CyberWarfare / ExoWarfare

Department of Disqualified: Fixing the Broken Military Medical Accessions Process

This affects most militaries, not just the US Army – and it often holds true for those applicants,
for whom the military should be bending over backwards to enlist, such as:
an Army effort to directly commission and provide recruitment bonuses to cyber warriors

 

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If discontent is the first necessity of progress, then the military medical accessions process — by which recruits are medically evaluated for military service — is ready for improvement. With 59 percent of Americans medically ineligible to join and tens of thousands of applicants medically rejected every year, there is plenty of discontent. I would know. I was one such disgruntled applicant.

I started applying to Army Officer Candidate School in October 2015 as a senior at the Massachusetts Institute of Technology. After seven months of navigating the medical accessions process, I was medically rejected from the Army on account of congenital scoliosis and a medical history of spinal fusion surgeries. Neither my career as a Division III Varsity soccer player nor a letter from my surgeon — a retired Army doctor and chief of orthopedic surgery — noting that I had “no limitations whatsoever” had any impact on my medical evaluation. After switching my application to the Navy the following spring, I was medically rejected again. Finally, after one last medical rejection from the Army National Guard in the summer of 2016, I gave up on my dream of serving my country in uniform.

As anyone who has served will tell you, the “needs of the military” come before any individual servicemember and, by extension, applicant. With this I completely agree. But what, exactly, are the needs of the military? We often hear about the military’s “brain drain,” from a well-documented dearth of military officers from top universities to the need for applicants with STEM skills (subjects of Science, Technology, Engineering and Maths), a shortage that former Secretary of Defense Ash Carter sought to address as part of  a comprehensive initiative known as the “Force of the Future.” In the complex security environment defined by rapid technological change described in the 2018 National Defense Strategy, it is likely that the impact of shortages will only be exacerbated.

Given these needs, the military should be going out of its way for applicants from top universities or with STEM skills. And while there are some promising initiatives, including an Army effort to directly commission and provide recruitment bonuses to cyber warriors, the overly restrictive medical accessions process is preventing countless similar applicants from joining military service. My personal experience is, unfortunately, not atypical. I have met a number of applicants with similar stories. A classmate at MIT, studying computer science, was medically rejected after having completed his first year of Reserve Officer Training Corps, forcing him to pay back his first year’s tuition scholarship in full. Why? Because of a minor tree nut allergy. I have a coworker who has multiple degrees from Stanford, on top of being a Rose Bowl Champion football player, who was rejected from military service on account of mild sleep apnea that is easily remedied with a mouth guard.

Thousands of highly qualified applicants are rejected each year for medical conditions that may not impact their ability to serve. Incredibly, despite its self-described needs, the military does not know how many such applicants are rejected each year, nor does it fairly evaluate most of the applicants it does reject. I propose an assisted accessions process for applicants with STEM skills and other highly qualified applicants to address the shortcomings of the waiver process and meet the changing needs of the armed forces.

A Troubling Pattern

If you think the examples discussed above are simply a few bad cases, consider this: In 2012, according to the Department of Defense’s Accession Medical Standards Analysis & Research Activity (AMSARA) Annual Report, 38,000 of 200,000 active duty applicants (or 19 percent) across all military services were medically disqualified from service. If disqualified, it is possible to apply for a waiver, but it is generally the recruiter’s decision. Yet recruiters are neither medical professionals nor are they empowered to evaluate an applicant holistically, weighing their talents and background against their medical condition. Such a holistic evaluation is the intent of the waiver process, but three-quarters of disqualified applicants never apply for one or, more commonly, they are never allowed to apply. In 2012, less than half of disqualified applicants (18,000 out of 38,000) applied for a waiver.  Similar trends exist between 2010 and 2015 (the last year for which AMSARA data is available) and across the Reserve and National Guard components. In my case, I was medically rejected pre-physical and not allowed to apply for a waiver during my rejections from the Army, the Navy, and the Army National Guard.

According to AMSARA, the top conditions for active duty medical disqualification from 2010-2014 were weight/body build (17 percent), psychiatric (12 percent), refraction (11 percent), and skin/allergies (9 percent). These conditions largely hold across years and components. Many conditions included in these categories may inhibit an applicant’s ability to serve effectively. However, many do not. Although overweight applicants would most likely not be able to meet military physical standards, according to AMSARA one-third of “weight/body build” disqualifications include cases of underweight applicants who may not have such issues. Ongoing psychiatric conditions should be taken seriously, but even symptoms or outpatient treatment of depression within three years of applying for military service is disqualifying, according to the Department of Defense’s Medical Standards for Appointment, Enlistment, or Induction regulations. Vision that cannot be corrected to 20/40 as well as allergic reactions to fish, insects, and nuts can be disqualifying as well.

My argument is not that the military should give up strict medical and physical standards entirely. Given the unique mission and demands that the military puts on servicemembers, these standards are necessary for many roles. But out of the 30,000+ applicants across all services and components who are medically disqualified each year without an appeal for a waiver, there are many who would provide tremendous value to the military despite their medical conditions — applicants who are “worth the risk.” These applicants should not be waived for certain physically demanding military occupations (Army and Marine Corps infantry, Air Force pilot) or career tracks (special operations), but have much to offer in other career fields (engineering, logistics, intelligence, cyber) where their medical histories will not have an impact on their job performance. Unfortunately, medical standards are not eased for these less physically demanding positions.

The rigidity of the military’s standards is particularly self-defeating when it comes to the disqualification of top-tier applicants and applicants with STEM skills. How many disqualified applicants might fall into these categories? The Department of Defense cannot even begin to answer this question. And that, too, is part of the problem. In the section “The Procrustean Bed: The Military Personnel System,” the Force of the Future report describes how the military services were unable to identify or even define top talent when asked by the Office of the Secretary of Defense. The report proposes that the military services start to capture, record, and employ the unique background and skills of their forces, especially Reserve and National Guard troops, who may have special expertise from their civilian jobs. Given the Defense Department’s limited internal talent management capacity, it seems unlikely that the department will attempt to understand the talent of accepted applicants, let alone rejected ones, in the foreseeable future. Thus, thousands of applicants each year will continue to be medically rejected without applying for a waiver. And the Defense Department will continue not to know what it is missing.

The Way Forward

With discontent accounted for, what of progress? There is certainly no shortage of ideas. Some, like Jacquelyn Schneider, advocate a complete reevaluation of the military accessions process and standards. Others counter that this could damage military readiness and have implications for military culture. However, there is a middle-ground approach that will give highly qualified and in-demand applicants a chance to serve without compromising readiness.

I propose creating an “assisted accessions process” for shepherding these applicants through the bureaucratic and often dysfunctional accessions process. Eligible applicants could be evaluated by a number of factors, including undergraduate university, grade point average, military aptitude test score, and/or physical fitness test score. If the military requires more recruits with a certain background — computer science, for example — applicants with skills in these fields could be flagged for the assisted accessions process. The system would give select applicants access to senior military leaders and medical professionals, who would evaluate the applicant holistically, weighing the talent they bring to the military against the risk that their medical history presents.

Theoretically, this is what the medical waiver appeals process is supposed to do. However, as my case illustrates, many steps and people stand between an applicant and a waiver appeal. The system proposed here would empower senior leaders to make more informed decisions earlier in the process, before highly qualified applicants are turned away or disqualified. Senior leaders are busy, but if managed correctly, such a system would not take much of their time — they would likely only be evaluating a few hundred applicants per year, and each would only take a handful of hours of each leader’s time (review of file, interview, shepherding). Considering the potential return on investment to the military, it would be time well spent. Moreover, much of this process could be automated: For instance, if an applicant gets a certain score on their Armed Forces Qualifying Test or Physical Fitness Test and gets medically rejected, they could automatically get entered into the waiver process.

I am confident that such a system would work because I benefited from such assistance, albeit informally. After my three medical rejections, I restarted my application to the military through the Air National Guard. Although I was, once again, initially medically rejected prior to a physical, this time I had backup. A friend who was a senior officer in the Air National Guard was, along with the State Air Surgeon, able to get me temporarily waived to take a physical at the Military Entrance Processing Station. Notably, this physical was the first time that I was officially screened in-person by a medical professional in any of my four accessions attempts. At the Military Entrance Processing Station, the physician, an independent medical reviewer, was forced to officially disqualify me based on regulations but recommended me for a waiver. My file then went to the office of the Air National Guard Surgeon General where, with strong advocacy from the State Air Surgeon, I received a waiver and was medically cleared for military service. Three years later, I now have the opportunity to serve my country as an engineering officer in the Air National Guard.

My story happens to have a happy ending because the stars aligned for me. I happened to be connected to senior military leaders who were not only able to assist me, but had an incentive to do so. (In the National Guard, recruits apply directly to their state of choice, as opposed to Active Duty recruits who process through a local recruiting station and then go off to the “big” Army or Air Force. Thus, National Guard units have an incentive to pursue waivers for applicants that they want in their unit.) Without those senior leaders, I would not have received a medical waiver. Many more like me could be allowed into military service if we gave them similar access and attention.

Skeptics of the assisted accessions process may object for a number of reasons including scalability, deployability, and affordability. First, they may argue that senior leaders do not have the time to assist applicants. However, the assisted accessions process would most likely only apply to a small number of highly motivated candidates per year. Additionally, as discussed, this system would not require an exceptional amount of time per applicant and some of the process could be automated. Second, some may suggest that my proposal runs contrary to Secretary of Defense James Mattis’ “deploy-or-get-out” rule for the military. But, I am not advocating changing military medical or physical standards. Rather, my proposed assisted accessions process aims to give specific applicants (those who fit the self-described needs of the military) the opportunity to apply for a medical waiver. If these applicants are rejected by the waiver authorities, so be it, as long as they are evaluated holistically and the military is making a conscious assessment that the applicants’ medical conditions will prohibit them from successfully completing military service. Third, skeptics might raise the concern of second-order financial impacts, such as potential future medical expenses in service and in retirement. However, the costs of tens or even hundreds of potential assisted applicants will be relatively small compared to the 100,000–150,000 military accessions per year.

And if the military truly needs top talent and STEM skills to compete with U.S. adversaries, the cost of inaction will be orders of magnitude higher than the cost of action.

Some readers might agree with the ends advocated here, but disagree with the means. These critics might posit that there are simpler ways to increase STEM talent or highly qualified service members in the armed forces — such as increasing the size of the MIT Reserve Officer Training Corps program, as an example — that are less burdensome than creating an entirely new process inside a large, bureaucratic organizations like the military services. However, expanding existing programs, like ROTC, will not solve the problem. Cadets will still need to receive a medical clearance before signing a contract. Thus, I would still be rejected as would my aforementioned MIT classmate. Additionally, focusing on existing ROTC-type programs would necessarily be reactionary. It would take five years for recruits to apply and be accepted to a university, complete their undergraduate education, and then commission as officers. Although STEM skills are likely going to be important for military operations for the foreseeable future, such a system would not be able to accommodate urgent needs for other skill sets. If the United States becomes involved in another major counter-insurgency, for instance, the armed forces may need more sociologists and psychologists. The assisted accessions process would be more agile and responsive to such needs, since it focuses on assisting current applicants, instead of recruiting and educating new applicants.

Still, I recognize that my proposal is a band-aid solution. Structural changes need to be made to the military recruitment and accessions process if the military wants to win the “war for talent” — specifically, the armed forces must reevaluate the incentives and qualifications of recruiters, the Military Entry Processing Station screening process, and the medical standards themselves. And recruitment and accessions are just one piece of the military talent management system that needs to be reimagined, including assignments, promotion, retention, and retirement. Thus, the assisted accessions process would be little more than a drop in the ocean — but it would be an important start.

Conclusion

Most people may not realize that some of this country’s greatest military and political leaders had to overcome significant medical barriers to enter military service. In his early twenties, John F. Kennedy was rejected from enlistment twice due to back issues. Only through connections from his father, the former ambassador to the United Kingdom, was Kennedy able to join the Navy. As an applicant to the United States Military Academy, Douglas MacArthur was rejected twice due to scoliosis. After moving to Wisconsin to work with a medical specialist for two years of intense physical therapy, he was able to reduce his spinal curvature sufficiently to gain entrance to West Point. Without their own champions and medical exceptions, these two great Americans, and surely many others, would not have been able to serve their country in uniform.

Today’s highly qualified applicants, who are already asking what they can do for their country, deserve to know that there is something their country is willing to do for them. Such is the discontent that we can prevent, and the progress we need.

 

Joe Schuman is a recent graduate of the Massachusetts Institute of Technology and an Air National Guard applicant. He works in Washington, DC in the defense innovation community. He can be contacted at joeschuman1234@gmail.com.

Image: Staff Sgt. Duane Duimstra

 

from: https://warontherocks.com/2018/11/department-of-disqualified-fixing-the-broken-military-medical-accessions-process/

 

 

Executive Summary: 

  • Develop a new career and promotion pipeline to capture a wide range of unique I+STEM skills and apply them to DoD challenges
  • Explore how military personnel would cycle between these innovation-specific positions and assignments in their functional field to avoid the I+STEM career field becoming its own stovepiped area as opposed to infusing innovation throughout the Department

Problem statement

Some of the biggest challenges the Department of Defense faces today include innovation, technology development and adoption, and recruiting and retaining STEM talent.  After enjoying multi-domain dominance for the last seven decades, DoD has settled into a complacent culture that accepts and even expects the norms of the last 70 years to remain viable in the future.  The abundance of new technology, the pace of technological change, and our adversaries’ ability to rapidly integrate and iterate this technology within their armed forces are changing the character of warfare and closing the advantage once enjoyed by the U.S.  Failing to adopt industry best practices in innovation and technology development, and continuing to rely on what has been successful in the past, will not deliver the technological advances required to increase the lethality of the Joint Force on tomorrow’s battlefield.

To retain multi-domain dominance, operational surprise, and an ability to adapt quickly, the Department must adjust the way it innovates and integrates new capabilities.  This will require a focus on cultivating and developing new skillsets and subject matter expertise in innovation, rapid capability development and adoption, data science, and STEM disciplines.  But there is no formal process to recruit, train, develop, and sustain a workforce with these skillsets and hone them as a core competency within the Department.  While assembling subject matter experts within certain branches is standard practice across the Services, this has not yet occurred for the abovementioned skillsets – significantly hindering the Department’s ability to rapidly innovate and close emerging capability gaps.

Proposed Solution

To maintain the technological advantage over our adversaries that has been in place since World War II, the Department must develop and integrate new skillsets into our processes to better mitigate the challenges posed by emerging and surprise technologies.  DoD developed Cyber Warfare as a new branch within the Services and established the United States Cyber Command as a unified combatant command to effectively address cyber warfare challenges.  This approach was taken to establish cyber as a core competency within the Department and develop the skills and subject matter expertise necessary for the United States to prevail in the Cyber Domain.  In fact, the Services have taken this same approach to manage their core competencies over the history of the Department of Defense based on changing doctrine and the changing character of warfare.  Nuclear Propulsion, Aviation, Space and Missile Defense, Information Operations, and Special Operations are all examples of how the Department adjusted existing culture and developed and focused the skillsets necessary to address emerging battlefield challenges.  The same approach must be taken with regard to the skillsets necessary to innovate and address the winding capability gap associated with rapidly changing technology and the changing character of warfare.

The Innovation+STEM, or I+STEM, Career Field (which would cover innovation, rapid capability development and acquisition, data science, and STEM) will operate in small teams across the Joint Force.  They will be assigned within the table of organization and equipment as a staff section to the Joint Staff, Combatant Commanders, force providers, doctrine developers, and test and evaluation commands.  Teams will advise and assist senior commanders in fostering an innovative culture, use of rapid acquisition techniques, identifying capability gaps and recommending and implementing innovative approaches to quickly mitigate them.  Teams will rely on industry standard best practices, STEM skillsets, and operational expertise derived from their experiences as well as the facilitated ideas emanating from within the organization to obtain the best results.  Duties will include: integration within the Joint Capability Integration Development System (JCIDS); training and mentoring on the latest business practices that foster innovation and experimentation across the Joint Force; software engineering;  identifying and integrating new and innovative technologies to meet current and future capability gaps; expeditiously iterating existing capabilities through the use of rapid acquisition practices; application development; and point of use technology and software upgrades.

Members of this career field must be diverse and possess a mixture of the skills and traits necessary to ensure mission accomplishment.  Many of skills required will be obtained through formal education programs prior to entering the service such as STEM degrees.  Other skills will be developed in service training schools, operational assignments, and during industry broadening assignments such as application development, understanding of industry best practices and available technologies, lean start-up, change management and domain expertise.  Finally, other skills are more inherent to individual service member personality traits such as: prudent risk taking; questioning the status quo; connecting typically unconnected insights to deliver disruptive new ideas; networking with diverse people to generate new ideas; low anxiety and a high degree of emotional stability and confidence.

Each team of I+STEM Career Field professionals must contain a balance of those with highly technical skills as well as those with less tangible personality traits and industry experiences.

Additional solution

As a caveat, we recognize that developing an innovation-specific career field risks creating a stovepiped career field that is disconnected from Service-led missions. Military personnel might come to view innovation as a separate field as opposed to something necessary in every position they find themselves in throughout their careers. The following proposal highlights the need for a new branch or branch-type option as a way to call attention to the inefficient way DoD prepares its people to think more intrapreneurially, but it is essential that innovation is integrated in core military duties, not added on top of them like another requirement.

To that end, while our recommendation does not delve into this option in depth, it is worth exploring how DoD would allow certain personnel to cycle between innovation-specific positions and assignments in their functional career field. This would create and enhance an elite and diverse cadre of innovation experts who can optimize innovation across all military disciplines. Alternating innovation development assignments with functional career positions will help achieve this recommendation without building potential stovepipes disconnected from the rest of the Joint Force.

In addition, current career fields can be adjusted and, in the case of the Air Force, for example, Special Experience Identifiers can be established to capture key expertise and support assignments to innovation fusion cells.

Why a New Branch is the Answer – Challenges with the Status Quo

Many of the skillsets required to address the emerging technological challenges exist within the Department today. Our research leads us to believe that people with such skills could be enticed to join the Department – particularly due to the success of new outreach efforts such as Hack the Pentagon, among others – if a formal career field supporting these skillsets existed.  Unfortunately, service members with these skillsets are contained in pockets across the force, often unknown to the Department, within multiple career fields that are subject to existing culture and personnel management policies.  Moreover, there is no formal process in place to train and further hone the skillsets of service members and focus their efforts on resolving Departmental challenges.  The same cannot be said for Nuclear Propulsion, Aviation, Space and Missile Defense, Information Operations, and Special Operations.  These branches, as well as the multitude of other branches within the service, are specifically recruited, trained, and sustained in order to focus on specific Departmental challenges.  These branches offer members a career field with a well-established path that includes ample opportunity for advancement within the career field. Traditional service culture and norms reward service member who follow a prescribed path, within their individual branch, and punish those who fall outside that path by failing to advance them because they are considered unqualified.

The Services have invested in discrete visionary programs to innovate and introduce rapid capability development techniques to increase the lethality of the Joint Force and get capabilities into the hands of service members sooner.  The Army’s Rapid Capability Office (RCO) and Rapid Equipping Force (REF); the Navy’s Rapid Prototyping, Experimentation and Demonstration (REPD) initiative; The Air Force’s Revolutionary Acquisition Techniques Procedures and Collaboration (RATPAC) program; and the Special Operations Command’s SOFTWERX programs are all great examples of a step in the right direction.  However, as previously mentioned, they are not a core competency of the Department and there are no formal processes in place to train and consolidate the subject matter expertise necessary to apply these visionary programs at scale.  Moreover, service members who remain within these programs for extended periods, risk future viability within their individual branches.

The Navy’s Chief of Naval Operations Rapid Innovation Cell (CRIC) provides an excellent example of what the lack of a specified career field portends for these initiatives.  This Cell was established to harness the talents of rising junior officers and enlisted service members from multiple branches across the Navy to solve emerging challenges within the Department.  The program allowed team members the flexibility, autonomy and support necessary to develop and implement new ideas, many of which were extremely successful.  However, after being in existence for a year, members of the team were returned to the fleet to continue broadening and development in the branches they came from for fear that they would be left behind and not competitive for future advancement.  The end result was that the subject matter expertise gained by the CRIC team was not solidified across the Navy and many of the team members left the service for other opportunities that would allow them to continue applying their skills. That in part led to the end of the CRIC.

For existing service members, policies, and organizational culture require individuals to be assigned to multiple positions within their operational branch or career field to generate the right broadening experiences to remain competitive for promotion to the next higher grade.  Individuals who fall outside this pre-determined path are not competitive for advancement and consequently leave the military.  As a result, individuals who possess the skillsets required to address the emerging technological challenges gaps are either not available, or only available for short periods of time.  Moreover, those who continue to peruse a non-traditional innovation or technology focused career path are effectively damaging their future career.  The end result is that these talented individuals either leave the service of their own volition or are forced out by an up or out promotion system.  Regardless of whether individual service members leave the force or return to their individual branches, the result is the same.  The Department is unable to fully capitalize and apply the skillsets and talent of these individuals at scale to solve core challenges.

The I+STEM Career Field does not replace the acquisition career field.  However, it does supplement and increase the effectiveness of acquisition professionals by acting as a tool for senior commanders to assist them in focusing on agile adaption, innovative problem solving, capability identification and development, and rapid acquisition approaches.  In the past, multi-domain dominance was dependent on superior weapons systems and platforms where the United States has maintained a distinct advantage.  This is where acquisition professionals provide the DoD an advantage because of their ability to manage large, fixed acquisition programs effectively.  However, the Department must acknowledge that these systems and their requirements are changing and future warfare will be dependent on software.  The country that is the most adept at identifying emerging requirements and quickly iterating the software of its major systems will have the advantage.  An F-35 is not a plane with a computer on board – it is a computer with wings.  Although we will continue to need acquisition professionals to procure new systems, we will also need the skills outlined in this proposal to agilely iterate the software within these systems to meet a rapidly changing threat environment.  Acquiring and iterating software is a distinctly different skillset that than procuring major defense systems.

Stepping back from solely acquisition, the Air Force, as an example, utilizes programs like Blue Horizons, run out of the Air Force Center for Strategy and Technology, to select talented STEM individuals and position them for future strategic planning, war gaming, and future technology exploration. The Air Force also offers mid-career incentive pay programs to retain talented individuals with STEM and cyber skills. These cases demonstrate where the military is already implementing this recommendation on a smaller scale and deserve further exploration to see how to expand these ongoing efforts.

Separately, the Marines are creating a discrete military occupational specialty (MOS) in cyber. While MOSs are commonplace, this is an example of working within the system to create a new career path, complementing the goals of DIB Recommendation 14, which aims to remove certain individuals from the normal military workforce.

Benefits of a New Career Field – A Practical Vignette

On a recent site visit, the Defense Innovation Board met with a senior Joint Force Commander.  During this engagement, the commander indicated that he wanted to lead the Department in innovation and apply the newest technologies to his command to better meet his current mission set.  To facilitate this, he engaged his Strategic Initiatives Group to act as his innovation catalyst.  This group, no doubt capable and extremely skilled in strategic and operational planning, does not have the expertise as is envisioned for the proposed career field.  Instead of being able to immediately engage with the implementation of their commander’s vision, this group will need to spend a considerable amount of time navigating bureaucracy and acquiring the knowledge and expertise required to facilitate innovative, agile, and adaptive capability integration.  Moreover, as the Initiatives Group Becomes more proficient, members of the group will begin rotating to new assignments being replaced by untrained teammates, with the process repeating itself.  The skills and experiences gained in rapid innovation techniques by the Strategic Initiatives Group will be lost as a useful tool for the force as they return to basic branch functions in future assignments.

As an alternative, with the integration of this recommendation, the commander would have access to a skilled and trained team who would immediately begin implementation of his or her vision.  Team members, knowledgeable of emerging technologies and rapid acquisition practices, and skilled at identifying capability gaps would work to quickly align new capabilities to increase the lethality of the Joint Force.  As these new capabilities begin to come on line, subordinate commanders would be mentored and coached on the best way to experiment and further develop those capabilities to increase lethality and adjust to changing threats from our adversaries.   Members with computer programming and application development skills would begin to quickly iterate existing capabilities based on the changing requirements on the battlefield without the need to engage private industry in lengthy and expensive software system upgrades.  When engagement from industry is required, team members would be able to effectively bridge the gap between contractors and service members making upgrades quicker and more effective based on the needs of the Joint Force.  Other team members would be working throughout the command providing training and mentorship on the principles of an innovative, adaptive and agile culture.  Acting as a filter for the commander, team members would coach, mentor and shape innovative solutions from the bottom of the organization up to ensure that the commander had a chance to evaluate and implement the best ideas from his command.

 

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