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Official websites use. Share sensitive information only on official, secure websites. Please address correspondence to Irma Kirtadze, M. This study describes the initiation and maintenance of illicit drug use, risky behaviors, and the substance use treatment experiences of women in Georgia. Participants presented diverse histories of drug use initiation and substance use, risky behaviors, and drug treatment participation. All participants reported concurrent use of different substances, including home-produced injection preparations. Women described their experiences of both the positive and negative effects physical and psychological that they attributed to their use of drugs. Findings enrich our understanding of the environment in which substance use is initiated and maintained in a female population in Georgia, and illustrate the importance of culture and the role of social factors in the development of injection drug use. Results can provide direction for tailoring the development of interventions for substance use disorders, public policy discussions regarding the treatment of women who use drugs, and future research on substance use among women in Georgia and other post-Soviet nations. Keywords: Caucasus region, homemade drugs, injection drug use, substance use, women-focused treatment. In Georgia, a country of 4. Intensive policing of opioid markets resulted in PWIDs switching to alternative drugs that required less involvement in the illegal drug marketplace and were considerably cheaper. Agonist maintenance with methadone or buprenorphine has been steadily expanding in recent years and, in , more than 2, people received maintenance pharmacotherapy. In the same year, only people received drug-free in-patient treatment two-weeks detoxification with no or few cases of post-detoxification psychosocial treatment Javakhishvili et al. HIV status is closely tied to the injection-drug-using community Chkhartishvili et al. Although HIV prevalence is low in the general population 0. Bouscaillou et al. Although this sample is small, there are no other studies that have estimated HCV rates for women who inject in Georgia. Women with substance use disorders are one of the most hidden and underserved populations in Georgia Javakhishvili et al. Given that drug treatment in Georgia has been designed to serve male beneficiaries, when treatment is available, it lacks sensitivity to the unique needs and challenges that injection-drug-using women face International Harm Reduction Development Program ; Javakhishvili et al. Empirical data on drug use by women in Georgia are scarce. Our previous research has examined the factors that motivate women who inject drugs to seek health care and the barriers they encounter when they do, and identified factors that may encourage or inhibit the disclosure of substance use to health service providers by women in Georgia Kirtadze et al. However, little is known regarding substance use initiation and the environment in which a substance use life course of women who use drugs in Georgia develops. This study examined the attitudes, beliefs, life circumstances, and contexts of drug use among injection-drug-using women in Georgia. A qualitative study was conducted during April-September in three cities: Tbilisi, Zugdidi, and Gori. These cities provide diversity in population numbers 1,,, 75,, and 49, inhabitants, respectively and geographic locations. Both Gori central Georgia and Zugdidi west Georgia border on two uncontrolled separatist regions South Osetia and Abkhazia, respectively and are characterized by a high prevalence of drug use. In all three cities, agonist treatment and low-threshold programs are available. Research staff briefly described the study to potential participants. Study-eligible and interested candidates made an appointment with staff to consent and interview them at a mutually convenient time and at a private location. All participants provided written informed consent prior to participating in an audiotaped interview. Of the 67 potential participants contacted, four refused participation during initial assessment and eight were ineligible, leaving a final sample of 55 women: 20 from Tbilisi, 20 from Gori, and 15 from Zugdidi see Figure 1. Eligibility criteria included: conversant in Georgian; 18 years or older; able to provide informed consent; injection of illicit drugs in the past 30 days as verified by venipuncture stigmata; and sexually active at least once in the past 30 days. Four respondents were in medication-assisted treatment, 14 were participants of needle and syringe programs at the time of interview, and two women were pregnant. The data collection strategy involved in-depth interviewing Goldstein ; Rosenbaum ; Waldorf Interviews lasted approximately 60 to minutes and covered six main topics: role of women in Georgian society; initiation and consumption of tobacco, alcohol, and drugs; gender differences in drug-using individuals; forms of violence associated with drug use; what drug treatment services are needed for women; and barriers to such services. All interviews were audio-recorded with participant written consent. Digital audio files were transcribed directly into Georgian in Unicode text format. Transcripts were exported as. The analytic process involved six key stages: 1 familiarization with the transcripts; 2 identifying a thematic framework focusing on the six specific issues; 3 coding—applying the thematic framework to the data using textual codes to identify specific statements corresponding to differing themes; 4 creating a node matrix from Matrix Coding query results and visualization; 5 mapping; and 6 interpretation, which included searching for associations, patterns, concepts, and explanations in the data, aided by visual displays such as cluster analyses, word frequency query, and connection mapping of thematic results. The aim of this procedure was to visually display ideas from the data as an aid in developing and testing interpretations. This process was intended to create an in-depth cultural model of the social reality of the participants from their point of view, the so-called emic perspective Pike The goal of the model was to describe how they perceived and categorized the environment in which they lived, their rules for behavior in a male-dominated network, what has meaning for them, and how they imagine and explain things. All transcripts were translated into English to permit review and discussion with US collaborators, and then back-translated into Georgian and the English-language transcripts corrected, if necessary , in order to ensure accuracy of translation. More than half of the sample smoked cigarettes, with 15 years being the mean age of smoking initiation. Participants indicated that their first drug experience was smoking marijuana or taking pills e. Four women were in medication-assisted treatment at the time of interview, and 14 were in a syringe and needle exchange program. This paper focuses on three main themes representing the major gaps in knowledge about the contexts surrounding substance use behavior among women in Georgia: initiation and maintenance of injection use, risk behaviors, and experience with substance use and general health services. Initiation of injection drug use was typically connected with a drug-injecting sexual partner husband or boyfriend and happened within a social network supportive of injection drug use. Although in rare cases a woman might make a deliberate decision to initiate drug use, in most cases first drug use was encouraged by and occurred in the presence of a male significant other—sex partner, friend, or relative. The man also was typically the drug supplier. Soon, the injection-drug-using woman became dependent on the man for both financial support and drug supply. The common belief among respondents was that a man is interested in a woman becoming dependent son drugs so that she would partner with him in terms of both a sexual relationship and financing their drug use—18 respondents disclosed that their current sexual partners had been the initiators of their first injection. But if a woman becomes a drug user, then both of them spend most of the money on drugs, leaving small amount for their kids. When a woman became part of a group that injected drugs, she preferred not to inject in front of men and moved to another room. When a woman lost her male partner due to arrest, death, separation, or other reason, she faced challenges and was pushed to search for alternative drug sources. She was forced to become part of a network of drug users, often desperately looking for money, and began injecting in male-dominated groups. Respondents highlighted that, due to this lack of access to drugs, women experienced more episodes of withdrawal compared to men. The usual scenario suggests that, when left alone, woman lack the requisite knowledge and skills to navigate through tightly woven, male-dominated drug networks. With few possibilities to find drugs and often limited knowledge of homemade drug production, such women often ended up partnering with a new man and may become part of a male-dominated group of injectors. All members of the group had their specific roles during the pre-consumption process. Women were usually assigned to get needles and cookers, get ingredients like potassium permanganate or red phosphorus, buy pills from pharmacies such as pregabalin, rivotril, antihistamines, cough and cold medicines , or just to be transporters of drugs. In addition to the predetermined non-privileged status of a woman in this group, she received very little respect from the group members and was considered untrustworthy. There are a lot of men who are squealing, each of them have been divulged now, so everyone knows who were cooperating with the police. As for woman, it does not really matter whether she is a user or not, after pressure they will all squeal. Knowledge about injection-associated risks for blood-borne infections was relatively high. However, in real-life situations, unsafe injection practice routinely occurred International Harm Reduction Development Program ; Rukhadze et al. In every male-dominated injector group discussed, the person contributing the most money defined the rules. Condom use among participants was not a usual practice. The common belief was that condoms should be used with a partner whom women trusted less, but not with a regular partner. In addition, women typically obeyed socio-cultural norms and traditions and so hardly dared to request protected intercourse, even when they knew their partner had sexual contacts outside their sexual relationship. Some respondents believed that refusal to have unprotected contact with their regular partner could lead to violence. Respondents also stated that condom use was widely perceived to be associated with commercial sex work. When used, condoms were utilized primarily for pregnancy prevention, not STI prevention. Some can beat their women for sexual intercourse refusal. Respondent: Again violence. Few participants were aware of female condoms 7 women out of Sexual contact in exchange for drugs or money was reported to be a frequent practice. In striking contrast with other behaviors and themes that emerged in our interviews, none of the respondents admitted ever practicing this behavior. Sex in return for drugs or money appeared in a majority of interviews, but exclusively as a behavior of others, not the respondent herself. Testing appeared to be a threat for women and they were afraid to hear positive results. Only a few participants indicated that they had been tested regularly for STIs. Some participants had fragmented information about either medication-assisted withdrawal or medication-assisted treatment; others were ignorant of the types of treatment available in Georgia. The majority of respondents indicated that there are no available treatment programs that would address the specific needs of women. Various issues related to the structure of programs were mentioned, such as absence of a separate entrance to the building for women, standing in a line for agonist medication at a dispensing area together with male patients and taking the preparation in front of them, and lack of privacy when speaking with their doctors in the presence of other patients and medical personnel. However, myths and prejudice towards medication-assisted treatment were common, including among the respondents who are engaged in such treatment. I prefer to ask some friend and overcome physical and psychological craving on my own. It affects teeth, liver, stomach. We found that sometimes, when a woman wished to enter treatment, either a male partner or a family member made the final decision about her treatment. Therefore, family members were reluctant to take any action that would risk disclosure. However, respondents indicated that, in many cases, family support might depend on the level of education and of socio-economic status of a family. In many cases, a common practice was to provide treatment at home with medical personnel visiting the patient at her residence and promising confidentiality to the family. Constant fear that this information will leak. I was working on a good position and when they found out that I was using, it was spread like a rumor or something, they dismissed me next day…. Furthermore, with many women having a history of imprisonment, employment opportunities were further reduced. Believe me, everyone would know in one week about her drug use status and prison history. In all public sectors they ask certificate of conviction, test employees several times a month, and those who have positive urine test or have imprisonment history are dismissed. Respondents shared a variety of experiences they had with health professionals: obstetricians and gynecologists, emergency room doctors, general practitioners, addiction physicians, psychologists, and nurses. Some comments were positive and suggested that, in certain cases women do receive appropriate treatment. When she learned that I was a user she must have felt pity for me and she thoroughly examined me. I felt very warm attitude from her, like mother and daughter attitude, but such things happen very seldom. Finally he told us to get away; otherwise he threatened to call the police. You can see it on their faces, how they treat you! This study enriches our understanding of the environment in which substance use is initiated and maintained in a female population in Georgia, and illustrates the importance of culture and the role of social factors in the development of injection drug use. This heightened risk of infection through unsafe injecting practices can be directly linked to the inequitable power distribution in male-dominated drug injection networks. In Georgia and elsewhere in the region, compared to men, women who use drugs have reported higher levels of sharing injecting equipment, drug paraphernalia, and needles International Harm Reduction Development Program ; Rukhadze et al. The majority of respondents were unemployed and never had held a job. In general, probably reflecting the traditionally good level of literacy and education in Georgia UNICEF , our participants were comparatively well-educated; however, they lacked job skills and social or economic support. Some had criminal records that were a major barrier to finding gainful employment Javakhishvili et al. Respondents believed it was particularly difficult for them to be hired because of what they saw as greater social stigma attached to jail time for women who use substances. Our previous reports identified socio-cultural and personal factors shaping help-seeking behavior of women with substance use problems in Georgia Kirtadze et al. The fear of social isolation and rejection causes substance-using women to delay seeking help, not just for the treatment of their substance use, but also for their general health and psychosocial needs. With the gradually narrowing gender gap in substance-use-related disorders, there has been increased attention from treatment providers focusing on issues related to substance use by women Greenfield et al. In Georgian reality, most women who use drugs do not seek treatment for their drug-related problems. The interviews underscore both the lack of and the need for the development of women-focused substance-use treatment services. As emphasized in our previous report Kirtadze et al. These gender disparities help to explain the lack of women in low-threshold and drug treatment programs in Georgia. Study limitations include a sampling approach which was purposive and not random, and the sample may not be representative of injection-drug-using women in Georgia. Findings rely on self-reports provided during in-depth interviews, creating a potential bias. However, to minimize bias, participants were guaranteed confidentiality and individual face-to-face interviews were conducted in private settings. With these cautions in mind, our findings provide information on several major issues that can be used to shape the direction for tailoring the development of interventions for substance use disorders, public policy discussions regarding the treatment of women who use drugs, and future research on substance use among women in Georgia and other post-Soviet nations. As a library, NLM provides access to scientific literature. J Psychoactive Drugs. Published in final edited form as: J Psychoactive Drugs. Find articles by Irma Kirtadze. David Otiashvili , M. Find articles by David Otiashvili. William Zule , D. Find articles by William Zule. Evgeny Krupitsky , M. Petersburg, Russia. Find articles by Evgeny Krupitsky. Wendee Wechsberg , Ph. Find articles by Wendee Wechsberg. Irma Kirtadze : M. David Otiashvili : M. William Zule : D. Evgeny Krupitsky : M. Wendee Wechsberg : Ph. PMC Copyright notice. The publisher's version of this article is available at J Psychoactive Drugs. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Professional education 2 years after high school education.

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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Similarly, the content of this particular summary does not necessarily reflect the official opinion of the Republic of Georgia and should be seen as the product of the particular programme of technical assistance. Authors: J. Javakhishvili, L. Sturua, I. Kirtadze, N. Balanchivadze, D. Otiashvili; edited by T. This country overview and auxiliary papers were created within the framework of the project Introducing Addictology in Educational System in Georgia and its component NDO. Last update: May It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. Unemployed persons comprise persons aged 15 to 74 who were: without work during the reference week; currently available for work; actively seeking work. Prison population rate per inhabitants. Georgia is located in the South Caucasus, a traditional trafficking corridor from Asia to Europe. The country consists of 11 regions; Tbilisi is the capital city with a population of 1 Other major towns are: Kutaisi , Rustavi , Batumi , Zugdidi , Chiatura 70 , Gori 70 , and Poti 50 The official language is Georgian, and in the territory of Abkhazia it is Georgian and Abkhazian. The main religion is Georgian Orthodox Georgia was annexed by Russia in the nineteenth century and then again by Soviet Russia in , becoming the Georgian Soviet Socialist Republic and part of the Soviet Union. Following the break-up of the Soviet Union Georgia regained its sovereignty on 14 November ; by a popular vote it became a presidential republic. Since then the country has gone through several economic, political and social crises, and two internal political conflicts with the Russian Federation that eventually led to the Georgian—Russian war in August The war resulted in de facto Russian occupation of two important border regions of Georgia — Abkhazia and South Ossetia — and internally displaced persons left those two regions. The relaxation of political, social and trade control since the fall of the Soviet Union and the existence of territories and borders not controlled by the legitimate government was accompanied by an increased and more visible use of illicit psychotropic substances and their greater availability. No data is available on drug use among the general population; no general population survey has ever been conducted due to lack of funding, nor is one planned by the national authorities for the foreseeable future. A sample of students aged 15 to 16 and representative of the capital city were interviewed in spring The study found that marijuana was the most frequently reported drug: 3. Ecstasy was the second most frequently used illicit drug, with a lifetime use reported by 7. Lifetime use of crack cocaine was reported by fewer respondents 1. Lifetime prevalence of powder cocaine use was reported by 0. At least one experience with drug injecting was reported by 0. Primary prevention of drug use by both the Georgian government and international donors has received limited attention so far. From the late s on there has been sporadic activity, insufficient funding, limited projects and beneficiaries, and a lack of quality control mechanisms for prevention activities. Currently, drug prevention activities are either substituted by general programmes promoting a healthy lifestyle or they are, to some extent, integrated into HIV-prevention activities. The extent of problem drug use in Georgia was traditionally calculated using estimates with unclear definitions and unknown authors that were widely used by media and decision makers. Until the mids, raw acetylated opium was prevalent in the black market. Heroin became the drug of choice for Georgian problem drug users PDUs from the late s until approximately — Since —09 home-made stimulants prepared from cough medicines containing pseudo-ephedrine or phenylpropanolamine which are easily available from pharmacies without a prescription have been among the most widespread injected drugs Otiashvili et al. There is no consensus among the experts regarding what is the final injectable product in this case, although desomorphine is definitely present in the final preparation personal communication with Tsulaia Ekaterine. Reliable and valid national data on the overall number of patients treated for drug use disorders do not exist in Georgia, as the standards according to which existing clinics are collecting and processing the data on the treated patients differ significantly and are not coordinated. In , there were patients males, 7 females enrolled in the opiate substitution treatment OST programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, while 1 individuals of whom 17 were female were in a methadone maintenance programme run by the state-funded OST services. For more details see the section on treatment response. Most were 29 to 40 years of age at the time of testing. In 2 cases the infection has progressed to the AIDS stage, and of these people have died. As of May , the cumulative shares of these two routes in all known HIV cases were In , some In the early s the registration of drug-related deaths was interrupted and there were no data available pertaining to drug-related deaths or mortality until In , a special drug-related mortality study based on matching the national narcologic register with the general population mortality register was launched by the Georgian Research Institute on Addiction currently The Centre for Mental Health and Prevention of Addiction within the SCAD Programme. As a result of this study, the lower limit for the number of males aged 18 to 64 that were registered with the narcologic register and died in was determined, which was 6 per 1 people of the same age group. This rate was double the mortality rate among the general population of males of a similar age group in Todadze, Since , The Levan Samkharauli Forensic Expertise Bureau re-started registration of drug-related death cases, though the number of the registered cases is very low from 39 cases in to 15 cases in and according to anecdotal evidence from the harm reduction services it does not reflect the reality in Georgia. Currently there are four clinics providing residential drug dependence treatment in Georgia, three of which are based in Tbilisi and one in Batumi. Before , a limited number of residential treatment cases were sporadically financed from the State budget, but from —09 the State did not fund any drug treatment case. In , the Ministry of Health resumed funding programmes for a limited number of treatment cases. In , the State programme funded the treatment of 80 patients out of a total of patients treated by the four clinics that are providing addiction treatment in Georgia. There are no mechanisms in place for the long-term follow-up of patients, and no national treatment guidelines or protocols exist; therefore, treatment effectiveness is not properly monitored and evaluated. In psycho-social rehabilitation services were introduced to strengthen the sustainability of the abstinence oriented treatment, though the number of patients involved both in AOT and psycho-social rehabilitation has declined every year since Opioid substitution treatment was initiated in Georgia in , with methadone as the only legal medication. Contrary to abstinence oriented treatment, demand for opioid substitution treatment OST and opioid-assisted detoxification is on the rise — there has been a steady increase in the number of patients, expanding geographical coverage and diversified treatment modalities included in the OST programmes. Additionally, the State co-funded 11 OST sites operating in different regions of Georgia, covering the costs of substitution medication, while patients paid approximately EUR 70 per month for services. In , some 1 people received services in the frame of the State-funded OST programme with methadone of which 17 were females. In , some prisoners were detoxified using methadone in a treatment site at Prison no. One of the significant outcomes of these efforts is the emergence and rapid growth of the HR-focused non-governmental organisations NGOs. In , seven organisations working in the field of harm reduction formed the Georgian Harm Reduction Network GHRN , which brought together 20 organisations in By the end of there were 10 HR sites of a combined type clients could receive both sterile equipment for injection and VCT in the same site run by members of GHRN in different towns of Georgia. In there were The GHPP commenced in and provides: risk reduction counselling to people who inject drugs; counselling and testing on HIV; testing for HCV and HBV; and peer-to-peer education and outreach services by employing the model of community level interventions. Many drug users have switch to new home-made substances that are in general more toxic and harmful. In comparison, a single dose of home-made preparations of amphetamine-type stimulants or opioids costs EUR 3—5. The amount of heroin seized by the Ministry of Internal Affairs of Georgia varied from However, the amounts of illegal drugs seized in Georgia have been constantly smaller compared to those seized in neighbouring countries. According to data from the Supreme Court of Georgia, 3 people were convicted of drug-related offences in Article 33 of the Penal Code of Georgia. Some1 of these were convicted for the illegal consumption of drugs. Thus, although the rate of imprisonment for drug consumption related offences has been gradually decreasing in the last three years, the number of people fined or subjected to conditional sentencing for these offences remains high relative to the population and the estimated number of drug users. Drug use per se constitutes an offence under Georgian legislation. It is punishable with both administrative and criminal sanctions. Court decisions on drug use offences are mostly based on rapid stripe test results positive urine test for either illicit drugs themselves or the inactive metabolites of drugs conducted by the forensic laboratory of the Ministry of Internal Affairs MoIA. However, such testing has become widespread. Out of 27 people tested for drugs and metabolites in , less than a third 8 gave a positive result using the rapid stripe tests. Possession of any amount of drugs is a criminal offence under the Penal Code of Georgia Article , with no differentiation between the possession of drugs for personal use or for trafficking. For the majority of substances that are widespread in Georgia there is no legal definition of what constitutes a small quantity, and therefore any amount found in the illegal possession of a person is deemed a large amount, leading to severe punishment. In , the Parliament of Georgia adopted a document setting out the main directions of the National Drug Strategy. The national priorities were defined as follows: treatment and rehabilitation; prevention; harm reduction; staff capacity building; informing the public; establishing a drug information system; coordination. The elaboration of the action plans according to the approved priorities and main aims was delegated to the relevant ministries, but no action was taken. Hence, the country was left with no formal or comprehensive drug strategy until In the Ministry of Justice of Georgia took the lead and started to facilitate strategy elaboration. The process is still ongoing. On 22 November the President of Georgia issued special decree no. The newly established Interagency Coordinating Council started work in , facilitated by the Ministry of Justice of Georgia. The Council unites representatives from the different supply and demand reduction governmental agencies, non-governmental legal entities and international organisations, experts and scientists working in relevant areas. The main objectives of the Council are: i the elaboration of drug abuse prevention policy based on human rights protection principles; ii the development, periodical revision and monitoring of the implementation of a national anti-drug strategy and corresponding action plans; iii the development of proposals and recommendations for elaborating the national anti-drug strategy; iv the coordination of interagency activities in the process of implementation of the national anti-drug strategy for the purpose of promoting implementation of corresponding measures. Baramidze, L. Chokoshvili Otar, A. Kirtadze, I. National Statistics Office of Georgia n. Available at www. Otiashvili, D. Sikharulidze, E. Sirbiladze, T. Todadze, Kh. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Overview of the national drug situation in Georgia Overview of the national drug situation in Georgia Last update: May Contents Drug use among the general population and young people Prevention Problem drug use Treatment demand Drug-related infectious diseases Drug-related deaths Treatment responses Harm reduction responses Drug markets and drug-law offences National drug laws National drug strategy Coordination mechanism in the field of drugs References. National Bank of Georgia, , Annual report. Council of Europe.

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