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Leo Verhagen Metman - One of the best experts on this subject based on the ideXlab platform.
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the core assessment program for surgical interventional therapies in parkinson s disease capsit pd tolerability of preoperative Neuropsychological Testing for deep brain stimulation in parkinson s disease p3 357
Neurology, 2016Co-Authors: Gian Pal, Bryan Bernard, Christopher G. Goetz, Virginia Persinger, Bichun Ouyang, Leo Verhagen MetmanAbstract:Objective: We examined tolerability of preoperative Neuropsychological Testing (the Core Assessment Program for Surgical Interventional Therapies in Parkinson9s Disease [CAPSIT-PD] protocol) for DBS. We also examined factors that may influence tolerability, including fatigue, global cognitive function, depression, and patient-based characteristics. Background:The CAPSIT-PD protocol was published in 1999 with the goal of providing the minimal requirements for a common patient evaluation protocol for surgical interventions, including DBS, in PD. Factors such as fatigability, baseline cognitive impairment, duration of Testing, and disease duration, may influence Neuropsychological performance, but have not fully been explored. Methods:We reviewed preoperative Neuropsychological Testing results from 35 patients who were scheduled for DBS. We examined the overall tolerability of the full battery and the tolerability of each test. We placed attention on a test9s placement in the fixed order of the battery to measure whether there was a clustering of poorly tolerated tests toward the end of the battery as an indication of fatigue. Spearman9s rank correlation was used to determine the relationship between tolerability and (1) global cognitive function, (2) depression, and (3) patient-based characteristics. Results:Fourteen subjects (40[percnt]) were able to tolerate the full battery and completed all 10 tests. The domains that were least tolerated pertained to executive function and procedural memory. There was a consistent time-based tolerability pattern that was observed. There was a significant correlation between tolerability and global cognitive function (ρ = 0.344; P = 0.043), but not depression (P = 0.197). There was a significant correlation between tolerability and age (ρ = −0.491; P = 0.003) and disease duration (ρ = −0.442; P = 0.008), but not UPDRS-III scores (P = 0.284). Conclusions:Given the limited tolerability of the Neuropsychological battery as outlined by the CAPSIT-PD protocol, we suggest the consideration of updating the Neuropsychological assessment used for DBS implantation. Disclosure: Dr. Pal has received personal compensation for activities with Medtronic, US World Meds, Allergan, Ipsen, Merz & Solstice Neurosciences, Sermo, Deerfield Institute, and Huron Consulting Services. Dr. Persinger has nothing to disclose. Dr. Bernard has received research support from the Parkinson9s Disease Foundation. Dr. Ouyang has nothing to disclose. Dr. Goetz has received royalty payments from Oxford University Press, Elsevier Publishers, Wolters Kluwer Health-Lippincott, and Wilkins and Wilkins. Dr. Verhagen has received personal compensation for activities with Medtronic, Depomed, and Impax as a consultant. Dr. Verhagen has received research support from Medtronic, Boston Scientific, Adamas, Osmotica, Avanir, WorldMeds, NIH, and the Michael J Fo
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the core assessment program for surgical interventional therapies in parkinson s disease capsit pd tolerability of preoperative Neuropsychological Testing for deep brain stimulation in parkinson s disease
Movement Disorders Clinical Practice, 2015Co-Authors: Gian Pal, Bryan Bernard, Christopher G. Goetz, Virginia Persinger, Bichun Ouyang, Leo Verhagen MetmanAbstract:Objective We examined tolerability of preoperative Neuropsychological Testing (the Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease [CAPSIT-PD] protocol) for DBS. We also examined factors that may influence tolerability, including fatigue, global cognitive function, depression, and patient-based characteristics. Methods In this retrospective study, we reviewed preoperative Neuropsychological Testing results from 35 patients who were scheduled to undergo DBS. We examined the overall tolerability of the full battery and the tolerability of each test. We placed attention on a test's placement in the fixed order of the battery to measure whether there was a clustering of poorly tolerated tests toward the end of the battery as an indication of fatigue. Spearman's rank correlation was used to determine the relationship between tolerability and (1) global cognitive function, (2) depression, and (3) patient-based characteristics. Results Fourteen subjects (40%) were able to tolerate the full battery and completed all 10 tests. The domains that were least tolerated pertained to executive function and procedural memory. There was a consistent time-based tolerability pattern that was observed. There was a significant correlation between tolerability and global cognitive function (ρ = 0.344; P = 0.043), but not depression (P = 0.197). There was a significant correlation between tolerability and age (ρ = −0.491; P = 0.003) and disease duration (ρ = −0.442; P = 0.008), but not UPDRS-III scores (P = 0.284). Conclusion Our results have shown limited tolerability of the full Neuropsychological battery as outlined by the CAPSIT-PD protocol. We suggest the consideration of updating the Neuropsychological assessment used in the CAPSIT-PD protocol.
Iriskatharina Penner - One of the best experts on this subject based on the ideXlab platform.
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bects evolving to landau kleffner syndrome and back by subsequent recovery a longitudinal language reorganization case study using fmri source eeg and Neuropsychological Testing
Epilepsy & Behavior, 2013Co-Authors: Alexandre N Datta, Iriskatharina Penner, Nadine Oser, G P Ramelli, Zanda N Gobbin, G Lantz, P WeberAbstract:Abstract By means of a longitudinal case study, we demonstrated the course of cerebral reorganization of language representation due to epilepsy in a child with benign epilepsy with centro-temporal spikes (BECTS) evolving to Landau–Kleffner Syndrome (LKS) and returning to BECTS. The child underwent the following procedures at the ages of 8.2, 8.6, and 9.3 years: 3D source EEG imaging, language fMRI (sentence generation and reading), and Neuropsychological Testing. He had a follow-up Testing at the age of 10.8 years. Further, 24-h EEGs were regularly performed. At the age of around 8 years, the child was diagnosed initially with left-hemispheric BECTS, which evolved to LKS with continuous bilateral discharges. In addition, 3D source imaging data revealed a left anterior temporal focus with a spreading to the right parietal and left centro-parietal areas. The patient had verbal agnosia with poor verbal yet good performance indices. Functional magnetic resonance imaging (fMRI) showed a left-hemispheric reading network but sentence generation was impossible to perform. After initiation of adequate treatment, continuous discharges disappeared, and only very rare left-hemispheric centro-temporal spikes remained. Verbal IQ and performance IQ increased at the age of 8.6 years. Functional magnetic resonance imaging showed, at this time, a right-hemispheric language activation pattern for sentence generation and reading. At the ages of 9.3 and 10.8 years, language tasks remained right-hemispheric and verbal IQ remained stable, but right-hemispheric non-verbal functions decreased due to possible crowding-out mechanisms.
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utility of Neuropsychological Testing for guiding treatment decisions in paediatric multiple sclerosis
Multiple Sclerosis Journal, 2013Co-Authors: Iriskatharina Penner, Martina Hubacher, Maria Rasenack, Till Sprenger, P Weber, Yvonne NaegelinAbstract:In the past years, there has been growing awareness about childhood onset multiple sclerosis (MS) and the relevance of psychosocial aspects such as cognitive disturbances, fatigue and depression in this population. We describe a case of a 16-year-old patient with relapsing-remitting multiple sclerosis (RRMS) who presented at our clinic with severe fatigue symptoms and who underwent repeated Neuropsychological examinations. A sudden significant slowing indicated a new relapse while neurological examination did not. This case highlights the high sensitivity and clinical relevance of Neuropsychological Testing in patients with juvenile MS even in the context of treatment decisions.
Mark R. Lovell - One of the best experts on this subject based on the ideXlab platform.
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concussion in professional football recovery of nfl and high school athletes assessed by computerized Neuropsychological Testing part 12
Neurosurgery, 2006Co-Authors: Elliot J. Pellman, Mark R. Lovell, David C. Viano, Ira R. CassonAbstract:OBJECTIVE: Acute recovery from concussion (mild traumatic brain injury) is assessed in samples of NFL and high school athletes evaluated within days of injury. METHODS: All athletes were evaluated within days of injury using a computer-based Neuropsychological test and symptom inventory protocol. Test performance was compared to preinjury baseline levels of a similar but not identical group of athletes who had undergone preseason Testing. Statistical analyses were completed using Multivariate Analysis of Variance (MANOVA). RESULTS: NFL athletes demonstrated a rapid Neuropsychological recovery. As a group, NFL athletes returned to baseline performance in a week with the majority of athletes having normal performance two days after injury. High school athletes demonstrated a slower recovery than NFL athletes. CONCLUSION: Computer-based Neuropsychological Testing was used within the overall medical evaluation and care of NFL athletes. As found in a prior study using more traditional Neuropsychological Testing, NFL players did not demonstrate decrements in Neuropsychological performance beyond one week of injury. High school players demonstrated more prolonged Neuropsychological effects of concussion.
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Concussion in professional football: Neuropsychological Testing--part 6.
Neurosurgery, 2004Co-Authors: Elliot J. Pellman, Mark R. Lovell, David C. Viano, Ira R. Casson, Andrew M. TuckerAbstract:OBJECTIVE: The National Football League (NFL) Neuropsychological Testing program is reviewed, and Neuropsychological test data are presented on various samples of NFL athletes who sustained concussion (mild traumatic brain injury, MTBI). METHODS: This study evaluated post-MTBI Neuropsychological Testing of NFL players from 1996 to 2001. All athletes completed a standardized battery of Neuropsychological tests and underwent postinjury Neuropsychological Testing within a few days after concussion. Test scores were compared with baselines using analysis of variance for athletes having on-field memory dysfunction, three or more concussions, or 7+ days out from practice and play. RESULTS: The MTBI group did not display significant Neuropsychological dysfunction relative to baseline scores within a few days of injury. However, a subsample of the injured athletes who displayed on-field memory dysfunction performed significantly more poorly on two of the memory tests. The Neuropsychological test results of a group of athletes with a history of three or more MTBIs did not differ significantly compared with a group who had fewer than three concussions or compared with league-wide normative data. The Neuropsychological performance of athletes who were out from full participation 7+ days was not significantly different from the group who returned to play within 7 days or the norms. CONCLUSION: Neuropsychological Testing is used within the overall medical evaluation and care of NFL athletes. Players who experience MTBI generally demonstrate rapid recovery of Neuropsychological performance, although poorer Neuropsychological test results were related to on-field memory dysfunction. NFL players did not demonstrate evidence of neurocognitive decline after multiple (three or more) MTBIs or in those players out 7+ days. The data show that MTBI in this population is characterized by a rapid return of Neuropsychological function in the days after injury. Language: en
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relation between subjective fogginess and Neuropsychological Testing following concussion
Journal of The International Neuropsychological Society, 2004Co-Authors: Grant L Iverson, Mark R. Lovell, Michael Gaetz, Michael W CollinsAbstract:The purpose of this study was to examine the relation between the subjective report of feeling foggy at oneweek post concussion and acute Neuropsychological outcome. The outcome variables were derived from a computerized Neuropsychological screening battery (ImPACT). Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5-10 days post injury (mean = 6.8 days). Athletes were divided into two groups on the basis of self-reported fogginess. The first group reported no fogginess (n = 91), whereas the second group reported experiencing some degree of fogginess (n = 19) on a 6-point scale. The athletes with persistent fogginess experienced a large number of other post-concussion symptoms, compared to the athletes with no reported fogginess. In addition, the athletes with persistent fogginess had significantly slower reaction times, reduced memory performance, and slower processing speed. Thus, athletes with any degree of self-reported fogginess at one-week post injury are likely to have persistent adverse effects from their concussions in multiple domains.
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Cerebral concussion in athletes: evaluation and Neuropsychological Testing
Neurosurgery, 2000Co-Authors: Joseph C. Maroon, Mark R. Lovell, John Norwig, Kenneth Podell, John W. Powell, Roger HärtlAbstract:OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological Testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the Neuropsychological evaluation, the Neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological Testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of Neuropsychological Testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.
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Cerebral concussion in athletes: evaluation and Neuropsychological Testing
Neurosurgery, 2000Co-Authors: Joseph C. Maroon, Mark R. Lovell, John Norwig, Kenneth Podell, John W. Powell, Roger HärtlAbstract:OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological Testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the Neuropsychological evaluation, the Neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological Testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of Neuropsychological Testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries. Language: en
Christopher Randolph - One of the best experts on this subject based on the ideXlab platform.
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baseline Neuropsychological Testing in managing sport related concussion does it modify risk
Current Sports Medicine Reports, 2011Co-Authors: Christopher RandolphAbstract:Baseline Neuropsychological Testing is mandated at various levels of play for hundreds of thousands of athletes each year. This paper reviews the risks associated with sport-related concussion, and the clinical validity and reliability data for the most commonly used baseline test, the ImPACT program. There is no evidence to suggest that the use of baseline Testing alters any risk from sport-related concussion, nor is there even a good rationale as to how such tests might influence outcome. Given the poor sensitivity and low reliability of these measures, they have an associated high false negative rate (i.e., classifying a player's neurocognitive status is normal, when in fact, it is not). The use of baseline Neuropsychological Testing, therefore, is not likely to diminish risk, and to the extent that there is a risk associated with "premature" return-to-play, the use of these measures even may increase that risk in some cases.
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returning pediatric athletes to play after concussion the evidence or lack thereof behind baseline Neuropsychological Testing
Acta Paediatrica, 2009Co-Authors: Michael W Kirkwood, Christopher Randolph, Keith Owen YeatesAbstract:When and how athletes should return to play (RTP) after a concussion is still not evidence-based. As such, various and conflicting opinions about sport-related concussion management continue to be offered by individual experts, consensus groups and practitioners. As neuropsychologists, we are especially interested in the role Neuropsychological Testing should play in the RTP decision. Conventional Neuropsychological assessment is a well-established method for evaluating individuals who have neurodevelopmental problems or acquired central nervous system insult. Neuropsychological assessment can objectively identify cognitive, psychosocial and achievement difficulties and assist with differential diagnosis and clinical and educational management. Using neurocognitive Testing for the specific purpose of making RTP decisions has been popularized through a ‘baseline Testing’ model. The model typically involves 25– 30 min of pre-season cognitive Testing for athletes participating in high-risk sports and follow-up Testing for those athletes who sustain a concussion during the season to determine whether they have returned cognitively to their baseline level. The test batteries were comprised originally of paper-and-pencil instruments, although several computerized tests are now commercially marketed and probably more commonly used. In theory, psychometric Testing within a baseline model is quite appealing, because it has the potential to provide objective information about whether a child has recovered from a concussive injury. However, before the model is recommended, we believe two essential questions must be answered: (i) Do the tests have adequate statistical and methodological properties for the proposed use? and (ii) Does such Testing actually improve real-life outcomes for young concussed athletes?
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implementation of Neuropsychological Testing models for the high school collegiate and professional sport settings
Journal of Athletic Training, 2001Co-Authors: Christopher RandolphAbstract:OBJECTIVE: To review models for the use of Neuropsychological Testing in the management of sport-related concussion at various levels of competition. BACKGROUND: As we come to understand the natural history of sport-related concussive brain injury, it is increasingly evident that significant neurologic risks are associated with this type of injury. These risks include (1) acute intracranial pathology, (2) catastrophic brain swelling from second-impact syndrome, and (3) the potential risk for markedly prolonged recovery or permanent cognitive dysfunction associated with multiple concussions. DESCRIPTION: Neuropsychological Testing has proved to be a useful tool in the medical management of sport-related concussion. In this paper, I describe a systematic model for the implementation of Neuropsychological assessment of athletes at various levels of competition. CLINICAL ADVANTAGES: The systematic model was designed to incorporate state-of-the-art techniques for the detection and tracking of neurocognitive deficits associated with concussion into recently formulated guidelines for the medical management of sport-related concussion. Current applications of the model are discussed, as well as ongoing studies designed to elaborate the empirical underpinnings of the model and refine clinical decision making in this area.
Gian Pal - One of the best experts on this subject based on the ideXlab platform.
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the core assessment program for surgical interventional therapies in parkinson s disease capsit pd tolerability of preoperative Neuropsychological Testing for deep brain stimulation in parkinson s disease p3 357
Neurology, 2016Co-Authors: Gian Pal, Bryan Bernard, Christopher G. Goetz, Virginia Persinger, Bichun Ouyang, Leo Verhagen MetmanAbstract:Objective: We examined tolerability of preoperative Neuropsychological Testing (the Core Assessment Program for Surgical Interventional Therapies in Parkinson9s Disease [CAPSIT-PD] protocol) for DBS. We also examined factors that may influence tolerability, including fatigue, global cognitive function, depression, and patient-based characteristics. Background:The CAPSIT-PD protocol was published in 1999 with the goal of providing the minimal requirements for a common patient evaluation protocol for surgical interventions, including DBS, in PD. Factors such as fatigability, baseline cognitive impairment, duration of Testing, and disease duration, may influence Neuropsychological performance, but have not fully been explored. Methods:We reviewed preoperative Neuropsychological Testing results from 35 patients who were scheduled for DBS. We examined the overall tolerability of the full battery and the tolerability of each test. We placed attention on a test9s placement in the fixed order of the battery to measure whether there was a clustering of poorly tolerated tests toward the end of the battery as an indication of fatigue. Spearman9s rank correlation was used to determine the relationship between tolerability and (1) global cognitive function, (2) depression, and (3) patient-based characteristics. Results:Fourteen subjects (40[percnt]) were able to tolerate the full battery and completed all 10 tests. The domains that were least tolerated pertained to executive function and procedural memory. There was a consistent time-based tolerability pattern that was observed. There was a significant correlation between tolerability and global cognitive function (ρ = 0.344; P = 0.043), but not depression (P = 0.197). There was a significant correlation between tolerability and age (ρ = −0.491; P = 0.003) and disease duration (ρ = −0.442; P = 0.008), but not UPDRS-III scores (P = 0.284). Conclusions:Given the limited tolerability of the Neuropsychological battery as outlined by the CAPSIT-PD protocol, we suggest the consideration of updating the Neuropsychological assessment used for DBS implantation. Disclosure: Dr. Pal has received personal compensation for activities with Medtronic, US World Meds, Allergan, Ipsen, Merz & Solstice Neurosciences, Sermo, Deerfield Institute, and Huron Consulting Services. Dr. Persinger has nothing to disclose. Dr. Bernard has received research support from the Parkinson9s Disease Foundation. Dr. Ouyang has nothing to disclose. Dr. Goetz has received royalty payments from Oxford University Press, Elsevier Publishers, Wolters Kluwer Health-Lippincott, and Wilkins and Wilkins. Dr. Verhagen has received personal compensation for activities with Medtronic, Depomed, and Impax as a consultant. Dr. Verhagen has received research support from Medtronic, Boston Scientific, Adamas, Osmotica, Avanir, WorldMeds, NIH, and the Michael J Fo
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the core assessment program for surgical interventional therapies in parkinson s disease capsit pd tolerability of preoperative Neuropsychological Testing for deep brain stimulation in parkinson s disease
Movement Disorders Clinical Practice, 2015Co-Authors: Gian Pal, Bryan Bernard, Christopher G. Goetz, Virginia Persinger, Bichun Ouyang, Leo Verhagen MetmanAbstract:Objective We examined tolerability of preoperative Neuropsychological Testing (the Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease [CAPSIT-PD] protocol) for DBS. We also examined factors that may influence tolerability, including fatigue, global cognitive function, depression, and patient-based characteristics. Methods In this retrospective study, we reviewed preoperative Neuropsychological Testing results from 35 patients who were scheduled to undergo DBS. We examined the overall tolerability of the full battery and the tolerability of each test. We placed attention on a test's placement in the fixed order of the battery to measure whether there was a clustering of poorly tolerated tests toward the end of the battery as an indication of fatigue. Spearman's rank correlation was used to determine the relationship between tolerability and (1) global cognitive function, (2) depression, and (3) patient-based characteristics. Results Fourteen subjects (40%) were able to tolerate the full battery and completed all 10 tests. The domains that were least tolerated pertained to executive function and procedural memory. There was a consistent time-based tolerability pattern that was observed. There was a significant correlation between tolerability and global cognitive function (ρ = 0.344; P = 0.043), but not depression (P = 0.197). There was a significant correlation between tolerability and age (ρ = −0.491; P = 0.003) and disease duration (ρ = −0.442; P = 0.008), but not UPDRS-III scores (P = 0.284). Conclusion Our results have shown limited tolerability of the full Neuropsychological battery as outlined by the CAPSIT-PD protocol. We suggest the consideration of updating the Neuropsychological assessment used in the CAPSIT-PD protocol.