Brain arteriovenous malformation (AVM) treatment in 741 Neurosurgery, Oncology, and Vascular surgery clinics worldwide

Context: Foreign patient/tourist Lack of signage for foreign patients is what exacerbated this horrible experience not knowing what is the correct entrance, the fact that you can't go any doctor and must go straight to the emergency reception for example (flat fee is also 200 EU which luckily was refunded by my travel insurance) 1 receptionist out of 7 was friendly, rest were horrible to an ill person despite being polite as possible 1 doctor in the emergency ward was pretty careless after dismissing me from the hospital (and was dismissive), not even providing a proper dressed bandage for my wound after removing a drip needle that was never used to give fluids (something usually done for pain or dehydration - I was expecting some for relief but none was given) A trainee had better bedside manners The doctors in the gyni section were absolutely fantastic, explaining everything, being friendly etc. However, nothing was found for the cause of my pain which was distressing and no pain relief was offered even. A traumatic experience for someone traveling alone. I hope this review helps someone in the future. Will never be traveling back to Cologne as the reception to tourists is 99% of the time cold as ice.

First , I can not comment on medical services , but the buildings and the arrangements, the wide variety of specialties and advanced equipment all are amazing. Well organized campus.

My wife gave birth there. This was the only good experience we had in hospitals. I want to give thumbs up for the best team in the world and especially to Frau Hannah. 🙏

The hospital oncology is careless and amateur. They mistreared and misdiagnosed a friend of mine for months with cancer. They told him he is fine, whereas he had severe abdominal pain. What kind of doctors work there? Have they not sworn to do no harm??

They just don’t have the knowledge to be doctors or nurses. Sadly, all the hospitals in Spain are like this. You can find some good specialist and surgeons, but that’s about it. Free healthcare=Poor quality.

I have been in Emergency hospitals here in Spain, was first time I got decent treatment, from receptionists, nurses and doctors was perfect the attendance. Do not give 5 stars because they did not make any treatment, because was not my reference Hospital. I think it¨s absurd, anyway was the best I have been in Spain so far.

They have a terrible Surgeon, is name is José Antonio Soriano, he was my surgeon and the results of the operation were disastrous, he only cares about money , and not about his patients. I filed a complaint at the hospital and the didn’t do nothing

Terrible experience. I tested positive for COVID three days ago, and began Paxlovid and fever reducers immediately. After three days, I am still having symptoms and testing positive. I called the ambulance to bring me to the hospital. My oxygen was 81 (after a dexamethasone injection and tablet today). The paramedic gave me oxygen right away in the ambulance. The doctor was useless. He refused to prescribe remdesivir. In nonhospitalized patients with mild to moderate COVID-19 who are at high risk of progressing to severe disease, remdesivir should be started within 7 days of symptom onset and administered for 3 days. The doctors name was Dr. Diego Lecona. I showed proof of my asthma and low oxygen saturation from prior attacks. He did nothing to help me and didn’t give me the medicine. All he did was charge me over $300 for a useless consult. Never again

Unfortunately I became quite I’ll on a recent trip to Mexico City. The physician on call for the hotel direct me to this hospital. My care in ER was efficient, caring and appropriate. Lilliana and Mezil in Er were so caring and great communicators. I was admitted and again impressed with the care of the team. Very professional and respectful. When called received prompt response. My physician, Dr Jessica was knowledgeable, great personality and did follow thru with communication upon my return home. Highly recommend and hope in US we can rid our staff of the EMR demands that take them away from the bedside. Perhaps then we can be as attentive as the team in this hospital. Thank you to the nurses, housekeeping and residents as well!

This hospital is part of the inherited Mexico, with a staff with the excellence that experience provides, but fatigue periodically takes its toll, so as a patient, everyone will talk about how the fair went. The staff makes an effort for the shortcomings they work with and for such a diverse population. More hospital centers like this are needed for this city. Abroad, dozens and even a few hundred spend hours and even days waiting for care for family members, either for medical appointments and studies, as well as those who are hospitalized for days in these facilities. There are those who already go with a folding bench, others rent chairs, umbrellas and some institutions offer a tent for those who come from afar to accompany a family member during their hospitalization period.

Excellent

Exceente

A big thank you to the staff of Galenia hospital!!! During our stay this month, my friend became suddenly ill and had to be hospitalized. Being from the US, I must say that it was a bit nerve wracking to have to seek medical help in a foreign country. However, our experience was entirely positive!!! To the concierge staff - Eric and Alfredo - I wish to extend tremendous gratitude!!! Your translation services as well as your kindness and hospitality were both indispensable and greatly appreciated!!!! I also wish to extend my gratitude to Dr. Allejandro (I don't remember your last name); not only were you genuinely gracious, you discovered the problem quickly and got my friend back on her feet in no time at all!!! Again, thank you Hospital Galenia for such a good experience!!! You took great care of my friend and went above and beyond in showing us courtesy and consideration!!!

BEWARE IF YOU ARE A TOURIST! My father was hospitalized on a family trip to Cancun. He was transported to this hospital and needed emergency surgery This hospital FAILED him. They wouldn’t even give him so much as saline or an antibiotic without payment in FULL. WE WERE CHARGED $4,000 FOR. He went 8 HOURS sitting on an emergency room bed when he should have been in surgery. THEY DEMANDED 50,000 DOLLARS PAID IN FULL BEFORE STARTING ANY CARE AND THAT WAS JUST FOR THE SURGERY. WE OFFERED TO PAY 25,000 SO THEY COULD START AND THEY REFUSED. WE OFFERED TO PAY THE REST THE NEXT DAY AND THEY REFUSED. WE TRANSFERRED MY FATHER TO THE OTHER HOSPITAL BECAUSE WE THOUGHT HE WAS GOING TO DIE. WE FELT USELESS WHILE THEY HAD ALL THE POWER TO DO SOMETHING THEY CHOSE TO DO NOTHING!!!!! THEY ARE SCAMMERS AND NOTHING MORE. ITS A MIRACLE MY FATHER SURVIVED AND ONLY BY THE HELP OF GOD WAS MY FATHER ABLE TO COME BACK HOME WITH US. JUST TO TOP IT OFF WHEN WE WERE PAST THE TRAUMA THAT THESE PEOPLE PUT US THROUGH THEY HAD THE AUDACITY TO BILL IS THE OXYGEN THAT WAS ADMINISTERED DURING THE AMBULANCE RIDE!! 2000 DOLLARS!!!!!!!! THEY WOULD RATHER WATCH YOUR FAMILY MEMBER DIE, I WILL NEVER FORGET THEIR DISGUSTING SMUG FACES

It feels very comfortable being there. Olivia is the best. She arranges everything for you when you are from outside the country of Mexico. You show up and all is prepared. Her personality is very welcoming and friendly. I love not having to worry about the stress of paper work especially since i don't know Spanish well. All her subordinates speak English as well and are all very nice. Galenia might be costly however the peace of mind you get not being stresses out with paperwork helps a lot. I don't even need to Contact my insurance. They do everything for you. Best service. The receptionist at imaging are a bit slow and don't know any English. But the staff attending to you in the radiation area are super friendly and helpful. I see many people complain about the price. This is a private hospital and will be costly. It is the same in my own country. Private hospitals cost a lot but if you have insurance and you are not from Mexico, then I highly recommend using their tourism concierge. They are a great help and speak English. They are all very nice and helpful. I have had the pleasure of meeting and being assisted by Olivia (who is the best), Ellen, Ricardo and another guy i cant remember his name. Not sure if it is Daniel or something with a D. That was over 2 years ago i met him. They arranged everything with my insurance prior to going there. I just showed up and Olivia walked me through everything. I was in and out as quick as possible. No long waiting. Use the concierge service they have. It really helps you from stressing about paperwork and payments. My journey at Galenia started September 2021 and I continue into 2023......

Do not reccomend to be attended by Dr. Jaime A. Estrella. Was forcing me to put workers comp when my injury had nothing to do with work, and threatend to report me as well for leaving half way through. Very bad doctor.

I've been go Almater Hospital twice now to have surgeries with Dr. Luque. I can't begin to express my gratitude for what wonderful experiences I've had. On both occasions, the staff both with Dr. Luque's clinic team, the surgical team, and the hospital staff have gone above and beyond to take exceptional care of me. They are patient with my insecurities and anxiety about the processes, they deliver excellent care, and are kind and considerate throughout. I'm a Nurse Practitioner by trade in the US and have had many surgeries in the US in the past. I can genuinely say the care I received at Almater hospital and by these medical professionals far exceeds any treatment I've ever received in the US. This will be my choice hospital for care with all procedures I'm able to utilize them for and highly recommend them to others.

Very bad hospital to get treated. I went for a procedure on my low back (cyst) and they charged me over 9,000 pesos for just medicine, and wanted to charge me 50,000 for the procedure. Of course they only told me the price after I had asked how much it was going to be. Also they charged me 1000 pesos extra for using a different doctor that supposedly is filling in for another. They wanted to keep me over night for no reason, I would have just been laying in bed (I assume to make more money of me). Communication between the workers is bad. Not recommend at all. Prices are way overpriced and the service is bad. Save your time and money and go to a different hospital

Clean hospital. But extremely expensive. They didn't inform us of the costs and we had to pay 10 times of than other european countries.

Terrible service. Completely disorganized, does care at all about their patients. I was begging them for help in resolving a billing issue and every department just ignored me. Do not go to this hospital. I went to this hospital to get an outpatient procedure done which required that I have an attendant with me. The hospital organized for an attendant to be provided, at a fee, from an outside company. On the day of the procedure I was brought to the billing department by member of their "concierge" team, Fernanda. They have an international "concierge" service which basically provides translators so that you can navigate the hospital if your Portugues is not great. At the billing office I was presented with a bill for the cost of the procedure. I agreed to pay it and was then given a credit card machine to make the payment. When the machine arrived, the amount they were requesting was higher than the quoted amount. When I asked Fernanda, she explained that the additional amount was for the cost of the attendant. I paid the invoice and was only provided with a little slip of paper that showed the amount that I had paid. It didn't say what services I had paid for, just that I had paid a certain amount. I then went and got the procedure done. I was put-under, so I don't know how the actual medical procedure went, but from what I saw before I went under, the medical professionals seemed like they were doing a good job. After the procedure was finished, I was brought to the payment office and presented with a new bill. The bill included the additional cost of part of the procedure, the cost to have a biopsy analyzed and the cost of the attendant (which I already paid for). For the next 3 weeks I was going back and forth with the International department, the complaints department and the billing department, trying to get them to acknowledge the fact that I had already paid for the attendant. No one from any of those departments did a single thing to try to help me. Each department passed me off to another department. The complaints department didn't even reply to my complaint. I had to call them up weeks after I had filed a complaint and they were fully aware of the situation, but didn't have enough respect to let me know that they were working on my case or bother to email or call me to help get it resolved. Neither did the International department. When I asked them to help me resolve the issue they just said "this is not my department, I don't know anything about billing" even though FERNANDA was there and was the one that explained to me that I was paying for the the price of the attendant. The billing department just kept sending me the same invoice over and over again and never acknowledging that I had paid for the attendant. It was only when I finally decided to go to the hospital and pay the bill that anything got done. I had to physically go to the International department and demand that they resolve the issue that instant. I spent another 2 hours going to different departments with the "concierge" lady, getting into arguments and explaining over and over what had happened. It was only then, that they acknowledged that the woman who processed my payment allocated the entire amount to the cost of the procedure, which was why this bill for the attendant was still outstanding. At my insistence they finally removed the charge and I was able to pay the invoice. If you go to a Brazilain Hospital, make sure that you get an itemized invoice for every single payment that you make. A little slip of paper with the amount on it is not enough. They will change the amount that you owe them and you have no proof of what you have already paid for. At the end of the day, I probably wasted about 4-5 hours of my time writing emails, sending messages on Whatsapp and arguing with the staff at the hospital. Not to mention all of the frustration it caused. This could have been resolved after 1 email, had anyone at the hospital taken ownership of the problem and been accountable. DO NOT GO HERE - THEY DON'T CARE ABOUT THEIR PATIENTS

One of the best hospital in South America

Dr. ABED from general surgery is amazing. Very down to earth, friendly and helpful. He did the procedure really quickly, and the pain I had was gone. Appreciate his kind approach.

I am writing to express my gratitude for the exceptional care and support provided by your hospital staff during my recent visits. In particular, I would like to extend my sincere thanks to (Doctor Aatif Shaikh, Consultant Physician , UROLOGY) and the entire medical team involved in my treatment. Their expertise, compassion, and dedication have made a significant difference in my recovery. I would also like to take this opportunity to provide some feedback and make a recommendation regarding the booking of required tests, such as X-rays, blood tests, and especially ultrasound appointments after the operation. I believe implementing an automated system to schedule these tests before visiting the doctor would greatly benefit patients.

Overall great facility (especially after the renovation) and very good doctors. I would have placed reviews on many of their doctors across several departments but many of them have left. Right now, I can highly speak about Dr Nathalie El Moukari, consultant radiologist. She’s confident and very thorough in her examination and takes the time to explain to the patient their situation and what they need to do. She communicates very well in, at least, three languages. Her team, I can cite Ms Mandy, is equally pleasant to deal with. The clinic is clean. Parking lots are available.

Bad Service, the doctor didn't examine my girlfriend Anna properly, we paid 70€ and after two weeks she is still sick.

Extremely bad hospital. One people doesn’t understand what doing other.. Contract’s conditions always changing same with fraud. On the start they promise one but finally u will left money more more more that for same service in USA! Stupid management!!!

Very stupid international service!!! They change conditions more than 4 times before baby delivery!!! They want much more money but don’t understand self final conditions. Finally in last week we was need change hospital.

The place is old, but the people who serve are super friendly, they went overboard!!!

In general it is old, the elevators are bad, slow and it is super big, the facilities are a little poorly maintained, the elevators and in my case to access the arrhythmia secretariat you have to go with a map and counting the steps go up to 5 and then go down to 4 because there is a closed part of the hospital. But as excellent quality specialists and within everything they comply with everything. (There is very little availability of hours).

Terrible attention. This place needs better customer service.

My wife gave birth to our daughter here. Amazing staff on rotation. We were there for 3 night and had an amazing experience from the food, the quality of the rooms, and the experience in the staff that always made us feel that we were priority.

PCR test done very quickly, good hygiene results the next morning. Not crowded, almost no waiting time, but people smoking marijuana, literally 2 meters IN FRONT of the entrance of the respiratory emergency... there should be security at the gates.

I had the best experience with all the staff at hospital. Everyone was super friendly even though I didn't speak a word of Spanish. Even other patients helped me out with translating information to the staff.

Ok

Imagine being in a wheelchair, trying to get into urgent care for a surgery you had there, and not being helped about when you arrive, somehow managed to get into the triage and then be left alone, then get the need to use the bathroom at a place not clearly design to be used for people with mobility issues, then the only person available to help you is another patient passing by. It's such a shame that all of this happened here, where I have yet to get medical attention for my urgent needs.

One if the best hospitals in Cali. Modern, well staffed, good service

Be aware of the medical assistant of Dr Dueñas ( third floor, big tower, " Jennifer"). She treats you wonderfully in front of the doctor, but when you ask for the results or extra important information at the reception or on the phone, she is the rudest. Staff needs to be trained in HOSPITALITY 101.

I see quite a bit of negative reviews which made me nervous going here, and I know it’s all subjective but I had a good experience. Although I do have international insurance so I’m sure that played a part. They got me in fast and the doctor was very friendly & helpful. She was gentle with my hurt shoulder and even offered pain meds in hospital although I declined. it may be a bit expensive in Peruvian standards but if you are coming from North America it is still a small fraction of what you would pay back home( just the X-rays alone in the US would have been significantly more than my total bill here) All in all not a bad experience at all just make sure you have cash or insurance because you pay at the time of visit not like in North America where you can do a payment plan

Simply THE WORST!!! I do not recommend this place at all, don’t even bother to call them because Janet (the secretary or receptionist) will transfer you or hang up. Don’t try to explain them why are you feeling sick because she will yawn and laugh at you. Bad bad experience!!!

High-end & premium hospital with very poor services. Everything is slow and unsystematic. Average waiting time is around 1hr ++ at each location (from at the clinic reception, meds collection at the pharmacy) The clinic receptionist were very unprofessional, loudly gossiping about their other colleague at the front desk area, I can clearly hear what they were talking while I was sitting at the other end of the room. There are more than 4 counters at the pharmacy but only 1 pharmacist was on duty at a time to hand over meds to the customers. I think the service at some gov hospitals are far way better than here.

Exellent service, all the staff, nurse and the doctor are amazing, you know that the are working wholeheartedly. The hospital is clean, treatment is done with procedure which make patient not waiting to long.

You can be in pain in comfort. The service is always efficient, with friendly and comforting nurses and doctors. There is a porter man that will accompany and bring you to xray places. The menu is always yummy and you can choose your food from the menu one day ahead. Everything is healthy but flavourful. The room is a single room with a sofa bed for someone to accompany you. Since I am covered by insurance, the cost is not under me, but I have to be referred with a referral letter and admitted. Otherwise, it would be quite costly to be treated here.

Gleneagles Hospital Gleneagles Hospital is a 221-bed private hospital in Singapore that provides a wide range of medical services and surgical treatment. Trusted, extensive and international - Gleneagles' network of multi-speciality private hospitals provides world-class excellence, from superior clinical outcomes to the highest standards of quality and care. As the signature international brand under IHH, Gleneagles hospitals are located in Malaysia, Singapore, India, China, Hong Kong and Brunei. Each offers dedicated personalised care and comprehensive modern facilities for ultimate comfort. Our continuous strive for excellence and superior care has been embedded in our culture since our first hospital opened in Singapore in 1959. At Gleneagles, empathy is at the heart of everything we do. We recognise that feeling better begins with knowing that they are in trusted hands, and that is why our patients and th

Very undesirable environment for some of group of the employees with no SOP from HR. Without proper protocol for meal time duration. Limited food variety in-house for the group of employees. Shift/annual leave schedule planning with non standard protocol and left it to department in-charge with unequal treatment subjected to their whim and fancy. Management may need to review to provide a better positive work environment to all.

Came to one of their clinics located here. Given wrong station exit info by Goggle maps (had to wait and cross the traffic junction twice), and exit 1 is the correct exit that leads up to the hospital. Staff at the front desk should be more attentive in the morning when patrons approached the desk. Had to "interrupt" to get to the right building.

I had an ongoing ear infection. I was seen by one the Ear, nose and throat doctor. I had a follow-up appointment at 10am, I had a confirmation text the day before. I took the day off work as I also had another doctor appointment at 11.30 not in the same hospital. Anyway, at 9.55am I got a call from Acibadem, someone speaking Turkish, I said in English please and then they hung up. Then at 9.57am I had another call from the hospital, this time someone speaking English saying that my appointment had changed to 11am, because my doctor arrived at that time. 3 minutes before the appointment and then I had to wait one hour, no explanations given, nothing. This is not a free hospital, I'm paying as an international patient more that I would pay back in my home country. Why do they feel like they can play with my time, no apologies. Nothing

Last week, I was at the hospital with my relative . We did a PET-CT and MRI scan. The oncologist wasn’t there that week, but we discussed with the hospital that we would do the interpretation of the results remotely with the doctor because we live in Tirana, Albania. However, it’s been 3 days, and they haven’t responded. I turned to your hospital with the idea that I might find a solution there. It is crucial to start treatment as soon as possible and you need to understand that the days that go by are not in his favor. I urgently need a meeting with the oncologist

You would have to be an absolute idiot to use this hospital, especially if you are not a Turk! I called today for an appointment and was told I would have to pay in Euro because I was not Turkish, but if I was from another Middle East country I would pay the same as the Turks. I have lived in Turkey for years, and married to a Turkish man. We make the Turkish LIRA! This is not the first bad experience we have had with this Hospital. This hospital will do everything they can to cheat you out of a dollar. If you are looking for terrible Doctors that don’t listen to your concerns, and to be treated like a walking bank, then it’s the hospital for you!!

Acibadam one of the best hospital in Istanbul . A hospital that uses the latest medical equipment, with a professional staff of doctors and a very high-quality nursing service. The hospital and patient rooms are excellent and equipped with the best equipment, but hospital prices are very expensive. There are higher prices for every non-Turkish foreigner and this is annoying. I advise the patient not to go to the hospital directly. Unless through a Turkish doctor who deals with the hospital directly, this is better for you in terms of prices. The nursing service is very good, and the cleanliness , Hygiene & decorations are excellent.

Had a good experience getting IVF and PGD/PGT-a + PGT-m treatment from Acıbadem Fulya hospital (IVF department). Many thanks to Dr Hale Çelik, the nurses, embryology lab and Mr Kenan (patient coordinator) who were all very professional, competent, helpful and made the experience seamless. I could always ask questions and got a response straight away. The IVF and PGD treatment worked and we now have healthy babies. I would recommend.

One of the translators of this hospital named Linda Yunita is only there to deceive people and get their money. I suggest that you be careful because this woman is very lying and deceitful

We also experienced the worst possible care. We were there the same night, September 11, 2023, when Marcia Lorena recently posted about the inhumane treatment toward her 87 year old grandmother, who the ER refused to treat. We are witnesses to this horrible treatment/nontreatment. We also were ignored for 3 and a 1/2 hours. We believe we were ignored because we are Americans. Several wonderful German women helped us by asking in German when my husband would be seen. They helped us four times. They were appalled that no one would see us. The desk person kept telling us that we had to wait and that they did not speak English. However, they told us a female doctor spoke English and would see us soon, but never did. It was 10pm at night and no one was in the Emergency Room and they still ignored us. During the 3 and 1/2 hours, we saw lesser cases come in and get assistance, while we continued to wait. We eventually left. I can tell you this would never happen in the United States of America. In the United States, they take you and care for you, no matter what country you are from. I wish these ER hospital personnel could experience the helplessness that we felt when they ignored us, when they are sick and outside of Germany, but unfortunately, if they are traveling in the United States, they will be well taken care of. Shame on them! Also, the Hospital Northwest should receive ZERO stars, but I had to give one, to do the post.

I was in for a sleeve gastrectomy and I could not have wished for better care in the week I was there. Absolutely amazing staff!

Management needs to be improved. A lady called me to cancel my OP the day before and said I have to wait 2 months even though I did all the pre-OP exams and of course arranged my work for sick leave before 1 week of hospital stay. When I asked if I can have the surgery with the same doctor who examined me, she started to yell, HE'S NOT MY CHEF ANYMORE in German and hung up before I responded. So I had to find another hospital to have OP. I don't understand how they can throw out a patient when their own doctor strongly suggests a surgery urgently. Also, why do they have to get ANGRY at patients just by asking questions who's already suffering and feeling already miserable?

Unfortunately, i have encountered biased towards forwigners attitude here. I had an appointment at Hasan Ünlütürk on october 6th 14.40. We were late, but registration was completed, payment made and we were waiting in front of doctor's room at 14.55. Doctor was not there, the woman that works with doctor (i will call her hostes) said since we were late he went to another side of the building to treat another patient. I said ok, then doctor came at 15.07. Hostes said that since we were late, she cannot accept us to doctor's room and took TWO other patients in front of us. This was unfair and rude attitude which resulted in us waiting for almost 40 minutes.

I don’t recommend this place for foreigners at all. Their staff are very rude and kind of racist. After reception didn’t help, we asked their information desk and they sent an English translator (a very good person) with us. In reception the staff again start fighting with the translator and especially one of them, a woman with hijab, start yelling at us. I asked the translator the reason and she said they are saying”Turkish people are priority!!!” A very regular doctor appointment and a blood test took us 4 hours to wait and we were very exhausted. I’ve been leaving in turkey around 5 years and that’s first and the only time I’ve seen such a bad behavior from Turkish people.

Should be avoided by foreigners. Irresponsible reception service. My sick son and I visited this hospital at night (3am) in emergency because of high temperature (40 degrees). No one person at reception knew English, no one knew how to apply insurance, no one was interested to help my son quickly - they offered me to wait at reception 2 hours, when pediatrician arrives. Only after pressures by insurance support service they took us to the doctor (very good one, to be honest). If you need to emergency help and professional organisation, chose another hospital.

This hospital is very bad. They don’t know what communication is. This is not Medicana (International) but MediKill Turkey. Stay away from Selin Merih Urlu and Ugur Sahin. these two are not doctors but butchers. They killed my best friend with cancer treatment. Gary from Holland.

Had an operation at the orthopedics department and stayed for a day. The close attention of the medical staff (especially Ms. Ece, my nurse) and the competence level of my doctor, Prof Dr. Şadan Ay were amazing. I don't recommend anybody to get sick but if you are sick this hospital is the right chouce to receive the best treatment

I was really disappointed about the service,my wife had to wait for more than 30 minutes to perform a PCR test even we were the only ones looking for the PCR test. The day after I went to get the results they couldn't even have the results paper in an envelope. They just gave us the paper. I hope you will improve your services and pay attention on those observations.