REPUBLIC OF THE PHILIPPINES

BATANGAS STATE UNIVERSITY ALANGILAN

COLLEGE OF ENGINEERING, ARCHITECTURE AND FINE ARTS

MECHANICAL ENGINEERING DEPARTMENT

ENGG 407 - INTRODUCTION TO ENGINEERING

FINAL PROJECT

“USE OF PIEZOELECTRIC ENERGY HARVESTING DEVICE IN MEDICAL

WEARABLE SENSORS FOR COVID-19 MONITORING”

SUBMITTED BY:
ME-1107
GROUP #8

MEMBERS
De Gracia, Marc Jemuel C.
De Guzman, Cristine Joy P.
Gutierrez, Pollyn F.
Manalo, Khyle Irish P.
Panaligan, Kurt Laurence D.

SUBMITTED TO:
ENGR. SHIELA MARIE T. DIMAYUGA
INSTRUCTOR

December 16, 2021

 CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Introduction

Widespread global health emergencies have been occurring for the past years

now. The global outbreak due to an infectious disease that has spread across large

regions and even countries brings forth a huge impact to human life worldwide. It

includes dramatic loss of lives, economic and social disruption, extreme poverty,

unemployment and most importantly the unprecedented challenge to public health and

medical care. This COVID-19 pandemic has been uncontrollable for quite a while now

due to limited investment in health care infrastructures and shortage of health care

workers in the Philippines. Implementation of strategies to control the virus is necessary

to gain back the efficiency of the public health system in our country. Hence, case

isolation, contact tracing, physical distancing and vaccine acquisition are currently

considered the backbone of effective COVID-19 control. Nevertheless, the quality of our

healthcare system is still undeniably greatly affected thus adding various medical

wearable sensors to be utilized in monitoring probable, suspect and even confirmed

COVID-19 cases will go a long way in the healthcare industry.

The need to improve and advance our digital framework for remote patient

monitoring is indeed a must today. Medical wearable sensors have been a viable

means of disease detection and individual monitoring. These are used to gather

physiological and physical or movement data thus enabling to know the status of a

patient. The function of these sensors is a necessity towards predicting possible

incidence of COVID-19. At the same time, it can provide valuable data in terms of

symptoms onset which can be tracked by our health care workers for them to help

mitigate the spread of the virus. This technology serves as a guide for the front-line

workers and the COVID-19 individuals themselves in tracking their health stability.

Since these devices can determine relevant physiological metrics, users of these

wearable sensors could be alerted when there are changes happening in their metrics

that match those associated with COVID-19. However, the widespread adoption of

medical wearable sensors is typically limited because of its duration time to function

without re-recharging. Therefore, to ensure uninterrupted monitoring, a sustainable and

continuous power supply is required for sensing, transmitting and analyzing data.

One necessary step to achieve autonomous and self powered medical wearable

sensors is through scavenging energy from the user’s surroundings. Energy harvesting

technologies cannot completely eliminate the battery storage unit however, it can

ensure a maximum duration of use. Consequently, the most promising and efficient

technique to generate electricity for powering wearable devices by considering the

user’s body movements is piezoelectric energy harvesting. Compared to other used

transduction mechanisms, piezoelectric materials have the potential ability to directly

convert changes in human motion into electrical signals without any further external

input.

Furthermore, in response to the emerging health emergencies, specifically the

COVID-19 pandemic all over the world and its impact to the quality and efficiency of the

health care system, the researchers arrived with the idea of an alternative sustainable

energy source to be utilized in various medical wearable sensors. As piezoelectric

energy being one of the prominent mechanical energy-harvested due to its many

advantages such as its simple structure, reliable operation and ease of implementation,

it has also indeed proved itself with its assistance in the advancement of healthcare

technologies.

In relation to the information presented, this research specifically aims to use

piezoelectric energy harvesting devices in medical wearable sensors for monitoring

probable, suspect and confirmed COVID-19 cases. Through this, health care workers

can remotely track their overall status that mitigates problematic patient access issues

in a good span of time without the need of constant re-recharging because of the ability

of certain piezoelectric materials to be a battery-less energy supply in those medical

wearable sensors.

Objectives

The objectives of this study are the following:

1. To improve the quality and efficiency of our current healthcare system

2. To give convenient and far from harm method of monitoring probable,

suspect and confirmed COVID-19 cases to our healthcare workers

3. To provide an alternative sustainable energy source to be utilize in

various medical wearable sensors

 4. To use piezoelectric energy harvesting device in medical wearable

sensors for COVID-19 monitoring

5. To create a prototype that is capable of harnessing piezoelectric energy

harvesting devices in medical wearable sensors for COVID-19 monitoring

through the means of SketchUp

6. To test and evaluate the prototype for further iteration if necessary.

Definition

Piezoelectric Energy Harvesting Device. Piezoelectric energy harvesting

device is used as the mechanism on converting vibration energy into useful electrical

signals from the human motions, which is beneficial for powering medical wearable

sensors in the study.

Medical Wearable Sensors. In the study, medical wearable sensors are utilized

for more advanced COVID-19 monitoring and will make use of the piezoelectric energy

harvesting method for it to power and function.

Remote Patient Monitoring. Remote patient monitoring will be more convenient

for the assigned healthcare workers to those probable, suspect and confirmed COVID-

19 cases in tracking their medical and other health data through medical wearable

sensors in the study.

 Physiological Metrics. In the study, physiological metrics convey precise

information about an individual’s bodily functions from medical wearable sensors use in

COVID-19 patients.
 CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter includes the ideas , finished thesis , generalization or conclusions,

methodologies and others. Those that were included in this chapter helps in

familiarizing information that are relevant and similar to the present study.

Conceptual Literature

Piezoelectric Energy Harvesting. Energy Harvesting is approaching an

interesting technological juncture when the power requirements for electronic devices

are decreasing and energy harvesting device efficiency is increasing. Piezoelectric

vibration energy harvesting has emerged as the preferred way for powering meso-to-

micro scale devices among numerous possible energy harvesting technologies.

Micro-harvesting methods that supply continuous power in the milliwatt range

rely on vibration as a significant source of energy. Walking burns roughly 200 Watts of

energy, which can be gathered at a rate of up to 4 pW/cm’. Vibrational energy is

generally available in structures such as bridges, as well as in industrial and automotive

scenarios, wherein the electrostatic energy can also be harvested through piezoelectric

cells or elastometers (Roundy et al., 2005).

Medical Wearable Sensors. There has been a lot of research on using

piezoelectric generators to power human-wearable systems. Since human motion is

characterized by large amplitude movements at low frequencies, designing a small

resonance generator to function on people is challenging. Human applications of

coupling through direct straining or hitting on a piezoelectric device are described below.

According to studies, the average walking human weighs 68 kg. With the help of the

shoe, it generates 67W of energy. While taking this much energy would disrupt the

stride, it is obvious that obtaining energy from a walking individual poses a possible

energy harvesting opportunity. Walking might produce 1.27W, according to the

theoretical limitations of piezoelectricity.

According to Wang Dan-shel et al. (2009), Piezoelectric ceramics (PZT) is one of

smart materials, which holds direct and converse piezoelectric effects and can use as

impedance transducer for structural health monitoring. However, the PZT transducers

must be waterproofed when they are embedded into the concrete structure to monitor

the inner stress field since the PZT is a type of moisture absorption material.

Remote Monitoring for COVID-19 Patients. One promising solution to use

during the COVID-19 pandemic is through remote patient monitoring because

telemedicine has proven its efficiency in managing chronic and respiratory diseases that

leads to it lessening the load of emergency situations in hospitals. This is one

alternative way to avoid the rise of COVID-19 cases and prevent further spread of the

disease caused by unnecessary health visits in different health institutions. Remote

patient monitoring involves the asynchronous transmission of health care data between

physically distant patients and health care providers that can be aided through various

medical wearable sensors (Tabacof et.al., 2021).

Infections with the coronavirus that causes severe acute respiratory syndrome

type 2 (SARS-CoV-2) are threatening public health systems in many nations. According
to the study of Sun et. al (2020), in the confines of one's own home, effective self-

monitoring is nearly impossible. Affected patients should monitor their temperature two

to three times a day and record their self-perceived symptoms on a regular basis,

according to certain health authorities. Objective indicators like SpO2, heart rate, and

respiratory rate, which have been shown to reduce mortality when observed early, are

not recorded.

According to Wurzer et. al (2021), to alleviate health-care systems and enhance

COVID-19 patients' overall prognosis, it is critical to identify patients at an early stage of

illness progression so that they can be admitted to the hospital as soon as possible. It is

also stated in their study that continuous vital parameter monitoring in high-risk patients

in residential isolation would allow for objective assessment of the patient's condition. A

low-cost, easy-to-use monitoring system could cover a critical gap in the management

of COVID-19 patients.

Related Literature

The convenience of a portable wearable device has been a demand of many

consumers thus producers made use of piezoelectric components. It resolves the

request for compact devices with smaller batteries, or no batteries at all and even its

longer charge duration. When force or pressure is applied, certain piezoelectric

materials will produce an electric charge. This effect is produced as a result of applied

stress, mechanical, thermal and others. Allowing wearable devices to be charged from

body movement, pressure or other external forces is one potential use for this
technology. Piezoelectric energy harvesting can only produce small amounts of energy

but its ability to store it in eliminating the need for supplemental batteries is promising.

Yet two factors that will solve the challenge of piezoelectric energy harvesting; creating

just a relatively small amount of energy are the versatility of piezoelectric components

and the reduction in power requirements for current wearable devices at the same time

increasing the efficiency of piezoelectric energy harvesting. There are many types of

materials that can be used for piezoelectric energy harvesting but ceramic is the most

preferred because of its low cost, effective piezoelectric properties and easy

incorporation into energy harvesting devices. The utilization of different electrical and

mechanical frequencies are caused by the unique properties of piezoelectric materials

and components. Hence, it is the most feasible method to be used in wearable devices

since it is capable of producing the power level needed for a small-scale. Specifically,

the devices that create an electrical signal when acted upon by any physical force like

pressure, acceleration, vibration and more are piezoelectric sensors. In which, the

signal serves as a monitor that eventually be directed to a data processing system.

These sensors are mostly used in medical industries for different purposes like remote

monitoring of patients with various medical conditions (APC, 2016).

According to Janes (2020), the use of piezoelectricity energy has the potential to

reduce, or eliminate the requirement for frequent device and battery charging. Energy

harvesting devices have the ability to completely transform how people utilize wearable

technology. Wearable devices would be able to charge and power themselves.

Consumers would be able to use products that didn't require batteries or electricity to

operate. Wearable devices and more energy-efficient batteries will have longer useful
lives as a result. This would also help to mitigate the environmental risks associated

with the frequent dumping of batteries and electrical components in landfills.

Consumer wearable devices are an accurate and commonly used technology for

establishing individual baseline health parameters, which can be utilized to detect

significant physiologic abnormalities at the outset of infection (Mishra, T. et al., 2020).

According to Li, X. et al (2017), early identification of Lyme disease can be done using

smartwatches and basic pulse oximeters, and heart rate and skin temperature can be

used to detect viral respiratory infections, even asymptomatic infections. Other studies

have shown that smartwatches can be used in epidemiological investigations to track

the spread of respiratory viruses by measuring higher heart rates.

According to Ates, H. C. (2021), during the coronavirus disease 2019 (COVID-19)

pandemic, the potential of wearable health devices has become increasingly apparent.

On the other hand, Mishra, T. et al. (2020) also stated that the use of wearable devices

has a lot of potential to help with the COVID-19 pandemic. Most infections are only

detected after symptoms appear, existing testing methods are unlikely to detect pre-

symptomatic carriers, posing a significant obstacle for the implementation of early-stage

measures to limit transmission. COVID-19 is thought to be asymptomatic in up to half of

those infected, allowing the virus to spread further. For early detection of COVID 19,

accessible and inexpensive methods are urgently needed.

There is a great need in healthcare for remote monitoring of COVID-19

symptoms as vaccinations are slow to arise in the market, wearable technology is being
used to monitor and predict the occurrence of COVID-19 using sensor devices (Bassam

et al., 2021).

In addition, the study of (Jang, B. et al., 2019) wearable gadgets are used to

track potential infected people's health symptoms and identify physiological changes

over time during quarantine, alerting them to the risk of infection. This early detection

enables patients to self- isolate in the designated facility assigned by the government as

stated by (Dazagany et al., 2020). In line with this, it can be a good step in taking

preventative measures to prevent infection and disease progression.

Moreover, according to Qureshi and Krishnan (2018), in health-care systems,

wearable body sensor networks are the ideal approach for remote monitoring. COVID-

19 virus can be detected using wearable sensors. Sensors transfer physiological data to

the cloud, where it is processed and analysed to anticipate the COVID-19 viral situation

among individuals (Johansson et al., 2010).

Furthermore, the study of (Ates et. al., 2021) stated that the COVID-19 has

brought attention to the possibilities of wearing electronic devices in healthcare. The

next generation of wearable sensors, with its ability to continually monitor both physical

characteristics and biochemical indicators, could play a crucial role in battling the next

pandemic with continuing development and innovation.

Energy is converted from vibrations that occur during walking, breathing, and

moving on numerous regions of the body when piezoelectric ceramic is used to harvest

energy. It is the ideal material for this sort of energy harvesting because of its low cost,

efficient piezoelectric capabilities, and ease of inclusion into energy harvesting systems
while piezoelectric vibration energy harvesting is the chosen system for usage with

wearable devices because it is the most capable of delivering the power level required

for small-scale devices.

When piezoelectric components are pressured, they generate an electrical

current that can be used or stored right away. The amount of energy generated is still

tiny, and the required bodily movements aren't always consistent and predictable. In

addition, to gather a substantial amount of energy, a huge surface area is frequently

required. When considering the small size required in wearable devices, it became a

challenge.

Figure 1

Direct and inverse piezoelectric effects

The adaptability of piezoelectric components, as well as the fact that

piezoelectric energy harvesting efficiency has grown while current wearable device

power requirements have decreased, are two hopeful considerations in dealing with

these constraints (Janes, 2020).

 Figure 2

Ultraflexible Piezoelectric Energy Harvesting and Sensing Device

In the study of Petritz et.al. (2021), wearable electronics for healthcare systems

requires energy autonomy and conformability as its essential elements. Hence,

ferroelectric polymer transducers and organic diodes for imperceptible sensing and

energy harvesting systems are integrated on ultrathin substrates. These ferroelectric

polymer transducers are sensitive enough to strain and pressure, fast response and

excellent mechanical stability. Because of this fact, it can form imperceptible wireless

electronic patches for precise pulse and blood pressure monitoring. Furthermore,

ferroelectric polymer transducers are used for vital parameter sensing while

piezoelectric nanogenerators are used for harvesting biochemical energy when

attached to the skin. These nanogenerators are combined with the harvesting circuits

that are composed of organic diodes as rectifiers and thin-film capacitors for energy

storage. Organic diodes represent good candidates for energy rectifiers and are created
either using a vertical-capacitor through an organic semiconductor in between two

different electrodes setup or in an organic thin-film transistor setup with shorted drain-

gate electrodes. Generally, the wearable sensor can monitor vital signs such as pulse

rate, human pulse wave and respiratory rate.

Figure 3

Building Block of a Typical Wearable Device

However, according to Liu et. al. (2021), highest power densities can be

achieved from piezoelectric transducers. To make a self-powered wearable device,

piezoelectric energy harvesting technique is preferred to convert mechanical energy into

electrical energy through a piezoelectric transducer. Then, the collected energy could

either be used directly or stored in a reservoir which can be a lithium-ion battery or a

super capacitor. For the sensing unit, it will be responsible for acquiring data from the

wearable environment through which be processed in the signal processing unit.

Moreover, energy storage is necessary to ensure continuous monitoring when it is

applied in critical medications without any loss of power. It provides an appropriate

amount of power and voltage throughout the materials of the wearable device. Given

that reason, battery lifetime has been an issue for it is very dependent on different vital

usage factors such as temperature, number of cycles and dept of discharge. Thus,

using nickel-metal hydride (NiMH) batteries are the most promising for it is less

replaceable than other kinds of batteries or capacitors. To add more, piezoelectric

energy harvesting devices can generate high power densities from the human body that

are enough to be used in extending the battery lifetime.

Synthesis

From the studies of APC (2016) and Janes (2020), the researchers can conclude

that the current study is the most promising solution to meet the demand of many

consumers in finding medical wearable devices that can able to power themselves on

their own at a long period of time. Because, they stated that utilizing piezoelectric

energy harvesting devices has a potential to reduce or eliminate the requirement for

frequent battery charging in a certain device wherein this research aims to achieve.

On the other hand, as Mishra et.al. (2020), Li et.al (2017) and Ates (2021) said

that our current situation with the COVID-19 pandemic has brought forth the need to

use wearable devices during these global health emergencies. In this way,

identification of COVID-19 symptoms can be tracked in the earliest time possible by

accumulating the health data detected using the device.

 The abovementioned statement was supported by Bassam et. Al. (2021), Jang

et.al (2019), Qureshi and Krishnan (2018) and Johansson et.al (2010). They further

added that using wearable sensors is the ideal approach in remote monitoring for

probable, suspect and confirmed COVID-19 cases since this is a good step in taking

preventive measures to avoid further spread of the disease.

Furthermore, the studies of Janes (2020), Petriz et.al. (2021) and Liu et.al. (2021)

discussed different piezoelectric materials and components and their own unique

functions and properties. They stated the increase in efficiency of piezoelectric energy

harvesting while there is a decrease in the power requirements of current wearable

devices. Nevertheless, modifications in their design were done by the researchers in

terms of the used elements in wearable sensors to meet the aims of the current study.

In relation to all of these, the existing studies mentioned are relevant to the

present study because the information gathered will be used by the researchers to

make the study feasible. At the same time, the studies presented will help the

researchers to further make improvements based on their design to set apart their own

objectives to the current ones.

 CHAPTER III

METHODS AND PROCEDURES

This chapter presents the methods and procedures involved in the study. It

includes the steps taken to achieve the set objectives.

Research Design

The researchers will make use of the engineering design process in conducting

the study. To be able to design and develop the use of piezoelectric energy harvesting

device in medical wearable sensors for COVID-19 monitoring, it will undergo through

series of steps which are defining the problem, brainstorming solutions, designing and

building a prototype of the solution, testing the solution and improving it if necessary.

This type of research design is then divided into four stages: design thinking, design

process, prototyping, and the final design. Through this method, the study is open for

iteration to make further improvements along the process.

1. Design Thinking

In this stage, the researchers provide a solution-based approach to solve the

problems involved in the study. This includes using a structured form of identifying the

challenges in gathering information to generate potential solutions, rethinking ideas, and

testing the solutions afterwards. Specifically, the use of a piezoelectric energy

harvesting device as the preferred mechanism to be utilized in medical wearable

sensors for COVID-19 monitoring is considered in terms of its capability to function as

what the researchers are expecting it to be - self-powered that has a longer charge
duration. Hence, the components, materials and structure of the said harvesting method

are also taken into consideration.

2. Design Process

This stage will focus on finding answers and solutions to achieve the objectives

of the study. It includes considering the existing design of piezoelectric energy

harvesting devices in medical wearable sensors to determine possible adjustments that

can be made concerning its operation of components. Thus, additional ideas will be

given by the researchers to add further improvements to the study. All of these will be

considered to eventually attain the desired output.

3. Prototyping

In this stage, the researchers will use all the gathered information and ideas from

the previous stages in fabricating the established solution. Changes will be applied to

set apart the current study in a more developed way from the existing studies. The

prototype will take place with the use of SketchUp and is expected to perform limited

operation due to the lack of skills of the researchers in the said platform. Also, this is

where the prototype of the use of piezoelectric energy harvesting device in medical

wearable sensors for COVID-19 monitoring will be analyzed to determine the

occurrence of possible problems in order to have immediate solution and iteration to be

applied for the last stage.

4. Final Design

After going through the first three stages, modifications are done in this stage.

The final prototype design will undergo some assessments made by the researchers to

identify if the said objectives for this study are achieved.

 CHAPTER IV

RESULTS AND DISCUSSION

This chapter presents the interpretation of the data gathered. These are

presented based on the objectives of this study.

4.1 IDENTIFYING PROBLEM

This research focuses on solving problems in the medical field. The researchers

thought of something that would help to improve the quality and efficiency of the current

healthcare system in our country especially during this time. In this time of pandemic,

everyone has been affected. Everything changes in just one snap. The set-up changes

into new normal and movements are limited. It became quite hard for everyone,

especially the healthcare workers who risked their lives to save others. In line with this,

the researchers also consider the things that would make the monitoring of cases easier

for the healthcare workers by giving a convenient and far from harm method of

monitoring of probable, suspected and confirmed COVID-19 cases.

4.2 PROVIDING SOLUTION

According to research, medical wearable sensors would be of great help in

COVID-19. It is also a great need for healthcare in monitoring symptoms.

 In these medical wearable sensors, the researchers think of something that

would provide an alternative sustainable energy source to be utilized. It is also to

minimize the high usage of energy made from non-renewable sources.

From having an idea coming from different studies, the researchers have decided

that the piezoelectric energy harvesting device is the most preferred because it is low

cost. The piezoelectric effect converts kinetic energy into electrical energy. Piezoelectric

generators provide a stable and dependable solution by turning ordinarily lost vibration

energy into usable electrical energy in the environment. They are ideal for applications

that need charging a battery, supercapacitor, or direct powering of remote sensor

systems. Piezoelectricity energy has the ability to eliminate the requirement for frequent

device and battery charging. Wearable devices and more energy-efficient batteries will

have longer useful lives as a result.

4.3 CREATING PROTOTYPE

The researchers think of a design for the prototype. This prototype is something

that is capable of harnessing piezoelectric energy harvesting devices in medical

wearable sensors for COVID-19 monitoring. In order to come up with the design, the

researchers searched for different ideas and considered the design thinking and

engineering design process to establish the desired solution.

Here are the different parts/processes of the said prototype.

Piezoelectric Transducers. These

are electroacoustic transducers

that transform electrical charges

created by certain solid materials into

energy. A piezoelectric substance is

employed as a sensing element in a

piezoelectric transducer, which

converts an input mechanical

quantity into a proportionate

electrical signal.

Organic Rectifying Circuit.

Rectifying circuit is the conversion of

alternating current to direct current

which only allows one way flow of

electric charge. This kind of rectifying

circuit that is used is the half-wave

rectifier.
 Nickel-metal Hydride. It is a type of

rechargeable battery. It has a higher

power and energy density and longer

life cycle compared to other batteries.

Piezoelectric Sensor. A

piezoelectric sensor is a device that

converts pressure, acceleration,

temperature, strain, or force into an

electrical charge using the

piezoelectric effect.

Before coming up with the final prototype, the researchers have brainstormed to

finalize what will be the design of the prototype and how it will work. It is not easy to

think and design. The researchers have also based on existing prototypes and modified

them to produce a new and better solution.

This is the final prototype that the researchers have come up with. It is made of

piezoelectric transducers, organic rectifying circuit, nickel-metal hydride and

piezoelectric sensor. This prototype would use a piezoelectric energy harvesting device

to generate electricity in a medical wearable sensor to monitor COVID-19.

 2D
Use of Piezoelectric Harvesting Device in Medical Wearable Sensors
for COVID-19 Monitoring

4.4 TESTING AND EVALUATION OF PROTOTYPE

After making the final prototype, the researchers have done testing and

evaluation. It is not literally tested since it is a 3D digital prototype that is made through

the means of SketchUp. It is evaluated in a way that researchers have been satisfied

with the design, achieved what the researchers had pictured out and what the

researchers think would work in a real product. This made the researcher realize more

of the real features of the potential final product. It also serves as a way in giving the

researchers’ better idea for iteration to achieve the desired solution.

 CHAPTER V

CONCLUSIONS AND RECOMMENDATIONS

Conclusions

The following conclusions were drawn based on the study.

1. The piezoelectric energy harvesting device can be used in medical wearable

sensors for COVID 19 monitoring.

2. The medical wearable is mostly consisted of piezoelectric components,

specifically a ceramic material because of its low cost.

3. It serves as an alternative energy source to be utilize in medical wearable sensor.

4. This project can help improve the current healthcare system in a way that easily

monitor through the sensor.

5. The design of this project went through various modifications in order to achieve

the desired solution.

Recommendations

The following conclusions were presented based on the conclusions of the study.

1. The wearable sensor must have more advance features in able to apply to the

latest technology.

2. This project can be used for the same purpose with different raw materials as

long as the raw materials are piezoelectric materials.

3. It should have more energy storage so that the wearable sensor can last longer

and work well.

4. Research on the improvement of the system by running certain simulations using

engineering applications like SolidWorks or by running an actual operation of the

system.

5. Researchers recommend to the future researchers to make use of this paper as

a reference.
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