Priority

优先级
  • 文章类型: Journal Article
    饮用水中日益严重的化学污染问题受到广泛关注。大量的有机污染物由于其浓度低,无法通过常规水处理技术去除,长期接触可能对人类健康构成重大风险。饮用水中的有机污染物应得到更多关注,一直是近年来备受关注的话题。为了识别需要注意的有机污染物,本研究提出了一种改进的健康风险筛查方法来定量分析风险积累,持久性,毒性,抗生素耐药性。与常规方法相比,26个化合物被添加到改进的筛选列表中,包括9个DBP(例如,NDMA),3种抗生素(例如,土霉素),PFNA等化合物。总的来说,抗生素和增塑剂在风险排名上升。从占总风险价值的比例来看,单一风险在排名中起着决定性作用(超过99%)。这种变化表明,抗生素耐药性和有机物的积累与其对人类的毒性风险同样重要。建议将58种化合物作为饮用水中有机污染物的优先控制清单。此列表提供了必要的信息,以供权威法规进行监控,control,评估,并管理中国饮用水中与环境相关的化合物的风险。
    The increasing chemical pollution of the drinking water is widely concerned. Large number of organic contaminants cannot be removed by conventional water treatment technology due to their low concentration, and long-term exposure may pose significant risks to human health. Which organic contaminants in drinking water should be given more attention has been a topic of great concern in recent years. To identify the organic contaminants that need attention, this research proposes an improved health risk screening method to quantitatively analyze the risks of accumulation, persistence, toxicity, and antibiotic resistance. Compared with conventional method, 26 compounds were added to the improved screening list, including 9 DBPs (e.g., NDMA), 3 antibiotics (e.g., oxytetracycline), PFNA and other compounds. Overall, antibiotics and plasticizers rose in the risk rankings. From the perspective of the proportion of total risk value, a single risk plays a decisive role (more than 99%) in the ranking. This change suggests that antibiotic resistance and the accumulation of organic matter are as important as their toxic risks to humans. 58 compounds were recommended for the priority control organic contaminants list in drinking water. This list provides the necessary information for authoritative regulations to monitor, control, assess, and manage the risks of environmentally relevant compounds in drinking water in China.
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  • 文章类型: Journal Article
    背景:患有多种慢性疾病的人面临复杂的医疗方案,临床医生可能不会关注对这些患者最重要的事情,这些患者的健康重点差异很大。PatientPrioritiesCare是促进者主导的流程,旨在确定患者的优先事项,并使决策和护理保持一致。但是对促进者的需求限制了它的广泛采用。
    目的:本研究的目的是为患者设计和测试机制,以完成确定优先事项并向临床医生提供优先事项的自我指导过程。
    方法:该研究涉及至少65岁的患者,有2个家庭医学实践,每个5名医生。我们首先测试了一个交互式网站的2个版本,并要求患者将他们的结果带到他们的访问中。然后,我们测试了来自网站问题的Epic预科问卷,并包括标准预科材料。我们完成了对参与患者的干预后电话访谈和在线调查,并收集了非正式反馈,并与参与医生进行了焦点小组。
    结果:在第一个网站版本的测试中,17.3%(35/202)的受邀患者访问了网站,11.4%(23/202)完成了所有问题,2.5%(5/202)为他们的访问带来了结果,中位会话时间为43.0(IQR28.0)分钟。患者对访问结果表示困惑。在第二个版本中澄清了这个问题之后,15.1%(32/212)的患者访问了该网站,14.6%(31/212)完成了问题,1.9%(4/212)带来了访问结果,中位会话时间为35.0(IQR35.0)分钟。在史诗调查问卷的测试中,26.4%(198/750)的患者在至少1次访视前完成问卷,中位完成时间为14.0(IQR23.0)分钟。8个主要问题的回答时间为62.9%(129/205)至95.6%(196/205)。完成问卷的患者比没有完成问卷的患者年轻(72.3vs76.1岁),并且更有可能完成至少1个其他分配的问卷(99.5%,197/198)比那些没有的人(10.3%,57/552)。198名患者中共有140名(70.7%)接受调查,86人记得完成问卷;78人(90.7%)不记得回答问题有困难;57人(68.7%)同意或有点同意问卷帮助他们和他们的临床医生了解他们的优先事项.医生指出,病情最重的患者没有完成问卷,讨论为临终护理提供了很好的参考。
    结论:将评估患者优先级的问卷嵌入患者门户中有望扩大获得优先级-一致护理的机会。
    BACKGROUND: Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients\' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption.
    OBJECTIVE: The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians.
    METHODS: The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website\'s questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians.
    RESULTS: In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care.
    CONCLUSIONS: Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.
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  • 文章类型: Journal Article
    在最近的一份关于藤黄的分区分类法的出版物中,发布了一个非法的多余部分名称和两个非法的同音异义词。在这里,我们选择一个合法的部门名称,GarciniasectionRhediopsisPierre,多余的名字GarciniasectionRheedia(L.)S.W.JonesexP.W.Sweeney;并在藤黄种为Allanblackiagabonensis(Pellegr。)Bamps和A.parvifloraA.Che.
    In a recent publication dealing with the sectional-level taxonomy of Garcinia, an illegitimate superfluous sectional name and two illegitimate homonyms were published. Herein we choose a legitimate sectional name, GarciniasectionRheediopsis Pierre, for the superfluous name GarciniasectionRheedia (L.) S.W.Jones ex P.W.Sweeney; and create two new legitimate names in Garcinia for Allanblackiagabonensis (Pellegr.) Bamps and A.parviflora A.Chev.
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  • 文章类型: Journal Article
    全球卫生治理的高度分散性质对概念化和系统地衡量疾病议程状况提出了重大挑战,受伤,导致集体疾病负担的风险和其他条件。最近提出了全球卫生议程设定的竞技场模型,以帮助应对这些挑战。进一步发展模型,这项研究旨在更有力地调查在全球卫生议程制定的一系列利益相关方领域中,优先级水平如何以及为什么会有所不同。我们分析了四个领域中八种传染病的优先级变化的顺序和幅度(国际援助,科学研究,制药业和新闻媒体)在超过二十年的时间里,与奖学金的五项主张有关。这些疾病的负担和在联合国可持续发展目标3中的突出地位各不相同,包括四个具有具体监测和评估指标的指标(艾滋病毒/艾滋病,结核病,疟疾,肝炎)和四个没有(登革热,腹泻病,麻疹,脑膜炎)。在任何领域,优先顺序都不符合疾病负担或国际发展目标。此外,使用新的方法来衡量指示优先级的资源分配年度变化规模,揭示了在更广泛的稳定模式下,所有领域疾病水平的波动性。对领域内和领域之间的长期优先模式的见解对于加强旨在确定关键因果机制的分析是不可或缺的。为了澄清竞技场是如何互动的,并测量它们产生的影响。
    The highly decentralized nature of global health governance presents significant challenges to conceptualizing and systematically measuring the agenda status of diseases, injuries, risks and other conditions contributing to the collective disease burden. An arenas model for global health agenda setting was recently proposed to help address these challenges. Further developing the model, this study aims to advance more robust inquiry into how and why priority levels may vary among the array of stakeholder arenas in which global health agenda setting occurs. We analyse order and the magnitude of changes in priority for eight infectious diseases in four arenas (international aid, scientific research, pharmaceutical industry and news media) over a period of more than two decades in relation to five propositions from scholarship. The diseases vary on burden and prominence in United Nations Sustainable Development Goal 3 for health and well-being, including four with specific indicators for monitoring and evaluation (HIV/AIDS, tuberculosis, malaria, hepatitis) and four without (dengue, diarrhoeal diseases, measles, meningitis). The order of priority did not consistently align with the disease burden or international development goals in any arena. Additionally, using new methods to measure the scale of annual change in resource allocations that are indicative of priority reveals volatility at the disease level in all arenas amidst broader patterns of stability. Insights around long-term patterns of priority within and among arenas are integral to strengthening analyses that aim to identify pivotal causal mechanisms, to clarify how arenas interact, and to measure the effects they produce.
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  • 文章类型: Journal Article
    目的:鼻窦疾病是结直肠外科医生治疗的常见病。该领域缺乏文献来指导这种状况的优化管理。作为PITSTOP研究的一部分,我们旨在确定政策和研究重点,为该领域提供指导。
    方法:邀请患者和外科医生参加。A\'那又怎样,现在进行了什么运动,根据PITSTOP的数据。这产生了研究和实践优先事项的陈述。进行了三轮在线Delphi研究,根据政策和研究分别对陈述进行排名。陈述被评为1(不重要)到9(重要)。超过70%的参与者对7-9的陈述进行了共识会议。各轮之间显示了个性化的投票反馈。举行了面对面会议讨论发言,参与者被要求使用加权选择投票对陈述进行排名。
    结果:22人参加了焦点小组,生成14项研究和19项政策声明。第1轮56名与会者、第2轮53名与会者和第3轮51名与会者对发言进行了表决。在共识回合中,共讨论了15份政策声明和19份研究声明。关键政策声明涉及治疗策略和强度,外科医生培训机会,需要分类和治疗对重返工作岗位的影响。研究建议包括未来试验的设计,方法论考虑和研究问题。
    结论:本研究确定了与患者和临床医生相关的藏毛窦疾病的研究和政策重点。这些应该为实践和未来的研究提供信息。
    OBJECTIVE: Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field.
    METHODS: Patients and surgeons were invited to participate. A \'So what, now what\' exercise was conducted, informed by data from PITSTOP. This generated statements for research and practice priorities. A three-round online Delphi study was conducted, ranking statements based on policy and research separately. Statements were rated 1 (not important) to 9 (important). Statements that were rated 7-9 by more than 70% of participants were entered into the consensus meeting. Personalized voting feedback was shown between rounds. A face-to-face meeting was held to discuss statements, and participants were asked to rank statements using a weighted choice vote.
    RESULTS: Twenty-two people participated in the focus group, generating 14 research and 19 policy statements. Statements were voted on by 56 participants in round 1, 53 in round 2 and 51 in round 3. A total of 15 policy statements and 19 research statements were discussed in the consensus round. Key policy statements addressed treatment strategies and intensity, surgeon training opportunities, need for classification and the impact of treatment on return to work. Research recommendations included design of future trials, methodology considerations and research questions.
    CONCLUSIONS: This study has identified research and policy priorities in pilonidal sinus disease which are relevant to patients and clinicians. These should inform practice and future research.
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  • 文章类型: Journal Article
    人们越来越关注有机污染物对环境和健康的不利影响。优先控制有机污染物(PCOP)清单可以为环境中有机化合物的使用和监测提供监管框架。在这项研究中,从中国15个“一级”地下水资源区采集了20,010个地下水样品。50(50)种有机化合物根据其患病率进行了分析,发生,和物理化学性质(持久性,生物蓄积性,和毒性)。结果显示,16个PCOP,包括12种杀虫剂,3芳烃(AHs),和1邻苯二甲酸酯,被认可。农药和AHs占高优先级污染物的75%和18.75%,分别。密闭地下水和潜水地下水之间的PCOP存在显着差异。主要在潜水地下水中检测到较高浓度的农药。在15个地下水资源区的样品中检测到的PCOP主要是农药和AHs。地下水数据表明,黄河流域(YRB)中检测到的有机化合物,长江流域(YZB),辽河流域(LRB),根据中国的污染物排名系统,松花江流域(SRB)主要分为Q1(高优先级)和Q2(中优先级)污染物。这项研究的结果提供了被调查地区PCOP广泛分布的快照,并有望在中国的区域和国家层面建立治疗和预防措施。
    There has been increasing concern regarding the adverse environmental and health effects of organic pollutants. A list of priority control organic pollutants (PCOPs) can provide regulatory frameworks for the use and monitoring of organic compounds in the environment. In this study, 20,010 groundwater samples were collected from 15 \"first level\" groundwater resource zones in China. Fifty (50) organic compounds were analyzed based on their prevalence, occurrence, and physicochemical properties (persistence, bioaccumulation, and toxicity). Results showed that 16 PCOPs, including 12 pesticides, 3 aromatic hydrocarbons (AHs), and 1 phthalate ester, were recognized. Pesticides and AHs accounted for 75 % and 18.75 % of the high-priority pollutants, respectively. There were significant differences in PCOPs between confined and phreatic groundwater. Higher concentrations of pesticides were mainly detected in phreatic groundwater. PCOPs detected in samples from the 15 groundwater resource zones were mainly pesticides and AHs. The groundwater data indicate that the organic compounds detected in the Yellow River Basin (YRB), Yangtze River Basin (YZB), Liaohe River Basin (LRB), and Songhua River Basin (SRB) are mainly categorized as Q1 (high priority) and Q2 (medium priority) pollutants based on the contaminants ranking system in China. The findings from this study offer a snapshot of the wide distribution of PCOPs in the surveyed regions, and are expected to establishing treatment and prevention measures at both the regional and national levels in China.
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  • 文章类型: Journal Article
    目的:专业支持在帮助自闭症儿童学习方面发挥重要作用,参与,和整体福祉。然而,关于利益相关者的观点和偏好的研究有限,这些观点和偏好是关于接受专业人员支持的儿童的目标结果。这项研究调查了利益相关者对在向自闭症儿童提供支持期间有意针对的结果的优先级和适当性的看法。
    方法:对181名参与者(包括72名自闭症成年人,85父母和69名专业人员)来自澳大利亚和新西兰。参与者在支持范围内对47个潜在的儿童和父母结果的适当性和优先性进行了评估。
    结果:最优先的结果是改善儿童的心理健康,最低的是减少感官寻求或回避行为。某些结果的优先等级根据孩子的年龄而有所不同。超过一半的参与者认为减少感官寻求/回避行为和减少集中兴趣是不适当的支持结果。Further,结果适当性的差异在参与者组之间是不同的。
    结论:反映了对神经多样性确认实践的日益接受,这些结果强调了对自闭症和自闭症社区有意义的目标结果的支持,不太强调那些反映神经典型行为标准的人。
    OBJECTIVE: Professional supports play an important role in aiding autistic children\'s learning, participation, and overall wellbeing. Yet, limited research exists on stakeholders\' perspectives and preferences regarding targeted outcomes for children undergoing support facilitated by professionals. This study investigated stakeholder views on the priority and appropriateness of outcomes intentionally targeted during the provision of supports to autistic children.
    METHODS: A survey of 181 participants (including 72 autistic adults, 85 parents, and 69 professionals) from Australia and New Zealand was conducted. Participants rated the appropriateness and priority of 47 potential child and parent outcomes within the context of support.
    RESULTS: The highest priority outcome was improving child mental wellbeing, with the lowest being reducing sensory seeking or avoidant behaviours. Priority ratings for certain outcomes differed based on the child\'s age. Over half of the participants rated reducing sensory seeking/avoidant behaviours and reducing focused interests as inappropriate outcomes of supports. Further, variations in the appropriateness of outcomes differed among participant groups.
    CONCLUSIONS: Reflecting the growing acceptance of neurodiversity-affirming practices, these results underscore support for targeting outcomes that are meaningful to the autistic and autism communities, with less emphasis on those which reflect neurotypical behavioural standards.
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  • 文章类型: Journal Article
    这项研究使用层次分析和多准则决策来检查呼吸器的可靠性。层次结构,其中包括三个评估标准和六个产品组件作为决策可能性,揭示了评估标准的优先级遵循成本的趋势,复杂性和技术。脸,三件式和遮阳板组件的故障率最高,根据装配级产品可靠性分析。然而,根据零件级别的分析,最有可能的故障出现在面部,上部和下部遮阳板框架,遮阳板,头带,呼气阀阀盘和呼气阀座。此外,Weibull分布函数(形状参数>1)可用于预测产品可靠性。在六个定义的产品组件中,根据敏感性分析,三件式组件和遮阳板组件的总重量对评估标准的优先级变化最敏感。
    This study examined the reliability of respirators using hierarchical analysis and multicriteria decision-making. The hierarchical structure, which consists of three assessment criteria and six product assemblies as decision possibilities, reveals that the priority of evaluation criteria follows the trend of cost, complexity and technology. Face-piece, triple-piece and visor assemblies have the highest failure rate, according to an analysis of product reliability at the assembly level. However, according to the analysis at the parts level, the most likely failures are found in the face-piece, upper and lower visor frames, visor, head-harness, exhalation valve disc and exhalation valve seat. In addition, the Weibull distribution function (with a shape parameter >1) can be utilized to predict product reliability. Among the six defined product assemblies, according to the sensitivity analysis, the overall weight of the triple-piece assembly and the visor assembly has the most sensitivity to changes in the priority of evaluation criteria.
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  • 文章类型: Journal Article
    由多重耐药病原体引起的医疗保健相关感染正在全球增加,和目前的抗微生物选择对这些强大的物种的功效有限。WHO详细介绍了通常与医疗器械HAIs相关的至关重要的细菌和真菌物种。医疗器械的有效灭菌在预防传染病发病率和死亡率方面起着关键作用。缺乏对协议的遵守和与每种灭菌方式相关的限制,然而,允许疾病的发生。此外,与环氧乙烷气体(EtO)的致癌排放有关的问题促使EPA提议限制EtO的使用或寻求医疗设备的替代灭菌方法。美国食品和药物管理局支持使用低温VH2O2作为EtO的替代品对医疗保健产品进行灭菌。随着生物材料和医疗设备的进步以及组合产品的使用越来越多,目前的灭菌方式变得有限。医疗设备消毒和灭菌的新方法,生物材料,和治疗有必要保障公众健康。噬菌体,内溶素,和抗菌肽被认为是预防和预防传染病的有希望的选择。这一及时的审查讨论了这些生物制剂作为抗微生物剂的应用,以对抗至关重要的世卫组织病原体,包括ESKAPE细菌物种。
    Healthcare-associated infections caused by multi-drug-resistant pathogens are increasing globally, and current antimicrobial options have limited efficacy against these robust species. The WHO details the critically important bacterial and fungal species that are often associated with medical device HAIs. The effective sterilization of medical devices plays a key role in preventing infectious disease morbidity and mortality. A lack of adherence to protocol and limitations associated with each sterilization modality, however, allows for the incidence of disease. Furthermore, issues relating to carcinogenic emissions from ethylene oxide gas (EtO) have motivated the EPA to propose limiting EtO use or seeking alternative sterilization methods for medical devices. The Food and Drug Administration supports the sterilization of healthcare products using low-temperature VH2O2 as an alternative to EtO. With advances in biomaterial and medical devices and the increasing use of combination products, current sterilization modalities are becoming limited. Novel approaches to disinfection and sterilization of medical devices, biomaterials, and therapeutics are warranted to safeguard public health. Bacteriophages, endolysins, and antimicrobial peptides are considered promising options for the prophylactic and meta-phylactic control of infectious diseases. This timely review discusses the application of these biologics as antimicrobial agents against critically important WHO pathogens, including ESKAPE bacterial species.
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  • 文章类型: Journal Article
    原核生物的命名受《国际原核生物命名法》(ICNP)的约束,部分受《国际藻类命名法》的约束。真菌和植物(ICN)。这些代码必须能够以通用和明确的方式确定分类单元的名称,从而成为跨不同领域和活动的共同语言。当新的命名代码出现时,这种统一就会被破坏,经过时间考验的代码,并使用相同的名称格式,但为名称分配不同的命名状态值。由此产生的术语混乱对更广泛的科学界没有好处。预计这种歧义是由于建立了“根据DNA序列数据描述的原核生物命名代码”(“SeqCode”),这是与ICNP和ICN的一般和具体冲突。ICNP解释中的缺点可能加剧了代码之间的不相容性。重申了为什么建议接受序列作为具有有效公布名称的物种和亚种的命名类型,现在在SeqCode中实现,尚未由国际原核生物系统学委员会(ICSP)实施,监督ICNP。ICNP缺乏对尚未培养的原核生物进行命名的某些规定是可以接受的科学论点,尽管它并不能证明建立单独的代码是合理的。此外,ICSP拒绝的建议对于充分规范未培育的原核生物的命名是不必要的.为广大科学界提供更好的服务,提出了一种修改ICNP的替代建议,这将导致Candidatus名称受到类似于有效发布名称的监管。该提案完全符合ICSP先前的决定,保留了术语的基本统一,避免了预期的术语混淆。
    The naming of prokaryotes is governed by the International Code of Nomenclature of Prokaryotes (ICNP) and partially by the International Code of Nomenclature for Algae, Fungi and Plants (ICN). Such codes must be able to determine names of taxa in a universal and unambiguous manner, thus serving as a common language across different fields and activities. This unity is undermined when a new code of nomenclature emerges that overlaps in scope with an established, time-tested code and uses the same format of names but assigns different nomenclatural status values to the names. The resulting nomenclatural confusion is not beneficial to the wider scientific community. Such ambiguity is expected to result from the establishment of the \'Code of Nomenclature of Prokaryotes Described from DNA Sequence Data\' (\'SeqCode\'), which is in general and specific conflict with the ICNP and the ICN. Shortcomings in the interpretation of the ICNP may have exacerbated the incompatibility between the codes. It is reiterated as to why proposals to accept sequences as nomenclatural types of species and subspecies with validly published names, now implemented in the SeqCode, have not been implemented by the International Committee on Systematics of Prokaryotes (ICSP), which oversees the ICNP. The absence of certain regulations from the ICNP for the naming of as yet uncultivated prokaryotes is an acceptable scientific argument, although it does not justify the establishment of a separate code. Moreover, the proposals rejected by the ICSP are unnecessary to adequately regulate the naming of uncultivated prokaryotes. To provide a better service to the wider scientific community, an alternative proposal to emend the ICNP is presented, which would result in Candidatus names being regulated analogously to validly published names. This proposal is fully consistent with previous ICSP decisions, preserves the essential unity of nomenclature and avoids the expected nomenclatural confusion.
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