surg. 2008 Dec;48(6):1382-8; discussion 1388-9
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioscopy - methods
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Cause of Death - trends
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Registries
Risk factors
Surgical Procedures, Elective - methods
Survival Rate - trends
Sweden - epidemiology
Treatment Outcome
Abstract
BACKGROUND: The management of infrarenal aortic aneurysms in high-risk patients remains a challenge. Endovascular aneurysm repair (EVAR) is associated with superior short-term mortality rates but unclear long-term results and has not been shown to improve survival in patients unfit for open repair (OR). The aim of this population-based study was to evaluate the outcome after elective EVAR compared with OR in a high-risk patient cohort. METHODS: Prospectively collected data from January 2000 to December 2006 were retrieved from the Swedish Vascular Registry. The high-risk cohort was defined as age >or=60 years, American Anesthesiologists Association (ASA) class 3 or 4, and at least one cardiac, pulmonary, or renal comorbidity. These criteria were met by 217 of 1000 EVAR patients and 483 of 2831 OR patients. Primary end points were 30-day and 1-year all-cause mortality. Kaplan-Meier curves for survival and multivariate Cox regression analyses were performed. RESULTS: The crude 30-day and 1-year all-cause mortality rates for EVAR vs OR for the whole treatment group (n = 3831) were 1.8% vs 2.8% and 8.0% vs 7.2%, respectively. In the high-risk cohort (n = 700), EVAR patients were approximately 2 years older and renal insufficiency and diabetes mellitus were more common, and smoking was more prevalent in the OR group. About two-thirds of EVAR procedures were performed at university hospitals and one-half of OR procedures were performed at county hospitals. In the high-risk cohort, there was no difference in mortality at 30-days (EVAR, 4.6% vs OR, 3.3%), but OR had lower 1-year mortality (8.5% vs 15.9%; P = .003). More bleeding complications occurred in the EVAR group, but more pulmonary complications occurred in the OR group; however, there was no difference in cardiac, cerebrovascular, or renal complications. The mean follow-up was 3.4 years. EVAR was associated with increased mortality risk after adjusting for age, ASA class, and comorbidities (hazard ratio, 1.50; 95% confidence interval, 1.07-2.12; P = .02). Kaplan-Meier survival analysis showed a lower mortality rate for patients undergoing OR, which remained during follow-up (P = .001). CONCLUSIONS: Elective OR of aortic aneurysms seems to have a better outcome compared with EVAR in this specific, population-based, high-risk patient cohort after adjusting for covariates. We cannot confirm the benefit of EVAR from previous registry studies with a similar high-risk definition. In clinical practice, OR may be at least as good as EVAR in high-risk patients fit for surgery.
PubMed ID
18829239 View in PubMed
Less detail

24 records – page 1 of 3.