A few years ago I was consulted by a new manager who was frustrated because several of his employees refused to sign their annual performance evaluation. Some accused him of playing favorites and being unusually harsh and punitive. After speaking with him, I learned that he had made several common but crucial mistakes.

First, using the score of 1 through 5, where 3 was acceptable performance, he decided that to score above a 3 the employee had to, in his words, "walk on water."  Previous managers used 3 as the baseline for the average employee (with 4 as superior and 5 as exemplary); so his employees now felt almost attacked at getting a 3. He made the mistake of not explaining his philosophy ahead of time. He also was very stingy with written comments, thus leaving the employee with the impression that they had done nothing extraordinary in any area. One employee said, "To me 3 is just for showing up."

Years ago maverick New York City Mayor Ed Koch was known for asking his constituents at meetings and in public "How am I doing, New York?" A performance evaluation should basically answer that question for the employee.

Start with the job description which lists all the performance expectations. You cannot reasonably expect an employee to perform outside of what has been mutually decided on. A job description is like a contract and expecting other behavior is a breach of contract.

Give feedback all year long. If an employee is surprised at evaluation time, that says more about the failings of the manager than it does about the employee. You should not keep score (positive or negative) and spring it on an employee once a year.

Arrange a time and place to allow ample time for a discussion. A good evaluation is a two way process and should not be rushed. There should not be just "judgment" by the manager, but feedback and questions from the employee as well. This is a time to evaluate performance, reward good performance and establish new goals and expectations.

As a manager, common mistakes to avoid include the halo effect. This is a cognitive bias whereby the manager is influenced by former behavior. So, the manager might be influenced by something that employee did earlier ( John is all good or all bad).  Or he might even score the employee based on the group to which the manager has mentally placed the employee (racial, gender, troublemaker, all chemistry techs etc). As silly as that sounds, the reasoning is that since all members of that group behave in a certain way, then John's performance cannot be any different.

Another common mistake that managers are guilty of, but rarely aware of, is recency. Recency is a bias that occurs whereby the employee is judged mostly on their most recent behavior. Again it could be something good or bad, but that is what stands out to the manager, so the employee is saddled with that one behavior as a representation of an entire year's performance.

Tools which I have used in the past include having an employee complete his/her own evaluation and then discussing it, pointing out areas of agreement and explaining areas where I rated them differently; with examples of behaviors I would consider acceptable. This can be more time consuming, but is ultimately a very valuable technique.

As a manager I also find 360 degree evaluation really invaluable. That is a process in which I ask all my customers (subordinates, peers, internal and external customers) to rate me confidentially (and preferably anonymously) based on 4 or 5 criteria. A confident manager should consider such honest feedback seriously and modify behavior accordingly.

Performance evaluation is an important tool; not just something required by regulatory agencies; and not just a means to fulfill an HR function. Done poorly it contributes to poor employee morale and does nothing to change behavior. Done well it can improve organizational performance tremendously.

I always advise questioners that one cannot get the flu from the flu shot, members of all high risk groups should take the shot, and taking the shot is the responsible thing to do since it protects the most vulnerable among us-as well as ourselves.

Three years ago after taking the seasonal flu shot, I developed a low grade fever, sore throat; and induration and pain at the site of the shot. My physician and nurse friends tried to convince me variously that I was allergic to the egg protein, already coming down with a cold which just expressed itself anyway, or even that I was imagining the entire thing-high temperature, red face and all.

This year, I took the flu shot again (a couple weeks ago) and hardly even felt the shot. I was absolutely fine. So I decided to take the H1N1 shot this morning. It's been just about10 hours and I have a raging fever, headache, sore throat and a very sore arm. Plus severe nausea. I felt perfectly fine before the shot. This could all resolve in the next few hours, I know. But there is a definite connection between the shot and my symptoms.

The CDC website has some excellent information about the H1N1 vaccine  including some of the possible side effects of the H1N1 flu vaccine.

I am certainly not advising against getting the shot, but wanted to share my experience. Has anyone else had a similar reaction?

Just over 2 months ago I wrote a blog discussing the NCA-ASCP merger. The blog elicited a lot of responses both directly on this site and through personal email. One nagging question has been the role of AMT in all of this. Some AMT certificants worried that they would become the forgotten step children. Would employers even start specifying "certification  by ASCP only" ?

However, the leadership of AMT decided  that they would not take the threat lying down. In fact they have turned the challenge into a new marketing campaign. The October 5 print edition of ADVANCE has a full page ad by AMT.  Across the page the words ASCP, NCA and AMT are written in big letters, with "NCA" significantly crossed through. It is subtitled "You Still Have a Choice."  The ad states that NCA is going out of business and "is being reabsorbed into the certification program of the American Society for Clinical Pathology (ASCP)."

It goes on to tout freedom of choice as a fundamental American liberty and states that AMT in fact espouses the NCA founding principles-a certification for the laboratory profession that is peer based, a program by, of and for the non physician clinical laboratorian.

They also offer a "special" whereby NCA certificants can join the fold of AMT. Interesting twist. Will this marketing ploy work or will most NCA certificants either decide to keep using their current certification, or adopt the new ASCP credential?

What do you think?

Just about everyone knows someone in the workplace whose mantra is "that's the way we have always done it here." People like that are usually afraid of change and so cling desperately to the status quo long after it has outlived its usefulness.

There is also an inherent element of power. A new hot shot technologist/scientist/director joins the work force and the "old timer" immediately feels threatened. In their mind the only sort of power they can exert is having historical knowledge. These are the people who know how to order an obscure test, access the old computer system, and who in the organization to call to iron out a sticky situation. Regardless of their official title they do maintain some informal power simply because they act as a valuable reference in very select situations.

Yet such individuals can be a royal pain; not only because they resist change, but because they often wield their power brutally. How do you deal with such individuals?

First, acknowledge their value. Thank them sincerely when they step up to the plate. However, do not reinforce their lop-sided importance by allowing any crucial knowledge to reside exclusively in their head. Have them make a list of contacts, passwords, procedures as necessary. These are the intellectual property of the organization, not a personal possession.

If they resist change and claim "historically, that's what we have done", do 2 things. First, remind them of all the things we did in the lab historically: mouth pipetted urine, sodium hydroxide, picric acid; picked up mercury with bare hands; ate and smoked at the bench; handled body fluids without gloves; spent hours doing enzyme assays.  As far as personnel actions, many organizations "historically" selected individuals for hire or promotion using factors other than qualifications. They freely discriminated based on age, race, gender, or sexual orientation with impunity.

Then ask if the "historical" actions are still in sync with best practices, legal and regulatory standards, organizational policies.

Next ask if the change contemplated is more efficient, cost effective, strategic, or mandated in some way. History is to be respected, but change is essential for progress.

Please share with us examples from your own lab.

Thanks for all who have supported these blogs with your comments and feedback. Don't forget to check out the podcasts where you can meet all the bloggers and learn a little bit more about them by hearing them talk about their respective blogs.

As we approach the flu season there are lots of questions about influenza testing and  horror stories about a looming epidemic or pandemic. Patients are flooding doctors' offices and emergency departments, and clinicians are demanding widescale testing; often unwarranted, but driven by patient demand or even hysteria.

Some emergency rooms have set up customized triage to route patients with influenza like symptoms to a special area so that they can be quickly  seen and released. Most will be given common sense advice, released and simply told to stay home and treat their symptoms.Only in very rare cases are specific treatment or admission necessary.

Many state health departments have advised hospitals to adopt he protocol of not testing any outpatients for the flu and referring positive Flu A/B on inpatients to health department labs for epidemiological reasons only. What is your laboratory doing? What role did the lab play in developing institutional policies and protocols?

There are lots of questions about flu and flu vaccines. Some parts of the popular press have been recounting stories of the number of shots required and playing up the risks of Guillain Barre syndrome or even autism from taking the flu shots. There are even claims that the H1N1 vaccine has cancer cells.

The Joint Commission is encouraging healthcare workers to take the flu vaccine as a personal protection as well as acting in the interest of patient safety. One consideration for labs: do we have a plan for uninterrupted service if large numbers of staff come down with the flu?

As largely behind the scenes clinical professionals, laboratorians do not usually offer patient advice, but it behooves us to have the most credible information available. The CDC website is an excellent resource for the seasonal flu and H1N1.

There are also a few well researched, yet simply written articles in some magazines that can be used as references for the lay person. Whatever tools you use, it is appropriate and important to act as rational resource. That's a legitimate role in healthcare that we need to adopt more aggressively.

The patient is tested with a preliminary enzyme immunoassay (EIA) screening test. If the result is repeatedly reactive, the patient result is listed as "preliminary positive"  and a blood specimen is further tested by a more specific test such as the Western Blot or an indirect immunofluorescence assay (IFA).

If the preliminary EIA test is negative, the patient is presumed to be  negative, with no further testing needed.

Over the years, rapid tests have become more specific, sensitive and less complex.  An oral specimen is now acceptable for some tests.

Public health authorities are encouraging that many more people get tested; not just those from the old so called "high risk groups." Tests therefore need to be accurate and fast and done in a way that will minimize hassle for patients, e.g. not requiring everyone to return for their results, or using 2 different EIA tests to produce a definitive result.

APHL issued the following release recently:

"The Association of Public Health Laboratories (APHL) has published 'HIV Testing Algorithms: A Status Report,' in collaboration with the Centers for Disease Control and Prevention. The report presents newly-proposed HIV testing strategies for both point-of-care and laboratory settings. The document's purpose is to facilitate the dissemination, evaluation and discussion of these alternative testing algorithms." You may read the executive summary here.

The release continues,  " Data are requested from any laboratory using alternative HIV testing algorithms or evaluating the performance of multiple HIV tests. These data will be used to evaluate the performance of these alternative algorithms and, eventually, lead to the development of improved guidelines for HIV testing. Specific data needs are outlined in the report. To submit data, complete the data questionnaire or contact hiv.algorithm@aphl.org."

Some employers have reduced work hours (for example, employees working 32 hours per week, instead of 40).

I am constantly asked, "What can I do to avoid or minimize a layoff?" While there is no magic formula to avoid the axe, there are definite strategies to increase your chances of flying under the radar and -if all else fails- to minimize the effects of being downsized.

1. Be indispensable.  No one is immune from the axe, but the more valuable you prove yourself to be, the lesser the likelihood of being the first to go. I bet you are already overwhelmed, but I am telling you to take on even more work. Managers especially need help with special projects like gathering information for reports, preparing for CAP inspections, collating data and the like.

Volunteer to work extra hours (that's more money for you as well), volunteer to take over cleaning up the store room, reorganizing the bulletin board and tackling all those things that need to be done, but no one wants to do them. Another way to show your value and commitment is to identify opportunities for improvement in some process.  Identifying ways to save money or reduce waste are also valuable feathers in your cap.

2. Don't have the "It won't happen to me" mentality. Be realistic. Do not be pessimistic and constantly stressed about the prospect of losing your job, but keep your options open and your resume fresh and ready, just in case. Continue to network and find out what's available in the local community. If you have the time, you might even want to get a PRN job. Again, this gives you extra money, plus gets you in the door. If it becomes necessary, the transition to that new employer will be easier.

3. Put some cash away for a rainy day. As difficult as it might be, get into the habit of putting some money aside from every pay check. Where can you find the money? You might have to cut out specialty coffees, try packing a lunch rather than buying lunch from the cafeteria or restaurant every day.  One friend of mine puts away a dollar every time he "breaks" a ten dollar bill. Another writes a check to his joint account with his wife (both signatures required for withdrawal) as soon as he is paid.

Financial planners advise that one should have 6 months salary saved up in case of emergencies or unexpected job loss. More conservative experts say with the increased difficulty getting a new job, you are better off if you have saved the equivalent of 8 months salary.

4. Minimize debt. Now is not the time to increase your debt. Try to pay down debt since credit card companies are raising fees, sometimes arbitrarily. If you become unemployed or under-employed, you might be caught in the spiral of paying the minimum due-or even less.  Only major essentials that are absolutely necessary - or small charges that you will pay off quickly- should be placed on credit. Luxuries and "just-nice-to-haves" are best postponed right now.

5. Be proactive. Start sending your resume out now. You don't have to be out of a job to search the classifieds and post your resume on the job boards.  It can't hurt to have it out there. It's OK to even attend a practice interview or 2. Even if you don't think you'll be terminated soon. Think of it as your back up 'just in case" plan. Your emergency parachute, so to speak.

6. Know that you'll be alright. When a colleague of mine was laid off he found his true passion. He was a CFO but had always liked cooking.  He started a catering business out of his home preparing ready to eat meals for his network in the industry. His speciality is complete heat and serve meals for the busy individual or family. But he now caters everything from weddings to parties and has employed his oldest daughter as his first employee.

You are not your job; you have transferable skills that can be used in many ways by people who are looking for what you have to offer. Having the attitude now, that you have skills, ambition and resilience, makes you feel less stressed now. That mindset will prove invaluable if you ever find yourself downsized or laid off.

I was speaking to a client the other day and he kept complaining about how underpaid he is. He resisted every exercise I suggested to list his strengths, competencies and value to his company. "I am very well qualified, I do a good job, I work very hard; so why can't they recognize that?" he asked.

His problem is really not that unique. Most people think they are not paid wages commensurate with their qualification, and the effort they expend. Entire groups of professionals like clinical laboratory practitioners rue the fact that others don't value them and employers don't pay them enough.

I have come to realize that employers must often be convinced of the worth or perceived value of an individual employee or group of employees. Bill Gates once said in a speech that the key to wealth is to position yourself as the most sought after person in your business, company or marketplace. He said people will pursue you and pay you handsomely if YOU convince them that you can solve their problems.

This could be the "problem" of selling, making money, taking care of patients, getting lab tests done- or whatever. Employers have a need and if they are convinced you fulfill that need, they pay you. If you fulfill that need uniquely or with the highest degree of competence, you get paid the most.

Motivational speaker Dr Robert Anthony is fond of saying, "Keep in mind if you are working for someone else, the only reason you are making the amount of money you make now is because you have not made yourself overqualified for that position by solving your company's immediate problems."

He believes that if you are not recognized and rewarded enough it is simply because you are not solving enough pressing problems for your employer or those who use your services.

Just think: what pressing problems can you solve at work? How can you make yourself more valuable by being the problem solver, instead of the problem?

What do you do when asked by an interviewer, or your boss during a performance evaluation, "What do you think is your greatest weakness?"   That question stops most people in their tracks.

President Bush asked by a reporter if  he had made mistakes was so flummoxed he said he could not think of one and added "I wish you'd have given me this written question ahead of time so I could plan for it."

Such a response will make you seem arrogant at best, and either disingenuous or woefully self unaware at worst. It is equally annoying and transparently untrue to say something like "I am such a hard worker, I will sometimes neglect my personal obligations to do a good job at work."

Yet do you want to list all your foibles and challenges? Certainly not.  I have had a t least two different bosses who have used my own self-identified opportunities for improvement as blunt weapons to use against me. I am sure I am not unique in that regard. Sometimes an employee will answer honestly that they want more experience in an area or want to work on improving competency in another.

They are often surprised and disappointed when these then show up on an evaluation as "areas that need work" or "employee needs to work on..." If you cop to doing most tasks yourself rather than delegating, you are likely to be pegged as someone with poor management skills or being unable to manage your time well.

So the best tack is to tell the truth, but phrase the answer in such a way that it shows honesty and the ability to turn a weakness into strength. Show that you have learned some lesson and are the better employee for it.

Ben Dattner, Ph.D., a psychologist who heads Dattner Consulting  in New York City,  advises both hiring managers and executive job seekers on how to make the best of an interview.  He is not a big fan of the  the "greatest weakness" question at all,  suggests being prepared for those interviewers who insist on asking it anyway.

Dr. Dattner suggests three possible ways to answer:

1. Focus the discussion on how you've improved over time. Instead of rehashing or overemphasizing a current weakness (assuming you can think of one), talk about a past shortcoming and how you resolved it. Maybe you used to have trouble meeting deadlines, for instance, until you took a time-management course that helped you get your schedule under control. "The idea is to show that you are interested in getting better and better at what you do," says Dattner.

2. Talk about how the job you're applying for will help you build on your skills. Again, no matter how good you already are, you can always improve - and you may see specific ways in which this particular job will help you do that. If so, the interview is a good time to mention it.  Rather than saying you have a problem multitasking, you might say: "I have been getting better in managing multiple assignments at once. It sounds like this job will challenge me to get even better in that regard."

3. Describe a valuable piece of advice someone gave you, and how it has helped your career. "This could be, for example, a boss who once told you not to give people the answers but to let them figure things out on their own," says Dattner.

"Or maybe a mentor once pointed out to you that not everyone is motivated by the same things you are, and that insight helped you become a better manager. Whatever the pearl of wisdom you received, a willingness to talk about its positive effect on you shows that you want to learn and grow," Dattner notes. "And that's really what hiring managers are trying to find out."

A good friend of mine who is a life coach is fond of saying "We teach what we most need to learn."  I have found that to be true not just in a metaphysical sense but also in leadership as well.

I once had a boss who always brought every topic back to patient safety or ethics. We were all shocked when we found that as a nurse she diverted pain medications from patients(for her own use/abuse).  Not only was she putting patients at risk; but little is more unethical, in my opinion.

Ever notice how micromanagers often point out that fault in others or declare how much they hate to be micromanaged?

It seems the most obstinate and rigid supervisors are the ones who wonder why their subordinates can't adapt to changes; of course they mean only the sort of change they endorse.

I recently had an encounter with a leader who connives and cuts people with her words. She enjoys seeing others wince. Yet she appeared mortified and deeply hurt when she was taken to task for inappropriate behavior.

It is a truism that if you see a certain behavior everywhere or ascribe certain motives to others, you might do well to examine yourself. To be a great leader, employee, colleague or individual it helps to look in the mirror periodically; but especially when you are incensed or deeply bothered by someone else.

Triggers and preoccupations often tell us more about ourselves than they do about others.

 Just in: The two largest national certification agency for clinical laboratorians announced in Chicago that they have merged  (finally!) 

Laboratorians have long recognized that one of the factors contributing to low recognition and confusion in the profession is the myriad of certification agencies.

Our credentials are a veritable alphabet soup that not only mystifies employers and human resource departments but even some of us in the profession itself.

The new Board of Certification (BOC) as well as the credential themselves will be identified as ASCP.  The titles MT (ASCP) and CLS (NCA) will both be converted to the new medical laboratory scientist -MLS (ASCP).

Some might see this as heavily weighted towards ASCP instead of an equal union of ASCP and NCA. Also should the well known CLS title have been adopted over the new, potentially confusing MLS; especially since the profession is now widely known as clinical lab science? Some states and educational institutions have even abandoned the medical technology/technologist monikers in favor of clinical lab science/scientist.

How do you feel about the union? The decision to morph previous certifications? How about the new name "medical lab scientist"?

A few minutes ago, the Senate Health, Education, Labor and Pensions Committee  passed a bill to revamp the health care system

Celebrating the passage of the bill, President Barack Obama, surrounded by nursing leaders at the White House , proclaimed "I love nurses!" This is the third time I have heard Obama repeat that sentiment. He talked about the time when one of his daughters had meningitis and , despite the fine work of the doctors, it was nurses who were there to take care of the child as well as comfort the parents.

The President made no mention of the fact that it was clinical laboratorians who provided the data for a definitive diagnosis, which would then guide treatment. Meningitis is  positively confirmed only through laboratory testing.

He described that during the birth of both his girls the OB/Gyn was present for "a total of maybe 10 minutes. The rest of the time the people we saw were nurses. I  know how important nurses are."

Again, I bet those infants had their cord blood tested, possibly bilirubin, certainly there was a host of new born screening tests including sickle cell, PKU and a host of others. I do not fault the President for ignoring the importance of clinical lab scientists. Certainly his view of us as a transparent profession is typical of society as a whole.

It is commendable when people, including the President, start realizing that doctors are not the only important players in healthcare. But they need to realize that others, including CLS/CLTs are vitally important as well.

As the debate on universal healthcare proceeds and heats up, we have yet another golden opportunity to explain to family, politicians, healthcare leaders and policy wonks that- whatever the outcome- clinical laboratory scientists must have a seat at the table.

Millions of people now practice social networking . In fact just about everyone I know has a profile on one or more sites like Facebook, MySpace, Bebo and Twitter.

Some networkers are more aggressive and dedicated than others and spend hours each week updating profiles and announcing to the world everything from their last meal to their emotional state. They also comment on the activities of others, offering advice or social commentary. Networks of "friends" constantly grow to include family, friends and acquaintances - old, new and newly rediscovered.

Many businesses have figured out how to taken advantage of the ever-expanding social networking web to attract specially targeted  "fans" who visit their sites rich with information or marketing material.

Social networking sites produce a unique challenge for employers; challenges that go way beyond employees' First Amendment rights of free expression -away from the workplace. For one thing, accessing social networking sites from work poses very real business concerns

• Reduced bandwidth to and from the company's servers
• Security challenges such as phising and access to confidential information about patients or  employees; or theft of proprietary information and intellectual property
• Decreased productivity as employees network on company time

Some organizations now block social networking sites from being accessed, even by those employees who have otherwise free access to the Internet at work. The argument that cell phones might interfere with critical medical equipment has gone back and forth for years. Now the use of cell phones at work is being revisited again by organizations, but, this time, for the added reason that an increasing number of employees now use cell phones to tweet and visit websites while at work.

Another consideration is that of the employee's social networking profile. Whatever an employee writes might reflect on their employer, especially if they explicitly state where they work. Engaging in political, religious or risqué discourse might be "politically incorrect" or even adversely affect an employee's evaluation at work. What about supervisors fraternizing with subordinates - using the excuse" after all we are not at work". Can you truly separate personal and professional? Crossing the line could be awkward at best. Blending both worlds could have dire consequences.

Employees have been known to use their profiles to comment on work events or office politics. It is easy to inadvertently describe details at work that violate patient confidentiality or otherwise open the organization to legal risk. Is it OK to badmouth a boss or colleague if names are disguised?

Increasingly organizations are developing (and training employees) on social networking policies. Such policies must address the delicate balance between personal right and professional obligation. Such gray areas will only increase as the Internet continues to change how we communicate and share our lives. But that is the world we currently live in.

Yesterday, I accompanied a friend to the doctor to provide moral support and also to "translate". My friend historically has had a very negative experience with the medical establishment and hasn't always had an advocate for her as she navigated the complex system. So I knew it was important to her that I tagged along as her "insider."

The visit itself went very well until my friend went to have blood drawn. The phlebotomist was overly made. sported fake nails, a low cut blouse and a lab coat with stains that I didn't even want to guess what they were. I could only imagine what the rest of her outfit under the baggy lab coat-shroud looked like.

Not only was the outfit distracting, she gave the appearance of someone who did not care enough about her work, her profession or her patients to present a professional appearance. Rightly or wrongly, I immediately thought she gave patients the impression of being less than competent.

She did a successful venipuncture on my friend on the second attempt. She did not have a badge so I did not know her name or title, but I was totally "underwhelmed" with the experience- as was my friend.

How many times have we looked around the workplace and seen colleagues sporting attire that was inappropriate for the workplace or untidy in some way? If laboratorians don't leave the lab or have patient contact is it , therefore, OK for them to be careless about their attire and appearance? People do judge us by our dress-they make all sorts of assumptions based on appearance.

Professionals, like clinical laboratorians, should be cognizant that whether or not clothes make the man - or woman,  they sure do create a powerful and lasting impression.

Healthcare providers are familiar with superiors or physicians sometimes demanding that providers act in a manner against the provider's better judgment, scope of practice or established policy and procedure "because!"

Recently, I  was privy to 3 separate instances in which laboratorians were "ordered" to act simply for the convenience of someone in authority. An ED physician insisted that electrolytes be performed on an EDTA specimen because the nurse lost venous access to a hard to stick patient and after several attempts they could collect only a CBC specimen. All entreaties and explanations from the technologist and laboratory supervisor- that the anticoagulant contained significant amounts of potassium -went unheeded. The physician essentially said "I am the physician, do as I order and I will evaluate the results as I see fit."

The second instance involved a nephrologist insisting that "all creatinine clearances from your lab are useless" because his manual calculation differed from the one on the laboratory report. It's true the lab did not correct for the patient's body surface area, but the explanation of typically reporting clearances based on a "normal" BSA just drew more ridicule and expletives from the doctor.

The last instance was of a director who had acquiesced to a cardiologist's demand to adopt reference intervals and diagnostic cut points from another local hospital lab that the cardiologist admired. The director pressured the lab, despite ethical, regulatory and scientific concerns. One wonders why a physician would want to substitute a laboratory interpretive report (based on faulty science) for clinical judgment. And why would that dangerous precedent not be evident to the director?

Our reputation, value and perception -as true educated professionals with critical thinking skills and independent judgment -are compromised every time a laboratorian acquiesces to an order "just because."

I would love to hear from readers about examples of similar demands, your response and your view on this entire matter.