Abstract: Embodiments include methods, systems and computer program products for reducing feature space in analysis of medical data. Aspects include receiving patient temporal traces. Aspects also include conducting sequential pattern mining on the patient temporal traces to produce sequential features. Aspects also include clustering the sequential features with a similarity metric. Aspects also include analyzing the clustered features to predict a healthcare outcome.

Abstract: Examples are disclosed herein that relate to integrating health data and work data of one or more users and recommending a time to perform a health activity. One example provides a computing device configured to receive health data relating to health behavior, the health data comprising information regarding a relationship between health activity scheduling and health outcome, receive work data relating to work activities, compare the health data and the work data to determine a time at which to recommend performing a health activity, and output a recommendation regarding the time to perform the health activity.

Abstract: Systems and methods for generating one or more actions are disclosed. The system retrieves data associated with patients from data sources. The data is analyzed to classify the patients into different categories. The system generates a set of profiles for the patients based on the data. A plurality of clusters is also generated based on the classification of the patients and the set of profiles. The system generates trend model based on the plurality of clusters. The trend comprises trend of plurality of diseases and rate of recovery of the plurality of diseases based on existing procedures and medications applied. Based on the trend model, the system generates scores corresponding to the plurality of clusters. Further, the clusters are ranked based on their scores. Finally, the system generates one or more actions (i.e., clinical actions) which include new procedure and a new medication based on the ranking of the clusters.

Abstract: The present disclosure relates to server and a method for vendor-independent acquisition of medical data by healthcare units. The method comprises transmitting request to a cloud database by the server at predefined intervals of time. The request comprise list of one or more medical devices associated with one or more subjects of the health care unit. Further, the server obtains medical data of the one or more subjects from the cloud database based on the request and correlation of the medical data with medical device data. Upon receiving the medical data, Device Message Layer (DML) communication session is established with a data manager of the health care unit by the server and the medical data is transmitted to the data manager through the established DML communication session by the server for vendor-independent acquisition of the medical data by health care units.

Abstract: Mechanisms are provided that ingest a corpus of content which includes a plurality of guideline documents having one or more positional statements. The mechanisms generate a set of insight data structures based on the ingested corpus, which are mapped to corresponding positional statements or guidelines in the content of the corpus from which the insight data structures were generated. The mechanisms receive a modification to a positional statement or guideline in the corpus and determine an insight data structure affected by the modification to the positional statement or guideline based on the set of insight data structures and the mapping to corresponding positional statements or guidelines. The mechanisms update the affected insight data structure, without re-ingesting the entire corpus, to generate an updated set of insight data structures, and perform a cognitive operation based on the updated set of insight data structures.

Abstract: Prediction of the physiological effect of phytotherapeutic products and the recommendation of phytotherapeutic products on the basis of physiological effects are provided. A first product profile includes a plurality of compound identifiers and a plurality of concentrations. Observational data is read regarding a plurality of subjects who have consumed a first product substantially conforming with the first product profile. From the observational data a first set of physiological effects is determined associated with the first product profile. In some embodiments, a second set of physiological effects associated with a second product profile is determined based on the first product profile, the second product profile, and the first set of physiological effects. In other embodiments, a second product profile associated with a second set of physiological effects is determined based on the first product profile, the first set of physiological effects, and the second set of physiological effects.

Abstract: An electronic payment system, a computer-implemented method, and a computer readable medium having stored thereon a computer executable program code for processing of the electronic medical invoices and reimbursement of medical costs is disclosed herein. The electronic payment system comprises a server operable for execution of an application management component and a set of server applications comprising receiver applications and processing applications, wherein the server comprises a processing unit and a memory storing computer executable code which when executed by the processing unit cases the server to execute the computer-implemented method.

Abstract: Aspects of the present disclosure involve various algorithms and mechanisms to automatically process large amounts of claims data in real-time and automatically identify patients as potential participants for inclusion into a health care and behavior modification treatment regime based on the processed claims data.

Abstract: A method for optimized wake-up strategy via sleeping stage prediction with recurrent neural networks is provided. The method comprises receiving a set of raw sensory data of a user's sleeping status; translating the set of raw sensory data into a plurality of sleeping stages; saving the plurality of sleeping stages as a history of sleeping stages; determining a current sleeping stage; predicting a plurality of future sleeping stages of the user in an upcoming interval; calculating a wakeup score of the current sleeping stage and a wakeup score of each future sleeping stage; determining an optimized sleeping stage for wake up based on the wakeup score through comparing the wakeup score of the current sleeping stage and the wakeup scores of the future sleeping stages; and triggering an alarm impulse to wake up the user at the optimized sleeping stage for wake up.

Abstract: Embodiments include method, systems and computer program products for predicting adverse drug events on a computational system. Aspects include receiving a personalized data set including a plurality of real-time drug doses for a first drug or drug combination and a plurality of corresponding real-time adverse drug reaction tolerance data for the first drug or drug combination for a patient. Aspects also include receiving known drug data for a candidate drug or drug pair.

Abstract: Disclosed are embodiments of method and system to predict health condition of a human subject. The method comprises receiving historical human-subject related data including records corresponding to multiple data views. The method estimates one or more latent variables based on: a first value indicative of count of records in a cluster, a second value indicative of count of records, and a third value indicative of a parameter utilizable to predict a fourth value. The fourth value corresponds to selection probability of a D-vine pair copula family, of a D-vine mixture model, utilizable to model a cluster. The method generates the D-vine mixture model based on the estimated one or more latent variables. The method further comprises receiving multi-view data of a second human subject and predicting health condition of the second human subject based on the multi-view data using a classifier trained based on the estimated latent variables.

Abstract: A diagnosis method, system, and computer program product, include processing a user input comprising medical symptoms, assigning the user to a team of physicians and a cognitive agent based on the processed medical symptoms, each of the physicians having a different medical specialty corresponding to a disease associated with the medical symptoms, and producing a consensus diagnosis from the team of physicians and the cognitive agent.

Abstract: An apparatus generates motor function estimation information by performing a process including calculating, using a sensor value of a subject, a feature vector corresponding to a feature value of a feature in a time segment, acquiring a first weight vector using the feature vector and a motor ability value of the subject, calculating a gradient vector with respect to the feature vector, determining a new time segment in the predetermined time period and a new feature value based on the new time segment, calculating, using the sensor value, a feature candidate vector corresponding to a feature value of the new feature in the new time segment, determining a feature candidate vector satisfying a predetermined condition associated with a gradient vector based on a difference between the feature candidate vector and the feature vector, and correcting the first weight vector to a second weight vector using the feature candidate vector.

Abstract: Image processing engines can be utilized to inject studies into other commercial or independently-developed peer review systems which are designed to review the medical findings identified by a set of physicians. Image processing engines detect, confirm or verify findings by physicians or other engines, where the engines operate as peer reviewers. The engines can prospectively “learn” from the feedback when these images are reviewed by the physicians during diagnostic interpretation creating a closed-loop quality assurance process and fostering a community platform approach to engine development which is supported by the security, governance, access control, regulatory compliance and other features of the Peer Review System. Utilizing machine learning based on the data collected from peer review, the Peer Review System can adapt and improve its performance as well as the measured performance of the physicians using the system for diagnostic interpretation.

Abstract: In some examples, a computing device may receive hierarchical data having a hierarchical structure including a plurality of levels. The computing device may determine a plurality of features based at least in part on the hierarchical data, and may select a subset of the features at a first level as candidates for consolidating to a next higher level in the hierarchical structure. The computing device may determine that a predicted loss of information from consolidating the subset of features is less than a threshold, and may revise the hierarchical structure to include a consolidated feature at the next higher level, rather than the subset of features. In some examples, a statistical model may be trained based on the revised hierarchical structure and used at least partially to make a determination, send a notification, and/or control a device.

Abstract: A control system, a control method, and a computer readable medium having stored thereon a computer executable program code for controlling a set of electromechanical medical devices records is disclosed herein. The method comprises: receiving by a control system an instruction to be executed by an electromechanical medical device of the set; translating the received instruction into a batch of commands parsable by an electronic controller of the electromechanical device; and sending the batch of commands from the control system to the electromechanical medical device.

Abstract: This AMS_BioRhythms computing program is capable of operating on any computing device, tool and/or equipment with a computing based Operating System to calculate and determine the three major personal Bio-Rhythm cycles for any specific entity or any situation for any time period. Such computing device, etc., can, and will, include any computer PC, laptop, tablet, phone and/or other device capable of running any type of computing program, such devices with a monitor/screen used to produce information for any entity and/or situation, via home computer, internet or any place of business. This Bio-Rhythm computing program is capable of producing, for any entity or situation, a combination of any two entities and/or situations; any of a single daily or a single yearly Bio-Rhythm graphics, or double daily or double yearly Bio-Rhythm graphics. Said Bio-Rhythm graphics and information is based upon the entity's birthdate or any situation's inception/start date.

Abstract: A feeding set for use with a peristaltic enteral feeding pump to deliver nutritional liquid fluid to a patient includes a container having nutritional liquid. A conduit assembly includes tubing placeable in fluid communication with the container and adapted for mounting on the enteral feeding pump. The tubing provides a fluid pathway for delivering the nutritional liquid from the container to a patient when the tubing is mounted on the enteral feeding pump. An identification member is mounted on the conduit assembly and has at least one characteristic of a nutritional liquid associated with the feeding set represented by the identification member. The identification member is positioned on the conduit assembly so as to permit automatic identification by the enteral feeding pump of the at least one characteristic of the nutritional liquid upon mounting the conduit assembly on the enteral feeding pump.

Abstract: Embodiments for scheduling the delivery of multiple medications to a patient by a processor. Any interactions between the multiple medications or between one of the multiple medications and a type of food are considered to construct an analytical model to identify an optimized schedule for delivery of the multiple medications to the patient. The optimized schedule is adjusted in real time as additional information concerning the multiple medications and the type of food are introduced, and delivered to a dispensing device associated with the one of the multiple medications.

Abstract: A system and method for assisting in the use of pain medication comprising: a) a medical monitoring sensor configured to sense at least one physiological parameter associated with responses to drugs in the human body; b) a communication network configured to receive and transmit the sensed data relating to the at least one physiological parameter to a processor in communication with the communication network; c) the processor configured to compare the transmitted sensed data relating to the at least one physiological characteristic to a table stored in memory, the table indicating ranges of acceptable, marginal and unacceptable data; d) the processor having at least one response for providing at least one medical response to at least one unacceptable range or limit of the transmitted sensed data relating to the at least one physiological parameter; and i) the processor transmitting at least one medical response to an authorized recipient.

Abstract: A device remotely supporting an implantable cardiac device is disclosed. The device includes at least one video input configured to receive at least a video signal from a programmer for an implantable cardiac device, at least one audio input, a network interface, a display, and a user input. The device may also include one or more hardware processors configured with instructions to transmit one or more video signals received at the at least one video input over a network to a remote location via the network interface, transmit one or more audio signals received at the at least one audio input over the network to the remote location via the network interface, receive patient data from a database on the network via the network interface, and display the patient data on the display.

Abstract: A system is provided including an implantable device configured to be implanted subcutaneously within a patient, a clinician monitoring and control device, an optional patient mobile device, a remote server and/or at least one data analyst device used by a data analyst. The implantable device may communicate with any or all of the monitoring and control device, the mobile device and/or the remote server through the charging device or by establishing a direct wireless connection with each such device. The data analyst device may establish a direct connection with the remote server and also may establish a connection with the monitoring and control device and the mobile device. By analyzing and reviewing the data generated by the implantable device, the data analyst may diagnose a medical condition or indicate a heightened risk of a condition.

Abstract: A method of facilitating management of a care pathway includes receiving a care pathway definition, having a first care pathway step and a second care pathway step, where each care pathway step is identified by a unique identification (ID) code. The method includes determining a keyword associated with each care pathway step; and identifying, in patient information, care episodes. The method may include extracting, from the patient information, episode information corresponding to the care episodes; associating the care episodes with the corresponding care pathway steps; and determining, based on the care pathway definition and the episode information, a care metric. A display device may be used to present a representation of the care metric to a user.

Abstract: Software applications, devices, systems, and methods are provided for monitoring, recording, and tracking cardiac health related metrics using an associated computing device. The software applications may monitor, record, and track physiological data such as cardiac electrical activity, heart rate, and blood pressure. Data transmission between a patient and a healthcare provider may also be enabled via the software applications disclosed herein.

Abstract: Systems, computer-implemented methods, and non-transitory computer readable media are provided for sharing medical data. The disclosed systems may be configured to create a first workgroup having a first knowledgebase. This first knowledgebase may be federated with a common knowledgebase, and with a second knowledgebase of a second workgroup. At least one of the first knowledgebase, common knowledgebase, and second knowledgebase may be configured to store data items comprising associations, signs, and evidence. The signs may comprise measurements and contexts, and the associations may describe the relationships between the measurements and contexts. The evidence may support these associations. The disclosed systems may be configured to receive a request from a user in the first workgroup, retrieve matching data items, and optionally then output to the user at least some of the retrieved matching data items. The request may comprise at least one of a first association and a first measurement.

Abstract: Disclosed are systems, devices, and methods for planning a procedure for treatment of tissue in a patient's lungs. An exemplary method includes generating a three-dimensional (3D) model of the patient's lungs, displaying the 3D model of the patient's lungs, selecting a target location in the tissue of the patient's lungs as displayed on the 3D model, identifying a point on a pleural surface of the patient's lungs with access to the target location, determining an access path between the target location and the identified point on the pleural surface, calculating a risk of injury to intervening structures between the identified point on the pleural surface and the target location, based on the determined access path, and displaying the access path and the calculated risk of injury for the access path on the 3D model.

Abstract: Systems and methods are provided for dispensing medication in a predetermined amount. An exemplary system and method may include operations and/or instructions comprising dispensing medicine from a first medicine container to a transfer device; dispensing medicine from the transfer device to a second medicine container, monitoring a medicine distribution relative to the first medicine container, the second medicine container, and the transfer device by way of at least one monitoring device, and automatically adjusting the medicine distribution among the first medicine container, the second medicine container, and the transfer device.

Abstract: A data processing system configured for computer visualization of drugs for drug interaction information retrieval is disclosed. For each of multiple different substances and using a camera within the mobile or other computing device, imagery of at least one external characteristic of a physical body of the substance is acquired. An identity of each of the multiple different substances is determined based upon the at least one external characteristic from the acquired imagery. Drug interaction data is retrieved for each of the multiple different substances using the determined identities. Drug interaction data for at least one of the multiple different substances is correlated with at least one other of the multiple different substances. At least one generic substance and/or cost information of at least one of the multiple different substances is identified. The correlated drug interaction data, the at least one generic substance, and/or the cost information are displayed.

Abstract: The present invention relates to a system and method for dispensing medication through a time controlled device linked to a web platform. The system includes a dispensing device in wireless communication with a computing device. A web platform on the computing device can be used to program the dispensing device with parameters such as the dosage number, minimum time period between dosages, and the like. Based on the programmed parameters, a solenoid in the dispensing device will lock or unlock based on dosages administered and the time between dosages.

Abstract: A variable dose dispensing system may include a processor and memory. The processor may receive a request for a variable dose order of a medication, such as from a user. The processor may request an amount of the medication to be administered, and receive, in response to the request, an indication of the amount to be administered. The processor may verify that the amount to be administered is within a range of the variable dose order. The processor may determine an item in a local inventory that contains at least the amount of the medication to be administered, and may dispense the item. If an amount of the dispensed item exceeds the amount to be administered, such as by a waste amount, the processor may display an indication of the waste amount to the user, and may transmit a notification of the waste amount, such as to a management server.

Abstract: In one implementation, an insulin delivery system using an on-body network includes an insulin delivery device that is adapted to administer dosages of insulin to a patient; a controller that is adapted to control operation of the insulin delivery device, to establish a first network connection in which the controller acts in a central role, and to establish a second network connection in which the controller acts in a peripheral role; one or more peripheral devices that are adapted to generate patient data related to blood glucose levels and to transmit the patient data wirelessly over the first network connection, the peripheral devices acting in a peripheral role over the first network connection; and a mobile application installed on a mobile computing device that is programmed to communicate with the controller over the second network connection, the mobile application communicating in a central role over the second network connection.

Abstract: An apparatus for health management includes an information collector configured to collect body composition information and characteristic information of a user, and a processor configured to determine a degree of muscle loss of the user based on the body composition information and the characteristic information of the user and provide a personalized health management program to the user based on the determined degree of muscle loss.

Abstract: The present Invention relates to methods of treating subjects preparing to undergo surgery or methods of treating chronic disease and methods for reducing transfusions and a computer readable storage medium and a physical computing device for carrying out these methods which include: a) receiving a profile of said subject, in a physical computing device, including a level of hemoglobin of said subject, level of creatinine of said subject, and information regarding current or past history of disease; b) applying said level of hemoglobin and said level of creatinine, in said physical computing device, to determine level of transfusion risk; c) applying said information regarding current or past history of disease of said subject, in said physical computing device, to determine level of comorbidity; d) applying said level of hemoglobin, said level of transfusion risk, and said level of comorbidity, in said physical computing device, to determine a patient care plan.

Abstract: Example embodiments may relate to a system, method, apparatus, and computer readable media configured for prompting a user to perform an exercise, monitoring form of the user while performing the exercise, and calculating an energy expenditure estimate for the user performing the exercise based on a type of the exercise and on the form of the user.

Abstract: Methods and systems for generating an electronic structured report associated with a displayed electronic medical image. One method includes receiving an annotation for the electronic medical image, automatically determining, with an electronic processor, an anatomical location within the electronic medical image associated with the annotation, and automatically determining, with the electronic processor, a location within the electronic structured report associated with the anatomical location based on a predetermined mapping. The method also includes automatically populating the location of the electronic structured report based on the annotation.

Abstract: Methods and systems for reviewing medical images. One system includes an electronic processor configured to receive an annotation for a displayed electronic medical image, wherein the annotation includes a label of a lesion represented within the medical image. The electronic processor is further configured to automatically determine whether the lesion is labeled one or more times in other medical images acquired during an imaging exam associated with the displayed electronic medical image, and identify a stored rule based on the annotation, wherein the stored rule specifies whether the lesion should be labeled in the other medical images. The electronic processor is also configured to execute the stored rule based on whether the lesion is labeled one or more times in the other medical images, and automatically initiate at least one automatic action based on executing the stored rule.

Abstract: Methods and systems for reviewing medical images. One system includes an electronic processor configured to display an electronic medical image, compile clinical information associated with the electronic medical image, determine a probability of a condition associated with a patient associated with the electronic medical image based on the clinical information, and display the probability of the condition with the medical image. The electronic processor is also configured to receive an annotation for the electronic medical image, determine an updated probability of the condition based on the clinical information and the annotation, and display the updated probability of the condition.

Abstract: There is provided a stress management system that manages psychological stress of a user. The system includes: a first sensor that detects biological data of a user; a second sensor that detects life log data indicating an activity history of the user; a generator that generates stress data using the biological data, the stress data indicating a time series variation in a stress level of the user; an estimator that, when the stress level included in the stress data exceeds a threshold value, estimates whether or not stress experienced by the user is interpersonal stress that is caused by contact with other people, using the life log data; and a notifier that notifies the user of a result of the estimation by the estimator.

Abstract: Presented herein are systems and methods for merging and manipulating data from different sources of clinical trial data. Clinical trial data is collected using multiple different ‘forms’ and can be from either a single clinical trial or from multiple clinical trials. In certain embodiments, the systems and methods described herein are provided in the form of an intuitive graphical user interface (GUI) that enables a user to merge and manipulate data from two or more source tables of clinical trial data associated with one or more clinical studies to produce a custom merged table, without having to rely upon complex computer code.

Abstract: Presented herein are systems, methods, and architectures related to a scalable and platform-agnostic framework that leverages multiple pluggable connectors to retrieve clinical trial data from different data sources (e.g. corresponding to different systems used to collect and manage data collected over the course of a clinical trial). The clinical connector technology described herein transforms the retrieved data to one or more standardized representations using one or more pre-defined data models. By providing clinical trial data to the client applications of stakeholders in one or more standardized formats (e.g. represented according to a standardize pre-defined data model), irrespective of the source of the clinical trial data, the systems, methods, and architectures described herein obviate the need for stakeholders to modify their workflow depending on the particular source.

Abstract: In a method of standard-compliant electronic case report form (eCRF) design and clinical data set collection, the steps comprise providing a standard specification document. Then, analyzing the standard specification document to generate a standard-compliant question information by a standard specification analyzer, and transforming the standard-compliant question information to a standard-compliant question object by a standard-compliant question generator. Generating a standard-compliant eCRF by a standard-compliant case report form design interface. Moreover, confirming the standard-compliant eCRFs whether comply with the standard specification by a standard rules validator.

Abstract: A method of collecting, monitoring and comparing data in a multi-variable, multi-participant clinical analysis system and integrating the collection and monitoring with a thesaurus database is disclosed. The method utilizes one or more computer-based units for collecting, validating, integrating and storing the integrated data from multiple participants in a clinical study. The method also utilizes a remote main computer system connected to the computer-based collection units for receiving the uploaded integrated data from the collection unit for further processing and downloading new or modified data and collection instructions to the remote collection units with software and interfacing apparatus cooperating for downloading and inputting new or updated data, the collection units and the main computer being synchronized so that the data in all the connected units is the same.

Abstract: A computer-implemented method according to one embodiment includes identifying a textual document, determining chemical data within the textual document, performing an analysis of the chemical data, and determining whether the chemical data is associated with one or more dangerous characteristics, in response to the analysis.

Abstract: A method to obfuscate images is provided. The method may include a monitoring engine determining which images and regions of images need to be obfuscated. The method may also include an obfuscation engine determining the proper obfuscation processes in order to optimally obfuscate an image. The method may further include obfuscating the regions of the image based on the determined proper obfuscation processes. The method may also include marking the regions with an identifier representing the obfuscation process used. The method may also include using the identifiers in order to then de-obfuscate the image without a loss of image quality.

Abstract: Federated systems for issuing playback certifications granting access to technically protected content are described. One embodiment of the system includes a registration server connected to a network, a content server connected to the network and to a trusted system, a first device including a non-volatile memory that is connected to the network and a second device including a non-volatile memory that is connected to the network. In addition, the registration server is configured to provide the first device with a first set of activation information in a first format, the first device is configured to store the first set of activation information in non-volatile memory, the registration server is configured to provide the second device with a second set of activation information in a second format, and the second device is configured to store the second set of activation information in non-volatile memory.

Abstract: Disclosed herein is a key rotation scheme for a DRM system in a DASH-based media content service. A DASH encoder generates media decryption keys and provides a key list including the media decryption keys to a CP manager. Each media decryption key is identified by a key identifier (KID). The CP manager delivers the key list to a license server. The license server creates ECLs based on the key list, and delivers an ECL list including ECLs to the CP manager. Each ECL is identified by KID and includes an encrypted media decryption key and an encrypted KID. The CP manager generates a pssh box in which the ECL list is inserted into a data field, and delivers the pssh box to the DASH encoder. The DASH encoder delivers the pssh box to a client device, with the pssh box being included in a DASH MPD or media segment.

Abstract: In an information processing apparatus, upon the calling of a web application being instructed, the information processing apparatus sets a URL corresponding to the web application in the web browser and makes a request to the web server, and when a request to perform a confirmation process for the license is received from the web server, the information processing apparatus generates signature information of the information processing apparatus, sends the signature information to the URL, and obtains authorization information from the web server. The web server confirms a license of the information processing apparatus in response to the request from the information processing apparatus, and responds to the information processing apparatus with web application content upon the license of the information processing apparatus being successfully confirmed.

Abstract: Features are described for efficiently and accurately identifying a user of an electronic device with limited user interaction. The features include receiving a mobile device identifier from the mobile device. The features include transmitting the mobile device identifier to a service provider associated with the mobile device. The features include receiving information identifying the user from the service provider. The features include identifying a set of candidates associated with at least a portion of the information. The features include generating a metric for the candidates included in the set of candidates. An individual metric indicates a degree of relatedness between a value for the user for the at least one data field and a value for a candidate for the at least one data field. The features include identifying the user as a specific candidate included in the set of candidates based on the metric corresponding to a threshold.

Abstract: A user is authenticated based on feature data of a target such as a body-part or other object obtained by a touchscreen of a computing device. When the user positions the target to interact with the touchscreen, interaction data is gathered. Feature data of the target is determined from the gathered interaction data. The feature data Is used to identify one or more of the target and the user. Various actions are executed based on the identification and authentication of the user.

Abstract: An image processing apparatus includes a reader, an authentication processor, and a process executor. The reader is configured to detect authentication medium in which authentication information is stored or displayed and read the authentication information from the authentication medium. The authentication processor is configured to execute user authentication on the basis of the authentication information read by the reader. The process executor is configured to, when the same authentication medium has been detected by the reader multiple times in a predetermined detection pattern, execute a preset process associated with the detection pattern.