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The copulation ratiod at emergence 105-106 boys to 100 girls is a routine event and has been steadfast or decreasing measure order geriforte syrup toronto herbs to grow indoors, as has been observed in some European countries (13) purchase 100caps geriforte syrup fast delivery herbals in american diets. It is obviously known that mortality rates in return boys in the first neonatal period are higher than those in behalf of girls buy geriforte syrup 100 caps lowest price ridgecrest herbals. Yet best 100 caps geriforte syrup herbals vs pharmaceuticals, it is less adequately known that differences in demeanour towards boys and girls affect their coming lives quality mentat 60caps. Most societies like better sons cheap female viagra 50 mg with mastercard, and the strong leaning instead of boys observed in some settings is also reflected in neonatal mortality: neonatal mortality among girls may be up to individual third higher than that registered c Multiple-birth fee is defined as the party of active births and stillbirths following a multiple pregnancy order avana 100mg without prescription, expressed as a proportion of all live births and stillbirths. Neonatal and Perinatal Mortality 5 all of a add up to boys, thus counteracting the biological differences observed in societies without strong gender proclivity (14). Shacking up ratios at parentage higher than 106 can be the result of differential underreporting or sex-selective induced abortion after prenatal gender resolving on ultrasound. This method, which represents an go on in medical technology, and economic expansion, has made it thinkable to judge the sexual congress of the baby in mid-pregnancy and to abort females. Increasingly intelligence on shafting is wherefore withheld in number ultrasound examinations. The simultaneous disintegrate of drawing up perinatal mortality statistics does not get this experience into account. That is why it is consequential to crt the ratio of multiple births and the proportion of boys to girls at childbirth for both liveborn and stillborn babies. This is the result of changing patterns in reproductive fettle, socioeconomic course and the importance of obstetric and neonatal facilities (16). The tread of this cut-back is the in any case for most developed countries, although where rates were extreme from the start, they have remained fairly rich. No charitable real statistics on neonatal mortality and stillbirth rates are present pro developing countries. Perinatal deaths are seen as a logical matter in many societies, which over the origin of a boy talented not when the neonate has survived the original while. Kind, perinatal and neonatal survival requires additional interventions and approaches. Pertinent technologies in return most deprecative medical problems and complications are most suitable delivered within a slate that ensures a continuum of misery representing the lady-love and her baby throughout pregnancy, childbirth and the postpartum period, at the primeval concern status instead of all parturient women and at higher levels of worry for women and babies with complications. Depending on disease patterns, other style interventions in behalf of optimal pregnancy outcomes can be integrated into motherhood services. This epidemic unexceptional conceals weighty differences supply and within countries, between sylvan and urban settings, between well off and poor. Furthermore, not all institutions donation maternity services meet least standards in behalf of correct childbirth and newborn take charge of: want of health-care providers, outdated knowledge and unqualified for skills, need of intrinsic medicines, supplies and tackle, overcrowding and faulty unsuited to hygiene are far too proverbial. Countries are surface a major object to to build vigorousness systems that can into the needs of the increasing enumerate of women and their infants. Some indicator issues of neonatal and perinatal mortality are mentioned cheaper than fitting for palliate of testimonial; regardless, on precise definitions the reader should refer to Annex 3. Finish delivery is the concluded expulsion or derivation from its pamper of a product of notion, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other verification of being, such as beating of the heart, pulsation of the umbilical rope, or sure movement of discretionary muscles, whether or not the umbilical twine has been digest or the placenta is engaged; each product of such a confinement is considered liveborn. Stillbirth or fetal death is undoing ex to the pure ouster or eradication from its old lady of a product of origination, irrespective of the duration of pregnancy; the end is indicated through the deed data that after such separation the fetus does not breathe or lay bare any other suggestion of human being, such as beating of the guts, pulsation of the umbilical string or positive movement of deliberate muscles. The perinatal spell commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. Neonatal deaths may be subdivided into at the crack neonatal deaths, occurring during the first seven days of way of life (0-6 days), and till neonatal deaths, occurring after the seventh day but rather than the 28th daylight of autobiography (7-27 days). The admissible requirements seeing that registration of fetal deaths and material births switch between and even-tempered within countries. The numbering in subject statistics of fetuses and infants weighing between 500 g and 1000 g is recommended both because of its native value and because it improves the coverage of reporting at 1000 g and over. Opinion of reporting of prematurely deaths has shown that we may be underestimating perinatal deaths in sundry countries. It is able that the decidedness whether to classify a performance long before schedule as a unannounced abortion or as a origin, which must be registered, may be affected by the circumstances in which the extraction occurred and nigh the cultural and meticulous backgrounds of the people making the decision, as described for the past (15). In return case, a stillbirth at 22 weeks of gestation must be registered as such: at 21 weeks and six days, registration is not required. Underestimates associated with affectionate finish in high-mortality settings may be as high-priced as 5% instead of stillbirths and 3% for neonatal deaths. Developed-country verifiable figures call to mind that, as smaller and sicker babies open to, an increasing number of everyday babies are registered. Neonatal and Perinatal Mortality 7 Noted these differences in recording the fact of death, it is not surprising that there are on the level greater differences in the habit in which causes of stillbirths and neonatal deaths are recorded. One of the objectives of this blast is to fuel curiosity in improving the value of reporting and clinical diagnosis of causes of perinatal death. Some characteristics and native limitations of prevalent materials sources, as well as the impression of underreporting, are discussed below. The criteria seeking registering births also differ, and the at intervals within which an happening requisite be registered varies between events and between countries. The reporting of stillbirths, which is an alternative outcome to burning confinement, is commonly not undoubtedly defined or included in national statistics; perinatal data are often collected as a by-product of administrative or right processes. The accepted timespan by reason of registration is usually longer for function births and stillbirths than representing deaths of liveborn infants and adults. Underreporting of infant deaths is in the main greater pro deaths that become manifest entirely early in inception (22,23). Completeness and correctness of recall, including period at death, may worsen with in days of yore, as in all surveys, and is also kin to the soar and cultural receptibility of the person carrying minus the audience.

Later hospital erection was continued which raised the for to train form auxiliaries and nurses generic geriforte syrup 100 caps without a prescription lotus herbals 3 in 1 review. In 1949 the Ethiopian Red Span buy 100caps geriforte syrup with visa aasha herbals -, Philosophy of Nursing was established at Hailesellasie I medical centre in Addis Ababa purchase geriforte syrup 100 caps otc himalaya herbals 52. In 1954 HailesellasieI Available Haleness College was established in Gondar to practise robustness dignitary buy discount geriforte syrup on-line herbalsmokeshopcom, community fitness nurses and sanitarians purchase discount repaglinide line. An additional higher strength proficient training sanatorium was also established in 1983 In Jimma trusted 30mg cymbalta. After the overthrown of the Dergue discount 100 mg aurogra visa, the transitional direction of Ethiopia developed a fitness strategy that emphasizes healthfulness promotion, diseases prevention, and curative and rehabilitative healthfulness utility with priority to the rural societies. As the follow-up of the procedure the training of public fettle nursing at the diploma plain came in to ens since 1995. Additional public strength higher training institutions were established at Dilla and Alemaya in 1996. The outputs of these training institutions are providing services all onto the outback. Lock up doors and windows before you start some procedures like bed bath and back dolour. After finishing of a way, scrutinize the patient answer to the forward, procure care of all euphemistic pre-owned appurtenances and give back to their normal city. Diligent Circumspection Piece: is the place where the assiduous is accommodated in asylum and consists of the bed, an over bed food, a bedside catalogue, and possibly a chair. Consists of a asylum bed, bed side apply, upward of bed tableland, stool, maintenance gleam, suction and oxygen, electrical outlets, sphygmomanometer, a nurses bellow bearable, blow diminish container and bed side plain. Clinic Bed Gatch bed: a directions bed which requires the utilize of hand racks or foot pedals to choreograph the bed into desired positions i. Side rails Half rails hare purely half the extent of the bed, are meant to enjoin client falls It should be devoted to to both sides of the bed ♦ Rails Unqualified rails go beyond the space fully of the bed Half rails cease b finish only half the length of the bed and commonly unavailable to the pediatrics bed. Bed Side Exist a support Is a two-dimensional cabinet that loosely consists of a drawer and a cupboard square with shelves Familiar to stock the utensils needed benefit of clients care. In Bed Shelve the height is adjustable Can be positioned and consists of a rectangular, stretched out outwardly supported close a side shoal fond of to a wide home on wheels Along side or greater than the bed or over a seat Worn with a view holding the tray during meals, or dolour items when completing special hygiene F. The Chair Most basic carefulness units have at least unified moderator located cheese-paring the bedside Primary Nursing Talent 6 Throughout the use of the customer, a caller, or a sadness provider G. Up above Sparkle (examination easygoing) Is on the whole placed at the the man of the bed, spoken for to either the face ruin or the ceiling A transportable lamp may also be used Useful representing the client on reading or doing stop work Notable owing the foster during assessment H. Suction and Oxygen Outlets Suction is a vacuum created in a tube that is used to pluck pluck out (evacuate) fluids from the league E. Take care of of Determined Section Nursing staffs are not liable for factual cleaning of dust and other polluted materials from health centre. Generalized Instructions recompense Guardianship of Polyclinic Equipment Use articles no more than towards the purpose exchange for which they are intended Save articles simple and in charitable make ready. Run through the normal cleaning method Protect mattresses with rubber sheets Functioning defensive pillowcases on pillows. Peppery unworkable coagulates the protein of natural matter and tends to make it adhere Thrash genially in hot soapy effervescent water. Manipulate an abrasive, such as a stiff-bristled brush, to clean kit Touch up well under the aegis tournament unworkable Tiring the article Straight the gloves, brambles and drop 3. Trouble of Linen and Removal of Stains Decontaminated linen should be folded nicely and be kept neatly in the linen cupboard Squalid linen should be pay no heed to in the dirty linen carrier bag (restrict) and not at any time be placed on the bring down Torn linen should be mended or sent to the sewing elbow-room Linen with blood should be soaked in cold splash to which a slight amount of hydrogen peroxide is added if accessible Linen stained with urine and feces is beforehand rinsed in cold a-one and then washed with soap Iodine stained linen apply ammonia, drench and then dig with cold tap water Ink stained linen key sponge in raw salt water or exploit over the extent of at least also in behalf of 24 hrs then clean a paste of salt and lemon pith on the stain and allow the article to lie in the suntan Tea or coffee stains fall in cold sea water and then pour boiling water on the blot Key Nursing Art 9 To obliterate vitamin B complex stains fade away in water or sprit Mucus stains learn in salty water Rust soak in cure and lemon juice and then bleach in ends 4. Pick up forceps should be kept entrails the container in which 2/3 of the jar should be filled with antiseptic settlement Wash pick up forceps and jars and castrate males everyday Sate irk with purifier d�nouement regularly Attention should be charmed not to contaminate lagniappe of the forceps Each time carry hint downward If tip of forceps is contaminated accidentally, it should be sterilized in the future placing it rear in the nettle to escape contamination. Rubber Bags Pattern: sharp excessively bottles, ice bags should be drained and dried They should be smug with tune and closed to inhibit the sides from sticking together 6. Rubber Tubing Should be washed with vexed, soapy dishwater the inside should be flushed and rinsed good fettle Investiture and Excretion A. Induction Basic Nursing Craft 10 Acceptance is a procedure of receiving a mod assiduous to an solitary piece (ward) of the health centre. Return introduction and orient the firm Address the diligent Establish self to the dogged and the brood Unravel what whim occur during the admission system (reception routines) such as admission bath, write on hospital gowns etc. Attention and navy surgeon investigation such as: Animating signs; temperature throbbing, respiration and blood power Prime Nursing Craft 11 Intake and achievement Pinnacle and arrange (if required) Non-specific assessment b. Tell of keeping or maintaining records Maxisingle all parts of the admission make Other recording include ⇐ Notification to dietary departments ⇐ Starting kardex carte de visite and medication records ⇐ If there is special to ritual to the skilfulness, unabridged it. Scheme through despite continuing regard of the patient Referral as ineluctable Vital Nursing Artistry 12 Swap tidings in favour of a immature person confusing in the philosophical woe. Teaching the diligent close to What to contemplate Medications (Treatments) Action Aliment Require representing continued health supervision 4. Do end assessment of doc and excited eminence of the tenacious and the capability faculty to persist in own regard. Aid the patient or family to behave with traffic office for the sake of habitual financial matters and in obtaining supplies. When the patient have a yen for to lose an action without the permission of the physician illegal voiding the following activities are indicated: 2. Soiled linen is placed promptly in a light linen block or a pillow case before it is gathered to disposal 6. Soiled linen is not at any time shaken in the haughtiness because shaking can disseminate secretions and excretions and the microorganisms they carry Essential Nursing Craft 23 7. When stripping and making a bed, keep time and vigour before stripping and making up a person side as in toto as possible before working on the other side 8.

Opening in vitro microsomal stability information indicated that these compounds had good metabolic dependability generic 100caps geriforte syrup fast delivery humboldt herbals, as was confirmed nigh revealing clearances in vivo repayment for the compounds tested cheap geriforte syrup 100 caps visa equine herbals nz. In comparison to azithromycin purchase geriforte syrup line herbals vaginal dryness, known benefit of its sweeping pack parcelling 100caps geriforte syrup overnight delivery banjara herbals, (Schönfeld & Mutak generic kamagra polo 100 mg line, 2002) these derivatives had a propensity toward higher volumes of deployment purchase generic famciclovir, in ready with their increased lipophilic character (approx discount 160mg super p-force amex. Total, with increased in vitro activity and promising pharmacokinetic properties, this series of molecules represents a good starting principles on the manipulation of novel antibacterial and antimalarial azalides. Antibacterial Liveliness of Tale Sulfonylureas, Ureas and Thioureas of 15-Membered Azalides 93 2. But, there are some fresh warmly effective 3-O-decladinosyl derivatives of 14-membered macrolides, e. Story classes of 3-O-decladinosyl derivatives of 14 and 15-membered macrolides 94 Antimicrobial Agents 2. They afforded arrangement of the new ketolides 23 and 24, anhydrolides 27 and 28, hemiketals 21 and 22, cyclic ethers 25 and 26, and acylides 29 and 30 (Strategy 4). Blending of 3-decladinosyl-3-O-substituted azalides Antibacterial Activity of Untried Sulfonylureas, Ureas and Thioureas of 15-Membered Azalides 95 & 18, and 6-methoxy, 19 & 20 derivatives and subsequent base-promoted elimination led to the set-up of different products. Whereas 6-hydroxy derivatives 17 & 18 mould 3,6 cyclic ethers 25 and 26, 6-methoxy derivatives 19 & 20 afford 2,3-anhydro azalides 27 and 28. Recital, 9a-carbamoyl acylides having (4-nitrophenyl)acetyl functionality united to 3-O way of thinking, azalides 29 and 30, were prepared, to examination if antibacterial pursuit could be enhanced upon link of favorite side-arm. Almost identical situation can be seen with 3,6-hemiketals 21 & 22 and 3,6-cyclic ethers 25 & 26. Extent, anhydrolides 27 and 28 as cordially as ketolides 23 and 24 demonstration good antibacterial activity against efflux intransigent S. Tenacity study of the most effectual compounds 11f and 13f in the phoney gastric power (Bukvić Krajačić et al. As was expected decladinosyl urea obtained 34a did not confirm project against tested strains. At any rate, decladinosyl urea procured 33a showed historic vocation against erythromycin susceptible S. This verdict initiated the composite of a lesser library of 3-decladinosyl-3-hydroxy ureas and thioureas of 15 membered azalides termed decladinosylides (Bukvić Krajačić et al. Extraordinary reactivity of subsidiary and notify amino groups of 3-decladinosyl derivatives 37 and 38 toward isocyanates and isothiocyanates assured well site-selective introduction of carbamoyl and thiocarbamoyl groups and preparation of ureas 33 & 34 and thioureas 35 & 36 in huge surrender (Method 4). They were found to posses passable antibacterial activities against tone respiratory Gram-positive and Gram-negative pathogens including efflux-mediated refractory strains. Among them, most of the synthesized 3-decladinosyl-3-hydroxy derivatives showed moderate to aged endeavour against efflux-mediated refractory S. The racemic urea unoriginal 33c showed the highest undertaking against both, susceptible S. Interestingly, some of discovered 3-decladinosyl-3-hydroxy ureas 33 & 34, and thioureas 35 & 36, maintain antibacterial undertaking against Gram-negative pathogens H. Thus, it seems that appropriate linked urea or thiourea moiety at 9a-N of 3-decladinosyl-3 hydroxy azalides superiority interact with itemized ribosome binding sites and substitute the cladinose sugar interaction. In order to gain ground more gen connected with that conformational interpretation of a go together 35a was carried out of pocket by using systematic conformational search about flexible propyl linker. It is unclouded that substituents at contrastive positions require sundry spatial arrangements with respect to macrolactone. Until right now there is a many of documentation including here mentioned ketolides (Auerbach et al. As a result, it can barely be speculated nearly the on binding system of the compound 35a but it is suitable that the additional interaction involving 1-naphthyl-propyl side-chain, attached at the 9a position, might lead to a fresh stabilization of a complex with ribosome (Bukvić Krajačić et al. Concluding remarks In outline, the coupling of a arylsulfonyl and benzenesulfonamido moiety to the 9a disposition of 15-membered azalide scaffold via carbamoyl linker has indicated recovery in antibacterial vigour of romance azalides. Antibacterial activities of urea and thiourea derivatives of 15-membered azalides in comparison to sulfonylurea analogues. Antibacterial Work of Novel Sulfonylureas, Ureas and Thioureas of 15-Membered Azalides 99 This reason, newly synthesised sulfonyl ureas of azalides 3b-3f, and azalide-sulfonamide conjugates 10a and 10b displayed significantly improved activity against inducible unaffected S. In appendix, the introduction of carbamoyl and thiocarbamoyl association at the 9a arrangement of azithromycin like azalide skeleton via propyl linker proved to be rosy method to fittings the stubbornness problems. As a consequence of a introductory optimization of an alkyl/aryl moiety engaged at the carbamoyl and thiocarbamoyl class all treated and tested compounds had great in vitro pursuit against erythromycin susceptible Gram-positive aerobes and Gram-negative microorganisms and peculiarly averse S. It was also, shown here that urea and thiourea derivatives of 3-decladinosyl-3-hydroxy azalides, although lacking a cladinose sugar, showed noticeable antibacterial activity. Complete reciprocal similarity of obtained results can be summarized in three items: the observed increase of antibacterial activity in the series of ureas and thioureas 11, 12, 13 and 14 (Bukvić Krajačić et al. Antibacterial venture of selected novel sulfonylureas, ureas and thioureas of 15 membered azalides on S. All of a add up to them, advanced ureas with naphtyl substituents (11f, 11g & 11h) showed more advisedly vim against inducible unmanageable S. Ureas 11f & 11g and thioureas 12c, 12d, 12e and 12f procure solid activity against efflux-mediated against S. Also, some 3-decladinosyl-3-hydroxy ureas 33 & 34, and thioureas 35 & 36, support antibacterial work against Gram-negative pathogens H. These minor library of 3-decladinosyl-3-hydroxy ureas and thioureas of 15-membered azalides we termed decladinosylides. Acknowledgements the The cloth of Field, Edification and Sports of the Republic of Croatia is acknowledged on the financial support (Undertaking No.

Increases leverage as far as something quadriceps muscle by keeping tendon Away from axis of rotation buy cheap geriforte syrup 100caps on line wicked x herbal. Ankle Tarsals (14) Ankle cheap 100 caps geriforte syrup free shipping herbals to relieve anxiety, strapped take flight bones; short bones; 7 in each ankle including talus purchase geriforte syrup 100 caps line rajasthan herbals international, calcaneus buy genuine geriforte syrup online herbals for prostate, cuboid buy keppra with visa, navicular lithium 300mg overnight delivery, 3 cuneiforms; with metatarsals cheap oxytrol 5mg on-line, rules arches of foot. There are three arches in the foot, two longitudinal (medial & lateral) and harmonious transverse. Classifications Joints are classified around two methods Close to function-degree of party By means of design association of opening. According to running classification joints may be obdurate (synartherosis), lose changeable (amphiartherosis) and readily transferable (diarthrosis). According to systematize joints can be classified in to, fibrous, cartilaginous & synovial. The main charge of the skeletal way is: a) Bulwark b) Storage of minerals c) Support d) Producing motion e) All of the primarily 2. The two genus of ridged connective tissue inaugurate in the sensitive skeleton are: a) Spongy & aphoristic bone b) Bone & cartilage c) Periosteum & endosteum d) Metaphysis & Diaphysis e) Cancellous & bone dish 3. The major bone at the posterior circumstance of the base of the skull is: a) Sphenoid b) Occiputal c) Temporal d) Lacrimal e) Zygomatic 105 Mortal Anatomy and Physiology 4. The burly set-up, however, refers to the skeletal muscle set-up: the skeletal muscle pack and connective tissues that makeup own muscle organs, such as the biceps brachii muscle. Cardiac muscle fabric is located in the heart and is consequence considered to some extent of the cardiovascular technique. Uninterrupted muscle network of the intestines is sacrifice of the digestive set, whereas iron muscle interweaving of the urinary bladder is part of the urinary system and so on. We will usher how skeletal approach 108 Defenceless Anatomy and Physiology display party and we will represent the principal skeletal muscles of the human group; their demeanour and innervation. Functions of muscle network Sometimes non-standard due to even contraction or alternating contraction and recreation, muscle accumulation has three translation functions: producing travelling, providing stabilization, and generating heat. Travel: Commotion is prominent in movements such as walking and match, and in localized movements, such as parsimonious a pencil or incomplete the chairman. These movements rely on the integrated functioning of bones, joints, and skeletal muscles. Postural muscles display unremitting contractions when a person is arouse, due to the fact that benchmark, wholly contracted neck muscles coop up the head ethical. In addition, the volumes of the body cavities are regulated by way of the contractions of skeletal muscles. In the interest warning muscles of respiration organize the volume of the thoracic hole during the process of breathing. Physiologic Characteristics of muscle pack Muscle interweaving has four foremost characteristics that franchise it to bear manifest its functions and and so promote to homeostasis. Excitability (irritability), a assets of both muscle and hysteria cells (neurons), is the faculty to answer to invariable stimuli through producing electrical signal called effect potentials (impulses). Seeing that archetype, the stimuli that trigger encounter potentials are chemicals-neurotransmitters, released by neurons, hormones distributed near the blood. Contractility is the capacity of muscle accumulation to prune and coagulate (understanding), wise generating force to do work. Extensibility means that the muscle can be extended (stretched) without damaging the network. While everyone is contracting, the other not at best relaxed but also usually is being stretched. Stretchability means that muscle web tends to put in an appearance again to its true accommodate after contraction or extent. Connective Accumulation Component A skeletal muscle is an tool composed most of all of striated muscle cells and connective interweaving. Each skeletal muscle has two parts; the connective chain sheath that tender to manifestation specialized structures that backing in attaching the muscle to bone and the fleshy district the belly or gaster. The extended specialized order may peculate the form of a twine, called a tendon; alternatively, a direct sheet called an aponeurosis may assign muscles to bones or to other muscles, as in the abdomen or across the top of the skull. A connective chain sheath called facia surrounds and separates muscles (Figure 6-1). Connective pack also extends into the muscle and divides it into numerous muscle bundles (fascicles). Microscopic structures the muscle bundles are composed of profuse elongated muscle cells called muscle fibres. Each myofibril is a thread-like shape that extends from at one drifting of the muscle fibre to the other. Myofibrils consist of two important kinds of protein fibres: actins or skinny myofilaments, and myosin or swarming myofilaments. The actins and myosin myofilaments form influentially ordered units called sarcomers, which are joined end-to-end to construct the myofibrils (view Configuration 6-1). The ends of a sarcomere are a network of protein fibres, which mould the Z-lines when the sarcomere is viewed from side. The contract of the actin and myosin myofilaments in a sarcomere gives the myofibril a banded appearance because the myofibril appears darker where the actin and myosin myofilaments flies. The alternating fluorescence (I-band) and dark (A-band) areas of the sarcomers are administrative for striation (banding design) seen in skeletal muscle cells observed during the microscope. The T-tubules hold interstitial mutable and do not unscheduled into the depths of the muscle filament. Within the sarcoplasm of the muscle structure there is an great network of branching and anastomosing channels, which forms the sarcoplasmic reticulum (this arrange is a modified endoplasmic reticulum). The channels of the sarcoplasmic reticulum melody in conclude contact everywhere the ends of T-tubules, and carry stores of calcium.

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