Effects of aromatherapy on sore throat, nasal symptoms and sleep quality in adults infected with COVID-19: A randomized controlled trial.

Background: Patients with coronavirus disease 2019 (COVID-19) usually complain of fever, cough, and sore throat. This study examined the effects of aromatherapy on sore throat, nasal symptoms, stress, fatigue, and sleep quality by administering it to adults with post-COVID-19 condition. Methods: This study was conducted in a randomised controlled design. Its target population were adults who were released from COVID-19 quarantine treatment within 45 days from infection onset and capable of performing daily activities after isolation treatment. The participants were randomised into aromatherapy group (AG) and control group (CG). To test experimental treatment effects, the levels of sore throat, nasal symptoms, stress, fatigue and sleep quality were measured at the baseline (pre-test) and after the trial (post-test), using the numerical rating scale for sore throat, stress and fatigue, the Total Nasal Symptoms Score for nasal symptoms, and the Korean Version of Modified Leeds Sleep Evaluation Questionnaire for quality of sleep. Results: After experimental treatment, there was a significant difference in sore throat in AG compared to CG on the 3rd day (t=-2.022 p=0.048) and 4th day (t=-2.450, p=0.017) of treatment. There was also a significant difference in fatigue between AG and CG on the 2nd day(t=-2.748, p=0.008), 3rd day (t=-2.948, p=0.005) and 4th day (t=-3.084, p=0.003) of treatment. There was no significant difference in TNSS, stress, and sleep quality between the two groups after the experimental treatment. Conclusion: Inhaling aroma essential oils reduced sore throat and fatigue in adults with post-COVID-19 condition, demonstrating the feasibility of aromatherapy as an effective treatment. Trial registration: The study was registered with Clinical Research Information Service (KCT0008029).

A randomized controlled trial of pectoralis major myofascial release massage for breastfeeding mothers: breast pain, engorgement, and newborns' breast milk intake and sleeping patterns.

PURPOSE: Supportive interventions to improve breastfeeding practice are needed in nursing. This study investigated the effects of pectoralis major myofascial release massage (MRM) on breast pain and engorgement among breastfeeding mothers and on breast milk intake and sleep patterns among newborns. METHODS: Breastfeeding mothers who had delivered between 37 and 43 weeks and had 7-to 14-dayold newborns were recruited from a postpartum care center in Gunpo, Korea. Participants were randomized to the MRM or control group. The outcome variables were breast pain and breast engorgement among breastfeeding mothers and breast milk intake and sleep time among newborns. The experimental treatment involved applying MRM to separate the pectoralis major muscle and the underlying breast tissue in the chest. After delivery, the first MRM session (MRM I) was provided by a breast specialist nurse, and the second (MRM II) was administered 48 hours after MRM I. RESULTS: Following MRM, breast pain (MRM I: t=-5.38, p<.001; MRM II: t=-10.05, p<.001), breast engorgement (MRM I: right, t=-1.68, p =.100; left, t=-2.13, p=.037 and MRM II: right, t=-4.50, p<.001; left, t=-3.74, p<.001), and newborn breast milk intake (MRM I: t=3.10, p=.003; MRM II: t=3.09, p=.003) differed significantly between the groups. CONCLUSION: MRM effectively reduced breast engorgement and breast pain in breastfeeding mothers, reducing the need for formula supplementation, and increasing newborns' breast milk intake. Therefore, MRM can be utilized as an effective nursing intervention to alleviate discomfort during breastfeeding and to improve the rate of breastfeeding practice (clinical trial number: KCT0002436).

Retraction notice to ``The effects of listening to Healing Beat Music on adults' recovery from exposure to stressful stimuli: A randomized controlled trial'' [Integrative Medicine Research 11_1_100753].

[This retracts the article DOI: 10.1016/j.imr.2021.100753.].

Effects of a Thermoelectric Element Band on Venipuncture-associated Pain and Anxiety: A Randomized Controlled Trial.

PURPOSE: Venipuncture is an invasive procedure for diagnosis and treatment, which is often attributed to pain and anxiety. In this study, a thermoelectric element (TEE) band was developed to apply heat therapy (40∼45°C), cold therapy (0∼10°C), or thermal grill illusion (TGI) therapy (40∼45°C, 0∼10°C) to cause an illusion of pain by simultaneously applying heat and cold. This band was subsequently used to investigate its effect on patient pain, anxiety, and satisfaction. METHODS: This was a randomized controlled study. Participants, who were to undergo venipuncture, were randomly assigned to the heat therapy, cold therapy, TGI therapy, or control groups. Each group had 30 participants. The interventions were employed for 10 seconds during venipuncture, and the pain, anxiety, and satisfaction were measured before and after the procedure. RESULTS: Subjective pain, anxiety, and physiological responses after TEE band intervention were not significantly different between the four groups. However, there was a significant difference in satisfaction (F = 4.21, p = .007) between the four groups, and the cold therapy group showed the highest satisfaction. CONCLUSION: In this study, when heat, cold, and TGI therapy were applied with a TEE band, pain and anxiety relief effects were not confirmed, but satisfaction was high. TEE band is a newly developed product that can easily apply hot and cold treatments without using ice packs or hot water packs. Further studies with various individual characteristics of chronic pain or repeated venipuncture are warranted to evaluate the effect of TEE.

The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

As the incidence and prevalence of diabetes increases, intervention through dietary education is becoming more important for diabetes control. This systematic review examines the evidence for the efficacy of dietary education interventions on diabetes control. The study subjects were patients with type 2 diabetes, and the main outcome variable was glycosylated hemoglobin level (HbA1c). The target studies were randomized controlled trials. Thirty-six studies were included in the analysis, of which 33 were included in the meta-analysis. The effect size between dietary education and general interventions was -0.42 (n = 5639, MD = -0.42; 95% CI -0.53 to -0.31) and was significantly different (Z = 7.73, p < 0.001). When subgroup analyses were performed following the application periods, intervention methods, and intervention contents, the mean differences in 4-6-month application, individual education, and diet-exercise-psychosocial intervention were -0.51, (n = 2742, 95% CI -0.71 to -0.32), -0.63 (n = 627, 95% CI -1.00 to -0.26), and -0.51 (n = 3244, 95% CI -0.71 to -0.32), respectively. Dietary education interventions provided for at least 3 months were highly effective in controlling HbA1c levels. Regarding the education method, individualized education was more effective, and contact or non-contact education may be applied for this. Combining diet, exercise, and psychosocial intervention is more effective than diet education alone.

Antimicrobial and hand hygiene effects of Tea Tree Essential Oil disinfectant: A randomised control trial.

BACKGROUND: Hand hygiene is paramount in preventing healthcare-associated infections in medical environments and the spread of infectious diseases in non-medical environments. AIMS: This study used a randomised controlled trial to investigate the effects of a tea tree (Melaleuca alternifolia) oil disinfectant on hand disinfection and skin condition. METHODS: A tea tree oil group received 5 mL of 10% tea tree oil disinfectant mixed in a ratio of 2:2:1:15 of Melaleuca alternifolia oil, solubiliser, glycerin and sterile distilled water. Data collection took place between April 9 and April 13, 2018. The subjects were 112 healthy adults. An alcohol group received 2 mL of a gel-type hand sanitiser comprising 83% ethanol used without water; a benzalkonium chloride group received 0.8 mL of a foam-type hand sanitiser containing benzalkonium chloride used without water and a control group received no treatment. Subjective skin condition, transepidermal water loss and adenosine triphosphate were assessed, and a microbial culture test was performed following treatment. RESULTS: The general characteristics and the pretreatment dependent variables did not differ significantly by group. Posttreatment adenosine triphosphate log10 values significantly differed across all four groups (F = 3.23, P = .025). Similarly, posttreatment bacterial density log10 values differed significantly across the tea tree oil, alcohol, benzalkonium chloride and control groups (F = 91.71, P < .001). CONCLUSION: The study confirmed that tea tree oil disinfectant is effective for hand disinfection. Accordingly, tea tree oil disinfectants may be introduced to nursing practice as a new hand hygiene product to prevent and reduce healthcare-associated infections.

A qualitative study on the experience of acupuncture treatment in infertile women.

BACKGROUND: This study aimed to record and analyze the experiences of infertile women who underwent acupuncture treatment. METHODS: This is a qualitative study in which in-depth interviews were conducted with women who underwent acupuncture as a treatment for infertility from the viewpoint of phenomenology, a method of understanding human behavior in the general human and social context, and grasping the nature of the experience in depth. The study participants were 12 women who had been receiving acupuncture treatment for infertility for more than 3 months. RESULTS: After analyzing the statements of the participants' experiences, the main concerns regarding infertility were "embarrassed by unexpected infertility," "overwhelmed with negative feelings," "blocking and defense," "sex as a duty," and "repeatition of expectations and failures." Significant statements regarding acupuncture treatments were "body warmth," "becoming a body," "care of the mind," "last trust and hope," and "difficulties of waiting." The experience with supporter was love-hate relationships, and the experience of the children's meaning was expressed as "precious beings in life." CONCLUSION: The results of this study suggest that acupuncture treatment for infertility in women results in positive thinking through changes in the body as well as through increased hope. Participants experienced a feeling of warmth in their bodies, regular menstrual cycle, and reduced fatigue through acupuncture treatment, indicating a state of psychological stability.

Effects of aromatherapy on dysmenorrhea: A systematic review and meta-analysis.

OBJECTIVE: Menstrual pain is not a disease, but it is a problem that periodically makes women uncomfortable during menstrual cycles. There has been a continuing effort to alleviate menstrual cramps in the medical field. Aromatherapy, one of the alternative complementary therapies, has been used as a way to alleviate menstrual cramps, but there is still little evidence of how to use it. Therefore, in this study, we tried to find and provide the evidence of relieving effects of menstrual cramps. DESIGN: This study involved a systematic review and meta-analysis. The study was to identify the effects of aromatherapy on menstrual pain through a systematic review of the relevant literature from Korea and abroad and a meta-analysis of the data from studies meeting our inclusion criteria. DATA SOURCES: We obtained articles published in English from PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL), and we also obtained articles by searching the Korean databases Research Information Service System (RISS), DBPIA, and Korean Studies Information Service System (KISS). REVIEW METHODS: A systematic review was performed on all searchable articles published form inception to October 17, 2016, using the international and Korean databases noted above. The search terms used was ((aromatherapy OR aroma* OR essential oil) AND (dysmenorrhea OR menstrual pain)). Articles were selected for analysis from among the retrieved articles based on the key questions and the inclusion and exclusion criteria using a PRISMA flow diagram. The 21 articles entire texts were reviewed and qualitatively analyzed while seven articles were quantitatively analyzed using RevMan software ver. 5.3. RESULTS: In a comparison between the experimental groups, which received an aromatherapy intervention, and the control groups, which received no treatment of any kind, the dysmenorrhea score in the experimental group decreased by 2.67 points (mean difference -2.67), showing a statistically significant difference(Z = 7.79, p < .001, Higgins I2 = 0%). Compared to the placebo group, which received a placebo oil treatment, the dysmenorrhea score in the experimental group decreased by 1.71 points (mean difference, -1.71), showing a statistically significant difference (Z = 4.51, p < .001), but high heterogeneity (Higgins I2 = 81%). CONCLUSIONS: Aromatherapy was an effective intervention for reducing dysmenorrhea. However, because the analysis showed that the aroma intervention methods were diverse and that the basis for the intervention methods was weak, the possibility of randomization bias was high.

The Effects of Aromatherapy on Intensive Care Unit Patients' Stress and Sleep Quality: A Nonrandomised Controlled Trial.

BACKGROUND: Stress has both physiological and psychological effects and can negatively impact patients' treatment and recovery. We examined whether the aromatherapy alleviated patients' stress and improved their sleep quality and provided data that can be utilized in clinical settings. METHODS: This was a nonrandomised controlled experimental study. Participants included lucid adult patients who were admitted to the intensive care unit and had spent more than two nights there. The experimental treatment required participants to engage in deep breathing with essential oils as part of the aromatherapy. The control group was instructed to go to sleep without receiving the lavender aroma oil. RESULTS: The experimental group and control group showed a significant difference in perceived stress (F = 60.11, p < .001), objective stress index (F = 25.65, p < .001), systolic blood pressure (F = 9.09, p < .001), diastolic blood pressure (F = 2.47, p = .046), heart rate (F = 5.71, p < .001), and sleep quality (F = 109.46, p < .001). CONCLUSIONS: The results revealed that aromatherapy alleviated stress and improved sleep quality in intensive care unit patients after 2 days of the experimental treatment. These results demonstrate that aromatherapy affects stress and sleep quality, thus indicating its value in nursing interventions. This trial is registered with KCT0002344.

[Effects of Aromatherapy on Menopausal Symptoms, Perceived Stress and Depression in Middle-aged Women: A Systematic Review].

PURPOSE: This study was a systematic review to evaluate the effects of aromatherapy on menopausal symptoms, perceived stress and depression in middle aged-women. METHODS: Eight databases were searched from their inception September 8, 2015. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. For analysis of the data, a meta-analysis of the studies was performed. RESULTS: From the electronic databases, 73 articles were selected, and 19 removed due to duplication. After two reviewers read the abstracts of 54 studies, 34 studies were selected. Complete papers for 34 original articles were read and, 12 studies which met selection criteria were reviewed and the effects of aromatherapy on menopausal symptoms, stress and depression analyzed using meta-analysis with RevMan. In the 2 studies which included Randomized Controlled Trials testing of aromatherapy on menopausal symptoms and comparison of control and placebo groups were done. Aromatherapy massage was favorably effective in reducing the menopausal symptoms compared to the control group (n=118, MD=-6.33; 95% CI -11.51 to -1.15), and compared to the placebo group (n=117, MD=-4.14; 95% CI -7.63 to -0.64). Also aromatherapy was effective in reducing stress (n=72, SMD=-0.64; 95% CI -1.12 to -0.17) and depression (n=158, MD=-5.63; 95% CI -10.04 to -1.22). CONCLUSION: There is limited evidence suggesting that aromatherapy for middle-aged women may be effective in controlling menopausal symptoms, perceived stress and depression.

[Inhalation Effects of Aroma Essential Oil on Quality of Sleep for Shift Nurses after Night Work].

PURPOSE: This study was an experimental study to compare the inhalation effects of aroma essential oil on the quality of sleep (QOS) for shift nurses after working nights. METHODS: The participants were 60 healthy adults who didn't have any disease. As an experimental treatment, the participants in the experimental group were asked to inhale essential oil for 3 minutes at a distance of approximately 10 cm fromt heir nose and then they were asked to sleep with the aroma stone beside their head (within a 30 cm distance). QOS were measured four times on Pretest, Day 1, Day 2, and Day 3 after they slept. To measure QOS, Perceived QOS (Numeric Rating Scale), the Verran & Synder-Halpern (VSH) Sleep Scale were used, and number of awakenings (NoA) was measured by Actigraph. RESULTS: There were no significant differences in the homogeneity tests for general characteristics and dependent variables prior to the experiments, except for VSH of subjective sleep quality. Also, there was no significant interaction between group and time. The VSH of the experimental group was higher than the control group (F=6.39, p=.002). The NoA between the experimental group and the control group was significantly different after experimental treatment 3rd day (F=13.35, p=.001). CONCLUSION: The findings show that the inhalation of aroma essential oil had effects to increase the quality of sleep. Therefore, the inhalation of aroma essential oil could be applied to general nursing interventions to improve the quality of sleep.

Aromatherapy for stress reduction in healthy adults: a systematic review and meta-analysis of randomized clinical trials.

The aim of this review was to systematically assess the effectiveness of aromatherapy for stress management. Seven databases were searched from their inception through April 2014. RCTs testing aromatherapy against any type of controls in healthy human person that assessed stress level and cortisol level were considered. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. Five RCTs met our inclusion criteria, and most of them had high risk of bias. Four RCTs tested the effects of aroma inhalation compared with no treatment, no aroma, and no odour oil. The meta-analysis suggested that aroma inhalation has favourable effects on stress management (n=80; standard mean difference (SMD), -0.96; 95% CI, -1.44 to -0.48; P<0.0001; I(2)=0%). Three of included RCTs tested aroma inhalation on saliva or serum cortisol level compared with control and meta-analysis failed to show significant difference between two groups (n=88, SMDs -0.62; 95% CIs -1.26 to 0.02, P=0.06, I(2)=46%). In conclusion, there is limited evidence suggesting that aroma inhalation may be effective in controlling stress. However, the number, size and quality of the RCTs are too low to draw firm conclusions.

Intra-operative music listening for anxiety, the BIS index, and the vital signs of patients undergoing regional anesthesia.

OBJECTIVE: The aim of this study was to investigate the effects of intraoperative music listening on anxiety, the BIS index, and the vital signs of patients undergoing regional anesthesia in an operating room. METHODS: Eighty patients who were scheduled for a surgery that would use regional anesthesia were allocated to either the music therapy group listened to music using headphones for the entire surgery or no-treatment control group. Outcome measures were blood pressure (BP) and the BIS index. RESULTS: Anxiety was significantly differed between the two groups (t=11.27, p=<.001). The BIS index was significantly lower in the experimental group than the control group from 15min to the end of the operation (F=7.25, p<.001). Vital signs marginally differed between the two groups. CONCLUSION: Music therapy during surgery maybe an effective nursing intervention that relieves anxiety and increases sedation in patients undergoing surgery with regional anesthesia.

Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units.

The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P < .001) and improving sleep quality (t = -3.65, P = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F = 4.63, P = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F = 6.93, P = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

Effects of aroma massage on home blood pressure, ambulatory blood pressure, and sleep quality in middle-aged women with hypertension.

The purpose of this study was to evaluate the effects of aroma massage applied to middle-aged women with hypertension. The research study had a nonequivalent control group, nonsynchronized design to investigate the effect on home blood pressure (BP), ambulatory BP, and sleep. The hypertensive patients were allocated into the aroma massage group (n = 28), the placebo group (n = 28), and the no-treatment control group (n = 27). To evaluate the effects of aroma massage, the experimental group received a massage with essential oils prescribed by an aromatherapist once a week and body cream once a day. The placebo group received a massage using artificial fragrance oil once a week and body cream once a day. BP, pulse rate, sleep conditions, and 24-hour ambulatory BP were monitored before and after the experiment. There was a significant difference in home systolic blood pressure (SBP) (F = 6.71, P = 0.002) between groups after intervention. There was also a significant difference in SBP (F = 13.34, P = 0.001) and diastolic blood pressure (DBP) (F = 8.46, P = 0.005) in the laboratory between aroma massage and placebo groups. In sleep quality, there was a significant difference between groups (F = 6.75, P = 0.002). In conclusion, aroma massage may help improve patient quality of life and maintain health as a nursing intervention in daily life.

Essential oil inhalation on blood pressure and salivary cortisol levels in prehypertensive and hypertensive subjects.

The purpose of this study was to identify the effects of essential oil inhalation on the 24-hour ambulatory blood pressure (BP) and salivary cortisol level in 83 prehypertensive and hypertensive subjects. The experimental group (n = 28) was asked to inhale an essential oil blended with lavender, ylang-ylang, marjoram, and neroli (20 : 15 : 10 : 2), whereas the placebo group (n = 27) was asked to inhale an artificial fragrance for 24 hours and the control group received no treatment (n = 28). The SBP (P < .001) and DBP (P = .009) measured at home in the experimental group were significantly decreased compared with the placebo group and the control group after treatment. The daytime SBP during the 24-hour ambulatory BP measurement of the experimental group presented with significant decreases in comparison with the measurements of the placebo group and the control group (P < .001). There was no statistically significant difference in the nighttime SBPs. The daytime DBPs during the 24-hour ambulatory BP measurements of the experimental group presented with significant decreases in comparison with the measurements of the placebo group and the control group (P = .002). There was no significant difference in the night time DBPs. The experimental group showed significant decreases in the concentration of salivary cortisol in comparison with the concentrations of the placebo group and the control group (P = .012). In conclusion, the inhalation of an essential oil had immediate and continuous effects on the home SBP, daytime BP, and the stress reduction. Essential oils may have relaxation effects for controlling hypertension.

[Effects of A-solution on halitosis and oral status in preoperative NPO patients].

PURPOSE: The aim of this study was to explore the effects of A-solution on halitosis and oral status in preoperative NPO patients. METHODS: A nonequivalent control group, non-synchronized pretest-posttest design was used in this study. The participants in this study were 66 patients who were admitted for gynecologic surgery. The experimental treatment was to give oral gargling with A-solution, blended essential oils and diluted with distilled water. To identify the experimental treatment effects, halitosis, salivary pH, and oral status were measured by a portable halitosis detector, visual analogue scale, Bromo Thymol Blue (BTB), Bromo Cresol Purple (BCP) test paper and oral assessment guide. Data were analyzed using χ²-test, t-test with PASW 18.0 version. RESULTS: Participants were homogeneous before experimental treatment. Objective halitosis in the experimental group, measured by a portable halitosis detector (t= -8.34, p<.001) was significantly lower than the control group. Subjective halitosis was significantly lower in the experimental group (t= -9.29, p<.001). Salivary pH was significantly different between two groups (t=8.81, p<.001). Oral status was significantly better in the experimental group (t= -13.31, p<.001). CONCLUSION: These findings indicate that oral gargling using A-solution is effective in reducing patient halitosis, and improving oral status.

Aromatherapy massage on the abdomen for alleviating menstrual pain in high school girls: a preliminary controlled clinical study.

This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.

Aromatherapy for treatment of hypertension: a systematic review.

OBJECTIVES: The objective of this review is to systematically review the evidence for the effectiveness of aromatherapy in the treatment of high blood pressure. METHODS: Twelve databases were searched from their inception through December 2009. Controlled trials testing aromatherapy in patients with hypertension of any origin that assessed blood pressure were considered. The selection of studies, data extraction and validations were performed independently by two reviewers. RESULTS: One randomized clinical trial (RCT) and four non-randomized controlled clinical trials (CCTs) met our inclusion criteria. The one RCT included tested the effects of aromatherapy as compared with placebo and showed significant reduction of systolic blood pressure and diastolic blood pressure. All of the four CCTs showed favourable effects of aromatherapy. However, all of the CCTs also had a high risk of bias. CONCLUSION: The existing trial evidence does not show convincingly that aromatherapy is effective for hypertension. Future studies should be of high quality with a particular emphasis on designing an adequate control intervention.