Doctors

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Family Medicine Doctors ‘Forgotten on the Front Lines’ of the Pandemic

When you think of frontline health care workers, doctors and nurses in hospitals might come to mind, but independent family doctors are in that category, too.



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“Forgotten on the front lines is what we are,” said. Dr. Guy Culpepper, founder of Bent Tree Family Physicians.

Culpepper says the front lines of the pandemic aren’t in emergency rooms, they’re at his front door.

“When you talk about flattening the curve, that curve flattening happened in my office,” he said.

From the parking lot of his Frisco office, Culpepper says more than 7,000 people have been tested for COVID-19. Nearly 1,200 have tested positive.

“We’ve kept 1,100 of them away from hospitals and emergency rooms,” Culpepper said.

Culpepper says he has about 250 active COVID-19 patients. Those recovering from home are checked on by phone every day. “We get about 1,500 telephone calls a day,” he said.

His numbers tell a story. They also speak to his heart.

“Part of the passion I have in managing my COVID patients and managing all my patients is the feeling of I’m only here because of them,” Culpepper said, emotionally.

Like many independent doctors, Culpepper closed his doors in the spring and furloughed all 75 employees.

On the verge of going out of business, it was a GoFundMe page set up by patients that helped him get through.

“We’re only kept up by those handful who know us and appreciate us because we know all too well that most of the country doesn’t know the work we’re doing,” Culpepper said.

Culpepper, who’s been in family medicine for 33 years, says no federal programs exist to sustain private physicians, like him. Nationwide, he says his profession is in crisis because private practices, “can’t handle the economics of a pandemic.”

He says nearly 10% of primary care practices that temporarily closed this year have yet to reopen.

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medicine

Doctors Have a Problem with Fat Shaming and Fat Phobia

Let me tell you a joke. An overweight woman walks into her doctor’s office and says, “doctor, it hurts when I bend my arm.”

The doctor says, “well… lose some weight.”

Unfortunately, that’s the reality for some overweight and obese people seeking medical treatment, including me. I remember the first time I realized my medical provider was more interested in my weight than my actual health. I was 23 years old, living on my own in NYC, and it was one of the first times—if not the first—I had made my own doctor’s appointment. In spite of my begging and pleading, my medical provider at the time completely dismissed my symptoms of persistent mental fog, memory loss, and depression. Instead of helping me, my doctor “prescribed” weight loss via vigorous exercise, because “exercise releases endorphins and endorphins make you happy!” (Yep, they quoted Elle Woods, the character from Legally Blonde, at me). It wasn’t until almost a decade later, at the age of 29, that I was properly diagnosed with adult attention-deficit/hyperactivity disorder (ADHD), a mental health disorder that affects every part of my life.

I suffered for years with the belief that everything I was feeling was a side effect of my weight, not realizing that I had an underlying problem that my medical provider failed to identify. And I am not the only one.

Medical Bias Is Hurting Overweight Patients

Multiple studies have shown that due to medical practitioners implicit biases against fat bodies, overweight patients may receive worse care than our straight-size counterparts; and it can lead to deadly consequences. Some experts argue that when overweight patients present symptoms doctors may not take them seriously, and the patients’ actual issues can go undiagnosed. In one study of over 300 autopsy reports, those who were overweight were 1.65 times more likely than others to have significant undiagnosed medical conditions, including serious conditions like endocarditis (an infection of the heart) or lung carcinoma (a cancer that begins in the lungs). Meaning that while other patients might be given life-saving tests and care such as CT scans and MRIs, overweight patients with the same symptoms might just be told to go home and lose weight.

“Yes, there is a weight bias in the medical community,” says Priscila Rodrigues Armijo, MD, Assistant Professor and Researcher at the University of Nebraska. Dr. Rodrigues Armijo has been conducting research on how environment and the total life of an overweight and obese patient should be a deciding factor in the treatment they receive from their health-care provider.

“The bias exists in not only how the [medical provider] sees the patient, but how they even interact with the patient, which is a problem,” says Dr. Rodrigues Armijo.

Fat Patients Fear Going to the Doctor, to Our Detriment

I didn’t realize it at the time, but the lack of diagnosis was the least of my issues with my then-doctor. Their not-so-subtle distaste for me and my fat body continued to bother me long after

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medicine

Doctors Without Borders physician returns to N.W.T. as new director of medicine

Next week, a new doctor will be leading physicians in the N.W.T.

Dr. AnneMarie Pegg has worked in conflict zones and played a significant role in shaping the medical approach for tackling epidemics, like Ebola.

Now, Pegg is set to be the new Territorial Director of Medicine, and in a way, the new role is something of a homecoming for the doctor who spent parts of her career in the N.W.T.

In 1999, Pegg came to the North as a community health nurse in Fort Simpson, N.W.T. She later returned to medical school and has since provided services as a contract and locum physician in the territory.

While keeping a practice in the territory, Pegg also held senior roles within Médecins Sans Frontières (Doctors Without Borders) where she spent time working in Syrian war zones. Recently, she was a clinical lead for epidemic response and vaccination.

Pegg says as her 12 years with Doctors Without Borders was coming to a “natural pausing point,” she wanted to rekindle her relationship with the N.W.T. and return on a more regular basis rather than just as a locum.

“Given the fact that we are in the middle of … a complex situation with COVID[-19] and the pandemic, I really thought that perhaps this is something that I could take on given my relationship with the North that has been quite long-standing now,” she said.

Working as a community health nurse and then as a physician, in Yellowknife, the Dehcho and the Beaufort Delta regions, gave her an appreciation for the geographical challenges faced by northerners.

“I think that being able to picture a place in my head, having a vision of what that place looks like, knowing the physical layout of the health centre, even, I think it’s going to really give me a lot of advantage,” Pegg said.

“It makes me feel like I’m coming in a little bit ahead in terms of awareness of where we are in the territory.”

‘Culturally acceptable’ medicine

She says communication is one of the biggest parts for her job.

“Listening to people and the importance of being aware that even in a very complicated situation or a complicated context, it’s usually possible to provide a service and to find a solution that can be mutually acceptable both to practitioners and to patients,” Pegg said.

Pegg says the territory has a long way to go to improve access to continuous care in certain areas, despite “enormous strides” made already.

She’s set to keep looking into how to provide services “in a manner that’s culturally acceptable” to the N.W.T. population.

“[It] has not always been a strong point of health care providers,” Pegg said.

The director of medicine for N.W.T. is the most senior physician administrative leader in the territory’s health system and is a member its executive team. The job is meant to provide leadership in areas of planning, operation and evaluation of delivery of quality health care services by practitioner staff to residents.

Caitlin Cleveland

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health

The Health 202: Doctors, hospitals blast Trump’s baseless claims they inflate coronavirus deaths for money

“You know that, right?” Trump said at a Michigan rally on Friday. “I mean our doctors are very smart people. So what they do is they say, ‘I’m sorry, but everybody dies of covid.’” 

Chip Kahn, president of the Federation of American Hospitals, said “it is so offensive.” 

There is no evidence that hospitals and doctors are lying about the number of covid-19 patients. 

That would be fraud and something the Department of Justice could prosecute. “It’s unethical, it’s illegal and it’s inappropriate,” Kahn said.

Without naming the president, the American Medical Association called Trump’s statement a “malicious, outrageous and completely misguided charge” and defended front-line health care workers. “They did it because duty called and because of the sacred oath they took,” said AMA President Susan Bailey.

The pandemic has actually cost medical facilities money, although by how much is unclear. 

Elective surgical procedures, which hospitals were forced to cancel or postpone for much of the spring, generate the most revenue for them. In contrast, carrying for severely ill coronavirus patients for weeks on end consumes lots of staffing hours and bed space for hospitals.

“Frankly, these are very expensive cases on average … the hospitalizations are long and so even the reimbursement is probably way below cost,” Kahn said. 

And hospitals don’t get extra money if a coronavirus patient dies. 

Hospitals bill the government and private insurers for specific services related to specific illnesses, regardless of the outcome.

“Hospitals do not receive extra funds when patients die from covid-19,” the American Hospital Association wrote in a blog post yesterday addressing the claims. “They are not over-reporting covid-19 cases. And, they are not making money on treating covid-19.”

Ashish Jha, dean of Brown University School of Public Health:

However, there is a coronavirus “bonus” for uninsured covid-19 patients.

The coronavirus relief package passed by Congress includes money to pay hospitals for treating uninsured covid-19 patients. The package allows hospitals to be paid 120 percent of typical Medicare rates. 

Yet Kahn feels that, if anything, hospitals aren’t getting paid as much as they need for caring for coronavirus patients. Trump’s comments, he feels, reflected little-to-no understanding of how the coding system works. 

Hospitals can only submit claims for the payments that list covid-19 as a patient’s primary diagnosis. For example, a patient admitted with sepsis due to the coronavirus would be given “sepsis” as a primary diagnosis and “covid-19” as a secondary diagnosis — even though the virus caused the sepsis to begin with. 

Hospitals have asked the Department of Health and Human Services to loosen those rules, charging that the majority of claims for coronavirus testing and treatment would be rejected and ineligible for reimbursement under the program.

Trump’s claim was just the tip of the iceberg in how he talked about the pandemic.

The president switched between blaming others for focusing on the pandemic while simultaneously promising a widespread vaccine within weeks.

He offered extreme depictions of a pandemic response might look like under a Biden administration.

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fitness

Doctors urge UAE residents to participate in Dubai 30×30 fitness challenge

Dubai Fitness Challenge DFC Yoga
Doctors say that it normally takes 21 days to form a habit, after the 30-day challenge, you have high chances of continuing your fitness regime.
Image Credit:

Dubai: The Dubai Health Authority (DHA) is calling upon on all Dubai residents to tie up their shoelaces and step up to take up the monthlong 30×30 Dubai fitness challenge which kicked off on October 30.

On its part DHA has launched several sports initiatives such as football, basketball and volleyball challenges to encourage its employees and is also disseminating health and fitness tips through all its social media platforms for the benefit of the community.

Slash blood pressure and blood sugar with fitness

Dr Suhail Al Rukn, Neurologist and Head of Stroke Unit at Rashid Hospital, says: “This initiative is like no-other. Seeing community members build a simple but highly effective routine of getting 30 minutes of exercise per day is something I feel grateful towards as a doctor. There is absolutely no doubt that we can prevent a host of non-communicable chronic diseases if we adopt a healthy lifestyle and exerreducecise is a key pillar to achieve good health. Inactivity is a real global problem when it comes to lifestyle modification and this challenge offers people so much support and it is simple.

“I strongly urge community members to take up this challenge but most importantly to continue it after 30 days and to make it a part of their daily routine. The health benefits of exercise are simply multifold. From improvement in mood and mental well-being to the physical benefits of exercise such as its ability to lower blood pressure, prevent an onset of several chronic diseases such as diabetes and even help reverse certain health conditions such as prediabetes, the benefits are plenty.”

Mental health

Mayo Clinic says that 30 minutes of regular exercise can help lower blood pressure. A reduction of five to 10 millimetres of mercury (mmHg) is possible. In some cases, that is enough to prevent or reduce the need for blood pressure medications. Al Rukn says regular exercise helps improve cholesterol, prevents or helps manage type 2 diabetes, prevents obesity and the underlying health problems that accompany it. Weight-bearing exercises can help prevent osteoporosis. Additionally it does wonders for mental health.

Work out to de-stress

Dr Rukn added: “Exercise is a stress-busting tool, it helps provide mental clarity and also improves mood as we release endorphins (a feel-good hormone) when we exercise. It helps improve mild-to-moderate depression and anxiety as well as improves sleep. It is important to note that fitness enthusiasts and amateurs alike should not overdo exercising and should focus on the correct form or posture to ensure they prevent sports injuries. It is also important to focus on progressive overload, which means you increase your weights or intensify your exercise routine after consistently working out and not suddenly as this can lead to injuries. The idea is to work out regularly and that is the beauty of this challenge, you simply have

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health

Doctors are not profiting from Covid. We are being consumed by it (opinion)

In the thoughtlessness that has become the hallmark of his presidency, Donald Trump stated at a rally this week that doctors are falsely inflating the numbers of coronavirus deaths for financial gain. These are fabricated musings, seemingly designed to shift blame from his own lack of competence by creating a false narrative for the American public.



a group of people standing in a room: Doctors and nurses wearing protective gear treat a patient in the Covid-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) in Houston, Texas, U.S., on Monday, June 29, 2020. Covid-19 cases and hospitalizations have spiked since Texas reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads. Photographer: Go Nakamura/Bloomberg via Getty Images


© Go Nakamura/Bloomberg/Getty Images
Doctors and nurses wearing protective gear treat a patient in the Covid-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) in Houston, Texas, U.S., on Monday, June 29, 2020. Covid-19 cases and hospitalizations have spiked since Texas reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads. Photographer: Go Nakamura/Bloomberg via Getty Images

As an emergency medicine physician treating patients with Covid-19, these words are piercing. Back in May, I wrote about the mental health toll that Covid-19 was having on health care providers. Five months later, I wish I could say things have gotten better. With 9.2 million cases and over 230,000 deaths, the stress we face in our field has not abated — we have just grown accustomed to its presence. No amount of cash could outweigh the negative impacts this pandemic is having on doctors.

Frontline health care workers have suffered from increased rates of post-traumatic stress syndrome, anxiety, and depression since the pandemic began. Most notorious was the death of Dr. Lorna Breen, an emergency physician in New York who committed suicide after treating patients with the disease as well as after contracting the illness herself.

One study found that over 1,300 health care workers in the United States have died from Covid-19. A Facebook group dedicated to the memory of some of these physicians now has over 8,000 members who regularly share their grief. Many of the casualties in the medical profession are young and in the prime of their life, such as Dr. Adeline Fagan, a resident physician who died after a prolonged course of the illness in Texas.

Health care workers have a significantly increased risk of contracting Covid-19 compared to the general population. Those who are Black, like me, have 21 times the risk of contracting the disease. These same workers undoubtedly played a role in ensuring that Trump’s own hospital stay went smoothly.

Trump’s claims about doctors inflating Covid-19 cases are unfounded. While the Coronavirus Aids Relief and Economic Security Act provides additional reimbursement to hospitals for cases of Covid-19, this applies only to a small subset of patients with the disease — those covered by Medicare and all cases must be confirmed by a documented positive Covid-19 test. Falsely claiming otherwise would constitute fraud.

Billing is based on a complicated mix of severity, diagnosis and the intensity of treatment. Trump should know this as it is based on an algorithm developed by the Centers for Medicare and Medicaid Services, part of the federal government structure that he was elected to lead. Trump’s own publicly

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health

More US patients to have easy, free access to doctor’s notes

More U.S. patients will soon have free, electronic access to the notes their doctors write about them under a new federal requirement for transparency.

Many health systems are opening up records Monday, the original deadline. At the last minute, federal health officials week gave an extension until April because of the coronavirus pandemic.

Britta Bloomquist of Duluth, Minnesota, has been reading her clinical notes for years, first struggling through red tape and more recently clicking into a secure online patient website.

“It means information about your care can no longer be hidden from you. And you have a say in your care,” said Bloomquist, 32, who has a rare type of arthritis that took years to diagnose.

WHAT’S CHANGING?

Patients have long had a right to their medical records, including doctor notes, but obtaining them could mean filling out requests, waiting for a response and paying fees. A 2016 law said delays and barriers must be removed.

If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information.

Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.

WILL THIS HELP ME?

Studies have shown that patients who read their notes understand more about their health, take their medications as prescribed more often and feel more in control of their care.

That’s true for Bloomquist. Diagnosed with a rare type of arthritis called ankylosing spondylitis, she had extensive surgery to straighten her right leg in 2018. She gets regular drug infusions and sees multiple specialists. It’s a lot to remember.

“I’ve become a health nerd,” Bloomquist said. “Reading the notes has kept me on the same page as my providers about what’s going on.”

WILL I UNDERSTAND THE JARGON?

You may have to look up terms. Or ask you doctor to translate at your next visit. And doctor’s notes tend to use abbreviations. “SOB” means short of breath, by the way. “BS” can mean bowel sounds.

And brace yourself if your weight is an issue.

“I’m a heavy-set person, OK? And their favorite word to use is obese,” said Rosie Bartel, 71, of Chilton, Wisconsin. “You have to get used to that. Doctors use that word.”

To Bartel, who became more involved in her care after getting an infection in the hospital, reading notes means she’s doing what she can to prevent errors and stay healthy.

“I don’t have to remember everything said to me in a 15-minute appointment,” she said.

WHAT IF I SPOT AN ERROR?

Patients do find mistakes in their notes and some errors

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health

For Mexico’s doctors, an especially mournful Day of the Dead

MEXICO CITY (AP) — The diminutive figure of a skeleton in a face mask and medical cap has a hand on a bedridden patient. At its side is the sort of skull made of sugar common on Day of the Dead altars. And behind is the photo of a white-haired 64-year-old man in glasses smiling at the camera: the late Dr. Jose Luis Linares.

He is one of more than 1,700 Mexican health workers officially known to have died of COVID-19 who are being honored with three days of national mourning on these Days of the Dead.

Linares attended to patients at a private clinic in a poor neighborhood in the southern part of the city, usually charging about 30 pesos (roughly $1.50) a consultation. Because he didn’t work at an official COVID-19 center, his family doesn’t qualify for the assistance the government gives to medical personnel stricken by the disease, his widow said

“I told him, ‘Luis, don’t go to work.’ But he told me, ‘Then who is going to see those poor people,’” said his widow, Dr. María del Rosario Martínez. She said he had taken precautions against the disease because of lungs damaged by an earlier illness.

In addition to the usual marigolds and paper cutouts for Day of the Dead altars, hers this year includes little skeleton figures shown doing consultations or surgeries in honor of colleagues who have died.

It’s echoed in many parts of a country that as of September, according to Amnesty International, had lost more medical professionals to the coronavirus than any other nation.

They include people like nurse Jose Valencia, and Dr. Samuel Silva Montenegro of Mexico City, whose images rest atop altars in the homes of loved ones in Mexico City,

Martínez’s altar is in a living room beside a room in their apartment where she and her husband gave consultations. Martínez, who also fell ill but recovered, now sees patients only online or by phone.

Linares died May 25 after being hospitalized at a peak of infections in Mexico City. Martínez lost consciousness at the news, but when she came to, she found her only son and her sister were hugging her. “Don’t touch me, don’t touch me!” she yelled, fearing they too would be infected.

At the peak of her own illness, she trekked from saturated hospital to overflowing clinic, looking for help.

Martínez, 59, said she now feels better, and at peace, though not resigned to the loss of her husband of 36 years, who she first met as a girl selling gum outside a movie theater to help support her eight brothers and sisters.

“I feel strange,” she said. “But I owe it to the patients and they are going to help me get through this.” She said, though, that she expects to work fewer hours.

“I’m afraid because we don’t know how much immunity you’re doing to have, how long it will work,” she said. “The illness is very hard, very cruel. …

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health

More US Patients to Have Easy, Free Access to Doctor’s Notes | Political News

By CARLA K. JOHNSON, AP Medical Writer

More U.S. patients will soon have free, electronic access to the notes their doctors write about them under a new federal requirement for transparency.

Many health systems are opening up records Monday, the original deadline. At the last minute, federal health officials week gave an extension until April because of the coronavirus pandemic.

Britta Bloomquist of Duluth, Minnesota, has been reading her clinical notes for years, first struggling through red tape and more recently clicking into a secure online patient website.

“It means information about your care can no longer be hidden from you. And you have a say in your care,” said Bloomquist, 32, who has a rare type of arthritis that took years to diagnose.

Patients have long had a right to their medical records, including doctor notes, but obtaining them could mean filling out requests, waiting for a response and paying fees. A 2016 law said delays and barriers must be removed.

If you already use a patient portal such as MyChart to email your doctor or schedule an appointment, you may soon see new options allowing you to view your doctor’s notes and see your test results as soon as they are available. You may get an email explaining where to look, how to share access with a caregiver and how to keep other eyes off your information.

Many people won’t notice a change. About 15% of health care systems already are letting patients read doctor notes online without charge. That means about 53 million patients already have access to their doctor’s notes.

Studies have shown that patients who read their notes understand more about their health, take their medications as prescribed more often and feel more in control of their care.

That’s true for Bloomquist. Diagnosed with a rare type of arthritis called ankylosing spondylitis, she had extensive surgery to straighten her right leg in 2018. She gets regular drug infusions and sees multiple specialists. It’s a lot to remember.

“I’ve become a health nerd,” Bloomquist said. “Reading the notes has kept me on the same page as my providers about what’s going on.”

WILL I UNDERSTAND THE JARGON?

You may have to look up terms. Or ask you doctor to translate at your next visit. And doctor’s notes tend to use abbreviations. “SOB” means short of breath, by the way. “BS” can mean bowel sounds.

And brace yourself if your weight is an issue.

“I’m a heavy-set person, OK? And their favorite word to use is obese,” said Rosie Bartel, 71, of Chilton, Wisconsin. “You have to get used to that. Doctors use that word.”

To Bartel, who became more involved in her care after getting an infection in the hospital, reading notes means she’s doing what she can to prevent errors and stay healthy.

“I don’t have to remember everything said to me in a 15-minute appointment,” she said.

Patients do find mistakes in their notes and some errors are serious enough to affect their care,

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fitness

Ask the Doctors: Studies show fitness trackers can predict illness | Health

Dear Doctors: My husband caught a cold this summer, and he swears the readings from his fitness tracker a few days before warned him that he was about to be sick. Do you think that’s really possible?

Dear Reader: Your husband’s observations about how changes in the data from his fitness tracker preceded the onset of a cold actually dovetail with the findings of a study that were published at the start of the year. And it’s not the first research of its kind to make the connection. With millions of people now using fitness trackers, scientists are diving into the trove of uploaded data to see what the details may be able to reveal about public health.

For anyone unfamiliar with fitness trackers, they’re wearable sensors, much like a wristwatch, that measure a range of activity and health metrics. Depending on the device — there are dozens of different brands and types — fitness trackers measure steps taken, total mileage, speed, direction, elevation climbed and duration of activity. On the physiological side of things, they can track heart rate, heart rhythms, skin temperature and minutes of sleep. Some manufacturers even claim that, using motion sensors and algorithms, their models can map how long someone spends in the various stages of sleep. (Full disclosure: Many sleep specialists are skeptical about the accuracy of the sleep-stage results.)

In a recent study, researchers from the Scripps Research Translational Institute analyzed data collected from the fitness trackers of 47,000 adult women and men. Using a minimum of two months’ worth of readings taken over the course of two years, which included activity, heart rate and sleep, the researchers found that their predictions of regional flu outbreaks matched the statistical data collected by the Centers for Disease Control and Prevention during those same time periods. An earlier study, published by researchers at Stanford University in early 2017, had come to similar conclusions. In that study, the scientists collected 250,000 daily readings from just 43 individuals over the course of a year. The participants wore a range of biosensors, which collected information about daily activity, heart rate, oxygen saturation levels, skin temperature and sleep data. They even tracked exposure to radiation, such as the X-rays and gamma rays encountered in air travel.

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