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How does the world work?

Today I sat down to think about how the world works. I wanted to clarify the systems underlying our society in order to decide what I should do with my future.

I tried to answer the question ‘how does the world work?’. The answers I came up with didn’t particularly help in my pursuit of meaningful work but it was kind of fun so I thought I’d share them anyway. I came up with a 1-sentence and a 5-sentence answer. I tried writing a longer one but it took too long.

 

1-sentence answer

Everything changes.

 

5-sentence answer

Laws exist; some (e.g. of physics) are obeyed better than others (e.g. of governments).

Everybody looks for things in the wrong places.

Patterns of thought spread throughout populations.

Everything is judged when it’s too soon to tell.

Everything changes.

(I considered ‘everything dies’ but I felt that’s too cliché)

 

What would be your 1- or 5-sentence answers?

By | 2018-01-12T19:17:23+00:00 January 11th, 2018|

All UK Medical Schools and Contact Details [REFERENCE]

I recently needed to find contact details for all of the UK medical schools. I have since messaged them and received replies from most.

I share them here in case there are useful to some.

These were the most up-to-date contact details as of 10th January 2018.

If you are on any of the below committees or know of updated details, please let me know in the comments below.

 

Medical school

Email

Websites

Barts + QMUL

medsoc@qmul.ac.uk

Birmingham

MED-SOC-president@adf.bham.ac.uk

http://uobmedsoc.com/contact.php

Brighton and Sussex

comms@bsmsmedsoc.co.uk

http://bsmsmedsoc.co.uk/contact-us

Bristol

president@galenicals.org.uk

secretary@galenicals.org.uk

http://www.galenicals.org.uk/committee/

Cambridge

president@cambridgemedsoc.com

vice-president@cambridgemedsoc.com

Cardiff

medsoc@cardiff.ac.uk

Contact specific previous committee emails:

http://www.cardiffmedsoc.co.uk/committtee-201314

Exeter

medsoc@groups.exeterguild.com

https://www.exeterguild.org/societies/medsoc/

Hull York

medsoc@hyms.ac.uk

http://www.hymsmedsoc.co.uk

Imperial

icsm.president@ic.ac.uk

http://www.icsmsu.com/exec/

KCL

Keele

Lancaster

lancastermedsoc@gmail.com

https://www.lancsmedsoc.co.uk

Leeds

medsocleeds@gmail.com

https://www.luu.org.uk/medicine/

Liverpool

president@lmssonline.co.uk

https://sites.google.com/site/lmssonlinenew1/contact-us

Manchester

contact@manmedsoc.com

http://manmedsoc.com/committee.html

Newcastle

https://www.medsoc.co.uk/the-committee/

Nottingham

nottsmedsoc@gmail.com

https://www.su.nottingham.ac.uk/healthcare/medsoc/medsoccommittee/

Oxford

president@oxfordmedsoc.com

secretary@oxfordmedsoc.com

https://www.oxfordmedsoc.com/

(Plymouth)

Sheffield

medsoc@sheffield.ac.uk

https://su.sheffield.ac.uk/groups/medical-society

Southampton

medsoc@soton.ac.uk

http://www.sotonmedsoc.org/your-medsoc

St George’s

Swansea

(contact form)

http://www.swanseamedsoc.com/contact

UCL

president@medicalsociety.org.uk

Vp@medicalsociety.org.uk

http://medicalsociety.org.uk/committee/

UEA (Norwich)

ueamedsoc1@gmail.com

http://www.ueamedsoc.co.uk/contact.html

Warwick

medsoc@warwicksu.com

Chris Lovejoychristopher.lovejoy1

By | 2018-01-10T18:12:40+00:00 January 10th, 2018|

The acquisition of cross-domain insights

Some insights are specific to one area. For example, an economist understands how the financial sector works.

Others are ‘cross-domain’ insights, which are relevant across a broader range of domains. These can be harder to put into words.

We can’t predict from where we will gain such cross-domain insights. A casual remark made by a friend may provoke a deep realisation. Or a more conventional ‘life-changing moment’ such as a near-death experience or the loss of a loved one may equally so.

While we can’t predict where they will come from, we can increase our chance of having them by exposing ourselves to as many different experiences as possible.

By | 2018-01-11T21:20:56+00:00 January 10th, 2018|

Always have an objective on the wards: Advice for medical students

So much happens in a hospital on any given day. It’s easy to just go with the flow and hope that you passively absorb all the things you need to. With this approach you may have the occasional great clinical experience and will gradually pick up the required knowledge and skills with enough time. However, the more self-directed you are, the quicker you can learn and the better you can become.

This is achieved by deciding your objective in advance. For me, this involved making a weekly priority list as well as a daily objective list. For the latter, at the end of each evening, I would take a piece of A4 paper and fold it in half three times. On this, I would write six things that I would like to achieve the following day, as in the example below. I would carry this in my pocket at all times, and cross things off when I achieved them, providing a small sense of achievement each time. Sometimes I would add a priority order by numbering them 1-6.

 

An example of my priority six:

  • Write in patient notes
  • Take blood from ≥3 patients
  • Recognise hepatomegaly
  • Understand Liver Function Tests (LFTs)
  • See 2 or 3 endoscopies
  • Understand 2 patient’s cases from the ward in depth

 

This list can be tailored to the opportunities that you know you will have, for example if you know there is an endoscopy list tomorrow. When you write the objectives, you can think of ways you will achieve them. For example, for the list above you could plan to join the ward-round and ask to write in the patient notes (1) as well as choosing two interesting patients from the ward-round to study later (6). You could ask to leave the ward-round early to attend endoscopy (5), then after lunch come back to the ward and ask if there are any bloods to be taken (2), any patients to examine with signs (3) and if any of the doctors are free to explain LFTs (4). However, it’s important to be flexible as you can’t always predict how things will go. Maybe the doctors won’t let you write in the notes on the ward-round, or they are all too busy to teach you about LFTs. In these cases, you must be adaptable and seek alternative ways to achieve your aims, for example finding a guide on LFTs on the internet and then looking through the blood results of patients with deranged LFTs. Or maybe there are no patients in the hospital with hepatomegaly, in which case you can think of another sign you want to learn to recognise. It is on these days where having the objectives is so important, as otherwise you may spend a lot of time waiting around and achieve very little.

A great little book with suggestions for objectives is “101 things to do with spare moments on the ward” by Dason Evans and Nakul Patel. (The title is self-explanatory.)

 

If you enjoyed this article, please share!

 

 

This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.

By | 2018-01-07T15:20:10+00:00 January 7th, 2018|

Expectation Anchors

We base our expectations on what we see around us.

If everyone we knew woke up at 5am to go the gym, it would only be a matter of time before we started doing it.

People are often successful in groups. The ‘Paypal mafia’ have been successful beyond that accounted for only by talent. They grew together, and each became able to change technology for good. “You are the product of the five people you hang out with most.”

Everyone becomes a product of their environment, although we have a degree of control over the environment we’re in.

Today, with the internet and increased social mobility, we have greater control over our environment. We can decide which tribes we join and what type of information and people we expose ourselves to on the internet.

It’s easy to hold artificial limitations in our mind based on what we see around us. “I could never do that”, we may say. But sometimes that mentality is something we picked up from society and isn’t grounded in objective truth.

There are people who will change what we think is possible. Don’t wait for a chance meeting with them – go out and find them.

By | 2018-01-07T17:39:17+00:00 January 6th, 2018|

Perspective, Targets and Limits: Medicine from 50,000 Feet

 

Learning Medicine

Medicine is a fascinating field with endless amounts of knowledge that can be obtained. Someone could, and many do, spend an entire life striving to learn as much medical knowledge as possible yet, like someone travelling the world, so much will always remain unexplored.

It can be a satisfying feeling to go from ignorance to relative expertise in certain topics. There are other incentives to work hard to obtain this knowledge too, such as admiration from your peers, praise from your parents and points for your CV.

 

A common pitfall

However, this leads to a common pitfall: working too hard. You may have heard this before a million times, but let me use a personal example to demonstrate a point.

In my first year of medical school I was aiming high. At the end of the year, I was disappointed with my result so I resolved to do better the following year. I made a lot of sacrifices; I skipped social events, spent less time with my friends and spent many late nights in the library. Half-way through the year, we had a full ‘mock’ exam and the hard work paid off; I achieved a mark that, based on projections from previous mock and actual marks, predicted I’d finish in the top 10 of our 400-person cohort. However, my approach wasn’t sustainable; before the end of the year I became apathetic, burnt out and achieved a good but, compared to my personal target, disappointing result once again.

 

Learning from failure

The following summer I spend a lot of time reflecting. My approach that year contributed to me breaking up with my girlfriend, feeling more distant from my friends and family and ultimately feeling less happy. I had sacrificed so much — what had it all been for?

I began to assess my motives. For a long time, I had been telling myself “I need to study hard so that I can be the best doctor I can be” but I realised this didn’t hold up to scrutiny: the difference between a good and a great result wouldn’t make me a much better doctor, yet the reduced life experiences from living in the library may well make me a worse one.

I realised that being the best had become part of my identity during school, causing me to lose perspective on how important it really is relative to other areas of life. I also realised that I cared too much about what other people thought of me and part of my motivation was to prove myself to others and show everyone how smart I was.

I want to stress that I don’t think that working extremely hard is a bad thing. On the contrary, I think it is important and admirable to work hard towards a worthy goal. Most people don’t work hard enough. However, we must be clear about our priorities, honest about our motives and strive to maintain perspective at all times.

I appreciate it is not that simple. If I had told my second-year self that exams aren’t the be-all and end-all, I doubt he would have listened. I needed that tough summer of soul-searching to figure things out. Sometimes you just have to make your own mistakes and learn from your own experiences.

Different people will come to appreciate their priorities and motives in different ways. Two techniques which, if undertaken with an open mind and honest approach, can help provide this clarity are ‘Following the Trail of Whys’ and ‘Attending Your Own Funeral’.

Follow the Trail of Whys

It is easy to ask ‘why’ and accept the response, even when it doesn’t really answer the question. For example:

Q: Why was the patient’s intravenous fluid run at the wrong rate?

A: Because the previous nurse didn’t change the run rate.

 

If we accept this answer without probing further, we will assume that this was the nurse’s fault and that she should be blamed or held accountable in some way. However, this doesn’t get to the bottom of the problem and is not a solution.

The founder of Toyota, Sakichi Toyoda, is credited with advising people to “Ask why five times.” The exact number is not important, but continually asking why can be effective at finding new answers and uncovering flaws in previous assumptions.

 

Let me demonstrate with the above example:

  1. Why was the patient’s intravenous fluid run at the wrong rate?

The previous nurse didn’t change the run rate.

  1. Why didn’t the previous nurse change the rate?

The doctor’s order had gone to the pharmacy and the medication administration record (MAR) was not updated.

  1. Why wasn’t the MAR updated?

The MAR is updated only once per day.

  1. Why is the MAR updated only once per day?

The hospital has chosen to use oral instructions for updates that happen more frequently.

  1. Why are oral instructions used?

The process was constructed a decade ago, when medication orders changed less frequently due to longer lengths of stay. Upon further study, the hospital determines that 40 to 50 percent of its medications change every day.

 

It isn’t until the fifth why that the actual answer to the question is found.

This technique can be applied to any situation, including understanding why you think or act in a certain way.

If I had been honest and objective with myself during my first two years of university, the Trail of Whys may have produced something like this:

 

  1. Why do you study so hard?

Because I want to get one of the highest marks.

  1. Why do you want to get one of the highest marks?

Because I want to show everyone that I’m the best.

  1. Why do you want to show everyone that you’re the best?

Because I derive some of my sense of self-worth from what others think of me.

  1. Why do you derive your sense of self-worth from what others think of you?

Because my upbringing taught me to seek the approval of others. This was an adaptive response to my environment but is not serving me well while studying a competitive course at a competitive university.

Therefore, the solution is to deliberately re-appraise how I evaluate myself, rather than to focus on how hard I am studying or working.

 

As you can see, this technique can get deep and personal pretty quickly. This is why absolute self-honesty is so important.

This technique can also be useful in academic learning. I shall discuss explore how in a future post.

Attend your own funeral

This technique involves visualising your own funeral, imagining how it could go and how you want it to go. The aim is that, by doing so, you will appreciate what really matters and is most important to you. There is a wider philosophy termed ‘memento mori’, meaning ‘remember that you have to die’, which believes meditating on our death can bring profound insights about ourselves.

 

Insights from a palliative care nurse

A palliative care nurse called Bronnie Ware revealed the five most common regrets that people have at the end of their lives:

  1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  2. I wish I hadn’t worked so hard.
  3. I wish I’d had the courage to express my feelings.
  4. I wish I had stayed in touch with my friends.
  5. I wish that I had let myself be happier.

 

The technique

Below is a description of the technique, from the book ‘The Charisma Myth’ by Olivia Fox Cabane. It can stir up emotions, so you are encouraged to do it in an environment where you feel comfortable being emotional and with time to process things after the exercise.

 

Set the scene and involve your senses:

  • Sit or lie down, close your eyes, and set the scene.
  • Where is your funeral being held? What day of the week? What time of day? What is the weather like?
  • See the building where the ceremony is being held. See people arriving. Who’s coming? What are they wearing?
  • Now move into the building and look around inside. Do you see flowers? If so, smell the flowers’ scent heavy on the air.
  • See people coming through the door. What are they thinking?
  • What kind of chairs are they sitting in? What do these chairs feel like?

 

Watch your funeral:

  • Think of the people you care most about or whose opinions matter most to you. What are they thinking?
  • See them stepping up one after another and delivering their eulogy. What are they saying? What regrets do they have for you?
  • Now think: What would you like them to have said? What regrets do you have for yourself?
  • See people following your coffin to the cemetery and gathering around your grave. What would you like to see written on your tombstone?

 

For a recording of the above guided exercise, visit http://foxcabane.com/audio/Funeral.mp3.

 

View exams as a game

A medical student colleague of mine wrote a great article about how he approaches exams by viewing them as a game.

 

Set limits, not just targets

Medicine can consume your life. With clearer understanding of your priorities, you can set not only more appropriate targets but you can also set limits.

It may be that you still want to aim to finish top in your medical school, and that’s fine. However, you may be content with a more modest target. For example, after my summer of reflection I set my target as finishing in the top 25% of all exams alongside enjoying life, spending time with friends and family and investing time and energy into other pursuits.

This limited the amount of time I spent studying and gave me more stress- and guilt-free time to enjoy. It also helped guide my studying. Whenever I came across new content, I would ask myself “would someone in the top 25% know this?” In some cases, the answer was “definitely yes”, in which case I would work hard to learn it as efficiently as possible, using techniques I shall outline in future posts. In other cases, the answer was “probably not”, in which case I decidedly did not learn it. As well as saving time, I found my studying was more consistent, as were my results.

Don’t get me wrong, I still work hard. But now I vent that same energy and determination into goals that I consider more worthwhile and more in-line with my deeper intrinsic values. I will elaborate more on this in a future post.

One fear that some medical students have is that if they don’t study as much as they can, they won’t pass their exams. However, if you are intelligent enough to get into medical school then you are definitely smart enough to pass exams with the right approach. There are approaches that you can take, such as spaced repetition, which can enable you to do better while studying less.

 

Summary

  • Studying medicine is competitive, there is an endless amount to learn and there are continuous exams. This means that many people sacrifice too much for work.
  • Perspective and clarity can be increased by following the ‘Trail of Whys’ and ‘attending your own funeral’, as well as by other techniques.
  • This enables us to set targets and limits. Limits can increase studying efficiency and help us find a good work-life balance.

 

If you enjoyed this article, please share!

This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.

 

Also published on Medium.

By | 2018-01-10T18:10:30+00:00 December 20th, 2017|

Spaced Repetition: How to Learn Medicine Faster

We all know the feeling. We spend long hours studying, desperately trying cover everything ahead of exams, only to feel that we’re not making any progress.

Yet there is a better way, which is grounded in neuroscience and psychology research. It’s called Spaced Repetition.

 

What is spaced repetition?

Spaced repetition involves reviewing content at gradually increasing intervals. Research has shown that it dramatically increases the memory retention and thus efficiency of learning[1]. The first scientist to demonstrate this phenomenon was Ebbinghaus[2].

Fig 1. Ebbinghaus forgetting curve

 

A system for incorporating spaced repetition into daily medical life

A practical way to use this in medicine is as follows: when you learn some new information, recall it from memory and review your notes after about one hour, then one day, then one week, then one month, then six months and then one year.

The principle is more important than the exact time spacing and can be adjusted around your life and schedule as required. You can organise this in a number of ways, on the micro (facts and concepts) and macro (topics) levels.

 

Micro (facts) level

One option for the micro level is to use electronic aids, such as Anki (where you can make your own flashcards) and Memrise (where you can use those created by others). These present you with flashcards and will re-present them at increasing intervals, based on your ease of recollection.

I found Anki most useful for fuelling active recall by having a condition name or an important concept on one ‘side’ of the card and lots of reference information copied from my notes on the back.

For example, Anki presents the card like this:

 

I would then spend about thirty seconds writing out as much as I can about Mallory-Weiss Syndrome (often using the rough format; aetiology, signs and symptoms, pathophysiology, complications, investigations, treatment).

I would then click ‘show answer’ at which point it would show the reference information, as below, for me to see how much I got and what I missed out.

 

Based on how easy I found it and how much I was able to recall, I would select the appropriate option at the bottom and would then be re-presented with this card after the relevant period of time.

 

Macro (topics) level

I created a Review System which is easily organised through a central document as shown below. This is only one way to incorporate Spaced Repetition, but I will explain it to demonstrate the principle.

 

 

The system works as follows:

At the end of each day, I spend about an hour recapping things that I have seen, learnt and been taught that day. Anything worth reviewing the next day is added to the ‘Daily Reviews’ column.

At some point during the following day, I will review topics in the ‘Daily Reviews’ column (by recalling content from memory and often doing some further study to clarify important concepts). If I feel the topic is worth reviewing again, I will move the topic into the ‘Weekly Reviews’ column. This means that I will review it again in approximately one week’s time and perform the same process (putting some into the ‘Monthly Reviews’ column and so on). Some smaller topics will be grouped into larger topics as they progress right-wards.

 

Here’s how this works on a daily basis:

Whenever I have a free moment during the day (such as between teaching sessions, before a clinic, between theatre operations or any other time when no learning opportunities are present), I open up the central document and work through the topics for review in the priority order shown above, from left to right. This usually involves grabbing a piece of paper and recalling as much as I can on the topic before later referring to my notes (which I sync to my phone). If necessary, the recall can be purely mental, such as if bored during a long operation.

I have found using this system a very effective way to make the most of gaps during the day. I can recount numerous occasions where I had a gap of 10-30 minutes, during which previously I would have killed time checking my phone or emails, but instead reviewed some content. I would often get home in the evening having covered the majority of my reviews during the day so I had the option of taking the evening off knowing I’d made good progress.

 

I would estimate that this system alone enabled me to spend 30-40% less time studying with a noticeable improvement in long-term retention. It also meant I was far less stressed during exam period, particularly finals, as the majority of the content was in my long-term memory thus reducing the need to ‘cram’.

 

[1] Melton, “The Situation with Respect to the Spacing of Repetitions and Memory.”

[2] “Classics in the History of Psychology — Ebbinghaus (1885/1913) Chapter 1.”

 

 

If you enjoyed this article, please share!

This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.

By | 2018-01-10T18:10:36+00:00 December 6th, 2017|

Why you shouldn’t tell people your exam results

Stop Trying To Define Yourself

The world we live in is pretty damn complicated, beyond levels our brains are able to comprehend. To cope with this, we instinctively look for ways to simplify things in order to understand them. This has served us well throughout history and continues to do so but it comes at a price.

The complexity of all things means they are not easily defined. Everything falls on a spectrum. For example, size can range from a quark to a Universe and any point in between. Human beings exist at any point on an infinite number of spectra, which can be challenging to comprehend.

So we often define ourselves in ways that can be measured far more easily; exam results, achievements, jobs, our social circle, Instagram followers, Facebook likes, etc.

We do this because it’s easier. It doesn’t hurt our brains as much. But it is damaging. Why? Two main reasons:

  1. If you only pursue things that can be defined, you will not invest time in things that can’t be. And it may just be that activity without a defined outcome which makes you the happiest.
  2. It inevitably leads to comparison. We all know that comparing ourselves to others unhealthy, but at times it can be difficult not to. Learning not to define ourselves and others can help.

So how can I stop defining myself and others in this way?

A useful approach is to cultivate what the notable 19th-century poet John Keats termed ‘negative capability’ — “the willingness to embrace uncertainty, live with mystery, and make peace with ambiguity”. In other words, being able to live without the need to define everything and categorise people into one box or another. We should also appreciate that this need can stem from our own insecurities.

Why I don’t tell anyone my exam results.

For the reasons described above I don’t tell anyone my exam results. When I start my revision I make this promise to myself, even if I were to come first in the year. I want my motivation to come from a place of healthy self-competition, not from a desire to prove myself to others. When my motivation is derived internally in this way it is more stable and less influenced by the words and actions of others.

In the words of another notable poet, this one from the 21st-Century:

“Accept yourself.
You don’t have to prove shit to no-one except yourself.”
– Drake, Tuscan Leather (2013)

By | 2018-01-10T18:10:40+00:00 November 30th, 2017|

Don’t go or don’t zone out.

Phones in Lectures

I’m sitting in a lecture, typing onto my phone.

Around me, many people are checking their phones and not paying much attention to the talk.

This makes me ask — why are we here?

We should value our time highly. We only have so long to learn things that will improve our life. There are some things that we must learn for our career or job — if we don’t learn these now, we will have to learn them later and this will require sacrificing something else. Therefore, not using our time effectively now is a false economy.

Most talks are not high yield, so I can understand why people may wish to zone out. However, attending and then zoning out shows a fundamental disrespect for the value of your own time.

Thinking rationally, therefore, we have two options:

1. Don’t go to the talk

The decision when NOT to do something is arguably the most important decision. In the information age, there is limitless amounts of information available. We must be selective.

I have written before about how I read 50–100 books a year. Even after 80 years of life, I will have only read a tiny fraction of the number of books that exist — millions of new books are published every year.

I appreciate that not attending semi-mandatory talks goes contrary to the expectations of society. However, we shouldn’t let the implicit rules of society influence us too greatly, particularly when they are not rational, as rules should never be followed blindly.

2. Don’t zone out

The ability to maintain focus, even when bored, is important for two reasons; developing the ability to focus and the experiential benefits of presence.

The default pattern of most is to be ‘switched off’ most of the time and then ‘switch on’ when it is required. A common pattern is to push ourselves at work due to the demands of the job and external pressures, then collapse back into unproductivity in our free time, whether that’s long periods of watching TV, browsing the internet or any other activity requiring little focus.

In his book Deep Work, Cal Newport argues that we should be taking breaks fromfocus rather than breaks from distraction. Our default should be periods of sustained focus, then short breaks away from this.

Some may argue that this is difficult to do but it is an ability that can be trained over time with discipline and yields large rewards.

The second reason is the benefits of being present where you are. This is an increasingly popular idea in the West with the flourishing of ‘mindfulness’. One element is avoiding ‘psychological transporting’, where our mind leaves the room and we think about other things.

Yuval Harari in an interview said “a huge range of human experience exists on the other side of boredom”. He is referring to experiences that people who continually look for something to ease their boredom will never realise.

 

In summary, we must respect our time through conscious decision making. We should decide what to attend and what not to. We should not let distractions, such as modern technology, steal our attention and disrupt our focus.

By | 2017-11-30T14:47:53+00:00 November 30th, 2017|

Value Hierarchy

Everything is on a value hierarchy.

There are variations between the value systems of different people and different cultures.

Some things have a greater consensus regarding their value, others have less consensus.

 

Our decisions are based on these values.

By choosing to read this, you are valuing it over other sources of information.

You care more about some of your possessions than others as you value them differently.

 

The way we process the world is also based on these values.

When deciding whether to agree with someone, you examine their argument against your values.

When you evaluate someone’s way of living, you do the same.

By | 2017-11-30T14:12:55+00:00 November 15th, 2017|