925 resultados para Attitude to Death


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This thesis reports a cross-national study carried out in England and India in an attempt to clarify the association of certain cultural and non-cultural characteristics with people's work-related attitudes and values, and with the structure of their work organizations. Three perspectives are considered to be relevant to the objectives of the study. The contingency perspective suggests that a 'fit' between an organization's context and its structural arrangements will be fundamentally necessary for achieving success and survival. The political economy perspective argues for the determining role of the social and economic structures within which the organization operates. The culturalist perspective looks to cultural attitudes and values of organizational members for an explanation for their organization's structure. The empirical investigation was carried out in three stages in each of the two countries involved by means of surveys of cultural attitudes, work-related attitudes and organizational structures and systems. The cultural surveys suggested that Indian and English people were different from one another with regard to fear of, and respect and obedience to, their seniors, ability to cope with ambiguity, honesty, independence, expression of emotions, fatalism, reserve, and care for others; they were similar with regard to tolerance, friendliness, attitude to change, attitude to law, self-control and self-confidence, and attitude to social differentiation. The second stage of the study, involving the employees of fourteen organizations, found that the English ones perceived themselves to have more power at work, expressed more tolerance for ambiguity, and had different expectations from their job than did the Indian equivalents. The two samples were similar with respect to commitment to their company and trust in their colleagues. The findings also suggested that employees' occupations, education and age had some influences on their work-related attitudes. The final stage of the research was a study of structures, control systems, and reward and punishment policies of the same fourteen organizations which were matched almost completely on their contextual factors across the two countries. English and Indian organizations were found to be similar in terms of centralization, specialization, chief executive's span of control, height and management control strategies. English organizations, however, were far more formalized, spent more time on consultation and their managers delegated authority lower down the hierarchy than Indian organizations. The major finding of the study was the multiple association that cultural, national and contingency factors had with the structural characteristics of the organizations and with the work-related attitudes of their members. On the basis of this finding, a multi-perspective model for understanding organizational structures and systems is proposed in which the contributions made by contingency, political economy and cultural perspectives are recognized and incorporated.

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This thesis investigates corporate financial disclosure practices on Web sites and their impact. This is done, first by examining the views of various Saudi user groups (institutional investors, financial analysts and private investors) on disclosure of financial reporting on the Internet and assessing differences, if any, in perceptions of the groups. Over 303 individuals from three groups responded to a questionnaire. Views were elicited regarding: users attitude to the Internet infrastructure in Saudi Arabia, users information sources about companies in Saudi Arabia, respondents perception about the advantages and disadvantages in Internet financial reporting (IFR), respondents attitude to the quality of IFR provided by Saudi public companies and the impact of IFR on users information needs. Overall, it was found professional groups (Institutional investors, financial analysts) hold similar views in relation to many issues, while the opinions of private investors differ considerably. Second, the thesis examines the use of the Internet for the disclosure of financial and investor-related information by Saudi public companies (113 companies) and look to identify reasons for the differences in the online disclosure practices of companies by testing the association between eight firm-specific factors and the level of online disclosure. The financial disclosure index (167 items) is used to measure public company disclosure in Saudi Arabia. The descriptive part of the study reveals that 95 (84%) of the Saudi public companies in the sample had a website and 51 (45%) had a financial information section of some description. Furthermore, none of the sample companies provided 100% of the 167 index items applicable to the company. Results of multivariate analysis show that firm size and stock market listing are significant explanatory variables for the amount of information disclosed on corporate Web sites. The thesis finds a significant and negative relationship between the proportion of institutional ownership of a companys shares and the level of IFR.

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The article looks first into the nature of the relations between Germany and the CEE countries a decade since the accession of the CEE countries to the EU. The relations are characterized as normalised and intensive with diverse levels of closeness and co-operation reflecting of the conceptual and ideological compatibility/differences. Next, the article focuses on the German attitude to the euro zone crisis. Germany has become a hegemon in the rescue effort aimed at stabilisation and economic invigoration of the euro zone. However, German hegemony has developed by default, not by design: her leading position is linked with considerable political and financial costs. Germany moved central stage and took the position of a reluctant hegemon. However, German role is contested internationally (it has not the support of the French government in key areas) as well as internally (particularly by the Federal Constitutional Court and the Bundesbank).The article argues that the new situation makes the German-CEE relations increasingly relevant for both sides. The German leadership of the EU increasing split along the north-south divide requires backing by the Northern group countries to which the CEE in general belongs. Given a number of reasons the CEE countries implement three distinctive strategies of co-operation with Germany in European politics. Also military co-operation, which remained rather limited so far, may receive new impulses, given the financial austerity. © 2013 The Regents of the University of California.

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The adequate attitude to the information models and information objects in the culture context is one of the main problems to be investigated on the threshold of information society. The goal of this paper is to outline some problems connected with the main styles of perceiving of the mental and artificially generated information models stored in the information objects and used in the processes of the Information Interaction or simply – in the Inforaction. The culture influence on inforaction is discussed.

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What is known and objective: Adverse drug reactions to prescribed medication are relatively common events. However, the impact such reactions have on patients and their attitude to reporting such events have only been poorly explored. Previous studies relying on self-reporting patients indicate that altruism is an important factor. In the United Kingdom, patient reporting started in 2005; though, numbers of serious reports remain low. Method: A purposive sample of fifteen patients who had been admitted to an inner city hospital with an adverse drug reaction were interviewed using a semi-structured questionnaire. Patients were asked to relate in their own words their experience of an adverse drug reaction. Patient's reactions to the information leaflet, adherence to treatment and use of other sources of information on medication were assessed. Interviews were recorded, and a thematic analysis of patients'responses was performed. Results and discussion: Analysis of the patient interviews demonstrated the reality of being admitted to hospital is often a frightening process with a significant emotional cost. Anger, isolation, resentment and blame were common factors, particularly when medicines had been prescribed for acute conditions. For patients with chronic conditions, a more phlegmatic approach was seen especially with conditions with a strong support networks. Patients felt that communication and information should have been more readily available from the health care professional who prescribed the medication, although few had read the patient information leaflet. Only a minority of patients linked the medication they had taken to the adverse event, although some had received false reassurance that the drug was not related to their illness creating additional barriers. In contrast to previous studies, many patients felt that adverse drug reporting was not their concern, particularly as they obtained little direct benefit from it. The majority of patients were unaware of the Yellow Card Scheme in the UK for patient reporting. Even when explained, the scheme was felt too cold and impersonal and not a patient's 'job'. What is new and conclusion: Patients having a severe adverse drug reaction following an acute illness felt negative emotions towards their health care provider. Those with a chronic condition rationalized the event and coped better with its impact. Neither group felt that reporting the adverse reaction was their responsibility. Encouraging patients to report remains important but expecting patients to report solely for altruistic purposes may be unrealistic. © 2011 Blackwell Publishing Ltd.

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Daniela Ivanova Dureva–Tuparova In this paper 3 pedagogical scenarios of e-learning courses are performed. The courses have been implemented in blended mode with the students in Master program “ICT in primary schools”. The courses apply different didactical methods such as “Jigsaw” interactive technique, on-line simulations, project based learning, etc. Some results from study of students’ attitude to the used didactical methods and technology enhanced educational activities are presented and discussed.

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The aims of this thesis were to investigate the neuropsychological, neurophysiological, and cognitive contributors to mobility changes with increasing age. In a series of studies with adults aged 45-88 years, unsafe pedestrian behaviour and falls were investigated in relation to i) cognitive functions (including response time variability, executive function, and visual attention tests), ii) mobility assessments (including gait and balance and using motion capture cameras), iii) motor initiation and pedestrian road crossing behavior (using a simulated pedestrian road scene), iv) neuronal and functional brain changes (using a computer based crossing task with magnetoencephalography), and v) quality of life questionnaires (including fear of falling and restricted range of travel). Older adults are more likely to be fatally injured at the far-side of the road compared to the near-side of the road, however, the underlying mobility and cognitive processes related to lane-specific (i.e. near-side or far-side) pedestrian crossing errors in older adults is currently unknown. The first study explored cognitive, motor initiation, and mobility predictors of unsafe pedestrian crossing behaviours. The purpose of the first study (Chapter 2) was to determine whether collisions at the near-side and far-side would be differentially predicted by mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function (including spatial planning, visual attention, and within participant variability) with increasing age. The results suggest that near-side unsafe pedestrian crossing errors are related to processing speed, whereas far-side errors are related to spatial planning difficulties. Both near-side and far-side crossing errors were related to walking speed and motor initiation measures (specifically motor initiation variability). The salient mobility predictors of unsafe pedestrian crossings determined in the above study were examined in Chapter 3 in conjunction with the presence of a history of falls. The purpose of this study was to determine the extent to which walking speed (indicated as a salient predictor of unsafe crossings and start-up delay in Chapter 2), and previous falls can be predicted and explained by age-related changes in mobility and cognitive function changes (specifically within participant variability and spatial ability). 53.2% of walking speed variance was found to be predicted by self-rated mobility score, sit-to-stand time, motor initiation, and within participant variability. Although a significant model was not found to predict fall history variance, postural sway and attentional set shifting ability was found to be strongly related to the occurrence of falls within the last year. Next in Chapter 4, unsafe pedestrian crossing behaviour and pedestrian predictors (both mobility and cognitive measures) from Chapter 2 were explored in terms of increasing hemispheric laterality of attentional functions and inter-hemispheric oscillatory beta power changes associated with increasing age. Elevated beta (15-35 Hz) power in the motor cortex prior to movement, and reduced beta power post-movement has been linked to age-related changes in mobility. In addition, increasing recruitment of both hemispheres has been shown to occur and be beneficial to perform similarly to younger adults in cognitive tasks (Cabeza, Anderson, Locantore, & McIntosh, 2002). It has been hypothesised that changes in hemispheric neural beta power may explain the presence of more pedestrian errors at the farside of the road in older adults. The purpose of the study was to determine whether changes in age-related cortical oscillatory beta power and hemispheric laterality are linked to unsafe pedestrian behaviour in older adults. Results indicated that pedestrian errors at the near-side are linked to hemispheric bilateralisation, and neural overcompensation post-movement, 4 whereas far-side unsafe errors are linked to not employing neural compensation methods (hemispheric bilateralisation). Finally, in Chapter 5, fear of falling, life space mobility, and quality of life in old age were examined to determine their relationships with cognition, mobility (including fall history and pedestrian behaviour), and motor initiation. In addition to death and injury, mobility decline (such as pedestrian errors in Chapter 2, and falls in Chapter 3) and cognition can negatively affect quality of life and result in activity avoidance. Further, number of falls in Chapter 3 was not significantly linked to mobility and cognition alone, and may be further explained by a fear of falling. The objective of the above study (Study 2, Chapter 3) was to determine the role of mobility and cognition on fear of falling and life space mobility, and the impact on quality of life measures. Results indicated that missing safe pedestrian crossing gaps (potentially indicating crossing anxiety) and mobility decline were consistent predictors of fear of falling, reduced life space mobility, and quality of life variance. Social community (total number of close family and friends) was also linked to life space mobility and quality of life. Lower cognitive functions (particularly processing speed and reaction time) were found to predict variance in fear of falling and quality of life in old age. Overall, the findings indicated that mobility decline (particularly walking speed or walking difficulty), processing speed, and intra-individual variability in attention (including motor initiation variability) are salient predictors of participant safety (mainly pedestrian crossing errors) and wellbeing with increasing age. More research is required to produce a significant model to explain the number of falls.

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A pénzügyi piacok és termékek egyre komplexebbé válnak, ami együtt jár a pénzügyeket illető információs szakadék mélyülésével is – a lakosság egyre kevésbé képes pénzügyeiről körültekintő döntéseket hozni. Jelen tanulmány a magyar felsőoktatásban tanuló fiatalokat pénzügyi attitűdjeik mentén szegmentálja és jellemzi, annak érdekében, hogy hozzájáruljon a pénzügyi kultúra szintjét növelő programok sikerességéhez, legyen az állami indíttatású (pénzügyi edukáció) vagy a versenyszféra által vezérelt. A vizsgált fiatalok alapvetően három csoportba sorolhatók: (1) Konzervatívak, (2) Lázadók és (3) Tapasztaltak. A Konzervatívakra a stabil morális értékrend, alacsony kockázatvállalási hajlandóság jellemző, céljaik között egyaránt találunk rövid és hosszú távúakat is – informáltságuk, és ebből eredően pénzügyi ismeretszintjük alacsony, a hitelekkel szembeni attitűdjük negatív. A Lázadók csoportjára az „Élj a mának!” magatartás a jellemző, vagyis rövid távú céljaik vannak, kevésbé tudatosak, pénzügyi ismeretszintjük alacsony, ugyanakkor nyitottak az újdonságokra és a kockázatvállalási szintjük magasabb a másik két csoporténál. A Tapasztaltak csoportjára a tudatosság és a pénzügyi megfontoltság a jellemző – pénzügyi ismeretszintjük magasabb a másik két csoporténál. Náluk a hosszú távú célok dominálnak, de alacsony kockázatvállalási hajlandóság mellett. _____ Financial markets and financial instruments have become more and more complex in the last decades. Unfortunately, financial literacy of population cannot keep up with the innovation activity of financial sector. By segmenting and describing Hungarian young adults along their financial attitudes, the aim of this study is to provide recommendations to the programs aiming to enhance the development of financial literacy. According to the authors’ results, 18-25 year-old young adults can be categorized as (1) conservatives, (2) rebels and (3) experienced. Conservatives can be characterized by stable moral and values, low risktaking willingness and inappropriate financial knowledge. Both short and long term goals can be explored among their preferences. Conservatives have negative attitude to bank loans. The rebels can be described by the ancient Latin saying: “Carpe Diem”. They have short-term goals and the future financial stability is not an issue for them – their financial literacy is low. However, rebels are open-minded and their risk-taking willingness is greater than the other two group members. Despite of the low level of risk-taking willingness, the highest level of financial literacy is showed by the experienced group. They have long-term goals and are able to receive information about complex financial instruments.

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A szerző tanulmányában a 2000 és 2010 közötti gazdasági és társadalmi változásokat és a munkával kapcsolatos értékek és attitűdök alakulását állítja időbeli párhuzamba, és azokra a kérdésekre keresi a választ, hogy milyen prioritások jellemzik 2010-ben a munka egyes aspektusaihoz való viszonyulást Közép-Kelet- Európa uniós tagállamaiban, és közöttük kiemelten Magyarországon? Vajon változtak-e ezek a jellemzők az elmúlt tíz év során, s ha igen, milyen irányú az elmozdulás. Azonos tendenciájúak-e a változások a vizsgált országokban? Megállapíthatók-e jellegzetes különbségek három kiválasztott, magas életszínvonalú, régebbi uniós (EU-15) tagországhoz viszonyítva? Elemzése jelentős mértékben támaszkodik az EVSfelmérés 2010-ben közzétett adataira, melynek alapját a 2008 és 2009 során lefolytatott adatgyűjtés képezi. Tanulmányában azokra a közép-kelet-európai országokra összpontosít, amelyek az elmúlt évtized során az unió tagjai lettek, és a 2000-es felmérésben is részt vettek már. _____ The author sets into parallelism economic and social changes and the development of values and attitudes regarding labour between 2000 and 2010, and looks for answers to questions what priorities characterize in 2010 the attitude to some aspects of labour in EU member countries of CEE, and especially in Hungary. Have these features changed in the last decade and in positive case, what is the direction of the shift? Are changes of similar tendency in countries under consideration? Can considerable differences be stated as compared to three selected, earlier EU 15 member countries with high living standard? The analysis largely relies on data of EVS survey, published in 2010 whose basis is the data collection carried out in 2008-2009. The essay focuses on Central Eastern European countries which have become members of the Union during the last decade and took part already in the survey of 2000.

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This dissertation explores the role of artillery forward observation teams during the battle of Okinawa (April–June 1945). It addresses a variety of questions associated with this front line artillery support. First, it examines the role of artillery itself in the American victory over the Japanese on Okinawa. Second, it traces the history of the forward observer in the three decades before the end of World War II. Third, it defines the specific role of the forward observation teams during the battle: what they did and how they did it during this three-month duel. Fourth, it deals with the particular problems of the forward observer. These included coordination with the local infantry commander, adjusting to the periodic rotation between the front lines and the artillery battery behind the line of battle, responding to occasional problems with "friendly fire" (American artillery falling on American ground forces), dealing with personnel turnover in the teams (due to death, wounds, and illness), and finally, developing a more informal relationship between officers and enlisted men to accommodate the reality of this recently created combat assignment. Fifth, it explores the experiences of a select group of men who served on (or in proximity to) forward observation teams on Okinawa. Previous scholars and popular historians of the battle have emphasized the role of Marines, infantrymen, and flame-throwing armor. This work offers a different perspective on the battle and it uses new sources as well. A pre-existing archive of interviews with Okinawan campaign forward observer team members conducted in the 1990s forms the core of the oral history component of this research project. The verbal accounts were checked against and supplemented by a review of unit reports obtained from the U.S. National Archives and various secondary sources. The dissertation concludes that an understanding of American artillery observation is critical to a more complete comprehension of the battle of Okinawa. These mid-ranking (and largely middle class) soldiers proved capable of adjusting to the demands of combat conditions. They provide a unique and understudied perspective of the entire battle.

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In the field of postmortem toxicology, principles from pharmacology and toxicology are combined in order to determine if exogenous substances contributed to ones death. In order to make this determination postmortem and (whenever available) antemortem blood samples may be analyzed. This project focused on evaluating the relationship between postmortem and antemortem blood drug levels, in order to better define an interpretive framework for postmortem toxicology. To do this, it was imperative to evaluate the differences in antemortem and postmortem drug concentrations, determine the role microbial activity and evaluate drug stability. Microbial studies determined that the bacteria Escherichia coli and Pseudomonas aeruginosa could use the carbon structures of drugs as a source of food. This would suggest prior to sample collection, microbial activity could potentially affect drug levels. This process however would stop before toxicologic evaluation, as at autopsy blood samples are stored in tubes containing the antimicrobial agent sodium fluoride. Analysis of preserved blood determined that under the current storage conditions sodium fluoride effectively inhibited microbial growth. Nonetheless, in many instances inconsistent drug concentrations were identified. When comparing antemortem to postmortem results, diphenhydramine, morphine, codeine and methadone, all showed significantly increased postmortem drug levels. In many instances, increased postmortem concentrations correlated with extended postmortem intervals. Other drugs, such as alprazolam, were likely to have concentration discrepancies when short antemortem to death intervals were coupled with extended postmortem intervals. While still others, such as midazolam followed the expected pattern of metabolism and elimination, which often resulted in decreased postmortem concentrations. The importance of drug stability was displayed when reviewing the clonazepam/ 7-aminoclonazepam data, as the parent drug commonly converted to its metabolite even when stored in the presence of a preservative. In instances of decreasing postmortem drug concentrations the effect of refrigerated storage could not be ruled out. A stability experiment, which contained codeine, produced data that indicated concentrations could continue to decline under the current storage conditions. The cumulative data gathered for this experiment was used to identify concentration trends, which subsequently aided in the development of interpretive considerations for the specific analytes examined in the study.

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The study aimed to analyze the nursing diagnoses of the nutrition domain from NANDA International in patients undergoing hemodialysis. This is a transversal study conducted in a university hospital in northeastern Brazil, with 50 hemodialysis patients. The data collection instrument was an interview form and a physical examination, in digital format, applied between the months of December 2013 to May 2014. Data analysis was divided into two stages. In the first, defining characteristics, related factors and risk factors were judged as to their presence by the researcher, according to the data collected. In the second stage, based on data from the first, diagnostic inference by experts was held. The results were organized in tables and analyzed using descriptive and inferential statistics for the diagnoses that showed higher frequencies than 50%. The project was approved by the Ethics Committee responsible for the research institution (protocol number 392 535), with Certificate Presentation to Ethics Assessment 18710613.4.00005537 number. The results indicate a median of 7 (± 1.51) nursing diagnoses of the nutrition domain per patient. Six diagnoses with greater frequency than 50% were identified, namely: Risk for electrolyte imbalance, Risk for unstable blood glucose level, Excess fluid volume, Readiness for enhanced fluid balance, Readiness for enhanced nutrition and Risk for deficient fluid volume. The defining characteristics, related and risk factors presented an average of 34.78 (± 6.86), 15.50 (± 3.40) and a median of 4 (± 1.93), respectively, and 11 of these components had statistically significant association with the respective diagnoses. Were identified associations between adventitious breath sounds, edema and pulmonary congestion with the diagnosis Excess fluid volume; Expressed desire to increase fluid balance with the nursing diagnosis Readiness for enhanced fluid balance; It feeds regularly, Attitude to food consistent with the health goals, Consume adequate food, expresses knowledge about healthy food choices, expresses desire to improve nutrition, expresses knowledge about liquid healthier choices and following appropriate standard supply with diagnosis Readiness for enhanced nutrition. It is concluded that the diagnosis of the nutrition domain related to electrolyte problems are prevalent in customer submitted to hemodialysis. The identification of these diagnoses contributes to the development of a plan of care targeted to the needs of these clients, providing better quality of life and advance in the practice of care

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The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness that leads the patient to death, usually due to respiratory complications. Thus, as the disease progresses the patient will require noninvasive ventilation (NIV) and constant monitoring. This paper presents a distributed architecture for homecare monitoring of nocturnal NIV in patients with ALS. The implementation of this architecture used single board computers and mobile devices placed in patient’s homes, to display alert messages for caregivers and a web server for remote monitoring by the healthcare staff. The architecture used a software based on fuzzy logic and computer vision to capture data from a mechanical ventilator screen and generate alert messages with instructions for caregivers. The monitoring was performed on 29 patients for 7 con-tinuous hours daily during 5 days generating a total of 126000 samples for each variable monitored at a sampling rate of one sample per second. The system was evaluated regarding the rate of hits for character recognition and its correction through an algorithm for the detection and correction of errors. Furthermore, a healthcare team evaluated regarding the time intervals at which the alert messages were generated and the correctness of such messages. Thus, the system showed an average hit rate of 98.72%, and in the worst case 98.39%. As for the message to be generated, the system also agreed 100% to the overall assessment, and there was disagreement in only 2 cases with one of the physician evaluators.

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The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness that leads the patient to death, usually due to respiratory complications. Thus, as the disease progresses the patient will require noninvasive ventilation (NIV) and constant monitoring. This paper presents a distributed architecture for homecare monitoring of nocturnal NIV in patients with ALS. The implementation of this architecture used single board computers and mobile devices placed in patient’s homes, to display alert messages for caregivers and a web server for remote monitoring by the healthcare staff. The architecture used a software based on fuzzy logic and computer vision to capture data from a mechanical ventilator screen and generate alert messages with instructions for caregivers. The monitoring was performed on 29 patients for 7 con-tinuous hours daily during 5 days generating a total of 126000 samples for each variable monitored at a sampling rate of one sample per second. The system was evaluated regarding the rate of hits for character recognition and its correction through an algorithm for the detection and correction of errors. Furthermore, a healthcare team evaluated regarding the time intervals at which the alert messages were generated and the correctness of such messages. Thus, the system showed an average hit rate of 98.72%, and in the worst case 98.39%. As for the message to be generated, the system also agreed 100% to the overall assessment, and there was disagreement in only 2 cases with one of the physician evaluators.

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This thesis aims to analyze the cross exhibition in sessions halls and audiences of the judiciary, considered the religious freedom and the limitations arising from the idea of State neutrality. It is known that the 1988 Constitution protects freedom of expression of thought, conscience and religion, in its various aspects, proclaiming, on the other hand, the neutrality of the state, to reinforce these same freedoms. Thus, the aim is to avoid confusion between state and religion, admitted, however, collaboration of public interest, in respect of attitude to the beliefs and individual choices of citizens. In modern societies, the dualism between the civil power and religion has to do with laicity and a broader phenomenon that took the name of secularism, meaning the loss of space of religion in societies or even decreased idea religious belonging. It is based on this finding that the work develops with reference to concepts such as civil society and rule of law relevant to an accurate understanding of the problem. The methodology consists of bibliographic and documentary research through books and thesis, in addition to the legislation and some precedents related to the topic in question, looking to investigate whether, even though the predominantly Catholic Brazilian people and recognized the strong influence that Christian values exercise on the public authorities, it is possible to sustain the symbolic differentiation state, a republic that is said secular and democratic and which has as one of the fundamental objectives to promote the good of all, without any form of discrimination. Starting from the idea that the presence in buildings and public institutions, symbols and Catholic imagery, like the crucifix, has some difficulty in reconciling the guarantee of religious freedom and the principle of laicity, the idea is to exactly propose a solution who can respect pluralism and diversity in a context where Catholicism remains a strong presence.