Stewards TTSH

Stewards TTSH We are a team within TTSH researching on the socio-behavioural aspects of appropriate antibiotic use.

The "SteWARdS" in our name is shorthand for the goal our team of researchers are working towards. It represents: Steering towards the wise use of antimicrobial through understanding and addressing the determinants in Singapore.

Our Principal Epidemiologist, Dr Guo Huiling, shared her research findings as a featured speaker at the Singapore Veteri...
28/04/2025

Our Principal Epidemiologist, Dr Guo Huiling, shared her research findings as a featured speaker at the Singapore Veterinary Association Local Vet Conference 2025, last weekend.

Her presentation on the VALUE of Companion SteWARdS: Understanding the facilitators and barriers to appropriate antibiotic prescribing in veterinary clinics for companion animals in Singapore revealed valuable insights in the local veterinary setting.

Thank you, Singapore Veterinary Association and Dr Boon Han Teo for the opportunity to be part of this significant event.

๐๐ฅ๐š๐ฌ๐ญ๐ข๐œ ๐–๐š๐ฌ๐ญ๐ž ๐š๐ง๐ ๐‚๐Ž๐•๐ˆ๐ƒ-๐Ÿ๐Ÿ— ๐ˆ๐ง๐œ๐ข๐๐ž๐ง๐œ๐ž ๐€๐ฆ๐จ๐ง๐  ๐‡๐จ๐ฌ๐ฉ๐ข๐ญ๐š๐ฅ ๐’๐ญ๐š๐Ÿ๐Ÿ ๐€๐Ÿ๐ญ๐ž๐ซ ๐ƒ๐ž๐ž๐ฌ๐œ๐š๐ฅ๐š๐ญ๐ข๐จ๐ง ๐ข๐ง ๐๐๐„ ๐”๐ฌ๐ž ๐ŸŒฟ๐ŸฉบA quality improvement project ...
24/04/2025

๐๐ฅ๐š๐ฌ๐ญ๐ข๐œ ๐–๐š๐ฌ๐ญ๐ž ๐š๐ง๐ ๐‚๐Ž๐•๐ˆ๐ƒ-๐Ÿ๐Ÿ— ๐ˆ๐ง๐œ๐ข๐๐ž๐ง๐œ๐ž ๐€๐ฆ๐จ๐ง๐  ๐‡๐จ๐ฌ๐ฉ๐ข๐ญ๐š๐ฅ ๐’๐ญ๐š๐Ÿ๐Ÿ ๐€๐Ÿ๐ญ๐ž๐ซ ๐ƒ๐ž๐ž๐ฌ๐œ๐š๐ฅ๐š๐ญ๐ข๐จ๐ง ๐ข๐ง ๐๐๐„ ๐”๐ฌ๐ž ๐ŸŒฟ๐Ÿฉบ

A quality improvement project using retrospective data from Tan Tock Seng Hospital and National Centre for Infectious Diseases compared COVID-19 incidence rates among hospital staff with those in the community, before and after implementation of PPE deescalation measures:

๐Ÿฆ  Pandemic phase/Before PPE deescalation (Oct 2021โ€“Sept 2022): Full PPE (N95 + gown + gloves)

๐Ÿ˜ท Endemic phase/After PPE deescalation (Oct 2022โ€“Sept 2023): N95-only for routine COVID-19 care

๐Ÿ“‰ The key finding:

No significant association between PPE de-escalation and COVID-19 incidence in HCP, with infection trends mirroring population infection rates.

๐ŸŒฑ The sustainability gains were significant:

โ€“ 66,080 kg less plastic waste

โ€“ 393,258 kg fewer COโ‚‚-equivalent emissions

โ€“ SGD 453,748 in cost savings

As we mark , this is a timely reminder: small systemic changes in healthcare can have significant environmental impact without compromising patient safety.

๐Ÿ“– Read the full publication: doi.org/10.1001/jamanetworkopen.2025.5264

This quality improvement study evaluates whether personal protective equipment (PPE) deescalation guidelines in Singapore was associated with staff COVID-19 incidence as well as the environmental sustainability outcomes of PPE deescalation.

Selamat Hari Raya! ๐ŸŒ™โœจ May your heart be light, your home be bright, and your day be filled with love and laughter! ๐Ÿ’›    ...
31/03/2025

Selamat Hari Raya! ๐ŸŒ™โœจ
May your heart be light, your home be bright, and your day be filled with love and laughter! ๐Ÿ’›

28/02/2025

๐Ÿ“ข ๐“๐ก๐ž ๐•๐€๐‹๐”๐„ ๐จ๐Ÿ ๐š๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐ฌ๐ญ๐ž๐ฐ๐š๐ซ๐๐ฌ๐ก๐ข๐ฉ ๐Ÿ๐จ๐ซ ๐œ๐จ๐ฆ๐ฉ๐š๐ง๐ข๐จ๐ง ๐š๐ง๐ข๐ฆ๐š๐ฅ๐ฌ: ๐”๐ง๐๐ž๐ซ๐ฌ๐ญ๐š๐ง๐๐ข๐ง๐  ๐š๐ฉ๐ฉ๐ซ๐จ๐ฉ๐ซ๐ข๐š๐ญ๐ž ๐š๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐ฉ๐ซ๐ž๐ฌ๐œ๐ซ๐ข๐›๐ข๐ง๐  ๐Ÿ๐จ๐ซ ๐ฉ๐ž๐ญ ๐œ๐š๐ญ๐ฌ ๐š๐ง๐ ๐๐จ๐ ๐ฌ ๐ข๐ง ๐ฏ๐ž๐ญ๐ž๐ซ๐ข๐ง๐š๐ซ๐ฒ ๐œ๐ฅ๐ข๐ง๐ข๐œ๐ฌ ๐ข๐ง ๐’๐ข๐ง๐ ๐š๐ฉ๐จ๐ซ๐ž ๐Ÿถ๐Ÿฑ

Our study explored factors influencing antibiotic prescribing for pet cats & dogs in Singapore. We found that:

โœ”๏ธ There were autonomous, yet unanimous, efforts by veterinarians to ensure appropriate antibiotic prescribing practices for pet cats and dogs, but these efforts were often attributed to the purpose of sustaining business revenue for the clinics.
โœ”๏ธ National guidelines were loosely followed; Clinic-level antibiotic practices were a reflection of key decision-making veterinariansโ€™ personal valuing of AMR.
โœ”๏ธ Taking reference from laboratory-based diagnostics for treatment with antibiotics was the known best practice, but potential poor owner satisfaction due to additional costs incurred was a misalignment with clinic valuing of business viability.
โœ”๏ธ Open discussions amongst colleagues to share knowledge and best practices in antibiotic prescribing were observed, and they involved veterinary nurses and technicians as well.
โœ”๏ธ Shared decision-making between veterinarians and pet owners were common, but it was usually for the purpose of respecting ownersโ€™ rights and not for improving appropriate antibiotic prescribing.
โœ”๏ธ Audits were welcomed, but resource limitations, such as manpower and effort, remained a key barrier.

๐Ÿ” Recommendations:

โœ… Formally recognise and integrate existing antibiotic stewardship efforts into clinic values and missions, that aligns with the clinic's prioritisation of business viability.
โœ… Provide collective training for all clinic staff, not just licensed veterinarians, and encourage conversations across different One Health sectors.
โœ… Continue shared decision-making with pet owners, extending further to educate and empower them to recognise and renounce unauthorised antibiotic use for their pets.
โœ… Track meaningful indicators, such as engaging in shared decision-making and tailoring antibiotic courses to pet owners' capacity to administer medication, as part of future audits.
โœ… Tap on technological advancements to address resource limitations for data extraction and monitoring.

Read the full study here: doi.org/10.1016/j.onehlt.2025.100994

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๐Ÿ‘ฅ ๐Œ๐จ๐๐ข๐Ÿ๐ฒ๐ข๐ง๐  ๐„๐Ÿ๐Ÿ๐ž๐œ๐ญ๐ฌ ๐จ๐Ÿ ๐“๐ซ๐ฎ๐ฌ๐ญ๐ž๐ ๐…๐ซ๐ข๐ž๐ง๐๐ฌ ๐ข๐ง ๐ญ๐ก๐ž ๐€๐๐จ๐ฉ๐ญ๐ข๐จ๐ง ๐จ๐Ÿ ๐‡๐ž๐š๐ฅ๐ญ๐ก๐ฒ ๐๐ž๐ก๐š๐ฏ๐ข๐จ๐ฎ๐ซ๐ฌFriends shape our behaviours, but how much d...
21/02/2025

๐Ÿ‘ฅ ๐Œ๐จ๐๐ข๐Ÿ๐ฒ๐ข๐ง๐  ๐„๐Ÿ๐Ÿ๐ž๐œ๐ญ๐ฌ ๐จ๐Ÿ ๐“๐ซ๐ฎ๐ฌ๐ญ๐ž๐ ๐…๐ซ๐ข๐ž๐ง๐๐ฌ ๐ข๐ง ๐ญ๐ก๐ž ๐€๐๐จ๐ฉ๐ญ๐ข๐จ๐ง ๐จ๐Ÿ ๐‡๐ž๐š๐ฅ๐ญ๐ก๐ฒ ๐๐ž๐ก๐š๐ฏ๐ข๐จ๐ฎ๐ซ๐ฌ

Friends shape our behaviours, but how much do they influence our health choices?

Our study of 2004 Singaporean/PRs (Nov 2020 โ€“ Jan 2021) explored whether having trusted friends to discuss health issues impacts the adoption of healthy behaviours.

๐Ÿ” Key Findings:
โœ… Only 16.5% of participants adopted a high level of healthy behaviours (healthy diet, regular exercise, no smoking, less sugar, good sleep).
โœ… Older adults (60+) were generally 2.36x more likely to adopt a high level of healthy behaviours than younger adults (

Modifying Effects of Trusted Friends in the Adoption of Healthy Behaviors 1 Angela Chow Tan Tock Seng Hospital Singapore Modifying Effects of Trusted Friends in the Adoption of Healthy Behaviors

๐Ÿถ๐Ÿฑ ๐๐ž๐ญ ๐Ž๐ฐ๐ง๐ž๐ซ๐ฌโ€™ ๐Š๐ง๐จ๐ฐ๐ฅ๐ž๐๐ ๐ž ๐จ๐Ÿ ๐€๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐”๐ฌ๐ž ๐š๐ง๐ ๐€๐ง๐ญ๐ข๐ฆ๐ข๐œ๐ซ๐จ๐›๐ข๐š๐ฅ ๐‘๐ž๐ฌ๐ข๐ฌ๐ญ๐š๐ง๐œ๐ž ๐š๐ง๐ ๐“๐ก๐ž๐ข๐ซ ๐€๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐๐ซ๐š๐œ๐ญ๐ข๐œ๐ž๐ฌ: ๐‚๐จ๐ฆ๐ฉ๐š๐ซ๐ข๐ฌ๐จ๐ง ๐๐ž๐ญ๐ฐ๐ž...
14/02/2025

๐Ÿถ๐Ÿฑ ๐๐ž๐ญ ๐Ž๐ฐ๐ง๐ž๐ซ๐ฌโ€™ ๐Š๐ง๐จ๐ฐ๐ฅ๐ž๐๐ ๐ž ๐จ๐Ÿ ๐€๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐”๐ฌ๐ž ๐š๐ง๐ ๐€๐ง๐ญ๐ข๐ฆ๐ข๐œ๐ซ๐จ๐›๐ข๐š๐ฅ ๐‘๐ž๐ฌ๐ข๐ฌ๐ญ๐š๐ง๐œ๐ž ๐š๐ง๐ ๐“๐ก๐ž๐ข๐ซ ๐€๐ง๐ญ๐ข๐›๐ข๐จ๐ญ๐ข๐œ ๐๐ซ๐š๐œ๐ญ๐ข๐œ๐ž๐ฌ: ๐‚๐จ๐ฆ๐ฉ๐š๐ซ๐ข๐ฌ๐จ๐ง ๐๐ž๐ญ๐ฐ๐ž๐ž๐ง ๐‚๐จ๐ง๐ญ๐ž๐ฑ๐ญ๐ฌ ๐จ๐Ÿ ๐’๐ž๐ฅ๐Ÿ ๐š๐ง๐ ๐๐ž๐ญ

We compared pet ownersโ€™ knowledge of antibiotic use, understanding of AMR and antibiotic practices for themselves and their pets.

Results from our study of 1,080 pet owners across 16 vet clinics in Singapore found:

๐Ÿ“‰ Poor antibiotic knowledge โ€“ 33.2% for themselves vs. 46.3% for pets (p < 0.001)
๐Ÿ’Š Inappropriate antibiotic use โ€“ 23.5% for themselves vs. 33.9% for pets (p < 0.001)
๐Ÿพ Non-dog owners had poorer knowledge of antibiotic use for their pet compared to dog owners (55.2% vs. 42.4%; p < 0.001)

These findings highlight the need for One Health education to improve antibiotic practices and curb AMR.

Read more here: doi.org/10.3390/antibiotics14020158

Objective: This study aimed to compare pet ownersโ€™ knowledge of antibiotic use, understanding of antimicrobial resistance (AMR) and antibiotic practices for themselves and their pets to guide behavioral interventions to reduce AMR. Methods: A cross-sectional study conducted between March 2023 and ...

Wishing you a prosperous and healthful Lunar New Year! ๐Ÿงง โœจ
29/01/2025

Wishing you a prosperous and healthful Lunar New Year! ๐Ÿงง โœจ

๐ŸŽ„โœจ Wishing you a season full of joy, health, love, and laughter. Merry Christmas! โค๏ธ
26/12/2024

๐ŸŽ„โœจ Wishing you a season full of joy, health, love, and laughter. Merry Christmas! โค๏ธ

๐—ฅ๐—ฒ๐—ฎ๐—น-๐—ช๐—ผ๐—ฟ๐—น๐—ฑ ๐—˜๐˜ƒ๐—ฎ๐—น๐˜‚๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—ฃ๐—ผ๐—ถ๐—ป๐˜-๐—ผ๐—ณ-๐—–๐—ฎ๐—ฟ๐—ฒ ๐—ง๐—ฒ๐˜€๐˜๐—ถ๐—ป๐—ด ๐—ณ๐—ผ๐—ฟ ๐—›๐—ฒ๐—ฝ๐—ฎ๐˜๐—ถ๐˜๐—ถ๐˜€ ๐—– ๐—”๐—ป๐˜๐—ถ๐—ฏ๐—ผ๐—ฑ๐—ถ๐—ฒ๐˜€: ๐—ก๐—ฎ๐˜ƒ๐—ถ๐—ด๐—ฎ๐˜๐—ถ๐—ป๐—ด ๐—›๐—ฒ๐—ฝ๐—ฎ๐˜๐—ถ๐˜๐—ถ๐˜€ ๐—– ๐—˜๐—น๐—ถ๐—บ๐—ถ๐—ป๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—˜๐—ณ๐—ณ๐—ผ๐—ฟ๐˜As p...
06/12/2024

๐—ฅ๐—ฒ๐—ฎ๐—น-๐—ช๐—ผ๐—ฟ๐—น๐—ฑ ๐—˜๐˜ƒ๐—ฎ๐—น๐˜‚๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—ฃ๐—ผ๐—ถ๐—ป๐˜-๐—ผ๐—ณ-๐—–๐—ฎ๐—ฟ๐—ฒ ๐—ง๐—ฒ๐˜€๐˜๐—ถ๐—ป๐—ด ๐—ณ๐—ผ๐—ฟ ๐—›๐—ฒ๐—ฝ๐—ฎ๐˜๐—ถ๐˜๐—ถ๐˜€ ๐—– ๐—”๐—ป๐˜๐—ถ๐—ฏ๐—ผ๐—ฑ๐—ถ๐—ฒ๐˜€: ๐—ก๐—ฎ๐˜ƒ๐—ถ๐—ด๐—ฎ๐˜๐—ถ๐—ป๐—ด ๐—›๐—ฒ๐—ฝ๐—ฎ๐˜๐—ถ๐˜๐—ถ๐˜€ ๐—– ๐—˜๐—น๐—ถ๐—บ๐—ถ๐—ป๐—ฎ๐˜๐—ถ๐—ผ๐—ป ๐—˜๐—ณ๐—ณ๐—ผ๐—ฟ๐˜

As part of the global effort to eliminate Hepatitis C Virus (HCV), it's critical to improve diagnostic methods. Our recent study evaluated the diagnostic performance of the HCV ๐—ฃ๐—ผ๐—ถ๐—ป๐˜-๐—ผ๐—ณ-๐—–๐—ฎ๐—ฟ๐—ฒ ๐—ง๐—ฒ๐˜€๐˜ (๐—ฃ๐—ข๐—–๐—ง) in the real world context of ๐—ฃ๐—ฒ๐—ผ๐—ฝ๐—น๐—ฒ ๐—ช๐—ต๐—ผ ๐—œ๐—ป๐—ท๐—ฒ๐—ฐ๐˜ ๐——๐—ฟ๐˜‚๐—ด๐˜€ (๐—ฃ๐—ช๐—œ๐——) in Singapore.

Hereโ€™s a quick snapshot of our findings:

- Out of 207 participants, 37.2% were tested positive for HCV antibodies. Our study compared results from venous blood testing for ๐—ฎ๐—ป๐˜๐—ถ-๐—›๐—–๐—ฉ ๐˜€๐—ฒ๐—ฟ๐—ผ๐—น๐—ผ๐—ด๐˜† with POCT methods: fingerstick capillary whole blood (FSWB) and oral mucosal transudates (OMT).

- POCT with ๐—™๐—ฆ๐—ช๐—• showed higher sensitivity (81.8%) and specificity (100%) against anti-HCV serology compared to ๐—ข๐— ๐—ง (sensitivity 74.0%, specificity 98.5%, p=0.014).

- Proper patient selection and pre-test preparation (30-min nil-by-mouth) improved POCT OMT performance (Sensitivity 77.5% and Specificity 98.4%), which could be affected by oral pathology, differences in oral fluid immunoglobulin secretion, and age.

In conclusion, HCV testing with POCT on OMT, paired with proper preparation, with expected convenience and acceptance, could boost HCV screening uptake rates and advance global HCV elimination efforts.

๐Ÿ“˜Read research paper here: doi.org/10.1111/jvh.14039

๐Ÿ“ฐRead the newspaper article here: https://www.straitstimes.com/singapore/health/new-initiatives-launched-to-help-ex-drug-offenders-get-tested-and-treated-for-hepatitis-c

๐Ÿ“ข ๐—ก๐—ฒ๐˜„ ๐—ฅ๐—ฒ๐˜€๐—ฒ๐—ฎ๐—ฟ๐—ฐ๐—ต ๐—”๐—น๐—ฒ๐—ฟ๐˜: ๐—จ๐—ป๐—ฑ๐—ฒ๐—ฟ๐˜€๐˜๐—ฎ๐—ป๐—ฑ๐—ถ๐—ป๐—ด ๐—”๐—ป๐˜๐—ถ๐—ฏ๐—ถ๐—ผ๐˜๐—ถ๐—ฐ ๐—˜๐˜…๐—ฝ๐—ฒ๐—ฐ๐˜๐—ฎ๐˜๐—ถ๐—ผ๐—ป๐˜€ ๐—”๐—บ๐—ผ๐—ป๐—ด ๐—ฃ๐—ฒ๐˜ ๐—ข๐˜„๐—ป๐—ฒ๐—ฟ๐˜€ ๐—ถ๐—ป ๐—ฆ๐—ถ๐—ป๐—ด๐—ฎ๐—ฝ๐—ผ๐—ฟ๐—ฒOur latest study dives into the...
29/11/2024

๐Ÿ“ข ๐—ก๐—ฒ๐˜„ ๐—ฅ๐—ฒ๐˜€๐—ฒ๐—ฎ๐—ฟ๐—ฐ๐—ต ๐—”๐—น๐—ฒ๐—ฟ๐˜: ๐—จ๐—ป๐—ฑ๐—ฒ๐—ฟ๐˜€๐˜๐—ฎ๐—ป๐—ฑ๐—ถ๐—ป๐—ด ๐—”๐—ป๐˜๐—ถ๐—ฏ๐—ถ๐—ผ๐˜๐—ถ๐—ฐ ๐—˜๐˜…๐—ฝ๐—ฒ๐—ฐ๐˜๐—ฎ๐˜๐—ถ๐—ผ๐—ป๐˜€ ๐—”๐—บ๐—ผ๐—ป๐—ด ๐—ฃ๐—ฒ๐˜ ๐—ข๐˜„๐—ป๐—ฒ๐—ฟ๐˜€ ๐—ถ๐—ป ๐—ฆ๐—ถ๐—ป๐—ด๐—ฎ๐—ฝ๐—ผ๐—ฟ๐—ฒ

Our latest study dives into the factors which were associated with pet owners' expectation for antibiotics for their pets during non-routine veterinary clinic consultations.

Key Findings:
๐Ÿพ ๐Ÿฎ๐Ÿณ.๐Ÿฑ% of pet owners expected antibiotics for their pets.
๐Ÿพ Poor knowledge of antibiotics increased the likelihood of expectation for antibiotics by nearly ๐Ÿฎ๐˜….
๐Ÿพ Pet owners with prior antibiotic use were ๐Ÿฑ๐˜… ๐—บ๐—ผ๐—ฟ๐—ฒ ๐—น๐—ถ๐—ธ๐—ฒ๐—น๐˜† to expect antibiotics for their pets.
๐Ÿพ Pet owners who expected antibiotics were more likely to receive antibiotics for their pets.

This underscores the importance of effective communication by veterinarians to address inappropriate antibiotic expectation among pet owners, thus tackling antibiotic resistance.

๐Ÿ“–: doi.org/10.3389/fvets.2024.1491054

Objectives: The present study aimed to assess the factors associated with pet ownersโ€™ expectations for receiving antibiotics for their pet dogs and/or cats and the factors associated with pets (dogs and/or cats) receiving antibiotics during non-routine veterinary clinic consultations in Singapore.

๐ŸŒ ๐—ช๐—ผ๐—ฟ๐—น๐—ฑ ๐—”๐—ป๐˜๐—ถ๐—บ๐—ถ๐—ฐ๐—ฟ๐—ผ๐—ฏ๐—ถ๐—ฎ๐—น ๐—”๐˜„๐—ฎ๐—ฟ๐—ฒ๐—ป๐—ฒ๐˜€๐˜€ ๐—ช๐—ฒ๐—ฒ๐—ธ (๐—ช๐—”๐—”๐—ช) ๐Ÿฎ๐Ÿฌ๐Ÿฎ๐Ÿฐ ๐ŸŒŸItโ€™s time to Act Now to combat antimicrobial resistance.AMR is a silen...
24/11/2024

๐ŸŒ ๐—ช๐—ผ๐—ฟ๐—น๐—ฑ ๐—”๐—ป๐˜๐—ถ๐—บ๐—ถ๐—ฐ๐—ฟ๐—ผ๐—ฏ๐—ถ๐—ฎ๐—น ๐—”๐˜„๐—ฎ๐—ฟ๐—ฒ๐—ป๐—ฒ๐˜€๐˜€ ๐—ช๐—ฒ๐—ฒ๐—ธ (๐—ช๐—”๐—”๐—ช) ๐Ÿฎ๐Ÿฌ๐Ÿฎ๐Ÿฐ ๐ŸŒŸ

Itโ€™s time to Act Now to combat antimicrobial resistance.

AMR is a silent global threat, but together, we can make a difference. Here are 5 key steps you can take today to help stop AMR:

1. Use antibiotics only when prescribed
Do not self-medicate or misuse antibiotics.

2. Complete the full course of treatment
Stopping your treatment early allows bacteria to survive and become resistant.

3. Practice good hygiene
Frequent handwashing, clean environments, and safe food practices keep infections at bay.

4. Stay up to date with your vaccinations
Vaccinations prevent infections and reduce the need for antibiotics.

5. Educate yourself and others about AMR
Knowledge is powerโ€”share it with your community!

๐ŸŒŸ Every action counts in safeguarding the future of antibiotics. Letโ€™s and build a healthier, safer world for everyone. ๐ŸŒ

๐Ÿ‘‰ What actions will you take today? Share below! ๐Ÿ’ฌ

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