The purpose of these lectures is to provide an experienced clinician's perspective on the delivery of individualized, comprehensive, patient-centered care and to identify and manage properly important clinical issues in primary care medical practice. Participants are expected to learn new approaches and techniques in medical interviewing (e.g., taking appropriate sexual and spiritual histories), diagnostic reasoning (e.g., determining when to perform imaging studies in patients with headache, appropriate diagnostic work-up of individuals with possible hypogonadism), clinical skills (e.g., appropriate methods for determining accurate blood pressure readings), medication management (e.g., appropriate use of hypnotic medications), and health counseling (e.g., encouraging proper dietary measures and exercise).
Topics and Objectives
Health Promotion 1: Encouraging a Healthy Body, Mind, and Spirit
Assess the patients current state of physical, psychological, and spiritual health
Analyze the patients current dietary and exercise practices
Discuss an individualized health-promotion strategy for the patient
Health Promotion 2: Making Healthy Lifestyle Choices
Hypertension: What Goes Up Must Come Down
Describe the appropriate measurement and classification of hypertension
Discuss the laboratory testing and imaging needed to diagnose the most common causes of secondary hypertension
Describe the major classes of anti-hypertensive treatment and discuss the particular type of patient likely to benefit from each class of medication
"Oh, My Aching Head!": Managing Headache
Discuss the appropriate use of brain imaging in evaluating patients with headache
Describe the appropriate use of abortive and preventive medications in the treatment of migraine
Describe the distinguishing clinical characteristics of tension-type and cluster headache
"Sick and Tired of Being Tired": Approach to Chronic Fatigue
Sleep Disorders: Insomnia and Hypersomnia
Describe the four stages of sleep and identify sleep disorders associated with each stage of sleep
Discuss elements of a sleep hygiene program
Explain the appropriate use of stimulant medications for patients with excessive daytime somnolence
Male Sexual Disorders: Restoring Vitality and Virility
Elicit a thorough, non-judgmental sexual history
Describe appropriate laboratory and radiologic testing in the evaluation of male sexual problems
Discuss the effects, risks, and benefits of testosterone replacement and medications for erectile and ejaculatory dysfunction
Diagnosing and Managing Depression: Overcoming the Blues
Get Me Out of Here!": Panic Disorder and Agoraphobia in Primary Care
Somatization: Illness as a Way of Life
Enhancing Clinician-Patient Communication: Becoming a Healer
Distinguish the technical, biomedical aspects of clinicians role from the personal and psychosocial aspects of care
Describe specific attitudes and values needed to create a healing environment with patients
Apply techniques for establishing and maintaining rapport with patients and enhancing clinician-patient communication
The Faith Factor: Practicing Spiritually-Sensitive Medicine
Elicit a spiritual history in an ethically-appropriate manner
Analyze the physiologic, psychological, social, and lifestyle effects of religious beliefs upon health outcomes
Describe the spectrum of possible interventions available for addressing patients spiritual needs
IMPORTANT INFORMATION
IMPORTANT NOTE: All conferees, their families, and guests must book their cruise within the CEI meeting group through Continuing Education, Inc./University at Sea® at 800-422-0711 or by registering online. This ensures our company can provide conference services and complimentary social amenities to all meeting participants and their guests. Thank you for your cooperation.
Conference Sessions generally take place on days at sea (as itinerary allows), giving you plenty of time to enjoy your meals, evenings and ports of call with your companion, family and friends.
BIAS FREE CME - No Commercial Support was provided for this CME activity.
Faculty
Dale A. Matthews, MD, FACP
Dale A. Matthews, MD, FACP
Associate Professor of Medicine (retired)
Georgetown University School of Medicine
Executive Healthcare Services (retired)
Dale A. Matthews, MD, FACP recently retired from a 40-year career of practicing and teaching primary care general internal medicine. He has served on the faculties of Yale University, the University of Connecticut, and Georgetown University and has lectured at over 30 medical schools. He gives lectures on primary care general internal medicine, the doctor-patient relationship, and the psychological and spiritual dimensions of medicine, including the role of religion, faith, and prayer in clinical care. He is the author of The Faith Factor: Proof of the Healing Power of Prayer (Viking, 1998), a four-volume research work (The Faith Factor: An Annotated Bibliography of Clinical Research on Spiritual Subjects), three documentaries, and over 65 peer-reviewed scientific articles, book chapters, and other publications.
Dr. Matthews is a graduate of Princeton (AB, cum laude, Romance Languages, 1976) and Duke University School of Medicine (1980). His internship and residency in internal medicine took place at the University of Connecticut (1980-3) and he completed the Robert Wood Johnson Foundation Clinical Scholar Program and Fellowship in Clinical Epidemiology at Yale (1983-5). In 1989, he was named the George Morris Piersol Teaching and Research Scholar of the American College of Physicians. He has received many awards for his compassionate patient care, including Washingtonian Magazine Top Doctor recognition. He has appeared on numerous television shows, including the Oprah Winfrey Show, Larry King Live, and Good Morning America.
He lives in McLean, Virginia with his wife, Demetra, a certified public accountant. He has two adult children and three grandchildren. He enjoys family and church activities, Bible study and teaching, golf, baseball, piano, singing, songwriting, ballroom dancing, travel, and photography.
Accreditation
In support of improving patient care, Continuing Education, Inc./University at Sea® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Credit Designation for Physicians: Continuing Education, Inc. designates this live activity for 16 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Osteopathic Physicians: This program is eligible for Category 2 credit with the American Osteopathic Association (AOA).
US or Canadian Family Physicians: Please let us know if you require AAFP Prescribed Credits.
Credit Designation for Nurses: Continuiung Education, Inc. designates this continuing nursing education activity for 16 contact hours.
Accredited status does not imply endorsement by Continuing Education, Inc./University at Sea® or ANCC of any commercial products displayed or used with an activity.
Royal College of Physicians and Surgeons of Canada:
Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.
Credit Designation for Pharmacists: This knowledge-based activity is approved for 16 hours of pharmacy continuing education credit.
ITINERARY
DATE
PORT OF CALL
ARRIVE
DEPART
Sun Dec 05
Ft. Lauderdale, Florida
-
4:30 pm
Mon Dec 06
*At Sea - Cruising
-
-
Tue Dec 07
Cozumel, Mexico
7:00 am
6:00 pm
Wed Dec 08
Roatan, Honduras
9:00 am
5:00 pm
Thu Dec 09
Costa Maya, Mexico
8:00 am
5:00 pm
Fri Dec 10
*At Sea - Cruising
-
-
Sat Dec 11
Ft. Lauderdale, Florida
6:15 am
-
*Tentative course schedule, actual class times may differ.
PORTS OF CALL
Ft. Lauderdale, Florida - There is an abundance of things to see and do in the Ft. Lauderdale area: visit the newly redesigned Ft. Lauderdale Beach and cafes, stroll the historic Riverwalk, shop the luxurious stores on Las Olas Boulevard or adventure to the Everglades for an intriguing air boat excursion.
At Sea - Cruising - Cruising
Cozumel, Mexico - With its lively tropical reefs, crystal-clear waters and ancient ruins, Cozumel is ripe for one-of-a-kind adventures. Cruise to Cozumel and head to Chankanaab National Park, where you can snorkel among the colorful reefs and schools of tropical fish that give this island its premier diving status. Or travel back in time on an adventure through the towering Maya ruins of Tulum. When you’re done exploring, unwind with a beachside massage at Playa Mia. From culture savoring to soaking up sunshine, you’ll find a world of adventure waiting for you in Cozumel.
Roatan, Honduras - The island of Roatan is known for its glittering bays and colorful coral reefs perfect for outdoor adventures like snorkeling and scuba diving. Discover your inner pirate in Roatan, where you can taste local rum, swim among starfish at Starfish Alley, or sample fresh seafood at local restaurants.
The 40-mile-long island borders the second-longest barrier reef on the globe, which attracts many divers each year. Go horseback riding at Little French Cay or unwind in paradise at West Bay. Don’t forget to try conch fritters and rum cake during your visit.
Costa Maya, Mexico - Exploring the dense tropical vegetation and wide sandy bays of the Costa Maya, it's easy to imagine the days when sacrifice and slavery, rite and ritual were rampant in the Mayan culture. Even today, the countless ruins of temple walls, stairs and secret pathways exude magic and mystery. And when your archaeology lesson is complete, glorious stretches of coral sand may inspire you to build your own empire-of sand castles, of course!
Royal Caribbean's Allure of the Seas
IMPORTANT NOTE: All conferees, their families, and guests must book their cruise within the CEI meeting group through Continuing Education, Inc./University at Sea® at 800-422-0711 or by registering online. This ensures our company can provide conference services and complimentary social amenities to all meeting participants and their guests. Thank you for your cooperation.
Prices below are for the full cruise including meals and evening entertainment
Suite/Deluxe
Junior Suite with Balcony (J3)
Quad Bedroom area with two twin beds that convert to Royal King. Full bathroom with tub. Sitting area with sofa. Private balcony. Stateroom: 287 sq. ft. Balcony: 80 sq. ft.
Junior Suite with Balcony (J4)
Bedroom area with two twin beds that convert to Royal King. Full bathroom with tub. Sitting area with sofa. Private balcony. Stateroom: 287 sq. ft. Balcony: 80 sq. ft.
Suite/DeluxeSpacious AquaTheater Suite with Large Balcony - 2 Bedrooms (A1) Master bedroom has a King size bed with Duxiana Mattress. Second bedroom has two twin beds that convert to Royal King and two Pullman beds. Vanity with chair in each bedroom, living area with double sofa bed, dining room, marble entry, entertainment center. Two bathrooms, master with tub. Expansive balcony with table and chairs. Stateroom: 823 sq. ft. Balcony: 772 sq. ft.
Suite/DeluxeAquaTheater Suite with Large Balcony - 2 Bedrooms (A2) Master bedroom has a King size bed with Duxiana Mattress. Second bedroom has two twin beds that convert to Royal King and two Pullman beds. Vanity with chair in each bedroom, living area with double sofa bed, dining room, marble entry, entertainment center. Two bathrooms, master with tub. Expansive balcony with table and chairs. Stateroom: 673 sq. ft. Balcony: 610 sq. ft.
Suite/DeluxeSpacious AquaTheater Suite with Large Balcony - 1 Bedroom (A3) Bedroom area with two twin beds that convert to Royal King. One bathroom with tub, large closets, sitting area with table and sofa bed. Private balcony with seating area and private dining. Stateroom: 433 sq. ft. Balcony: 362 sq. ft.
Suite/DeluxeAquaTheater Suite with Large Balcony - 1 Bedroom (A4) Bedroom area with two twin beds that convert to Royal King. One bathroom with tub, large closets, sitting area with table and sofa bed. Private balcony with seating area and private dining. Stateroom: 421 sq. ft. Balcony 126 sq. ft.
Suite/DeluxeGrand Panoramic Suite - 1 Bedroom (GP) Grand entrance exposes lofty views two-decks-high. Single-floor suite with doorbell has dining room with dry bar and entertainment center, living room with sofa bed, and guest bath with shower. Master bedroom has a King size bed with Duxiana Mattress and sitting area, master bathroom with tub, shower, two sinks and bidet. Private balcony with jacuzzi. Stateroom: 914 sq. ft. Balcony: 161 sq. ft.
Suite/DeluxeGrand Suite - 1 Bedroom (GS) Bedroom area with two twin beds that convert to Royal King. Full bathroom with tub and two sinks. Living room with sofa that converts to double bed. Private balcony with seating area and private dining. Stateroom: 371 sq. ft. Balcony: 105 sq. ft.
Suite/DeluxeGrand Suite - 2 Bedrooms (GT) Two bedrooms with two twin beds that convert to Royal King, two Pullman beds. Vanity with chair in each bedroom, living area with double convertible sofa, marble entry, entertainment center, two bathrooms - master bath with tub. Private balcony with table and chairs. Stateroom: 580 sq. ft. Balcony: 237 sq. ft.
Suite/DeluxeCrown Loft Suite (L1) Two-decks-high stateroom with panoramic views. Master bedroom with Royal King size bed and bath on second level. Bath with shower on main level. Private balcony with chairs, dining area with dry bar, table/desk. Living room sofa converts to double bed. Stateroom: 545 sq. ft. Balcony : 114 sq. ft.
Suite/Deluxe Crown Loft Suite (L2) Two-decks-high stateroom with panoramic views. Master bedroom with Royal King size bed and bath on second level. Bath with shower on main level. Private balcony with chairs, dining area with dry bar, table/desk. Living room sofa converts to double bed. Stateroom: 545 sq. ft. Balcony : 114 sq. ft.
Suite/DeluxeOwner's Panoramic Suite - 1 Bedroom (OP) Grand entrance exposes lofty views two-decks-high. Single-floor suite with doorbell has dining room with dry bar and entertainment center, living room with sofa bed, and guest bath with shower. Master bedroom has a King size bed with Duxiana Mattress and sitting area, master bathroom with tub, shower, two sinks and bidet. Private balcony with jacuzzi. Stateroom: 1076 sq. ft. Balcony: 161 sq. ft.
Suite/DeluxeOwner's Suite - 1 Bedroom (OS) Two twin beds that convert to Royal King. Private bathroom with tub and two sinks, marble entry, large closets, living area with table and sofa. Private balcony with table and chairs. Stateroom: 556 sq. ft. Balcony: 243 sq. ft.
Suite/DeluxeRoyal Loft Suite (RL) Two-decks-high stateroom with panoramic views. On second level, master bedroom has a King size bed with Duxiana Mattress; bathroom with tub, shower, two sinks and bidet and a closet. On main level, second bedroom with closet and two twin beds that convert to Royal King; dining area with dry bar, living room with sofa that converts to double bed; bathroom with shower. Private balcony with whirlpool and dining area. Stateroom: 1,524 sq. ft. Balcony (main level): 843 sq. ft.
Suite/DeluxeStar Loft Suite (TL) Two-decks-high stateroom with panoramic views. Master bedroom and bathroom on second level. Bedroom has a King size bed with Duxiana Mattress. Stairway to second level. Bathrooms with shower for two. Private balcony with dining area. Dining area with dry bar. Living room sofa converts to double bed. Closets on each level. Up to 4 guests. Stateroom: 722 sq. ft. Balcony: 410 sq. ft.
Oceanview with Balcony - Accessible (2D)
Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 272 sq. ft. Balcony: 80 sq. ft.
Oceanview with Balcony (3D)
Quad Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyUltra Spacious Oceanview with Large Balcony (1A) Two twin beds that convert to Royal King. Sofa converts to double, two Pullman beds, private bathroom and sitting area. Stateroom: 271 sq. ft. Balcony: 82 sq. ft.
BalconyOceanview with Large Balcony (1C) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyOceanview with Balcony (1D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyCentral Park View with Balcony (1J) Two twin beds that convert to Royal King, boardwalk view balcony, sitting area, and a private bathroom. Stateroom: 182 sq. ft. Balcony: 52 sq. ft.
BalconyOceanview with Large Balcony (2C) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyBoardwalk View with Balcony (2I) Two twin beds that convert to Royal King, boardwalk view balcony, sitting area, and a private bathroom. Stateroom: 182 sq. ft. Balcony: 52 sq. ft.
BalconyCentral Park View with Balcony (2J) Two twin beds that convert to Royal King, Central Park view balcony, sitting area, and a private bathroom. (274 sq. ft. Balcony 86 sq. ft.)
BalconyOceanview with Balcony (4D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyBoardwalk View with Balcony (4I) Two twin beds that convert to Royal King, boardwalk view balcony, sitting area, and a private bathroom. Stateroom: 182 sq. ft. Balcony: 52 sq. ft.
BalconyOceanview with Balcony (5D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyOceanview with Balcony (6D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyOceanview with Balcony (7D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
BalconyOceanview with Balcony (8D) Two twin beds that convert to Royal King, sitting area with sofa, full bathroom and private balcony. Stateroom: 182 sq. ft. Balcony: 50 sq. ft.
OutsideUltra Spacious Oceanview (1K) Two twin beds that convert to Royal King, two Pullman beds in separate area, separate sitting area with sofa bed and bathroom. Stateroom: 271 sq. ft.
InsideSpacious Interior (1R) Two twin beds that convert to Royal King. Sofa converts to double, two Pullman beds, private bathroom and sitting area. Up to 6 guests. Stateroom: 260 sq. ft.
InsideCentral Park View Interior (1S) Two twin beds that convert to Royal King, boardwalk view, sitting area, and a private bathroom. Stateroom: 191 sq. ft.
InsideInterior Stateroom Triple (1V) Two twin beds that convert to Royal King, private bathroom and sitting area with twin sofa bed. Stateroom: 140 sq. ft.
InsideInterior Stateroom - Accessible (Cat 6V) Two twin beds that convert to Royal King, private bathroom and sitting area with twin sofa bed. Stateroom: 274 sq. ft.
Note: Above Prices include cruise fare, port charges, gratuities, taxes and fees and NACLNC® Conference registration.
Prices are Per Person, Double Occupancy, Subject to change.
3rd/4th in Stateroom - Call for Pricing
Port Charges, Taxes & Fees $308.54 per person.
Deposit $250.00 per person
Course Fee Cancellation Policy: 30+ days before sailing date - 75% Refund ; 7-29 days before sailing date - 50% Refund; Less than 7 days before sailing date - No Refund
Cruise Cancellation Policy: Cancellation policies vary by cruise line, destination and sailing date. Please check with one of our agents for policies applicable to this cruise.
* COMPETITIVE PRICING PROMISE: While we are not a 'cruise discounter,' we will match any price offered by the cruise line, directly to the general public, at the time of booking. This offers includes many short-term, promotional rates. All cruise line rates can be withdrawn by the cruise line at any time and are capacity controlled.
PRICING SUBJECT TO CHANGE: Although subject to change at any time, the listed prices are generally available up to about 90 days before sailing; at that time they convert to typically higher, market rates. Rates offered directly by the cruise line and quoted by our agents are also subject to change at any time, can be withdrawn at any time and are capacity controlled.
CANCELLATION PENALTY POLICY WILL APPLY: Cancellation policies vary by cruise line, itinerary and length of cruise. When reserving your stateroom, please review the policy applicable to this cruise with our staff. We strongly recommend Travel Insurance to cover the unexpected.
FUEL SUPPLEMENT: Cruiselines may implement a fuel surcharge depending on the price of crude oil.
Chubb Travel Protection Overview
Standard Plan Benefits
Travel Basics
Travel Essentials
Travel Choice
Trip Cancellation
100% of Trip Costs ($100,000 maximum)
100% of Trip Costs ($100,000 maximum)
100% of Trip Costs ($100,000 maximum)
Trip Interruption
100% of Trip Costs ($100,000 maximum)
150% of Trip Costs ($150,000 maximum)
150% of Trip Costs ($150,000 maximum)
Trip Interruption - Return Air Only
$500
$750
$1,000
Trip Delay
$500 ($100 per day)
$750 ($150 per day)
$1,000 ($200 per day)
Missed Connection
NA
$250
$500
Baggage & Personal Effects
$750 ($50 deductible)
$1,000
$2,500
Baggage Delay
$200
$300
$500
Accident & Sickness Medical Expense*
$15,000 ($50 deductible)
$25,000
$50,000
Emergency Evacuation & Repatriation of Remains
$150,000
$500,000
$1,000,000
Accidental Death & Dismemberment
NA
$10,000
$50,000
Assistance Services
Included
Included
Included
Additional Benefits (if purchased within 15 days of Initial Trip Payment; Day 1 is the date the Intial Trip Payment is made)
Pre-Existing Medical Condition Exclusion Waiver
Included
Included
Included
Trip Cancellation/ Interruption due to Financial Default
Included
Included
Included
Accident Sickness Medical Expense
Excess Coverage
Primary Coverage
Primary Coverage
Baggage & Personal Effects
Excess Coverage
Excess Coverage
Primary Coverage
Flight Accident
$25,000
$50,000
NA
Missed Connection
NA
Additional $250
Included in base plan
Optional Benefits (if selected byt the Applicant and required premium is paid)
Medical Coverage Upgrade
Included in base plan
Included in base plan
Additional $50,000
including Emergency Evacuation*
Additional $150,000
Additional $500,000
Included in base plan
Car Rental Collision Coverage
$35,000 ($250 Deductible)
$35,000 ($250 Deductible)
$35,000 ($250 Deductible)
Flight Accident
Amount selected up to $500,000
Amount selected up to $500,000
NA
*Coverage, pricing and availability may vary by state *Additional Benefits change not available for CA, CO, KS, MN, MO, MT, NH, NY, PA, TX or WA residents at this time.
2520
before you cruise
Cambria Suites
141 SW 19th Court
Dania Beach, FL 33004
If you're looking to enhance your cruise vacation from Fort Lauderdale, FL, come in a day early and stay at Cambria Hotel & Suites Fort Lauderdale, Airport South & Cruiseport .
A 4-mile drive from Fort Lauderdale-Hollywood International Airport, this relaxed hotel is also 9 miles from the Port Everglades cruise terminal, and 7 miles from Gulfstream Park's casino and sports venues.
Low preferred rates available through Continuing Education Inc./University at Sea ® :
Date
Price
*January 1 - April 3, 2021
*$139.00
April 4 - October 2, 2021
*$89
October 3 - December 31, 2021
*$119.00
*Black Out Dates: Feb. 12-14, 2021 & Oct 28-31, 2021
The above rates are based upon availability and subject to change. All rates are subject to applicable sales and occupancy tax,
currently 13%.
INCLUDED IN THE RATE:
WIFI in sleeping rooms and public spaces
Complimentary Airport Transportation from 5:00am to 12 Midnight.
Self-Parking at no charge while staying at the hotel, extended stay parking is $8.00 per day per vehicle
INCLUDED CAMBRIA:
King or Queen Bed
In Room Coffee Maker
Microwave and Refrigerator
Sofa Bed
Flat Screen
In room save
Check-In/Check Out
Check in time is 3:00pm and checkout is 11:00am
**Available at Cambria, Gourmet Bistro serving an Ala Carte Breakfast. tax.
Full service Bar & Restaurant also opens for Cocktails and Dinner at 5pm. Restaurant and bar options are subject to COVID19 safety regulations.
Cambria Fort Lauderdale
141 SW 19th Ct, Dania Beach, FL 33004
Welcome to Cambria!
The Cambria® Hotel Ft Lauderdale Airport South & Cruise Port in Dania Beach is not only a stylish hotel with friendly service, it's also conveniently located near some of the area's best attractions, including Fort Lauderdale Beach and the Dania Casino. Wake up to complimentary served gourmet coffee in the lobby, a state-of-the-art fitness center, resort-style heated outside pool and whirlpool, and a "newly renovated" restaurant & bar! Dine with confidence and convenience with choices to dine inside or enjoy the breeze in our outdoor seating area.
Questions? Call us at 800.422.0711
We can assist you with all your travel arrangements. We'd be happy to help you plan your flights, hotels or tours before and/or after your cruise conference.
